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Home My WebLink AboutBLD2012-00308 S 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#: BLD12-00308 Received Date 10/3/2012 SITE ADDRESS: 70 SEA VISTA TERR Issue Date 10/3/2012 PORT LUDLOW, 98365 APPLICANT: JOHN R LEWIS JR PHONE: 360-437-9097 LEE A LEWIS 70 SEA VISTA TER PORT LUDLOW WA 98365-9584 47 SUBDIVISION: TEAL LAKE VILLAGE Block: Lot: PARCEL NUMBER: 998700047 Section: 21 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, JOHN R LEWIS JR PHONE: 360-437-9097 if different: LEE A LEWIS 70 SEA VISTA TER PORT LUDLOW WA 98365-9584 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 10/3/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: )/1/"3- \c)V4- 1 FinalApproval: t C 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 Ilk ILDING PERMIT APPLICATIN BLDI2-00308 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD12-00308 Received Date: 10/3/2012 SITE ADDRESS: 70 SEA VISTA TERR PORT LUDLOW, 98365 OWNER: JOHN R LEWIS JR PHONE: 360-437-9097 LEE A LEWIS 70 SEA VISTA TER PORT LUDLOW WA 98365-9584 TEAL LAKE VILLAGE SUBDIVISION: Block: Lot: 47 PARCEL NUMBER: 998700047 Section: 21 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 DESCRIPTIO1` HEAT PUMP TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION 10,032.00 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: I Approved/Date Permit $195.25 LYK 10/03/12 135265 Plan Check $126.91 LYK 10/03/12 135265 APPROVE' State Building Code $4.50 LYK 10/03/12 135265 0L: 3 2012 Total: $326.66 Jefferson County Planninc & Building Department \\firlcmor4\rlafo\fnrme\C RI n Ann PIA rnf 1/1/Z/1m • z III �4,-- 0N c06 JEFFERSON COUNTY (,,:,c_. DEPARTMENT OF COMMUNITY DEVELOPMENT ' `d 621 Sheridan Street• Port Townsend •Washington 98368 & 360/379-4450 • 360/379-4451 Fax C# www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: 1 \,( , { 1 ,( 1', Project Descripti n(include separate sheets as necessary): Tax Parcel Number: aqs-rZer..-e- -' Property Size: (acres/square feet) Site Address and/or Directions to Prop®erty: `` Property Owner(s)of Record: 0 L Telephone: 3( --LA 31^CI6 el 1 Fax: email: Mailing Address: 10 c '46! -TO leg-' C2 * t t).bL ui W et. 1.$•3(,s Applicant/Agent(if different from owner): A! e Pub ¢-(-E i\-r P t — . Telephone: 30®-�J5S-ts s° Fax 3C6 -r90 3 . 3Cfl I emai3�Q L � ' Mailing Address: a`r ttll_ '� ' . ST t ,(y U i i4� I k�-- ctg 3% ')— uu What kind of Permit?(Check each box that applies ❑Building 0 Critical Areas Stewardship Plan ---- ❑o Demolition Permit 0 Variance(Minor,Major or ReasCnPl t j Oki) j Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a),C(d),or C ❑ Manufactured Home 0 Modular 0 Discretionary"D"or Unnamed Use Classification O Commercial* 0 Special Use(Essentiatfublic Facilities)" ❑ Change of Use 0 Boundary Line Adjii -- " i1 ❑ Address 0 Road Approach 0 Short Plat** I 1 I''' t 0 Home Business 0 Cottage Industry 0 Binding Site Plan"f U U i-JI ❑Propane ❑Long Plat'* 0 Sign 0 Planned Rural ResidentiiR! eveC /Amendmen *" 0 Allowed`Yes"Use Consistency Analysis 0 Plat Vacation/Alteration OF C "14411�1 DF!E OPMFNT U Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions" ❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development** ❑Temporary Use 0 Shoreline Management Variance 0 Wireless Telecommunication* 0 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 •r to act as my agent in matters relating to t is ap ication for permit(s). ' OWNER SIGNATURE � Nt, i Date: 9I5 /2- _ By signing this application fin,the owner/agent attests that the information provided herein,and In any attach ents,is true and correct to the best of his,her or its knowledge. 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 I 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 ent to Jefferson County and its employees,representatives or agents for the sole purpose of application k review and any requir-• r ins ction-. St s access and right of entry will be assumed unless the applicant inf rms • t e County in writing at the time of the application - e or.he s pri no ice. e .I Signature: Date: p )� / 2/ / ! The action or actions Ap•icant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species an" could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the "Endangered Species or or`ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued ' 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 a in mpliance wit the efferson County development code.The Applicant acknowledges t t he,s or it holds individual and non-transferable r spo sibili for a r oo and d complying with the ESA. The Applicant has read this discla erped ig s dates it below. J ` .Signature: Date: G:\PemritCenter\###FO \DRD FORMS\Master Permit Application 5-29-08.doc -Y,14A4L CI.i 1-S 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 CONT CTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: 01r V (_. ( ) ( ) MAILIN ADDRESS! EMAIL' CONTRACTORS 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 O Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel 0 Concrete Total: Height: 0 Individual System ❑ Repair 0 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 youIIave 000d nrce? / No If this is a Propane Tank and/or Appliance Installation permit,mark all items below a I Underground Tank I Above ground Tank Size of Propane Tank: ; ) r- I ' I Heat Stove I Cook Stove I Woodstove I Fireplace Insert I Hot Water Tank I Pellet Stove 1 Other Is this appliance being installed in a Manufactured 1 Mobile Home? Yes / No r,_ When applying for a permit to install a propane tank you must also submit a site i an showing ail of the buildings, ,petty lines,tank location and size,distances from the propane tank to all property linesL buildings and septic system c•1,r•rn ts, including the reserve area. 1 a Square Footage Current Proposed to P �iAaki t j,: :3 4 �`.r:ti 1- - Main Floor Heated h. ,- . 4 EH BId App Review: lip2"�Floor Heated ., Consistency Review: Other Heated y, Base fee: .:7,-:,";7,7Y.,-,..-, „.":„..ti qs.25 Mezzanine Additional Section: Heated Basement 0 - k -' Plan Check fee: q Unheated Basement ;-` - State Surcharge fee: W it , c Other Unheated ,Will,,, w Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: S Jj Other »•a= - 0 V 5 . u " TOTAL $32k, •(_,Cn ,� 1'• r'! l- g s � Receipt Number _1C1V40 Cash/Check Number: ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish «-3 1 2 (ft00 Initials: — —� • G:\PembtCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc