HomeMy WebLinkAboutBLD2012-00237 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 #: BLD12-00237 Received Date 8/2/2012
SITE ADDRESS: 2757 WEST VALLEY RD Issue Date 8/2/2012
CHIMACUM, 98325
APPLICANT: NEVILLE PEAR ALL PHONE: 360-132-4198
PO BOX 632
CHIMACUM WA 98325-0632
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901271008 Section: 27 Township: 29N Range: 01W
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, NEVILLE PEAR ALL PHONE: 360-132-4198
if different: PO BOX 632
CHIMACUM WA 98325-0632
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 8/2/2013.
REQUIRED INSPECTIONS:
Tank/Line/Appliance:
FinalApproval: - �- 1LI _
4!
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 8/2/2012
Sj ILDING PERMIT APPLICA1N B
Review 0237
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD12-00237 Received Date: 8/2/2012
SITE ADDRESS: 2757 WEST VALLEY RD
CHIMACUM, 98325
OWNER: NEVILLE PEARSALL PHONE: 360-132-4198
PO BOX 632
CHIMACUM WA 98325-0632
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901271008 Section: 27 Township: 29 N Range: 01 W
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 DESCRIPTION NEW DUCTLESS HEAT PUMP
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP MEC MAIN:
VALUATION 2,800.00 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 By: Date: Receipt: Approved/Date
Permit $83.25 LYK 08/02/12 135066 AP ROVED
Plan Check $54.11 LYK 08/02/12 135066
State Building Code $4.50 LYK 08/02/12 135066 AUG �j 2012
Total: $141.86 Jefferson County Planning
Building Department
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` DEPARTMENT OF COMMUNITY DEVELOPMENT _
621 Sheridan Street• Port Townsend •Washingtix 98368
360/379-4450 • 360/379-4451 Fax
\49/31Natp� www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: 1t.._;,. l l tl.
Project D scriptVn(include sea to sheets a necessary):
C
Tax Parcel Number: Prop'rdy Size: (acres/square feet)
Site Address and/or Directions to Property:
Property Owner(s)of Record: V -L 0
Telephone: Fax: email:
Mailing Address:__( G--
Applicant/A ent(if different from owner):
Telephone:, , ax: ..1S email•
Mailing Address: .,_ : L-C
What kind of Permit?(Check each box that applies ('.... )' \
❑Building 0 Critical Areas Stewardship Plan
❑ Demolition Permit ❑Variance ;Minor �$t51le/�J , c s )
,,t Single Family 0 Garage Attached/Detached 0 Conditiona ( �T�`lJ
❑ Manufactured Home 0 Modular 0 Discretiona y e lassifica
❑ Commercial* 0 Special Use( ,htial Public Facilities)** 1
❑ Change of Use El Boundary L ne'Adjustment _ L L�12 ;II
❑ Address 0 Road Approach 0 Short Pla *' p\3(JI
❑Home Business 0 Cottage Industry ❑Binding Site Plan**
❑Propane 0 Long Plat*' 1
❑Sign 0 Planned I a,r Resi � �� endments•'
❑Allowed"Yes'Use Consistency Analysis 0 Plat Vacatic rl/Alteration**F �M�,_NITY flE�.L
❑Stormwater Management ❑Shoreline N:aster Prt p Ion/Permit Revisions**
❑ Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline N rinagement Substantial Development**
❑Temporary Use 0 Shoreline N anagement Variance
❑Wireless Telecommunication* ❑Compreh r:Ave Plan/UDC/Land Use District Map Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium CI Jefferson C:Aunty Shoreline Master Program Amendment
*May require a Pre—Application Conference 0 Tree Veq:lt ition Request
**Re L'fires a Pre-Application Conference
Please identify any other local,state or federal permits required fc r this proposal, if known:
1 1DESIGNATION OF AGEtt7
I (�
hereby designate� )f '0? & 1 l'l.Ct to act as my agent in matters relating to this application for permit(s).
OWNErt SIGNATURE P(.F'A `s-� S' .Q.Q_ e I'�.i'A �i Cr i k-t p Da R
By signing this application form,the owner/agent attests that the information provided here ri,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 iv/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 liabilitir+s,,judgments,court costs,reasonable attorneys fees and
expenses which may in any way accrue against Jefferson County as a result of or in corsec,uence of the granting of this permit.
I further agree to provide access and right of entry to Jefferson County and its employee i, epresentatives or agents for the sole purpose of application
review and any required later inspections. Staffs access and nght of entry will be assume GI unless the applicant informs the County in writing at the
time of the application that he or she wants prior notice.
Signature: _, Date: I
The action or actions Applicant will undertake as a result of the issuance of this permit r al negatively impact upon one or more threatened or
endangered species and could lead to a potential"take"of an endangered species as th:ra B terms are defined in the federal law known as the
"Endangered Species Act"or"ESA."Jefferson County makes no assurances to the appl c1 nt 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 3,r,pplicant acknowledges that he,she or it holds individual
and non-transferable responsibility for adhering to and complying with the ESA. The Ap:iU;ant has read this disclaimer and signs and dates it below.
Signature: _ Date
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 refere+i:ed 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: Ph iO CIE: FAX:
•
(t; l)''c' 4 Q: c, (64OLP q' 3 °-1-?)'
MAILING ADDRESS:y\,.,\ 3 ; Cry 7
CONTRACTORS LICENSE \-y( Zj ,�
NUMBER: ` NI IMBER
ARCHITECT/ENGINEER: Pt1ONE ( ) Fax;( )
MAILING ADDRESS: EMA;L
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
O New ❑ Wood Existing: _-- ❑ Sewer
O Addition ❑ Steel Proposed: _-- Bank ❑ Community System
❑ Concrete Total: Height: 0 Individual System
❑ Repair ❑ Masonry SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: ._. Setback: ❑ Private well ❑ Two Party
Type of Heat: Proposed: _..__ 0 Public
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: _ Will you have Food Service? Yes / No
If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply:
1 Underground Tank 1 Above ground Tank Size of Propane Tank:
1 Heat Stove 1 Cook Stove 1 Woodstove 1 Fireplace Insert 1 Hot Water 'ank 1 Pellet Stove I Other
Is this appliance being installed in a Manufactured l Mobile Home? Yes / Ni
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.
':1� t u V t_ a sky ' n,� i�. � R s x
`^ w-zit-� � �'- � r � r �t ", �i
Square Footage Current Proposed �irpl „xt. �,r ',x :,` u., lpunt..._ ,�r °'St( -
Main Floor Heated ; to is EH Bld App F'.e,rew:
2- Floor Heated •-�� ' Consistency review:
Other Heated ' Base fee:
Mezzanine srP Additional Sect:on:
Heated Basement is • -• c ' I
Unheated Basement �` ; StateSQfcha'g t e: / ��c-
Other Unheated a , Pot Waterr� view�F e
PI
Garage/Carport + H SILBTQ' Au
Decks •t� , w•: Kim ahfge
c r�rs Ga Wr r, r F!o? EN I
'0)NITl'D
Other $ ICI
'' �� �� TOTAL:
.= Receipt Number:
CashlCheck Number:
pc
ESTIMATED COST(REQUIRED) F,{C.,`, Date: ^�
'Fair market value of all labor and materialslbundation to finish
Initials:
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc