HomeMy WebLinkAboutBLD2012-00182 •
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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 *: BLD12-00182 Received Date 6/14/2012
SITE ADDRESS: 95 SEAWAY PL Issue Date 6/14/2012
PORT LUDLOW, 98365
APPLICANT: HUGH M PENNINGTON PHONE: 360-437-9628
CHAROLTTE A PENNINGTON
95 SEAWAY PL
PORT LUDLOW WA 98365-8751 64
SUBDIVISION: TEAL LAKE VILLAGE Block: Lot:
PARCEL NUMBER: 998700064 Section: 21 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, HUGH M PENNINGTON PHONE: 360-437-9628
if different: CHAROLTTE A PENNINGTON
95 SEAWAY PL
PORT LUDLOW WA 98365-8751
PROJECT DESCRIPTION: NEW 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 6/14/2013.
REQUIRED INSPECTIONS:
Tank/Line/Appliance:
FinalApproval: \ 4. �,)Ld IL
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
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BUILDING PERMIT APPLICATION B Review
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD12-00182 Received Date: 6/14/2012
SITE ADDRESS: 95 SEAWAY PL
PORT LUDLOW, 98365
OWNER: HUGH M PENNINGTON PHONE: 360-437-9628
CHAROLTTE A PENNINGTON
95 SEAWAY PL
PORT LUDLOW WA 98365-8751 TEAL LAKE VILLAGE
SUBDIVISION: Block: Lot: 64
PARCEL NUMBER: 998700064 Section: 21 Township: 28 N 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
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP NEW HEAT PUMP
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP MEC
VALUATION 3,200.00 MAIN:
CODE EDITION: 2009 ADD'L: HEAT TYPE:
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total:
Routing Date:
Type Amount Paid By: Date: Receipt: pr ved/_Date p r
1 1. '
Permit $97.25 LYK 06/14/12 134914
Plan Check $63.25 LYK 06/14/12 134914 JUN t4-
State Building Code $4.50 LYK 06/14/12 134914 Jefferson County planning
Total: $165.00 & Building Department
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°14 coo. JEFFERS•COUNTY 4
A DEPARTMENT OF COMMUNITY DEVELOPMENT'
4--'
621 Sheridan Street• Port Townsend •Washingtor 98368
360/379-4450 • 360/379-4451 Fax
\tgs411-NOtip www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: N 0 M U
rojject D scripti n(include separate sheets s necess ry):
y
Tax Parcel Number. 9 q 8 1000(oLll Prop,lrl,Size: (acres/square feet)
Site Address and/or Directions to Prope
q f o L ?t f A Lc, A\m.) D ek sr u t
Property Owner(s)of Record: •
Telephone:' L Fax: email:
Mailing Address: ._. —_- ` �
Applicant/Agent(if different from owner): (L' And LX A�-'l v
Telephone:(,��; `I - a. k C ) Fax;!,1C- C '��' 0 ' j 1 email', 1 YYu 1-r��11 i.M.t1.o-t'l
Mailing Address: j �� A.N( ` L 04 a., •'‘ 4. _.. (..0 4 .. (1 , ry-1
What kind of Permit?(Check each box that applies 1 f1 7 II V
❑Building ❑Critical Areas Stewardhj Flan
❑ Demolition Permit ❑Variance(Minor,Majorgr�F7easonable Economic Use)
mingle Family ❑Garage Attached/Detached 0 Conditional Use[C(a),C(d),or C 'I"'
CI Manufactured Home 0 Modular 0 Discretior,ary"D"or Unnamed UWB'Clas� JIlisifibat aitY4
❑ Commercial* 0 Special Use (Essent[alJPuj lic Facilities)**
❑ Change of Use ❑Boundary Line Adju$tmenti
❑ Address ❑ Road Approach ❑Short Pia '" I JEFFERSON COUNTY
❑Home Business 0 Cottage Industry CI Binding Site Plan"'l�FPT OF COMMUNITY DEVELOPMENT
❑Propane 0 Long Plat"'
❑Sign 0 Planned Rural Residential Development(PRRD)/Amendments'"
❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacelic n/Alteration"
❑Stormwater Management ❑Shoreline N aster Program Exemption/Permit Revisions**
❑ Site Plan Approval Advance Determination(SPAAD)' ❑Shoreline N anagement Substantial Development"
❑Temporary Use ❑Shoreline N anagement Variance
❑Wireless Telecommunication' ❑Compreh r sive Plan/UDC/Land Use District Map Amendment
❑Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson C aunty Shoreline Master Program Amendment
*May require a Pre—Application Conference 0 Tree Vegetation Request
**Re El lies a Pre-Application Conference
Please identify any other local,state or federal permits required fc r this proposal, if known:
D SIGNATION OF AGEIIT
I hereby designate J to act as my agent in matters relating to/ -�this application for permit(s).
OWNER SIGNATURE "-A , 7 r — Date: b D/..`-
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 liabilitih,s,,judgments,court costs,reasonable attorneys fees and
expenses which may in any way accrue against Jefferson County as a result of or in cor sequence of the granting of this permit.
I further agree to provide access and right of entry to Jefferson County and its employee a, 'opresentatives or agents for the sole purpose of application
review and any required later inspections. taffs access and right of entry will be assui at a unless the applicant informs the County in writing at the
time of the appl ' n t the or she w prior noti _� �u �
Signature: O^'� .__._ Date: l "� �" /f-2 '
The action or actions Applicant will undertake as a result of the issuance of this permit rr a; negatively impact upon one or more threatened or
endangered species and could lead to a potential"take"of an endangered species as thDs::terms are defined in the federal law known as the
"Endangered Species Act"or"ESA."Jefferson County makes no assurances to the appl c;it 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.Th a Applicant acknowledges that he,she or it holds individual
and non-transfera re onsibility t r/dhering'tQQ complying with the ESA. The Ap all:.ant has read this discla er and signs and dates it below.
Signature: _..._ Date: /-:
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
IP
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BUILDER STATEMENT
The signer of this statement does hereby certify that they are the Owners of the parcel refute iced 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 ANUFACTUREDn HOME INSTALLER: Pilo IE: FAX:
c t1,v�c�-r� l at'f� (e i'c )4 41 -�1 cz, (a!Ole q' 30-4 3'
MAILING ADDRESS:y`f) 3 1 44 -'c Eel I 1.:, rn A e �r` .,1a.A
` _
CONTRACTOR'S LICENSE D .e u -Y�� vb- - t, A C 4
- �_ iil,IS (,c m
NUMBER: NI IM 99ER
ARCHITECT/ENGINEER: P+10,IE ( ) Fax:( )
MAILING ADDRESS: E,4A 1.
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New ❑ Wood Existing: _.• ri Sewer
❑ Addition ❑ Steel Proposed: Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: _._ Height: D Individual System
❑ Repair 0 Masonry SEP Permit#
❑ Demolition 0 Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well D Two Party
Type of Heat: Proposed: _.._.• D Public
Total: _... Name of System:
l _ l
If this is a Commercial Project you must answer the following:
Number of Parking Spaces: Current: Proposed: Number of ADA -- p s
Number of occupants(includes owners,tenants,employees,etc) Current P I t, C ,
IBC Occupancy: IBC Type of construction: Will you have Foot V 7 Yes / No
If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply:,1
I Underground Tank I Above ground Tank Size of Propane fk,nk: f! N i 4 2012
i Heat Stove I Cook Stove I Woodstove I Fireplace Insert I Hot Water"ank I Pellet Stove Ijther I //
Is this appliance being installed in a Manufactured/Mobile Home? Yes / ND j 1
When applying for a permit to install a propane tank you must also submit a site plan showing all of the ifrvifziliSf2 QIN13(roperty
lines,tank location and size,distances from the propane tank to all propea ty Pines,buildings a04,4471 -:., -nd gt9Wife NDl f )iiiel7
including the reserve area. y
itft..„1?; . ,.
Square Footage Current Proposed Fo �k ,1.,, :(i .t_ ::`f .:, " ��I rw* ; 's1'd ..-: _,_
Main Floor Heated 'i ; ` EH Bid App F�.e iiew:
' �
2na Floor Heated '' r�:* Consistency Ike view:
Other Heated �`,€ tN°�i . Base fee:
Mezzanine • ',1,! '' Additional Settiun: t
Heated Basement r�`" �;: Plan Check fee:
Unheated Basement .0 v• r State Surcha•y tee: 4.
Other Unheated V''',:-. Pot Water R :vi ww fee.
Garage/Carport StiFI.OTAL
Decks • :. '`F I 911/Rd Appr)aCh fee.
IIr _..
Other ri rt{r TOTAL: $ U
. �`14yf f '� 1 (�
tA# Ltd. .._..
Receipt Number: 1 3 4-I 14
" ,,,,, z_, Cash/Check N,.imber 2ZZa,
a
ESTIMATED COST(REQUIRED) ' ')-,gtfs Date: '--I ��
.Fair market value of all labor and materials foundation to finish --
Initials:
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G:\PermitCcnter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc