HomeMy WebLinkAboutBLD2007-00132 • •
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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 #: BLD07-00132 Received Date 3/28/2007
SITE ADDRESS: 809 E GO-ANNA BEACH RD Issue Date 3/28/2007
QUILCENE, 98376
APPLICANT: K M RANDALL PHONE: 253-773-9030
VALERIE M RANDALL
1700 S 22()TH ST
DES MOINES WA 981987906
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 601274012 Section: 27 Township: 26N Range: 01W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2008
OWNER, K M RANDALL PHONE: 253-773-9030
if different: VALERIE f\A RANDALL
1700 S 220TH ST
DES MOINES WA 981987906
PROJECT DESCRIPTION: INSTALLLING 500 GAL PROPANE TANK & GAS PIPING
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 3/28/2008.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: -/-)K Z L1Jr245,---
FinalApproval: 1* 0-2
BUILDINGBUILDING 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
GILDING Revviewiew T Ty PERMIT APPLICA•N BL y132
pe:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD07-00132 Received Date: 3/28/2007
SITE ADDRESS: 809 E GO-ANNA BEACH RD
QUILCENE, 98376
OWNER: K M RANDALL PHONE: 253-773-9030
VALERIE M RANDALL
1700 S 220TH ST
DES MOINES WA 981987906
SUBDIVISION: Block: Lot
PARCEL NUMBER: 601274012 Section: 27 Township: 26 N Range: 01 W
CONTRACTOR: SUNSHINE PROPANE PHONE 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP"C77QP Expires 11/17/2008
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION INSTALLLING 500 GAL PROPANE TANK & GAS PIPING
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 2003 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 $153.00 DJK 03/28/07 89644
Total: $153.00
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SITE VISIT REPORT
(PLOT PLAN)
JOB EtJ iotJ 0r,l_L DATE : 3/Zo (a3 .
CONTACT:
ADDRESS C-O- Oti)0 A D►2, (�' U i L , PHONE #:
DIRECTIONS FAX #: .
Email
PLANNER:
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(..-. 5'"N".e.tr, JEFFERSON•UNTYR IP I v�vl�'�t�V 1DEPARTMENT OF COMMUNITY DEVELOPMENT "ill )),441 ` 621 Sheridan Street• Port Townsend •Washington 98368360/379-4450 • 360/379-4451 FaxMAR 2 $ 27
• 0� www.co.jefferson.wa.us/commdevelopment
Master Permit Application MUMPlitli'
PP MLA: Y\t> XV\lik V-- Q.
Project Description(include separate sheets as necessary): ,
Tax Parcel r /Property
Number: I. 7 1+ O I a_ Size: .S (acres/square feet)
Site Address and/or Directions to Property:n/� g 0 6 0 — 0 IJ/ ik I) ( _ Q[,f/L 783 7(o
Property Owner(s)of Record: 1< . K 19-0 /J L
Telephone: a--3 - -7 7 3— 0 3 c) Fax: email:
Mailing Address: 17 D 0 S- 0 St Der Po 0 i vl QJ (,t/(j 9 c' L S a
Applicant/Agent(if different from owner): _�Gt, r '/N 2 /'`9ie0p/7--/v e
Telephone: 3 OS S 775' 7 Fax: ,' Q,5 8-S 7f email: /N P-0 S4,/37//r7c_pio,/74Q .
Mailing Address: 7 0 F. lefiLv0 y ,C7/2, Pi—ft /77,C_is Uc (,v�. y �-3 F cD
What kind of Permit?(Check each box that applies)
❑ Building ❑Variance(Minor,Major or Reasonable Economic Use)
❑ Demolition Permit ❑ Conditional Use[C(a),C(d),or C]**
0 Single Family ❑ Discretionary"D"or Unnamed Use Classification
0 Garage Attached/Detached ❑ Special Use(Essential Public Facilities)**
❑ Manufactured Home ❑ Boundary Line Adjustment
❑ Modular ❑Short Plat**
❑Commercial* ❑ Binding Site Plan**
❑Change of Use ❑ Long Plat**
0 Address ❑ Road Approach 0 Planned Rural Residential Development(PRRD)/Amendments**
g Propane ❑ Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions**
0 Stormwater Management ❑ Shoreline Management Substantial Development**
❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Variance
❑Temporary Use 0 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:
SIGNATIO GENT
I he y cj dig at ct a .gent i att- : - al • : + isoion .- (s).
w StErNAT / C-3ate: N._.
By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,isAtrwte 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 attomey'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
111 review and any requir later inspecti n .Access and f entry to this property shall be requested and shall occur only during regular business
hours. 1 (
('.1 Signature: (_. i F (, - 01`i tC 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
• \5 action(s)even if arein co plian 'th the Jeff rson County development code.The Applicant acknowledges that he,she or it holds individual
and non-tran fe ble respon ' ility f ad erin nd complying with the ESA. The Applicant has read this disci imer d signs and dates it below.
v7 Signature: c:` / Date: /
G:\PetmitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc (
I53-
• OWNER BUILDER STATEMENT 0
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 will be assuming the responsibility of the General Contractor for the proposed project.
Signature: Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
Sun S, '/A/t ,O2 opA-tJ E (360) .3 8S-s 797 (366) .38s - 587S
MAILING ADDRESS: / 0 r ,- ? ,If-0 0 y 0l'& EMAIL: In Fo C.fu ristfrh e PRap4-te . cAii
CONTRACTOR'S LICENSE `� A ' $ p O'7 7 Q NUMBERWAINS
,V NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
O New 0 Wood Existing: ❑ Sewer
O Addition 0 Steel Proposed: Bank ❑ Community System
O Alteration/Remodel 0 Concrete Total: Height: 0 Individual System
O Repair 0 Masonry SEP Permit#
O Ccrnc lion ❑ Ot is Rwrirnnrns: Water Suppiy:
Existing: Setback: ❑ Private well ❑ Two Party
Type of Heat: Proposed: ❑ Public
Total: Name of System:
If this is a Commercial Prolect 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 VAbove ground Tank Size of Propane Tank: / - 0 '--
❑ Heat Stove 0 Cook Stove 0 Woodstove ❑ Fireplace Insert 0 Hot Water Tank ❑ Pellet Stove 0 Other
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 1,i „14
Current Proposed - Amount
Main Floor Consistency Review:
2NU Floor Base fee:
3fO Floor Additional Section: �'.
Mezzanine: Plan Cheee.
Heated Basement State Surcharge fee: ,.. ... .7rt*:,,i,?,.4,,,,d
Unheated Basement Pot Water Review fee: . <4 � .r
Other Unheated 911/Rd Approach fee: + � j}A4 + r
Garage/Carport
It s
Decks Receipt Number:
9
k
�
Other ' .CashlCh�Number: ` It M, 4 ` f . `
�
ESTIMATED COST(REQUIRED) Date ` >t ,, p.hx "�r" ,• .
.Fair market value of all labor and materials foundation to finish , t t la
Iy■nitials. J, : .-▪ '
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc