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Home My WebLink AboutBLD2010-00263 • • 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 #: BLD10-00263 Received Date 7/27/2010 SITE ADDRESS: 2863 BEAVER VALLEY RD Issue Date 7/27/2010 PORT LUDLOW, 98365 APPLICANT: ELI PAYTON PHONE: 415-509-1284 LESLIE S PAYTON 190 GATES ST SAN FRANCISCO CA 94110-5658 4 SUBDIVISION: Block: Lot: PARCEL NUMBER: 821073012 Section: 7 Township: 28N Range: 01 E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 ((33 p) Contractor's License SUNSHP*077QP Expires 11/67/20103g5 -5875 OWNER, ELI PAYTON PHONE: 415-509-1284 if different: LESLIE S PAYTON 190 GATES ST SAN FRANCISCO CA 94110-5658 PROJECT DESCRIPTION: A/G 120 GAL PROP TANK, LINES, WATER HEATER& BBQ 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 7/27/2011. REQUIRED INSPECTIONS: Tank/Line/Appliance: ( 1e-el L)r)F._ y-,o FinalApproval: -5"0 `� (� �I,t� W (;re 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 ADAY I:\F_BLD_Permit_Propane.rpt 10/29/19 • BUILDING PERMIT APPLIC ION BL Review vy263 iew T Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00263 Received Date: 7/27/2010 SITE ADDRESS: 2863 BEAVER VALLEY RD PORT LUDLOW, 98365 OWNER: ELI PAYTON PHONE: 415-509-1284 LESLIE S PAYTON 190 GATES ST SAN FRANCISCO CA 94110-5658 SUBDIVISION: Block: Lot: 4 PARCEL NUMBER: 821073012 Section: 7 Township: 28 N Range: 01 E 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 DESCRIPTIOr A/G 120 GAL PROP TANK, LINES, WATER HEATER & BBQ TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2009 HEAT BASE: HEAT TYPE: OCCUPANCY: OCCUPANCY: UNHEATED: #OF STORIES: 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 $213.00 LYK 07/27/10 118042 Total: $213.00 I r"-se ) • • 4 p 1 1 1k4 , JEFFERSON COUNTY ` DEPARTMENT OF CMMUNITY DEVELOPMENT itl 621 Sheridan Street•COMMUNITY Townsend •Washington 98368 360/379-4450 • 360/379-4451 $q�ZITN spy www.co.jefferson.wa.us/commdeveloFaxpment IIll 2 7 Master Permit Application MLA: Lb nI_P- ' 1 Project Description(include separa e sheets as necessary): a-11- < / ,w /4J -- -f r , T , Tax Parcel Number: lY i _Q 7 3 — C)(2. Property Size: (acres/square feet) Site Address and/or Directions to Property: 3 0 e -24-- V , Property Owner(s)of Record: L-rsz./e. c L.I pA OAI Telephone: '/'- c 50 5 - / cY y Fax: y email: Mailing Address: / `j U oc.r.� 1 _--. J ' G-rt c�-c..r7 / �- • 51/l U Applicant/Agent(if different fpdm owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies ❑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)** ❑ 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** Propane 0 Long Plat** ❑Sign 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration** ❑Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions** ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development** ❑Temporary Use ❑Shoreline Management Variance ❑Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendment ❑Forest Practices Ad/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 hereby designate to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE.,� i Date: 7--/c`(� 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 attorneys 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 at he or sshe wantsso4 notice. / Signature: �� — --r1 Date: 7`-/C-io 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 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-transferabl spons lity for ring to a d complying with the ESA. The Applicant has read this disclaimer ar%sig s and dates it below. Signature:_ � Date: C�1 O G:\PermitCentcr\###FORMS###\DAD FORMS\Master Permit Application 5-29-08.doc �1 -� UV 35(O�6 1 f ) - • • 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: GENERAL CONTRACTO j OR MANUF TURED HOME INSTALLER: PHONE: FAX: Ny - . ( ) 38s.shy 7 ( ) MAILING ADDRESS: /O C3 3 0,7„t. EMAIL: CONTRACTOR'S LICENSE ,'.Jr. WAINS NUMBER: q.Jk kJ J 7-P *b 7 q_ P NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New !1 Wood Existing: ! Sewer O Addition [i Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel Li Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other. Bedrooms: Water Supply: Existing: Setback: (1 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 apply: 1 Underground Tank (rAbove ground Tank) Size of P ne-Tnk: JJ_OL)C-- , i Heat Stove 1C�ook o� 1-Wood-stove i Fireplace Insert Hot Water Ta k t Pellet Stove i Other 8 6 *y2_2_, Is this applianc$-beirt�nitalied in a Marn factured/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_ Us nIY. AillOWIt ,.. . <*`% Main Floor Heated ' EH Bid App Review: —2-63 Floor Heated Consistency Review: Other Heated Base fee: I - Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement 1 State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $, Receipt Number. ( 1 -,t12_. Cash/Check Number: �09 0 ESTIMATED COST(REQUIRED) Date: R .Fair market value of all labor and materials foundation to finish Initials: Th'-- G:\PemutCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc 1 SITE VISIT REPORT (PLOT PLAN) JOB ./t- E4.i 1'A i ) DATE : e /O 7// 0 CONTACT: ADDRESS c78.62 41,C\it r, PHONE #: DIRECTIONS FAX #: Email PLANNER: • 04/ I , E � r 14i Br i JUL 2 7 2010