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Home My WebLink AboutBLD2009-00240 • • PROPANE/PELLET/WOOD STOVE & TANK INSTALLATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD09-00240 Received Date 7/28/2009 SITE ADDRESS: 261 TIMBERLINE RD Issue Date 7/28/2009 PORT TOWNSEND, 98368 APPLICANT: THOMAS BERG PHONE: 360-643-1112 LESA BARNES PO BOX 1579 PORT TOWNSEND WA 98368-0055 TX 18 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001204014 Section: 20 Township: 30N Range: 01W CONTRACTOR: 'gL i vn H +-� I ME PHONE: 3(oQ- ; r i ►tC� 0 bx 40l,E, L'1VAT:5 ?xral s3S 333 ‹i 1 vedatS Li•- ac q g323 Contractor's License , fir , t+C'q�.4nk OWNER, THOMAS BERG PHONE: 360-643-1112 if different: LESA BARNES PO BOX 1579 PORT TOWNSEND WA 98368-0055 PROJECT DESCRIPTION: NEW HEAT PUMP Directions To Site: 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 7/28/2010. REQUIRED INSPECTIONS: Tank/Line/Appliance:_ / / J 3 - /Ci J� /? FinalApproval: /( - / `' ?'/ P BUILDING INSPECTION HOT-LINE 379-4455. 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 JILDING PERMIT APPLIC BLD09-00240 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD09-00240 Received Date: 7/28/2009 SITE ADDRESS: 261 TIMBERLINE RD PORT TOWNSEND, 98368 OWNER: THOMAS BERG PHONE 360-643-1112 LESA BARNES PO BOX 1579 PORT TOWNSEND WA 98368-0055 SUBDIVISION: Block: Lot: TX 18 PARCEL NUMBER: 001204014 Section: 20 Township: 30 N Range: 01 W CONTRACTOR: PENINSULA HEAT INC PHONE 457-2775 782 KITCHEN-DICK RD SEQUIM WA 98382 Contractor's License PENINHI005DB Expires 3/2/2010 REPRESENTATIVE: PHONE PROJECT DESCRIPTIOr NEW HEAT PUMP TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: CODE EDITION: 2006 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: CONST TYPE: OTHER: GARAGE: SHORELINE CONST TYPE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 0 Prop: 0 Total: 0 Total: 0 Routing Date: Type Amount Paid By: Date: Receipt: AP MEE Permit $142.00 LYK 07/28/09 108839 -' Total: $142.00 JUL 2009 Jefferson County Plannin &Building Department ______ OP al / cod JEFFERSON COUNTY w ' ,\, DEPARTMENT OF COMMUNITY DEVELOPMENT "' 04 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax ems..., o www.co.jefferson.wa.us/commdevelopmentJUL 2 8 2009 Master Permit Application MBA: I J (y tk EED 1 Project Description(include separate sheets as necessary): fl'STACL Wt(Z(1-tCr Po Vie: Fd2 9ue-n.Es5 14EAr PVMP Tax Parcel Number: nr-l_zr)y n I Property Size: 2 cre'square feet) Site Address and/or Directions to Property: 261 I M anzca K(c r?p !702 7 OtveSEvv Property Owner(s)of Record: Th'44 *Fee- 4 t_e3'A E•Apki( Telephone: V 0 G 3 if (0/ z— Fax: email:_V` ballo _d_r_w•Coµt Mailing Address: (740.5 130 ?C L 5-7 ? (o y f PG t1-1ttfQl L Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies 0 Lot or Road Segregation %Building ❑ Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family ❑ Garage Attached/Detached ❑ Conditional Use[C(a), C(d),or C]** ❑ Manufactured Home ❑ Modular ❑ Discretionary"D"or Unnamed Use Classification ❑ Commercial* ❑ Special Use(Essential Public Facilities)** ❑ Change of Use ❑ Boundary Line Adjustment ❑ Address ❑ Road Approach ❑Short Plat** ❑ Home Business ❑ Cottage Industry ❑ Binding Site Plan** ❑ Propane ❑ Long Plat** ❑ Sign - 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes" Use Consistency Analysis 0 Plat Vacation/Alteration** ❑ Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions** ❑ Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development** ❑Temporary Use 0 Shoreline Management Variance ❑Wireless Telecommunication* ❑ Comprehensive Plan/UDC/Land Use District Map Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference ❑Tree Vegetation Request **Requires a Pre-Application Conference Please identify any other local, state or federal permits required for this proposal, if known: DESIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of uis,her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet nay result in this permit being null and void. further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs, reasonable attorney's fees and :xpenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. further agree to provide access and right of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application eview and any required later inspections. Staffs access and right of entry will be assumed unless the applicant informs the Co my in writing at the me of the appli ti hat he or she wait rice. � Z� O ;ignature: Date: he action or actions Applicant will undertake as a result of the issuance of this errni ;r g y impactupon p tligc'�'ne ativel u on one or more threatened or ndangered 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 Brmit 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 :tion(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual id non-transferable respfnsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. gnature: _ � - / i _ Date: 71217 G) I BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be ass ming th sponsibility of the General Contractor for the proposed project. Signature: Date: „?1f cvt- 2 U d GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: Fax: iP4 //7sU/ 6, 1) 6 V - 333 ( ) MAILING ADDRESS: 0 EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: 'l New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: ❑ Public 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 / No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: I Underground Tank I Above ground Tank Size of Propane Tank: Heat Stove I Cook Stove Woodstove Fireplace Insert I Hot Water Tank Pellet Stove i 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 Current Proposed For Office Use Only Amount Revision Main Floor Heated ' EH Bld App Review: 2nd Floor Heated Consistency Review: Other Heated Base fee: I 1 Mezzanine Additional Section: `-( Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $ I H2-" Receipt Number: ( �� Cash/Check Number: ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish Initials: s1 f \Pr,mit P"tPr\###FORMS###\DRI)FORMS\Currenr DRD Fnrmc\Mader Permit Ann1,e,tinn S-?9-ORrinr N L 0, , (� M J C9 0 CV00 �. v �X t a I w� ,", _ a za co NI W '`J o. u. l uj tiJ ci Q?) ---) N ) 7a-_-- ))7)1 ?/ / 7 m \AlJ Z h >--- - � 440 v. .'':4: > w j ),__YI _ w , 1- . -_._. 1_.-1-3,J / z �U M (�t,i) K Ij t J 1 0 0 // 1 wk (J M ? cv (` \ o ` o i ( - .,,(..., v Li I I � Q N re ca — oO Q w ,�I Iv O 1.... w U W a a. w a z