HomeMy WebLinkAboutBLD2007-00854 Propane - BLD Permit / Conditions - 5/17/2007 FORM MUST BE COMPLETED IN INK PERMIT NO. 1)1_ �� _
PLEASE PRESS HARD MASON COUNTY
PLUMBING/MECHANICAL PERMIT APPLICATION
426 W.Cedar•P.O. Box 186, Shelton,WA 98584
Shelton (360)427-R710•Belfair(360)275-4467• Elma(360)482-5269
n the web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner L't"_=1 G W Company Name Idr zu-
Mailing Address '311 e. Mailing Address "El Jkc c �: 'h3
City All=I State &I Zip Code I a City &'elb^dS, State G'«" Zip Code
Phone n 0'+- Other Ph. Phone 7'•0'M-R-709 Other Ph.'7b*%-_J! 2M
Lien/Title Holder Contractor Reg.4 Exp.
E mail address E Mail Address �^+�t S� t ^I• "1
Drivers Lic.# DOB Drivers Lic.# DOB c
SEPTIC INFORMATION - Connect to New Septic Existing Septic. Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION - 12 Digit trcrl No. Fire District —
Legal Description
Site Address (Pleas g include s reet na , street urnt ; i
Directions to ite 11�
Is property within 200'of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15%
TYPE OF JOB - New Add Alt Repair Other Use of Building
Location of Fixtures/Units- 1 st Floor 2nd Floor. Basement Ga a Closet
PLUMBING FIXTURES (Show Number of each) MECHANICAL UNIYK
Type of Fixture No. of Fixtures Fees Fuel Type:Electn LP Natural Gas_ Heat Pump_
Toilets Type of Unit f Units Fees
Bathroom Sink Furnace
Bath Heat um s
Showers s Spot VentFan
Water Heater Propane Tank
Clothes Washer Gas Ou ets
Kithen Sinks Wood/ Pellet Stove
Dishwasher Kitchen Exhaust Hood
Hosebibs Dryer Vent
Other Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
CWNER/BULDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acknowledgement of
such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declare that I am entitled to receive this
permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the necessary parties.If permission is
required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have obtained
permission from them to it and conduct the work proposed. The owner or agent on owners behalf,represents that the information
provided is accu grants employees M County access to the above described property and structure for review and inspection.
PROOF OF NUATION OF WOR Y M S OF A PROGRESS INSPECTION.
X Date: s�r+���-
Owner ers Raw ontractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by: Planning Pd Ck# Date Bld Pd Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building DepartmentL I�
Occ Grouo-Tyve Constr.
Planning Department
Environmental Health Department
FEES
Plumbing& Base Fee Site Ins ection
Mechanical &Base fee UFC Plan Review Fee
Wood/Gas/Pellet Stove Fee Other
Violation Fee TOTAL FEES
Look Up a Contractor, Electrician or Plumber License Detail Page 1 of 2
Washington State Department of Labor and Industries
General/Specialty Contractor
A business registered as a construction contractor with L&I to perform construction work
within the scope of its specialty.A General or Specialty construction Contractor must
maintain a surety bond or assignment of account and cant'general liability insurance.
License Information
License ECONOHH956P8
Licensee Name ECONOMY HEARTH&HOME
Licensee Type CONSTRUCTION CONTRACTOR
UBI 602547521
Ind.Ins.Account Id
Business Type INDIVIDUAL
Address 1 8753 STATE HIGHWAY 303
Address 2
City BREMERTON
County KITSAP
State WA
Zip 98310
Phone 3606928709
Status ACTIVE
Specialty 1 BOILER/STEAM FIT/PROC PIPING
Specialty 2 OTHER(SPECIFY)
Effective Date 10/28/2005
Expiration Date 10/28/2007
Suspend Date
Separation Date
Parent Company
Previous License
Next License
Associated License
Business Owner Information
Name Role Effective Date Expiration Date
GARCIA,JEFFREY M I OWNER 10/28/2005
Bond Information
Bond Bond
Company Account Effective Expiration Cancel Impaired Bond Received
Bond Name Number Date Date Date Date Amount Date
Until
#1 CBIC SG3802 10/25/2005 Cancelled $6,000.00 10/28/2005
Savings Information
No Matching Information
https:Hfortress.wa.gov/lni/bbip/printer.aspx?License=ECONOHH956P8 5/18/2007
Permit number BLD
Mechanical Permit Checklist
• Name of owner: Name of Installer:
• Fuel Type? LPG Nat Gas Electric Other
• If propane, what is the proposed size of tank(s)?
• What type of mechanical unit will be installed? (i.e.freestanding stove,forced air furnace, etc.)
f��'3 5 V sb'�
• If the unit is a wood stove, provide: Make Model
Year Label Number
• What is the use of the structure? (Circle one) Residen ' Commercial
(A permit application for a commercial mechanical permit wi be issued upon satisfactory review by staff Include a floor plan
showing the location of units) and layout of duct work with the permit application.)
• Type of structure: (Circle one) Sit�Ho Manufactured Home Other
• What room will the mechanical unit be located? (\' A,-,
• Will the unit be located in a basement?(circle one) Yes No
• How will combustion air be supplied to the mechanical unit? (Describe, i.e. direct vent, air inlets, etc.)
C>' V.en h—
• How will the mechanical unit be exhausted to the outside? Applies to appliances using gas, oil or wood fuel.
(Indicate B-vent, direct vent, L-vent,etc.) V,ng"j V<nk--
• What year was the structure constructed? Was this structure part of a PUD upgrade?
• What type of controls will be installed? (i.e. thermostat, etc.) noA,-
• Will the proposed mechanical unit be a heat source?(circle one) es - No
• Additional information:
Signature of Applicant Date -��'�-�'
Typical mechanical fees:
Forced air furnace $ 14.80
Heat pump 10.65
Propane tank 10.65
Gas Outlets 10.65 additional outlets over 5, $1.00 each
Mechanical base fee 23.50 or $ 7.25 if base fee was paid on an active building or mechanical permit
Freestanding unit, fireplace, pellet stove or wood stove $52.30
$4.50 state fee will not be collected on mechanical permits
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