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Home My WebLink AboutBLD2011-00251 • • 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 #: BLD11-00251 Received Date 9/13/2011 SITE ADDRESS: 113 PORT HADLOCK HEIGHTS RD Issue Date 9/13/2011 "18e T I11R[YCr L. U ik cIS 33(1 APPLICANT: CLAY KLINGER PHONE: 360-379-6421 113 PORT AHDLOCK HTS DR PORT HADLOCK WA 98339 1-45 SUBDIVISION: PORT HADLOCK HEIGHTS MH PARK Block: Lot: PARCEL NUMBER: 989500001 Section: 11 Township: 29N 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, CLAY KLINGER PHONE: 360-797-7722 if different: 113 PORT AHDLOCK HTS DR PORT HADLOCK WA 98339 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 9/13/2012. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: danewei( 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 UILDING PERMIT APPLICAAN BRLD11 00eview p2e51 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD11-00251 Received Date: 9/13/2011' SITE ADDRESS: 113 PORT HADLOCK HEIGHTS RD OWNER: CLAY KLINGER PHONE: 360-379-6421 113 PORT AHDLOCK HTS DR PORT HADLOCK WA 98339 PORT HADLOCK HEIGHTS MH PARK SUBDIVISION: Block: Lot: 1-45 PARCEL NUMBER: 989500001 Section: 11 Township: 29 N Range: 01 W 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 DESCRIPTION NEW HEAT PUMP TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION 4,500.00 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: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid Bv: Date: Receipt: Approved/Date Permit $111.25 LYK 09/13/11 128121 Plan Check $72.31 LYK 09/13/11 128121 State Building Code $4.50 LYK 09/13/11 128121 Total: $188.06 . oN c . .AV 0 JEFFERSON COUNTY `4A DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 . 360/379-4451 Fax �� p$ www.co.jefferson.wa.us/commdevelopment rt (Ail usa '6 Master Permit Application MLA: Project Description(include separate sheets as necessary): \ f) \1 \\_(/ !l_.4 cC,r"_ Tax Parcel Number. vl 9000 I Property Size: (acres/square feet) Site Address and/or Directions to Property: "j Qtic4 U&)J t,L1 -. � A( \-k''J 0c" cc- AI nc \4._ LC O— G B/S?A Property Owner(s)of Record: C. Telephone:"3 L • `E i Fax: • email: Mailing Address: -.1a dr._t a.;,;: J, Applicant/Agent(if differentifr•oiii owner):�jc LA/NA'A£c V-Vt k'1 11 Telephone: L\� , tt� Fax::_O '`S �_A email: i p'U-t'A11Cf{hn�...G0I'' 4--1't► , Mailing Address: 4t t c. 1")- L:vA P L ��& -z- Le 0-- CI rr>1 �' n .Y1 What kind of Permit?(Check each box that applies ❑Building 0 Critical Areas Stewardship Plan ❑ Demolition Permit D Variance(Minor,Major or Reasonable Economic Use) ❑Single Family 0 Garage Attached/Detached 0 Conditional U e[C(a),C( ** ❑ Manufactured Home 0 Modular 0 Discretionary"D r Unn {{I O Commercial* 0 Special Use U ihs) O Change of Use 0 Boundary Lin cj fitment ❑ Address 0 Road Approach 0 Short Plat** ` ❑Home Business 0 Cottage Industry 0 Binding Site I n 1 pcp 1 1 7_01" 11 D Propane ❑Long Plat"* 1 I I ❑Sign 0 Planned Rur l' 'dential Development(PRRD1 ments** ❑Allowed"Yes'Use Consistency Analysis 0 Plat Vacatio Alteration*" ❑Stormwater Management 0 Shoreline Mester Pr rarr{ Oi6rmit Revision ** ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Manage tial'Devel ** 0 Temporary Use 0 Shoreline Management Variance ❑Wireless Telecommunication* 0 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 Conference Please identify any other local,state or federal permits required for this proposal, if known: Q� 1 DESIGNATION OF AGENT I hereby aesignate 1J(tY`.t , it.-I11 .0 act as my anent in matters rela inp to this-application for permit(s). ) / , OWNER SIGNATURE Date: 3 _ , By signing this application fo ,t owner/agent attests that the inform ' n provided herein,and in any attachments,is true and correct to the best of his,her or its knowledge. An terial 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 a S d right of entry will be assumed unless the applicanxinforms`the County in writing at the time of the licaSIOn that h n rior n Signature: Al)-----.)‘' , Date: L' ' The action or actions Appl' nt will undertake as a result of th s uance of this permit may negatively impact upon one or more threatened or endangered species and Could lead to a potential lake"of an angered species as those terms are defined in the federal law known as the "Endangered Species Mt"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 C my development code.The Applicant acknowledges that he,she or it holds individual and non-tra ra a resp sibility for adhering t L ying w h the ESA. The Applicant has read this disclaim�nd signs and dates it below. Signatur �' {�11 , Date: 7,.- G:\PermitCentcr\#�#FO1 S###\DRD FORMS\Master Permi A 'cation 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: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: D6 t_h\n r\ y,A OW j q IA^ate 3 7 b . MAILING ADDRESS: � ko, \ J Vb Qt.- �� C�,-L EMAIL: irY�-P�.J�(dX„M1L,r, ..,1r ,c CONTRACTORS LICENSE�tL jr\kOCI \Q `krlk,iWAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAx:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: ❑ Sewer O Addition ❑ Steel Proposed: Bank ❑ Community System %Alteration/Remodel 0 Concrete Total: Height: 0 Individual System O Repair 0 Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setuack: CI Pnvate well 0 Two Paity :f Heat: Proposed: ❑ Public • ►E% \ 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 yo If this is a Propane Tank and/or Appliance Installation permit,mark all items below�7; I U V E I Underground Tank I Above ground Tank Size of Propane Tank: i III r--- I Heat Stove I Cook Stove I Woodstove I Fireplace Insert I Hot Water Tank I Feljet Stove I Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / No n SEP ,j [U When applying for a permit to install a propane tank you must also submit a site Flan Showing all of the building 11 nperty lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system co nents, including the reserve area. il Square Footage Current Proposed i°ta y# f F ?;'ri ,h1,,7 ti; M F `y1 t 4 i c : t...-.s r, _. i«+- Main Floor Heated tK, EH Bld App Review: 2na Floor Heated Consistency Review: �t�R d 'i. dI" `� i+: Other Heated 1*i, ;�& `'`A Base fee: ' 1 I � a f, 1 Mezzanine 'Et ��, Additional Section: Heated Basement 14. V; Plan Check fee: q a 31�� , Unheated Basement `° R State Surcharge fee: Other Unheated .4 '� _ ,,,. Pot Water Review fee: Garage/Carport ` ' # SUBTOTAL • t �' Decks � gi 911/Rd Approach fee: Other '�� 5 TOTAL: $ 0 g t "� Receipt Number: Val G I *tr "f'" Cash/Check Number: 0.1 ESTIMATED COST(REQUIRED) Date: 'Fair market value of all labor and materials foundation to finish r 11 4- 5°0 Initials: • G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc