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Home My WebLink AboutBlD2010-00391 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 #: BLD10-00391 Received Date 11/17/2010 SITE ADDRESS: 30 ELK CT Issue Date 11/17/2010 BRINNON, 98320 APPLICANT: BYRON L BEEMAN PHONE: 360-796-4553 WILLA R BEEMAN 30 ELK CT E BRINNON WA 98320-9668 23 SUBDIVISION: OLYMPIC CANAL ADDITION 5 Block: 14 Lot: PARCEL NUMBER: 981301422 Section: 21 Township: 25N Range: 02W CONTRACTOR: PRECISION HTG & COOLING INC PHONE: 360-779-9208 PO BOX 4018 SILVERDALE WA 98383 Contractor's License PRECIHC954OK Expires 9/12/2011 OWNER, BYRON L BEEMAN PHONE: 360-796-4553 if different: WILLA R BEEMAN 30 ELK CT E BRINNON WA 98320-9668 PROJECT DESCRIPTION: NEW DUCTLESS NC SYSTEM 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 11/17/2011. REQUIRED INSPECTIONS: Tank/Line/Appliance: " ( FinalApproval: /j- / - / C) 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 IUILDING PERMIT APPLICA N BLRD10-00391 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00391 Received Date: 11/17/2010 SITE ADDRESS: 30 ELK CT BRINNON, 98320 OWNER: BYRON L BEEMAN PHONE: 360-796-4553 WILLA R BEEMAN 30 ELK CT E BRINNON WA 98320-9668 OLYMPIC CANAL ADDITION 5 SUBDIVISION: Block: 14 Lot: 23 PARCEL NUMBER: 981301422 Section: 21 Township: 25 N Range: 02 W CONTRACTOR: PRECISION HTG & COOLING INC PHONE: 360-779-9208 PO BOX 4018 SILVERDALE WA 98383 Contractor's License PRECIHC954OK Expires 9/12/2011 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP NEW DUCTLESS A/C SYSTEM TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION 3,700.00 ADD'L: HEAT TYPE CODE EDITION: 2009 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $97.25 LYK 11/17/10 120277 Plan Check $63.21 LYK 11/17/10 120277 State Building Code $4.50 LYK 11/17/10 120277 Total: $164.96 ' kii ° c0e., JEFFERSO4 UNTY • ic `kiiii.,,z, DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax ��gNa, p www.co.jefferson.wa.uslcommdevelopment rirMaster Permit Application MLA: kv Wc/A I' N Project Description(include separate sh ets as necessary): DU( t IPss , Sc S+Ev-I Tax Parcel Number: 57g•/ ,3B / 4712 Z. Property Size: (acres/square feet) Site Address and/or Directions to Property: a Property Owner(s)of Record: M Telephone:,..we—79v .f�,j 3 Fax: email: Mailing Address: , " Cr j . /(l/t/l1 9�-3 , Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies Building ❑ Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) Single Family 0 Garage Attached/Detached ❑ Conditional Use[C(a),C(d),or CI'" ❑ Manufactured Home 0 Modular ❑ Discretionary"D"or Unnamed Use Classification ❑ Commercial* 0 Special Use(Essential Public Facilities) ❑ Change of Use 0 Boundary Line Adjustment ❑ Address 0 Road Approach ❑ Short Plat** ❑ Home Business 0 Cottage Industry ❑ Binding Site Plan** ❑ Propane 0 Long Plat** ❑Sign 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis El Plat Vacation/Alteration""' 0 Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions** ❑Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Substantial Development** ❑Temporary Use ❑Shoreline Management Variance ❑Wireless Telecommunication* El Comprehensive Plan/UDC/Land Use District Map Amendment o Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment *May require a Pre-Application Conference 0 Tree Vegetation Request **Requires a Pre-Application Conference Please identify any other local, state or federal permits required for this proposal, if known: 224'C7-&/CAL. 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 his,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 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 ri ht of ry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any required later inspectio s. taffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the ap " t he or she w Signature: Q-a-z-vG•w Date: ) t 7/ C, Ail 0 The action or actions App cant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and uld 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 compli ce with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transfe ble responsibili fo adheri to and complying with the ESA. The Applicant has read this disclairqr and si s and dates it below. Signature:��-�1L/.-M-'—' ,r..✓Z- - -•-r , Date: / I i c L G:\PennitCentcr\###F ORMS###\DRD FORMS\Master Permit Application 5-29-06.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: FAX: i 7QE CI S/o A/ 6/4,47211 6 el c o o.iiv6. (34e) 77 ?-9ae g (3 O 7?? /33? MAILING ADDRESS: P.d gj X -Vo r $4.✓Ai?flitLF i,4 EMAIL: ioti�aciVerra E,4//n��cc m CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: Li New p4 Wood Existing: 2 ❑ Sewer ❑ Addition Li Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel Ll Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# , ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: / Setback: ; I Private well ❑ Two Party Type of Heat: Proposed: I] 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 andlor Appliance Installation permit,mark all items below that apply: I Underground Tank 1 Above ground Tank Size of Propane Tank: 1 Heat Stove 1 Cook Stove 1 Woodstove 1 Fireplace Insert 1 Hot Water Tank i Pellet Stove 1 Other/ZW1:9 MP Is this appliance being installed in a Manufactured I 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 '�w Revision Main Floor Heated EH Bld App Review: ea Floor Heated Consistency Review: Other Heated Base fee: °C 7 05 Mezzanine Additional Section: Heated Basement Plan Check fee: LP5 .`1 Unheated Basement , State Surcharge fee: _ t Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $ I iQ`Y q(0 Receipt Number: �Zri Cash/Check Number: ESTIMATED COST(REQUIRED) Date: . •Fair market value of all labor and materials foundation to finish �.1 6fd m d �j`�_ - Initials: G:\Pent(enter\###FORMS###\1DRll FORMS\Master Permit Application 5-29-08.doc 1 • • .4 7 E --tr f t Q ' 4 C 4 /A t - .t. . ki \ 1 1 1 N la 1\"'i - 1, k) 14 b V 1 N. v V