HomeMy WebLinkAboutBLD2006-00123 • .
INSTALLATION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD06-00123 Received Date 3/17/2006
SITE ADDRESS: 130 PLEASANT HARBOR RD Issue Date 4/5/2006
BRINNON, 98320
APPLICANT: DENNIS N GAUL PHONE: 928-846-0818
BONNY GAUL
130 PLEASANT HARBOR RD
BRINNON WA 98320
SUBDIVISION: CEDAR COVE SHORT PLAT Block: Lot:
PARCEL NUMBER: 502104046 Section: 10 Township: 25N Range: 02W
CONTRACTOR: DANA'S HEATING INC PHONE: (360)876-7670
PO BOX 607
BURLEY WA 98322
Contractor's License DANASHI000DZ Expires 3/23E)R76-3177
OWNER, DENNIS N GAUL PHONE: 928-846-0818
if different: BONNY GAUL
130 PLEASANT HARBOR RD
BRINNON WA 98320
PROJECT DESCRIPTION: MECH PERMIT- HEAT PUMP SYST
THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE.
THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR.
THE EXPIRATION DATE IS 4/5/2007.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: �� Gr�¢��$-riper 5/3/07
FinalApproval: Z,j(/ for "CIKa.) 5/..0 'r/
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:00 a.m. -4:30 p.m.
HOT LINE AVAILABLE 24 HOURS A DAY
I:\F_BLD_Permit_Propane.rpt 10/29/19.
BLD06-00123
!UILDING PERMIT APPLICAllitN Review T ype:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD06-00123 Received Date: 3/17/2006
SITE ADDRESS: 130 PLEASANT HARBOR RD
BRINNON, 98320
OWNER: DENNIS N GAUL PHONE: 928-846-0818
BONNY GAUL
130 PLEASANT HARBOR RD
BRINNON WA 98320 CEDAR COVE SHORT PLAT
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 502104046 Section: 10 Township: 25 N Range: 02 W
CONTRACTOR: DANA'S HEATING INC PHONE: (360) 876-7670
PO BOX 607
BURLEY WA 98322
Contractor's License DANASHI009DZ Expires 3/2/2008
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr MECH PERMIT - HEAT PUMP SYST
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP MEC
VALUATION MAIN:
CODE EDITION: 2003 ADD'L: HEAT TYPE:
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: # OF STORIES:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total:
Routing Date: 30)0(-D
Type Amount Paid By: Date: Receipt: ••r• tjetPermit $209.25 LYK 03/17/06 79193 '" "
Plan Check $136.02 LYK 03/17/06 79193
State Building Code $4.50 LYK 03/17/06 79193 APR 5 MS
Total: $349.77 Jefferson County Planniny
&Building Department
0 b' T T��(a
(iisON cdj,� JEFFERSON COUNTY i —* DEPARTMENT OF COMMUNITY DEVELOPMENT
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'< 621 Sheridan Street• Port Townsend •Washington 98368 MAR 1 7 2006 -
.. - , . 360/379-4450• 360/379-4451 Fax
.qs, N0�O www.co.jefferson.wa.us/commdevelopmentL
Master Permit Application MLA: f -r c A' V —
Project Description(include separate sheets as necessary):
a.,(, n CL VIPaAwxyy N si' Y\
Tax Parcel -- Property
Number: ��� , Size: (acres/square feet)
Site Address and/or Directions to Property: 13D tern .(-# Wu 126\c- � _
Property Owr er(s of Record: n Ci t s 0-ca L l
Telephone: 2 4111--SLl iD ) Fax: email:
Mailing Address: \i�'ter6ci�1# ils-b6- (►IA t no NC21 C183 e
Applicant/A e_n_t_(if different fromowner): 1 n S 14eo-- n A nc_.
�
Telephone:7' l b-�1} L_ad�' Fax: 3 //�� - email:m( �.L j ,C6/11
T O _l1_)
Mailing Address: 1 k Lyn `'�LL1 'J 1 t..i.. Q Zz
What kind of Permit?(Check each box that applies)
U Building Li Variance(Minor,Major or Reasonable Economic Use)
_ Demolition Permit i I Conditional Use[C(a),C(d),or C)**
Single Family LI Discretionary"D"or Unnamed Use Classification
i Garage Attached/Detached LJ Special Use(Essential Public Facilities)'*
_ Manufactured Home IJ Boundary Line Adjustment
J Modular Li Short Plat**
L Commercial* L_I Binding Site Plan**
L Change of Use LI Long Plat**
J Address l Road Approach I i Planned Rural Residential Development(PR RD)/Amendments**
L Propane a Plat Vacation/Alteration**
Li Allowed"Yes"Use Consistency Analysis L Shoreline Master Program Exemption/Permit Revisions**
LI Storrnwater Management I: Shoreline Management Substantial Development**
Li Site Plan Approval Advance Determination(SPAAD)* I.. Shoreline Management Variance
LJ Temporary Use Li Comprehensive Plan/UDC/Land Use District Map Amendment
u Wireless Telecommunication* Li Jefferson County Shoreline Master Program Amendment
u Forest Practices Act/Release of Six-Year Moratorium
'May require a Pre—Application Conference 'Requires a Pre-Application Conference
Please identify any other local,state or federal permits required for this proposal, if known:
11,,, L DESIGNATION OF AGENT
I hereby designate /t?�1\u1$T•1'ei.-ki 1,rlL. to act as my agent in matters relating to thisapplicationf for permit(s).
OWNER SIGNAL ^i►,l.G�{14144 - c. Date: a /i 5-/O 0
By signing this a; i form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of
his,her or it's knc Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet
may result in this,. ping null and void.
I further agree to sa: emnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and
expenses which ma; ;way accrue against Jefferson County as a result of or in consequence of the granting of this permit.
I further ree to prov; cess an right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review a any require, ii...i ins ns.Access and right of entry to this property shall be requested and shall occur only during regular business
hours. �I D `,to
Signature Date:
The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or
endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the
"Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this
permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non- ansf9rable res onsi I y for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature Date: ,7�I LA ZIP,
C:,Documents and Settuigs anocittl,Desktop,Maste*PeniutApplication 8-04.doe
• •
OWNER BUILDER STATEMENT
The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licen1se ractprs and that i
they will be assuming the responsibility of the General Contractor for the proposed project. 6►AUont1 / ?f P` 1
Signature: Date: .-I
;
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: ' .I..__FAx:-. ____
' Ina-5\-kea- r- G 11�(- , EO)B b 2-100�y �( 4O)t � (lS-���t3177
MAILING ADDRESS: "PO )< /„6-7 -Tat((�Q; I I C. ZEMAIL" k Rat(3�wi� lheCJL�l I1UV:CLS r,1
CONTRACTOR'S LICENSE lllL �l t v 1 WAINS J
NUMBER: .ti\S ��� - NUMBER
ARCHITECT/ENGINEER: �� PHONE ( ) FAX: ( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
J New J VVood Existing: _l Sewer
J Addition I Steel Proposed: Bank J Community System
X Alteration/Remodel _I Concrete Total: Height: LJ Individual System
J Repair I Masonry SEP Permit#
LI Demolition J Other: Bedrooms: Water Supply:
Existing: Setback: 11 Private well U Two Party
Ty p e of Heat: Proposed: a Public
l�-� mp Total: Name of System:
If this is a Commercial Project you must answer the following:
Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces:
Number of occupants(includes owners,tenants,employees,etc) Current Proposed
IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes I No
If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply:
Underground Tank i Above ground Tank Size of Propane Tank:
i Heat Stove i Cook Stove i Woodstove i Fireplace Insert i Hot Water Tank j Pellet Stove j Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No
When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property
lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system components,
including the reserve area.
Square Footage For Office Use Only
Current Proposed Amount
Main Floor Consistency Review:
2"u Floor Base fee:
oq.a5
3fd Floor Additional Section:
Mezzanine: Plan Check fee:
Heated Basement State Surcharge fee: 4
Unheated Basement Pot Water Review fee:
Other Unheated 911/Rd Approach fee:
cc- (.1
Garage/Carport TOTAL: $ �.L\q 1
Decks t
Receipt Number: 1 q I C 1)
Other Cash/Check Number. 63 52
ESTIMATED COST(REQUIRED) Date: I�/��
.Fair market value of all labor and materials foundation to finish C)l
1 Z I D OC) Initials: f ' J
C:,Ducun ients and Settings moan],Desktop,Mastei Permit Application?-8-04.doc tr-�
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