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HomeMy WebLinkAboutBLD2014-00137 • BUILDING PERMIT APPLI ION BRDI4-00pe7 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD14-00137 Received Date: 4/17/2014 SITE ADDRESS: 521 GARDINER BEACH RD SEQUIM, 98382 OWNER: RON E REYNOLDS PHONE: 360-797-7214 FRANCES K REYNOLDS PO BOX 2964 SEQUIM WA 98382-4352 SUBDIVISION: Block: Lot: TX 19 PARCEL NUMBER: 002341016 Section: 34 Township: 30 N Range: 02 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 DESCRIPTION Install (single port) Ductless Heat Pump, SEP in vio TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: HTP 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: OSS WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Apprroved/D to Permit $152.00 MEB 04/17/14 148603 APPRO\/EL' Total: $152.00 Jefferson County DCC \\+irlcmorIt\rin+n\fnrmc\C RI rl Ann PId rn+ A/17/1111A 411111 (1/b\oN c/I - I sq . .,s c, JEFFERSON COUNTY .... -, DEPARTMENT OF COMMUNITY DEVELOPMENT 0)7' 621 Sheridan Street I Port Townsend, WA 98368 I Web: weivi colefferson.wa.usiCommunitydeveiopment 4., ut9/....;,(5- Tel:360.379.4450 I Fax:360.3794451 I Email,dcdecodefferson.wa,us Building Permits&inspections I Deve/opment Consistency Review!Long Range Planning! Watershed Stewardship Resource Center Master Permit Application MLA: Project Description(include eseppratesheets as necessay): t (DA 64C45 ili RI IPA uio r C((lifit p '(4 Tax Parcel Number: 000/3'i'le2/6 D r o oerty S ze (acres/square feet) Site Address and/or Directions to Propely 6-2/ 6' _R nee 861€,A _ ___ , 1 v. Property Owner(s)of Record: _ e L__. _ 4-1„, A,. - Telephone ik, ? ,f - ?2/44 Fax: email: riggrAr 02(6 . i'i- 4..i.,1 , . y. Mailing Address: 4.-c.`t Applicant/Agent(if different from owner): A4,6154,141 ,/-14 co. Telephone:3 4.b 4,451 31;3 Fax em :/n.,G1e..4)44,01,Sutor4ik i.coo- Mailing Address: P.O. AO y IV3 1 Ca-daigl, 14,14 .. What kind of Permit?(Check eacn box that apples 7 Lot or Road Segregation 2f3uilding 7. Criticai Areas Stewardship Plan l E Demolition Permit :_Li Variance(Minor,Major or Reasonable Economic Use) C Single Family C Garage Attached I Detached 11 Conditional Use 1C(a),C(d).or Cl** O Manufactured Home - Modular :Discretionary"0"or Unnamed Use Classification O Commercial* _ Special Use(Essential Public Facilities)** LI Change of Use = Boundary Line Adjustment O Address _ Road Approach _ Short Plat"* 0 Home Business 7 Cottage Industry I— Binding Site Plan"* 1 D Propane Li Long Plat** I LD Sign C Planned Rural Residential Development(PRRD)!Amendments" 7 Allowed"Yes Use Consistency Analysis 7: Plat Vacation/Alteration L. Storrnwater Management f: Shoreline Master Program Exemption/Permit Revisions** L Site Plan Approves Advance Determination SPAAD)* • Ad/Release of Six-Year Moratorium •May require a Pre-ApplicatiOn Conference - Shoreline Management Substantial Development C Temporary Use ** C Shoreline Management Variance 0 Wireless Telecommunication 7 Comprehensive Plan/UDC/Land Use District Map Amendment Li Forest Practices A _Jefferson County Shoreline Master Program Amendment J. Tree Vegetation Request —Requires a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal, if known: r r 1 . 0 SIGNATION OF AGENT . I hereby designate ?(":///7 5l(/a_ #97` r . "..o act as my agent in matters relating to this application for permit(s). / OWNER SIGNATURE 401111/4,;(4 BMW e......" .. ......e;ir• .''All ' .... Date: V --ffEfrs — 7/ : By signing this applicat or form,the owner/agent attests that the information provided herein,aria 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 oeing 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 an 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 ew and any required later inspections Staffs access and right of entry will be assumed unless the applicant informs the County in welting at the time of the apploatio . -. ir-i- wants oboe./ ,.- Aier.-4111.v - ---; „aly Date: ..----"'" .---/ ,-- Signature: ............/,-.......K..:i ...... ' The action or a • 5 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 read to a potential lake'of an enclangerec species as those terms are defined it tne federal law knowr as the 'Endangered Species Act-or'ESA.`Jeffe7sor County makes no assurarces to the applicant that the actions that will ce undertaken .ise:nis 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 sne or rt holds individual a nd non-transfer-. .i..-7.-..ibilise aarip.,.._ • a • . .tr,... ing writ,tne ESA. The Applicant has read this dIscraimer and signs and dates it below Signature. AV).ks . Ar ' :,.../ fi've------ Date f... ,- :4 .:.,I•• • BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel referenced nerem that they are rot licensed cortrac:o•s and that they wi;l be assn r, r ..nsibII .. he Genera •an .,ctor for the proposed project Signature. - /At,Ai Date: V — r / _ GENERAL C.• <RACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: P ('t (t. f#61,1 Cil • X 34►) (981' ;333 (o)W -.724'&(• MAILING'ADDRESS: EMAI`� l7L ebb, P,G•I3 ok I'�-3 e C�c,rlslo•�, W F1 . �,purl CONTRACTOR'S L'CENSE WAINS NUMBER: Pe iAl . oi[iciV NUMBER ARCHITECT/ENGINEER: PRONE ( ) FAX:( ) MAILING A©oRESS: EMAIL Project Type: , Frame Type: Bathrooms: 1 Shoreline: Type of Sewage Disposal: _ New _ Wood Existing: , _ Sewer Addition I Steel Proposed: I Bank - Community System _ Alteration/Remodel _ Concrete Total: Height: _ Individual System Repair Masonry SEP Permit# Demolition I Other: Bedrooms: Water Supply: Existing. Setback: Private well _ Two Party T vff heat:. Proposed: Public � Y 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 oerrnit.mark all items below that apply: Underground Tank Above ground tank Size of Propane Tank: Heat Stove Cook Stove Woodstove Fireplace .nserl re O ' evotS te11eP ' knaT retaWtoH i Is this appliance being installed in a Manufactured i Mobile Home? Yes r 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: 2rr".Floor Heated Consistency Review: Other Heated Base fee: i j Mezzanine , Additional Section: , Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated i Pot Water Review fee: Garage/Carport l SUBTOTAL Decks__. 911/Rd Approach fee: Other TOTAL: $ Receipt Number: IL{MO O3 Cash/Check Number: \,5 5 I t,4� ESTIMATED COST(REQUIRED) Date: w :Fair market veiue of sit labor and materrars foundation to finish ►_ 1 /� Initials: - f �w �i o2 JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT -ssyf SGSe$ � // Date: \LTime Received: ., k am/ m,' on Tue. Wed. Thur. Fri. Date: 2 —t BLD: '1.-- 2";1 Contact Name: Owner: , - �.eJ C,. Contact Number: 360 "7r"? w.` '? t Address: ` C L,AGK ,. 206 I" Notes: l0 0.--1 ,,,_._ 1r Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Underground 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 • • 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 #: BLD14-00137 Received Date 4/17/2014 SITE ADDRESS: 521 GARDINER BEACH RD Issue Date 4/17/2014 SEQUIM, 98382 APPLICANT: RON E REYNOLDS PHONE: 360-797-7214 FRANCES K REYNOLDS PO BOX 2964 SEQUIM WA 98382-4352 TX 19 SUBDIVISION: Block: Lot: PARCEL NUMBER: 002341016 Section: 34 Township: 30N Range: 02W CONTRACTOR: PENINSULA HEAT INC PHONE: 360-681-3333 PO BOX 173 CARLSBORG WA 98324 Contractor's License PENINI*0440W Expires 10/18/2014 OWNER, RON E REYNOLDS PHONE: 360-797-7214 if different: FRANCES K REYNOLDS PO BOX 2964 SEQUIM WA 98382-4352 PROJECT DESCRIPTION: Install (single port) Ductless Heat Pump, SEP in vio 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 4/17/2015. REQUIRED INSPECTIONS: Installation per Manufacturer Specifications/CO2: Tank/Line/Appliance: Final Approval: (" .--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 4/17/2014