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Home My WebLink AboutBLD2012-00397 • 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 #: BLD12-00397 Received Date 12/10/2012 SITE ADDRESS: 333 S BAY LN Issue Date 12/10/2012 PORT LUDLOW, 98365 APPLICANT: DAVID T UNIESKI PHONE: 360-437-0444 SALLY UNIESKI 333 S BAY LN PORT LUDLOW WA 98365-8785 29 SUBDIVISION: LUDLOW POINT VILLAGE DIV 1 Block: Lot: PARCEL NUMBER: 969400029 Section: 16 Township: 28N Range: 01 E CONTRACTOR: WASHINGTON ENERGY SERVICES CO PHONE: 206-282-4700 2800 THORNDYKE AVE W SEATTLE WA 98199 Contractor's License WASHIES971OB Expires 9/2/2013 OWNER, DAVID T UNIESKI PHONE: 360-437-0444 if different: SALLY UNIESKI 333 S BAY LN PORT LUDLOW WA 98365-8785 PROJECT DESCRIPTION: REPLACE ELECTRIC FURNACE & 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 12/10/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: `-1--- 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 12/10/2012 itILDING PERMIT APPLICATN BRL Review ICi Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD12-00397 Received Date: 12/10/2012 SITE ADDRESS: 333 S BAY LN PORT LUDLOW, 98365 OWNER: DAVID T UNIESKI PHONE: 360-437-0444 SALLY UNIESKI 333 S BAY LN PORT LUDLOW WA 98365-8785 LUDLOW POINT VILLAGE DIV 1 SUBDIVISION: Block: Lot: 29 PARCEL NUMBER: 969400029 Section: 16 Township: 28 N Range: 01 E CONTRACTOR: WASHINGTON ENERGY SERVICES CO PHONE: 206-282-4700 2800 THORNDYKE AVE W SEATTLE WA 98199 Contractor's License WASHIES971OB Expires 9/2/2013 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP REPLACE ELECTRIC FURNACE & HEAT PUMP TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2009 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: OCCUPANCY: OTHER: CONST TYPE: 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 Bv: Date: Receipt: Approved/Date Permit $222.00 LYK 12/10/12 139812 Total: $222.00 6 2 efferson County PlflovEr annint n, Building Department \\4irlemor4\rlofo\fnrmc\C RI f1 Ann Plrl rr,+ 10/1(1/0(110 *, ON C, �, JEFFERSONCOUNTY W4 OG j DEPARTMENT OF COMMUNITY DEVELOPMENT ''' 'N •:` '4 621 Sheridan Street• Port Townsend •Washington 98368 • 360/379-4450 • 360/379-4451 Fax qs (pP www.co.jefferson.wa.us/commdevelopment FANG Master Permit Application MLA: NO MLA Project Description(include separate sheets as necessary): REPLACE 15KW ELEC FURNACE AND 4 TON HEAT PUMP Tax Parcel Property Number: 969400029 Size: (acres/square feet) Site Address and/or Directions to Property: 333 SOUTH BAY LANE, PORT LUDLOW 98365 Property Owner(s)of Record: DAVID UNIESKI Telephone:360-437-0444 Fax: email: Mailing Address: 333 SOUTH BAY LANE,PORT LUDLOW 98365 Applicant/Agent(if different from owner): NORTHWEST PERMIT INC. Telephone: 360-945-2787 Fax: 360-945-2091 email: NAIDA@NWPERMIT.COM Mailing Address: 1345 GULF RD,POINT ROBERTS WA 98281 What kind of Permit?(Check each box that applies ❑Building ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit ❑Conditional Use[C(a), C(d),or C]** ❑Single Family ❑Garage Attached/Detached ❑ Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home ❑ Modular ❑Special Use(Essential is Facili+ies)** ❑ Commercial* ❑Boundary Line Adjusicnanf • 1 ❑ Change of Use ❑Short Plat** j r ' 'L_ IN ❑ Address ❑Road Approach ❑ Binding Site Plan*4 ❑ Home Business ❑Cottagelndustry ❑Long Plat** ;I ❑ Propane ❑Planned Rural Residential Development(PRRD)Amend is** ❑Sign ❑Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisio ❑Stormwater Management ❑Shoreline Management Substa yrlup nt** ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management}( i,,..;,,,,.r�i I.I n , ❑Temporary Use ❑Comprehensive Plan/UDC/1liseiist ent ❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment ❑Forest Practices Act/Release of Six-Year Moratorium ❑Tree Vegetaion Request *May require a Pre—Application Conference **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 NORTHWEST PERMIT INC. to act as my agent in matters relating to this application for permit(s). ff OWNER SIGNATURE /, U,lL 2k I Date: /441'7— 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 it's 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 application that he or she wants prior notice. Signature: Pa 4:_ ( lJ Date: ,,,1, i2 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 lake"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 r o�for adheeng to and complying with the ESA. The Applicant has read this disclaimer and ign and dates it below. Signature: U Date: /1/`!/[ C:\Documents and Settings\carat\Local Settings\Temporary Internet Files\Of.K86\Master Permit Application 12-19-2006.doc • I 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: WASHINGTON ENERGY SERVICES ( 800)398-4663 ( ) MAILING ADDRESS: 3909195t6 St SW Lynnwood wA 98036 EMAIL: 3909196th St SW Lynnwood WA 98036 CONTRACTOR'S LICENSE WAINS NUMBER: WASH I ES971 OB 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 ✓ Alteration/Remodel Concrete Total: Height: Individual System Repair Masonry SEP Permit# Demolition Other: Bedrooms: Water Supply: Existing: Setback: Private well Two Party Type of Heat: Proposed: Public ELEC HEAT PUMP 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 ha,0,I od ryistt?-ass If this is a Propane Tank and/or Appliance Installation permit,mark all items below thgt,applrQ .__ --Ti ❑Underground Tank 0 Above ground Tank Size of Propane Tank: i ., 1 / 1 ❑Heat Stove ❑Cook Stove 0 Woodstove 0 Fireplace Insert ❑Hot Water Tank 0 Pellet Stovve 0 Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / 46 Tit When applying for a permit to install a propane tank you must also submit a site plan shoving all of the buildings,all it 1ty lines, tank location and size,distances from the propane tank to all property lines,building m corn n , including the reserve area. JD TC RsoN COUNTY r1, ., r, _,,_., I,N- Di url nr'MENT Square Footage Current Proposed For Office Use Only Amount Re on Main Floor Heated EH Bld App Review: 2ntl Floor Heated Consistency Review: Other Heated Base fee: !lam i Mezzanine Additional Section: �ff Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $C.. a ---- Receipt Number: 1,59 8 I -2 Cash/Check Number: fr1 / ESTIMATED COST(REQUIRED) Date: I3, 0`1. .Fair market value of all labor and materials foundation to finish 1 Initials: /� C:Allocuments and Settings\caral\Local Settings\Temporary Internet Files\OLIL86\Master Permit Application 12-19-2006doc