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Home My WebLink AboutBLD2013-0197 • • MECHANICAL AND DEMOLITION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD13-00197 Received Date 6/25/2013 SITE ADDRESS: 43 NANTUCKET PL Issue Date 6/25/2013 PORT TOWNSEND, 98368 APPLICANT: DAVID L SCHNEIDER TRSTE PHONE: SCOTT B SCHNEIDER TRUSTEE 43 NANTUCKET PL PORT TOWNSEND WA 983689533 SUBDIVISION: KALA POINT#3 Block: Lot: PARCEL NUMBER: 965000023 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, DAVID L SCHNEIDER TRSTE PHONE: if different: SCOTT B SCHNEIDER TRUSTEE 43 NANTUCKET PL PORT TOWNSEND WA 983689533 PROJECT DESCRIPTION: LIKE IN KIND REPLACEMENT OF TWO HEAT PUMP SYSTEMS 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 6/25/2014. REQUIRED INSPECTIONS: Tank/Line/Appliance: AXT goo,, JrS1r.44 FinalApproval: 7)/4' �-�'�Ze5/3'j BUILDING INSPECTION HOT-LINE 379-4455. REQUESTS MUST BE RECEIVED BY 3 PM THE DAY BEFORE THE INSPECTION IS NEEDED. Office Hours 9:00 a.m. -4:30 p.m. Monday-Thursday HOT LINE AVAILABLE 24 HOURS A DAY \\tidemark\data\forms\F_BLD_Perm it_Propane.rpt 6/25/2013 0UILDING PERMIT APPLIC$N BLD13-00197 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD13-00197 Received Date: 6/25/2013 SITE ADDRESS: 43 NANTUCKET PL PORT TOWNSEND, 98368 OWNER: DAVID L SCHNEIDER TRSTE PHONE: SCOTT B SCHNEIDER TRUSTEE 43 NANTUCKET PL PORT TOWNSEND WA 983689533 KALA POINT#3 SUBDIVISION: Block: Lot: PARCEL NUMBER: 965000023 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 DESCRIPTIOP LIKE IN KIND REPLACEMENT OF TWO HEAT PUMP SYSTEMS TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP MEC VALUATION MAIN: CODE EDITION: 2012 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: 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 Bv: Date: Receipt: Approved/Date Permit $228.00 MEB 06/25/13 142212 Total: $228.00 \iricmor4\rlofo\fnrmc\C RI fl 4nn Rlrl rnf R/9c/Or i • I IiiirlikJEFFERSON COUNTY �} DEPARTMENT OF COMMUNITY DEVELOPMENT id 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450• 360/379-4451 Fax .�.0 www.co.jefferson.wa.us/commdevetopment Master Permitt Application MLA: Project Dq.scription(include separate sheets as necessary): LI % Y_1tJfl QIAGEtket l- OF 1 o Ne_kr POA0 `�`✓tg,K5 Tax Parcel Number: g6� COO elk; Property Size: C,AG to (acres/square feet) Site Address and/or Directions to P T opertylephoh)r(s) zl?7 Record: -��2. l�/ Fax Tetepttolle: ✓uj ��i/.7J' marl. Melling Address: 3 A �/G:L=TLeft 9 L'id,k_PAIR FLO HEATING 221 W. CEDAR SEQUIM WA 98382 683-3901 or 385-5354 LJ uommerttat• acil ties) ,....ow.. ❑ Change of Use 0 Special Use(Essential Public Facilities)" ❑Road0 BoundaryLine Ad .❑Horne Business Approach ❑Short Plat" hrstmeM ❑Cottage Industry ❑Binding Site Plan'• ❑Propane ❑Sign 0 Long Plat" ❑ 'Yes'Use ConsistencyAnalysis0 Planned Rural Residential Development(PRRDyAmendments" ❑Al Allowed Yr s'M Use nnt D Plat Vacation/Alteration" ❑She Pian0 Shoreline Master Program Exemption/Permit Revisions" ❑Tem rn ApprovalU Advance Determination(SPAAD)' ❑Shoreline Management Substantial Development" ry 0 Shoreline Management Variance ❑Wireless Teiecommurtication• 0 Comprehensive Plan/UDC/land Use District Map Amendment ❑Forest Practices Ad/Release of Sox-Year Moratorium 0 Jefferson County Shordline Master Program Amendment •May require a Pre-Application Conference 0 Tree Ve getation Request Please Identify any other local,state or federal /nits Requires a Pra APPAcaeon'Con crane pe required for this proposal,if known: i I hereby designate fl t t- IGNA ON OF AGENT V ; -f n3 to act as my agent in matters relating to this ppi Uon for permit(s). OWNER SIGNATURE _ l'] , 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. My material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result rn this permit being null and void. 1 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 ty as a rtisort of or in consequence I further agree to provide access of the granting of this permit.right of entry to County and its employees,representatives or agentspurposeapplication review and any required Staffs a d right of entry MI be assumed unless the for the sole of time of the appucatio is prior applicant reforms the County in writing at the Signature: Date: (7 /9 The action or actions Applicant will undertake as a result of the Issuance of this lead to a endangered spades and could permit may negatively impact upon one or more threatened or potential lake of an endangered species es those terms are defined in the federal law known as the 'Endangered Species Act^or'ESA.'Jefferson County makes no assurances to the appicant that the actions that we be undertaken because this permit has been issued we not violate the ESA Any Ind ,group or agency can file a lawsuit on behalf of an endangered action(s)even If you i development code.The species regartfing and non•transis fits with the J ApPNcant advrowledges that he,she or K holds Nidual r Signature: ng to and ng with the ESA. The Applicant has read this disclaimer and nit and dates itbelow. Date: 7/17/5 G:\PesmitCerpri\###DORMS###\DRD FORMS\Msster Peanut Application 5. d c. i3O --Eli%9 - -----N 1 r: il_11 JUN252013 J JEFFERSON COUNTY DEPT OF COMMUNITY DEVELOPMENT • tellAONc6JEFFERSOIOUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax ape www.co.jefferson.wa.us/commdevelopment i7N Master Permit Application MLA: Project Description(include separate sheets as necessary): Tax Parcel Number: Property Size: (acres/square feet) Site Address and/or Directions to Property: Property Owner(s)of Record: ` Telephone: Fax: email: Mailing Address: Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies 0 Lot or Road Segregation ❑Building 0 Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) ❑ 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 , 0 Boundary Line Adjustment ❑ Address 0 Road Approach_ 0 Short Plat** ❑ Home Business 0 Cottage Industry 0 Binding Site Plan** 0 Propane ❑ Long Plat** ❑ ;,ign 0 Plarinea Rural Residential Development(PRRD)/Amendments** 0 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 0 Shoreline Management Variance ❑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 0 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 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 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: Date: G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc aBUILDER STATEMENT 0 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:!I -E 0 E II V l Imo-. CONTRACTORS LICENSE W NUMBER: i 111 Nt�MBi? j ARCHITECT/ENGINEER: t1[1PI 9 ri 201 PH t,lE;'(I ) - Ax: ( ) MAILING ADDRESS: EMAIL L L _/ Project Type: Frame Type: Bathrooms: I Shoiilifie:Oh l O1 e of Sewage Disposal: C New El Wood Existing: CFPT OF COMMUN!T ! @I T ❑ Addition E Steel Proposed: Bank C Community System C Alteration/Remodel ❑ Concrete Total: _ Height: ❑ Individual System ❑ Repair C Masonry — SEP Permit# _ U Demolition C Other: Bedrooms: Water Supply: Existing: Setback: U Private well C 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 13C 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. Square Footage Current Proposed For Office Use Only Amount Revision Main Floor Heated EH Bld App Review: 2nd Floor Heated Consistency Review: Other Heated Base fee: Mezzanine Additional Section: 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: $ Receipt Number: %A- ID Cash/Check Number: "4 Q Vi2+ ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish 5^I 3 Initials: — G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc 1