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Home My WebLink AboutBLD2010-00165 vs 0 S 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 #: BLD10-00165 Received Date 5/19/2010 SITE ADDRESS: 380 JEFFERSON AVE Issue Date 5/19/2010 PORT LUDLOW, 98365 APPLICANT: MICHAEL R ASBURY PHONE 360-437-9541 JANE D ASBURY 380 JEFFERSON AVE PORT LUDLOW WA 98365-9656 SUBDIVISION: EDSALL SHORT PLAT 2.06AC Block: Lot: PARCEL NUMBER: 978900124 Section: 4 Township: 28N Range: 01 E CONTRACTOR: ALL WEATHER HTG & COOLING PHONE: 302 KEMP STREET PORT ANGELES WA 98362 Contractor's License ALLWEHC003DC Expires 7/30/2011 OWNER, MICHAEL R ASBURY PHONE 360-437-9541 if different: JANE D ASBURY 380 JEFFERSON AVE PORT LUDLOW WA 98365-9656 PROJECT DESCRIPTION: REMOVES & REPLACE EXISTING HEAT PUMP &AIR HANDLER 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 5/19/2011. REQUIRED INSPECTIONS: Tank/Line/Appliance: itgi„ ct/ FinalApprovaI: de-7k.J )4 — 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 11F_BLD_Permit_Propane.rpt 10/29/19 QUILDING PERMIT APPLICA BLD10-00165 •N Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD10-00165 Received Date: 5/19/2010 SITE ADDRESS: 380 JEFFERSON AVE PORT LUDLOW, 98365 OWNER: MICHAEL R ASBURY PHONE: 360-437-9541 JANE D ASBURY 380/JEFFERSON AVE PORT LUDLOW WA 98365-9656 SUBDIVISION: EDSALL SHORT PLAT 2.06AC Block: Lot: PARCEL NUMBER: 978900124 Section: 4 Township: 28 N Range: 01 E CONTRACTOR: ALL WEATHER HTG & COOLING 302 KEMP STREET PHONE: PORT ANGELES WA 98362 Contractor's License ALLWEHC003DC Expires 7/30/2011 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOt REMOVES & REPLACE EXISTING HEAT PUMP & AIR HANDLER TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC VALUATION 13,732.00 MAIN: CODE EDITION: 2006 ADD'L: HEAT TYPE OCCUPANCY: HEAT BASE: HEAT TYPE OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: OTHER: CONST TYPE: GARAGE: SHORELINE: DECK: SETBACK: SEWAGE DISPOSAL: BANK HEIGHT: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $237.25 LYK 05/19/10 117728 Plan Check $154.13 LYK 05/19/10 117728 State Building Code $4.50 LYK 05/19/10 117728 Total: $395.88 Ai) G JEFFERS COUNTY ;I` hA, 14 DEPARTMENT OF COMMUNITY DEVELOPMENT 14 > ` 621 Sheridan Street • Port Townsend • Washington 98368 i -''' 360/379 4450 • 360/379-4451 Fax 1 www.co.jefferson.wa.us/commdevelopment Master Permit Application �. )I IMLA: d I Project DescriptionpQ(include separate sheets as necessary): r/, 1t M:lif lj 4e,47r 09 P1/Shn " fi flz'1 p1, 4 4lV'`iCx�t:1 ier Tax farce %9 ` , Property Number: (�(� Z- Size: (acres/square feet) Site Address and/or Directions to Property: 3 JcC "tLYI '(4�. k-)- Luck.1 1,03 R q �`.Property Owner(s)of Record: I �Vf�it 11l Telephone: &S,), L3 C)16.-.1 Fax. Mailing Address: aXinne. email: Applicant/A ent(if different from owner): HC��-ti�nt-j Cf-y�� t • Telephone: , l.�j?�� Fax: � Z Sk l"1 Mailing Address: . Ka"'y� email:tvLl („@ C�Ip ,c�vr�Z What kind of Permit?(Check each box that applies ❑Building ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit ❑Conditional Use[C(a), C(d), or C]** SO,Single Family ❑Garage Attached/Detached ❑Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home ❑ Modular ❑Special Use(Essential Public Facilities)** ❑ Commercial* ❑Boundary Line Adjustment ❑ Change of Use ❑Short Plat** ❑ Address ❑Road Approach ❑Binding Site Plan** ❑Home Business ❑Cottagelndustry ❑Propane ❑Long Plat** ❑Sign ❑Planned Rural Residential Development(PRRD)/Amendments** ❑Plat Vacation/Alteration** ❑Allowed"Yes" Use Consistency Analysis ❑Slowed ter Management ❑Shoreline Master Program Exemption/Permit Revisions** ❑Site Plan Approval Advance Determination SPAAD ❑Shoreline Management Substantial Development** ❑Temporary Use ( ) ❑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 *Ma re uire a Pre-A lication Conference **Re uires Pre-A lication ❑Tree Vegetaion Request Please identify any other local, state or federal permits required for thisa proposal, if knownence I hereby designate 1 DESIGNATION OF AGENT r to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE�/7Llt'_ C e/1 ? _ � _ _ Date: —J 62`eJ By signing this application form,the owner/agent attests that the informa on provided herein,and in any attachments,is true and correct to the best of his,her or it's knowledge. 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 permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any required later inspections. Staffs acces and right of entry will be assumed unless the applicant informs the County in writing at the time of the ap lication that he or she wa rior notic . Signature: i 1 Date: /L 1 The action or actions Applicant will• ertake 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-tran rable responsibility for hering to a complying with the ESA. The Applicant has read this dis�lai 7nd signs and dates it below. �C:\Documents and Settings\carat\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-19-2000.doc • .. • • ' • • • 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 assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL\CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: `� \ l/l Y�( y- - \_1c� I *Qj�\a S� T - FAx: MAILING ADDRESS: . L f� Sts EMAIL:aLLy L ) � �1�1CONTRACTOR'S LICENSE `� , ` J WAINS 'J C` l NUMBER: i., 0E.- �1�}GTj'M 1 ► t�� NUMBER ARCHITECT/ENGINEER: ,V, W` , ` PHONE ( ) FAX: MAILING ADDRESS: 3e).2 /) '''//n11 y� 7 ( ) KC w( r;f -pa f eY-I"4.1,1,(,f�ao� EMAIL (: ) c. �(�. y0 e n,,c'fl I Project Type: Frame Type: Bathyooms: Shoreline: / 'Type of Sewage Disposal: ❑ New ❑ Wood Existing: ❑ Addition ❑ Steel Proposed: Bank 0 Sewer Alteration/Remodel ❑ Community Systemm p Masonry Concrete Total: Height: ❑ Individual ❑ Repair ❑ M ry SEP Permit# ElDemolition ❑ Other: Bedrooms: Water Su I Existing: Setback: pp y: Type of Heat: Proposed: ❑ Private well ❑ Two Party A. i \kyN\p Total: ❑ Public 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 IBC Occupancy: Proposed P y 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: 0 Underground Tank Ell Above ground Tank Size of Propane Tank: 0 Heat Stove 0 Cook Stove 0 Woodstove 0 Fireplace Insert 0 Hot Water Tank 0 Pellet Stove 0 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 al/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 1 Current Proposed For Office Use Only Main Floor Heated Amount i Revision: �% ,� EH Bid App Review: • 2ntl Floor Heated Consistency Review: - Other Heated Base fee: Mezzanine 2.3 7 2,______5 Additional Section: Heated Basement _ . Plan Check fee: I u Unheated Basement / ✓ /. State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL C. C Decks 3 VD• 0 911/Rd Approach fee: Other TOTAL: $ 00 Receipt Number: I 17 7 xg Cash/Check Number: z` 54 ESTIMATED •Fai Pi yawl;of all labor and materials oundation to finish Date: i3, 7 321. e)e) Initials: �� C:\Documents and Settings\carat\Local Settings\Temporary Internet Files\OLK8G\Master Permit Application 12:17:707oc • FtA1),OP\C ., 113 \ -e v- \ GP,16ASL , •