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HomeMy WebLinkAboutBLD2008-00208 i • 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 #: BLD09-00208 Received Date 7/7/2009 SITE ADDRESS: 276875 HWY 101 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: PROPANE NORTHWEST INC PHONE: (503) 678-4305 PO BOX 1162 CANBY OR 97013 Contractor's License PROPANI948QC Expires 11/6/2010 OWNER, DISCOVERY BAY LSEHLDRS ASSOC PHONE: (360) 797-7222 if different: 2261 OLD GARDINER RD SEQUIM WA 98382-8718 dbrv2261 Ca�embargmail.com PROJECT DESCRIPTION: SWAP OUT 500 GAL A/G PROPANE TANK, SAME SIZE, SAME Directions LOCATION 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 7/7/2010. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: 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 APPLICAI'iON B D Review Typ08 y e: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD09-00208 Received Date: 7/7/2009 SITE ADDRESS: 276875 HWY 101 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: PROPANE NORTHWEST INC PHONE: (503) 678-4305 PO BOX 1162 CANBY OR 97013 Contractor's License PROPANI948QC Expires 11/6/2010 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP SWAP OUT 500 GAL A/G PROPANE TANK, SAME SIZE, SAME LOCATION 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: Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $71.00 KAS 07/07/09 1C8696 Total: $71.00 ON n d, JEFFERSONUNTY !(ECE]L� 1 DEPARTMENT OF COMMUNITY DEVELOPMENT '� 621 Sheridan Street • Port Townsend •Washington 98368 _ 360/379-4450 • 360/379-4451 Fax '�`�� ' q�, N ,�p www.co.jefferson.wa.us/commdevelopment Master Permit Application JEf FERSON CHM UCO MLA: Project Description(incjgde separate sheets as nepessary): s--a>7,,/ � Tax Parcel Number: 002 3s 3 Qom Property Property Size: 0 CLreS (acres/square feet) Site Address and/or Directions to Property: 22 W old Ceiit�P K'G/ e:1 CA gsJsz - 1156 ; Z-cc, Property Owner(s)of Record: a:i4;ou,;�y A4,5ehale- Tele hone: 1 , p 3 . '77 / /22-✓ Fax. © ' • ' 2 3 email: c • ited Con— Mailing Address: Z2/ 6 a (7 ,;f. ,� 9 87 S2 Applicant/Agent(if different from owner): U Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies ❑Lot or Road Segregation ❑Building ❑Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]** ❑ Manufactured Home .0 Modular - 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* 0 Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment ❑ Address 0 Road Approach ❑Short Plat** ❑ Home Business 0 Cottage Industry ❑Binding Site Plan** /Propane 0 Long Plat** ❑Sign 0 Planned Rural Residential Development(PRRD)/Amendments** • ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** ❑ Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions** 7 Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development** 7 Temporary Use 0 Shoreline Management Variance 7 Wireless Telecommunication* ❑ Comprehensive Plan/UDC/Land Use District Map Amendment I Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference ❑Tree Vegetation Request **Requires a Pre-Application Conference ase identify any other local,state or federal permits required for this proposal, if known: S' / DESIGNATION OF AGENT eby designate 1(x—,._ to act as my agent in matters relating to this application for permit(s). aye, fl(SIGNATURE Date: f /Zza R� ling this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of r or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet stilt in this permit being null and void. agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and )s which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application nd any required later inspectio s. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the ie application that he or sh w nts Nor notice. �j Date: //G,ZOd 7 1 or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or Id species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the ed Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your fen if you are in lia ce with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual nsferable respo i li or adhering to and complying with the ESA. The Applicant has read this disclaiff a signs and dates it below. // - Date: / Zoe 7 r\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc NMI11 • • 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: GEERAL CONTRACTOR, R MANUFACTURED� HOME INSTALLER: PHONE: Fax: •/,•� /, , . A l,:r I /Yew / (-1oo` ) 6 al i t j'v c{ ( ) MAILIN/ADDRESS: 2 j J t,��4> NL' OR EMAIL: CONTRACTOR'S LICENSE ) 7o,Z0 WAINS NUMBER: tf 13 LO-2.3,Z'�t)i Z 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# ❑ Other: Bedrooms: Water Supply: • Demolition Existing: Setback: ❑ Private well ❑ Two Party Proposed: El Public Type of Heat: 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 Tank �4bove ground Tank Size of Propane Tank: 5 �-4-- /�u� i Heat Stove I Cook Stove i Woodstove i Fireplace Insert 'X Hot Water Tank i Pellet Stdve Other / r Is this appliance being installed in a Ma red/Mobile Home? Yes / to When applying for a permit t0 install a proibah4 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 For Office Use Only Amount Revision Main Floor Heated {��""' EH Bid App Review: 2nd Floor Heated JEF1 �+ Consistency Review: Other Heated Base fee: 00 Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL 1 f' OD Decks 911/Rd Approach fee: Other TOTAL: $ ,Q2 Receipt Number: I O 0 &a Cash/Check Number: 24 „n' ESTIMATED COST(REQUIRED) Date: ��� `� •Fair market value of all labor and materials foundation to finish Initials: Ct G:\Peru tCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc 73 Or,ri �� ,s ...,_. c'f--- _...-- . Pz Z 1 a -A. , ra � � � CP ts1.1) . 1110 I- 11 m . . Ez° Q .-4 F z____ zo ; to . • O -I • r m r rn v r O L rb. . v 44. K rn , . c....,,--,r0 ..* -ri , i , ___>. _.„, zi-, 0 It m • Z m i o V) m o b- - - - t z ...:Z:S' II,: . Si 1 ,lm 4.. ITI ,t:p O y