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Home My WebLink AboutBLD2011-00245 • 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 #: BLD11-00245 Received Date 9/7/2011 SITE ADDRESS: 51 W LUDLOW POINT RD Issue Date 9/7/2011 PORT LUDLOW, 98365 APPLICANT: LOUIS SILVERSTEIN PHONE: 360-437-0489 51 W LUDLOW POINT RD PORT LUDLOW WA 98365-8786 27 SUBDIVISION: LUDLOW POINT VILLAGE DIV 1 Block: Lot: PARCEL NUMBER: 969400027 Section: 17 Township: 28N Range: 01 E CONTRACTOR: FAST WATER HEATER COMPANY PHONE: 425-636-7054 12601 132ND AVE NE KI RKLAN D WA 98034 Contractor's License FASTWWH948BC Expires 1/4/2012 OWNER, LOUIS SILVERSTEIN PHONE: 360-437-0489 if different: 51 W LUDLOW POINT RD PORT LUDLOW WA 98365-8786 PROJECT DESCRIPTION: REPLACE ELECTRIC WATER HEATER 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 9/7/2012. REQUIRED INSPECTIONS: Tank/Line/Appliance: / / /67— FinalApproval: 0/ 1/ ICE/ r? 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 • • BLD11-00245 BUILDING PERMIT APPLICATION Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD11-00245 Received Date: 9/7/2011 SITE ADDRESS: 51 W LUDLOW POINT RD PORT LUDLOW, 98365 OWNER: LOUIS SILVERSTEIN PHONE: 360-437-0489 51 W LUDLOW POINT RD PORT LUDLOW WA 98365-8786 LUDLOW POINT VILLAGE DIV 1 SUBDIVISION: Block: Lot: 27 PARCEL NUMBER: 969400027 Section: 17 Township: 28 N Range: 01 E CONTRACTOR: FAST WATER HEATER COMPANY PHONE: 425-636-7054 12601 132ND AVE NE KIRKLAND WA 98034 Contractor's License FASTWWH948BC Expires 1/4/2012 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOt REPLACE ELECTRIC WATER HEATER 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 Bv: Date: Receipt: Approved/Date Permit $71.00 LYK 09/07/11 128084 Total: $71.00 • 0 553192 4�.g o COO,. JEFFERSON COUNTY /J `\'' ,'..3 DEPARTMENT OF COMMUNITY DEVELOPMENT `' '`':c '< 621 Sheridan Street• Port Townsend•Washington 98368 360/379-4450• 360/379-4451 Fax p www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: 1 O mug IaD )b Project Description(include separate sheets as necessary): Remove/Replace Electric Water Heater Tax Parcel 969400027 Property Number: Size: (acres/square feet) Site Address and/or Directions to Property: 51 LUDLOW POINT RD Property Owner(s)of Record: SILVERSTEIN, LOUIS Telephone: (360)437-0489- D Fax: !� email: Mailing Address:_51 L1,�Cq I Qt,v c Le i ''CY •+ Lt �� .v yi:-T Applicant/Agent(if different from owner): FAST WAT ANY Telephone: 425-636-709y Fax: 425-636-70csc ema(OfMtl tastwaterneatet-.corn Mailing Address: What kind of Permit?(Check each box that applies CiBuilding 0 Variance(Minor,Major or Reasonable Economic Use) O Demolition Permit 0 Conditional Use[C(a),C(d),or C)** ICI Single Family 0 Garage Attached/Detached 0 Discretionary"0"or Unnamed Use Classification ❑ Manufactured Home 0 Modular ❑Special Use(Essential Public Facilities)""' ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use 0 Short Plat** O Address 0 Road Approach 0 Binding Site Plan*'* ❑Home Business 0 Cottagelndustry 0 Long Plat** ❑Propane ❑Planned Rural Residential D nts** ❑Sign ❑Plat Vacation/ era pp ri tioe-' n '// I r A , CIAllowed"Yes"Use Consistency Analysis ❑Shoreline Mas erg� iue t R6vPi s * ❑Stormwater Management 0 Shoreline Man genhhnt SubstaritfaTDevelopment ❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Mangy gen'iont Variance El Temporary Use 0 Comprehensiv4 Plan/UDC/Land Use District Map en rrlent 0 Wireless Telecommunication* 0 Jefferson Courtty Shoreline Master Program Amen e ❑Forest Practices Act/Release of Six-Year Moratorium 0 Tree Vegetaion Request *May require a Pre—Application Conference **Requires aPr ipplication Conference Please identify any other local,state or federal permits required for this proposal,]fiktftSWtteOUNTY OFPT.OF COMMUNITY DEVFLOPMENT DESIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE See attached 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 it's knowledge. Any material falsehood or any omission of a materiel 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 app'catl n that a or she ants prior notice. Signature: ,e- Date: 9/2/11 The action o actions Applicant will and ake 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-transfer ble esponsibility for hering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: ,-e- Date: 9/2/11 C\Documents and Settings\carat\Local Settings\Temporary Internet Files\OLKa6\Master Permit Application 12-19.2006.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: FAST WATER HEATER COMPANY ( ) 425-636-70 i ( )425-636-70% MAILING ADDRESS: 12601 132ND AVE NEKINKCANU, WA 98034 Ewa: civil astwaterheatl=r corn CONTRACTOR'S LICENSE WAINS NUMBER: FASTWWH948BC NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New 0 Wood Existing: 0 Sewer O Addition ❑ Steel Proposed: Bank 0 Community System OXAlteration/Remodel 0 Concrete Total: Height: 0 Individual System ❑ Repair 0 Masonry SEP Permit# O Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback:. .- - 0 P,ivate ,;j�I kaijy Type of Heat: Proposed: M I f ) c�y :_ V = r-4l Total: I ,I If this is a Commercial Project you must answer the following: 11 Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces:_ I ) Number of occupants(includes owners,tenants,employees,etc) Current Proposed Ii J IBC Occupancy: IBC Type of construction: Will you have Food Se ' y l,e If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: [ l', 'COUNTY .�P' Ch COMiJiJN'�TY DFUFI OPMFNT El Underground Tank j�Above ground Tank Size of Propane Tank: -- - - — ❑Heat Stove ❑Cook Stove ❑Woodstove ❑ Fireplace Insert 0 Hot Water Tank 0 Pellet Stove ❑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 For Office Use Only Amount Revision Main Floor Heated EH BId App Review 2n°Floor Heated Consistency Review: Other Heated Base fee: — Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other Water Heater _ 1 _ TOTAL: $ (7 I Receipt Number: ' *Oi Cash/Check Number. I I ESTIMATED COST(REQUIRED) Date: C1 _ _ .Fair market value of all labor and materials foundation to finish Initials: __----- C:\Documents and Settings\coal\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-19-200G.doc