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HomeMy WebLinkAboutBLD2012-00035 • • 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 #: BLD11-00035 Received Date 2/15/2011 SITE ADDRESS: 1380 SCHWARTZ RD Issue Date NORDLAND, 98358 2/15/2011 APPLICANT: GRETCHEN KAISER PO BOX 223 PHONE: NORDLAND WA 98358-0223 SUBDIVISION: 2 Block: Lot: PARCEL NUMBER: 021212004 Section: 21 Township: 30N Range: 01 E CONTRACTOR: QUALITY HEATING &A/C 9960 SILVERDALE WAY PHONE STE 14 SILVERDALE WA 98383 Contractor's License QUALIHA016JH Expires 12/30/2011 OWNER, GRETCHEN KAISER PHONE if different: PO BOX 223 NORDLAND WA 98358-0223 PROJECT DESCRIPTION: 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 2/15/2012. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: ((--- 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 ItILDING PERMIT APPLICA1N BLD11-00035 Jefferson County Department of Community Development Review Type: 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD11-00035 Received Date: 2/15/2011 SITE ADDRESS: 1380 SCHWARTZ RD NORDLAND, 98358 OWNER: GRETCHEN KAISER PO BOX 223 PHONE: NORDLAND WA 98358-0223 SUBDIVISION: Block: Lot: 2 PARCEL NUMBER: 021212004 Section: 21 Township: 30 N Range: 01 E CONTRACTOR: QUALITY HEATING &A/C 9960 SILVERDALE WAY PHONE: STE 14 SILVERDALE WA 98383 Contractor's License QUALIHA016JH Expires 12/30/2011 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP HEAT PUMP TYPE OF WORK NON SQUARE FOOTAGE TYPE OF IMP MEC VALUATION 11,984.00 MAIN: CODE EDITION: 2009 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 $209.25 LYK 02/15/11 123212 Plan Check $136.01 LYK 02/15/11 123212 State Building Code $4.50 LYK 02/15/11 123212 Total: $349.76 �4 gON C, • �4 0 JEFRSOOUTY ` ,J DEPARTFEMENTN OF COMMUNITY DEVELOPMENT �4 621 Sheridan StreetC •NPort Townsend • Washington 98368 360/379-4450 360/379-4451 Fax gS, NG,SO www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Nn MC lL Proj ct Description(include separate sheets as necessary): QQ �t- n-ip" Tax Parcel Number:102 1 2 fl 2 CI 0 L/ Property Size: (acres/ square square feet) Site Address and/or Directions to Property: 13 670 Sci-% LA)a.,r}Z R NI o rc1 I j-CL6fA. FIa9lee Rd- - Tvrr, Rz./11.1 al ScL,A,a,/Z - /so.,, y e 3 a n /�i��f S/as tt' v i`.eo a Property Owner(s)of Record:, 6r C'"k-CLB in t<cu sc tr Telephone: Fax: email: Mailing Address: PO Box. 1,2 3 Applicant/Agent(if different from owner): Q U0.(i{ H cod t' y "`J n...SAC" CondL�tontrt,__��_.-_.Telephone: 4 0 6 13 SG I Y Fax: 3Co 6 y 92 4 -f- email:Sc.,€�]e �y<.J i41.���,/l�y,r oa, Mailing Address:q c G 0 S, rare cad lte ta„� # t / ' Si /verda/4. 4414 ?a sh•3 7ff What kind of Permit?(Check each box that applies J28ullding ❑ Critical Areas Stewardship Plan LI Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) el Single Family ❑ Garage Attached/Detached ❑Conditional Use(C(a), C(d),or Cl** ❑ Manufactured Home 0 Modular 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* 0 Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment ❑ Address O Road Approach ❑Short Plat** ❑ Home Business 0 Cottage industry 0 Binding Site Plan** ❑Propane 0 Long Plat** ❑Sign ❑ Planned Rural Residential Development(PRRD)/Amendments"" ❑Allowed"Yes"Use Consistency Analysis ❑ Plat Vacation/Alteration** ❑ Stormwater Management ❑ 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 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: —__- • DESIGNATIkQO_AG_ENT : hereby designate QUel t y I';e� �yw _ to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE • •..date: /Y/ 2 e7/ it 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. F I further agree to save,indemnify and hold harmless Jefferson County aga II 4 i,fS•,tCbU+t costs,reasonable attorneys 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 access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applicatio that he or she want p for notice ` Signature. / / 9 � �C(/�-�'�l Date: �[/ - -2 // 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-transferable r sponsibility for d �eringto and complying with the ESA. The Applicant has read this di clai errand signs and dates it below. Signature'{ ` Date: . d/ 2 0 // r;,permitcenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.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: Qualify 11-ecti1rwl at.eP Air co+►ott<4. 0Alin (36d 60,s-a/y (360)69,2- 7ers-e MAILING ADDRESS: 9 aG o S;I v erdr..1� t,.)O..y it /Y EMAIL: CONTRACTOR'S LICENSE s; 1 V er Q. e HJ A RB 3 rJ WAINS NUMBER. Q UAC I NUMBER b�/}D16-T1 ARCHITECT/ENGINEER: PHONE ( ) FAX ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New ood Existin Sewer ' g: - Addition ;_I Steel Proposed: Bank 11 Community System Alteration/Remodel LI Concrete Total: Height: ❑ Individual System Repair Clare 0 C Masonry SEP Permit# . : Demolition 14 erj 1)41p C Other: Bedrooms: Water Supply: Existing: Setback: •I Private well Two Party Type of HeA Ptoposed. Public 114 veYli0 Total Name of System: If this is a Commercial Protect 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: 1 Underground Tank I Above ground Tank Size of Propane Tank: 1 Heat Stove 1 Cook Stove 1 Woodstove 1 Fireplace Insert 1 Hot Water Tank 1 Pellet Stove 1 Other Very,'st Ea Is this appliance being installed in a Manufactured I Mobile Home? Yes /©° H e J Pv ,0 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 Fot,Off s� Zjnly H, ', Amount f evlslon .(• Main Floor Heated a tv 4t 'R "� I,,, 0 EH Bld App Review: tt fi i 2n0 Floor Heated ft: . k Consistency Review: Other Heated "gi - ; ti Base fee: 8oq. a5 Mezzanine - . Additional Section: Heated Basement : Plan Check fee: Unheated Basement , 1K. Imo. ° 1 � 4 , � State Surcharge fee: /, Other Unheated K,, Pot Water Review fee: kK . Garage/Carport t �� •f SUBTOTAL Decks A t 911/Rd Approach fee: ri, Other C hoonl a Ov+ El TOTAL: $ .3_1 ! I(, P1 t/✓ r"-. Receipt Number: /9 fi''' Cash/Check Number: 1° 653 ESTIMATED COST(REQUIRED) Date: rI' l •Farr market value of all labor and materials foundation to finish I11-4 8 3, s Initials: t G'\YcmutC.enter\ti##FORtvtS###\1DRD FORMS\Master l'ennit Application 5-29 08.doc it;tl