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Home My WebLink AboutBLD2012-00259 r 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#: BLD12-00259 Received Date 8/22/2012 SITE ADDRESS: 30 KEM ST Issue Date 8/22/2012 PORT HADLOCK, 98339 APPLICANT: DAVID G BELL PHONE: 360-535-2066 MARILYN P BELL 30 KEM ST PORT HADLOCK WA 98339-9534 15 SUBDIVISION: CHALMER'S 2ND ADDITION Block: 8 Lot: PARCEL NUMBER: 942900806 Section: 3 Township: 29N Range: 01W CONTRACTOR: BRENNAN HTG &NC LLC PHONE: 206-248-7900 4601 S 134TH PL SEATTLE WA 98168 Contractor's License BRENNHA971R9 Expires 12/29/2013 OWNER, DAVID G BELL PHONE: 360-535-2066 if different: MARILYN P BELL 30 KEM ST PORT HADLOCK WA 98339-9534 PROJECT DESCRIPTION: 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 8/22/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: Zq�t3 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 8/22/2012 IJILDING PERMIT APPLICATS B Review 0259 Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD12-00259 Received Date: 8/22/2012 SITE ADDRESS: 30 KEM ST PORT HADLOCK, 98339 OWNER: DAVID G BELL PHONE: 360-535-2066 MARILYN P BELL 30 KEM ST PORT HADLOCK WA 98339-9534 CHALMER'S 2ND ADDITION SUBDIVISION: Block: 8 Lot: 15 PARCEL NUMBER: 942900806 Section: 3 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 BRENNHA971R9 Expires 12/29/2013 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION DUCTLESS 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: Routinq Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $83.25 LYK 08/22/12 135132 APPRovEr Plan Check $54.11 LYK 08/22/12 135132 State Building Code $4.50 LYK 08/22/12 135132 AUG 22. ; 2 Total: $141.86 Jefferson County Planning & Building Department \firlemerIArInfn\forma\F RI n 4nn PIA rnf R/97/0(199 4iivii cO� JEFFERSON�UNTY 0 IS, 141 , s DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend Washington )8368 360/379-4450 • 360/379-4451 Fax � ` �`SBINC ° www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: no 11-)L Project D scription(include s parate sheets a necessary): • Tax Parcel Number:q t4�0n8DLe Propert} Size: (acres/square feet) Site Address/and/or Directions to Pr rty: if--0 ,si- 1 tlii Property Owner(s)of Record: L5\ (C2C-j_Cc\ Telephone: Fax: email: c Mailing Address: Applicant/A ent(if different from owner): Telephone: G OD Fax: b email: /YU- l.. i_J .. ,r1 Mailing Address: \ L_ ' C ` r C ../J2.-L • C t ,7— What kind of Permit?(Check each box that applies ❑Building ❑Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(M nor,Major or Reasonable Economic Use) ,,ig=8ingle Family 0 Garage Attached/Detached 0 Conditional Use[C(a),C(d),or C]** ❑ Manufactured Home 0 Modular ❑Discretionary"D"or Unnamed l lca r�lascifir�4in� ❑ Commercial* ❑Special Use(Ess I' )�{�/j (� ❑ Change of Use ❑Boundary Lyle A 'y U �:/ [ ❑ Address 0 Road Approach ❑Short Plat** ❑Home Business ❑Cottage Industry ❑Binding Site Plan ❑Propane 0 Long Plat !i-• �tII''rr '? ') ',r ❑Sign 0 Planned Rural Residential Dement(PRRD)/Am; • e is** ❑Allowed"Yes'Use Consistency Analysis 0 Plat Vacation/Alteratiol t* ❑Stormwater Management 0 Shoreline Master Pi'ogra ieieins** ❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management SubstalfiEi� &IN nt'* ❑Temporary Use 0 Shoreline Management 'idifdd)MMUNITY DFVEtOPMENT ❑Wireless Telecommunication' 0 Comprehensive Plan/UDC/LLand 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 ❑Tree Vegetation Request **Requires a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal, if known: ESIGNATION OF AGENT I hereby designate c to act as my agent in matters relating to this application for permit(s). Q OWNER SIGNATURE .y( k. C F\Cl N.Q ti Y1r UptaCLA 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 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 lake"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,r,pplicant 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:\PennitCenter\###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: ENERAL CONTRACTOR OR1 MANUFACTURED HOME INSTALLER: PH)I E: FAX: ,11 1 0.---\%1 l Q 4) )4 9? a1 CC, (`‘A Off, Ci'3 j 0 '? [:j MAILING ADDRESS:y \ 3 \ A V\ - EM cur.:. tta rn a-t Gt'-`.b'(�,vq.t'\ r\ �.r a_-h . CONTRACTORS LICENSE \(,e A,N,� (�`-1_k (` Lj 41 11IS C L r NUMBER: NUMI.;ER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: O New El Wood Existing: ❑ Sewer ❑ Addition 0 Steel Proposed: Bank ❑ Community System ,Fr"Alteration/Remodel 0 Concrete Total: Height: 0 Individual System ❑ Repair Cl Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ii Private well ❑ Two Party Types Df Heat: Proposed: _._- 0 Public l:-' tc. Total: Name of System: If this is a Commercial Proiect 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 1 Above ground Tank Size of Propane Tank: I Heat Stove I Cook Stove I Woodstove I Fireplace Insert I Hot Water Tank 1 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 sho a lafiA e lines,tank location and size,distances from the propane tank to all property lines,buildings a c! E including the reserve area. r �+ ups t ��F � ( �,PIN'� ':': ra , T by i jy A vt k� ,+ I b Square Footage Current Proposed .Fo i i�ifi . -..c:,. .,:.:. 1.j. (r f,.. ' ,. int..l „, E~. Main Floor Heated EH Bid App Fe"iew: , ,ie,�'y., c Lf 2'Floor Heated : .::. :. : tJ Consistency Review: 1 '4, r �- _ EEEF e0N COUNTY i Other Heated ' f<, �`f D Base fee: =0;yr..OM UNITY DEVELOPMENT Mezzanine Y} ; �, Additional Section: Heated Basement J;ry,A;,..Za,"+a' - Plan Check fee ) eii x+,k=�r _ �� Unheated Basement v I If. State Surcharge fee: ` Li . Other Unheated A, • ° Pot Water Review fee: Garage/Carport f , ,, SUBTOTAL Decks 1�A1 911/Rd Approach fee: Other V,1„ , TOTAL: $ I l.k I , 51c7 ` I Receipt Nurit-er: 13 FJ1,32 `�T ,�1--;, Cash/Check l umber: a 3,47 ai ESTIMATED COST(REQUIRED) ±7C,C Date: Q- .Fair market value of all labor and materials fo f undation to finish f�Initials: C G:\PemvtCcnter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc