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Home My WebLink AboutBLD2012-00323 • 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 #: BLD12-00323 Received Date 10/11/2012 SITE ADDRESS: 21 CHIMACUM CREEK DR Issue Date 10/11/2012 PORT HADLOCK, 98339 APPLICANT: VALERIE MILLICAN PHONE: 360-379-3816 PO BOX 1175 PORT HADLOCK WA 98339-1175 15 SUBDIVISION: CHIMACUM CREEK ESTATES DIV 2 Block: Lot: PARCEL NUMBER: 943700016 Section: 2 Township: 29N Range: 01W 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 OWNER, VALERIE MILLICAN PHONE: 360-379-3816 if different: PO BOX 1175 PORT HADLOCK WA 98339-1175 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 10/11/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: / O /9', / FinalApproval: ! G - / " / 1472 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_Permit_Propane.rpt 10/11/2012 ItILDING PERMIT APPLICATIVN BRDI2-003 eview Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD12-00323 Received Date: 10/11/2012 SITE ADDRESS: 21 CHIMACUM CREEK DR PORT HADLOCK, 98339 OWNER: VALERIE MILLICAN PHONE: 360-379-3816 PO BOX 1175 PORT HADLOCK WA 98339-1175 CHIMACUM CREEK ESTATES DIV 2 SUBDIVISION: Block: Lot: 15 PARCEL NUMBER: 943700016 Section: 2 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: UNHEATED: #OF STORIES: OCCUPANCY: 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 By: Date: Receipt: A1 'PPermit $83.25 LYK 10/11/12 135290 Err Plan Check $54.11 LYK 10/11/12 135290 O`, State Building Code $4.50 LYK 10/11/12 135290 I �uj2 Total: $141.86 Jefferson County Planninc & Building Deriartment i \\firicmor4\r1,4n\forme\F RI n Ann 1:21r1 rr.f 1nn1iOn1', , t 4 . SG 4 ON CO6 JEFFERSON COUNTY `IA DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax �/ p'$ www.co.jefferson.wa.us/commdevelopment 81N Master Permit Application MLA: no (\/ALA crIcfctje scripkion(ict�lude se a i e1 as ssary): r YY' Tax Parcel Number: •:,�C tO Property Size: (acres/square feet) Site Address nd/or Directions to Property: 2 \ r�n \ rn m c c•c-c\L Dr. y 1�c Property Over(s)of.f Record: : \\\ �-Q� Telephone: DO ' J �` l.0 Fax: email: Mailing Address: p�J�0-- Applicant/' ent(if different from owner): Telephone:. 1 . ,d F-- 1 Mailing Address: Ol _ L • ' CI PA(0C2, .�YYI What kind of Permit?(Check each box that applies ❑Building 0 Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use) Single Family 0 Garage Attached/Detached 0 Con L1sQ[L:(a}6fd}, _ , ❑ Manufactured Home 0 Modular 0 Dis eti a ton ❑ Commercial* 0 Specialll a ❑ Change of Use 0 Boundary, yie Adjustment ❑ Address 0 Road Approach 0 Sho "(' ❑Home Business 0 Cottage Industry 0 Binding Site Plarf T 1 1 2012 1, ❑Propane 0 Long Plat** ❑Sign 0 Planned Rural Residential Developmer R )/Amendments** ❑Allowed"Yes'Use Consistency Analysis Cl Plat Vacanor�fA�ter ❑Stormwater Management ❑Shoreline Master 19 frmit evisions** ❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline(v`jariagein nt** ❑Temporary Use 0 Shoreline Management Vanance ❑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 ❑Tree Vegetation Request **Regales 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��/�� (nj �1��, Q y� to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE c-.._2 2 (\&1-C 1 .-A JI� r`-L- �Ccic-\ 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 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 appli on that he or she,1w�antsprior notice. %f _ ZC/ a Signature: 1` k -Lu-t'1t l2 �-`� 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"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 Date: Signature: G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc 1 • • 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: GENERAL CONTRACTOR OR ANUFACTURED HOME INSTALLER: PHONE: FAX: 05 MAILING ADDRESS: 3 1\cCC \ _ ' h _ -Z EM III .\(Linnke a ,•(.{.v,.e\a.Y, k)a 1 r\q . CONTRACTOR'S LICENSE NO(e,�.,,-\ 'sue _k_ �� 4 LAWNS ('.t,t'Y1 NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: 1 Type of Sewage Disposal: U New ❑ Wood Existing: _ ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System k7 'Alteration/Remodel ❑ Concrete Total: Height. ❑ Individual System • Repair ❑ Masonry SEP Permit# ❑ Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party TyeQf Heat: Proposed: ❑ Public (- I C 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-f-No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that agAds. L� ['VIE i Underground Tank i Above ground Tank Size of Propane Tank: i i Heat Stove i Cook Stove I Woodstove i Fireplace Insert i Hot Water Tank i Pellet Stove I Other I Is this appliance being installed in a Manufactured I Mobile Home? Yes / No '_ ,_J12 When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings]:• •r•perty lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system co,• .•n,nts, including the reserve area. t u N-rn Square Footage Current Proposed For Sg s `ntyI," 4.4ii .r ArnountM�,`�,..i-."'` I' Main Floor Heated ?f, . 3 r .; EH Bld App Review: 2n°Floor Heated s Consistency Review: Other Heated Base fee: �3 25 31 Mezzanine it .- Additional Section: • r,' Heated Basement -` Plan Check fee: 5- j 1 Unheated Basement }:1 State Surcharge fee: Other Unheated ' ' Pot Water Review fee: Garage/Carport " SUBTOTAL tel Iiii'W`-TWA Decks '6 i- r,:^ 911/Rd Approach fee: Other `'r 1'� TOTAL: $ I Li 1 w Receipt Number: 114& rirreTtt Cash/Check Number: . ESTIMATED COST(REQUIRED) 0 Yt Date: .Fair market value of all labor and materials foundation to finish Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc