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HomeMy WebLinkAboutBLD2014-00114 UILDING PERMIT APPLICA�N BLD14-00114. Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00114 Received Date: 3/25/2014 SITE ADDRESS: 23 NANTUCKET PL PORT TOWNSEND, 98368 OWNER: FRANK E POLLARD PHONE: 360-379-0650 LYNDA G POLLARD 23 NANTUCKET PL PORT TOWNSEND WA 98368-9533 KALA POINT#3 SUBDIVISION: Block: Lot: 167 PARCEL NUMBER: 965000025 Section: 27 Township: 30 N Range: 01 W CONTRACTOR: PENINSULA HEAT INC PHONE: 360-681-3333 PO BOX 173 CARLSBORG WA 98324 Contractor's License PENINI*0440W Expires 10/18/2014 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr SWAP OUT ELECTRIC FURNACE TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2012 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 MEB 03/25/14 148506 Total: $152.00 APPROVED Jefferson County DCD \\firlcmer4\rhfo\fnrrrte RI t1 Ann Rlrl rnf 4MF/9MA -M gin rann M -''''1'1"1-ti MAR-25-2014 09:051 FROM:PENINS AT COMPA 3E06512086 T6@794473 P.2'4 � ��'�$ow °6 JEFFERSON COUNTY 1 t l -- I C q' DEPARTMENT OF COMMUNITY DEVELOPMENT 4, � 621 Sheridan Street{Port Townsend,WA 98368{Web:www.co.iefferson.wa.us/comm nitvdevelooment fNV � Tel:360.379.4450{Fax:360.379.4451{Email:dcdt co.iefferson.wa.us Building Permits&Inspections k Development Consistency Review I Long Range Planning I Watershed Stewardship Resource Center Master Permit Application MLA: Proj scription(include separate sheets as necessary): .�STA'L { OM OF ELE (-TA f r Ls'Cc 6v- L tir-E- Tax Parcel Number: 9 b CO 00 pas''* Property Size: (acres/square feet) Site Address and/or Directions to Property: P-3 Aiotritickve P1 . t Property Owner(s)of Record: Frc..r`1� Po itL✓-c(, Telephone: 3(f1U • 3 • vtoSO Fax: email: 4 Q / _/ _Af .•t2 Mailing Address: ; &P O.u. ..k.4--PI • Applicant/Agent(if different from owner): ?CAA. hSc...t a. 1.4 c.J- Co • Telephone: 36O - &$( - 3333 Fax: 3 •O`(061- 2464 email: % QjJy.s ./ .. ), Mailing Address: P.0• p ? w fs- • 7— What kind of Permit?(Check each box that applies ❑Lot or Road Segregation OBuilding 0 Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use) 0 Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a),C(d),or C] 0 Manufactured Home 0 Modular 13 Discretionary•D"or Unnamed Use Classification 0 Commercial* 0 Special Use(Essential Public Facilities)** 0 Change of Use 0 Boundary Line Adjustment ❑ Address 0 Road Approach 0 Short Plat** O Home Business ❑Cottage Industry ❑Binding Site Plan** ❑Propane 0 Long Plat** 0 Sign ❑Planned Rural Residential Development(PRRD)Amendments** ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** 0 Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions** U Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development** O Temporary Use 0 Shoreline Management Variance 0 Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment 0 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 Pro-Application Conference Please identify any other local,state or federal permits required for this proposal,if known: y g )&MAI � / DESIGNATION OF AGENT I hereby designate ` 4• to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE /11 / Date: oVets-f olef y By signing this application form, a 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 inspecti,.... Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the anal' -,n, at he or sh:a7• - • 'or notice. Signature: ; A, `► Date: / a ) r S The action or actions Appli t 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 yo e in complian the Jefferson County development code.The Applicant acknowledges that he,she or It holds individual and non-transfes onsibility f ring to and complying with the ESA- The Applicant has read this disclai and s an da it b tow. Gate: Signature: 02 y /07/24/201: MAR-25-2014 09:06A FROM:PENINSUAT COMPA 3606812086 *3603794473 P.3'4 BUILDER STATEMENT The signer of th'._ tatement d. - eby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be a-•;, t".he respo,-i f ty of the General Contractor for the proposed project. J,� Signature: i ,� Date: 1 - 0'6/ GENERAL CONTRA TOR OR MAN FACT RED HOME INSTALLER: PHONE: FAx: Feunsu.1� � -P CO e (310) 6_0 II ' 3333 (fi0)61" 116 MAILING ADDRESS: F 42. r.# . 0 shl le ()/ . EMAIL: `L 'H 1 CONTRACTOR'S LICENSE WAINS NUMBER: Pel(�jN i -d Li`�U►/V NUMBER ARCHITECT/ENGINEER: II�� r PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: Li New Li Wood Existing: [3 Sewer u Addition 11 Steel Proposed: Bank ❑Community System I... Alteration/Remodel L1 Concrete Total: Height: Ii Individual System 11 Repair l.1 Masonry SEP Permit# n Demolition 1.1 Other: Bedrooms: Water Supply: R itGp i!rt u Existing: Setback: CI Private well L Two Party Type of Heat: Proposed: [" Public ,dvU tt I p- 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: Heat Stove Cook Stove Woodstove Fireplace.nsert rehtO I evotS telleP I knaT retaWtoH t 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 Bid App Review: 2"°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: - Cash/Check Number: ESTIMATED COST(REQUIRED) Date: rFair market value of all labor and materials foundation to finish Initials: i07/24/201' F; MAR-25-2014 09:07A FRDM:PENINS AT COMPA 3606812086 3603794473 P.4'4 Page 1 of 1 Mary Lofstrom From: Lynda Pollard[lyndap @olypen.com] Sent: Tuesday, March 25, 2014 9:43 AM To: mary©peninsulaheat.com Subject: permit authorization We authorize Peninsula Heat to act as our agent for Jefferson County permits. Lynda and Frank Pollard 23 Nantucket Place Port Townsend,WA 98368 3/25/2414 MAR-25-2014 09:05A FROM:PENINSULAIT COMPA 3606812086 71,603794473 P.1/4 To: Mary Blame From: Mary Lofstrom / Peninsula Heat Co. ?6, --- 8 /- 3333 f'1,' 360 - 61 — 208,6 JEFFERSON COUNTY. \ / N . NO. 06566 DATE RECEIVED FROM , , l )._0 -csA-rovu-- 111 DESCRIPTION BARS# AMOUNT CURRENCY 1 2--( '. . COIN �� [ , CHECKS 2 ../61t4v ,.,4,, C)?-5"--N• ., 1es,, „ 4, ..f.,,,, 4,4,,,i-:,,,„, rn RECEIVED BY - TOTAL _( � (I°. Jefferson Co Dept of Comm D.WA - Online Payments Page 1 of 1 CA Jefferson County Step 1:Select Payments Step 2:Review and Submit Step 3:Confirmation and Receipt Step 3: Confirmation and Receipt Result: Payment Authorized Confirmation Number: 13266420 Your payment has been authorized successfully and payment will be processed. Jefferson County Department of Community Development thanks you for your payment.For questions about your account,please call 360-379-4452 Thank you for using our bill payment services. Please save or print a copy of this receipt for record keeping purposes. My Bills Description Amount Due Residential Applications payment of$171.00 on Parcel Number 965000025 $171.00 Subtotal: $171.00 Customer Information Convenience Fee: $5.00 First Name: Mary Total Payment: $176.00 Last Name: Lofstrom Address Line 1: PO box 173 Address Line 2: City: Carlsborg State: Washington Zip Code: 98324 Phone Number: 360-681-3333 Email Address: mary©peninsulaheat.com Payment Information Card Number: *"""""''*""-0383 Expiration Date: ""/"" Print https://client.pointandpay.net/web/JeffersonCoDeptofCommDevWA 3/25/2014 le ell ,4,45ON ooG JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT N,TKI h G.tO 1 ate: 10 Time Received: 2j' 1 1-1 am/pm Mon. Tue. Wed. Thur. Fri. Date: Contact Name: _t"rGh IL- Pollard I Contact Number: 360 .� CAD'S-0 I. d 206 ■ddress: 2 & L dotes: Foundation Plumbing Framing Propane Tank Mechanical Framing Under ground g Under ground Furance g Footing Rough In Air Seal Above ground •as",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 • *- 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#: BLD14-00114 Received Date 3/25/2014 SITE ADDRESS: 23 NANTUCKET PL Issue Date 3/25/2014 PORT TOWNSEND, 98368 APPLICANT: FRANK E POLLARD PHONE: 360-379-0650 LYNDA G POLLARD 23 NANTUCKET PL PORT TOWNSEND WA 98368-9533 167 SUBDIVISION: KALA POINT#3 Block: Lot: PARCEL NUMBER: 965000025 Section: 27 Township: 30N Range: 01W CONTRACTOR: PENINSULA HEAT INC PHONE: 360-681-3333 PO BOX 173 CARLSBORG WA 98324 Contractor's License PENINI"0440W Expires 10/18/2014 OWNER, FRANK E POLLARD PHONE: 360-379-0650 if different: LYNDA G POLLARD 23 NANTUCKET PL PORT TOWNSEND WA 98368-9533 PROJECT DESCRIPTION: SWAP OUT ELECTRIC 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 3/25/2015. REQUIRED INSPECTIONS: Installation per Manufacturer Specifications/CO2: Tank/Line/Appliance: Final Approval: 41 cI 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_Permit_Propane.rpt 3/25/2014