20150160 Permit Pkg 041512015City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: ROBERT LEE
Address: 16236 PRAIRIE CRK LP SE
YELM WA 98597
Property Information:
Site Address: 16236 PRAIRIE CREEK LP SE
Assessor Parcel No.: 69240004700 Subdivision
Contractor Information:
Name: BLACK HILLS, INC
Address:
1003 85TH AVE SE
OLYMPIA WA 98501
Contractor License No.: 10091
Project Information:
Project: MECHANICAL
Description of Work: REPLACE GAS FURNACE
Permit No.: 20150160
Issue Date: 4/15/2015
(Work must be completed within 180 days)
Phone:
Owner: ROBERT LEE
PRAIRIE CREEK
Expires
Phone:
12/31/2015
Sq. Ft. per floor: First Heat Type (Electric, Gas, Other):
Second
Third
Garage
Basement
Fees:
Item
MECHANICAL
Contractor
BLACK HILLS. INC
TOTAL FEES:
Applicant's Affidavit:
I certify that I have read and examined the information contained within the application and know the same
to be true and correct. I also certify that the proposed structure is in conformity with all applicable City of
Yelm regulations including those governing zoning and land subdivision, and in addition, all covenants,
easements and restrictions of record. If applying as a contractor, I further certify that I am currently
registered in t e State of Washington.
Signature 'I— ) Date u -15- C)
Firm
Lot: 47
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City of Yelm
(36 ) 458 -3244
REC #: 00192461 4/15/2015 11:28 AM
OPER: CO TERM: 001
REF #: 15944
PAID BY:
IRAN: 33.0000 BUILDING PERMITS
20150160 29.50CR
LEE, ROBERT
16236 PRAIRIE CREEK LP SE
MECH 29.50CR
TENDERED: 29,50 CHECK
APPLIED: 29.50-
CHANGE: 0.00
From:Black Hills Inc
360 705 8584 04/14/2015 13.47 #817 P.001 /003
�,OisZ) / (,PC
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: 34 ,rc'u c Or r Parcel #: lq;RQ 0�_no b
Subdivision: Lot #: Plan #: Zoning:
New Construction Re -Model / Re -Roof / Addition Home Occupation Sign
Plumbing Mechanics! -i Mobile / Manufactured Home Placement Other
Project Description /Scope of Work: t r / ktautv)Es
Project Value: LtI:Sbo
Building Area (sq. ft) 1s` Floor 2 "d Floor 3`d Floor Garage -2 car 3 car
Covered Patio Covered Porch Patio Deck
# Bedrooms— # Bathrooms— Heating: GAS /OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel?
If yes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAM
ADDRESSM�;t3 Si, EMAIL
CITY STATE JA�P, ZIP TELEPHONE a7° qU °�, ~ a-:7
AR'CHITECTIENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHANICAL: CONTRACTOR I
ADDRESS 0665 < G F_
CITY pi Ct- STAY WM-1A- ZIP
CONTRA O 'SR LICENSE #
HON
EMAIL
—FAX
DATE CITY LICENSE # g
Copy of mitigation agreement with Yelm Commu
f Schools, if applicable.
[ hereby certify that the above information is correct and that the construction on, and the occupancy and the use of the
above described property will be in accordance with the laws, rules and regulations of the State of Washington and the
City of
Applicant's Signature Date
Owner / Contractor I Owner's Agent / Contractor's Agent (Please circle one.)
All permits are non - transferable and will expire if work authorized by such permit is not begun
within 180 days of issuance, or if work is suspended or abandoned for a period of 180 days
_ FJVED
_ APR 14 2015
105 Yelm Avenue West (360) 458 -333.5
Yelm, WA 98597 (360) 458 -.31Z FAX
wwu,.ci.velm.wa.us -- . ---�_
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: le C i a'-LA- Lft Parcel #: 10 Q;QQOW
Subdivision:
Lot #: Plan #: Zoning:
New Construction Re -Model / Re -Roof / Addition Home Occupation Sign
Plumbing Mechanical -_ ,Mobile / Manufactured Home Placement Other
Project Description /Scope of Work:� nb—CJL,
Project Value: L-%DO
Building Area (sq. ft) 1St Floor 2nd Floor 3`d Floor -
Covered Patio Covered Porch Patio
Garage -2 car 3 car.
Deck
# Bedrooms_ # Bathrooms_ Heating: GAS /OTHER or ELECTRIC (Circle One)
Are there any environmentally sensitive areas located on the parcel?
If yes, a completed environmental checklist must accompany permit application.
BUILDING OWNER NAM :
ADDRESSIL093 S EMAIL
CITY STATEL_ZIP TELEPHONE ZUO- - -J
ARCHITECT /ENGINEER LICENSE #
ADDRESS EMAIL
CITY STATE ZIP TELEPHONE
GENERAL CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
PLUMBING CONTRACTOR TELEPHONE
ADDRESS EMAIL
CITY STATE ZIP FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHANICAL CONTRACTOR LVTELEPHONE 6LQQ
ADDRESS S EMAIL
CITY STAT LuA- ZI
' P � I FAX
CONTRA O 'S LICENSE # L aG))FXP DATE CITY LICENSE # • U Q
3 IS 1-1
Copy of mitigation agreement with Yelm Community Schools, if applicable.
I hereby certify that the above information is correct and that the construction on, and the occupancy and the use of the
above described property will be in accordance with the laws, rules and regulations of the State of Washington and the
City of Yelm.
Applicant's Signature Date
Owner/ Contractor/ Owner's Agent/ Contractor's Agent (Please circle one.)
All permits are non - transferable and will expire if work authorized by such permit is not begun
within 180 days of issuance, or if work is suspended or abandoned for a period of 180 days
105 Yelm Avenue West (360) 458 -3835
Yelm, WA 98597 (360) 458 -3144 FAX
www.ci.velm.wa.us
Duct Leakage Test Results (Existing Construction)
Permit #: ` (t
House address or lot number:
City:
L�-} Zip:
1
Cond. Floor Area (ft2): f
❑ Duct tightness testing is not required for this residence per exceptions listed at the end of this document
Test Result: y� CFM @25Pa
Ring (circle one): Open 1 2 6
Duct Tester Location: \1 f V VP
Pressure Tap Location: f ��
Company Name: Ct Inc,
Duct Testing Technician: ,�`�F' c. hr: n
Technician Signature: Date:
Phone Number:
r
Washington State Energy Code reference:
101.3.2.6 Mechanical Systems: Those parts of systems which are altered or replaced shall comply with Section 503 of this Code.
When a space - conditioning system is altered by the installation or replacement of space - conditioning equipment (including replacement
of the air handier, outdoor condensing unit of a split system air conditioner or heat pump, cooling or heating coil, or the furnace heat
exchanger), the duct system that is connected to the new or replacement space - conditioning equipment shall be tested as specified in
RS -33. The test results shall be provided to the building official and the homeowner.
EXCEPTIONS: 1. Duct systems that are documented to have been previously sealed as confirmed through field verification
and diagnostic testing in accordance with procedures in RS -33.
2. Ducts with less than 40 linear feet in unconditioned spaces.
3. Existing duct systems constructed, insulated or sealed with asbestos.