HomeMy WebLinkAboutBLD2008-00236 01° •
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 #: BLD08-00236 Received Date 6/3/2008
SITE ADDRESS: 523 BLUE RIDGE RD Issue Date 6/3/2008
PORT TOWNSEND, 98368
APPLICANT: PATRICIA M BRITT PHONE: 360-385-3626
GWENDOLYN B MOORE
PO BOX 158
PORT TOWNSEND WA 983680158 P 33+
SUBDIVISION: DISCOVERY BAY RIDGE DIV IV Block: Lot:
PARCEL NUMBER 001305033 Section: 30 Township: 30N Range: 01W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339 ((33 pl 3g5
Contractor's License SUNSHP*077QP Expires 1 1/67/2008 5875
OWNER, PATRICIA M BRITT PHONE: 360-385-3626
if different: GWENDOLYN B MOORE
PO BOX 158
PORT TOWNSEND WA 983680158
PROJECT DESCRIPTION: A/G 500 GAL PROP TANK& GAS LINE - 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 6/3/2009.
REQUIRED INSPECTIONS:
Tanlc/Linel ppliance 62-11-6�
FinalApproval: (v'ti-o ( A-(-lc.r,1t wf c.l_c.-.-Pvi
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 APPLICASN BLD08-00236
Review
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD08-00236 Received Date: 6/3/2008
SITE ADDRESS: 523 BLUE RIDGE RD
PORT TOWNSEND, 98368
OWNER: PATRICIA M BRITT PHONE: 360-385-3626
GWENDOLYN B MOORE
PO BOX 158
PORT TOWNSEND WA 983680158 DISCOVERY BAY RIDGE DIV IV
SUBDIVISION: Block: Lot: P 33+
PARCEL NUMBER: 001305033 Section: 30 Township: 30 N Range: 01 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 A/G 500 GAL PROP TANK & GAS LINE - 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:
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $105.00 LYK 06/03/08 '100234 APPROVED
Total: $105.00
JUN 3 2008
Jefferson County Planning
&Building Department
SITE VISIT REPORT
(PLOT PLAN)
JOB (OD( _ /irt DATE : .
CONTACT:
ADDRESS PHONE #: •
DIRECTIONS FAX #:
Email
PLANNER: •
,,/
i I
Sa a
\�D
RECEITV ED
\/
JUN - 3 2008
JFFFERSON COUEN Y DCO
�•�9.¢goN 06 JEFFERSO�OUNTY E C Elf vE D
/ '�' \,a lA DEPARTMENT OF COMMUNITY DEVELOPMENT
i" " 621 Sheridan Street • Port Townsend •Washington 98368 JUN — 2008
360/379-4450 • 360/379-4451 Fax
4.q �,� www.co.jefferson.wa.us/commdevelopment
s N Y JEFFERcnj�� r;1����,,,( %��,�,�
��
pp ��
Master Permit Application MLA:
Project Description (include separate sheets as necessary):_ '
c_5o 0 L�49-L- /2izo - -< ✓ /�-r.J S i--r.,--,, L_I
Tax Parcel Property
c—'
Number: - , 2$" 03 _ Size: (a:.res/square feet)
Site Address and/or Directions to Property. '
5c23 _J /2-.. , P,• . 7--)o
Property Owner(s)of Record: M obr' I �c L L-t- I
S Telephone: 3 k - 36� Fax: email:
Mailing Address: /'O L r--- /(5.(r
Applicant/Agent(if different from owner): S(4-MS H I N E P R.o PA N E
Telephone: 385-571 7 Fax: 313S'SO7S email: INFQSuAisN/N1E-PT'ofArie.
Mailing Address: I Des 3 RHODy D 2• / >o l• (-.(I Wyk LJ A_ 9 833`� �'"t
What kind of Permit? (Check each box that applies
❑Building 0 Variance(Minor, Major or Reasonable Economic'.Jse)
❑ Demolition Permit 0 Conditional Use[C(a),C(d),or C]**
❑ Single Family 0 Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification
❑ Manufactured Home 0 Modular ❑ Special Use(Essential Public Facilities)**
❑ Commercial* 0 Boundary Line Adjustment
❑ Change of Use 0 Short Plat**
❑ Address 0 Road Approach 0 Binding Site Plan**
❑ ome Business 0 Cottagelndustry 0 Long Plat**
Propane ❑ Planned Rural Residential Development(PRRD)/Amendments**
❑ ign ❑ Plat Vacation/Alteration**
❑Allowed"Yes" Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions**
❑ Stormwater Management 0 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* 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:
{fit c �S R DESIGNATION OF AGENT
--I hereby designate u N I�� �P to act as my agent in matters relating to this application fog permit(s).
�NER SIGNATURED C IU c it
(Date: q.•3 10
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
UUU 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 a•_ ' -ii'tha�.,he pr she yva 'or nonts ice.
/ 3 D
ignature: ) 4� "" `'`e` 1� Date: `�I I
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
J 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-ransf esponsibility for ad ,ng to and complying with the ESA. The Applicant has read thisdiscl i er nddsigns and da:t s it below.
�' SignaturE +�_ �
A Date:\1 /9 3(0 o
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc
0 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:
SO�H l I�t; P t2o pan� PHONE: FAX:MAILING ADDRESS: (360) 3 S 5- 5 77 ( 36 Q) 3g 5-58 75
10853 k)0y Aviv e- P. FI. EMAIL: In-Fp�o w nivic pro pan e 6 Ct
CONTRACTORS LICENSE WAINS
NUMBER: $u034 P+ 0t7n n p NUMBER
ARCHITECT/ENGINEER: 1 l "(
PHONE'( ) FAX: ( )
MAILING ADDRESS:
EMAIL
Project Type: Frame Type: Bathrooms:
0 New Shoreline: Type of Sewage Disposal:
❑ Wood Existing: 0 Sewer
0 Addition ❑ Steel Proposed: Bank
❑ Alteration/Remodel ❑ Concrete Total: ❑ CommualtS stemm
Height:
❑ Repair ❑ Masonry ❑ Individul System
❑ Demolition ❑ Other: Bedrooms: SEP Permit#
Existin Water Supply:
Type g: Setback: ❑ Private well ❑ Two
yp of Heat: Proposed: Party
Total: 0 Public
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
IBC Occupancy: IBC Type of construction: Proposed
If this is a Propane Tank and/or Appliance Installation permit,mark all items you have Food Service? Yes / No
below thatapply:
app
i Underground Tank Above ground Tank`
Size of Propane Tank: S a o
i Heat Stove I Cook Stove i Woodstove I Fireplace Insert I Hot Water Tank I Pellet Stove�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 Footage Current Proposed ,,:- ` iron r, I `,�. * Fly Am t '
p ` 1=lp ltj o t-,20b wa;kd ivt.0.ti i . + "AfiiioUnt ii k a}r vi.41 dt ✓„ :?'
Main Floor Heated t n
t c e EH Bid App Review:
2"°Floor Heated •
` s" * `'
x`� "`a '`a, ConsistencyReview:
s "tl
Other Heated t 4S 4 "'``'
Mezzanine o- Base feeYYO ff`nt f C 5 Ob` _ y X a , Additional Section:
Heated Basement - 2008 Plan Check fee:
I40� Y� � u
Unheated Basement x4 z =t�.1-•`
State Surcharge fee:
Other Unheated
v r" �% Pot Water Review fee:
Garage/Carport , R x
� SUBTOTAL
Decks £' '� a = ��� .OD
I ' 911/Rd Approach fee:
Other � ,a..
f� TOTAL: $ 1 5_ oD
h ,.- d Receipt Number: 1 Dba34
Cash/Check Number:
ESTIMATED COST(REQUIRED) Date:
•Fair market value of all labor and materials foundation to finish e 10
Initials: l'
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc