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Home My WebLink AboutBLD2012-00305 • • 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 #: BLD12-00305 Received Date 10/3/2012 SITE ADDRESS: 161-5 N BAY LN Issue Date 10/3/2012 PORT LUDLOW, 98365 APPLICANT: W TERRY UMBREIT PHONE: 509-592-3531 JULIE UMBREIT 8988 ARDEN MEADOWS DR GERMANTOWN TN 38139-5700 605 SUBDIVISION: PORT LUDLOW CONDO#2 Block: Lot: PARCEL NUMBER: 990200035 Section: 8 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, W TERRY UMBREIT PHONE: 509-592-3531 if different: JULIE UMBREIT 8988 ARDEN MEADOWS DR GERMANTOWN TN 38139-5700 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 10/3/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: 1/ G - / L ' FinalApproval: Cyf / �' / — / y/ � 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 10/3/2012 BLD12-00305 ILDING PERMIT APPLICATP Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD12-00305 Received Date: 10/3/2012 SITE ADDRESS: 161-5 N BAY LN PORT LUDLOW, 98365 OWNER: W TERRY UMBREIT PHONE: 509-592-3531 JULIE UMBREIT 8988 ARDEN MEADOWS DR GERMANTOWN TN 38139-5700 PORT LUDLOW CONDO#2 SUBDIVISION: Block: Lot: 605 PARCEL NUMBER: 990200035 Section: 8 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 DUCTLESS HEAT PUMP TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION 4,666.00 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 $111.25 LYK 10/03/12 135262 I P P R V E r Plan Check $72.31 LYK 10/03/12 135262 State Building Code $4.50 LYK 10/03/12 135262 U1! 3 2012 Total: $188.06 Jefferson County Planning:. & Building Department 11+„+e.,,n.I1,+o+,1a.,r,v,c1G P1 n Ar,, PIA r,+ 1n/1/0(110 III ��4ON co�� JEFFERSCOUNTY r1 r.a, DEPARTMENT OF COMMUNITY DEVELOPMENT q 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax &q�$ O� www.co.jefferson.wa.us/commdevelopment TNG Master Permit Application MLA: Pn nft Proje Description (include separate sheets as necessary): (t51 Au- 1 LESS l-�EkT M.��M4 S`�S'f� `��lQ(o. Tax Parcel Number: Lq°200 0"33 Property Size: (acres/square feet) Site Address and/or Directions to Property: I(cl ' _Vir- Pori' Lid �� ?g &s- _ � Property Owner(s)of Record: Tq-tr dL) La e.. 1 iN't i Telephone: ..)LCk - Z•?jC. I Fax: email: Mailing Address: ��,^� Applicant/Agent(if different from owner): i ' UCH- i 17( it ._ r. ,y - Telephone:=j70O'la Q )- '�j t 0 i Fax: - email:t 0i4 K1-6 ' Mailing Address: Z.21 W- Bill£ f /yr. A- 14 gAg2- What kind of Permit?(Check each box that applies ❑Building ❑Critical Area wardship P O Demolition Permit ❑V eta _• .� �/t- il-'• omic Use) 0 Single Family 0 Garage Attached/Detached 0 CO,n 1�r.1—e r.)i.r t ❑ Manufactured Home 0 Modular 0 Discte• ry-U"or Unname Use s fi tion O Commercial* 0 Spe • se(Essential Public Facility 0 Change of Use 0 Bouii ry Line Adjustment I ❑ Address ❑ Road Approach ❑Shor!t Ii'lat** 1 ❑ Home Business ❑ Cottage Industry ❑Bindjng'\Site Plan** j ❑ Propane 0 Long PH** ❑Sign 0 Planned Ruraliiifikreliielo nt( RD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis ❑Plat Va arAti r 'T�`*DF'rELOP ENT ❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions""'` ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development** 0 Temporary Use 0 Shoreline Management Variance ❑Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land 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 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 this application for permit(s). OWNER SIGNATURE 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 attorney'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 -ccess and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any requir=• .ter'nspectio . Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the application : .n t' ( >t' Signature: (MY ' 4A3a— Date: 1 r The action or actions Applicant will undertake as a result of e 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 yo re in compliance ith the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferabl re " "ity fora to nd complying wan the ESA. The Applicant has read this disclai r jk s and dates it below. Signature: . ly u:0 Date: ` G:\PermitCentcr\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc k. IIIBUILDER 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 NTRACT OR MANUFACTURED HOME INSTALLER: PHONE: FAX: tQ ( ) ( ) MAILI G ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: ❑ Sewer ❑ Addition i 1 Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel L 1 Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: 1 Private well ❑ 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 Tart i — 1 r--, fi \ _2 -� i Heat Stove i Cook Stove i Woodstove i Fireplace Insert i Hot WaterTh 1 I : !'�� Is this appliance beinq installed in a Manufactured/Mobile Home? Yes / N When applying for a permit to install a propane tank you must also submit a, ' plan showing all of the bo tdin s,all property lines, tank location and size,distances from the propane tank to all propertyil�nl s,buildings and septic syytle components, includingthe reserve area. I II 'I I i I JJ Square Footage Current Proposed For,Office Usek nl ?1•,,, - q g po O Y, w r,..,; �.. ,:Amount. �. ,;;�j�vrsipn _ � _:. Main Floor Heated EH BId App Review: ea Floor Heated Consistency Review: 1 g Other Heated .: , � Base fee: 2:5 Mezzanine x :: - - Additional Section: F Heated Basement Plan Check fee: rr2• 2 , Unheated Basement ''. State Surcharge fee: /' Other Unheated - Pot Water Review fee: Garage/Carport ""'' SUBTOTAL Decks 911/Rd Approach fee: Other 4440 e TOTAL: $ I W040 E Receipt Number: l�C-/2_' i-T ,,xe 01 x nrJ Cash/Check Number �n � ESTIMATED COST(REQUIRED) Date: `1 .Fair market value of all labor and materials foundation to nish — 4 (V_/ - Initials: K ----- .--___ __D- I • G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc