HomeMy WebLinkAboutBLD2011-00345 •
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 #: BLD11-00345 Received Date 12/28/2011
SITE ADDRESS: 433 TOG RD Issue Date 12/28/2011
BRINNON, 98320
APPLICANT: JEROME L WRIGHT PHONE: 360-796-3919
433 TOG RD
BRINNON WA 98320-9679
1+
SUBDIVISION: DISHER'S SHORT PLAT Block: Lot:
PARCEL NUMBER: 602234029 Section: 23 Township: 26N Range: 02W
CONTRACTOR: QUALITY HEATING &A/C PHONE:
9960 SILVERDALE WAY
STE 14
SILVERDALE WA 98383
Contractor's License QUALIHA016JH Expires 12/30/2011
OWNER, JEROME L WRIGHT PHONE: 360-796-3919
if different: 433 TOG RD
BRINNON WA 98320-9679
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 12/28/2012.
REQUIRED INSPECTIONS:
Tank/Line/Appliance:
FinalApproval:
l & 0—
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
D
WILDING PERMIT APPLICATION BR vew00345
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD11-00345 Received Date: 12/28/2011
SITE ADDRESS: 433 TOG RD
BRINNON, 98320
OWNER: JEROME L WRIGHT PHONE: 360-796-3919
433 TOG RD
BRINNON WA 98320-9679
DISHER'S SHORT PLAT
SUBDIVISION: Block: Lot: 1+
PARCEL NUMBER: 602234029 Section: 23 Township: 26 N Range: 02 W
CONTRACTOR: QUALITY HEATING &A/C PHONE:
9960 SILVERDALE WAY
STE 14
SILVERDALE WA 98383
Contractor's License QUALIHA016JH Expires 12/30/2011
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI' NEW HEAT PUMP
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP MEC MAIN:
VALUATION 8,135.00 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 $167.25 LYK 12/28/11 131321
Plan Check $108.71 LYK 12/28/11 131321
State Building Code $4.50 LYK 12/28/11 131321
Total: $280.46
c 0 0(..„...,e/50N06. JEFFERSON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
gyp$ www.co.jefferson.wa.us/commdevelopment
BIN
Master Permit Application MLA: tj(-) MCA 1
Proj Descripti (include sheets as necessary):/�
Tax Parcel Number: /a UA 42 y0�-% Property Size: i3Q I 'F/ (acres/square feet)
Site Address and/or Directions to Property:
2/A5 %o e-d rift /146n1 10A ci1.3
Property Owner(s)of Record: `1 f 0 r le- Lt..)45 eihr
Telephone:-.3 ()-7Cl(¢-3 1/4 Fax: email:
Mailing Address: .S0.,#1e-2., �j
Applicant/Agent(if different from owner): e30 Dil lea- Jh (tom/,i
Telephone:0 '(Q 13 '5 Lt Fax:3 o' (2�[�•- ,�- ' 7 - email: p
Mailing Address: 41 1(2 C) 2Z lcl e L t� 3 40 t/` e 1 u) 4 1 io .F-
What kind of Permit?(Check each box that applies
❑Building 0 Critical Areas Stewardship Plan
O Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use)
j1�Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a), C(d),or CJ**
O Manufactured Home ❑ Modular 0 Discretionary"D"or Unnamed Use Classification
O Commercial' 0 Special Use(Essential Public Facilities)**
O Change of Use ❑Boundary Line Adjustment
O Address 0 Road Approach 0 Short Plat**
❑Home Business 0 Cottage industry 0 Binding Site Plan**
0 Propane 0 Long Plat**
❑ Sign 0 Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alter tinn**
❑Stormwater Management 0 Shoreline Master r m :Cr •:!!:eF}nyee •
❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Manage n a -I - e p pn I
❑Temporary Use 0 Shoreline Manage ariance
Wireless Telecommunication' 0 Comprehensive PI pc/Land Use District Map A • • ent
0 Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County r I rie Mfice Pr2igpim Amend
'May require a Pre—Application Conference ❑Tree Vegetation R Cjtle
**Requires a erjeqiiification Conference i
Please identify any other local, state or federal permits required for this p posal, it ifttFFEW COUNTY
DEPT.OF COMMUNITY DEVELOPMENT
-- DESIGNATION OF AGENT
I hereby designate i( L� to act as my agent in matters relating to this application for permit(s)
OWNER SIGNATURE Date: rot!/d,/,2or /
By signing this appli on 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 re ired later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the applic on that h ors w pr r notice.
Signature: Date: /.247f or
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 u are in compliance ith the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transf ble�,reesspconst ��heering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature.6C-ei �`� _ Date: /01/4.S /7 di i
U\1'cnrinCenter\U#kFORMS###\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 ming the res o ibility of he G neral Contractor for the proposed project.
Signature: 14,177`4- Date: !4!! 11or !
GENERAL C NTRACTQR OR MANUFACTURED HOME INSTALL R: PHONE: FAX:
t: _ULI--(r ,64e-a-- ;Pt 4 ►/�'le C'�rtc•i actin yin )(Q/3 - SCE!ti G30-1 (04�'`L�'Sg
v
MAILING ADDRESS: GtC%/G c) 3�1��/�I' ND EMAIL: � 1 D c l, t w,T,�c, ( ,(i ,.coca.)-)coca.)-)CONTRACTOR'S LICENSE ` WAINS 0
NUMBER: () 1.-4MP- t-4 NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: T pe of Sewage Disposal:
: New h-Wood Existing: Sewer
ddjtioa . Steel Proposed: Bank ] Community Systerrl,----;--
ijQ
Alteration/Remq 1- U Concrete Total: Height: ❑ Individual System
Repair ❑ Masonry SEP Permit#
Demolition C Other: Bedrooms: Water Supply:
Existing: Setba : 1 Private well ❑ Two Party
Tye of Heat: _ Propose .
P "�Pro Public
LI - 4 o 11 w, t,I Total: Name of System:
A l�1 c ' p/.(a"10 L[/clia-1 e% ,
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:
1 Underground Tank 1 Above ground Tank Size of Propane Tank:
1 Heat Stove 1 Cook Stove I Woodstove 1 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 Fp . jjt0 esbnIY Amount 4.,, :, ion ll 7
Main Floor Heated ?I '.,:'>it EH Bid App Review:
.i3it3: .A.t
2r°Floor Heated Fr, smirk'. Consistency Review: _____
Other Heated 7 Base fee: r
1 . 25
Mezzanine - Additional Section: _-----
Heated Basement Plan Check fee: l Oft • I
C�
Unheated Basement ,,, State Surcharge fee: 4 Q
Other Unheated Pot Water Review fee: —_____
Garage/Carport SUBTOTAL
Decks . 1- 1/ q} mh fee: -, r
-OTAL
(40
d' n
e./ 1/c/Cd 1- I a i�. ',,BReAe1pt N br
"'' Cash/Che ber:
`-t . -r
ESTIMATED COST(REQUIRED) II IEFFERSOA G�®
.Fair market value of all labor and materials founjiation(p_tioiski COMMON T DFtVFIOPMENT
yi 3S 3�— `` t ,r to g.
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JEFFERSON COUNTY
DEPT.OF COMMUNITY DEVELOPMENT