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Home My WebLink AboutBLD2012-00192 r 0 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 #: BLD12-00192 Received Date 6/21/2012 SITE ADDRESS: 1280 DOSEWALLIPS RD Issue Date 6/21/2012 BRINNON, 98320 APPLICANT: ROBERT CROWELL PHONE: 360-796-4232 CLAUDETTE CROWELL 1280 DOSEWALLIPS RD BRINNON WA 98320-9643 T 51+ SUBDIVISION: Block: Lot: PARCEL NUMBER: 602341003 Section: 34 Township: 26N Range: 02W 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, ROBERT CROWELL PHONE: 360-796-4232 if different: CLAUDETTE CROWELL 1280 DOSEWALLIPS RD BRINNON WA 98320-9643 PROJECT DESCRIPTION: 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 6/21/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval. - -6 7//5 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 tILDING PERMIT APPLICA1N BLD12-00192 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD12-00192 Received Date: 6/21/2012 SITE ADDRESS: 1280 DOSEWALLIPS RD BRINNON, 98320 OWNER: ROBERT CROWELL PHONE: 360-796-4232 CLAUDETTE CROWELL 1280 DOSEWALLIPS RD BRINNON WA 98320-9643 SUBDIVISION: Block: Lot: T 51+ PARCEL NUMBER: 602341003 Section: 34 Township: 26 N Range: 02 W 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 DUCTLESS HEAT PUMP TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION 2,890.00 ADD'L: HEAT TYPE CODE EDITION: 2009 HEAT BASE: HEAT TYPE: OCCUPANCY: 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 By: Date: Receipt: Approved/Date Permit $83.25 LYK 06/21/12 134931 Plan Check $54.11 LYK 06/21/12 134931 State Building Code $4.50 LYK 06/21/12 134931 Total: $141.86 � 7 �� , 1 q .i c 0 ;/ c:N- \\°�� JEFFERSON COUNTY ,.., . kiiii..; 1 DEPARTMENT OF COMMUNITY DEVELOPMENT_ 621 Sheridan Street• Port Townsend •Washingt�:r 98368 360/379-4450 • 360/379-4451 Fax �<yS,�NO�p$ www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: MO MCP E lb Project Description(include sep rate ,she t as necessary. .1{. v ` , C, 1 Tax Parcel Number: (..002 t- 100 3 Prop:rt r'Size: (acres/square feet) Site Address and/or Directions to Property: - - CD . LuakAi C? N- tt : n Property Owner(s)of Reccord: W t Telephone: -�1�Q • . Fax: email: Mailing Address: t�rYl� (L;) i.V--<__ _ l` ,� Appi cant/ ent(if different from owner): FYI Telephone: ��1`,x Y C� Fax email:� Mailing Address:�t �P C _ l LA.�H'1-� `j` %1 �4�k , 4,Li m What kind of Permit?(Check each box that applies ❑Building ❑Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance ;Minor,Major or Reasonable Economic Use) Single Family ❑Garage Attached/Detached ❑Conditional Use[C(a),C(d),or C]*` ❑ Manufactured Home 0 Modular ❑Discretior al�, "D"or Unnamed Use Classification ❑ Commercial* 0 Special USE (Essential Public Facilities)** ❑ Change of Use 0 Boundary L lie Adjustment ❑ Address ❑Road Approach ❑Short Pia * ❑Home Business ❑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 Vacalie n/Alteration** ❑Stormwater Management 0 Shoreline N.aster Program Exemption/Permit Revisions** ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development** ❑Temporary Use 0 Shoreline N anagement Variance ❑Wireless Telecommunication* ❑Compreh arr3ive Plan/UDCiLand Use District Map Amendment ❑Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson C:runty Shoreline Master Program Amendment *May require a Pre-Application Conference 0 Tree Veg::t non Request **Re Lilies a Pre-Application Conference Please identify any other local,state or federal permits required fr,r this proposal, if known: (,� DESIGNATION OF AGENT I hereby designate \) O to act as my agent in matters relating to this application for permit(s), OWNER SIGNATURE. ✓ <- CA-- /�� a (�C� // Date: iL c j " - By signing this application form,the owner/agent attests that the information provided here n,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 mad a 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 liabilitlris,judgments,court costs,reasonable attorneys fees and expenses which may in any way accrue against Jefferson County as a result of or in copse auence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employee •epresentatives or agents for the sole purpose of application review and any requir later ins ctions. Staffs access and right of entry will be asswled unless the applicant informs the County in writing at the time of the appl' at he-o nts priori1 . Signature: .� b v rs c ` '� -2 � Lei (--1/ _ Date: (c' The action or actions Applicant will undertake as a result of the issuance of this permit n negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered species as th)se terms are defined in the federal law known as the "Endangered Species Act"or"ESA."Jefferson County makes no assurances to the appl cr 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 co pliance with the Jeffe n County development code.Ths Applicant acknowledges that he,she or it holds individual and non-transf I respon✓ili r adherin d complying with the ESA. The Ap,li,:ant has read this disclaimer and signs and dates it below. Signature: �y( �Q_44 J e--7/ Date: 6 2 G:\PermitCenter\###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 refeie 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 ANUFACTURED HOME INSTALLER: PFIo IE: FAX: c � � — %► (c(T ZO )y q: -1A m, ( ote q' '3 0 q?)`j MAILING ADDRESS:y\,z) 3 1 -Z.. EIIAI.:AIL MA-r LZ:4U.T.{"I've -r• Y.\ ia•-k r.c? . CONTRACTOR'Sh'(e LICENSE x4.v\ —�_a, (.�\ L./ l VS f. . NUMBER: Y NI IMEER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: O New ❑ Wood Existing: __ D Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel 0 Concrete Total: Height: ❑ Individual System O Repair 0 Masonry SEP Permit# O Demolition ❑ Other: Bedrooms: Water Supply: —�" Existing: _,_ Setback: ❑ Private well 0 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: I U• nderground Tank I Above ground Tank Size of Propane TEink: I Heat Stove I Cook Stove I Woodstove I Fireplace Insert I Hot Water''ank I Pellet Stove I Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / No When applying fora 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 AO `.°- L ,. ;,', Arti�ntit'tt...; ,�.},;, it06 Y �-' . `^ Main Floor Heated tii ,,,, t EH Bld App F,e riew: 2'Floor Heated tip try z Consistency i2eview: Other Heated r a� . Base fee: 2-5 Mezzanine Additional Section: Heated Basement + s4yigiii Plan Check iiae 5q Unheated Basement - . t DA State Surcha fee: „triiiititiOther Unheated 1t,,,t . s : Pot Water R€visw fee: f . Garage/Carport ffi. SUBTOTAL Decks ( 911/Rd Appr,Tach fee: 4 Other �+�� `' n . ai'�r "'TOTAL: $ '4 •sr, - Receipt Number: ` 93 43 k Cash/Check Number: = Z3 ESTIMATED COST(REQUIRED) Date: �,`_ .Fair market value of all labor and materials foundation to finish (0-:� S_____ ed C'q `, Initials: ---- G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc