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Home My WebLink AboutBLD2011-00273 • • 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 *: BLD11-00273 Received Date 10/4/2011 SITE ADDRESS: 212 GOLIAH LN Issue Date 10/4/2011 PORT LUDLOW, 98365 APPLICANT: EDWARD RAN HILL PHONE 360-437-2911 DEBRA JO HILL 212 GOLIAH LN PORT LUDLOW WA 98365-9675 98 SUBDIVISION: PORT LUDLOW NO 2 AREA 2 Block: Lot: PARCEL NUMBER: 990600298 Section: 9 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, EDWARD RAN HILL PHONE: 360-437-2911 if different: DEBRA JO HILL 212 GOLIAH LN PORT LUDLOW WA 98365-9675 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 10/4/2012. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: . 7 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 ill UILDING PERMIT APPLICA ON BLD11-00273 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD11-00273 Received Date: 10/4/2011 SITE ADDRESS: 212 GOLIAH LN PORT LUDLOW, 98365 OWNER: EDWARD RAN HILL PHONE: 360-437-2911 DEBRA JO HILL 212 GOLIAH LN PORT LUDLOW WA 98365-9675 PORT LUDLOW NO 2 AREA 2 SUBDIVISION: Block: Lot 98 PARCEL NUMBER: 990600298 Section: 9 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 NEW HEAT PUMP TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC VALUATION 4,500.00 MAIN: CODE EDITION: 2009 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: OTHER: GARAGE: SHORELINE: CONST TYPE: 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 $111.25 LYK 10/04/11 128204 Plan Check $72.31 LYK 10/04/11 128204 State Building Code $4.50 LYK 10/04/11 128204 Total: $188.06 ON • ,9 411 1 C'0 JEFFERSON COUNTY 557 41 r r7; DEPARTMENT OF COMMUNITY DEVELOPMENT 1.4 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax �.' 1.O" www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: % A QfL-t'vi►� Project Description(inclucj separate sheets as necessary): \ V\('-`\\(\:\\ ;._) • n \roc\ NJ/s) _:\ .V .', ti\-\_ ..-t . Tax Parcel Number: Property Size: (acres/square feet) Site Address and/or Directions to Property: Property Ow er(s)of Record: Telephone: , 410 Fax: email: Mailing Address: Applicant/Aent ff'ere. t fromowner): _ Telephone:(�(C�niif \ Fa / 1/ ' email: (� Mailing Address: ` "�, \• � ` G� �� ( i Y,'1 rYl What kind of Permit?(Check each box that applies ❑Building 0 CriticalanAreas Stewards_' _ ,, �� n ❑ Demolition Permit ❑Variance(Minor,Major �, -,,1� rti (U ,--Single Family 0 Garage Attached/Detached ❑Conditional Use[C(a),' ❑ Manufactured Home 0 Modular 0 Discretionary"D"or d Use Classification ❑ Commercial* 0 Special Use Essenti I ''i Faai s **4 on1 ❑ Change of Use ❑Boundary Line Adjus n'1 U,,I ❑ Address ❑ Road Approach 0 Short Plat** ❑Home Business 0 Cottage Industry 0 Binding Site Plan** iJ 0 Propane 0 Long Plat** ( JEFFERSON COUNTY ❑Sign 0 Planned Rural Residential DepfslppgmliplpRIVAtfitii ❑Allowed"Yes'Use Consistency Analysis 0 Plat Vacation/Alteration** ❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions** ❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial 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 ❑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: DESIGNATION OF AGENT I hereby designate �' to act as my agent in matters relating to this application for permit(s). ( ,: OWNER SIGNATURE 731. J /e i (,)° Date: — z (•- / i 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 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 t the applica//4 that he a' \ p/r nq- tics. q Signature: //`/ �l-Ci(,J,'� Date: ` ` 2 G - /) 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-transferap responsibility f9r adh ring to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: obtf)7 �-r Date: g—Z6—I/ G:\PermitCenter\###FORMS###\ORD 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: GENERAL CONTRACTOR OR ANUFACTURED HOME INSTALLER: PHONE: FAX: \ 1 ( Oify )y -aA e� ( tau, (V ,3 0=03'5 l MAILING ADDRESS: `\�,1) 3 \ \ \ {` t� "L EMAIL: CONTRACTOR'S LICENSE �'�(C Y�Y� \s`-- `- _CA L 4 V INS + (,� m, NUMBER: \ NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New El Wood Existing: [1 Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System of Repair ❑ Masonry , SEP Permit# O Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: [1 Private well ❑ Two Party Tyke of Heat: Proposed: LI Public c i• 'Y I Total: Name of System: t-- — If this is a Commercial Protect you must answer the following: r.l J �1 Number of Parking Spaces: Current: Proposed: um arking Spaces'- l Number of occupants(includes owners,tenants,employees,etc) Current I J Proposed IBC Occupancy: IBC Type of construction: Will you-have FoitdiService? Yes / No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: U I Underground Tank 1 Above ground Tank Size of Propane Tankt iJ L• j I Heat Stove I Cook Stove I Woodstove I Fireplace Insert 1 Hot Water Tank i Pellet StQVHER(i(Qtb@NNTY Is this appliance being installed in a Manufactured/Mobile Home? Yes / No DFPT.OF COMMUNITY DEVELOPMENT I 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 Fq ,'--7 .+ a Flit' I ,�,„ ' `. s � ' � y` Aittount...:= ...�,�Xisit�n -�-, a. Main Floor Heated o F s �* EH Bld App Review: "`tile 2n°Floor Heated ` a� I'61 z � ��, Consistency Review: Other Heated ri , ,j„ Base fee: 1 1 ( •�5 Mezzanine ,, ' Additional Section: s Heated Basement ` Plan Check fee: Unheated Basement State Surcharge fee: ,j �,\ r ,�.. _ ✓'1 .ic) Other Unheated ' Pot Water Review fee: Garage/Carport : SUBTOTAL g .0('{ r .Decks � 4 ti ,''4 911/Rd Approach fee: 1,i- C/ Other AP A'Lrf $ ( b g '(AO "et, ° `I1 " TOTAL: CI4i `'4f i,i , Receipt Number: t 9act, Cash/Check Number: ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish 1 Q-LA- ‘ Initials: ___________ G:\PermitCcnter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc