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HomeMy WebLinkAbout739 Christman Place Address: 739 Christman Place PREPARED 3/12/15, 12:37:40 INSPECTION TICKET PAGE 1 CITY OF PORT ANGELES INSPECTOR: JAMES LIERLY DATE 3/12/15 ------------------------------------------------------------------------------------------------ ADDRESS . : 739 CHRISTMAN PL SUBDIV: CONTRACTOR AIR FLO HEATING CO INC PHONE (360) 663-3901 OWNER PETERSON KEVIN P/C S PHONE PARCEL 06-30-14-5-7-0140-0000- APPL NUMBER: 15-00000207 RES MECHANICAL PERMIT ------------------------------------------------------------------------------------------------ PERMIT: ME 00 MECHANICAL PERMIT REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTS/COMMENTS ------------------------------------------------------------------------------------------------ ME99 Ol 3/ JL MECHANICAL FINAL March 12, 2015 12:37:02 PM pbarthol. - COMMENTS AND NOTES -------------------------------------- CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY & ECONOMIC DEVELOPMENT- BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number . . . . . 15-00000207 Date 3/12/15 Application pin number . . . 004843 Property Address . . . . . . 739 CHRISTMAN PL A ASSESSOR PARCEL NUMBER: 06-30-14-5-7-0140-0000- �l Application type description RES MECHANICAL PERMIT REPORT SALES TAX Subdivision Name . . . . . . on your state excise tax form Property Use . . . . . _ . to the City of Port Angeles Property Zoning ,,I c �f Application valuation . . 7345 (Location COuC OJOL) Application desc 2 DUCTLESS HP ---------------------------------------------------------------------------- Owner Contractor PETERSON KEVIN P/C S AIR FLO HEATING CO INC 739 CHRISTMAN PL 221 W. CEDAR PORT ANGELES WA 983624926 SEQUIM WA 98382 (360) 683-3901 Permit . . . . . . MECHANICAL PERMIT Additional desc 2 DUCTLESS HP Permit Fee . . . . 79.60 Plan Check Fee .00 Issue Date . . . . 3/12/15 Valuation . . . . 0 Expiration Date 9/08/15 Qty Unit Charge Per Extension BASE FEE 50.00 2.00 14.8000 EA ME-FURN/HP/FAU < OR = 5 TON 29.60 ---------------------------------------------------------------------------- Special Notes and Comments Per Washington State Code 51-51-315, installation of Carbon Monoxide detector(s) is required if you are installing or replacing a fuel burning appliance (wood, pellet, gas)and must be in place prior to the final inspection of this permit. They are required to be place directly outside of each sleeping . area and at least one on each floor of the house. - 1 ------------------------------- --------------------------- ----- t Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ------- -- ---------- Permit Fee Total 79.60 79.60 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 79.60 79.60. .00 .00 6`J Separate Permits are required for electrical work,SEPA,Shoreline,ESA,utilities,private and public improvements. This permit becomes null and void if work or construction authorized isnot commenced within 180 days,if construction or work is suspended or abandoned for a period of 180 days after the work has commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of n state or local law regulating construction or the performance of construction. Date Print Name Signature of Contractor or Authorized Agent Signature of Owner(if owner is builder) T:Forms!Building Division/Building Permit BUILDING PERMIT INSPECTION RECORD PLEASE PROVIDE A MINIMUM 24-HOUR NOTICE FOR INSPECTIONS-- Building Inspections 417-4815 Electrical Inspections 417-4735 Public Works Utilities 417-4831 Backflow Prevention Inspections 417-4886 IT IS UNLAWFUL TO COVER,INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT INCONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE. Inspection Type Date Accepted By Comments FOUNDATION: Footings Stemwall Foundation Drainage/Downspouts Piers Post Holes(Pole Bldgs.) PLUMBING: Under Floor/Slab Rough-in Water Line Meter to Bldg) Gas Line Back Flow/Water FINAL Date Accepted b AIR SEAL: Walls Ceiling FRAMING: Joists/Girders/Under Floor Shear Wall/Hold Downs Walls/Roof/Ceiling Drywall Interior Braced Panel Only) T-Bar INSULATION: Slab Wall/Floor/Ceiling MECHANICAL: Heat Pum /Furnace/FAU/Ducts Rough-in Gas Line Wood Stove/Pellet/Chimney Commercial Hood/Ducts FINAL Date Accepted b MANUFACTURED HOMES: Footing/Slab Blocking&Hold Downs Skirting PLANNING DEPT. Separate Permit#s SEPA: Parkin /Lighting ESA: Landscaping SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE Inspection Type Date Accepted By Electrical 417-4735 Construction- R.W. PW /Engineering 417-4831 Fire 417-4653 Planning 417-4750 Building 417-4815 T:Forms/Building Division/Building Permit 03/03/2015 TUE 17: 06 FAX 360 683 3971 Air Flo Heating Co. 10001/007 THE: 3 For City Use CITY OF Y N Permit# S- W' A S H I _H G T o N, U. S. Date Received: —� 321 E 5th Street Date Approved Port Angeles,WA 9836 P:360-417-4817 F:360-417-4711 Email:permits a0citvofpa.us BUILDING PERMIT A LICATION Project Address: -739 Chr l g�rnan PI a c e Phone: 1 -7 - 4734 Prima Contact: Kew) �� SO^Pl Email: Name Phone Kin � rah tangy P*,�c rS�In �°I 1-N73�{ Property Mailing Address .1� n_VtS�� Email Owner (� City State zip C1$31,2 Name '7 Ph PO-r FW F-�e7�ih one ►S l� �- Mol Contractor Address Email ILLI til. Cc& . Information City State Vq zip Contractors License# Exp.Date: Legal Description: Zoning: Tax Parcel# Project Va oIy lue: (materials and labor) oro 'Oiy s� occe I $ Residential Commercial ❑ Industrial ❑ Public ❑ Permit Demolition ❑ Fire ❑ Repair ❑ Reroof(tear off/lay over) ❑ Classification For the following fill out both pages of permit application: (check New Construction ❑ Exterior Remodel ❑ Addition ❑ Tenant Improvement ❑ appropriate) Mechanical ❑ Plumbing ❑ Other ❑ Fire Sprinkler System? Irrigation System? Proposed Bathrooms Proposed Bedrooms Yes ❑ No ❑ Yes ❑ No ❑ Project Description t 1 _ 7 _, a.14 I I Is project in a Flood Zone: Yes ❑ No❑ Flood Zone Type: If in a FIood Zone, what is the value of the structure before proposed improvement? $ I have read and completed the application and know it to be true and correct. I am authorized to apply for this permit and understand that it is my responsibility to determine what permits are required and to obtain permits prior to work. I understand that plan review fees are not refundable after review has occurred. I understand that I will forfeit review fees if I withdraw the application before the permit is issued. I understand that if the permit is not picked up/issued within i8o days of submittal,the application will be considered abandoned and the fees will be forfeited. r' I , t YL) Date Print Name Sign e 03/03/2015 TUE 17: 07 FAX 360 683 3971 Air Flo Heating Co. I4007/007 y i o This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17,2009 and Dec 31, 2013. I i L3 01%it I M,�&'p-A Uterfificatre Of Product Rd h Iff 111b AHRI Certified Reference Number: 4934170 Date: 3/2/2015 Product: Variable Speed Mini-Split Heat Pump,with Remote Outdoor Unit Air-Source, Free Delivery Outdoor Unit Model Number: MUZ-FE12NA1 Indoor Unit Model Number: MSZ-FE12NA Manufacturer: MITSUBISHI ELECTRIC COOLING & HEATING Trade/Brand name: MR.SLIM Series name: Manufacturer responsible for the rating of this system combination is MITSUBISHI ELECTRIC COOLING & HEATING Rated as follows in accordance with AHRI Standard 210/240-2008 for Unitary Air-Conditioning and Air-Source Heat Pump Equipment and subject to verification of rating,accuracy:.by AHRI sponsored,:independent,third party testing.. - - - - C�o11n Ca atilt, ( tuh2bDD -•_: _ _°-_ g p y ) -..._.. MER Ratin g (Cooling) 12.9Q MH SEER Rating (Cooling); 23,DD to Heating G'aacix9(ltut�) F 136I}D Region lV#fSPJ _Etij (Feafitg) 1 50ztf T..:........ ..,._ _ _ ............,::.: Heating paCity(Btuh @ 1 F 7804 Ca CERTIFIED RATINGS FOR VARIABLE-SPEED,MINI-AND MULTI-SPLIT SYSTEMS ARE VALID FOR ALL COMBINATIONS OF INDOOR UNITS (BASED ON COMBINATION TYPES)WITH THE SPECIFIC OUTDOOR UNIT LISTED ABOVE AND IN THE AHRI DIRECTORY OF CERTIFIED EQUIPMENT.VISIT VWWV.AHRIDIRECTORY.ORG TO VERIFY THAT THIS COMBINATION IS AN ACTIVE LISTING AND THE DATA LISTED ON THIS CERTIFICATE IS ACCURATE.SEARCH ON THE AHRI REFERENCE#TO QUICKLY LOCATE THIS COMBINATION IN THE DIRECTORY. Ratings to lowed by an asterisk r)indicate a voluntary rerate of previously published data,unless accompanied with a WAS,which indicates an involuntary rerate. DISCLAIMER AHRI does not endorse the product(s)listed on this Certificate and makes no representations,warranties or guarantees as to,and assumes no responsibility for, the product(s)listed on this Certificate.AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s),or the unauthorized alteration of data listed on this Certificate.Certified ratings are valid only for models and configurations listed in the directory at www.ahridirectory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRI.This Certificate shall only be used for individual,personal and confidential reference purposes.The contents of this Certificate may not,in whole or in part,be reproduced;copied;disseminated; entered into a computer database;or otherwise utilized,in any farm or manner or by any means,except for the user's individual, personal and confidential reference. AIR-CONDITIONING,HEATING. CERTIFICATE VERIFICATION &REFRIGERATION INSTITUTE The information for the model cited on this certificate can be verified at www.ahridirectory.org,click on"Verify Certificate"link v c o:ac Iiia barer and enter the AHRI Certified Reference Number and the date on which the certificate was issued, which is listed above,and the Certificate No.,which is listed at bottom right. s 130698191545519832 62014 Air-Conditioning,Heating,and Refrigeration Institute -E2IFICATE NO rLZG 03/03/2015 TUE 17: 07 FAX 360 683 3971 Air Flo Heating Co. 10006/007 E o This combination qualifies for a Federal Energy Efficiency Tax Credit when placed in service between Feb 17, 2009 and Dec 31,2013. ff %1fertificagmte of HrOducCA at1&ftraF,% AHRI Certified Reference Number: 4934170 Date: 3/2/2015 Product: Variable Speed Mini-Split Heat Pump,with Remote Outdoor Unit Air-Source, Free Delivery Outdoor Unit Model Number: MUZ-FE12NA1 Indoor Unit Model Number: MSZ-FE12NA Manufacturer: MITSUBISHI ELECTRIC COOLING& HEATING Trade/Brand name: MR. SLIM Series name: Manufacturer responsible for the rating of this system combination is MITSUBISHI ELECTRIC COOLING& HEATING Rated as follows in accordance with AHRI Standard 210/240-2008 for Unitary Air-Conditioning and Air-Source Heat Pump Equipment and subject to verification of rating_accuracy,by AHRI-sponsored,: ndependent,third party testing. :........:....:. = - of :act .. f3ttrh .. :..;..._;..12000 ..........._...._.,: _...: -< _.. .__•E�i�RatinglCoollt',g). ..::,: -.. ER_ ---Rating(Cpoling) , 23.02 -,• _ - Heatln Ca a F€egiQi:l, FiRI?F Retln�{#tea(T�g 9 0 50 HeSti Ca Cit_(13twh7F:::•:::.:78U0 CERTIFIED RATINGS FOR VARIABLE-SPEED,MINI-AND MULTI-SPLIT SYSTEMS ARE VALID FOR ALL COMBINATIONS OF INDOOR UNITS (BASED ON COMBINATION TYPES)WITH THE SPECIFIC OUTDOOR UNIT LISTED ABOVE AND IN THE AHRI DIRECTORY OF CERTIFIED EQUIPMENT.VISIT WWW.AHRIDIRECTORY.ORG TO VERIFY THAT THIS COMBINATION IS AN ACTIVE LISTING AND THE DATA LISTED ON THIS CERTIFICATE IS ACCURATE.SEARCH ON THE AHRI REFERENCE#TO QUICKLY LOCATE THIS COMBINATION IN THE DIRECTORY. `Ratings followed by an asterisk(`)indicate a voluntary rerate of previously published data,unless accompanied with a WAS,which indicates an involuntary rerale. DISCLAIMER AHRI does not endorse the product(s)listed on this Certificate and makes no representations,warranties or guarantees as to,and assumes no responsibility for, the product(s)listed on this Certificate.AHRI expressly disclaims all liability for damages of any kind arising out of the use or performance of the product(s),or the unauthorized alteration of data listed on this Certificate.Certified ratings are valid only for models and configurations listed in the I directory at www.ahrldiroctory.org. TERMS AND CONDITIONS This Certificate and its contents are proprietary products of AHRf.This Certificate shall only be used for individual,personal and confidential reference purposes.The contents of this Certificate may not,in whole or in part,be reproduced;copied;disseminated; Am entered Into a computer database;or otherwise utilized,in any form or manner or by any means,except for the user's individual, personal and confidential reference. AIR-CONDITIONING,HEATING, CERTIFICATE VERIFICATION &REFRIGERATION INSTITUTE The information for the model cited on this certificate can be verified at www.ahrldirectory.org,click on"Verify Certificate"link we,,,s;;e life better" and enter the AHRI Certified Reference Number and the date on which the certificate was issued, which is listed above,and the Certificate No.,which is listed at bottom right. e T— ©2014 Air-Conditioning,Heating,and Refrigeration Institute CERTIFICATE-NO 130698191545519832 i 03/03/2015 TUE 17: 07 FAX 360 683 3971 Air Flo Heating Co. IA005/007 I AIR FLO HEATING CO. (DATE Name Address Phone $egwm WA 70 degrees vfdoor.23 degrees Outdoor L095 Ne,.r Typ Poor AiRFA Tv.A. 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Port Angeles Service Address Contractor Name 65,000 I. Z 60,000 H f m 55,000 N N 0 50,000 J r d 45,000 tD 0 40,000 6 m 35,000 rn � CL C � 30,000 O o C 25,000 w � �+ d 20,000 a tv d = 15,000 rn rn r, 10,000 I � f: � I I 5,000 M x � 0 w 0. 5 10 15 17 20 25 27 30 35 37 40 45 47 50 55 60 65 68 70 Io Outdoor Temperature (F) r W F L o ' N fn 0 M o I r 0 0 Heat Pump Balance Point Worksheet -73q ' C�r1S�2+n Port Angeles Service Address l.r IFLy Contractor Name 65,000 — -- Z 60,000 D I.- 55,000 N H C 50,000 J lC d 45,000 t7f 40,000 0 CD 35,000 en � C 3 " (0 4.0 30,000 X O o C 25,000 w � d 20,000 r = 15,000 fr M 10,000 fD 5,000 fn x w 0 0 5 10 15 17 20 25 27 30 35 37 40 45 47 50 55 60 65 68 70 Outdoor Temperature (F) W H Ln 0 N f�1 O fn O C e I 1 03/03/2015 TUE 17: 06 FAX 360 683 3971 Air Flo Heating Co. 14002/007 I Residential Structures For Office Use Area Description(SQ FT) Existing Proposed $$value Basement First Floor Second Floor Covered Deck/Porch/Entry Deck(over 30"or a" floor) Garage Carport Other(describe) Area Totals Commercial Structures For Office Use Area Descriptions(SQ FT) Existing Proposed $$Value Existing Structure(s) Proposed Addition Tenant Improvement? Other work(describe) Site Area Totals Lot/Site Coverage Calculations Lot Size(sq ft) Lot Coverage(sq ft) %Lot Coverage(Total lot coverage_lot size) Site Coverage(Sq Ft of all impervious) %of Site Coverage(total site coverage_lot size) Mechanical Fixtures Indicate how many of each type of fixture to be installed or relocated as part of this project. Air Handler Size: # Haz/Non-Haz Piping Outlets: Appliance Exhaust Fan # Heater(Suspended,Floor,Recessed wall) # I Boiler/Compressor Size: # Heating/Cooling appliance # I re air/alteration Evaporative Cooler(attached,not # Pellet Stove/Wood-burning/Gas # portable) Fireplace/Gas Stove/Gas Cook Stove/Misc. Fuel Gas Piping #of Outlets: Ventilation Fan,single duct # Furnace/Heat Pump/ Size: # Ventilation System # Forced Air Unit Plumbing Fixtures Indicate how many of each type of fixture to be installed or relocated Plumbing Traps # Fuel gas piping #of Outlets: Water Heater # Medical gas piping #of Outlets: Water Line # Plumbing Vent piping # Sewer Line # Industrial waste pretreatment interceptor Grease Trap) Size Other describe T:\BUILDING\APPLICATION FORMS\Current BP Application\Building Permit 4.17-13.docx Address: 739 Christman Place PREPARED 9/17/14, 11:57:19 INSPECTION TICKET PAGE 1 CITY OF PORT ANGELES INSPECTOR: JAMES LIERLY DATE 9/17/14 ------------------------------------------------------------------------------------------------ ADDRESS . : 739 CHRISTMAN PL SUBDIV: CONTRACTOR B & B ENTERPRISES PHONE (360) .417-0436 OWNER PETERSON KEVIN P/C S PHONE PARCEL 06-30-14-5-7-0140-0000- APPL NUMBER: 12-00001653 RES MECHANICAL PERMIT -------------------------------------------------------------------------------------------- PERMIT: ME 00 MECHANICAL PERMIT REQUESTED INSP DESCRIPTION . TYP/SQ COMPLETED RESULT RESULTS/COMMENTS ------------------------------------------------------------------------------------------------ ME99 01 9/17/14LL MECHANICAL FINAL .�(1kSeptember 17, 2014 8:45:59 AM pbarthol. Kevin 797-4734 -------------------------------------- COMMENTS AND NOTES -------------------------------------- BUILDING PERMIT INSPECTION RECORD PLEASE PROVIDE A MINIMUM 24-HOUR NOTICE FOR INSPECTIONS— Building Inspections 417-4815 Electrical Inspections 417-4735 Public Works Utilities 417-4831 Backflow Prevention Inspections 417-4886 IT IS UNLAWFUL TO COVER,INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN CONSPICUOUS LOCATION. KEEP PERMIT AND APPROVED PLANS AT JOB SITE. t^ \!1 Inspection Type Date Accepted By Comments FOUNDATION: Footings Stemwall Foundation Drainage/Downspouts Piers Post Holes(Pole Bldgs.) PLUMBING: Under Floor/Slab Rough-in Water Line Meter to Bldg) Gas Line Back Flow/Water FINAL Date Accepted b AIR SEAL: Walls Ceiling FRAMING: Joists/Girders/Under Floor Shear Wall/Hold Downs Walls/Roof/Ceiling Drywall Interior Braced Panel Only) T-Bar INSULATION: Slab Wall/Floor/Ceiling MECHANICAL: Heat Pum /Furnace/FAU/Ducts Rough-In Gas Line Wood Stove/Pellet/Chimney Commercial Hood/Ducts FINAL Date Accepted b MANUFACTURED HOMES: footing/Slab .13locking&Hold Downs Skirting PLANNING DEPT. Separate Permit#s SEPA: Parkin /Lighting ESA: Landscaping SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE Inspection Type Date Accepted By Q Electrical 417-4735 .� Construction-R.W. PW I Engineering 417-4831 Fire 417-4653 ( 1 Planning 417-4750 Building 417-4815 T:Forms/Building Division/Building Permit CITY OF PORT ANGELES i►.� DEPARTMENT OF COMMUNITY& ECONOMIC DEVELOPMENT-BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, WA 98362 Application Number . . . . 12-00001653 Date 12/26/12 Application pin number . . . 616113 Property Address . . . . . . 739 CHRISTMAN PL ASSESSOR PARCEL NUMBER: 06-30-14-5-7-0140-0000- REPORT SALES TAX Application type description RES MECHANICAL PERMIT Subdivision Name . . . . . . on your state excise tax form Property Use . . . . . . . . to the City of Port Angeles Property Zoning (Location Code 0502) Application valuation 5000 Application desc Woodstove permit ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ PETERSON KEVIN P/C S B & B ENTERPRISES 739 CHRISTMAN PL 520 ROSE ST. PORT ANGELES WA 983624926 PORT ANGELES WA 98362 (360) 417-0436 ---------------------------------------------------------- Permit . . . . MECHANICAL PERMIT Additional desc WOODSTOVE . Permit Fee . . . . 60.65 Plan Check Fee .00 Issue Date . . . . 12/26/12 Valuation . . . . 0 Expiration Date 6/24/13 Qty Unit Charge Per Extension BASE FEE 50.00 1.00 10.6500 EA ME-STOVE/FIREPLACE/MISC. APP. 10.65 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 60.65 60.65 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 60.65 60.65 .00 .00 Separate Permits are required for electrical work,SEPA,Shoreline,ESA,utilities,private and public improvements. This permit becomes null and void if work or construction authorized is not commenced within 180 days,if construction or work is suspended or abandoned for a period of 180 days after the work has commenced, or if requiredinspections have not been requested within 180 days from the last inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of construction. Date Print Name Signature of Contractor or Authorized Agent Signature of Owner(if owner is builder) T:Forms/Building Division/Building Permit "LES, THE fYVFor City Use CITY cOF W A S H I N G T 0 N , U . S . Permit# �C Date Received: �-- 321 East 51h Street Port Angeles, WA 98362 Date Approved �d- P: 360-417-4817 F: 360-417-4711 permits@cityofpa.us Building Permit Application Project Address: _ -7,3 Main Contact: Phone # Co 1,7 0 n p E-Mail: Property Name Phone �Tels o 1 7 7 ? V ?3 Owner Mailing Address Email c m� PL C City State Zip o r� n A e UTA— 9x-36 ,,,— Contractor 36a- Contractor Name Phone K l30 r,��� `16a Ll S96 Mailing Address Email S2-0 Sys City PA-- State ' A Zips t-3 6D- Contractor License # Expiration: 8F- r 1-13P-4 Project Value: Zoning: Tax Parcel # Lot# $ J�CiU©�� Type of Residential ❑ Commercial ❑ Industrial ❑ Public ❑ Permit Demolition ❑ Fire ❑ Repair ❑ Reroof(tear off/lay over) ❑ For the following, fill out both pages of permit application: New Construction ❑ Remodel ❑ Addition ❑ Tenant Improvement ❑ Mechanical/,�J Plumbing ❑ Other ❑ V,o oC�S'TO-pc- Existing Fire Sprinkler System? Maximum height of structure Proposed Bedrooms Proposed Bathrooms Yes ❑ No ❑ Project Description I have read and completed the application and know it to be true and correct.I am authorized to apply for this permit. I understand that it is my responsibility to determine what permits are required and to obtain permits prior to working on projects. I understand that the plan review fee is not refundable after plan review has occurred. I understand that I will forfeit the review fee if I cancel or withdraw the application before the permit is issued. I understand that if the permit is not issued within 180 days of receipt,the application will be considered abandoned and the fees forfeit. Date Print Name Signature 1-2-12-6112— <WL7on 19DO'd Residential Structures For Office Use Area Description (SQ FT) Existing Proposed $$value Basement First Floor Second Floor Covered Deck/Porch/Entry Deck Garage Carport Other(describe) Area Totals Commercial Structures For Office Use Area Descriptions (SQ FT) Existing Proposed, $$Value Existing Structure (s) Proposed Addition Tenant Improvement? Other work(describe) Area Totals Lot/Sit V Lot/Site Coverage Calculations Footprint(SQ FT) of all Structures: Lot Size: %Lot Coverage SQ FT Site coverage (all impervious+ %Site Coverage structures Mechanical Fixtures Indicate how many of each type of fixture to be installed or relocated as part of this project. Air Handler Size: # Haz/Non-Haz Piping #of Outlets: Appliance Vent — # —H-&titer ,(Suspende—ic,—Floor,Recessed wall) #- Boiler/Compressor Size: # Heating/Cooling appliance # repair/alteration Evaporative Cooler(attached,not # Pellet Stove/Wood-burning/Gas # portable) Fireplace/Gas Stove Gas Cook Stove/Misc. Fuel Gas Piping #of Outlets: Ventilation Fan,single duct # Furnace/Heat Pump/ Size: # Ventilation System # Forced Air Unit Plumbing Fixtures Indicate how many of each type of fixture to be installed or relocated Plumbing Traps # Fuel gas piping #of Outlets: Water Heater # Medical gas piping #of Outlets: Water Line # Vent piping # Sewer Line # Industrial waste pretreatment # interceptor Other describe : T:\BUILDING\APPLICATION FORMS\BUILDING PERMIT 081212.DOCX