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Home My WebLink AboutBLD2012-00123 • 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 #: BLD12-00123 Received Date 4/18/2012 SITE ADDRESS: 87 SCOTT CT Issue Date 4/18/2012 PORT LUDLOW, 98365 APPLICANT: WILLIAM D WEIR PHONE: 87 SCOTT CT PORT LUDLOW WA 983659302 1 SUBDIVISION: OAK BAY SHORT PLAT Block: Lot: PARCEL NUMBER: 821162011 Section: 16 Township: 28N Range: 01 E CONTRACTOR: HOOD CANAL HTG & COOLING INC PHONE: 360-375-4992 PO BOX 2940 BELFAIR WA 98528 Contractor's License HOODCHCO27LJ Expires 2/11/2013 OWNER, WILLIAM D WEIR PHONE: if different: 87 SCOTT CT PORT LUDLOW WA 983659302 PROJECT DESCRIPTION: REPLACEMENT GAS 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 4/18/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: r PtekC L- C' it- V/ `y 1 FinalApproval: 1.1 1- 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 eILDING PERMIT APPLICA1N BLD12-00123 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD12-00123 Received Date: 4/18/2012 SITE ADDRESS: 87 SCOTT CT PORT LUDLOW, 98365 OWNER: WILLIAM D WEIR PHONE: 87 SCOTT CT PORT LUDLOW WA 983659302 OAK BAY SHORT PLAT SUBDIVISION: Block: Lot: 1 PARCEL NUMBER: 821162011 Section: 16 Township: 28 N Range: 01 E CONTRACTOR: HOOD CANAL HTG & COOLING INC PHONE: 360-375-4992 PO BOX 2940 BELFAIR WA 98528 Contractor's License HOODCHCO27LJ Expires 2/11/2013 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI REPLACEMENT GAS FURNACE TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION 3,185.00 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 $97.25 LYK 04/18/12 131653 Plan Check $63.21 LYK 04/18/12 131653 State Building Code $4.50 LYK 04/18/12 131653 Total: $164.96 • • �goNco G� JEFFERSON COUNTY (':-4 DEPARTMENT OF COMMUNITY DEVELOPMENT "< ` 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax p . ww.co.jefferson.wa.us/commdevelopment t.....,,isv $INO w ��-, i Master Permit Application MLA: NO MUt�—t� Project Description(include separate sheets as necessary): 6Z2p1uC.ern�,A- oC S PUX&JAC Tax Parcel rq•1 ' I q e Property Size:V v� (pZ 0 lSize: (acres/square feet) Site Address and/or Directions to Property: t �� fl a,o• A- CA , ('&& L- of w Property Ownn,ers)of Record: T>1 1 t va tth., Telephone: �71D'- 7'53I- el 0 Fax: email: Mailing Address: >1 '(O•t �.� C (-1/43A 4824.it - . Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies Building r ■ „ - 1T i or,Major or Reasonable Economic Use) � Demolition Permit ! I , U �!, ,.iatis se[C(a),C(d),or C]** Elt Single Family ❑Garage i ' -• i- _.^ "D"or Unnamed Use Classification ❑ Manufactured Home ❑ Modulair .-/ , ❑1 Speci. Essential Public Facilities)** ❑ Commercial* ( ''I''I f �1 �q 1 ,- ��E1.. oun • _ Adjustment ❑ Change of Use Ian** ❑ Address ❑ Road A1ptoabh ❑Bindi El Home Business El Cottagekndu- ❑Lon. " : * ❑PropaneR�-anned Rur.l Residential Development(PRRD)/Amendments** JEFFERSON COU.�. ❑ Sign ■ P a1. -tio Alteration** CEPT.OF COfJIMUNITY DF-I . ter Program Exemption/Permit Revisions** El Allowed"Yes"Use Consistency Analysia ❑Stormwater Management - 0 Shoreline Management Substantial Development** ❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Variance ❑Temporary Use El Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* ❑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: � V,,l-.p� ,4 DD SIIGNATION OF AGENT I hereby designate ((''UL• ��,,.,,""71 .' itt 1 to act as my agent in matters relating to this application for permit(s). '1[ OWNER SIGNATURE Date: V`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 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 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 an - ht of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any required later insp ctionS. a s ac ss and right of entry will be assumed unless the applicant informs the County in writing at the time of the appli,cat o that he or she is pr r noti "/lj //.Z Date: rill j/ 'X Signature: 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 SA. 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 ith , Jeff rson County development code.The Applicant acknowledges that he,she or it holds individual and non-transf rable r ponsibility for a er g to a complying with the ESA. The Applicant has read this discjai emer 2and signs and dates it below. Signature: ,,,— �/ Date: II ( 6/( — ll 1 C:\Documents and Settings\caral\Local Settings\'l emporary Internet Files\01,K86\Master permit Application 12-19-2(16.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: G NERA CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: (111\1/4CLQOWL-6 M 4" c'e1k c )71s--ttet i a ( ) 15~ MAILING ADDRESS: 1)0 VA "KJ '7 EMAIL: T l� et.0\iw ten CONTRACTOR'S LICENSE 49� WAINS NUMBER: I4tooeRC, --t(,-T3 NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New Wood Existing: Sewer Addition Steel Proposed: Bank Community System Alteration/Remodel Concrete Total: Height: _ Individual System Repair - Masonry SEP Permit# Demolition _ Other: Bedrooms: Water Supply: Existing: Setback: Private well Two Party Type of Heat: Proposed: _ Public Total: Name of System: If this is a Commercial Protect 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: ❑Underground Tank 0 Above ground Tank Size of Propane Tank: ❑Heat Stove 0 Cook Stove 0 Woodstove 0 Fireplace Insert 0 Hot Water Tank ❑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 Current Proposed For Office Use Only Amount Revision Main Floor Heated EH Bid App Review > 2"0 Floor Heated Consistency Review: Other Heated Base fee: q- 25 Mezzanine Additional Section: Heated Basement `± - CO E7.7j J \J �: �S SJ Unheated Basement State S1 ch�� e fee: p Other Unheated j �' : P?1, 1 ': Pot Wa,e' Fr view fee: t Garage/Carport L% ,I iI BTOTAL // JEf IERSON e6U'vlg11/Rd Approach fee: Decks DEPT.aE COMMUNITY DFVEI OPMENT Other TOTAL: $ I(P`I Cj c 4k.).,‘,-0-Y1C.e Yj,,,,t ceps N 3\ >'" Receipt Number: "`'"`NN'"''"''�� Cash/Check Number: ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish Initials: C:\Documents and Settings\caral\Local Settings\Temporary Internet Files\t)1.K86\Master Permit Application 12-19-2006.doc i % i GA RA-tat _ STDN(f f ,JaD • �° V��1 T=VRIJACW • �_�c,_v5 - ue/VACE azaM 1 y CSC--k/A l..{> ► at YeNTS -0 (1.00fr1 _ _ M .- 4 - OP-z'P�� EL.1 a,(2. e..? wow. U P S /.. 1-- -- --- .--- - OP ro 1"11.i N L�V E"L O��i C,G ,4MILLf- 12,0-0P- �'k �� -- 7 5 _ Cr- L_O fe_ . Le... .L � ' (A o4�,—G. g'A i -To S) -' �.T 1,....�J ill—f�l.rJ 'ffH CHI {IVE 1 !L r Ili APR 1 8 2,, J C.\' JEFFERSON COUNTY • DFPT.OF COMMUNITY DEVELOPMENT