HomeMy WebLinkAboutBLD2007-01757 Final Heat Pump - BLD Permit / Conditions - 10/2/2007 FORM MUST BE COMPLETED IN INK PERMIT NO.
PLEASE PRESS HARD MASON COUNTY
PLUMBING/MECHANICAL PERMIT APPLICATION C 1
426 W.Cedar•P.O.Box 186, Shelton,WA 98584
Shelton (360)427-R7(�•Bel�air 360)275-4467• Elma(360)482-5269
n t ewe co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner Penny Mott Company f Ulympic Heating & Cooling, LLC'
Mailing Address PO Box 1 202 Mailing Adi 181 SE Morgan Road
CityHoodsport State WA Zip Code 98948 City Shelton, WA 98584
Phone 8 7 7-6 6 3 3 Other Ph. Phone— 360-426-9945
Lien/Title Holder Contractor OLYMPHC986BA Exp 1-1-08
E mail address E Mail Add
Drivers Lic.# DOB Drivers Lic.# DOB
SEPTIC INFORMATION - Connect to New Septic Existing Septic Connect to Sewer System
Name of Sewer System
PARCEL INFORMATION- 12 Digit Parcel No. Fire District 1 a
Legal Description LAKE CUSHMAN #8 LOT: 1 7 3
Site Address (Please include street name, street number and city) 411 N Fairway Dr E, Hoodsport
Directions to site Hwy 1 1 9 (Lake Cushman Rd) , Left on Clubhouse Wav,Lef t on
Fairwav Dr E to site.
Is property within 200'of Saltwater Lake River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15%
TYPE OF JOB - New Add AIL X Repair Other Use of BuildingResi dent; al
Location of Fixtures/Units- 1st Floor 2nd Floor Basement Garage X Closet
PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS
Type of Fixture No. of Fixtures Fees Fuel Type:Electric_�LPC�_ Natural Gas Heat Pump
Toilets Type of Unit No.of Units Fees
Bathroom Sink Furnace 1 Ito,
Bath Tubs Heatpumps I
Showers Spot Vent Fan
Water Heater Propane Tank
Clothes Washer Gas Outlets
Kithen Sinks Wood/GastPelletStove
Dishwasher Kitchen Exhaust Hood
Hosebibs Dryer Vent
Other Other
Base Fee Base Fee a
TOTAL PLUMBING TOTAL MECHANICAL - '
OVOE R/BULDER Acknowledges submission of inaccurate information may result in a stop work order or pemvt 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.M 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 apply for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information
provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection.
PROOF Iner
CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION.Date:/ nsrs Representative/ ontrac r (indicate which one)
�-/ FOR OFFICIAL USE BEYOND THIS POINT
Accepted by Planning Pd Ck# Date 10 3_C3-7 Bid Pd Receipt No.
DEPARTM4MrAL REVIEW APPROVED DENIED NOTES
Building Depa ent ern ho T.4cjS '�'L En f 5 .
Occ Group—Type Constrs
Planning Department
Environmental Health Department
FEES
Plumbing & Base Fee Site Inspection
Mechanical&Base fee UFC Plan Review Fee
Wood/Gas/Pellet Stove Fee Other
Violation Fee TOTAL FEES
Permit number BLD
Mechanical Permit Checklist
• Name of owner: 2� Md 7:�' Name of Installer: d e
• 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)
6t
• What is the use of the structure? (Circle one) EDued
al Commercial
(A permit application for a commercial mechanical permit upon satisfactory review by sta,�`.' Include a floor plan
showing the location of unit(s)and layout of duct work with the permit application)
• Type of structure: (Circle one) S' a Built ome Manufactured Home Other
• What room will the mechanical unit be located? +
• Will the unit be located in a basement?(circle one) Yes
• How will combustion air be supplied to the mechanical unit? (Describe, i.e. direct vent, air inlets, etc.)
• 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)
• 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) }—
• Will the proposed mechanical unit be a heat source?(circle one) es No
• Additional information:
Signature of Applicant Date �0 �Z
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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