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Home My WebLink AboutBLD2012-00244 • • 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#: BLD12-00244 Received Date 8/9/2012 SITE ADDRESS: 1165 WOODLAND DR Issue Date 8/9/2012 PORT TOWNSEND, 98368 APPLICANT: FRANCIS P CAVALLERO PHONE: 360-379-0347 VICTORIA S CAVALLERO 1165 WOODLAND DR PORT TOWNSEND WA 98368-2521 38 SUBDIVISION: WOODLAND HILLS NO 1 Block: Lot: PARCEL NUMBER: 001275030 Section: 27 Township: 30N Range: 01W 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, FRANCIS P CAVALLERO PHONE: 360-379-0347 if different: VICTORIA S CAVALLERO 1165 WOODLAND DR PORT TOWNSEND WA 98368-2521 PROJECT DESCRIPTION: HEAT PUMP REPLACEMENT 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 8/9/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: �� i7K 8/30//3 FinalApproval: or -cot -Q�n '/3O/i3 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_Perm it_Propane.rpt 8/9/2012 • B LDIN PERMIT APPLICATIM BLD12-00244 G Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD12-00244 Received Date: 8/9/2012 SITE ADDRESS: 1165 WOODLAND DR PORT TOWNSEND, 98368 OWNER: FRANCIS P CAVALLERO PHONE: 360-379-0347 VICTORIA S CAVALLERO 1165 WOODLAND DR PORT TOWNSEND WA 98368-2521 WOODLAND HILLS NO 1 SUBDIVISION: Block: Lot: 38 PARCEL NUMBER: 001275030 Section: 27 Township: 30 N Range: 01 W 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: AIR FLO HEATING PHONE: 360-385-5354 221 W CEDAR ST SEQUIM WA 98382 PROJECT DESCRIPTION HEAT PUMP REPLACEMENT TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION 13,333.00 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 $237.25 LYK 08/09/12 135083 APPROVEr Plan Check $154.21 LYK 08/09/12 135083 State Building Code $4.50 LYK 08/09/12 135083 AUG q t`.;2 Total: $395.96 Jefferson County PlanniN 8uildina Denartmeni \\firlcmorb\r4n+n\fnrrnc\F RI Il Ann RH rnf RI0I71)19 • ¢gON CO III,.4i 6 JEFFERSON COUNTY . I]�Ck , , , , , 4 DEPARTMENT OF COMMUNITY DEVELOPMENT 'd 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax 4qS, o fr > www.Co.jefferson.wa.us/commdevelopment Master Permit Application MLA: '\ 00 M CA- Project Description(include separate sheets as necessary): LIKE 14 vi ol5 Zek, ._EMENT op- Hekr poll►\' SYSTEM 413, 333 ,n Tax Parcel Number: Z)0( -R-7 5 ')3) Property Size: (acres/square feet) Site Address and/or Directions to Property: 1 “ WOOD L tip DIZ\VE 1 PoiLT 'Tovhs16ENt Property Owner(s)of Record: I'M11 A V t e-1 C Q l IN Cs i 4 LL E LO Telephone: 3(¢O-31c1 —0 341 Fax: email: Mailing Address: II1•25 W )OOLQND DR.\glc t P(Q..f IOVJI'. 5 NfD , vJA' 61736 ' Applicant/Agent(if different from owner): K I Q P Lo L4L R 1 1 J G- Cebu Telephone:3�0 ^3S-S35`1 Fax: 360-42%3 - 3 0 •I:� . c.6vK- Mailing Address: ,-a l • �-C D�g- ST t What kind of Permit?(Check each box that applies 1 I; DBuilding II ;I ILi ,I 0 Critical Areas Stewardship(Plan ❑ Demolition Permit I I;m) ❑Variance(Minor,Major' r f easonable Economic Use) ❑ Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a), (94,9r C]** ❑ Manufactured Home 0 Modular I h ❑ Discretionary"D"or U baned Use Classification ❑ Commercial* I ti u Public Facilities)** ❑ Change of Use 0 615fiii i tment ❑ Address ❑Road Approach❑ Home Business 0 Cottage Industry Dr rf �nd11"ifnl'Ig44�' nF"rl Site Plan** ❑Propane ❑Long Plat'"' ❑Sign 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration*" ❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions** ❑ Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development** Cl Temporary Use ❑Shoreline Management Variance 0 Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendment ❑Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment "May require a Pre-Application Conference 0 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 — }/� to act as my agent in matters relating to thisthi applicatio for permit(s). OWNER SIGNATUR Z_C----- / / / �J �J „Z �-� Date: By signing this application orm,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 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 e try to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any required late pections. St s ccess and right of entry will be assumed unless the applicant inform the ounty in writing at the time of the application that o s rr s prio ' Signature: ` Date: The action or actions Applicant will undertake as a result of the suance 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:\PemutCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc i 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: GEN RAL CO I}ACTOR R MANUFACTURED HOME INSTALLER: PHONE: FAX: td (LING AD ESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: Li New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System Alteration/Remodel LI Concrete Total: Height: ❑ Individual System [I Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ii Private well 0 Two Party Type of Heat: Proposed: ❑ 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: 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 Tank 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. :h. il sSquare Footage Current Proposed F0Eflant► 6N:i. . m uu t4 s10 Main Floor Heated a EH Bld App Review: 6 2"e Floor Heated ,� `�. Consistency Review: Other Heated e¢ 1, r g r t Base fee: 7 Mezzanine -1 Additional S . n Heated Basement ff r �, I I Plan Check f � r-- (3-4-) I Unheated Basement - State Surcharge�ijee; ' I 1 ti Other Unheated N Pot Water Review fr: L. Garage/Carport -, SUBTOTAL Ji fF[RSON UPPN I nI-P OF C:nnr NIjv n'Vr nF'r Decks r 1 . 911/Rd Approach fee: Other ° ° TOTAL: $ 3 9(1,0 Receipt Number. Cash/Check Number: (0')—/ ESTIMATED COST(REQUIRED) Date: r_______TSi_.. ..y- -› .Fair market val a of all laboral materials foundation to finish 13 33 • Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc