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HomeMy WebLinkAboutBlD2011-00165 • • 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 #: BLD11-00165 Received Date 6/23/2011 SITE ADDRESS: 101 WINDROSE DR Issue Date 6/23/2011 PORT LUDLOW, 98365 APPLICANT: JEFFREY G RUDD PHONE: 206-227-7806 COLLEEN M RUDD 101 WINDROSE DR PORT LUDLOW WA 98365-9552 26 SUBDIVISION: BAYVIEW VILLAGE DIV 1 Block: Lot: PARCEL NUMBER: 931900026 Section: 16 Township: 28N 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 OWNER, JEFFREY G RUDD PHONE: 206-227-7806 if different: COLLEEN M RUDD 101 WINDROSE DR PORT LUDLOW WA 98365-9552 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 6/23/2012. REQUIRED INSPECTIONS: Tank/Line/Appliance: /7 " 1' - ckC c.e_DJ' /o/2S`� 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 • S D, ► p up L`c JUN 2 3 2011 L JEFFERSON COUNTY DEPT.OF COMMUNITY DEVELOPMENT 124(012,4141.e (( LA c) 64t C,-Pk,ik A E L RILDING PERMIT APPLICATS B Review 0165 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD11-00165 Received Date: 6/23/2011 SITE ADDRESS: 101 WINDROSE DR PORT LUDLOW, 98365 OWNER: JEFFREY G RUDD PHONE: 206-227-7806 COLLEEN M RUDD 101 WINDROSE DR PORT LUDLOW WA 98365-9552 BAYVIEW VILLAGE DIV 1 SUBDIVISION: Block: Lot: 26 PARCEL NUMBER: 931900026 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 BRENNHA971 R9 Expires 12/29/2011 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr NEW HEAT PUMP TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION 3,180.00 ADD'L: HEAT TYPE CODE EDITION: 2009 OCCUPANCY: HEAT BASE: HEAT TYPE: 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 By: Date: Receipt: Approved/Date Permit $97.25 LYK 06/23/11 123638 Plan Check $63.21 LYK 06/23/11 123638 State Building Code $4.50 LYK 06/23/11 123638 Total: $164.96 di GA q ON Co t 4i 6. JEFFERSON COUNTY ` DEPARTMENT OF COMMUNfTY fiV e 621 Sheridan Street• PortTpi C 9 1:1) i t. - .. 360/379-4450 • 360/379-`4 0 l ax �`�81N0�'p www.coJefferson.wa.us/co �@velopment I JUN 2 3 2011 Master Permit Application I lam: �� ©r Project D scripti n(inclu e sep ate sheets as necess ): JEFFERSON COUNTY ,� \ 0� DEPT.OF COMMUNITY DEVELOPMENT Tax Parcel Number: Property Size: (acres/square feet) Site Address and/or Directions to Property: \ :- \ \ \ V\A t G'' \ CC-.).('-� L.) c�\ ��v o_ (1 F J Property Owner(s)of Record: ��.'s\ �.L�•.Q Telephone:,'O o•r '- • T- *C T Fax: email: Mailing Address: �,.�._0 Applicant/A ent(if differenCt,from owner): AI ►_ !. _ fN-R Telephone: �ilc= �\c` �1 C� Fax: -a `.- C _ email: I rYlA-P_ �(�I(P 4'lX a�l Mailing Address: Li ,. C- --, 1� \' ' 9 L. _`_-�Pn_ -C q. 21 (40P kfi_.&-4'`1 mci_. (x What kind of Permit?(Check each box that applies ❑Building ❑ Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use) ,fa'Single Family 0 Garage Attached/Detached ❑Conditional Use[C(a),C(d),or C]*" ❑ Manufactured Home 0 Modular 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* 0 Special Use(Essential Public Facilities)** O Change of Use 0 Boundary Line Adjustment ❑ Address ❑ Road Approach 0 Short Plat** O Home Business 0 Cottage Industry ❑ Binding Site Plan** O Propane ❑Long Plat** ❑Sign 0 Planned Rural Residential Development(PRRD)/Amendments'"' ❑Allowed"Yes'Use Consistency Analysis 0 Plat Vacation/Alteration** ❑Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions** ❑Site Plan Approval Advance Determination (SPAAD)* 0 Shoreline Management Substantial Development** O Temporary Use 0 Shoreline Management Variance O Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendment ❑Forest Practices Act/Release of Six-Year Moratorium ❑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: ESIGNATION OF AGENT I hereby e inn to " to act as my agent in matters relating to this application for pennit(s). OWNER SIGNATURE %' Date: £l /6 /if/. / 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. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,Judgments,court costs,reasonable attomey'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 wan,prior notice. Signature: 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 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,si ns and dates it below. Signature: Date: L',' a t' !' G.\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: ENERAL CONTRACTOR OR ANUFACTURED HOME INSTALLER: PHONE: FAX: MAILING ADDRESS: 'C1 r:1. '� 1 i r': -� C. \t�f LANA(\AiY1 0'-t'\y..ct . CONTRAC OR S LICENSE 1 1`_'1V\4,C (+�Y� NUMBER:\i c tx...X� �, 10I NUMBER ARCHITECT/ENGINEER: I PHONE ( j i FAX:( ) MAILING ADDRESS: I J U N 2 EMAIul Project Type: Frame Type: {{{�oms: S ,S . , ine: Type of Sewage Disposal: ❑ New ❑ Wood Exis i it- — 0 Sewer ❑ Addition I I Steel Proposed: JEFFERSON COUNTY Bank i ❑ Community System Alteration/Remodel 0 Concrete _07111l6ta1MMUNITY DEVELOP''^keight: 0 Individual System ❑ Repair 0 Masonry SEP Permit# O Demolition 0 Other: Bedrooms: Water Supply: Fxisting: ____ __, Setback: ! Private well n Two Party Typei f Heat: Proposed: ❑ Public . -e C t( 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 ground Tank Size of Propane Tank: I Heat Stove I Cook Stove I Woodstove I Fireplace Insert I Hot Water Tank I Pellet Stove I Other Is this appliance being installed in a Manufactured/Mobile Home? Yes I No 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. S t 4 y f:: Si;. �� > A.• 14 : �� .ti r( t.. • i. . i, Square Footage Current Proposed Igoi ,„tt,s:id a..G 3, ;� x..,t .,hi.. " � rtw aJ: i� ,t ` s Main Floor Heated • ' :1 '� EH Bid App Review: 4 tip r« 2'Floor Heated ,, `t'I Consistency Review: el ri 5 Other Heated , ` R 1 pi; Base fee: }• r � . 4° ' "'-1` Additional Section:Mezzanine ,,e� 4" C)1 •Heated Basement i. ` Mor in Plan Check fee: Unheated Basement �, ,•-4 State Surcharge fee: 2-- 50 444 .Other Unheated tf �, ate' i Pot Water Review fee: t y. t tea= Garage/Carport a`a 'k' < SUBTOTAL Decks lint i„, 911/Rd Approach fee: t t F2 ;:Other i ,itr ii1 F IRiiFlr TOTAL: $ ��() I Q c ' ,, ' . Receipt Number: ' 2 /��3Vi '``4' ' " Cash/Check Number: pp — ESTIMATED COST(REQUIRED) Date:.Fair market value of all labor and materials foundation to finish l 1 Q 3- 4 Initials: -- . G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc