HomeMy WebLinkAboutBLD2005-00475 •
PROPANE/PELLET/WOOD STOVE & TANK INSTALLATION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD05-00475 Received Date 7/20/2005
SITE ADDRESS: 140 PINE DR Issue Date 7/20/2005
PORT TOWNSEND, 98368
APPLICANT: JANA W HALVORSON PHONE:
1417 PACIFIC ST
REDLANDS CA 923736935
37
SUBDIVISION: CAPE GEORGE VILLAGE DVI 4 Block: Lot:
PARCEL NUMBER: 940800037 Section: 13 Township: 30N Range: 02W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2006
OWNER, JANA W HALVORSON PHONE:
if different: 1417 PACIFIC ST
REDLANDS CA 923736935
PROJECT DESCRIPTION: INSTALL TWO-120GAL A/G PROPANE TANKS,PIPING AND M!§4+
""'GTOVE
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 7/20/2006.
REQUIRED INSPECTIONS:
Tank/LineeAppliance:` .56iS'05
FinalApproval:j/►.14.Sw i..010E. <e-g-o$'
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:00 a m. -4:30 p.m.
HOT LINE AVAILABLE 24 HOURS A DAY
I:\F_BLD_Permit_Propane.rpt 10/29/19
•UILDING PERMIT APPLICAN BLD05-00475
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD05-00475 Received Date: 7/20/2005
SITE ADDRESS: 140 PINE DR
PORT TOWNSEND, 98368
OWNER: JANA W HALVORSON PHONE:
1417 PACIFIC ST
REDLANDS CA 923736935
CAPE GEORGE VILLAGE DVI 4
SUBDIVISION: Block: Lot: 37
PARCEL NUMBER: 940800037 Section: 13 Township: 30 N Range: 02 W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2006
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION INSTALL TWO-120GAL A/G PROPANE TANKS,PIPING AND HEAT
STOVE
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW
VALUATION MAIN:
CODE EDITION: 2003 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 By: Date: Receipt: roved/Date
Propane Tanks/Stoves $49.00 PRB 07/20/05 73488 APPH `. , `', ' '
Total: $49.00 Jul 2 0 2005
Jefferson County Planning
& Buildi Department
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SITE VISIT REPORT •
(PLOT PLAN)
JOB -Ipo..DA FIoLA‘R DATE : "/"7/o`.7
CONTACT:
ADDRESS 1 '40 Rot l^7. rz PORT Mowtosc7.30 PHONE #:
DIRECTIONS Coe FAX
J i 1 Ia be FAX #: •
Email
E PLANNER: l�oQ .
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DEPARTMENT O COMMUNITY DEVELOPMENT i C. �c. t,fl
621 Sheridan Street • Port Townsend •Washington 98368 fl 1
. $ 360/379-4450 • 360/379-4451 Fax ; ' JUL 2 0 2005 i 4.,
�y O www.co.jefferson.wa.us/commdevelopment
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Master Permit Application MLA:
Project Description(include separate sheets as necessary): ,
Y Pill/ / a-','c-s * �'� ]E/ee--t f µe Q.y?�.� 6a-¢� rcCJ
Tax Parcel uu Property
Number: 10 O Q 60 3 7 Size:
(acres/square feet)
Site Address and/or Directions to Property: _ / /O A 11...c._ i',v-c,
Property Owner(s)of Record: 'Ta-A- F/ '2 L ) (it')
Telephone: 3 7 el O /v Fax: email:
Mailing Address: i -.? _
Applicant/Agent(if different from owner): , <r `-'-'
Telephone: 38- -- 7 c1 7 Fax:
email:
Mailing Address: /) r5 -z Lc. I°j � „ c/ /9
What kind of Permit?(Check each box that applies)
C; Building ❑Variance(Minor,Major or Reasonable Economic Use)
Li Demolition Permit ❑ Conditional Use[C(a), C(d),or C]**
❑ Single Family ❑ Discretionary"D'or Unnamed Use Classification
❑ Garage Attached/Detached ❑ Special Use(Essential Public Facilities)**
Manufactured Home ❑ Boundary Line Adjustment
Cl Modular ❑ Short Plat**
Cl Commercial* 0 Binding Site Plan**
❑ Change of Use ❑ Long Plat**
❑Address ❑ Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments**
Propane ❑ Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions**
❑ Stormwater Management ❑ Shoreline Management Substantial Development**
Li Site Plan Approval Advance Determination (SPAAD)* ❑ Shoreline Management Variance
❑Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium
*May require a Pre—Application Conference **Requires a Pre-Application Conference
Please identify any other local,state or federal permits required for this proposal, if known:
DESIGNATION OF AGENT
I he eby esigna to act a y ag i matter lating to this icati for permit(s).
O ER GNATURE D ---J
By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is tale and correct to the best of
his,her or it's 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.Access and right of entrye to this property shall be requested and shall occur only during regular business
Signature: '`7"9 K /-/./� K.�[ /9✓1.. 1c L1Ae,c_> y' ,
Date: ;1/4 �,
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 co plying ' the ESA. Vie Applicant has read this disclaimer and signs and dates it below.
Signature: -,. i:--.ire.l ` A ;;1. ,•,�I
/
ItDate: 7A 57 O
c;:\PermaCenter\FORMS\DRD FORMS\Master permit Application 7-8-04.doc
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OWNER BUILDER STATEMENT IIIThe signer of this statement does hereby certify that ey 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 MANUFACTU 0 HOME INSTALLER: PHONE: p FAX:
af -r.,5)-4-t-r- Gr _ q6O) Jeff- , 7 517 ( )
MAILING ADDRESS: /0 S ? , et' EMAIL:
CONTRACTOR'S LICENSE /) 7�� ///C G / 'J ) WAINS
NUMBER: Set N jf/f-J,w e) 717 G .lam NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
U New ❑ Wood Existing: ❑ Sewer
[1 Addition ❑ tel Proposed: bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete d, Te ' Haight, ❑ Individual System
❑ Repair ❑ Masonry -- - SEP Permit#
❑ Demolition ❑ Other: Bedrooms: -- Water Supply:
Existing: l K Setback: •1 ❑ Private well ❑ Two Party
Type of Heat: Pro sec.
p° ►.4 rm1- - r 7nnr L'f 7 Public
to It ` ti - \lame of System:
k Z
aF
If this is a Commercial Project you must answer the following:'''PT. OF CMr
(_ _'
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 A,Above ground Tank
X 2 Size of Propane Tank: /a 0 6--A-- ,
Ise Heat Stove Cl Cook Stove ❑ Woodstove L l Fireplace Insert [l Hot Water Tank ❑ Pellet Stove X Other g P
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 For Office Use Only
Current Proposed Amount '
Main Floor Consistency Review: 24%
53.
1---Nu Floor Base fee: qq C5C)
3rd Floor Additional Section:
Mezzanine: Plan Check fee:
Heated Basement State Surcharge fee:
Unheated Basement Pot Water Review fee:
Other Unheated 911/Rd Approach fee:
Garage/Carport TOTAL: $ t3 ,
co
Decks l n
Receipt Number: •
Other Cash/Check Number:
ESTIMATED COST(REQUIRED) Date: _
•Fair market value of all labor and materials foundation to finish 1 1 2� OS-
Initials:
(i:\Pcm itcenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc