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Home My WebLink AboutBLD2012-00221 s 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#: BLD12-00221 Received Date 7/17/2012 SITE ADDRESS: 74 BAYSIDE CT Issue Date 7/17/2012 PORT LUDLOW, 98365 APPLICANT: JOHN B OLSON TRUSTEE PHONE: 360-437-5104 PATRICIA C OLSON TRUSTEE 74 BAYSIDE CT PORT LUDLOW WA 98365-8744 1 SUBDIVISION: BAYSIDE SHORT PLAT Block: Lot: PARCEL NUMBER: 821163008 Section: 16 Township: 28N Range: 01 E CONTRACTOR: AIR FLO HEATING COMPANY INC PHONE: 360-683-3901 221 W CEDAR SEQUIM WA 98382 Contractor's License AIRFLI*206DG Expires 4/25/2014 OWNER, JOHN B OLSON TRUSTEE PHONE: 360-437-5104 if different: PATRICIA C OLSON TRUSTEE 74 BAYSIDE CT PORT LUDLOW WA 98365-8744 PROJECT DESCRIPTION: INSTALL NEW HEAT PUMP & REMOVE EXISTING PROPANE Directions BOILER 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 7/17/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: -(T4-`P) 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 7/17/2012 WILDING PERMIT APPLICA BLD12-00221 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD12-00221 Received Date: 7/17/2012 SITE ADDRESS: 74 BAYSIDE CT PORT LUDLOW, 98365 OWNER: JOHN B OLSON TRUSTEE PHONE: 360-437-5104 PATRICIA C OLSON TRUSTEE 74 BAYSIDE CT PORT LUDLOW WA 98365-8744 BAYSIDE SHORT PLAT SUBDIVISION: Block: Lot: 1 PARCEL NUMBER: 821163008 Section: 16 Township: 28 N Range: 01 E CONTRACTOR: AIR FLO HEATING COMPANY INC PHONE: 360-683-3901 221 W CEDAR SEQUIM WA 98382 Contractor's License AIRFLI*206DG Expires 4/25/2014 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr INSTALL NEW HEAT PUMP & REMOVE EXISTING PROPANE BOILER TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION 11,000.00 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 A ED Permit $209.25 LYK 07/17/12 134998 ROV Plan Check $136.01 LYK 07/17/12 134998 PP State Building Code $4.50 LYK 07/17/12 134998 JUL I7 2012 Total: $349.76 Jefferson County Plannint. & Building Department ' \\4irlcmorle\rintn\forme\F RI Il Ann PH rn+ 7/17/1/11') • • (iffrAe°11. c , JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax www.co.jefferson.wa.us/commdevelopment INS Master Permit Application MLA: I v l C Project Description(include separate sheets as necessary): (2&MOVC Es. rro e c bock For too\ 4- .T.tiya-kil New tteal-RInd Tax Parcel Number: III(D 3 to Property Size: (acres/square feet) Site Address and/or Directions to Property: 74 Bayside Court, Port Ludlow Property Owners))of Record: John & Pat Olson Telephone: 437-5104 Fax: email: Mailing Address: 74 Bayside Court, Port Ludlow, WA 98365 Applicant/A f re )' nt from owner Air Flo Heating e g -Telephone: UI Fax: 683-3971 emaitiberson@airfloheating.com Mailing Address:_ 2Lr W. Cedar Street, Sequim, WA 98382 What kind of Permit?{Check each box that applies ❑Building 0 Critical Areas Stewardship Plan ❑ Demolition Permit O Variance(Minor,Major or Reasonable Economic Use) ❑ Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a),C(d),or C]*" • O Manufactured Home 0 Modular ❑Discretionary"D"or Unnamed Use Classification ❑ Commercial* ❑Special Use(Essential Public Facilities)** ❑ Change of Use ❑Boundary Line Adjustment ((( ❑ Address ❑Road Approach ❑Short Plat'" ❑ Home Business ❑Cottage Industry 0 Binding Site Plan** ❑ Propane ❑Long Platt ((7�:_, (�❑Sign ❑Planned f tar t2esid 9evele nient t )/Amendments ❑Allowed*Yes"Use Consistency Analysis 0 Plat Vacation/ Iteration** 0 Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions" O Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development** O Temporary Use ❑Shoreline Management Variance ❑Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendment 0 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: DESIGNATION OF AGENT I hereby designate J`e-4 s .a to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: 1 1 1 f j By signing this application form,the ow er/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 mate I Isehood 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 attomey'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. Staff's 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 she wants prior notice. Signature:_ 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 compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferable responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: Date: G:\PemmitCenter\tl##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: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: Air Flo Heating (369 683-3901 (360)683-3971 MAILING ADDRESS:221 W. Cedar St. , Sequim, WA 98382 EMAIL: jberson@airtioheating.corn CONTRACTOR'S LICENSE WAINS NUMBER: AIRFI.,1206DG NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: • EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank 0 Community System E Alteration/Remodel 0 Concrete Total: Height: 0 Individual System ❑ Repair 0 Masonry SEP Permit* O Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well 0 Two Party Type of Heat: Proposed: 0 Public Total: Name of System: If this is a Commercial Project you must answer the following: l -�1\' Number of Parking Spaces: Current: Proposed: ber-o' Pack-As. Number of occupants(includes owners,tenants,employees,etc) Current Proposed t1� IBC Occupancy: IBC Type of construction: Will you have Food Service? 'as I No If this is a Propane Tank and/or Appliance Installation permit.mark all items below that apply: 1 • S Underground Tank i Above ground Tank Size of Propane Tank: i I Heat Stove I Cook Stove i Woodstove i Fireplace Insert i Hot Water Tahk—i--PYTltfie Is this appliance being installed in a Manufactured/Mobile Home? Yes / No ,,- I rinrTNT 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. �.:! a+-'--' n'�' �` y, •-� �--'�'' s sf IUr- mow. s' '�`^?" a -* v t i �Il;iM� kt t' I� 1 �+ F4�I�� '•'t Square Footage Current Proposed y , . � 4 .. t � mis ' ' ,�.t. .� : - .- - , Main Floor Heated a �g+a EH Bld App Review: 2n°Floor Heated „ ; Consistency Review: i Other Heated ' " Base fee- S � , t 2oq. 2 Mezzanine a` `c` Additional Section: Heated Basement r =h -tts Plan Check fee: 12( Unheated Basement State Surcharge fee: ,I ,50 Other Unheated Pot Water Review fee: Garage/Carport '. SUBTOTAL Decks �rT i, l t 911/Rd Approach fee: �'ry ��r j . �jxn t9'ru .ygJ^41i yrt.rxy .� Other i. `, 6 TOTAL: $54 01.7(0 t. Receipt Number: 1131., qq$ ,6;,,' , ,.,; Cash/Check Number. ray ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish ( i a Initials: _ G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc