HomeMy WebLinkAboutBLD2010-00140 •
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 #: BLD10-00140 Received Date 5/4/2010
SITE ADDRESS: 30 S CHANDLER CT Issue Date 5/4/2010
PORT LUDLOW, 98365
APPLICANT: IRENE F KYSAR TRUSTEE PHONE:
I F KYSAR LIVING TRUST
30 S CHANDLER CT B
PORT LUDLOW WA 98365-9541
SUBDIVISION: INNER HARBOR VILLAGE CONDOS Block: Lot:
PARCEL NUMBER: 961600902 Section: 17 Township: 28N Range: 01 E
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTP198306 Expires 9/26/2010
OWNER, IRENE F KYSAR TRUSTEE PHONE:
if different: IF KYSAR LIVING TRUST
30 S CHANDLER CT B
PORT LUDLOW WA 98365-9541
PROJECT DESCRIPTION: INSTALL A/G 120 GAL PROP TANK & GAS INSERT
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 5/4/2011.
REQUIRED INSPECTIONS:
k/Line/ ppliance_Uhi 4/'-k1J1A c( .K CA-- 69 t I Lwv:vr
efentita_i_ 8-Ps6 duz-cL-- ,
FinalApproval 10
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 APPLICAODN BLD10-00140Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD10-00140
Received Date: 5/4/2010
SITE ADDRESS: 30 S CHANDLER CT
PORT LUDLOW, 98365
OWNER:
IRENE F KYSAR TRUSTEE PHONE:
I F KYSAR LIVING TRUST
30 S CHANDLER CT B
PORT LUDLOW WA 98365-9541 INNER HARBOR VILLAGE CONDOS
Block:
lock: Lot:
PARCEL NUMBER: 961600902 Section: 17 Township: 28 N Range: 01 E
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI98306 Expires 9/26/2010
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP INSTALL A/G 120 GAL PROP TANK & GAS INSERT
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: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
CONST TYPE: 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 $213.00 LYK 05/04/10 117643
Total: $213.00
w
•
•
• INNER :HARBOR . VILLAGE: COHOOMOHOUNIS, PHASE S
.. A CONDOMINIUM'
• • • 4.VORT1ON•GOV'T. LOTS.2 do 3; SEC. 17, TWP. 28N.,. RGE..1 E.; V.M. • •
• JEFFERSON •COUNTY, WASHINGTON • • .
�- . B��Lo
•
•
•
IIA*ca..IL. .S,�R U'B.
Iw .+.s ..+m..s a • .
• OiCE , . .iil Art . •
. b
4116—4" 1: , . .
•
. • - .
•
u.TSA-• - • r •
Jt ...
9uittrtvmlr� .
• r6slx� $ .
.
•
x
•X �699.a:«a 1 .{000 a 41.N
• outwear
• ��• X$X .
.. 304 • x • 306.
. .r ar
u +.,
am •
. n 0...49 r�ao11 a . .
...
Urla=MN AKA •
• •
• Mr .
' '
WIRD CC111161 MLA •
. • (99T 90 UNIT 90
•• 0UILu1 00 9
• Waal rI u1 •
0._• . . tt ' 0 . • 6� Z I E e JCS .Na e5-• ��` ''=_
, :; •• ce
3o • �(Z, � ,i .
3Q':?B ..4zo3:14 KA ' SHEET a of s
:,
Wig
0
INNER 'ARBOR VILLAGE C®R®® lONEIUMS, PHASE 8
A CONDOMINIUM
PORTION GOUT. LOTS 2 do 3, SEC. 17, TWP. 28N., RGE, 1E., W.M.
JEFFERSON COUNTY, WASHINGTON
is.t.r,...«e.R.
O/OOrt.[ot 3-
MMEW •
. - ivVERN :::...44, 1i 11•a •,1, PHASE 2 PHASE 9 PHASE
S~
E
•
aa 4 +m�� mu ' • I, ,• .user • a . . i g •o
t...^ .. ; I t i n• e
r . •
i —r�9 /T�ta 420. Y J May.KN'
10•1:0 V M a C°t.o1
.' ,�.td j�j/( M; OOCOMY et&WM.&O .wt.
. 1M%LOMCA)Io • Y6 ` / CK II.SCYCMry11Y/ 3
•
• y `MGM+ I - r 7 r'4 /R�i:o• / ,-,I.e - 41107.
K , [ M10.' t��
•�• t 9 .:' `-t>`�' /� lA•z+'`f.II KaK-trmrt
,� , .v • ,I �` it I
.. M.. [
i .111111(
�� //
, .CC(i!a NIK1Ir.
ol)3..;1 ,1?) P./•
1.
-o • ,� • oa
4 t,' .; •-, /./1:. O(I. SCALE: 1.4,SO.
• Q . • ,.•' :s ao , �o / `i. + r n ,uv.«.Ir wtam44.44.SOv clomp now(
jam►,. • • � r.e • • a.. «« .«T,K Mwe coma.Pools
T t Ny a...an a„.P. eze P° , 't!t:b• •
Ws 8ryQCCC M M ILO./3.7f tNSQID V K OOI.Q►O.OII
- l�� .+ N ^ . 1 •. MAI.OI1Kd N
Yia . j o x iv ,�e
X>i o. .r. • 2`h °°
i
a bA ,
at
3 IA
t.
,. ,d ua • .
'. ti
trt,---\ fr. •tti i S
. 11,4,.$81:41, 1. .. .5/. •.0 FUT UR E
V. \(6 ". „ ,.
♦„ ',*.
I I si NEED NOT BE BUILT
dtP e 'lr'PHASE 'e c,o r.,
3 Joe N0. 88-159 -e,4' G �'
1 _ •'• e TRIAD ASSOCIATES INC. t C C)
11415 NC 1281h STREET �- 0
KIRKLAND,WASH. 98030
•
• I (2061 821-644e
SHEET4 OF. 8 ... ,
• nee,
h S���'s01v Co0,, JEFFERSOOOUNTY •
w ' j DEPARTMENT OF COMMUNITY DEVELOPMENT
` 14 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
1TIN�
� 0 wwww.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: 00 M P ��l'b
Project Description dude separate sheets as ces6ary :
Tax Parcel Number: k' ,( 1 Property Size: (acres/square feet)
Site Address and/or Directions to Property:
jot ) , 0 b- r CI f_f` ,1 CI au, L DA q f g Lnd f
Property Owner(s)of Record: '`2' (L )c _
Telephone: Fax: r- I email: •
Mailing Address: - I C.rI f CC ✓ _t 5r�t � 1( ( ( ' i (. '( �[j
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
at kind of Permit?(Check each box that applies7r1...4)
0 Lot or Road Segregation
Building 0 Critical Areas Stewardship Plan
emolition Permit ❑Variance(Minor, Major or Reasonable Economic Use)
❑ Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]**
❑ Manufactured Home .❑ Modular 0 Discretionary"D"or Unnamed Use Classification
❑ Commercial* ❑Special Use(Essential Public Facilities)**
❑ Change of Use ❑Boundary Line Adjustment
❑ Address El Road Approach ❑Short Plat**
❑,Home Business ❑ Cottage Industry El Binding Site Plan**
(,/g. .lopane ❑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**
❑Temporary Use 0 Shoreline Management Variance
❑Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendment
El 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:
DESIGNATION OF AGENT
I I hereby designate to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE Date:
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 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 inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the application that he or she wants prior notice.
/Signature:/.C.-rt i 1 / _./IIA Kt. • Date: ; - c ' .- / C,
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 tederal 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
and non-transfIrable responsibi its for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
/Signature:-- /t--t--wt_ t 1> %/,z_— Date: ') - c% y -/()
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
•
BUILDER STATEMENT III
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:
GEN7l- ONTRACTOR OR MANUFACTU HOME INSTALLER: PHONE: FAX:
A,V)-t_CtL L.) tcb_nilL_
MAILING DRESS: 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 ❑ Steel Proposed: Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: _ Height: ❑ Individual System 1
❑ Repair ❑ Masonry SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type of Heat: Proposed: ❑ Public
Total: Name of System:
If this is a Commercial Protect 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 a
i Underground Tank'Above ground Tank Size of Propane Tank: 2 - r
i iCook Stove i Woodstove - it la Insert i HotWater Tank i Pellet Sto e i Other
Heat Stove ireplace e
Is this appliance being installed in a Manufacture /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 For Office Use Only Amount Revision
Main Floor Heated EH Bld App Review:
•
2nd Floor Heated Consistency Review:
Other Heated Base fee:
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: $ 1
Receipt Number: 1 17(C(('
Cash/Check Number: .3-1
CC
ESTIMATED COST(REQUIRED) Date:
•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