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Home My WebLink AboutBLD2009-00277 • 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 #: BLD09-00277 Received Date 8/18/2009 SITE ADDRESS: 2340 W VALLEY RD Issue Date 8/19/2009 CHIMACUM, 98325 APPLICANT: CHARLES TANDY PHONE: 360-3851-0435 PO BOX 1906 PORT TOWNSEND WA 98368 TX 10 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901271003 Section: 27 Township: 29N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 ((33Bg0p1l 338g5 Contractor's License SUNSHP*077QP Expires 11/17/2010 5875 OWNER, CHARLES TANDY PHONE: 360-3851-0435 if different: PO BOX 1906 PORT TOWNSEND WA 98368 PROJECT DESCRIPTION: SWAP OUT A/G 250 GAL PROP TANK Directions SEE MAP IN FILE 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 8/19/2010. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: �-7 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 BUILDING PERMIT APPLICA BLD09-00 N Review Type:pe: 277 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD09-00277 Received Date: 8/18/2009 SITE ADDRESS: 2340 W VALLEY RD CHIMACUM, 98325 OWNER: CHARLES TANDY PHONE: 360-3851-0435 PO BOX 1906 PORT TOWNSEND WA 98368 SUBDIVISION: Block: Lot: TX 10 PARCEL NUMBER: 901271003 Section: 27 Township: 29 N Range: 01 W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2010 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION SWAP OUT A/G 250 GAL PROP TANK TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2006 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: 'CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: VATER SYSTEM: IEDROOMS: BATHROOMS: xist: Exist: rop: Prop: otal: Total: outing Date: pe Amount Paid By: Date: Receipt: Approved/Date opane Tanks/Stoves $71.00 LYK 08/18/09 110766 Total: $71.00 4111P SITE VISIT REPORT (PLOT PLAN) JOB CIL(i I Z'h4,,V DATE : p , ' l CONTACT: • ADDRESS Q Lf 3c� Ut°`� ,`le KC PHONE #: • DIRECTIONS FAX #: Email PLANNER: c0r-e { \ i'C 2 � f o ,/ �� N c"--0 c 1,\I' �) AUG 1 8 2009 U ,7 I ( e, f 1 ON co o JEFFERSON COUNTY h \� ,`".� DEPARTMENT OF COMMUNITY DEVELOPMENT o ►� 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax �zp� www.co.jefferson.wa.us/commdevelopment $rNG Master Permit Application MLA: til. fl t . (f .t Project Description(include separate sheets as necessary): iRNfC r Tax Parcel Number: 7 / oa 3 Property p y Size: (acres/square feet) Site Address and/or Directions to Property: c Li )ZA�Vfe I� i� , Ch I atA� - Property Owner(s)of Record: k L l.PP "TC0 i^i�.1.4� Telephone:3 --1,0 &S /-- 06(3-� Fax: email: Mailing Address: 0 I f) �r--i D,an werTir, -_ Applicant/Agent(if different from owner): 5(4/4 1jr✓10 ,1-4-'ajOQ v-L2 Telephone: 3 3— -S 79'—) Fax: & S 7S email: Mailing Address: /3o.5 fzp ��el— What kind of Permit?(Check each box that applies ❑ Lot or Road Segregation ❑Building 0 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]** 0 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 0 Short Plat** ❑ Home Business 0 Cottage Industry 0 Binding Site Plan** 1 Propane 0 Long Plat** 0 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** ❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development** ❑Temporary Use 0 Shoreline Management Variance ❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑ 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 Please identify any other local,state or federal permits required for this proposal, if known: ESIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE } c�� Date: � By signing this application rm,the owner/agent att sts at e information provided herein,and in any attachments,is true and correct to the best of his,her or its knowledge. Any material falsehood or y o ission 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 tq pr ' access and right of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application review and any requ'a later inspec ns. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applicati t t he or nts pri notice. Signature: r,' Date: /mac/ : The action or actions Applicant will undertake result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potentia e"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 is`syied• ill 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 e i complian with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferable+res n ibilit heri ' to and complying with the ESA. The Applicant has read this dis i er-a Signature: ` • I / rlI aq tes it below. Date: i�(f •\pPrrriit(crntrr\#4ttimRmstato r-mr)MR MC\rn. ,,-r pr F....., \T.f.,or..no.....:. a....r....:,,.,S .in no a,.,, ! • 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: GE RAL CONTRACTORTR � O. NUFACTURED HOME INSTALLER: PHONE: FAX: • �1 M_ll (PHONE ( ) MAILING ADDRESS: EMAIL. 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: ❑ Sewer ❑ Addition 0 Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel 0 Concrete Total: Height: ❑ Individual System ❑ Repair 0 Masonry SEP Permit# ❑ Demolition 0 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: Jnderground Tank i-Above ground Tank Size of Propane Tank: 2-SD I Heat Stove i Cook Stove I Woodstove i Fireplace Insert i Hot Water T k 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 ,� � i�u�l� �► �,� Amount Revision Main Floor Heated EH Bid App Review: 2' Floor Heated Consistency Review: Other Heated Base fee: �`j ; Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $ Receipt Number: ' t�� Cash/Check Number: 4 "4 1 ESTIMATED COST(REQUIRED) Date: L-f `- •Fair market value of all labor and materials foundation to finish �� Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc