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HomeMy WebLinkAboutBLD2012-00004 • • 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 #: BLD12-00004 Received Date 1/4/2012 SITE ADDRESS: 8-7—ORtF1WOO CT I2Z- C 2�,— Issue Date 1/4/2012 PORT LUDLOW, 98365 APPLICANT: DOUG PULLING PHONE: 206-200-0870 CELESTE ARCHAMBAULT 87 DRIFTWOOD PORT LUDLOW WA 98365-8781 3 SUBDIVISION: LUDLOW POINT VILLAGE DIV 4 Block: Lot: PARCEL NUMBER: 969800003 Section: 17 Township: 28N Range: 01 E CONTRACTOR: ALL WEATHER HTG & COOLING PHONE: 302 KEMP STREET PORT ANGELES WA 98362 Contractor's License ALLWEHC003DC Expires 9/7/2013 OWNER, DOUG PULLING PHONE: 206-200-0870 if different: CELESTE ARCHAMBAULT 87 DRIFTWOOD PORT LUDLOW WA 98365-8781 PROJECT DESCRIPTION: 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 1/4/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: ; I - j-1 3 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 BLD12-00004 QUILDING PERMIT APPLICA N Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD12-00004 Received Date: 1/4/2012 SITE ADDRESS: 87 DRIFTWOOD CT PORT LUDLOW, 98365 OWNER: DOUG PULLING PHONE: 206-200-0870 CELESTE ARCHAMBAULT 87 DRIFTWOOD PORT LUDLOW WA 98365-8781 LUDLOW POINT VILLAGE DIV 4 SUBDIVISION: Block: Lot: 3 PARCEL NUMBER: 969800003 Section: 17 Township: 28 N Range: 01 E CONTRACTOR: ALL WEATHER HTG & COOLING PHONE: 302 KEMP STREET PORT ANGELES WA 98362 Contractor's License ALLWEHC003DC Expires 9/7/2013 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION HEAT PUMP TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION 11,447.00 ADD'L: HEAT TYPE: CODE EDITION: 2009 HEAT BASE: HEAT TYPE: OCCUPANCY: OCCUPANCY: UNHEATED: #OF STORIES: 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 By: Date: Receipt: Approved/Date Permit $209.25 LYK 01/04/12 131343 APPROVED Plan Check $136.01 LYK 01/04/12 131343 State Building Code $4.50 LYK 01/04/12 131343 Total: $349.76 Jefferson County Planninct & Building Department • • JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT " - 4 621 Sheridan Street • Port Town send • Washington 98368 As ri t 360/379-4450 • 360/379-4451 Fax 7.-- 0, www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Y O MUD, ,o t N Project Description(include separate sheets as necessary): 1n34ckIlailun Cr"C Iv.u•A- pump e cxtf htknclttf _ Tax Parcel f tc u U© S Property Number: `�I l(d Size: 'a.,(JJ tOt (acres uar ?_ Site Address and/or Directions to Property: . 57 brt -±-�. Y; -k_ a e.L Property Owner(s)of Record: Quv u `�V(li/l J Telephone: aoo --aO( -Q8 7U`J Fax: email: Mailing Address: ia,e (O"ber Lin Applicant/Agent(if different from owner): Aii 'ir ej../.4-hr{ Heat—jai d Cti.U'lir'1.ci Telephone:S. . - r.a- i i �-- Fax"�jp0 `•15a.-5i,7 7 e—rrail: aik—Wk-0Olypeel, t^s�*1'YA Mailing Address: 3OI �/.,,/yip ,]t What kind of Permit?(Check each box that applies Building ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit 0 Conditional Use[C(a), C(d), or C]** ❑Single Family 0 Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home 0 Modular 0 Special Use(Essential Public Facilities)** ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use 0 Short Plat** ❑ Address 0 Road Approach 0 Binding Site Plan** ❑Home Business 0 Cottagelndustry 0 Long Plat** ❑Propane 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Sign 0 Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** ❑Stormwater Management 0 Shoreline Management Substantial Development** 0 Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Variance ❑Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment 0 Wireless Telecommunication* 0 Jefferson County Shoreline Master Program Amendment ❑Forest Practices Act/Release of Six-Year Moratorium 0 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: ,,, p + DE I AT QF AGENT I hereby designate Alt W 1 (1 m a ent in matte s rel' ' Ilia ' a I Y 9 _� 9 �PR'fQ p� it(s). OWNER SIGNATURE 1, •�'\ "L k.1-- r /. // i By signing this application form,the owner/agent attests that he information provided herein,and in any attachments,is'true ifnd comb to ih best of his,her or it's knowledge. Any material falsehood or any, ission of a material fact made by the owner/agent with respect to this appli acket may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgr'nents, orney's fees nd expenses which may in any way accrue against Jefferson County as a result of or in consequen(;e of the grantiild4tltl§ s 1. t�r,` r r HI,V,V�.I< rp, f I further agree to provide ac and ri ntry to Jefferson County and its employees,representatiyes.nt'a a s-for ose o application review and any required la) r ins e ' ns. a ,access and right of entry will be assumed unless the applic,nt forms th County in writing at the time of the application thaf he or an ri no•ce. / �,�- Signature: t b� Date: ` .) �// The action or actions Applicant will undertake as a r ult of the issuance of this permit may negatively impact upon one or morei threatened or endangered species and could lead to a potential"t e"of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act"or"ESA."Je rson unty makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued w)11,not viola) the SA. An individual,group or agency can file a lawsuit on behalf of an end gered species regarding your action(s)even if you ar in akmpli ce wi the Je ri County development code.The Applicant acknowledggs t he,she r it holds individual and non-transferable aspon4i9 r r g t d complying with the ESA. The Applicant has read thJ/J ' er nd gns and dates it below. Signature: ( Date: C:\Documents and Settings\caral\Local Settings\Temporary"ntemet Files\OLK86\Master Permit Application 12-19-2006.doc • • BUILDER STATEMENT The signer of this stat m t does here y rti$y that they are the Owners of the parcel referenced herei ,that they are not licensed contractors and that they will be assumi g the s ./ sib'' of a eral Contractor for the proposed prpi t. Signature: , Date: 1/ ENERAL CONTRACTOR OR MANUFACTURED E INSTALLER: 4I n Q�J( �',� PHONE: FAX: ll VV` c�� itn� (uoll�n 0 95a-9 3/3 , i5.si 7 7 MAILING ADDRESS: 30 6. r" '1P ,ct- WAINSEMAIL: CJI�Jl1V1L( vky1tP1, t JCao'1 CONTRACTOR'S LICENSE NUMBER: A L L tk) rw 1-4 134 4�U NUMBER ARCHITECT/ENGINEER: 1 PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: ❑ New Shoreline: TypeS of Sewage Disposal: ❑ Wood Existing: I:' Addition ❑ Steel Proposed: Bank ❑ Co ewer 1r Alteration/Remodel 1-1 ConcreteTotal: Height: (I Individual mul S System Sym Repair ❑ Masonry SEP Permit# Pi Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: PP Y Tye of Heat: Proposed:- l-i Private well Two Party '`� P tv ;yip Total: ❑ Public 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 IBC Occupancy: Proposed P Y 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: 0 Underground Tank °Above ground Tank Size of Propane Tank: ❑Heat Stove 0 Cook Stove 0 Woodstove ❑ Fireplace Insert 0 Hot Water Tank 0 Pellet Stove 0 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 I Current Proposed For Office Use Only Amount Revision Main Floor Heated EH Bld App Review __ 2"Floor Heated Consistency Review Other Heated Base fee: --�� _ Mezzanine 'x t a Additional Section: Heated Basement Plan Check fee: Unheated Basement i 3(4,i 1) State Surcharge fee: ti S i Other Unheated Pot Water Review fee: -1 t Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: _ Other Grp ii bTAl- 13Lti17to Receipt Number: 13[343 J5HkSh/Check Numbe : a ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to fiish I_l l 711 ItifitaiWNCOUNTY �' ' TV 13FYLI t��h9r�hTy C:\Documents and Settings\coal\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.doc