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Home My WebLink AboutBLD2012-00177 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 #: BLD12-00177 Received Date 6/12/2012 SITE ADDRESS: 71 CAMANO LN Issue Date 6/12/2012 PORT LUDLOW, 98365 APPLICANT: CAROL GALVAN TRUSTEE PHONE: 360-437-9801 KAREN BLOOMER TRUSTEE 71 CAMANO LN PORT LUDLOW WA 98365-9627 45 SUBDIVISION: PORT LUDLOW NO 2 AREA 2 Block: Lot: PARCEL NUMBER: 990600245 Section: 9 Township: 28N Range: 01 E CONTRACTOR: BRENNAN HTG &A/C LLC PHONE: 206-248-7900 4601 S 134TH PL SEATTLE WA 98168 Contractor's License BRENNHA971R9 Expires 12/29/2013 OWNER, CAROL GALVAN TRUSTEE PHONE: 360-437-9801 if different: KAREN BLOOMER TRUSTEE 71 CAMANO LN PORT LUDLOW WA 98365-9627 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 6/12/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval:1 Co 2�'`�- J 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 BIIILDING PERMIT APPLICATI, BRD e2N00pe 7 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD12-00177 Received Date: 6/12/2012 SITE ADDRESS: 71 CAMANO LN PORT LUDLOW, 98365 OWNER: CAROL GALVAN TRUSTEE PHONE: 360-437-9801 KAREN BLOOMER TRUSTEE 71 CAMANO LN PORT LUDLOW WA 98365-9627 PORT LUDLOW NO 2 AREA 2 SUBDIVISION: Block: Lot: 45 PARCEL NUMBER: 990600245 Section: 9 Township: 28 N Range: 01 E CONTRACTOR: BRENNAN HTG &NC LLC PHONE: 206-248-7900 4601 S 134TH PL SEATTLE WA 98168 Contractor's License BRENNHA971R9 Expires 12/29/2013 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr NEW DUCTLESS HEAT PUMP TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION 2,500.00 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 Bv: Date: Receipt: Approved/Date Permit $83.25 LYK 06/12/12 131797 Plan Check $54.11 LYK 06/12/12 131797 State Building Code $4.50 LYK 06/12/12 131797 Total: $141.86 . , lit 4 v/. e(,, • ms). „e 00,. JEFFERSONbUNTY 4 , • IV a DEPARTMENT OF COMMUNITY DEVELOPMENT `4 621 Sheridan Street• Port Townsend •Washingtc;n 98368 360/379-4450 • 360/379-4451 Fax k,g4S ,SO$ www.co.jefferson.wa.us/commdevelopment a Master Permit Application MLA: 100 1) f • Project Description(inc a sepa a sheets as cessary): A 0 C41-t (-1) ry\--9 Tax Parcel Number: ( C7)( S Pro r 'Size:`°[ ` ptrt) (acres/square feet) Site Address and/or Directions to Property: C& Ln of-A- Lv \ \ ouL3 Property ner(s)of Record: ' OA Telephone`C • 4?3r • t d Fax: email: Mailing Address: Applicant/Agent(if!diferent from owner): S3V(- 01 &:•k Telephony �i�D `t tj [�(1 F• • email: 01 ). ")V ANA,\.o.-'\ktA.,l-tT Mailing Address: ts,\ r2,L A e.., U.''� (x-- Q c 1 le . co What kind of Permit?(Check each box that applies ❑Building 0 Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance 'Minor,Major or Reasonable Economic Use) . ingle Family ❑Garage Attached/Detached 0 Conditional Use[C(a),C(d),or C]** ❑ Manufactured Home 0 Modular 0 Discretioraiy"D"or Unnamed Use Classification ❑ Commercial* 0 Special USE (Essential Public Facilities)** ❑ Change of Use 0 Boundary L ne Adjustment ❑ Address 0 Road Approach 0 Short Plal *` ❑Home Business 0 Cottage Industry 0 Binding Site Plan** ❑Propane 0 Long Plat*• ❑Sign 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacatic n/Alteration** ❑Stormwater Management 0 Shoreline N aster Program Exemption/Permit Revisions** ❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline N inagement Substantial Development** ❑Temporary Use 0 Shoreline N a3nagement Variance ❑Wireless Telecommunication* 0 Compreher sive Plan/UDC/Land Use District Map Amendment ❑Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson C:runty Shoreline Master Program Amendment *May require a Pre—Application Conference 0 Tree Veg at,)tion Request **Rem Tres a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal, if known: DESIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE ,^ Date: ,' / - - /•) 4-- By signing this application form,the owner/agent attests that the information provided heien,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 mach I ry, 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 Ilabllitk,s,judgments,court costs,reasonable attorneys 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, •epresentatives or agents for the sole purpose of application review and any requir later inspections. Staffs access and nght of entry will be assume()unless the applicant informs the County in writing at the time of the applicatio hat he qr she wants prior notice. Signature: Y_ _ -- .___— Date:Daaaartee:: S ' k/ Z The action or actions Applicant will undertake as a result of the issuance of this perrnit e a el t1 \/. -threatened or endangered species and could lead to a potential"take"of an endangered species as th e 1 -• •• , - z.r•r, • •-i known as the "Endangered Species Act"or"ESA."Jefferson County makes no assurances to the appl cr:?t that the actions that will be un(_ ken because this permit has been issued,will of violate the ESA. Any individual,group or agency can file lawsuit on behalf of an endangeir pecies regarding your action(s)even if you a pliance with the Jefferson County development code.Th s i ipplicant acknowledg6S)t he,I- •_ •r it holds individual and non-transferabje r9spon ibility for adhering to and complying with the ESA. The Ap:)h;ant has read this disclaimer art4�s and dates it below. Signature: C _ Date: I ) (:i _ JEFFERSON COUNTY DEPT.OF COMMUNITY DEVELOPMENT G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc s • • BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel refeieiced 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 A,NUFACTURED HOME INSTALLER: Pi.iO•NE: FAX: c I L (L()1D )L , c, 02104 (- '?3 0 ?)5 MAILING ADDRESS:y\..c) 3 ,1 • 44 Er IA l': CIA OA A-t ZOh f t.r\,t1.z-rN �11 o,•-h . CONTRACTOR'S LICENSE `n:e.u\.Y\ — _I, A J l� ql tis C,e tyr, NUMBER: NI IMfIER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMI. t. Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: Ci Sewer ❑ Addition ❑ Steel Proposed: .__. Bank ❑ Community System .❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: [1 Private well ❑ Two Party Typgpf He t: Proposed: ❑ Public l t C. t 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: V/ill you have Food Service? Yes / No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: i Underground Tank i Above ground Tank Size of Propane Tank: i Heat Stove I Cook Stove I Woodstove I Fireplace Insert 1 Hot Water•artk I Pellet Stove i Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / ND 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. t5 .E;:'` a' isr ,a "4 r *',' �" it e = ".'�t- Square Footage Current Proposed ,F*jp_ , �, . ;, i , , print_: . isibrli: Main Floor Heated Yt EH Bid App F:e dew:r ` _ Oa Floor Heated '' O: w�, ConsistencyRE view: s" lar _ Other Heated WNk Base fee: Mezzanine =gyp i- , }, Additional Sect:o7n: -f • Heated Basement ;k j f r ' Plan Check Fi•r,. ' 5 jL\- II Unheated Basement t; i �j: �t State Surcha'g fee: C, Other Unheated Pot Water Review fee: 1 Garage/Carport ''s .+' r"... Si16TOTAL i fi rj +lr�y5:� T Decks 5@ t 911/Rd Approach fee: Other � ��" TOTAL: $ y11Receipt Nurrtter: I ' 's 1.r °:, Cash/Check Number: ' ESTIMATED COST(REQUIRED) 4 7 , . Date: Ni O1Z .Fair market value of all labor and materials foundation to finish u Initials: JEFFERSON COU TY _DEPT.OF COMMUNITY DEV MFNT G:\PermitCenter\###FORMS###\DRD FORMS\Master Pemnt Application 5-29-08.doc • as\.„ h F S I cG �T \.