HomeMy WebLinkAboutBLD2012-00360 • •
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#: BLD12-00360 Received Date 11/7/2012
SITE ADDRESS: 823 WALKER WAY Issue Date 11/7/2012
PORT LUDLOW, 98365
APPLICANT: JANE E NAVONE PHONE: 360-437-0327
823 WALKER WAY
PORT LUDLOW WA 983659792
79
SUBDIVISION: PORT LUDLOW NO. 4 Block: Lot:
PARCEL NUMBER: 990500079 Section: 8 Township: 28N Range: 01 E
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, JANE E NAVONE PHONE: 360-437-0327
if different: 823 WALKER WAY
PORT LUDLOW WA 983659792
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 11/7/2013.
REQUIRED INSPECTIONS:
Tank/Line/Appliance:
FinalApproval:l f L-2,S-12,
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 11/7/2012
ILDING PERMIT APPLICA1IN BLD12-00360
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD12-00360 Received Date: 11/7/2012
SITE ADDRESS: 823 WALKER WAY
PORT LUDLOW, 98365
OWNER: JANE E NAVONE PHONE: 360-437-0327
823 WALKER WAY
PORT LUDLOW WA 983659792
PORT LUDLOW NO. 4
SUBDIVISION: Block: Lot: 79
PARCEL NUMBER: 990500079 Section: 8 Township: 28 N Range: 01 E
CONTRACTOR: BRENNAN HTG &NC LLC PHONE: 206-248-7900
4601 S 134TH PL
SEATTLE WA 98168
Contractor's License BRENNHA971 R9 Expires 12/29/2013
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr 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:
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 $222.00 LYK 11/07/12 135382 M
Total: $222.00 ✓f
NOV 1 2uie
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& Building Be,artmnnt
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��.�,- oft, JEFFERSON COUNTY
I \, \ DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street• Port Townsend •Washing:on 98368
360/379-4450 • 360/379-4451 Fax
Zr-IN�"�S, CI C) www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: Ft I 1
Project Description(in de s p ate sh ets as ne ssary):
I -�-ar� C \1c e '0(
5o� --
Tax Parcel Numbe . 001 Property Size: (acres/square feet)
Site Address and/or Directions to Property:
tc‘ g W(k\Vk W.0_,LA Chi CA" LO A OL-k-Th
Property Owner(s)of Record: -C 1 \a V thn 4
Telephone:- Fax: email:
Mailing Address: -
Applicant/ ent(if different from owner):
Telephone: CC Fax: 0.4:, S email: Al 2i.PAD
Mailing Address: N ` 'j l_ P pP? 1 IRL t CrIPIn
What kind of Permit?(Check each box that applies
❑Building ❑Critical Areas Stewardship Plan
❑ Demolition Permit 0 Variance(Minor,Major or )
,,, t Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a),C(d),)dr I " �
❑ Manufactured Home 0 Modular 0 Discretionary"D"or Unnam� se assi Classification
ID Commercial* Special Use(Essential Pub, Oracilities)"
•❑ Change of Use 0 Boundary Line Adjustment 2012
❑ Address 0 Road Approach 0 Short Plat**
— 7
❑ Home Business ❑ Cottage Industry 0 Binding Site Plan" I
❑Propane 0 Long Plat t i
❑Sign 0 Planned Rural Residential Developnithff(MICOVAjf bndments""
❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration**_ UPI OF COMMUNITY DEVELOPMENT
0 Stormwater Management ❑Shoreline Master Program Exemption/PermitRevisions
❑ Site Plan Approval Advance Determination(SPAAD)• 0 Shoreline Management Substantial Development"
❑Temporary Use 0 Shoreline Management Variance
❑Wireless Telecommunication* ❑ Comprehensive Plan/UDC/Land Use District Map Amendment
❑Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment
*May require a Pre—Application Conference 0 Tree Vegetation Request
"Re uires a Pre-Application Conference
Please identify any other local,state or federal permits required for this proposal, if known:
ESIGNATION OF AGENT
I hereby designate to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE _t(. n i VA fr k1 01 •St 4 lewd.d. QC o.pD.) 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 attorneys 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 application that he or she wants prior notice.
Signature: 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.
Signature: R Date:
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Apphcatlon 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:
ENERAL CONTRACTOR OR ANUFACTURED HOME INSTALLER: PHONE: FAX:
(
MAILING ADDRESS:y�N\ 3 ' A ( ' r�l'c. EMAIL:.\ VY AI,�b c C,N '0:�
CONTRACTOR'S �LICENSE (i' Yam°� '--R � � ZILS�I 9 is i.f/ 'NS C
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 0 Community System
,,,,,e--Alteration/Remodel ❑ Concrete Total: Height: 0 Individual System
❑ Repair ❑ Masonry SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: ,—_ Setback: pp y'
Type a Heat: Proposed: —__ Private well ❑ Two Party
❑ Public
e ( . 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 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 for a 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.
I,1 k55 j�: V a ' z h L� �j d iv y,.k,i �
Square Footage Current Proposed ;F1o`�# tSf ri ., ,e ..b :° ,p ii r 4 riffiel '" -'`'-Kin r
Main Floor Heated t' ,:wke' ir EH Bid App Review:
'1 t[r r�r k+(
Floor Heated r '" `g Consistency Review:
Other Heated riAMAN Base fee: r
f4�
Mezzanine `:� -�����, Additional Secti m:
Heated Basement h,, as' Plan Check fee:
w
Unheated Basement s , t..r ',, State Surcharge'fee:
Est
Other Unheated jilt a:F `: Pot Water Review fee:
Garage/Carport UB 15eC
Decks ' St j*,! 911/Rd Approach fee:
Other {� 6 TOTAL: $ 9(„ '
Receipt Number,-_ C-'
2,41; y Cash/Check lumber;IL J ' ''
r
ESTIMATED COST(REQUIRED) i"L ; Date:
.Fair market value of all labor and materials taundation to finish
Initials: . _
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc