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Home My WebLink AboutBLD2011-00187 • 110 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 #: BLD11-00187 Received Date 7/18/2011 SITE ADDRESS: 850 MOUNTAIN TRAIL RD Issue Date 7/18/2011 BRINNON, 98320 APPLICANT: DIANE M HENRY PHONE: 253-925-5194 850 MOUNTAIN TRAIL RD BRINNON WA 983209515 76 SUBDIVISION: OLYMPIC CANAL ADDITION 7 Block: 14 Lot: PARCEL NUMBER: 981901416 Section: 16 Township: 25N Range: 02W CONTRACTOR: WASHINGTON ENERGY SERVICES CO PHONE: 206-282-4700 2800 THORNDYKE AVE W SEATTLE WA 98199 Contractor's License WASHIES9710B Expires 9/2/2011 OWNER, DIANE M HENRY PHONE: 253-925-5194 if different: 850 MOUNTAIN TRAIL RD BRINNON WA 983209515 PROJECT DESCRIPTION: DUCTLESS 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 7/18/2012. REQUIRED INSPECTIONS: Tank/Line/Appliance: i� 1/ 2//re, ti CCfl i f 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 ILDING PERMIT APPLICATJ B RD1e 00187 Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD11-00187 Received Date: 7/18/2011 SITE ADDRESS: 850 MOUNTAIN TRAIL RD BRINNON, 98320 OWNER: DIANE M HENRY PHONE: 253-925-5194 850 MOUNTAIN TRAIL RD BRINNON WA 983209515 OLYMPIC CANAL ADDITION 7 SUBDIVISION: Block: 14 Lot: 76 PARCEL NUMBER: 981901416 Section: 16 Township: 25 N Range: 02 W 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: PHONE: PROJECT DESCRIPTION DUCTLESS HEAT PUMP TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC VALUATION MAIN: CODE EDITION: 2009 ADD'L: HEAT TYPE: 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 $195.25 RAC 07/18/11 127911 Plan Check $126.91 RAC 07/18/11 127911 State Building Code $4.50 RAC 07/18/11 127911 Total: $326.66 0 JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT I' ' '� 621 Sheridan S ett- E!lu t wrLS�lt V ytQn 98368 360/379-4450 • 300 3 5 F� -1 1 � p www.co.jefferso . v its-to Master Permit Application �� 1 8 2011 MLA: t;C, O--y_p Crc r N Project Description(include separate sheets as 6icessary): —1 INSTALL 1 DAIKIN HEAT PUMP MINI SPLIT SYSTEM JEFFERSON COUNTY Tax Parcel _ DEPT.OF COMMUNITY DEVELOPI)rZT y_ Number: 981901416 Size: (acres/square feet) Site Address and/or Directions to Property: 850 MOUNTAIN TRAIL RD, BRINNON 98320 Property Owner(s)of Record: DIANE HENRY Telephone:360-796-2074 Fax: email: Mailing Address: 850 MOUNTAIN TRAIL RD,BRINNON 98320 Applicant/Agent(if different from owner): NORTHWEST PERMIT INC. Telephone: 360-945-2787 Fax: 360-945-2091 email: 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* ❑ 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 RTHwEST PERMIT INC. to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE ‘ Date: c 1�� By signing this application form,the owner/agent attests that the in or ation 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 applicat hat he qr she wants r' r notice. Signature: Date: lP The action or actions Appli ant will undertake as a result of the issu e 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-transfer responsibility for adheri to and complying with the ESA. The Applicant has read this disclaimer nd signs and dates it below. Signature: Date: tf' ac6 \ 1' C:\Documents and Settings\caral\Local Settings\Temporary Internet Files\0LK86\Master Permit Application 12-19-2006.doc • III 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 C( .,TRACTO1R OR MANUFACTURED HOME INSTALLER: PHONE: FAX: MAILING ADDRESS: EMAIL: CONTRACTORS LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: ❑ Sewer ❑ Addition 0 Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System O Repair ❑ Masonry SEP Permit# O Demolition 0 Other: Bedrooms: Water Supply: Existing: -- ell CI Two Party Type of Heat: Proposed: �� V Total: : IllNarre otfystem:- If this is a Commercial Project you must answer the following: t 1, j I I I 1 )it Number of Parking Spaces: Current: Proposed: Number of ADA Parkirgaces: Number of occupants(includes owners,tenants,employees,etc) Curren L Prnrpserl IBC Occupancy: IBC Type of construction: ''''I rJ Q %ervice? Yes / No If this is a Propane Tank and/or Appliance Installation permit,mark all itemsf F Q l(?PP'4E�R i Underground Tank I Above ground Tank Size of Propane Tank: i Heat Stove I Cook Stove I Woodstove I Fireplace Insert 1 Hot Water Tank 1 Pellet Stove 1 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 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 '- [ ffice U ..° .*ix,.,. . , . .< ...,. A 1 ialtatt-'401-400 Main Floor Heated 'A-t ,., EH Bld App Review: . 2"Floor Heated #,. x , Consistency Review: Other Heated Base fee: . Mezzanine ' • Additional Section: xtk •Heated Basement ° „ > Plan Check fee: , 7 t Unheated Basement State Surcharge fee: Jr - t ' Other Unheated• t ' Pot Water Review fee: Garage/Carport SUBTOTAL Decks kYg 911/Rd Approach fee: Other TOTAL: $ 3?e . (Pk, tz: - x Receipt Number: I Dig ( ` , Cash/Check Number: ESTIMATED COST(REQUIRED) Date: -7 S ,I I .Fair market valuer� of all labor and materials foundation to finish L_-1 1�J 1 (D Initials: \lutlti,-o,1C444.1+\r Dr\vnoasc\r-...✓.._.1-111T\1 ..Y_\r.r n____• a__c__.:__e.nn nn_1__ p:N�• p( N )2 y GAS,INSTALLATION.SKETCH -. . . _ +• Sso M-crJ "'RAIj. AMdiss.. s, : Rap. 1. s . KOj ciND02 5.1..oc,K tNDc,b l2 • . ) cRAw4 lr"ww pow k) 1 A Aces SLSµ-�.tN j'lj GRAIL Q G+ GIL ' L •._{, .. ) -----__...,1 ) I „ow. , oz.,),,i : �Gcri/Z O ,N --_ , .. _ ( , 4, 1 I ., . . • . EcovE . • \o . .. . . \, . . Jul_ 1 8 2011 \-.) . . .. i JEFFERSON COUNTY DEPT.OF COMMUNITY DEVELOPMENT • • Property Owners Name: //ENR y Assessor's parcel yg i Ro I'-t 1 Co Site Address: Pso /ric7 Site Plan North Legend: property line Building perimeter Map Scale.1"(in)=20'(f) V` O �s' y`` z 24, pliirp r6 to7 � � C ouN T/.�fN ?R.AtL tZo ! +. . t 1 8 2011 JEFFERSON COUNTY DFPT.-OF_COMMUNITY..DEVELOPMENT