HomeMy WebLinkAboutBLD2011-00096 •
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 #: BLD11-00096 Received Date 4/25/2011
SITE ADDRESS: 40 LAND'S END LN Issue Date 4/25/2011
PORT TOWNSEND, 98368
APPLICANT: PETER H ALBRECHT PHONE: 360-531-0393
MARY LYNN ANDERSON
PO BOX 1026
PORT TOWNSEND WA 98368-0010 TX 10
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 101333007 Section: 33 Township: 31N Range: 01W
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, PETER H ALBRECHT PHONE: 360-531-0393
if different: MARY LYNN ANDERSON
PO BOX 1026
PORT TOWNSEND WA 98368-0010
PROJECT DESCRIPTION: NEW ELECTRIC BOILER
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 4/25/2012.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: 4" `-' L(, flE)
FinalApproval: .' J
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 APPLICA BLD11-00096
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD11-00096 Received Date: 4/25/2011
SITE ADDRESS: 40 LAND'S END LN
PORT TOWNSEND, 98368
OWNER: PETER H ALBRECHT PHONE: 360-531-0393
MARY LYNN ANDERSON
PO BOX 1026
PORT TOWNSEND WA 98368-0010
SUBDIVISION: Block: Lot: TX 10
PARCEL NUMBER: 101333007 Section: 33 Township: 31 N Range: 01 W
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
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP NEW ELECTRIC BOILER
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP MEC MAIN:
VALUATION 6,170.00 ADD'L: HEAT TYPE
CODE EDITION. 2009 HEAT BASE: HEAT TYPE:
OCCUPANCY:
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total:
Routing Date:
Type Amount Paid Bv: Date: Receipt: Approved/Date
Permit $139.25 LYK 04/25/11 123428
Plan Check $90.51 LYK 04/25/11 123428
State Building Code $4.50 LYK 04/25/11 123428
Total: $234.26
/4�,g0N c o, JEFFERSOPOUNTY v'
4karpoei DEPARTMENT OF COMMUNITY DEVELOPMENT E C� E 0 V 2
621 Sheridan Street• Port Townsend •Washington 98368 U 360/379-4450 • 360/379-4451 Fax
�' www.co.jefferson.wa.us/commdevelopment APR 2 2 2011
s8nva`s°
Master Permit Application MLA:
Project Description(include separate sheets as necessary): \,R ll E1� L \ l bINVA _CePUNITY DEVEIOPMEN-
Tax Parcel Number: ,(',I �_3T 57 Property Size: (acres/square feet)
Site Address and/or Directions to Property:
LA \ 0, v\s),_',) ,...:E v-vi. \r-N Coc-Nc --\-osoy\ i-c .
Property Owner(s)of Record: P
Telephone:' ,0 C) •53\ • Q3Q` Fax: email:
Mailing Address:
Applicant/A ent(if different from owner): �(kiv\AA V\
Telephone Dko eQ q y o O Fax:TGC b Jt O-A- 5 email: YY\.:t-2(Z\pc(,vuv....i,,,rl
Mailing Address: Li to 0 t 5 \'-Lq--Vh ?L_ A- \-e.- W & Q R IG., 1...c.c.--�i yvk L-orv,
What kind of Permit?(Check each box that applies
❑Building ❑Critical Areas Stewardship Plan
El Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use)
'Single Family 0 Garage Attached/Detached ❑ Conditional Use[C(a), C(d),or Cj**
❑ Manufactured Home 0 Modular 0 Discretionary"D"or Unnamed Use Classification
❑ Commercial* ❑Special Use(Essential Public Facilities)**
❑ Change of Use 0 Boundary Line Adjustment
❑ Address 0 Road Approach 0 Short Plat**
❑Home Business 0 Cottage Industry 0 Binding Site Plan**
❑ Propane 0 Long Plat**
❑Sign 0 Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes'Use Consistency Analysis 0 Plat Vacation/Alteration**
0 Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions**
❑Site Plan Approval Advance Determination (SPAAD)* ❑Shoreline Management Substantial Development"
❑Temporary Use 0 Shoreline Management ariance -_
❑Wireless Telecommunication* ❑Comprehensive Pla yp nd Use District Map Amen t
❑Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shr rie Oaster Program Amendme
*May require a Pre-Application Conference 0 Tree Vegetation Req eskc ,
**Requires a Pre+ApOicationrConference 2011
Please identify any other local,state or federal permits required for this pr se, if known:
1__
DESIGNATION OF AGENT JEFT777701377
I hereby designate to act as my agent in matte aiSENEUIROVOil fa'ptshirrit(s).-1
OWNER SIGNATURE •.J f..i lc3'.a-tia..-‘--------- t ^..,...
By signing this application form,the owner/agent attests that the information hrovr_c t 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 tnaren l 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 or she wants prior notice.
Signature:_ — . r•i G•u '' -_- Date: `/ - / /' 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 it 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: .� .`:---- i-f e c ---------- /
Date: --/- i/- //
G:\PezrnitCenter\#k`#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:
?. i.t,v\-}r\C1/4.,CN Ni dq`3 'qoo (scab q 0-1- -'
MAILING ADDRESS: L Q O` \r-b�a,r EMAIL:JQ,VM.1-c_.C. brt_.vnN\A• N.VV a a.--;yVk co m
CONTRACTOR'S LICENSE (� -A Q c WAINS
NUMBER: ��� � ►�` NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
Li New ❑ Wood Existing: r7 Sewer
❑ Addition [1 Steel Proposed: Bank U Community System
,I Alteration/Remodel ❑ Concrete Total: Height: C Individual System
• Repair 0 Masonry SEP Permit#
❑ Demolition 0 Other: Bedrooms: Water Supply:
Existing: Setback: Private weii ❑ Two Party
Type.of Heat: Proposed: :: Public
ID I I 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:
I Underground Tank I Above groundTatik -Size of Propane Tank:
I Heat Stove I Cook Stove f`aV Love, [ i � /_ A Hot Water Tank I Pellet Stove I Other
Is this appliance being installed Ina Manufactured I Mobi e? Yes / No
When applying for a perm�t tY4istall a propane tank you i s !so submit a site plan showing all of the buildings,all property
lines,tank location and si#e,i stances from thepropane - k o'all property lines,buildings and septic system components,
including the reserve area II ` 1 '` t I a��
�l u b'u "`.Ih i :�y C�� n�i'4aE 'b i�if4dwt na-@� < _.iY:4 i
Square Footage Current :. , Ar" <i•E- ? I 'y, 4,i4 �. z = �. `
q g • s s w{r� ,,,>s . a .,, m 1.,,•' ,•Y1-1'1 ,. ,4441t<,gt 1•' 3"u. :1
Main Floor Heated j °ON 64i {-�t �,�C ' EH Bld App Review
,__ DFI'T OF COMM' N?, i?:• ,:
2"0 Floor Heated ` k
,,�,�, Consistency Review:
Other Heated '. r td
`z t � ��'� Base fee: may.,
Mezzanine -" Additional Section:
,
Heated Basement It Plan Check fee: C
CI .5c
Unheated Basement State Surcharge fee:
4- 50
„.
ti
Other Unheated : - s_'4,,.:;, Pot Water Review fee:
Garage/Carport Ri ;' a SUBTOTAL
Decks ' t, t r
3 ` ; 911/Rd Approach fee:
Other Ni,r�� � TOTAL: $, 33-' oir
141 = Receipt Number:
P te.e,.1`;'-, ,1 Cash/Check Number:
ii-ESTIMATED COST(REQUIRED) Date:
•Fa' market value of all labor and materials foundation to finish
Ul D Initials:
t
G:\Permitanter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
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J V �oJEFFERSON COUNTY
DEPT.OF COMMUNITY DEVELOPMENT
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