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Home My WebLink AboutBLD2011-00064 • . 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 #: BLD11-00064 Received Date 3/21/2011 SITE ADDRESS: 61 HILLER DR Issue Date 3/21/2011 PORT HADLOCK, 98339 APPLICANT: TERI M PROCTOR PHONE: 206-818-2182 4545 334TH CT SE FALL CITY WA 98024-8100 SUBDIVISION: HILLERS WF TR INC TL Block: Lot: PARCEL NUMBER: 960300009 Section: 7 Township: 29N Range: 01 E CONTRACTOR: WASHINGTON ENERGY SERVICES CO PHONE: 206-282-4700 2800 THORNDYKE AVE W SEATTLE WA 98199 Contractor's License WASHIES971 OB Expires 9/2/2011 OWNER, TERI M PROCTOR PHONE: 206-818-2182 if different 4545 334TH CT SE FALL CITY WA 98024-8100 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 3/21/2012. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: — - I L 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 tILDING PERMIT APPLICA•N BLRD1e 00064 w Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD11-00064 Received Date: 3/21/2011 SITE ADDRESS: 61 HILLER DR PORT HADLOCK, 98339 OWNER: TERI M PROCTOR PHONE: 206-818-2182 4545 334TH CT SE FALL CITY WA 98024-8100 HILLERS WF TR INC TL SUBDIVISION: Block: Lot: PARCEL NUMBER: 960300009 Section: 7 Township: 29 N Range: 01 E CONTRACTOR: WASHINGTON ENERGY SERVICES CO PHONE: 206-282-4700 2800 THORNDYKE AVE W SEATTLE WA 98199 Contractor's License WASHIES971OB Expires 9/2/2011 REPRESENTATIVE: NW PERMIT INC PHONE: (360) 945-2787 1345 GULF RD (360) 945-2091 POINT ROBERTS WA 98281 PROJECT DESCRIPTIOr NEW HEAT PUMP TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION 4,422.00 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 $111.25 LYK 03/21/11 123314 Plan Check $72.31 LYK 03/21/11 123314 State Building Code $4.50 LYK 03/21/11 123314 Total: $188.06 ¢sox co �� , JEFFERSON COUNTY W ' \ \ 'j DEPARTMENT OF COMMUNITY DEVELOPMENT `I I 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax ' gip-' www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: 00 r Uj-\ e '. Project Description(include separate sheets as necessary): INSTALL 2 1 TON DAIKIN HEAT PUMP UNITS(MINI SPLIT SYSTEM) Tax Parcel 960300009 Property Number: Size: (acres/square feet) Site Address and/or Directions to Property: 61 HILLER DR, PORT HADLOCK 98339 Property Owner(s)of Record: RANDY&TERI PROCTOR Telephone:206-818-2182 Fax: email: Mailing Address: 61 HILLER DR,PORT HADLOCK 98339 Applicant/Agent(if different from owner): NORTHWEST PERMIT INC. Telephone: 360-945-2787 Fax: 360-945-2091 ernaii...NAIDA@NWPERMIT.COM Mailing Address: 1345 GULF RD,POINT ROBERTS WA 98281 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]""' ❑ Single Family ❑Garage Attached/Detached ❑ Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home ❑ Modular ❑Special Use(Essential Public Facilities)** ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use ❑Short Plat** ❑ Address ❑ Road Approach ❑Binding Site Plan** ❑ Home Business ❑ Cottagelndustry ❑ Long Plat** ❑ Propane ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑Sign ❑ Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisions** ❑Stormwater Management ❑Shoreline Management Substantial Development** ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Variance ❑Temporary Use ❑Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium ❑Tree Vegetaion Request *May require a Pre-Application Conference **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 NORTHWEST PERMIT INC.♦ to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE�`1"1'-- /,rLt `-'�'gU Date: r l 111 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 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 access and right of entry will be assumed unless the applicant informs the County in writing at the time of the application that he orshe wants prior notice. 3 Signature: , -/c�1'` ` 4-1.�� Date: /i 5/1 i 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 responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature-- -' —L - ,A,t LI.e s1J Date: 3/i �— I r C:\Documents and Settings\caral\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.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: WASHINGTON ENERGY SERVICES ( 800)398-4663 ( ) MAILING ADDRESS: 2800 THORNDYKE AVE W SEATTLE 98199 EMAIL: 2800 THORNDYKE AVE W SEATTLE 98199 CONTRACTOR'S LICENSE WAINS NUMBER: WASHIES971 OB NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New - Wood Existing: - Sewer - Addition - Steel Proposed: Bank Community System J 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 ELEC HEAT PUMP 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: ❑Underground Tank ei Above ground Tank Size of Propane Tank: ❑Heat Stove 0 Cook Stove 0 Woodstove ❑ Fireplace Insert 0 Hot Water Tank ❑Pellet Stove 0 Other Is this appliance being installed in a Manufactured I Mobile Home? Yes / N,6 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: 2"0 Floor Heated Consistency Review: Other Heated Base fee: II ( Mezzanine Additional Section: Heated Basement Plan Check fee: •� 3I Unheated Basement State Surcharge fee: c,( Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $ I .00 Receipt Number: ( a.5-1 Cash/Check Number: ESTIMATED COST(REQUIRED) . Date: Fair market value of all labor and materials foundation to finish .- - I I Liaq � Initials: L.. C:\Documents and Settings\caral\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.doc • 41. Property Owners Name: 1r,' �lv6%o/^ Assessor's parcel Site Address: 6/ Site Plan North (A) el Legend: property line Building perimeter 7-� Map Seale:1"(in)=20'(ft) } 1 ( 74 t I) t r Ta-A,