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Home My WebLink AboutBLD2009-00206 • 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 #: BLD09-00206 Received Date 7/7/2009 SITE ADDRESS: 2261 OLD GARDINER RD#67 Issue Date 7/7/2009 SEQUIM, 98382 APPLICANT: DISCOVERY BAY LSEHLDRS ASSOC PHONE: (360) 797-7222 2261 OLD GARDINER RD SEQUIM WA 98382-8718 SUBDIVISION: Block: Lot: PARCEL NUMBER: 002353002 Section: 35 Township: 30N Range: 02W CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTPI983O6 Expires 9/26/2010 OWNER, DISCOVERY BAY LSEHLDRS ASSOC PHONE: (360) 797-7222 if different: 2261 OLD GARDINER RD SEQUIM WA 98382-8718 PROJECT DESCRIPTION: SWAP OUT 120 A/G GAL PROPANE TANK, SAME SIZE, SAME Directions LOCATION To Site: ELIZABETH LEWANDOWSKI 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 7/7/2010. REQUIRED INSPECTIONS: Tank/Line/Appliance: ( ` k- .-MRFinalApproval: _( V kA 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 OBUILDING PERMIT APPLICf ON B RDowoo206 Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD09-00206 Received Date: 7/7/2009 SITE ADDRESS: 2261 OLD GARDINER RD#67 SEQUIM, 98382 OWNER: DISCOVERY BAY LSEHLDRS ASSOC PHONE: (360) 797-7222 2261 OLD GARDINER RD SEQUIM WA 98382-8718 SUBDIVISION: Block: Lot: + PARCEL NUMBER: 002353002 Section: 35 Township: 30 N Range: 02 W CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTP1983O6 Expires 9/26/2010 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP SWAP OUT 120 A/G GAL PROPANE TANK, SAME SIZE, SAME LOCATION ELIZABETH LEWANDOWSKI 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 $71.00 KAS 07/07/09 108695 Total: $71.00 al • v r K . R EV ,iL i1 l'ED . ��Si JEFFERSON COUNTY • • W Y 4 DEPARTMENT OF COMMUNITY DEVELOPMENT r ''' 621 Sheridan Street•Port Townsend•Washington 98368 AL _ 2r,' ti • 360/379-4450. 360/379-4451 Fax �,E pip www.co.jefferson.wa.us/commdevelopment '6 IN JEFfERSfN COUNTY DCD Master Permit Application MLA: Project Description(ndude separate sheets as necessary): Propane tank swap out: same size, same location. Tax Parcel Number. Property Size: (acres/square feet) Site Address and/or Directions to Property: 2261 Old Gardiner Road Lot 67, Sequim, WA 98382 Property Owner(s)of Record: T.SrelJ(i Ar,;t If A i t.,,s Telephone: 7Ll L F email: Mailing Address: Applicant/Agent(if different from owner): Elizabeth Lewandowski Telephone: 360-797-7474 Fax: email: notsoblew@yahoo.com Mailing Address: 2261 Old Gardiner Road Lot 67, Sequim, Wa 98382 1 j What kind of Permit?(Check each box that applies 0 Lot or Road Segregation )(IXBuilding Jo ❑Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use) ❑Single Family ❑Garage Attached/Detached 0 Conditional Use[C(a),C(d),or C]** ❑ Manufacturer!Home_ . .❑ Modular • - - 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* ❑Special Use(Essential Public Facilities)** ❑ Change of Use ❑ Address 0 Boundary Line Adjustment ❑Road Approach 0 Short Plat** 0 Binding Site Plan** 0 Home Business ❑Cottage Industry XN Propane Lf Long Plat** ❑Sign ❑Planned Rural Residential Development(PRRD)/Amendments** . ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** ❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions** ❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development** 0 Temporary Use 0 Shoreline Management Variance ❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment 0 Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment *May require a Pre Application Conference ❑Tree Vegetation Request **Requires a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal,if known: S; DESIGNATION OF AGENT I hh/ereby designate S i., to act as my agent in matters relating tot this application for permit(s). ..... M. 1�/3l/2oa/ IGNATURE Date: By signing this application form,the owneragent attests that the information provided herein,and in any attachments,is true and correct to the best of his,her or its 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 review and any required later i «ons. 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 - is prior notice. / Signature: � . Date: "/ 'c(2- / 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 specie::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 7 and non-transferable resp for hering to and complying with the ESA. The Applicant has read this disdaimerand signs and dates it below. Signature: • Date: 7 ! 7� / a G:\P \##.t/FORMS#IIfA\DRD FORMS\Current DRD Forms\Master Pewit Application 5-29-08.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 projec- Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: Mountain Propane (360) 683-1881 ( ) MAILINGAoDREss265 Chimacum Rd, Port Hadlock, WA 9830(EMAn: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: 0 Sewer ❑ Addition 0 Steel Proposed: Bank ❑Community System ❑ Alteration/Remodel 0 Concrete Total: Height: ❑ Individual System ❑ Repair 0 Masonry SEP Permit# O 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 Projectyou 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 FoodSeririce? Yes / No ' ' _ .. If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply!, , i Underground Tank I Above ground Tank XX Size of Propane Tank: 120 Existing Swap Out Only f Heat Stove i Cook Stove i Woodstove i Fireplace Insert I Hot Water Tank i Pellet Stove i Other Is this appliance being jnstalled in a Manufactured I Mobile Home? Yes I No • When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all properly lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. t.,}4"'w •z r '!•aa,i`s!'. �a_';1; . i L`4:-ly�t k p • Y. •'o _ •z4k $"it Square Footage Current Proposed •; " S _ .it� 'u�*.:�� tag '..Y: - t�.- ) o r��5� Main Floor Heated `'; EH Bld App Review: 2'Floor Heated i‘k Consistency Review: Other Heated =��,�fi�.�t,{ er;,,,��'. Base fee: 71.00 Mezzanine �-r` r; "' Additional Section: Heated Basement s'` e , " Plan Check fee: Unheated Basement ;`. s State Surcharge fee: ' Other Unheated * y•, Pot Water Review fee: Garage/Carport t e '-'0. . SUBTOTAL 71.00 Decks •"j; ' " s riI 911/Rd Approach fee: lz�zzv' 4 Other P; ; _.-' . TOTAL $ 71.00 �� D@@/ ,, . , Receipt Number. 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