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HomeMy WebLinkAboutBLD2007-00606 • • 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 #: BLD07-00606 Received Date 12/17/2007 SITE ADDRESS: 2510 SNOW CREEK RD Issue Date 12/17/2007 QUILCENE, 98376 APPLICANT: CARL A JARVIS PHONE: 360-765-4239 CATHLEEN JARVIS 2510 SNOW CREEK RD QUILCENE WA 983769530 SUBDIVISION: Block: Lot: PARCEL NUMBER: 802221005 Section: 22 Township: 28N Range: 02W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2008 OWNER, CARL A JARVIS PHONE: 360-765-4239 if different: CATHLEEN JARVIS 2510 SNOW CREEK RD QUILCENE WA 983769530 PROJECT DESCRIPTION: 500 GAL AIG PROP TANK SWAPOUT -NO MLA REQ'D 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 12/17/2008. REQUIRED INSPECTIONS: 11 ine/Appliance: tZ--28—tf 7 FinalApproval: 1.2=28--c'q 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 • 00606 BUILDING PERMIT APPLICATION Review Type: Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00606 Received Date: 12/17/2007 SITE ADDRESS: 2510 SNOW CREEK RD QUILCENE, 98376 OWNER: CARL A JARVIS PHONE: 360-765-4239 CATHLEEN JARVIS 2510 SNOW CREEK RD QUILCENE WA 983769530 SUBDIVISION: Block: Lot: PARCEL NUMBER: 802221005 Section: 22 Township: 28 N Range: 02 W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2008 REPRESENTATIVE: SUNSHINE PROPANE PHONE: (360) 385-5797 10853 RHODY DR (360) 385-5875 PORT HADLOCK WA 98339 PROJECT DESCRIPTIOP 500 GAL A/G PROP TANK SWAPOUT -NO MLA REQ'D TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: CODE EDITION: 2006 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: 10--7 Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $51.00 AMS 12/17/07 95592 Total: $51.00 / • 0 • SITE VISIT REPORT (PLOT PLAN) ( JOB c/91fQ/ - c J et/(4kTE : /-2/07/�7 . c/e2 CONTACT: ADDRESS 2„ 1Vr� 'eI R4 PHONE #: 76 S=7' .2 0? DIRECTIONS ( laL-Ce-rP3 (,4Ji3c FAX #: . i26 Email PLANNER: /2L -- . ?� .'F1ffRS1J C3►►N1YILCL ,i G,,\.,2_,,c-, u-,,i,\A, I D0 / .....L...... si;06--- s ch------z--- c- .. --112, litioui3t,r1 1-) ' , 1 N, 4"--' 041L t) L G-1= M,/c--r" a 4411}0. v.. f�,, /� f� �-y, I it / 11 1-- `U�- 4-d- u\J 1 ,Z is UA) 77�� ,�"' t 6ied'�. )- i • RECEIVED 11:460N C JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT _ 621 Sheridan Street • Port Townsend • Washington 98368 ;_DEC 1 72007 360/379-4450 • 360/379-4451 Fax qS .0 www.co.jefferson.wa.us/commdevelopment jiii[MIAPP.rif Master Permit Application MLA: no In ( c,� r'e "1 /CV Project Description(include separate sheets as nece sary): / — n Sap), �( Z C. !io C -<4-7-, �/Ld � C-,AJAir Tax Parcel Property Number: O 3-- 2 02 / OQS Size: (acres/square feet) Site Address and/or Directions to Property: • Property Owner(s)of Record: [^cam-/ - \,/ / V?f f Telephone: 7c 5 4,4'-3 - Fax: email: Mailing Address: ` 7. Applicant/Agent(if different from owner): 3(-L NS H I N E p R.o PA N E Telephone: 395''5797 Fax: 33S' SO17S email: /NFoesuAlsoiNeProP e• Mailing Address: I D853 RHODy D( - / . - . NF}O I-Dc/C LO R- 9 833`j `0ni What kind of Permit?(Check each box that applies ❑Building 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use[C(a), C(d),or C]** ❑ Singie Family 0 Garage Attached i Detached 0 Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home 0 Modular 0 Special Use(Essential Public Facilities)** ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use ❑ Short Plat** ❑ Address 0 Road Approach 0 Binding Site Plan** ❑ ome Business Propane 0 Cottagelndustry 0 Long Plat** 0 Planned Rural Residential Development(PRRD)/Amendments** ❑ ign ❑ Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management ❑ Shoreline Management Substantial Development** 0 Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Variance ❑Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* 0 Jefferson County Shoreline Master Program Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium 0 Tree Vegetaion Request *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: ,oeDESIGNATION OF AGENT \‘'I hereby designate Su I IS t) I N1E 1.-12o P A-ine____to act as my agent in matters relating to this application for permit(s). --OWNER SIGNATURE J ("01,/I)��d/Vbi) (Date: I z 0 By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true 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 f( review and any required later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applicatio "ha o she wants p for notice. I. ignature: �d � Date: i0 3/©7 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-ransferab iresp si ility for,adh in to and c mplying with the ESA. The Applicant has read this disclaimer nd sign and dates it below. '� Signature: Date: 17)/3// G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc l • • BUILDER STATEMENT 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: tsS'H PR,o (360) 395- 5797 ( 360) 385-587-; MAILING ADDRESS: 1 0853 }}-oo y 11 elk) 1•e 1.1 EMAIL: (fl f b Avksthvlee pro pane 6 CeM CONTRACTOR'S LICENSE l WAINS NUMBER: S'u ifIs'14 P7 O I r c P NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well 0 Two Party Type of Heat: Proposed: 0 Public Total: Name of System: If this is a Commercial Protect 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 A liance Installation permit,mark all items below that apply: U• nderground Tank Above ground Tan Size of Propane Tank: So ti I Heat Stove I Cook Stove Woo stove I Fireplace Insert I Hot Water Tank I Pellet Stov I 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 Foota a Current Proposed 'For.* i elUseµOb1 ;x. Amountt. ,s Rev, i° 1 Main Floor Heated >. , ' EH Bld App Review: 2nd Floor Heated Consistency Review: r Other Heated Base fee: �� ,�?) Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement f State Surcharge fee: • Other Unheated � Pot Water Review fee: Garage/Carport -" SUBTOTAL Decks si 911/Rd Approach fee: r'; 5 Other TOTAL: $ c D O r ♦ iQ4 Receipt Number: CI GjG) e Cash/Check Number: y�l � ESTIMATED COST(REQUIRED) Date: 1�f l.� 167•Fair market value of all labor and materials foundation to finish Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc