20150253 Permit Pkg 07132015City of Yelm
Community Development Department
Building Division
Phone: (360) 458 -8407
Fax: (360) 458 -3144
Applicant:
Name: JUSTIN STAPLETON
Address: 16471 GREENBRIAR ST SE
YELM WA 98597
Property Information:
Site Address: 4Rd71 (- RPPAIC2RIAD CT CG
Assessor Parcel No.: 56510004000
Contractor Information:
Permit No.: 20150253
Issue Date: 7/13/2015
(Work must be completed within 180 days)
Phone: 318 - 243 -8266
Owner: JUSTIN STAPLETON
Subdivision: JOHNS MEADOWS
Name: BLACK HILLS, INC Phone
Address:
1003 85TH AVE SE
OLYMPIA WA 98501
Contractor License No.: Expires
Project Information:
Project: MECHANICAL
Description of Work: INSTALL AIR CONDITIONING. DUCT TEST REQUIRED.
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 ntractor, I further certify that I am currently
registered in the State ofton. 7/1 5
Signature Date
Firm
705 -8590
Lot: 40
Fees
$ 29.50
$ 29.50
OFFICIAL USE ONLY
# Sets of Prints:
Final Inspection:
Date:
By:
City of holm
(36 ) 458 -3244
REC #: 00200492 7/13/2015 9:46 AM
OPER: CO TERM: 001
REF #: 16239
PAID BY:
TRAN: 33.0000 BUILDING PERMITS
20150253 29,50CR
STAPLETON, JUSTIN
16471 GREENBRIAR ST SE
MECH 29.50CR
TENDERED: 29.50 CHECK
APPLIED: 29.50 -
CHANGE: A 0.00
Ao(sa �
CITY OF YELM
RESIDENTIAL BUILDING PERMIT APPLICATION FORM
Project Address: I (.t Lo( (�aaab n tr % Parcel #: 15-Q S IOC OLICob
Subdivision: Lot #: Plan #: Zoning:
❑ New Construction - Re -Model / Re -Roof / Addition _ Home Occupation Sign
❑ Plumbing Mechanical =�_ Mo"-bille �n/ Manufactured Home Placement Other
Project Description /Scope of Work: �L�TC�IkJI &j-Y e(ii
Project Value: U%w
Building Area (sq. ft) Vt Floor 2 "d Floor.
Covered Patio Covered Porch
3`d Floor Garage -2 car 3 car.
Patio Deck
# Bedrooms_ # Bathrooms_ Heatina: 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 N E: U
ADDRESS EMAIL
CITY=1AeJJy1 STATE ZIP S TELEPHONE 3J 3 - 0, oZ.Ce A
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 ZIF FAX
CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE #
MECHANICAL CONTR�AQyTOR G UL k% TELEPHONE -51Q.0 - lg - 'WD 1 O
ADDRESS 3 6 EMAIL
CITY .4. STATE ZI SO1 FAX
CONTRA O 'S LICENSE *QjLW_ 1eTg(oLEXP DATE CITY LICENSE # - - 0
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.
App ant'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, TVA 98597 (360) 458 -3144 FAX
www.ci.velm.wa.us
Duct Leakage Test Results (Existing Construction)
Permit #:
House address or lot number: _ UL4
City: Zip:
Cond. Floor Area (ft2):
❑ Duct tightness testing is not required for this residence per exceptions listed at the end of this document
Test Result: C) b CFM @25Pa
Ring (circle one): Open 2
Duct Tester Location:
Pressure Tap Location:
Company Name: 3a
Duct Testing Technician:>
Technician Signature: �`` Date: 15 w
Phone Number: F.
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 handler, 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.