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Home My WebLink AboutBLD2012-00173 • • 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 #: BLD12-00173 Received Date 6/7/2012 SITE ADDRESS: 6492 COYLE RD Issue Date 6/7/2012 QUILCENE, 98376 APPLICANT: WALTER H PEDERSON PHONE: 360-765-3476 PEGGY L PEDERSON PO BOX 9 QUILCENE WA 983760009 TX 6 SUBDIVISION: Block: Lot: PARCEL NUMBER: 701274008 Section: 27 Township: 27N Range: 01W CONTRACTOR: BRENNAN HTG &A/C LLC PHONE: 206-248-7900 4601 S 134TH PL SEATTLE WA 98168 Contractor's License BRENNHA971 R9 Expires 12/29/2013 OWNER, WALTER H PEDERSON PHONE: 360-765-3476 if different: PEGGY L PEDERSON PO BOX 9 QUILCENE WA 983760009 PROJECT DESCRIPTION: NEW HEAT PUMP i €rAS EDrI C , Lu165, i. AA 120 GAL Papp 1k. 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 6/7/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: /v-2 o - I Z FinalApproval: 62-Z0 -%Z� BUILDING INSPECTION HOT-LINE 379-4455. Request must be received by 7am the day the inspection is needed Office Hours 9:00 a.m. -4:30 p.m. MONDAY-THURSDAY HOT LINE AVAILABLE 24 HOURS A DAY I:\F_BLD_Permit_Propane.rpt 10/29/19 IILDING PERMIT APPLICATIllk BLD12 Review T Typype: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD12-00173 Received Date: 6/7/2012 SITE ADDRESS: 6492 COYLE RD QUILCENE, 98376 OWNER: WALTER H PEDERSON PHONE: 360-765-3476 PEGGY L PEDERSON PO BOX 9 QUILCENE WA 983760009 SUBDIVISION: Block: Lot: TX 6 PARCEL NUMBER: 701274008 Section: 27 Township: 27 N Range: 01 W CONTRACTOR: BRENNAN HTG &A/C LLC PHONE: 206-248-7900 4601 S 134TH PL SEATTLE WA 98168 Contractor's License BRENNHA971 R9 Expires 12/29/2013 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION NEW HEAT PUMP, C7<15 2NAC L&.k. s *Iy'c (2 D Gm. f jADL TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC VALUATION MAIN: CODE EDITION: 2009 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: 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 Bv: Date: Receipt: Approved/Date Permit $139.25 LYK 06/07/12 131785 Plan Check $90.51 LYK 06/07/12 131785 State Building Code $4.50 LYK 06/07/12 131785 Total: $234.26 e°14" % JEFFERSON COUNTY • 0a �� I DEPARTMENT OF C ` � COMMUNITY DEVELOPMENT �� 621 Sheridan Street• Port Townsend •Washington 98368 4. , ,, 360/379-4450 • 360/379-4451 Fax �`� www.co.jefferson.wa.us/commdevelopment oiciN Master Permit Application MLA: 1 Y C,P- eG3 Project Description(ind de separate'sheets as necessa )• (l `,--),IN l 1 1-4- y ...) Tax Parcel Number: 7( 7 1 Property Size: (acres/square feet) Site Address and/or Directions to Property: • . •. .I -<--- �Z A ‘ (' i Property Owner(s)of Record: L3 0.l \/ �- . ( L'f C;,--ATelephone:a�(' 0 - • / Fax: email: Mailing Address: COX Q v'i1 C .c,n l 0 o. (-4 ge l i. Applicant/Agent(if different from owner): �t.L p� a -A-1 Y�p1 Telephone: C�c ,.� Fax.: l ` � email: a i r'YU 4' L'i �)''• '...n Mailing Address:'s(1 `� j74\� V ( i PD l k4. P> co r What kind of Permit?(Check each box that applies ❑Building 0 Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use) ,,mingle Family ❑Garage Attached/Detached ❑Conditional Use[C(a),C(d),or C]** ❑ Manufactured Home 0 Modular ❑ Discretionary"D"or Unnamed Use Classification ❑ Commercial* 0 Special Use(Essential RubtiCil )l*v ❑ Change of Use 0 Boundary Line Adjustment ❑ Address ❑ Road Approach 0 Short Plat** ❑Home Business 0 Cottage Industry 0 Binding Site Plan** ❑Propane ❑Long Plat" I H is-e (,,_ ) ❑Sign 0 Planned Rural Residential D rit ORRD/Am n nts** ❑Allowed"Yes'Use Consistency Analysis 0 Plat Vacation/Alteration** !J ❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revision **' ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development** ❑Temporary Use ❑Shoreline Management Variance ❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference ❑Tree Vegetation Request **Requires a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal, if known: 1 DESIGNATION OF AGENT I hereby designate 6{AA-A..4L n ,�(/- k y\_O1 to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE ljt i fr.i •-r , ,9 ,71e-_T Date: `C I 1) I • 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 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/sh�w is prior notice. V Signature: l . /� � ��'Z/ Date: ' 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 complian.,e with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-trans ble responsibif fah?ad Bring to and complying with the ESA. The Applicant has read this disclaimer andns isig and dates it below. Signature: fr, ^2 _ Date: . , G:\PemritCenter\###FORMS###\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 assuming the responsibility of the General Contractor for the proposed project. Signature: Date: ENERAL CONTRACTOR OR ANUFACTURED HOME INSTALLER: PHONE: FAX: A ► �-r, ( ov )y� -au t, ( Ou, (-1' V) MAILING ADDRESS:y��\ i�� " 4'--(— EMAIL: on A•t icb(t4A.a‘._4-,-. ki a,-h 1' . CONTRACTOR'S LICENSE s(_. v-\&.S°---(V�k. (a\ q�� INS f,-C in NUMBER: Y NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New CI Wood Existing: H Sewer ❑ Addition ❑ Steel Proposed: Bank 0 Community System .-Alteration/Remodel 0 Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: I Private well ❑ Two Party Typag Prof Heat: Proposed! ❑ Public I {(' 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 U• nderground Tank 1 Above ground Tank Size of Propane Tank: 1 Heat Stove 1 Cook Stove I Woodstove I Fireplace Insert 1 Hot Wat Is this appliance being installed in a Manufactured/Mobile Home? Yes �_� � I When applying for a permit to install a propane tank you must also subm I Ira GJ t ebthlldings,all property lines,tank location and size,distances from the propane tank to all properly lines,buildings and serf c ystern components, including the reserve area. i j R 7y' 'F1 .P k r. i :i� :J 3 ,, may,, Square Footage Current Proposed iFi? ;t.t,=`,,! ?= ' . ` 4 ti 01+° In ., . , l'n Main Floor Heated .' , r EH Bld App Review: 1 iv t~ Yx IFF( SON COUNTY 2na Floor Heated to "'''4:r<•' Consistency Review: " !1NITY OFVFLOPMENT Other Heated rK- Base fee: Mezzanine 1,'''i' .,; Additional Section: Heated Basement }s rr` +,x�.� '} Plan Check fee: (i �- I � Unheated Basement * State Surcharge fee: - . 4 t,a° •�! Other Unheated '�s a ,t Pot Water Review fee: Garage/Carport 44 SUBTOTAL .meµ K1. S;. Decks '� 01 �+ll 911/Rd Approach fee: +sa;mow Other s„-tT. 'TOTAL: $ 3L 7 Receipt Number: I 3 r Mtn L � °R ..' Cash/Check Number: .' , ESTIMATED COST(REQUIRED) Date: 1-7 .Fair market value of all labor and materials foundation to finish £ Initials: ' - � G:\PermitCentcr\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc r 1 I 1 ' ' ` ' JuN - 7 2012 --/- 1:::::3 ..„...„.,_ ! ii L, 1 JEFFERSON COUNTY DEPT OF COMMUNITY DEVELOPMENT