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Home My WebLink AboutBLD2011-00144 111/ • 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 #: BLD11-00144 Received Date 6/9/2011 SITE ADDRESS: 121 MARINA VIEW DRIVE Issue Date 6/9/2011 PORT LUDLOW, 98365 APPLICANT: LUDLOW MAINTENANCE COMM PHONE: 360-437-9201 PO BOX 65060 PORT LUDLOW WA 983650060 TX 5+ SUBDIVISION: Block: Lot: PARCEL NUMBER: 821162004 Section: 16 Township: 28N Range: 01E 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, LUDLOW MAINTENANCE COMM PHONE: 360-437-9201 if different: PO BOX 65060 PORT LUDLOW WA 983650060 PROJECT DESCRIPTION: REPLACE 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 6/9/2012. 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_Perm it_Propa ne.rpt 10/29/19 PILDING PERMIT APPLICATI BLD1 Review Type:Review Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD11-00144 Received Date: 6/9/2011 SITE ADDRESS: 121 MARINA VIEW DRIVE PORT LUDLOW, 98365 OWNER: LUDLOW MAINTENANCE COMM PHONE: 360-437-9201 PO BOX 65060 PORT LUDLOW WA 983650060 SUBDIVISION: Block: Lot: TX 5+ PARCEL NUMBER: 821162004 Section: 16 Township: 28 N Range: 01 E 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 REPLACE HEAT PUMP TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: TYPE OF IMP MEC MAIN: INDUSTRIAL: VALUATION 4,850.00 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: NUMBER OF EMPLOYEES: WATER SYSTEM: BATHROOMS: Exist: Prop: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $111.25 LYK 06/09/11 123574 Plan Check $72.31 LYK 06/09/11 123574 State Building Code $4.50 LYK 06/09/11 123574 Total: $188.06 ON I • 4 COS, JEFFERSONfOUNTY k ` DEPARTMENT OF COMMUNITY DEVELOPMENT il621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax '$��NasO� www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: tO oqua e E ' 66 Pr Q ct De cription(inclu a separate sheets as necessary): ' r ,_ Ct.) g YY\A) ‘ L.._ \/z • c Lk-\2.t. Tax Parcel Number. �5, )( � � Property Size: (acres/square feet) ( q Site Address and/or Directions to Property: l a\ Y(\1 �\y\ . \} \- .0 Property ner(s)of Record: �(YVitJ�yR '��C Q ,`tlf�a� Telephoner_ C t 'k Fax: email: Mailing Address: Applicant) ent(if different from owner): Telephone • _ Fax: - email: !'� Mailing Address: ' `� What kind of Permit?(Check each box that applies ❑Building 0 Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor, Major or Reasona 5Ie Economic Use ❑Single Family ❑Garage Attached/Detached ❑ Conditional Use[C(a),C(t , ❑ Manufactured Home 0 Modular 0 Discretionary"D"or Unna• �1 �ti . 'Commercial* ❑Special Use(Essential, I ❑ Change of Use ❑Boundary Line Adjus ❑ Address 0 Road Approach 0 Short Plat** 1 ❑Home Business 0 Cottage Industry 0 Binding Site Plan** JUN - 9 2011 ❑Propane ❑Long Plat'* ❑Sign ❑ Planned Rural Resid I velopment PRR ents ❑Allowed"Yes'Use Consistency Analysis 0 Plat Vacation/Alterati ** JEFFERSON COUNTY ❑Stormwater Management 0 Shoreline Master Program Etx l t(tiem !il ❑Site Plan Approval Advance Determination(SPAAD)' 0 Shoreline Management Subaidtrtidl 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 ❑Tree Vegetation Request **Requires a Pre-Application Co iference Please identify any other local,state or federal permits required for this proposal, if known: DESIGNATION OF AGENT I hereby designateit46 '�u�_`') Vto act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE . Date: 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 res xect 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 fcr 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 orspe wants prior notice. Signature: Y i'a,_ --- --•---__:. , p)- I 1 Date: 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 thathe,she or it holds individual and non-transferable resp ility for adherin to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: 4 .-.--- ^-- --�� " , i, Date: k G:\PeunitCenteI\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc 1 • . 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: ENERAL CONTRACTOR O MA UFACTURED HOME INSTALLER: 'PHON`E-: `� FAX: HO lr t"Y\VNLLXI Y� �l� % fj )- MAILING ADDRESS: Lk(�,�,k S k 34. \ V L EMAIL: CONTRACTOR'S LICENSE Q `(,� (� ` {� �'� WAINS NUMBER: .1�{C.Y\.V\��O_k t �.-=1 NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: E Sewer O Addition ❑ Steel Proposed: Bank C Community System ❑ Alteration/Remodel 0 Concrete Total: Height: C Individual System ❑ Repair 0 Masonry `EP Permit# O molition 0 Other: Bedrooms: Water Supply:.4'\& _ Existing: Setback: Private well ❑ Two Party Tyelof Fie at: Proposed: C Public �r �r r 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 1 Above ground Tank Size of Propane Tank: 1 Heat Stove i Cook Stove i Woodstove T Fireplace Insert i Hot Water Tank I 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 al,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 ,� `� w , ti g gat ' '5 ; Main Floor Heated �_ . EH Bid App Review: r 2na Floor Heated 4t C• onsistency Review: Other Heated Yi� r B• ase fee: Mezzanine4; Additional Section: 1.tea.. �„� JF': R y.. /leStBu Daoenibi�i i rfi Plan i:i eC1C fee: .' Unheated Basement ` ' ` State Surcharg fe ee: 3 0 �: Other Unheated , �.� Wat R therew f Garage/Carport `k SUBTOT _ == -- 9 2011 Decks *:AO a �',.. 1s.1 ; 911/Rd Approacrl f 10 Other ',tfw i 7,, 4 {RSON COUNTY TOTAL $ j r k -1' tlktflityrtur r�^-.r l�� l `` ' `ij Receipt Number. 37i4 ' s� Cash/Check Number n2 J /3 ESTIMATED COST(REQUIRED) Date: .Fair marks value of all labor and materials foundation to finish _ ( 1 Initials: • — G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc May 27 2011 8: 08RM HP •ERJET FAX p. 1 L pL0c..3 (N\ R , �JC Miv1/4 ‘SS 10c \ c� ��A v L I bZ L OE_ per,.-c �.L.) c.,L) Ca 9 36 5 ��. porgi [IVE Zor3 F! JUN - 9 2011 I . JEFFERSON COUNTY DEPT.OF COMMUNITY DEVELOPMENT •T