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HomeMy WebLinkAboutBLD2010-00128 • • 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 #: BLD10-00128 Received Date 4/26/2010 SITE ADDRESS: 145 BLUE SKY DR Issue Date 4/26/2010 PORT TOWNSEND, 98368 APPLICANT: RICHARD L CHOCIEJ PHONE: 360-385-4933 MEGAN W CHOCIEJ 145 BLUE SKY DR PORT TOWNSEND WA 98368-9081 12 SUBDIVISION: DISCOVERY RIDGE DIV II Block: Lot: PARCEL NUMBER: 001195012 Section: 19 Township: 30N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 138; -5875 Contractor's License SUNSHP"077QP Expires 1 / 1 OWNER, RICHARD L CHOCIEJ PHONE: 360-385-4933 if different: MEGAN W CHOCIEJ 145 BLUE SKY DR PORT TOWNSEND WA 98368-9081 PROJECT DESCRIPTION: A/G 120 GAL PROP 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 4/26/2011. 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 ItUILDING PERMIT APPLICASDN B RD10 00p1e 8 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00128 Received Date: 4/26/2010 SITE ADDRESS: 145 BLUE SKY DR PORT TOWNSEND, 98368 OWNER: RICHARD L CHOCIEJ PHONE: 360-385-4933 MEGAN W CHOCIEJ 145 BLUE SKY DR PORT TOWNSEND WA 98368-9081 DISCOVERY RIDGE DIV II SUBDIVISION: Block: Lot: 12 PARCEL NUMBER: 001195012 Section: 19 Township: 30 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 DESCRIPTIOP A/G 120 GAL PROP TANK SWAP OUT - SAME SIZE & LOCATION 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: 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 04/26/10 117592 Total: $71.00 . '• • SITE VISIT REPOR (PLOT PLAN) JOB i GtC : e2 ' 2 f c/o. CONTACT: ADDRESS //) BL-ue S'Cy &e l/ e PHONE #: 3eS- yq3? . DIRECTIONS /Sr /QFT oFF- BAte Sky IQIVe,FAX #: Email PLANNER: //4, a►k' ti/ �\ is ` Gb\ / �l i -re, g�J 2 5 'n ON • • /'yam �o JEFFERSON COUNTY / ' ' DEPARTMENT OF COMMUNITY DEVELOPMENT i `"° 'N V 621 Sheridan Street . Port Townsend .Washington 98368 360/379-4450 , 360/379/-4451 Fax ' www.co.jefferson.wa.us/commdevelopment ...y Master Permit Application MLA: NO � A Qi t j I ► Project Description (include separate sheets as necessary): h4 1 K S,4-o - s�4p),.� S t Z C c ..+T.„.,� c-c�L�n . Tax Parr-el Number: O0 j 1 CIS 0 12 _ Property Size: (acres/square feet) Site Address and/or Directions to Property: 145 aloe Ski 0-. P l " L J(- Property Owner(s)of Record: i C N pf, T EM CC4-4 y SS (.i�1 Telephone: 34`'5"" L(Ci 33 Fax: email: Mailing Address: 14-D (ScitAl" "jr-3-1 . t —t2—T T 3s rkD(o Applicant/Agent(if different from owner): `� �-- 0 /U4y ---- Telephone: . @5 - 5 7 7 Fax: 38 5-- 875: email: �4 c S d 4`Dyay• • ,c�,,, Mailing Address:, /d cf$3 k/-/o i/ Oi PT T . //fl-0 L o c% 1,1)/1 What kind of Permit? (Check each box that applies ❑ Lot or Road Segregation ❑Building 0 Critical Areas Stewardship Plan 0 Demolition Permit ❑Variance (Minor, Major or Reasonable Economic Use) 0 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 0 Commercial* 0 Special Use(Essential Public Facilities)** 0 Change of Use 0 Boundary Line Adjustment 0 Address 0 Road Approach 0 Short plat** 0 Home Business 0 Cottage Industry ❑ Binding Site Plan*"' 'ropane 0 Long Plat** 0 Sign 0 Planned Rural Residential Development(PRRD)/Amendments** ' 0 Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration ** 0 Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions** 0 Site Plan Approval Advance Determination (SPAAD) * 0 Shoreline Management Substantial Development** ©Temporary Use 0 Shoreline Management Variance 0 Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment 0 Forest Practices Act/Release of Six-Year Moratorium ❑ Jefferson County Shoreline Master Program Amendment *May require a Pre-Application Conference 0 Tree Vegetation Request **Requires a Pre-Application Conference Please identify any other local, state or federal permits required for this proposal, if known: DESIGNATION OF AGENT I ereby designate / to act as my agent in matters relating to this application for permit(s). 6 p •WNER SIGNATURE /� C` O - D 6 rr Date: r� By signing this application form,the owner/agent attests that the information p oyided 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 m teri• fact made by the owner/agent with respect to this application packet may result in this permit being null and void. C,, 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 re red later.inspections. Staffs access and right of entry will be assumed unless the applicant I 'forme the County in writing at the time of the appli n that or she nts prior notice. v • • •nature ti G (.'- 4 Date: ic�f The action or actions Applicant will undertake as a result of the issuan f this permit may negatively impact u n one or more threatened or endangered species and could lead to a potential"take."of an endange 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 yo are in compliance with the Jefferson County development code.The Applicant acknowledges hat he, she or it holds individual and non-transfe le resppnsibi.lity oring to an complying.with the ESA. The Applicant has read this di rf1i and dates it below. Signature: Date: f/`1/� 6"1 111 (:•v Pr r,,,f r.,n',A###RCIRM.C###MIRY"FfR MC\f,”---firm F,..,,,>A 7,4,.., ,n..,,,:t a.,.,ti ..,.,,c 'n rw,i,... 411 • f The signer of this statement does herebyBUILDER STATEMENT certify thate they are the Owners of the parcel referenced herein,that they are not licensed contractors and that the wil be this g the responsibility of the certify t are thContractor for the proposed ref. Signature: GENERAL CONTRACTOR . Date: ER' PHONE: SI.Lt� c� l h [P(�a> {�> � FAX: MAILING ADDRESS: (2(�d ) eS -I- 7 7 ( 3 G� eS S 7-5CONTRACTORS LICENSE ' l r1 r P. (( EMAIL: J NUMBER: WAINS ARCHITECT/ENGINEER: NUMBER MAILING ADDRESS: PHONE FAX:(( ) Project Type: Frame T EMAIL 0 New ype; Bathrooms: 0 Wood Existing: Shoreline: Type of Sewag p j, 0 Addition 0 Steel Proposed:0 Alteration/Alteration/Remodel __ 0 Sewer 0 Concrete — Bank 0 Community System ❑ Repair d MasonryTotal: Height; ❑ Demolition ��"` 0 Individual System Cl Other: Bedrooms: SEP Permit# Type of Heat: Existing Water Supply well Two Party r— -"— Proposed: Setback: LI Pri Total: C Public Name of System: If this.is a Commercial Project ou must answer the followin : _ Number of parking Spaces: Current: Number of occupants (includes owners,tenants, employees etc)QCurrent Number of ADA Parking Spaces: IBC Occupancy: IBC Type of construction: Proposed If this is a Pro•ane Tank and/or A.•liance Installation •ermit mark all items below that a•. Will you have Fo6cl'SerOice? Yes�No I Underground Tank ' .•ova •round : I . I Heat Stove I Cook Stove I WFireplace oodstove iSize of Propane Tank: ) �a Is this a liance.bean installed In a Manufac ured/Mobile Home?t Yes 1 No Water k I Pellet Stove I Other_�___��When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings, lineslines, tank location and size, distances from the propane tank to all property lines,buildings and septic ,to• the reserve area. kw) systemgs,al/property property components Current Pro. ',`I �� t�.r k '� ar y;; osed �n") 1 j4 i S"i'�, < y e Y,, b F� Main Floor Heated ,,, uT,c cliff m �'`ISL 1.,4 off';',',� e yr,,,,,,,,„,,,,I,..;` Na „: 44, ,; ii°r11r/stli,;: u EH Bld R ���@I� �.t,rt �t,. :f,° �.; 2 S Floor H /�, :r r App Review: r x ,; Heated z , Ill..11 I Consistency Review: Other Heated ter Mil :T ' Base fee: MezzanineIIIMIIIMIIIIIIIIIIII t ' �, 4 .) Additional Section; Heated Basemen IIIIIIINAa t'`?,"; ;; Plan Check fee: Unheated Basement ' _ MIN __ rio('' ij¢ State Surcharge fee: Other Unheated _ X 'r e n; Pot Water Review fee: i Garage/Carport I E pr':=4,1,:‘, ?` SUBTOTAL Decks 1 ip;r 11 � , °! 911/Rd Approach fee; Other r +et pv � tif TOTAL: r�rt'�A , t}� yr� A z, , Receipt Number: I I 9 WV V ' Cash/Check Number `7 ESTIMATED COST(REQUIRED) I tt } •Fair market value of all labor and materials foundation to finish Date: Initials: C �7 G:\PemvtCenter\###FORMS### D \ RD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc