HomeMy WebLinkAboutBLD2012-00343 • .
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#: BLD12-00343 Received Date 10/24/2012
SITE ADDRESS: 151 SEAL DR Issue Date 10/24/2012
BRINNON, 98320
APPLICANT: ROBIN HALE PHONE: 206-406-5970
17101 SE 267TH ST
COVINGTON WA 98042-8311
17
SUBDIVISION: OLYMPIC CANAL ADDITION 10 Block: 2 Lot:
PARCEL NUMBER: 982800216 Section: 21 Township: 25N Range: 02W
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, ROBIN HALE PHONE: 206-406-5970
if different: 17101 SE 267TH ST
COVINGTON WA 98042-8311
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 10/24/2013.
REQUIRED INSPECTIONS:
Tank/Linplia cn e: ). n R a
FinalApproval: 11'115 s Ca.-
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_Propa ne.rpt 10/24/2012
RILDING PERMIT APPLICATS BLD12-00343
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD12-00343 Received Date: 10/24/2012
SITE ADDRESS: 151 SEAL DR
BRINNON, 98320
OWNER: ROBIN HALE PHONE: 206-406-5970
17101 SE 267TH ST
COVINGTON WA 98042-8311
OLYMPIC CANAL ADDITION 10
SUBDIVISION: Block: 2 Lot: 17
PARCEL NUMBER: 982800216 Section: 21 Township: 25 N Range: 02 W
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 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:
Routing Date:
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $222.00 LYK 10/24/12 135341
Total: $222.00 APPROVE'
o c l '[:;12
Jefferson County Plannin
& Building Denartmenf
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,,-4,.... JEFFERSON COUNTY
rJ DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan _ r ;, �7t tan 98368
�y 360/379-4450 ¢ -•:-'• ' .--�xvi •L!
i , Q www.co.jefferson.�Na.us/commdevelopme
Master Permit Application U` 14 i UiZ MLA: `) rOL-{3
Project Description(include separate sheets ps ner•.assary)•1n Q\a r.0 jL.�,r\,(3 \1& - ,rye )
JEFFERSON I�TV'`'� r v . `'�
W()p PT OE COMMUNITY DEtlftOPMENT
Tax Parcel Number: of Pro`perty Size: (acres/square feet)
Site Address and/or Directions to Property:
1 _ \ 0( s1nAla
W� ggSQo
Property Owner(s)of Record: IL•
Telephone:' Fax: _ email.
Mailing Address: 1744 D l 3E g lc S-1(- C ) i • 0 SI'•\ u q ei:;. kQ
Applicant/ en�t(if different from owner): lib. ,. .& . -
Telephone:_,�t Vlp • C Far, • - 4 _ ka email: • ar
Mailing Address: rn V L... ! • _i t_ LIdt(4:0
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What kind of Permit?(Check each box that applies
[Building ❑Critical Areas Stewardship Plan
❑ Demolition Permit ❑Variance ;Minor,Major or Reasonable Economic Use)
_..I 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
❑ Commercial* 0 Special Use(Essential Public Facilities)**
❑ Change of Use ❑Boundary Line Adjustment
❑ Address 0 Road Approach 0 Short Play
❑ Home Business 0 Cottage Industry 0 Binding Site Plan**
0 Propane ❑Long Plat**
❑Sign ❑Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes'Use Consistency Analysis 0 Plat Vacation/Alteration**
❑Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions**
❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development**
0 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
**Regyires 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 119 L,.-/ li\L1 to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE, )Q St. . ��t(1 in �f nl,-.Q.,.( 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 s
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. I
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.
Signature: Date.
G:\PermitCenter\###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:
GENERAL CONTRACTOR OR ANUFACTURED HOME INSTALLER: PHONE: FAX:
c mares, ( C' )y q M1 (C104 (l'3- o 1-3:5
MAILING ADDRESS:y�c)` 3 ,ar\---... L. _( ]/j� .j�EMAIL: ,rnA� ��cJr A J r k ja, \l3
CONTRACTOR �
S LICENSE (Q v\���-C\' i, jY` llm' INS e•
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
0 New ❑ Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank 0 Community System
Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System
❑ Repair 0 Masonry SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: __ Setback: I J Private well 0 Two Party
Typgpf Heat: Proposed: _______ n Public
t�. Total: Name of System:
If this is a Commercial Protect 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 I Pellet Stove I Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No
When applying fora permit to install a propane tank you must also submit a site plan showing all of the buildings,all property
lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system components,
including the reserve area.
Square Footage Current Proposed 40, ,� ~f. -1::,�
q 9 P 4� .w; `••�, u, r ,�. ,Amount,t,�T .>< I7- ,,,..:,:A'�'
Main Floor Heated 'f"J in I; EH Bld App Re iiew.
2nd Floor Heated .!fej.c s t' Consistency Review:
Other Heated (-1:"
.„.,,�"' Base fee:
_yLh PYM1I? k A.
Mezzanine T4 E 'sri Additional Section:
Heated Basement f;;i ,° pP Y� Plan Check fee:
Unheated Basement iAr State Surcharge fee:
h� ..
Other Unheated 1 `/ � 5, 3i,��`��f 4 U�'� -clt Water Review fee:
Garage/Carport , %j I { * '
. , n ,Iirt,'�, SUBTOTAL Da....._
), 1 s r,tt � ,:.
Decks 3 � � i .11/Rd Approach fee:
Other .7 4"""I n
JEFFERSON t 1�f. _iF TOTAL $ Q.�
DF T OF COMMON! i :I ,,
, 's',4 Receipt Number: i3 l
''1 '` .. Cash/Check Number: •ESTIMATED COST(REQUIRED 5 DG Date: /� I ' l
.Fair market value of all labor and materials foundation to finish - ` '
Initials:
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc