HomeMy WebLinkAboutBLD2009-00135 • •
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 #: BLD09-00135 Received Date 4/30/2009
SITE ADDRESS: 2261 OLD GARDINER RD#48 Issue Date 4/30/2009
SEQUIM, 98382
APPLICANT: SUNSHINE PROPANE PHONE:
10853 RHODY DR
PORT HADLOCK WA 98339
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 002353003 Section: 35 Township: 30N Range: 02W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339 p 3g5
Contractor's License SUNSHP*077QP Expires 11/((33 67/2010-5875
OWNER, DISCOVERY BAY LSEHLDRS ASSOC PHONE: (360) 797-7222
if different: 2261 OLD GARDINER RD
SEQUIM WA 98382-8718
PROJECT DESCRIPTION: SWAP OUT TANK -SAME SIZE, SAME LOCATION - NO MLA REQ'D
Directions TENANT- MARCIA PERLSTEIN
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 4/30/2010.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: .
FinalApproval: � fit' �(L '
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 APPLICAJN BLD09-00135
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD09-00135 Received Date: 4/30/2009
SITE ADDRESS: 2261 OLD GARDINER RD#48
SEQUIM, 98382
OWNER: DISCOVERY BAY LSEHLDRS ASSOC PHONE: (360) 797-7222
2261 OLD GARDINER RD
SEQUIM WA 98382-8718
SUBDIVISION: Block: Lot: +
PARCEL NUMBER: 002353003 Section: 35 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) 385-875
PORT HADLOCK WA 98339
PROJECT DESCRIPTIOr SWAP OUT TANK - SAME SIZE, SAME LOCATION - NO MLA REQ'D
TENANT - MARCIA PERLSTEIN
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:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total:
Routing Date:
A k0 l og
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $71.00 KAS 04/30/09 108349 APPROVED
Total: $71.00
APR 302009
Jefferson County Planning
& Building Department
•
SITE VISIT REPORT
(PLOT PLAN)
/ JOB DATE : 4 1 Dcl
CONTACT:
ADDRESS 2-2-( Ot 1A.P-0rNe,(L R�. -116 PHONE #:
DIRECTIONST \SC_OV (Lk '"BA`'\ R,\,/ , FAX #:
'PAC-V-- , R ,5, ID t ' ‘ Email
?�'7T PLANNER: 1J4- L
APR 3 r
JEFFERSON COUNTY ACC
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STi N 120 V N-eix_T 'To"1v2A(l e(_,
�i, N Co,� JEFFERSO•OUNTY • RECIrVD
• \� `r3 DEPARTMENT OF COMMUNITY DEVELOPMENT_ _`
�� 621 Sheridan Street • Port Townsend • Washington 98368 M 3 n L1^-'
360/379-4450 • 360/379-4451 Fax
�yS, NGrp www.co.jefferson.wa.us/commdevelopment
4.1
Master Permit Application MLA:
Project Description(includeseparate sheets as necessary): jE f fi•.
r 3-z 2, _
Tax Parcel s Property
Number: 0 0 - 3 3 - vc Size: (acres/square feet)
Site Address and/or Directions to Property: 7 P„-,o, r—
Property Owner(s)of Record: O/J Cov/. 6 ily 2 _ S S o c.
j
Telephone: d'7 77-7." , Fax: email:
Mailing Address: .]--Z G,( D/d1 ck-v-S-.c�,,, /z,9 ,cL 62 . c-J lP
Ci'd' ? ,F )
Applicant/Agent(if different from owner): S CL.NS H I NE' P Ro PA N E
Telephone: 395-57 9 7 Fax: 3 3__C- 58 7S email: INFoe SuAL5H/NE ProPA-r .
Mailing Address: I D4353 RHODy D 2. / PI—. NA LDck L . 9 333'1 Bpi
What kind of Permit? (Check each box that applies '
❑Building El Variance(Minor, Major or Reasonable Economic Use)
El Demolition Permit El Conditional Use[C(a), C(d),or C]**
❑ Single Family ❑ Garage Attached i Detacned Li Discretionary"D"or Unnamed Use Classification
❑ Manufactured Home ❑ Modular ❑ Special Use (Essential Public Facilities) **
❑ Commercial* El Boundary Line Adjustment
❑ Change of Use El Short Plat**
El Address ❑ Road Approach ❑ Binding Site Plan**
❑ Home Business ❑ Cottagelndustry ❑ Long Plat**
Propane ❑ Planned Rural Residential Development(PRRD)/Amendments**
❑ Sign El Plat Vacation/Alteration**
❑ Allowed"Yes" Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions**
❑ Stormwater Management ❑ Shoreline Management Substantial Development**
LJ Site Plan Approval Advance Determination (SPAAD)* ❑ Shoreline Management Variance
❑ Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* 0 Jefferson County Shoreline Master Program Amendment
iJ Forest Practices Act/Release of Six-Year Moratorium ❑ Tree Vegetaion Request
*Ma re.uire a Pre—A..lication Conference **Re•uires a Pre-A.•lication Conference
Please identify any other local, state or federal permits required for this proposal, if known:
•
1)t DESIGNATION OF AGENT
I hereby designate J L(�S I P2fl P to act as my agent in matters relating to this application for permit(s).
WNER SIGNATURE /LL) 4/Z7/ZC2
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.
` 1 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 inspecti+ns. Staff's access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the application that he or s'e an . prior notice.ignature �� Date: T U
27 2v,
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 respo i lity or adhering to and complying with the ESA. The Applicant has read this disclaimer a d sig sand dates it below.
SignatureT �)
J Date: 7 Z ZdaEJ
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-1 9-2006.doc
•
• 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:
So q2H NE P2o pail e (360 ) 3i35- 5797 ( 36o) 385-5875
MAILING ADDRESS: )0 853 O t/ � i u f y}. f-I. EMAIL: Q n fW 3Liv\sHwlwe prop t(e 6 C '1
CONTRACTOR'S LICENSE WAINS
NUMBER: SUv1Sf4 P+ D !�In (l Q r(� NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX: ( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New in Wood Existing: ❑ Sewer
El Addition LI Steel Proposed: Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System
Cl Repair ❑ Masonry SEP Permit#
Demolition r' 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,emolcyees.etc) Current Proposed
IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No
If this is a Pro ane liance Installation permit,mark all items below that apply:
I Underground Tank 1 Above ground Tank Size of Propane Tank: /oZO e,..._
I Heat Stove 1 Cook Stove o e 1 Fireplace Insert 1 Hot Water Tank 1 Pellet Stove 1 Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No
When applying for a permit to install a propane tan/ 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 °For'.Office Use:"Only ' Amount. Revision
Main Floor Heated EH Bid App Review:
rii
2 d Floor Heated Consistency Review:
Other Heated ��f l L., Base fe 11 ro l I V
`0r�
Mezzanine Additional Se ion:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee:
Garage/Carpol SUBTOTAL 1 i W rr�
Decks 911/Rd Approach fee:
_-
Other TOTAL: $ 1 L. )D
Receipt Number: [6546
Cash/Check Number: 4564
564
ESTIMATED COST(REQUIRED) Date: ,
.Fair market value of all labor and materials foundation to finishti:A6C1
Initials:
( \Permit(:enter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc