HomeMy WebLinkAboutBLD2011-00080 • t
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 #: BLD11-00080 Received Date 4/11/2011
SITE ADDRESS: 2071 DOSEWALLIPS RD Issue Date 4/11/2011
BRINNON, 98320
APPLICANT: KAREN WOOD PHONE: 360-796-4282
2071 DOSEWALLIPS RD
BRINNON WA 98320-9644
TX 4
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 602284006 Section: 28 Township: 26N Range: 02W
CONTRACTOR: BRENNAN HTG &A/C LLC PHONE: 206-248-7900
4601 S 134TH PL
SEATTLE WA 98168
Contractor's License BRENNHA971R9 Expires 12/29/2011
OWNER, KAREN WOOD PHONE: 360-796-4282
if different: 2071 DOSEWALLIPS RD
BRINNON WA 98320-9644
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 4/11/2012.
REQUIRED INSPECTIONS:
Tank/Line/Appliance:
FinalApproval: `i 17 II
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
GILDING PERMIT APPLICA N BL v
Reviewiew T Ty080
ype:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD11-00080 Received Date: 4/11/2011
SITE ADDRESS: 2071 DOSEWALLIPS RD
BRINNON, 98320
OWNER: KAREN WOOD PHONE: 360-796-4282
2071 DOSEWALLIPS RD
BRINNON WA 98320-9644
SUBDIVISION: Block: Lot: TX 4
PARCEL NUMBER: 602284006 Section: 28 Township: 26 N Range: 02 W
CONTRACTOR: BRENNAN HTG &NC LLC PHONE: 206-248-7900
4601 S 134TH PL
SEATTLE WA 98168
Contractor's License BRENNHA971R9 Expires 12/29/2011
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr NEW HEAT PUMP
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP MEC MAIN:
VALUATION 4,150.00 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 $111.25 LYK 04/11/11 123383
State Building Code $4.50 LYK 04/11/11 123383
Plan Check $72.31 LYK 04/11/11 123383
Total: $188.06
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Mar 28 2011 7: 30AM Westeattle Furnace 206 94/10735 p. l
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�V,gON CG JEFFERSON COUNTY
' + DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street• Port Townsend-Washington 98368
360/379-4450 - 360/379-4451 Fax
SIN www.co.jefferson.wa.us/commdevelopment
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Master Permit Application MLA: QC !� t
Iid\(ir de separat ets��s nece sary �
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Tax Parcel`Number. ( C 91r1CO' ` Property Size: (acres/square feet)
Site Address and/or Directions to Property:
Q U-4-- a.\\ Yir\ ,N)(Nz c q St6cQ C)
Property Oyzier(s)of Record:
��U Fax: email:
Telephone —
Mailing Address: -0,- `
Applicant! •:nt(if dci�fferent from owner): .► .► •'
' ak f a 1 V
Telephone'.. i • r�l l v C)b Fax*, 440 lit email: .C`*,Lk,t7 by{.f\Y•A-'(1
Mailing Address: \4 Q S `_ R L.. 0. -(_ 0-_. q ko tz3 v...4_0_4't rA.CAn
What kind of Permit?(Check each box that applies
❑Building 0 Critical Areas Stewardship Plan
O Demolition Permit O Variance(Minor,Major or Reasonable Economic Use)
`ingie Family 0 Garage Attached/Detached 0 Conditional Use[C(a),C(d),or C]"
❑ Manufactured Home 0 Modular 0 Discretionary'I)"or Unnamed Use Classification
❑ Commercial' 0 Special Use(Essential Public Facilties)"
O Change of Use 0 Boundary Line Adjustment
❑ Address 0 Road Approach 0 Short Plat"
O Home Business ❑Cottage industry 0 Binding Site Plan•'
❑Propane ❑Long Plat"
❑Sign 0 Planned Rural Residential Development(PRRD)/Amendments""
❑Allowed'Yes'Use Consistency Analysis 0 Plat Vacation/Alteration"
❑Stormweter Management 0 Shoreline Master Program Exemp-aNPe mit Revisions"
O She Plan Approval Advance Determination(SPAAD)" 0 Shoreline Management Substa cl Development"'
O Temporary Use 0 Shoreline Management Varfa 1) j.4i. •„' , j j(
❑Wireless Telecommunication' 0 Comprehensive PlarVUDC/Lan DtstncUMMs dht�tj�
0 Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment
'May require a Pre-Application Conference C1 Tree Vegetation Request
' Requires a Pre-Appilcation Conf> 1 1 2011
Please identify any other local,state or federal permits required for this proposal,If known: &U
DESIGNATION OF AGENT I[CE[[j�i( r-�(11�^i'pj (1�(1
I hereby designale2f-e.AN.ti\.l-'t'1 to act as my agent in matters relating tollhI of 6,fbtfielrtrit(); [I
`g���Jn ` �,yf/``-- , Da Lj1 - l t'.C" / (
OWNERSIGNATUREx+�/ 1Lv(f!I( �1�C �C
By signing this apptcatlon form,the owner/agent attests that the Information provided herein,and in any ettachmerrs.Is true and correct to the beat of
his,her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with r tspect 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, easonable attorneys fees and
expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting a 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 ineorms the County in writing at the
time of the app n he or she wants V or notice. / — 0
Signature G2k -i(_J _ U--tV—[t-a te . Dal / L / 1
The action or actions Applicant will undertake as a result of the Issuance of this permit may negatively impact upon one or mom 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 es the
`Endangered Species Act'or'ESA.'Jefferson County makes no assurances to the applcant that the actions that wll 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 hat he,she or it holds Individual
and non-t ra possibility f herIng to and complying with the ESA. The Applicant has read this dadar arrdsigns and dates it below.
Signature CJL<"t--• � Gt- L'&_/ Da1�: l- �f 0 11
G:\PcmitCente ttittiFORMS###\DRD FORMS\Muster Permit Applicaon ti 5-27-08.do< J�
Mar 28 2011 7: 30AM West/Wattle Furnace 206 930110735 p. 2
BUILDER STATEMENT
The signer
of
thisnln the hereby certify
re of the Gana they
eyC are the
Owners
the ofpr the pared cel
referenced herein,that they are rot licensed contractors and that
they will e
Data:
Signature:
- PHONE: FM: _
GENERAL CONTRACTOR OR NUFACTURED HOME INSTALLER: ,^�} �� n OO OW O�'
MAILING ADDRESS: ‘--\ka t'')\ S 13� L. IN�\lx, AINS
CONTRACTOR'S LICENSE'(�'C� \ Q \ "k NUMBER
NUMBER: �J PHONE ( ) FAX:( )
ARCHITECT/ENGINEER: Ewa
ON
MAILING ADDREss: Shoreline: T rpe of Sewage Disposal:
Project Type: ' Frame Type: Bathrooms: ❑Sewer
U New ❑ Wood Existing:
C Addition
0 Steel Proposed: Bank C.Community System
Total: Height O Individual System
Pr--AlteratbnlRemodel CI Concrete SEP Permit#
0 Repair 0 Masonry Bedrooms: Wiater Supply:
❑ Demolition O Other. Existing: Setback: il Private well 0 Two Party
Type of Heat: Proposed: Public
y Total: hmme of System:
if this Is a Commercial Protect you must answer the following; Number of�►DA Parking Spaces:
Number of Parking Spaces: Current: Proposed:
Number of occupants(includes owners,tenants, employees,etc) Current Propos4
IBC Occupancy: IBC Type of construction: Will you have Food Senvice? Yes 1 No
If thisis a e T nk a or II nee Installati n ermit mark all Ite a below a
•
I Underground Tank 1 Above ground Tank Size of Propane Tank:
i Heat Stove i Cook Stove i Woodstove I Fireplace Insert 1 Hot Water Tank I Pellet Stove Other
isjhis appliance being Installed in a Manufactured I Mobile Home? Yes 1'513a)
When applying fora permit to install a propane tank you must also submit a site plan showing a.1 of the buildings,all property
lines,tank location and size,distances from the propane tank to all property lines,buildings ant septic system components,
including the reserve area. Flr ,, , i 1; i ,t I:. ` :� tt , L ... C
S.,uare Footase Current Pr• •osed t= , 1:(i,,. Ma yr�: ' irANlr4 P'4 '. f..Nr t? , , s
Main Floor Heated f ;f,',"li, i' EH Bld App Review:
,i'n,wa 1�;,,"J.' t Consistency Review
2"P Floor Heated 1 ter, 4:
^►� `i s l I
Other Heated € ,, .,A, tit i. Base fee:
y(_ )
Mezzanre :e '^ w'@ Additional Section:
'. t,rt0'+ ,. far Plan Check fee: -7� 3I
Healed Basement 1t�, �x �. /
J
Unheated Basement '" ```i-TA Slate Surcharge fee: 4-7-7N
Other Unheated 1 .1;1) q Pot Water Review fee:
- 1,4 ., „;41,, SUBTOTAL
Garage/Carport r4VyP1.144.1.1.41, tx^;
Decks 1"st ° , 911/Rd Approach fee:
�• �� di:• c/v
Other '' .E ;.9 TOTAL: $ I '�`'�'
i r ax�: •-• Receipt Number: J ,
1'+-ri�Rr=" Cash/Check Number. , v -,
ESTIMATED COST(REQUIRED) 1l Date: ' _�
1
'Fair maiketva ofiaijabwand materials foundation to finish 1 initials:
G:\PennitCentrr\###FORMS####\DRD FORMS\Master Permit Appiicstion 5.29-08.doc