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HomeMy WebLinkAboutBLD2014-00336 - MECHANICAL OUILDING PERMIT APPLICA'TON BRLD1e4-00336 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00336 Received Date: 9/17/2014 SITE ADDRESS: 65 CLEVELAND ST PORT HADLOCK, 98339 OWNER: PATRICIAA BURNETT PHONE: 360-379-1988 65 CLEVELAND ST PORT HADLOCK WA 98339-9712 9627 SUBDIVISION: Block: Lot: PARCEL NUMBER: 962700075 Section: 7 Township: 29 N Range: 1E CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP Swap out Propane Tank 120 gallon TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC VALUATION MAIN: CODE EDITION: 2012 ADD'L: HEAT TYPE: PRO OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: 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 APPROVED Total: SEP172014 Jefferson County DCD . \\tidemark\data\forms\F_BLD_App_Bld.rpt 9/17/2014 i Wig 33t �4�,SON co�� JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street 1 Port Townsend,WA 98368 I Web:www.co.jefferson.wa.us/communitvdevelooment rsgrNOC Tel:360.379.44501 Fax:360.379.4451 I Email:dcdta7co.iefferson.wa.us Building Permits&Inspections I Development Consistency Review!Long Range Planning I Watershed Stewardship Resource Center Master Permit Application MLA: Project es_cription(include separate�sheet as necessa4 W- V ( Tax Parcel Number: Q ( ) 7 no 0 7£5 Property Size: •5 , C . (acres/square feet) Site Address and/or Directions to Property: Property Owner(s)of Record: • Telephone ?(pO 310 L Q Fax: email::�.A AANed• 0 M Mailing Address: -5.l1 M. Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies ❑Lot or Road Segregation ❑Building ❑Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use) ❑Single Family ❑Garage Attached/Detached ❑Conditional Use[C(a),C(d),or C]** ❑ Manufactured Home ❑ Modular ❑Discretionary"D"or Unnamed Use Classification ❑ Commercial* ❑Special Use(Essential Public Facilities)** ❑ Change of Use ❑Boundary Line Adjustment ❑ Address ❑Road Approach ❑Short Plat** ❑Home Business ❑Cottage Industry ❑Binding Site Plan** ,Propane ❑Long Plat** ❑Sign ❑Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration** ❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions** ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development** ❑Temporary Use ❑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 ❑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 perriit 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. Staff's access and right of entry will be assumed unless the applicant informs the County in writing at the time oft plica'on the orshe wa e. 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 J-,_ " County development code.The Applicant acknowledges that he,she or it holds individual and non-xransfe -ble - •• ibility for adre 6-to a .co plying with the . A. 1 he Applicant has read this disclaimer"ehfitgns and dates i below. Signature: •' "kg_ •. _ -4%&,,d. Ate& Date: y • • 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 wii6t. iiijI g the responsibil'•• • -General Contractor for the proposed project. Sign 4\1 at . V ! L.• 1• Date: \---1 C...-T-1- ...�`' l GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: v 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 ❑ 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 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: Underground Tank Above ground tank Size of Propane Tank: 1'vl O Gs A L_. Heat Stove Cook Stove Woodstove Fireplace.nsert rehtO i evotS telleP I knaT retaW toH Is this appliance being installed in a Manufactured/Mobile Home? Yes /(r. 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: 12 '()C3 Mezzanine Additional Section: Iii ' °o 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: $ `'2--i . vC) Receipt Number: 15129 Cash/Check Number: (12�r ESTIMATED COST(REQUIRED) Date: �/�1! l .Fair market value of all labor and materials foundation to finish T Initials: , Parcel Details Page 1 of 2 . S‘' er on o n '%r % � // ' i r ' wry�i�'117 i , g. �. 'i i o ,O% J ii' ' i ' �� ,. sr wry r G y i 'o/% F 5� Weather Stabh "Tatabase To©�l 14a...�,. : Home County Info Departments Search - Parcel Number: 962700075 SEARCH Parcel Number: 962700075 Printer Friendly Owner Mailing Address: PATRICIA A BURNETT 65 CLEVELAND ST PORT HADLOCK WA98339-9712 Site Address: 65 CLEVELAND ST PORT HADLOCK 98339 Section: 7 School District:Chimacum (49) Qtr Section: NW1/4 Fire Dist: Chimacum (1) Township: 29N Tax Status: SNR/DSBL Range: 1E Tax Code: 0211 Planning area:Tri-Area (4) Sub Division: 9627 - IRONDALE ACRE TRACTS Assessor's Land Use Code: 1900 - Cabins, Park Models, RV Utilities Property Description: IRON DALE AC TRACTS 73(E 2 AC LESS PT SW OF RD) Tax,AN, Sales, Photos, and Permit Data Bldg Data Map Parcel Plats&Surveys Septic Monitoring Info 1 °,;;,, ,:.° jeffersonont %, ,- ',-,, HOME I COUNTY INFO I DEPARTMENTS I SEARCH Best viewed with Microsoft Internet Exp`orer 6.0 or later Windows - Mac http://www.co.jefferson.wa.us/assessors/parcel/parceldetail.asp?Parcel_N0=962700075 9/17/2014 -��g0\ co G • • JEFFERSON COUNTY ,c 2 DEPARTMENT OF COMMUNITY DEVELOPMENT Date: f Z 1114111e Received: am/pm Mon. Tue.Or Thur. Fri. Date: BLD: '�"' 2 l.0 Contact Name: Owner: c,4 V.O.,V.-e..7tk '' t^ �} Contact Number: 360 2 Dk.= ( Address: O'S tit-- 0 c44.--t-CL cX (66 , 206 Notes: Foundation Plumbing Framing rho ,one Tank ) Mechanical Setbacks Under-ground Framing Under ground Furance Footing Rough In Air Seal Above ground_)� Gas Stemwall Hydronic Exterior shear Exterior lines Oil Straps Hot Water Htr Interior shear Interior lines Ducts Post Hole Ventilation Appliance Underfloor Gas/Wood stove Man-Homes Insulation Final Inspection Setbacks Floor Foundation Wall Address Posted Block&Tile Ceiling S 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#: BLD14-00336 Received Date 9/17/2014 SITE ADDRESS: 65 CLEVELAND ST Issue Date 9/17/2014 PORT HADLOCK, 98339 APPLICANT: PATRICIAA BURNETT PHONE: 360-379-1988 65 CLEVELAND ST PORT HADLOCK WA 98339-9712 SUBDIVISION: 9627 Block: Lot: PARCEL NUMBER: 962700075 Section: 7 Township: 29N Range: 1E CONTRACTOR: OWNER/BUILDER PHONE: OWNER, PATRICIAA BURNETT PHONE: 360-379-1988 if different: 65 CLEVELAND ST PORT HADLOCK WA 98339-9712 PROJECT DESCRIPTION: Swap out Propane Tank 120 gallon 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 9/17/2015. REQUIRED INSPECTIONS: Installation per Manufacturer Specifications/CO2: Tank/Line/Appliance: Final Approval:; to—1'k-i 1 , 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 9/17/2014