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  • For Inspections, call: Town of Coupeville PO Box 725 360-678-4461 BUILDING DEPARTMENT 4 NE 7th Street 24 Hours Notice Requested PERMIT APPLICATION Coupeville WA 98239

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    Name or Name of Business

    APPLICANT: Complete this form within shaded area for the work to be done under this permit.

    Mailing Address PLUMBING City/State/Zip Telephone # No. Type of Fixture or Item Fee, $

    Water Closet (Toilet)

    AR

    CH

    ITE

    CT

    Name

    Bathtub w/shower head Lavatory (Wash Basin)

    Address

    Shower (stall) Kitchen Sink & Disposal

    City/State/Zip

    Telephone # Dishwasher Laundry Tray

    CO

    NTR

    AC

    TOR

    Name Clothes Washer Water Heater

    Address

    Urinal Drinking Fountain

    City/State/Zip

    Telephone # Floor Sink or Drain Slop Sink

    State License Number

    Yard Sprinkler System

    Residential Demolish Plumbing

    Commercial Fence Mechanical Non-commercial Swimming Pool Addition Permit New Remodel Repairs Total Plumbing Fee

    Assessors Tax Parcel Number MECHANICAL Natural Gas Oil LPG Electric

    Nature of Work to be done No Type of Equipment Fee, $ Residential Heating System Ventilation Fan

    Range Hood Gas Piping

    Proposed use:

    NOTICE: This permit becomes null & void if work or construction authorized is not commenced within 180 days, or if construction or work is suspended or abandoned for a period of 180 days at any time after work is commenced. I hereby certify that I have Permit read and examined this application & know the same to be true and correct. I will comply Total Mechanical Fee with all provisions of the laws & ordinances governing this type of work whether or not Building Fee Calculation Valuation, $ Fee, $ PER

    MIT N

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    ESS:

    specified herein. Approval of this permit does not presume to give authority to violate or Building (001.322.10) cancel the provisions of any other state or local law regarding construction or Plumbing (001.322.10) performance of construction. Mechanical (001.322.10) Plan Check (001.345.83) X State Fee ($4.50) (001.389.01) Signature of Owner or Authorized Agent Date Other______________ Building Fees Due NOTE: Permit Limit One year (Except DEMOLITIONS, which shall be completed in sixty days; moving permits in thirty days.)

    Public Works Permits Account Fee, $

    Side Setback Street Setback Rear Setback Right of Way 001.322.90.01 Lt. Rt. Stormwater 001.322.10.03 Zoning Lot Area Vacant Site Clearing & Grading 001.322.10.03 Yes No Water Hookup Right 410.900.000.343.40 Type of Construction Occupancy Group No. of Dwelling Units Sewer Hookup Right 420.900.000.343.50 Park Impact Fee 109.345.85.00.01 --------- Size of Building (total) Sq. Ft. Basement No. Stories Max. Occupancy Load Water Inspection Fee 410.343.40.00.14 Sewer Inspection Fee 420.343.50.00.14 Fire Zone Fire Sprinklers Required? Other __________ Yes No TOTAL FEES DUE Deck Fireplace/Stove Culvert Date paid Date application received: Plans checked by: Approved for Issuance by: Amount paid Receipt Number

    WHEN SIGNED & DATED BELOW, THIS IS YOUR PERMIT AND RECEIPT. Permission is hereby given to do the above described work, according to the conditions herein, and according to the approved plans and specifications pertaining thereto, subject to compliance with the ordinances of the Town of Coupeville. Permit Issued , 20 By , Building Official

    Original: Applicant copy to: Building File, A/R bldg permit application, final 072109.doc, rev 05/11/04

  • PLUMBING / MECHANICAL 1. Has this building been previously heated? ____________

    2. Is this for a mobile home? _____ If yes, approval of an alteration permit from the Department of Labor and Industries is required for interior fixtures.

    3. Please attach a floor plan indicating location of proposed fixtures. ____________

    4. Propane tank (s) proposed? _____ If yes, How many? ____ # of gallons? _______ ASME tank/DOT tank Above ground/Underground (circle as appropriate). Provide site plan showing proposed location(s) of tank(s) including setbacks from property lines and structures.

    PLUMBING: Type of fixtures@ $10.00 per fixture MECHANICAL: Toilet/Bidet Ventilation Fans @ $ 7.00 Each Bathtub/Shower Combo/Shower Stall Appliance Vents @ $ 7.00 Each Bathroom Sink Range Hood @ $11.00 Each Kitchen Sink/Disposal Wall Heaters @ $15.00 Dishwasher F.A. Furnace @ $20.00 Hot Water Heater Baseboard @ $15.00 Laundry Washer Fireplace or Woodstove @ $20.00 Each Laundry Sink Pellet Stove @ $15.00 Each Wet Bar Sink Propane Tank @ $11.00 Each Spa/Jacuzzi Tub Gas/Propane Piping System @ $ 5.00 Floor Sink or Drain Repairs and Additions @ $14.00 Waste Interceptor Heat Pump @ $15.00 Each TOTAL FIXTURES Ductless Unit @ $10.00 Each Building Sewer @ $10.00 Air Handler @ $15.00 Each Grease Trap @ $10.00 Ea. Other ____________________ @ $ Lawn Sprinkler @ $10.00 + $1.00/sprinkler Backflow Device @ $10.00 Ea. Total Fixture Fee $ Other ____________________ + Base Permit Fee $ 30.00

    = $ Total Fixtures x $10.00 + $ 30.00 Base Permit Fee TOTAL MECHANICAL = $

    = $ TOTAL PLUMBING FEE

    I affirm that I am the owner or owners authorized representative and all information on this form is complete and accurate. Applicant signature________________________________ Printed name______________________________________

  • 1

    Permit #: Project Address:

    This set of forms has been developed to assist permit applicants documenting compliance with the Washington

    State Energy Code, (2015 edition).

    This set is for structures built under the IRC and located in Climatic Zone Marine 4. This form in not a substitute

    for the energy code itself. To obtain a copy of the energy code, go to the following web address.

    http://www.energy.wsu.edu/code.

    The following forms provide much of the required documentation for plan review. The details noted here must

    also be shown on the drawings (WSEC 103.2).

    TABLE R402.1.1

    INSULATION AND FENESTRATION REQUIREMENTS BY COMPONENT (a)

    CLIMATE ZONE 5 AND MARINE 4

    FENESTRATION U-FACTOR (b) 0.30

    SKYLIGHT(b) U-FACTOR 0.50

    GLAZED FENESTRATION SHGC(b, e) NR

    CEILING R-VALUE(k) 49

    WOOD FRAME WALL(g, m, n) R-VALUE 21 int

    Mass Wall R-Value(i) 21/21

    FLOOR R-VALUE 30

    BELOW-GRADE(c,m) WALL R-VALUE 10/15/21 int + TB

    SLAB(d) R-VALUE & DEPTH 10, 2 ft

    For SI: 1 foot = 304.8 mm, ci = continuous insulation, int = intermediate framing.

    (a) R-values are minimums. U-factors and SHGC are maximums. When insulation is installed in a cavity which

    is less than the label or design thickness of the insulation, the compressed R-value of the insulation from

    Appendix Table A101.4 shall not be less than the R-value specified in the table.

    (b) The fenestration U-factor column excludes skylights. The SHGC column applies to all glazed fenestration.

    (c) "10/15/21 +TB" means R-10 continuous insulation on the exterior of the wall, or R-15 continuous insulation

    on the interior of the wall, or R-21 cavity insulation plus a thermal break between the slab and the

    basement wall at the interior of the basement wall. "10/15/21 +TB" shall be permitted to be met with

    R-13 cavity insulation on the interior of the basement wall plus R-5 continuous insulation on the interior

    or exterior of the wall. "TB" means thermal break between floor slab and basement wall.

    (d) R-10 continuous insulation is required under heated slab on grade floors. See R402.2.9.1.

    (e) There are no SHGC requirements in the Marine Zone.

    (f) Reserved.

    (g) Reserved.

    (h) Reserved.

    (i) The second R-value applies when more than half the insulation is on the interior of the mass wall.(

    (j) Reserved.

    (k) For single rafter- or joist-vaulted ceilings, the insulation may be reduced to R-38.

    (l) Reserved.

    (m) Int. (intermediate framing) denotes standard framing 16 inches on center with headers insulated with a

    minimum of R-10 insulation.

    (n) Log and solid timber walls with a minimum average thickness of 3.5 inches are exempt from this insulation requirement.

    Town of Coupeville 4 NE Seventh PO Box 725 Coupeville, WA 98239

    360 678 4461 360 678 3299 Fax www.townofcoupeville.org

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    . . .

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    . . .

    http://www.energy.wsu.edu/code

  • 2

    WA STATE ENERGY CODE SECTION R406

    ADDITIONAL ENERGY EFFICIENCY REQUIREMENTS

    Choose sufficient options from Table R406.2 so as to achieve the following minimum number of credits:

    1. Small Dwelling Unit: .......1.5 credits Dwelling units less than 1500 square feet in conditioned floor area

    with less than 300 square feet of fenestration area. Additions to

    existing building greater than 500 square feet of heated floor area

    but less than 1500.

    2. Medium Dwelling Unit: ...3.5 credits All dwelling