HomeMy WebLinkAboutBLD2013-00169 r '
*BUILDING PERMIT APPLIC•ION BLD13-00169
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD13-00169 Received Date: 5/30/2013
SITE ADDRESS: 136 BRUSH PLANT RD
QUILCENE, 98376
OWNER: ANDREW M PRESCOTT TRSTE PHONE: 360-765-4010
SANDRAJ PRESCOTT TRUSTEE
PO BOX 35
QUILCENE WA 98376-0035 HAMILTON'S 5AC TRACTS
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 956100043 Section: 13 Township: 27 N Range: 02 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: ALL WEATHER HEATING AND COOLING PHONE: 360-452-9813
302 KEMP STREET 360-452-5177
PORT ANGELES WA 98362
PROJECT DESCRIPTION INSTALL AMANA FURNACE
TYPE O F WORK RES SQUARE FOOTAGE:
TYPE OF IMP MEC MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 2009
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OTHER:
CONST TYPE: SHORELINE:
GARAGE:
CONST TYPE: SETBACK:
DECK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total:
Routing Date: 5/341 1
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $228.00 ZAL 05/30/13 142137 APPROVED
$228.00 APPROVED
MAY 302013
Jefferson County DCD
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�.�,r o. JEFFER OUNTY •
DEPARTMEF COMMUNITY DEVELOPMENT
621 Sheridan Street• Port Townsend •Washington 98368
360/379-4450 . 360/379-4451 Fax
�q 4.0 www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA:
Project Description(include separate sheets a necessary):
U
Ins* rvo,no, kern CUL/
Tax Parcel Number. °I 51e ID 0 ny 3 Property Size: (acres/square feet)
Site Address and/or Directions to Property:
13(4o brush Plcr+ Loop
Property Owner(s)of Record: AING1.(ty.) c _So.grill a PfeSt CYO-
Telephone:3(00- 7l o S-90 10 Fax: email:
Mailing Address: PO (dpi. 3 S CA,.)' I CQ v\( 1 v i A tie 3 7 t
Applicant/Agent(if different from owner): Al I t4 tc■-i-VICX Walt Al Coolikni
Telephone: '3(9 0 454.-61g I3 Fax: -145 a-517�J email: k-yVlc,IN eater rl 0 (elf %Lie cad h.ei hc,
Mailing Address: DA._ Vie.vvlo St- colivV
What kind of Permit?(Check each box that applies I
Building 0 Critical Areas Stewardship Plan I
❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use)
itit.Single Family ❑Garage Attached/Detached 0 Conditional Use[C(a),C(d),or C]**
O Manufactured Home ❑ Modular ❑Discretionary"D"or Unnamed Use Classification
O Commercial* ❑Special Use(Essential Public Facilities)**
❑ Change of Use ❑Boundary Line Adjustment
❑ Address ❑Road Approach ❑Short Plat**
❑Home Business ❑Cottage Industry 0 Binding Site Plan**
0 Propane 0 Long Plat'*
O Sign ❑Planned Rural Residential Development(PRRD)Amendments**
O Allowed"Yes'Use Consistency Analysis ❑Plat Vacation/Alteration"*
❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions**
O Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development*"
O Temporary Use 0 Shoreline Management Variance
O 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
"Requires a Pre-Applicatkn 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 !.rile(f v Date: S- a
By signing this applicatio orm,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. Staff's access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the applica on that he o nts prior notice. /
Signature: Date: �Z -3
The action o actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or
endang 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,grow 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 a• •ng to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: ... i v - Date: S//t..0,
(::\PermitCrntcr\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
• BUILDER STATEMENT •
The signer of this stateme •• • --• certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be assu • , responsibi r• the General Contractor for the proposed project.
Signature: �i �� Date: SIB 03
GENERAL • TRACTOR 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 0 Wood Existing: ❑ Sewer
❑ Addition 0 Steel Proposed: Bank 0 Community System
❑ Alteration/Remodel 0 Concrete Total: Height ❑ Individual System
❑ Repair 0 Masonry SEP Permit#
❑ Demolition 0 Other. Bedrooms: Water Supply:
Existing: Setbadc ❑ Private well 0 Two Party
Type of Heat Proposed: ❑ Public
Total: Name of System:
If this is a Commercial Protect cop 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:lion: Will you have Food Service? Yes / No
If this Is a Propane Talk and/or Appliance Installation permit,mark all Items below that apply:
1 Underground 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 fora 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.
.f• ..a r �' ' �'t i '� :.r.x "r $ .t fir' Y E a x s"Y" #,z, R!
Square Footage Current Proposed �`rr ;, " ,.� `F _
Main Floor Heated 11010,i-4,411=;F:;. 47 EH BM App Review:
�� xx3•s
2"a Floor Heated ••s Consistency Review:
Other Heated -F # - Base fee:
Mezzanine 'u"'-, "�f=-'= Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee:
Garage/Carport `' SUBTOTAL
Decks t r r 911/Rd Approach fee:
Other TOTAL: $
Receipt Number.
Cash/Check Number
ESTIMATED COST(REQUIRED) Date:
'Fair market value of all labor and materials foundation to finish
Initials:
G:\PcrmitCenter\###FORMS###\DRD FORMS\Master I'emut Application 5-29•O8.doc
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aw4$ON co JEFFERSON COUNTY
w DEPARTMENT OF COMMUNITY DEVELOPMENT
9`rK7NO.SO
Date: \2'\.,..-,-\ Time Received: �'� am/re Mon. CD. Wed. Thur. Fri.
Date: V0-`\`'' ^ \3.
BLD: \ S"-- \' .0c1 Contact Name: ��e...>
Owner: F� -� Psresc..-A Contact Number: 360 -7,-.5., yo\�
Address: \1,4-9 3\/U \,--. Pte,,,, 206
Notes: \ P'SNOL f'f1J\✓} e,.C..s�—�
Foundation Plumbing Framing Propane 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 7K_
Setbacks Floor
Foundation Wall Address Posted
Block&Tile Ceiling
0 •
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#: BLD13-00169 Received Date 5/30/2013
SITE ADDRESS: 136 BRUSH PLANT RD Issue Date 5/30/2013
QUILCENE, 98376
APPLICANT: ANDREW M PRESCOTT TRSTE PHONE: 360-765-4010
SANDRA J PRESCOTT TRUSTEE
PO BOX 35
QUILCENE WA 98376-0035
SUBDIVISION: HAMILTON'S 5AC TRACTS Block: Lot:
PARCEL NUMBER: 956100043 Section: 13 Township: 27N Range: 02W
CONTRACTOR: OWNER/BUILDER PHONE:
OWNER, ANDREW M PRESCOTT TRSTE PHONE: 360-765-4010
if different: SANDRA J PRESCOTT TRUSTEE
PO BOX 35
QUILCENE WA 98376-0035
PROJECT DESCRIPTION: INSTALL AMANA FURNACE
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 5/30/2014.
REQUIRED INSPECTIONS:
Tank/Line/Appliance:
ia--,-
FinalApproval: i —[3-1S-
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_Permit_Propane.rpt 5/30/2013