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Home My WebLink AboutBLD2010-00071 • 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 #: BLD10-00071 Received Date 3/15/2010 SITE ADDRESS: 10893 RHODY DR Issue Date 3/15/2010 PORT HADLOCK, 98339 APPLICANT: ARCEOS LLC A WA LLC PHONE: 360-385-5285 10893 RHODY DR PORT HADLOCK WA 98339-9745 TX 43 SUBDIVISION: CHALMER'S 2ND ADDITION Block: 28 Lot: PARCEL NUMBER: 942902802 Section: 3 Township: 29N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 ((33 p) Contractor's License SUNSHP*077QP Expires 11/67/ 3g52010-5875 OWNER, ARCEOS LLC A WA LLC PHONE: 360-385-5285 if different: 10893 RHODY DR PORT HADLOCK WA 98339-9745 PROJECT DESCRIPTION: A/G 500 GAL OPROP TANK SWAP OUT- SAME SIZE & LOCATION 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 3/15/2011. REQUIRED INSPECTIONS: Tank/Lin e/Appliance: FinalApproval: 3I 14tt) . 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 BLD1 0-00071 FOLDING PERMIT APPLICATI• Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00071 Received Date: 3/15/2010 SITE ADDRESS: 10893 RHODY DR PORT HADLOCK, 98339 OWNER: ARCEOS LLC A WA LLC PHONE: 360-385-5285 10893 RHODY DR PORT HADLOCK WA 98339-9745 CHALMER'S 2ND ADDITION SUBDIVISION: Block: 28 Lot: TX 43 PARCEL NUMBER: 942902802 Section: 3 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 A/G 500 GAL OPROP TANK SWAP OUT - SAME SIZE & 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 LYK 03/15/10 114010 Total: $71.00 • SITE VISIT REPORT (PLOT PLAN) JOB F1E5T1) —Sht is Ct7. RE577 DATE : 3/i Ito . CONTACT: ADDRESS PHONE #: DIRECTIONS FAX #: Email PLANNER: 1 5 '010 100 • ;) `JCC) G Y S iiiirmik--oNcd JEFFERSON CSJTYiDEPARTMENT OF COMMUNITY DEVELOPMENTi )1.ej 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax IS Nwww.co.jefferson.wa.us/commdevelopment ZIIMaster Permit Application MLA: t ,bi (/YLA 1_6 Project Description (include separate sheets as necessary): _ r / Tax Parcel , ) ,/ _ 0 _ o 0 Property Number: / �` 9 Size: (acres/square feet) Site Address and/or Directions to Property: Property Owner(s)of Record: A 2 C EOS L-L C..- Telephone: t�.(}',5---,5 e s -' Fax: email: Mailing Address: Applicant/Agent(if different from owner): S(-1-NS H NE E P R.o PA N E Telephone: 395-5717 Fax: 3BS' S87S email: INIFOe SurJ3N/NEPrOPA4-7C• Mailing Address: I CDS5.3 R HODy D e• P. 1- Afl LOCK LA)R- 9&3.3. cool What kind of Permit? (Check each box that applies ❑Building ❑ Variance (Minor, Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use [C(a), C(d),or C]** ❑ Single Family ❑ Garage Attached/Detached U Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home ❑ Modular ❑ Special Use(Essential Public Facilities)** ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use 0 Short Plat** ❑ Address ❑ Road Approach 0 Binding Site Plan** ❑ Home Business 0 Cottagelndustry 0 Long Plat** Propane ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑ Sign 0 Plat Vacation/Alteration** ❑Allowed"Yes" Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management 0 Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination (SPAAD)* 0 Shoreline Management Variance ❑ Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* 0 Jefferson County Shoreline Master Program Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium ❑ 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: t DESIGNATION OF AGENT �x I herebyP� designate t5t,(n1S It�1E Q to act as my agent in matters relating to this application for permit(s). �NER SIGNATUR� {s:y ' Date: O.3 — 1 5 ^ l 0 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 iiabiiities,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 a ess and right of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application review and any required er inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the a plication t he o sh nts prior notice. ignature� Date: ) U S f VS —— id 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 1,_) permit has been issued will no iolate 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 c pliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual Aand non^tr_ansferable resp ibility r ring to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature_i.) t Cate G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc • BUILDER STATEMENT The signer of this statement does hereby^ertify 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 10E P2.op (360) 3�35- 5797 ( 36o) 385-587.; MAILING ADDRESS: O f� EMAIL: i n sU�si-mt Pro Pine C CAA �o�s3 �++-OoY �i�u � 6 CONTRACTOR'S LICENSE WAINS NUMBER: �uhs'>- P+ orrr7Q P NUMBER ARCHITECT/ENGINEER: PHONE( ) FAx: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: I] Sewer CI Addition ❑ Steel Proposed: Bank a Community System E. Alteration/Remodel ❑ Concrete Total: Height: I I Individual System F. Repair ❑ Masonry SEP Permit# I.:1 Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: 17 Private well ❑ Two Party Type of Heat: Proposed: I I Public Total Name of System: If this is a Commercial Proiect 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 (Above ground Tanl Size of Propane Tank: JOO j-a--. I Heat Stove I Cook Stove I Woodstove I Fireplace Insert I Hot Water Tank 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 ;'xFtliOfficelUse.;Only :.. .?^ ,,.,+.)". 1 Amount--:! l evislonv. Main Floor Heated ` EH Bld App Review: i 2n1 Floor Heated Consistency Review: Other Heated Base fee: 6-7( r Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport t SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $ 1 I Receipt Number: 1 -TI O fi � . ..� � I I lJ -` Cash/Check Number: 1-5-1 Co ESTIMATED COST(REQUIRED) Date: / .Fair market value of all labor and materials foundation to finish 1 Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc