HomeMy WebLinkAboutBLD2012-00386 • •
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 #: BLD12-00386 Received Date 11/29/2012
SITE ADDRESS: 753 BYWATER WAY Issue Date 11/29/2012
PORT LUDLOW, 98365
APPLICANT: ALLEN W TAYLOR PHONE: 360-683-3901
PHYLLIS L TAYLOR
753 BYWATER WAY
PORT LUDLOW WA 98365-9238 2
SUBDIVISION: WHITE ROCK COVE DIV IV Block: Lot:
PARCEL NUMBER: 821355064 Section: 35 Township: 28N Range: 01E
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, ALLEN W TAYLOR PHONE: 360-683-3901
if different: PHYLLIS L TAYLOR
753 BYWATER WAY
PORT LUDLOW WA 98365-9238
PROJECT DESCRIPTION: HEAT PUMP SYSTEM
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 11/29/2013.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: iip-r -{emu 1.4 J Ys`rG—r4 n r
FinalApproval: E -Emixr `J y- p,u tj(� �� y, h„,,1 tt/7/l3
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 11/29/2012
tILDING PERMIT APPLICAT BLDI2-00386
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD12-00386 Received Date: 11/29/2012
SITE ADDRESS: 753 BYWATER WAY
PORT LUDLOW, 98365
OWNER: ALLEN W TAYLOR PHONE: 360-683-3901
PHYLLIS L TAYLOR
753 BYWATER WAY
PORT LUDLOW WA 98365-9238 WHITE ROCK COVE DIV IV
SUBDIVISION: Block: Lot: 2
PARCEL NUMBER: 821355064 Section: 35 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 DESCRIPTIOI HEAT PUMP SYSTEM
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP MEC MAIN:
VALUATION 11,569.00 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: Approved/Date
Permit $222.00 JLA 11/29/12 139788
Total: $222.00 APPROVEr
NOV 2012
Jefferson County Planninz
& Building DeJartmen*
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„5_ , c06. JEFFERSOCOUNTY III
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DEPARTMENT OF COMMUNITY DEVELOPMENT
'-4 621 Sheridan Street• Port Townsend • Washington 98368
/IC&
360/379-4450 • 360/379-4451 Fax
www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA:
Project Description(include separate sheets as necessary):
Tax Parcel Number: g .-I 3 5 vU 1 Property Size: (acres/square feet)
Site Address and/or Directions to Property:
(Is3 6k.v.itviert. wk , 0 1-'J bt_oW
Property Owner(s)of Record: f\ e r\ 4 Pr 1 11 i S I e1.Or
Telephone: '131- "1 l0 35 Fax: email:
Mailing Address: i S 13 /YV'3i cr W 2`� 1 c.-'O 0- u_xcf lcr .
Applicant/Agent(if different from owner): F,(r it f) \ tee t J
Telephone: 3 -La-`63--Sato 1 Fax: 3 1r:.0 - ' `63— 3'1-1 t email: a f`r\-v 1tir-S ( 3I.raw
Mailing Address: ova\ VN), Cec.\2,” S'‘- . Se..(a .-M 1\,J?t- 1•S - Cler21t1 CYO., Cue"
What kind of Permit?(Check each box that applies d
❑Building ❑Critical Areas Stewardship Plan
❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use)
B.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
❑ Commercial* ❑Special Use(Essential Public Facilities)**
❑ Change of Use 0 Boundary Line Adjustment
❑ Address ❑Road Approach El Short Plat**
❑ Home Business 0 Cottage Industry ❑Binding Site Plan**
❑ Propane 0 Long Plat**
❑ Sign 0 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**
❑Temporary Use ❑Shoreline Management Variance
El Wireless Telecommunication* ❑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
**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 to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE W- M �,� Date: ; j ' at" ZDI 2
By signing this application form,the owner/a ent 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 thefow /agent wit�j r$apect to this application packet
may result in this permit being null and void. J [J `/
I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judiments,court costs,reasonable tt mey's fees and
it
expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this perm . I:.
I further agree to provide access and right of entry to Jefferson County and its employees,repre4entatNe r ebedts for the so purpose of application
review and any required later inspections. Staff's access and right of entry will be assunielcL1
ugldss the applicant informs the in writing at the
time of the applicption that he or w nts prior notice. Li
Signature: 'N Alt'.*, \A1 . l D. IRS CO l°'.� ' Zd Z) -
pT CUB. umil'OEVELOFt.1fNT
The action or actions Applicant will undertake as a result of the issuance of this permit may nega ore reatened 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
prriOnlel Auen if vnn Pro in n....Z..C-.r..-...aN.!-. L-ff„_ ^ .,-• ia_-' _ .. i _
-,...,.-• _. .. -,.�:�;-� ..an:a�.::�uwi:.Jys that�E,sn...ri it n0:3�intirvfuuw.
and non-tra fer ble responsibifi fo adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: J 44J#._ Date: 1)• 2-6-Z0/Z
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 MANUFACTURED HOME INSTALLER: PHONE: FAX:
( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S 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
❑ Addition ❑ Steel Proposed: Bank ❑ Community System
o Atteration/Remodel 0 Concrete Total: Height: ❑ Individual System
❑ Repair ❑ Masonry SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: t] 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 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:
1 U• nderground Tank 1 Above ground Tank Size of Propane Tank:_
1 Heat Stove 1 Cook Stove 1 Woodstove 1 Fireplace Insert 1 Hot Water Tank 1 Pellet Stove 1 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.
:._ lei-�''5'av� S �ca..,€ �x s�-��i.i.. �yC'�t l �?i" ��:1 �
S
Square Footage Current Proposed - ' _�'(I��� .c� r'li:�n� .�-�!�"O- .:f t� �,,,<;� �,.,�.;_ �-0�sy :
Main Floor Heated 7e `'k: EH BId App Review:
2-- m Floor Heated
t.: _ Consistency Review:
7
Other Heated 1 Base fee:
Mezzanine _`9 Additional Section:
Heated BasementK Plan Check fee:
6477--
Unheated Basement -'I State Surcharge fee:
5r:. Z. 9 LUlZ Ii j i,
Other Unheated za Pot Water Review.fee: J
Garage/Carport .it SUBTOTAL ]LI FER3G,J COUNTY
DFPT.01 L •• '"n DEVELOPMF"1
Decks 4, . 'R 911/Rd Approach fee:
V
Other 'E PO Wili1 (Q1. . - TOTAL $ /2:2,----
c
, ,Sqc td\ = � `� M Receipt Number. / y7 7 SY�'
-ex�. Cash/Check Number: I/a /`V
ESTIMATED COST(REQUIRED) Date: L
.Fair market value of all labor and materials foundation to finish �!I
A l t C ct• J� I Initials: -
54 _ I j
G:\Perry[Center\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc