HomeMy WebLinkAboutBLD2012-00258 • •
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#: BLD12-00258 Received Date 8/21/2012
SITE ADDRESS: 3811 PARADISE BAY RD Issue Date 8/21/2012
PORT LUDLOW, 98365
APPLICANT: STANLEY T MESSER PHONE: 360-437-9144
KRISTYNE A MESSER
46 VILLAGE WAY STE 183
PORT LUDLOW WA 98365-9762 1
SUBDIVISION: DEDERER SHORT PLAT Block: Lot:
PARCEL NUMBER: 821271017 Section: 27 Township: 28N Range: 01 E
CONTRACTOR: BRENNAN HTG &NC LLC PHONE: 206-248-7900
4601 S 134TH PL
SEATTLE WA 98168
Contractor's License BRENNHA971 R9 Expires 12/29/2013
OWNER, STANLEY T MESSER PHONE: 360-437-9144
if different: KRISTYNE A MESSER
46 VILLAGE WAY STE 183
PORT LUDLOW WA 98365-9762
PROJECT DESCRIPTION: 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 8/21/2013.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: C j � ` e
FinalApproval: / TZ3'(
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 8/21/2012
ItJILDING PERMIT APPLICA•N BLD12-00258
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD12-00258 Received Date: 8/21/2012
SITE ADDRESS: 3811 PARADISE BAY RD
PORT LUDLOW, 98365
OWNER: STANLEY T MESSER PHONE: 360-437-9144
KRISTYNE A MESSER
46 VILLAGE WAY STE 183
PORT LUDLOW WA 98365-9762 DEDERER SHORT PLAT
SUBDIVISION: Block: Lot: 1
PARCEL NUMBER: 821271017 Section: 27 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 DESCRIPTION HEAT PUMP
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP MEC MAIN:
VALUATION 2,500.00 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 Bv: Date: Receipt: Approved/Date
Permit $83.25 LYK 08/21/12 135127 n P P R Q V F i
Plan Check $54.11 LYK 08/21/12 135127 /'� �/
State Building Code $4.50 LYK 08/21/12 135127 AUG 7I BIZ
Total: $141.86 Jefferson County Plannin
& Building Denartmpn°
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rn*4. ox c� JEFFERSON!UNTY • i ��
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` DEPARTMENT OF COMMUNITY DEVELOPMENT _
621 Sheridan Street• Port Townsend E.
Washingta n i 8368
360/379-4450 • 360/379-4451 Fax
k� „�pti www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: IW f ILL
Project Description(include separate sheets as necessary): 1 ( \\ ( ' \ 1'\\ sy i 1 --\ k.QU_.-Sc Y \4
Tax Parcel Number: 9, \ 2 \ N --1- Propel) Size: (acres/square feet)
Site Address an irections to Property:
.3)c.'A ' 0...1 (1 A\":_ ..5L__ &LA Q k
,, , ..,
Property Owner(s)of Record: ` `'
Telephone:. Fax: email:
Mailing Address:
Applicant/A ent(if different from owner): k
Telephone: \[) C� , F : 1 ,-4_ email: 1,t In t e C. cAA} .0..,n
Mailing Address: LC \ c`Q Gil ' -C ( i 1 '\24411k.ti . CZ'rr)
What kind of Permit?(Check each box that applies
❑Building 0 Critical Anaas Stewardship Plan
❑ Demolition Permit 0 Variance I M nor,Major or Reasonable Economic Use)
Single Family ❑Garage Attached/Detached ❑Conditionsd Jse[C
❑ Manufactured Home ❑ Modular 0 Discretion ar i"D"or s Ml i
❑ Commercial ❑Special Die(Elseilttl 1
❑ Change of Use ❑Boundary Li le AdjJsirr ent
❑ Address ❑ Road Approach ❑Short Plat*' `I
❑Home Business ❑Cottage Industry 0 Binding S le Plan"• i 1 ' AUG 2 1 2012
❑Propane 0 Long Plat"` I
❑Sign 0 Planned F:u.al Re4iden I Development(PRRD)/Am a is**
❑Allowed"Yes"Use Consistency Analysis ❑Plat Vaca Ic n/Afte lion"' JEFFERS C
❑Stormwater Management 0 Shoreline Miister Itirogr I jsio s**
MiNI❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Vanage
❑Temporary Use ❑Shoreline Management Variance
❑Wireless Telecommunication* 0 Comprehl-nE;ive Plan/UDC/Land Use District Map Amendment
❑Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson C unty Shoreline Master Program Amendment
*May require a Pre—Application Conference 0 Tree Vegi:t Ilion Request
""Re i l t!,.es a Pre-Application Conference
Please identify any other local,state or federal permits required far :his proposal, if known:
DESIGNATION OF AGEPIT
I hereby designate d �/i2 b\A�\ 0� V11�i�to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE 2�- /_ -7�y."---1-4..----- _ Date: I—/ — f
By signing this application form,the owner/agent attests that the information provided here r,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 I,y 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 con se quence of the granting of this permit.
I further agree to provide access and right of entry to Jefferson County and its employee 5, ,opresentatives or agents for the sole purpose of application
review and any required later inspections. Staffs access and right of entry will be assui ned unless the applicant informs the County in writing at the
time of the application that he or she wants prior notice.
Signature:,,Z./, (,-. ���L� �i 'r � Date: g 2-- 1 J ^i 2.
The action or actions Applicant will undertake as a result of the issuance of this permit n ay 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 appicant 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:s,pplicant acknowledges that he,she or it holds individual
and non-trans
fera
ble resoonsibility for adhering to and complying with the ESA. The Ar pl ant has read this disclaimer and signs and dates it below.
Signature:,, l - _. Date: /5 r`7\
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s — •
BUILDER STATEMENT
The signer of this statement does hereby certify that they are the Owners of the parcel refer3n•::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:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PH 9t.E: FAX:
MAILING ADDRESS: ‹' EMau.:
W�, 3 1,_. &. -Z tt.i ax ae OVp--( rvx\-a-r, AI c-1 r\q .
CONTRACTOR'S LICENSE ' y .. V\Ar\ ,` "4_I, Q\ 4 DINS e m
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
O New El Wood Existing: I Sewer
❑ Addition ❑ Steel Proposed: Bank J Community System
Alteration/Remodel ❑ Concrete Total: _- Height: ❑ Individual System
❑ Repair ❑ Masonry SEP Permit#
0 Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well 0 Two Party
Typgof Heat: Proposed: _ ❑ Public
€- I L 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 rank:I Heat Stove 1 Cook Stove I Woodstove I Fireplace Insert I Hot Water Tank I P:I-t H I. L I \/
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 pia I--• 'rig all of the buildings,a • %•=rty
lines,tank location and size,distances from the propane tank to all property lines, • d s angptjc fysem co .• r
including the reserve area. I I I i I I
}�4i•6Y�4.* i E{. t` 1 t 1-. ! 1F sn r
i kf '� 1'�k- k et •` r°. . y'gel k4.0 I �'. ' r.£-`
JJ k (f •tl @J
Square Footage Current Proposed -L.'
oc� rI ..;A+, •I s a. '. -. m !w . .,..... -
Main Floor Heated _ EH Bld A Review: �D
t PP DEPT.OF COMMUNITY DEVELOPMENT
I r'='4
2' Floor Heated `ti tir' l Consistency Review:
j. -
Other Heated Base fee:
Mezzanine „ j ll. Additional Section:
•sae
Heated Basement . .p Ag ' _Plan Check fee.
Unheated Basement m'�¢I•h State Surcharge fee: ,/___, ,SO
Other Unheated 'I, 1 ' Pot Water Review fee:
Garage/Carport SUBTOTAL
iA ni
Decks � c;! 911/Rd Approach fee:
Other *t + t TOTAL: $ ,C.{ , , Yj
' '''''''4)''''' I ✓ ✓I 2-1
C : Receipt Number:
,y ,v;f,� Cash/Check Number: 23t (,/ _
'2,41ESTIMATED COST(REQUIRED) jcc' Date: Q.-71—(Z j
.Fair market value of all labor and materials foundation to finish _C5—fit
Initials: —
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