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Home My WebLink AboutBLD2012-00085 • • 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 #: BLD12-00085 Received Date 3/19/2012 SITE ADDRESS: 731 NO NAME RD Issue Date 3/19/2012 PORT LUDLOW, 98365 APPLICANT: ROBERT V COFER PHONE: (360) 732-7520 731 NO NAME RD PORT LUDLOW WA 983658780 T 16+ SUBDIVISION: Block: Lot: PARCEL NUMBER: 821063017 Section: 6 Township: 28N Range: 01 E CONTRACTOR: WASHINGTON ENERGY SERVICES CO PHONE: 206-282-4700 2800 THORNDYKE AVE W SEATTLE WA 98199 Contractor's License WASHIES9710B Expires 9/2/2013 OWNER, ROBERT V COFER PHONE: (360) 732-7520 if different: 731 NO NAME RD PORT LUDLOW WA 983658780 PROJECT DESCRIPTION: NEW DUCTLESS 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 3/19/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: ' l / - l Z 770 'J FinalApproval: 9 f ( - 1 Z l 513 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 BLD12-00085 ILDING PERMIT APPLICAN Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD12-00085 Received Date: 3/19/2012 SITE ADDRESS: 731 NO NAME RD PORT LUDLOW, 98365 OWNER: ROBERT V COFER PHONE: (360) 732-7520 731 NO NAME RD PORT LUDLOW WA 983658780 SUBDIVISION: Block: Lot: T 16+ PARCEL NUMBER: 821063017 Section: 6 Township: 28 N Range: 01 E CONTRACTOR: WASHINGTON ENERGY SERVICES CO PHONE: 206-282-4700 2800 THORNDYKE AVE W SEATTLE WA 98199 Contractor's License WASHIES971OB Expires 9/2/2013 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr NEW DUCTLESS HEAT PUMP TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION 5,465.00 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 Dated N Type Amount Paid By:- ----Date: Receipt: j p give /Date Permit $125.25 LYK 03/19/12 131551 Ov E D Plan Check $81.41 LYK 03/19/12 131551 q State Building Code $4.50 LYK 03/19/12 131551 MAR 1 1 2012 Total: $211.16 Jefferson County Planning & Building Department OG JEFFERSON COUNTY � ''\ DEPARTMENT OF COMMUNITY DEVELOPMENT v' "4 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax rS p www.co.jefferson.wa.us/commdevelopment ING Master Permit Application MLA: ((.V\ Project Description(include separate sheets as necessary): INSTALL 1 DAIKIN DUCTLESS HEAT PUMP MINI SPLIT SYSTEM Tax Parcel 82 063017 Property Number: Size: (acres/square feet) Site Address and/or Directions to Property: 731 NO NAME RD, PORT LUDLOW 98365 Property Owner(s)of Record: BOB COFER Telephone:360-732-7520 Fax: email: Mailing Address: 731 NO NAME RD,PORT LUDLOW 98365 Applicant/Agent(If different from owner): NORTHWEST PERMIT INC. Telephone:360-945-2787 Fax: 360-945-2091 email: NAIDAaNWPERMIT.COM Mailing Address: 1345 GULF RD,POINT ROBERTS WA 98281 What kind of Permit?(Check each box that applies ❑Building CD Variance(Minor,Major or Reasonable Economic Use) �] Demolition Permit lm Conditional Use[C(a),C(d),or C]** Single Family D Garage Attached/Detached Discretionary"D"or Unnamed Use Classification E Manufactured Home ❑ Modular DI Special Use(Essential Public Facilities)** Commercial* Et Boundary Line Adjustment n Change of Use ®Short Plat** El Address 1 8 Road Approach CI Binding Site Plan** Q7 Home Business ❑Cottagelndustry Di Long Plat** 0 Propane Ell Planned Rural Residential Development(PRRD)/Amendments** El Sign Di Plat Vacation/Alteration** lQ Allowed"Yes"Use Consistency Analysis D Shoreline MasterIR a x * �� R' Q7 Stormwater Management Di Shoreline Manageme S :• I dbplen Th\ lD Site Plan Approval Advance Determination(SPAAD)* Di Shoreline Managemer;7 Variance 0 Temporary Use Di Comprehensive Plan/ QC/Land Use District Map Amend/t)ent 0 Wireless Telecommunication* DI Jefferson County Shoreline WIT Prmarrymendment D Forest Practices Act/Release of Six-Year Moratorium ®Tree Vegetaion llequest. *May require a Pre—Application Conference **Requires a pi-feplication Conference 21 _ Please identify any other local, state or federal permits required for this Ipropoial, ;f1EF�of 1c]COUNTY DFPT OF COMMUNITY DFVFI OPMFNT DESIGNATION OF AGENT I hereby designate NORTHWEST PERMIT INC. to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date:I ,. (-- ,2 op_ By signing this applicati n 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 it's 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 alt 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 of the application that he or she wants prior notice. Signature.r��r_. Date: 3'51*^ 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-transferable responsibility for adhering o and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signatureq[w es-- - /, �Jbu__ Dater,--‘'- 2 0 t Z C:\Documents and Settings\caral•,l.ocal ticttings\Temporary Internet Files\OLK86\,Allister Permit Application 12.19-2011 .doe • • 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: WASHINGTON ENERGY SERVICES ( 800)398-4663 (Q)I MAILING ADDRESS: 2800 THORNDYKE AVE W SEATTLE 98199 EMAIL: 2800 THORNDYKE AVE W SEATTLE 98199 CONTRACTOR'S LICENSE WAINS NUMBER: WASHIES971 OB NUMBER PHONE ^' FAx: I-,— ARCHITECT/ENGINEER: I v -- — — -- — - — - MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New 0 Wood Existing: 0 Sewer tion 0 Steel Proposed: Bank ❑Community System 9/ Alteration/Remodel • AlterationlRemodel 0 Concrete (Total: Height 1 ElIndividual System SEP Permit# , ❑ Repair 0 Maso Other Bedrooms: Water Supply: ❑ Demolition Existing: Setback: 0 Private well 0 Two Party HEAT PUMP Proposed: 1 0 Public ELEC HEAT Heat: Total: `1 Name of System:�� If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current:I I Proposedl Number of ADA Parking Spaces:[ Number of occupants(includes owners,tenants,employees,etc) Current J Proposed I IBC Occupancy:I I IBC Type of construction:f Will you have Food Service?FeTR No I If this is a Propane Tank and/or Appliance Installation permit,mark ail items l;elow-that-aPPI1 ❑Underground Tank 1n Above ground Tank Size of Propane Tank:I , i p L� 0 Heat Stove ❑Cook Stove 0 Woodstove 0 Fireplace Insert 0 Hot Water Tank ❑'Peii ove O _I Is this appliance being installed in a Manufactured I Mobile Home'? kval/ N4 When applying for a permit to install a propane tank you must also submit a site plan showing al of the buildi . I .roperty lines, tank location and size,distances from the propane tank to all property lines,buildings andseptic system . . 'nents, Lincluding the reserve area. i ` I Square Footage Current Proposed For Office Use Only i 1EIGFitiB COUN Revision Main Floor Heated EH Bid App Review: r 01 OF COMMUNITY DFVE OPMENT 22"�Floor Heated — Consistency Review: Other Heated IIIIII Base fee: to 5 'a5 Mezzanine Additional Section: Heated BasementMI Plan Check fee: Q t Unheated Basement 111111 State Surcharge fee: Sv • Other Unheated Pot Water Review fee: Garage/Carport I SUBTOTAL Decks I I 911/Rd Approach fee: r Other TOTAL: $ a t l . ( — Receipt Number: I "j 155 Cash/Check Number: t S3 ESTIMATED COST(REQUIRED) ' Date: _ ' .Fair market value of all labor and materials foundation to finish Initials: C:',,Docomcnts and Settings\coral.,Local Settings\Tcmporarr Internet Files VOI.IKl6`,'Laster Permit Application 12-'9.2006.doc