HomeMy WebLinkAboutBLD2008-00484 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 #: BLD08-00484 Received Date 11/17/2008
SITE ADDRESS: 1325 OLD GARDINER RD Issue Date 11/17/2008
SEQUIM, 98382
APPLICANT: ELIZABETH VAN DYKE TRSTEE PHONE: 360-797-0066
MORGAN VAN DYKE, TRSTEE
1325 OLD GARDINER RD
SEQUIM WA 983828782 1
SUBDIVISION: ROLLINS SHORT PLAT Block: Lot:
PARCEL NUMBER: 002342055 Section: 34 Township: 30N Range: 02W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
1/1.7 2 5875
Contractor's License SUNSHP"077QP Expires 1 / 010
OWNER, ELIZABETH VAN DYKE TRSTEE PHONE: 360-797-0066
if different: MORGAN VAN DYKE, TRSTEE
1325 OLD GARDINER RD
SEQUIM WA 983828782
PROJECT DESCRIPTION: SWAP OUT EXSISTING 120 GAL A/G PROPANE TANK
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 11/17/2009.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: j + N lL.7
FinalApproval:TM i` t -/Z —
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
11113UILDING PERMIT APPLICA BLD08-00484
N Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD08-00484 Received Date: 11/17/2008
SITE ADDRESS: 1325 OLD GARDINER RD
SEQUIM, 98382
OWNER: ELIZABETH VAN DYKE TRSTEE PHONE: 360-797-0066
MORGAN VAN DYKE, TRSTEE
1325 OLD GARDINER RD
SEQUIM WA 983828782 ROLLINS SHORT PLAT
SUBDIVISION: Block: Lot: 1
PARCEL NUMBER: 002342055 Section: 34 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 11/17/2010
REPRESENTATIVE: SUNSHINE PROPANE PHONE: (360) 385-5797
10853 RHODY DR (360) 385-5875
PORT HADLOCK WA 98339
PROJECT DESCRIPTIOI` SWAP OUT EXSISTING 120 GAL A/G PROPANE TANK
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 Bv: Date: Receipt: Approved/Date
Propane Tanks/Stoves $52.00 RAR 11/17/08 103023
Total: $52.00
SITE VISIT REPORT
(PLOT PLAN)
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JOB EL l 2 ,Me 7-Ef + ihO A6-ibv DATE : ii��// re
ADDRESS /32i Gl /�,J PHONE c
� � PHONE #: 7?-7— 0a6
DIRECTIONS ,'4441 LA, / Lo,6f 'a S'7z,i2 X #:
Email
PLANNER:
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ire)'. JEFFERSOFUNTY [�1 �, R ,
y,� DEPARTMENT OF COMMUNITY DEVELOPMENT R. E( ,i! J If ``` i '; j��
�' -Ns, E.(4 621 Sheridan Street • Port Townsend • Washington 98368
360/379-4450 • 360/379-4451 Fax N 0 V 1 l 26(18
�.qs, p� www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: if f flSUN (,(�IV I 1 t11,11
Project DescriptioNinclude separate sheets as necessary):/ - • � Q �
Lr3)0 2_ � 7'vf -J -r---
Tax Parcel / Property
Number: 0 0 � pa— D�> Size:
(acres/square feet)
Site Address and/or Directions to Prooertv:
/ 3, ..5 o/k 6 -, ,.- A , PI . T Property Owner(s)of Record: ��/]�-? -*? -r ex- (//t a /j L_4 —
_
Telephone: 711 7— 00 (a 6 Fax: email:
Mailing Address: / 3�5 d/d 5 �1/rr e_ f)fZ Q _ 9 .
Applicant/Agent(if different from owner): S 0L.Nth F /N E P Ro PA N E
Telephone: 3635 57 9 7 Fax: 3SS- SO7S
email: Foe Sun1sN/NE ProPgYt'ic,
Mailing Address: 10853 R HOD y D 2- / pi-. NHfl Lock L)A- 9 833q corn
What kind of Permit? (Check each box that applies
❑Building 0 Variance(Minor, Major or Reasonable Economic Use)
O Demolition Permit ❑ Conditional Use[C(a), C(d),or C]**
0 Singie Family 0 Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification
❑ Manufactured Home 0 Modular 0 Special Use(Essential Public Facilities)**
❑ Commercial* 0 Boundary Line Adjustment
0 Change of Use 0 Short Plat**
0 Address 0 Road Approach 0 Binding Site Plan**
0 Home Business ❑ Cottagelndustry 0 Long Plat**
Propane ❑ Planned Rural Residential Development(PRRD)/Amendments**
0 Sign 0 Plat Vacation/Alteration**
❑Allowed"Yes" Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions**
0 Stormwater Management ❑ Shoreline Management Substantial Development**
❑ Site Plan Approval Advance Determination (SPAAD)* ❑ Shoreline Management Variance
❑ Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* 0 Jefferson County Shoreline Master Program Amendment
0 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:
/.<
JE P DESIGNATION OF AGENT
I hereby designate S H It P to act as my agent in matters relating to this app ication for permit(s).
�WNER SIGNATURE CO (Date: O
By signing this application form,th owner/agent attests t t e in rmation 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 o' i sion 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 Je erson County as a result of or in consequence of the granting of this permit.
St`6Y' I further agree to provide access and right of e to Jeff rson County and its employees, representatives or agents for the sole purpose of application
V` review and any required late inspe -on St cess nd right of entry will be assumed unless the applicant info the ounty in writing at the
\` time of the application hai f or s ant ' r no'ce.
1 ignature: Date: 0 .
The action or actions Applicant ill undertake as a result the issuance of this permit may negatively impact upon o e or ore threatened or
endangered species and could I d to a potential"take"of n endangered species as those terms are defined in the federal law known as the
"Endangered Species Act"or"E A."Jefferso County makes no assurances to the applicant that the actions that will be undertaken because this
S1, permit has been issued will not violate the • SA. Any i'dividual,group or agency can file a lawsuit on behalf of an endangered species regarding your
\` action(s)even if you -r: 'n cimplia ce /1- - -ffers,'n County development code.The Applicant acknowledges that e,she it holds individual
and non ansferaiv e 'on- 'flit fir -.hering\to a d ompl ' g with the ESA. The Applicant has read this disclaimer nd sig an tes it below.
Signature: —v- Date:
illl - 1 j 1 ii 'CI
G:\PermitCenter\###FORMS###\DRD FORMS\Master 1i- it Application 12-19-2006.doc t 3-20a
• BUILDER STATEMENT • •
The sig;ier 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:
SOt\SS'H NE P2o pai1 (360) 3235- 5797 ( 360) 385-5875
MAILING ADDRESS: )0853 M-00Y n e U e_ P. rI. EMAIL: I nfo(0Sta►\sfIIV\e pro Pane 6 Ctx►1
CONTRACTOR'S LICENSE L WAINS
NUMBER: 'SI,(V1S 'r� Px 0 /�/r Q P NUMBER
ARCHITECT/ENGINEER: PHONE( ) FAX: ( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New ❑ Wood Existing: ❑ Sewer
❑ Addition Li Steel Proposed: Bank ❑ Community System
❑ Alteration/Remodel L1 Concrete Total: _ Height: ❑ Individual System
❑ Repair LI Masonry SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type of Heat: Proposed: ❑ Public
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 permit,mark all items below that apply:
i Underground T.I.. cAbove ground Tan l - Size of aup Tank: J a- O f,- -___ ry-L�,4-
1 Heat Stove !„off., ; •�, s ove r I e t k I Pellet Stove t Other 1-X t' !o 4,1-e_
Is this applia ce •elnq ins ailed in a Manufacture o i e Home? Yes / No (7a1•tiG t�l
When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings, all propertfz`Pr
lines, tank location and size, distances from the propane tank to all property lines,buildings and septic system components, yel
including the reserve area.
Square Footage Current Proposed For:Office,UseOnly , .r Amount :ri,RevI idi -;, _
Main Floor Heated EH Bld App Review:
2n°Floor Heated Consistency Review:
Other Heated Base fee: Z--
Mezzanine ' Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee:
Garage/Carpoi t SUBTOTAL
Decks 911/Rd Approach fee:
Other TOTAL: $ 57i
Receipt Number: (()2O2 3
Cash/Check Number: LA 2-5CP
ESTIMATED COST(REQUIRED) Date: 1t 11, ob
.Fair market value of all labor and materials foundation to finish
is,
Initials: 2
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc