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Home My WebLink AboutBLD2012-00201 . • 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#: BLD12-00201 Received Date 7/5/2012 SITE ADDRESS: 650 RAINIER LN Issue Date 7/5/2012 PORT LUDLOW, 98365 APPLICANT: LAURIE DOKKEN PHONE: 360-821-2649 650 RAINIER LN PORT LUDLOW WA 98365-9775 54 SUBDIVISION: PORT LUDLOW NO. 3 Block: Lot: PARCEL NUMBER: 990700054 Section: 17 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, LAURIE DOKKEN PHONE: 360 821 2649 if different: 650 RAINIER LN PORT LUDLOW WA 98365-9775 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 7/5/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: ` " (Z (V FinalApproval: / -l4 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 \\tidemark\data\forms\F_BLD_Permit_Propane.rpt 7/5/2012 ILDING PERMIT APPLICAT.1 BLD12-00201 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD12-00201 Received Date: 7/5/2012 SITE ADDRESS: 650 RAINIER LN PORT LUDLOW, 98365 OWNER: LAURIE DOKKEN PHONE: 360-821-2649 650 RAINIER LN PORT LUDLOW WA 98365-9775 PORT LUDLOW NO. 3 SUBDIVISION: Block: Lot: 54 PARCEL NUMBER: 990700054 Section: 17 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 BRENNHA971 R9 Expires 12/29/2013 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP NEW HEAT PUMP TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION 3,025.00 ADD'L: HEAT TYPE: CODE EDITION: 2009 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: 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: Approved/Date Permit $97.25 LYK 07/05/12 134962 Plan Check $63.21 LYK 07/05/12 134962 State Building Code $4.50 LYK 07/05/12 134962 Total: $164.96 \\4ir4cmor1ArInfn\fnrmc\C RI fl Ann Rlrl rn+ 7/FI')(11') pit,,,,, o>\r cod JEFFERSON c'OUNTY ��'DEPARTMENT OF COMMUNITY DEVEL P ,,.., ::: DEVELOPMENT 621 Sheridan Street• Port Townsend •Washingti.n 98368 360/379-4450 • 360/379-4451 Fax ��S�N�4.0—'' www.co.jefferson.wa.us/commdevelopment JUN 2 Q J 2n�/ 4 �. Master Permit Application MLA: Project Description(include separate sheets as necessary): \ ;jj& 11 0' i I.,1 1'1 t'4.—k— - • (;tiy Tax Parcel Number 461 0'7C015(4 Propurl1 Size: (acres/square feet) Site Address ancjlo Directions to Property: " ( , /a-.4 I s - " .-C ,Vt r Lc r� _ w r-�.. q v Property Owner(s)of Record: i'1 YQ Telephone:. .Ct • 1 • Fax: email: Mailing Address: Ja.._ , Applicant) ent if dillejre`nt fCro,m owner): _)A�( { L Telephoner�'�('1 c�C `i ��!"% F\a t ) } - em 'I: t llJ. '44vruv1t A-h� . Maiiing Address: L, `( t 7) \-3 �`-Y L _ -11--_ Ui c I ) C.I' Irl� What kind of Permit?(Check each box that applies ❑Building 0 Critical Area s Stewardship Plan ❑ Demolition Permit 0 Variance 'N inor,Major or Reasonable Economic Use) ... Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a),C(d),or C]*" ❑ Manufactured Home 0 Modular 0 Discretior aiy"D"or Unnamed Use Classification O Commercial* 0 Special Use /Essential Public Facilities)** ❑ Change of Use 0 Boundary L.rye Adjustment ❑ Address 0 Road Approach 0 Short Pla ' ❑Home Business 0 Cottage Industry 0 Binding Site Plan** ❑Propane 0 Long Pia:' 0 Sign 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis 0 Plat Naomi n/Alteration** ❑Stormwater Management 0 Shoreline tv aster Program Exemption/Permit Revisions** ❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline N,anagement Substantial Development** ❑Temporary Use 0 Shoreline Management Variance ❑Wireless Telecommunication* 0 Compreh arrive Plan/UDC/Land Use District Map Amendment ❑Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference 0 Tree Veg at:ttion Request **Re Luires a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal, if known: D SIGNATION OF AGENT I hereby designate (4.,, 11s2_ �- act as my agent in matters relating to this application for permit(s). OWNERSIiiivAiURE UlAIWAA Date: 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 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,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 info s the Coun in writing at the time of the applica' th t or a ants prior notice. Ue Signature: _.._ Date. The action or actions Applicant will undertake as a result of the issuance of this permit r a). 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 appi cia'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.awsuit 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-transfe bl r p VW ibli or ering to and complying with the ESA. The Ap ali:ant has read this disclaimrerd signs nd�� dates it below. Signature: � _-_ Date. e P/ 71/.2/ G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc . A • ._. • 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: PHO:IE: FAX: 1 a_-\=, (C? F )y c\ -aft M ( Ok q' r3 0 4 ° MAILING ADDRESS: �'l\..c,\ 3 ; Et IA I.: CONTRACTORS LICENSE �:(. ,�� vb._ `4_I, A q 4 r� l�,IS �, onNUMBER: Ni IM 8ER ARCHITECT/ENGINEER: P!4O,JE ( ) FAX:( ) MAILING ADDRESS: Er1A I. Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: _., ❑ Sewer ❑ Addition L] Steel Proposed: •_.. Bank ❑ Community System --Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# O Demolition ❑ Other: Bedrooms: Water Supply: Existing: _., Setback: n Private well ❑ Two Party Type Qf Heat: Proposed: __ ❑ Public C l Z I 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 Underground Tank I Above ground Tank Size of Propane Tank: 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 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. r r 1 A.vK,v S' .. I- 1 -. Iqi ! F Wit.`C • *l `S i L ' d MM,�kr k 7p t} i.,'i"44' -`�'yei�',"R�t�� Square Footage Current Proposed ;F ,ls( PV'-''''' - , . ;, „� 41 . rn,.,:; y_..iA„ `off $ ;, f r ... Syr Main Floor Heated , t,, Q 7;, EH Bld App F e��iew: ii,�r a _ 2'Floor Heated " `t1144a:' Consistency Review: Other Heated *w Base fee: /;r7. Mezzanine Additional Section: Heated Basement g;4 � 1,`ra` Plan Check fire I Unheated Basement State Surcharg:fee: tS Other Unheated t r :lV f , Pot Water Review fee: Garage/Carport -k SUBTOTAL �' _ Decks 911/Rd Appoarch fee: Other 3' s t� Rr _'TOTAL: $ Ito "L Receipt Number: t 3,Lq ' y;. Cash/Check Number: 'T al,,, . ;, ,,,_5 733D3 ESTIMATED COST(REQUIRED) .-1-) Cyr Date: Z .Fair market value of all labor and materials foundation to Wish Initials: _ _G:\PemutCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc