The URL can be used to link to this page

Home My WebLink AboutBLD2012-00355 • • 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#: BLD12-00355 Received Date 11/1/2012 SITE ADDRESS: 11-1 #2 SEAVIEW CT Issue Date 11/1/2012 PORT TOWNSEND, 98368 APPLICANT: ALAN R BLACK TRUSTEE PHONE: 360-385-9638 SHARON S BLACK TRUSTEE 11 SEAVIEW CT#2 PORT TOWNSEND WA 98368-9508 SUBDIVISION: KALA HEIGHTS Block: Lot PARCEL NUMBER: 965500011 Section: 27 Township: 30N Range: 01W 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, ALAN R BLACK TRUSTEE PHONE: 360-385-9638 if different: SHARON S BLACK TRUSTEE 11 SEAVIEW CT#2 PORT TOWNSEND WA 98368-9508 PROJECT DESCRIPTION: HEAT PUMP REPLACEMENT 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 11/1/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: /Q --/f•-Aj 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 11/1/2012 JILDING PERMIT APPLICATIN BLD12-00355 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD12-00355 Received Date: 11/1/2012 SITE ADDRESS: 11-1 #2 SEAVIEW CT PORT TOWNSEND, 98368 OWNER: ALAN R BLACK TRUSTEE PHONE: 360-385-9638 SHARON S BLACK TRUSTEE 11 SEAVIEW CT#2 PORT TOWNSEND WA 98368-9508 KALA HEIGHTS SUBDIVISION: Block: Lot: PARCEL NUMBER: 965500011 Section: 27 Township: 30 N Range: 01 W 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 DESCRIPTION HEAT PUMP REPLACEMENT TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC VALUATION 8,301.00 MAIN: CODE EDITION: 2009 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: OTHER: GARAGE: SHORELINE: CONST TYPE: SETBACK: DECK BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: pprgved/ Permit $222.00 LYK 11/01/12 135369 cit patel I1 V I'_ Total: $222.00 NOV ( 2ur2 erforoon County PIann;ref. « Building Demartrneat �\}irlcmnrL\rinfn fnrmc\G PI n Ann PIA rn4 11/1 nnl') . ON • no � JEFFERS OUNTY ,3 DEPARTMENT OF COMMUNITY DEVELOPMENT r� 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax www.co.jefferson.wa.us/commdevelopment KYsBING Master Permit Application MLA: nO MLA Project Description(indude sepa to sheets as necessary): L!KC. !4 KuNTT KE'PLIkc-E ME KIT of ti. ks Po M P S'ST M Tax Parcel Number: -ttoSSOOO It Property Size: (acres/square feet) Site Address and/or Directions to Property: l I Se PcNi 1 E \A " . PoRr '�'ovit3 s ►Dr Ml A' Property Owner(s)of Record: Sharon, 61aCK Telephone: 3(so ,3%S - (7110 3$ Fax: email: Mailing Address: Il Sp C-t- *7_. Applicant/Agent(if different from owner): Air F-lo tt k- Telephone: 343S -5354 Fax: 1o'33 - S"1-1 l email: C 1:eft @c al(i 1kikftfJ- O t Mailing Address: 0 1 V\1 . Cezi r Si- e i,M ,WA cAg31-- - What kind of Permit?(Check each box that applies ❑Building ❑Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use) P"Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a),C(d),or C]'"' ❑ Manufactured Home 0 Modular ❑ Discretionary"D"or Unnamed Use Classification 0 Commercial* 0 Special Use(Essential Public Facilities)** 0 Change of Use ❑Boundary Lin • ❑ Address ❑ Road Approach ❑Short Plat** ' 7 I�, l� V c (� g (�/7 E ❑ Home Business ❑Cottage Industry ❑Binding Site Par �--- ❑ Propane ❑Long Plat** j 1 ❑Sign 0 Planned Rural Re idential Development(PRRD dments** ❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration*''''(" - 1012 I 0 Stormwater Management 0 Shoreline Ma4te fogram Exemption/Permit i s** ❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Manaegnt Substantial Developmei ❑Temporary Use ❑Shoreline Management VqQ N c0❑Wireless Telecommunication* 0 Comprehensive Plan/ Rispnr Amendment CD Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline as(er ivyrd irJment *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: A DESIGNATION OF AGENT I hereby designate tkt r RO t e<a- f\S to act as my agent in matters relating to this application for permit(s). 4 OWNER SIGNATURE ) tra L to 4 elk_ Date: (O! 4 I 1 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 attomey'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 ap lication that he or shunts prior notice. .� L Signature: ' «. :,i• �., r:v_ ( l �— 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-transferablerr responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and sign and dates it below. Signature: S k-6z re-,A t3(c c Date: (0 1-4 k `)— G:\PeimitCenter\###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 MANUFACTURED HOME INSTALLER: PHONE: FAX: Nit rrW kkEi'V\IJ 6°- ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: AM Ft-amp/_ T I _ NUMBER ARCHITECT/ENGINEER: n l O� �P V Vr PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New LI Wood Existing: L1 Sewer ❑ Addition [1 Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System U Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: I 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 p IBC Occupancy: IBC Type of construction: Will tie Fo rvico?We If this is a Propane Tank and/or Appliance Installation permit,mark all items belgwy hat apply: I Underground Tank I Above ground Tank Size of Propane Tank I Heat Stove I Cook Stove I Woodstove I Fireplace Insert I Hot Water Tank i I Pellet Stove I Oth 12 Is this appliance being installed in a Manufactured/Mobile Home? Yes / No i] L When applying for a permit to install a propane tank you must also submit a site plans fldih s a l property lines, tank location and size,distances from the propane tank to all y Qp g p p property lines,b(/ildin 5b1 �yyst m com rents,including the reserve area. 1 DEPT OF COMMUNI DEVELMIE wp. Square Footage Current Pro.. „ w�ywEE° .y°`�r� > t' �` ` q gsect .4 ', ,;(. ''1 t : v014 ,} ram_✓a : i.�. agi it iti l A r 1 Main Floor Heated EH Bld App Review: t4 2"°Floor Heated ' „�; . ';t""�` i Consistency Review: Other Heated . , Base fee: Aia MezzanineCQ AfItt,r Additional Section: Heated Basement 4' Plan Check fee: Unheated Basement W: r { : . State Surcharge fee: tingtra Other Unheated litt_flY.L: — Pot Water Review fee: :IXGarage/Carport 1� i, 4y: SUBTOTAL • Decks „` = ry g 11/Rd Approach fee: .G; ram``+., G N pia Other 1�� i t. 130 1 ��1 "� � TOTAL: $cc�ry c9 i l V, y r ,, � Receipt Number. 1 3�0 4,,,,,,,,..t. Cash/Check Number: -aac00 ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish (- 4 13oi , iO Initials: G:\PernutCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc