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Home My WebLink AboutBLD2011-00003 • • 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 #: BLD11-00003 Received Date 1/5/2011 SITE ADDRESS: 181 CONDON LN Issue Date 1/5/2011 PORT LUDLOW, 98365 APPLICANT: DOUGLAS L HABERSETZER PHONE: DONNA M HABERSETZER PO BOX 874302 WASILLA AK 99687-4302 32 SUBDIVISION: PORT LUDLOW NO 1 Block: Lot: PARCEL NUMBER: 990400232 Section: 9 Township: 28N Range: 01 E CONTRACTOR: HENDRICKSON HVAC SERVICES INC PHONE: 360-687-2034 PO BOX 1810 BATTLE GROUND WA 98604 Contractor's License HENDRHS940QF Expires 11/6/2012 OWNER, DOUGLAS L HABERSETZER PHONE: if different: DONNA M HABERSETZER PO BOX 874302 WASILLA AK 99687-4302 PROJECT DESCRIPTION: INSTALL 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 1/5/2012. REQUIRED INSPECTIONS: Tank/Line/Appliance: f) � /6 FinalApproval: / ^ / 3 - L Z / i • 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 BLD11-00003 •UILDING PERMIT APPLICA•N Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD11-00003 Received Date: 1/5/2011 SITE ADDRESS: 181 CONDON LN PORT LUDLOW, 98365 OWNER: DOUGLAS L HABERSETZER PHONE: DONNA M HABERSETZER PO BOX 874302 WASILLA AK 99687-4302 PORT LUDLOW NO 1 AREA 2 SUBDIVISION: Block: Lot: 32 PARCEL NUMBER: 990400232 Section: 9 Township: 28 N Range: 01 E CONTRACTOR: HENDRICKSON HVAC SERVICES INC PHONE: 360-687-2034 PO BOX 1810 BATTLE GROUND WA 98604 Contractor's License HENDRHS940QF Expires 11/6/2012 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIO1` INSTALLESS HEAT PUMP TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION 9,371.00 ADD'L: HEAT TYPE: CODE EDITION: 2009 HEAT BASE: HEAT TYPE: OCCUPANCY: OCCUPANCY: UNHEATED: #OF STORIES: 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 $181.25 LYK 01/05/11 120384 Plan Check $117.81 LYK 01/05/11 120384 State Building Code $4.50 LYK 01/05/11 120384 Total: $303.56 Dec30 1004:35p SI ELLEN FARMS 31009615 p.1 , JEFFERSON COUNTY kj4,4(for DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98366 $ 360(379-4450 • 360/379-4451 Fax +A � p www.cc.jefferson.wa.us/commdevelo3rr:ent Master Permit Application MLA: (T) I jj ' .S Project Description(include separate sheets as necessary): Il y>%AL. /)c/C TLf'cS 1/tl-1/ / &',i- 7 Tax Parcel Number: 7 q c 4ex'Z ?2 Property Size: (acres/square feet) Ste Address and/or Directions to Property: /16/ (CA/Di / tigAGe; /no r Zt-,) t:;ei, , IA//, 993 5 Property Owner(s)of Record: .1 c'G h/A.S4..z_5 .7"21-� Telephone: Fax: email: Mailing Address: , C ge-x e57e--.. '� , /rt1�►/LEA, ?l G'7- y30 Appticant/Agent(if different from owner): 1-tif_,VVR/C,rCSe2," /f ' c .5 .AZ P"/Cs:-y, /A/C- Telephone:260 6c 1 ZC.;4/ Fax:36 0 tt r G' -7C 7? email: S.;mIS�f/ts✓>.•,:C kitx-Yv: ,e.r.,-, Mailing Address: /7C $C.:A /e/C fir. 7'-'i—e-- . 6.,2 Ce/,,,/v /A/n 9f;-"6'4 What kind of Permit?(Check each box that applies Building 0 Critical Areas Stewardship Plan O Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use) O Single Family E Garage Attached/Detached O Conditional Use[C(a), C(d). or C)" O Manufactured Home 0 Modular 0 Discretionary`D"or Unnamed Use Classification. O Commercial* 0 Special Use(Essential Public Facilities)" Cl Change of Use 0 Boundary Line Adjustment O Address 0 Road Approach ❑Shor.Plat" O Home Business 0 Cottage Industry 0 Binding Site Plan"" O Propane 0 Long Plat•• O Sign 0 Planned Rural Residential Development(PRRD)/Amendments"" O Allowed`Yes"Use Consistency Analysis 0 Plat Vacation./Alteration" O Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions" 0 Site Plan Approval Advance Determination(SPAAD)• 0 Shoreline Management Substantial Development"" O Temporary Use 0 Shoreline Management Variance O Wireless Te}ecommunication• 0 Comprehensive Plan/UDC/Land Use District Mao Amendment 0 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-Appfiration Conference Please Identify any other local,state or federal permits required for this proposal,if known: DESIGNATION OF AGENT I hereby designate HENDA/LKSLW/ '.9L/ .t,�•cz- i,s act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE <sZ � Cr-- 2A—Z Date: 4,2 ' -5✓, /ci iBy signing this application form,the owner/agent attests that the inform ion 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 owreriagent with respect to this application packet may result in this perm:being null and void I further agree to save,indemnify and hold harmless Jefferson Ccunty against all tiabilihes,judgments.court costs,reasonable attorneys fees and expenses which may in any way accrue against Jefferson County as a result cf 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 agen5 for the solo purpose of application review and any required later inspections. Staffs access and right of entry will be assumed en ess the applicant informs the County in writing at the time of the application that he or she wants prior notice. r Sgnature: cat{ Date. /,.2- • -Z-r' . /U i The action or actions Applicant will undertake as a result of tIlle4Auance cf 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 we 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 adcnornedges that he,she or it holds individual and non-transferable responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: i 7--✓re-h.-- Da:e: / t) , i& C_., G:\?crrrctCancrV##FFORtdS #WW\DAD FORMS\M3.stcr Pamir/tnnliarion 5-29=:8.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: HFNvA/ /C.S�N /11119e SE.Zr,;C<"S //v C (36c)66'7-ZCl3Lj (3C) 1& -XX- '7-7 MAILING ADDRESS: /70 /c c /ftf/U p�jf�?Lt L,L'�tca✓v 1:44 EMAIL: S/�7/i3 6'HEA/J/?�L,l�sc,J/71y 9c.l4i�7 CONTRACTOR'S LICENSE 961 PLr WAINS NUMBER: PEA/DRI,S %4Ci cr NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: U New 1 Wood Existing: 7 Sewer l Addition H Steel Proposed: Bank U Community System I I Alteration/Remodel Concrete Total: Height: ❑ Individual System [i Repair r Masonry SEP Permit# ❑ Demolition L Other: Bedrooms: Water Supply: Existing: Setback: i Private well C Two Party Type of Heat: Proposed: J Public Total: -- Name of System: If this is a Commercial Proiect 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: Underground Tank i Above ground Tank Size of Propane Tank: Heat Stove 1 Cook Stove i Woodstove Fireplace Insert 1 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 o, F Fb Main Floor Heated EH Bld App Review: s 0r•y.I 22 Floor Heated 1 i�' '". Consistency Review: Other Heated _ Base fee: I Od5 Mezzanine -- Additional Section: Heated Basement - Plan Check fee: Ili . i Unheated Basement r-- State Surcharge fee:• • Other Unheated Pot Water Review fee: .-L} Garage/Carport SUBTOTAL Decks - i 911/Rd Approach fee: Other TOTAL: $(03.8c • Receipt Number: I2Q yj Cash/Check Number: to ,—, ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish I ?3.)/. c'c'' Initials: G:\PcmvtCcntcr\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc • Conden Lane co 0 0 C r CD N � N (D r 0 n O