HomeMy WebLinkAboutBLD2012-00070 •
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 #: BLD12-00070 Received Date 3/5/2012
SITE ADDRESS: 110 HARBOR VIEW PL Issue Date 3/5/2012
PORT LUDLOW, 98365
APPLICANT: ANTHONY J BRENNA TRSTEE PHONE: 360-437-9493
ELENA R BRENNA TRUSTEE
110 HARBORVIEW PL
PORT LUDLOW WA 98365-9503 7
SUBDIVISION: TERMINATION POINT Block: Lot:
PARCEL NUMBER: 998600006 Section: 3 Township: 27N Range: 01 E
CONTRACTOR: QUALITY HEATING &A/C PHONE:
9960 SILVERDALE WAY
STE 14
SILVERDALE WA 98383
Contractor's License QUALIHA016JH Expires 1/5/2014
OWNER, ANTHONY J BRENNA TRSTEE PHONE: 360-437-9493
if different: ELENA R BRENNA TRUSTEE
110 HARBORVIEW PL
PORT LUDLOW WA 98365-9503
PROJECT DESCRIPTION: NEW HEAT PUMP & FURNACE
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 3/5/2013.
REQUIRED INSPECTIONS:
Tank/Line/Appliance:
FinalApproval: }v-.5--3\kct I Z
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
II1AJILDING PERMIT APPLICASN BLD12-00070
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD12-00070 Received Date: 3/5/2012
SITE ADDRESS: 110 HARBOR VIEW PL
PORT LUDLOW, 98365
OWNER: ANTHONY J BRENNA TRSTEE PHONE: 360-437-9493
ELENA R BRENNA TRUSTEE
110 HARBORVIEW PL
PORT LUDLOW WA 98365-9503 TERMINATION POINT
SUBDIVISION: Block: Lot: 7
PARCEL NUMBER: 998600006 Section: 3 Township: 27 N Range: 01 E
CONTRACTOR: QUALITY HEATING &A/C PHONE:
9960 SILVERDALE WAY
STE 14
SILVERDALE WA 98383
Contractor's License QUALIHA016JH Expires 1/5/2014
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr NEW HEAT PUMP & FURNACE
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP MEC MAIN:
VALUATION 10,692.00 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 By: Date: Receipt: Approved/Date
Permit $195.25 LYK 03/05/12 131521
Plan Check $126.91 LYK 03/05/12 131521
State Building Code $4.50 LYK 03/05/12 131521
Total: $326.66
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JEFFERSON COUNTY
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4-' DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
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$ www.co.jefferson.wa.us/commdevelopment
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Master Permit Application MLA: OD rn( .A e b
Project Description(include separate sheets as necessary):
1 cs i !/ a- I=1.4 r.c14_c ? hem../ iIL 'ii 7
Tax Parcel Number q9 "1Oo00 Property Size: (acres/square feet)
Site Address and/or Directions to Property:
la o k/ct.r 6 60- I)I'e i /OL- PPyi 1 i e/% Q S
Property Owner(s)of Record:4,v it/AA-r 6 re 4/1 a
Telephone:36e 0 -4/3'7 -q q_8 / Fax: email:
Mailing Address: S.evyA'td_ CZ5 a 64-4cc--
Applicant/Age��n""t(if different from owner):/ ()Lc I. �t� . / ,/w �,
Telephone: %& t, -54/9 JFax: - - �Y email: l A-! O "fit {Y-L etei./r
Mailing Address: (d 0 rI i /C)e7 1 S,/fir a e yr3 �— lllt��
Wit kind of Permit?(Check each box that applies
Lidding ❑ Critical Areas Stewardship Plan
E ,Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use)
D.Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]""
❑ Manufactured Home 0 Modular 0 Discretionary"D"or Unnamed Use Classification
❑ Commercial• 0 Special Use(Essential Public Facilities)"*
O Change of Use 0 Boundary Line Adjustment
❑ Address 0 Road Approach 0 Short Plat•"
❑ Home Business ❑ Cottage Industry 0 Binding Site Plan*"
i ❑Propane 0 Long Plat**
❑ Sign ❑Planned Rural Residential Development(PRRD)/Amendments""
❑Allowed"Yes" Use Consistency Analysis ❑ Plat Vacation/Alteration**
O Stormwater Management ❑ Shoreline Ma ( r i� skon;""
❑Site Plan Approval Advance Determination (SPAAD)• ❑ Shoreline Mahar tt t• n�rl D�ror u-rt""ti'
❑Temporary Use ❑ Shoreline Mah $merit Vdrtdnt,cs
❑Wireless Telecommunication• 0 Comprehensive Plan/UDC/Land Use District Mac A"IEndment
O Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Maste�Prggcam Amenc+rient
•May require a Pre—Application Conference 0 Tree Vegetation Request LUU LL
"Requires a Pe-Application Conference
Please identify any other local, state or federal permits required for this pr po alJE PERSON COUNTY
DEPT.OF COMMUNITY DEVELOPMENT
�p fI i DESIGNATION OF AGENT
I hereby designate Cale✓.�c Dt t vVC -4/c- to act as my agent in matters relating to this ap lication for permit(s).
J 2./>e'�.2c,/2
OWNER SIGNATURE / 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 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 fired later inspections Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the appli on that h or w rio ot�i ' ,//O
Signature: (CD 0 1 WO Date: 2//
(/1t//L
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 i.late the ESA. An individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)even if you are in co)4 liance with the J rson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transferabl spo r•ility for dh a id complying with the ESA. The plicant has read this disclaimer and signs and dates it below.
Signature. / C 6/7a Oa/44 /• , (Date: V11'4Cr/
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• •
• 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 CONTRACTO OR MANUFACTURED HOME INSTALLER: PHONE: FAx:
Ct.�(, Q..Li'n n •C' • .%O)(. f 3 -SCQ!y (.3(ob)
MAILING ADDR S: / I.C.) i EMAIL: /1�1 >O `
CONTRACTOR'S LICENSE air (U't-rr6ti te—_ 3 3 WAINS
NUMBER: tjL..t_CL1._t IA(, __ otL kt NUMBER
ARCHITECT/ENGINEER: `+� PHONE ( ) FAx:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
_I New ri Wood Existing: ] Sewer
A5dItion ;i Steel Proposed: Bank D Community System
.ridteration/Remodel LI Concrete Total: Height: 0 Individual System
Repair C_ 1i1asonry SEP Permit#
Demolition [[ Other: Bedrooms: Water Supply:
Existing: Setback: I Private well L Two Party
Type of Heat: Proposed: I Public
rare_.ext ,,2-- 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 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 T Above ground Tank Size of Propane Tank:
I Heat Stove 1 Cook Stove 1 Woodstove 1 Fireplace Insert i Hot Water Tank 1 Pellet Stove i Other
Is this appliance being installed in a Manufactured I 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. yyy.
Square Footage Current Proposed F)u #, t t sekonIY� ..,.,a Amount �.?kEtevlsion
Main Floor Heated i$� �its EH Bld App Review:
. �.[3 S iit-{>a'.ePot,::i. -
2 Floor Heated a,r fyo Consistency Review:
Other Heated '` 4�tr y'' Base fee:
Mezzanine 4fAi Additional Section: r
Heated Basement Plan Check fee:
Unheated Basement t #,, i State Surcharge fee:
Other Unheated t a Pot Water Review fee: �_
t ,�t f F
Garage/Carport t t , SUBTOTAL / 1 /
Decks f el U/VAE+aph'\ee:
Other
� ::✓MAR ?ill? �Z(o
R5ceipt 1 Numaer: I i5at —
,`-'`°" Cash/Check Mtrr b r:
ESTIMATED COST(REQUIRED) /O & jcow/ut��C}OUNTY
i3 93
.Fair market value of all labor and materials foundat .OF CMNTT�EVELUPMENT 3_<s
Initials:
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