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HomeMy WebLinkAboutBLD2010-00364 i i 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 #: BLD10-00364 Received Date 10/14/2010 SITE ADDRESS: 191 QUINAULT LOOP Issue Date 10/14/2010 PORT TOWNSEND, 98368 APPLICANT: MARY A MUNFORD PHONE: MICHAEL R PORTER 191 QUINAULT LOOP PORT TOWNSEND WA 98368-9463 22 SUBDIVISION: CAPE GEORGE COLONY DIV 4 Block: 10 Lot: PARCEL NUMBER: 938701021 Section: 13 Township: 30N Range: 02W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17 2015 5875 OWNER, MARY A MUNFORD PHONE: if different: MICHAEL R PORTER 191 QUINAULT LOOP PORT TOWNSEND WA 98368-9463 PROJECT DESCRIPTION: A/G 120 GAL PROP TANK, INSERT& PIPE 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 10/14/2011. REQUIRED INSPECTIONS: Tank/Line/Appliance: An)K,— t.i1'h3 --APpL )4-9 - I 0 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_Perm it_Propa ne.rpt 10/29/19 BLD10-00364 QUILDING PERMIT APPLICA N Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00364 Received Date: 10/14/2010 SITE ADDRESS: 191 QUINAULT LOOP PORT TOWNSEND, 98368 OWNER: MARY A MUNFORD PHONE: MICHAEL R PORTER 191 QUINAULT LOOP PORT TOWNSEND WA 98368-9463 CAPE GEORGE COLONY DIV 4 SUBDIVISION: Block: 10 Lot: 22 PARCEL NUMBER: 938701021 Section: 13 Township: 30 N Range: 02 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 DESCRIPTIOr A/G 120 GAL PROP TANK, INSERT & PIPE TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: CODE EDITION: 2009 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: 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 10/14/10 120202 Total: $213.00 et • r - SITE VISIT REPORT (PLOT PLAN) JOB WR` uYI D12 ¶ N1 c144 Por`-'43 DATE : `i hill b . CONTACT: . ADDRESS PHONE #: . DIRECTIONS CA?R.CweDTose,.t.4 lbrN ('/a fk TPfctSt. c Dr ,FAX #: . 5.?1 f4 LwA.sk.r (Lf( 0\0,rr'Yav LG 11.0 o t L . To t4 I ct 1 ni,q L. Email . PLANNER: av-e.,L, 4 4 7 5,,,p,„1,c),,..1L \•, C. ,per�'� � I ,'T Rm. i4�` �o-7 Eu, G�35 Lip 5 Qd TA,41 TY a'P * 10 IDO w NTK BL.tO\l, A; .W\ � � CL CSO _T rb1 — ` , ii 21. u,i C a\Y\F rE a A STL- aci LL C r 5 5L-99-c-- ç (; _ > - 90` ZvirJQA:T Loo 20 , ex,, o l r4 6 c4 CA`P-1 EX, c-roo 5 Li r 'TLC, *c ..ws o at a‘)3 st`ioza,Ss s r . uP A$1n -rn,op, F-.LL 5Nvokxo ILozy cl,vosx.4 i III . oN c JEFFERSON COUNTY IIItelf1) DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend • Washington 98368 360/341 ,,oft 800 79-4450 • 360/379-4451 Fax www,co.jefferson.wa.us/commdevelopment . Master Permit Application MLA: rin ('r A- e,5(r_ ' f Project Description(include separate sheets as necessary): PA 4 -- 047. �` ....4....„4„-7- �__ Tax Parcel Number: 93 d - 7O/ — O ,2-/ Property Size: (acres/square feet) Site Address and/or Directions to Property: / / a&fiii fr (.4)6 Property Owner(s)of Record: C. -7 `h 7/7 Telephone: Fax: email: Mailing Address: ` /^( Applicant/Agent(:f different from owner): '7:v _,-. _�'•.=;.-r. . �/�/ , ..I)il f.-.,*_— Telephone: ,7�5 - 57' 7 Fax: -J8 s 875, email; Gy i S d< `O a•-e. ,cam,,-, Mailing Address: /0 d'$3 k//(6 y 614 f i //O o c/ _,)R What kind of Permit?(Check each box that applies 0 Lot or Road Segregation ❑Building 0 Critical Areas Stewardship Plan U Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family ❑ Garage Attached.4;Detached LI ConditiOnal Use[C(a), C(d),or C] ** • ❑ Manufactured Home 0 Modular • ❑.Discretionary"D" or Unnamed Use Classification ❑ Commercial* (<t 0 Special Us (Essential Public Facilities)** 0 Change of Use i ❑ Boundary Line Adjustment ❑ Address 0 Road Approach ❑Short Plat*" O Home Business 0 Cottage'Industry _ 0 Binding Site Plan** Propane 0 Long Plat** © Sign .. 0 Planned Rural Residential Development(PRRD)/Amendments*' 0 Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** O Stormwater Management o Shorelihe Master Program Exemption/Permit Revisions*" ❑ Site Plan Approval Advance Determination (SPAAD)* ❑ Shoreline Management Substantial Development** 0 Temporary Use ❑Shoreline Management Variance O Wireless Telecommunication* • 0 Comprehensive Plan/UDC/land Use District Map Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium 0 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 ereby designate to act as my agent in matters relating to this application for permit(s). 50j WNER SIGNATURE Date: /D zQ By signing this application form, the owner/agent a ests that the information provided herein,and in any attachments, is true and correct to the best ci 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 1 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 applicstic n 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 r time of the appli at he or shy nts p for n Pe. �/ nature: % Date: /Df.s / ' IThe 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-transfe able responsibility for adhering t and complying with the ESA, The Applicant has read this disclaf r and signs and,dates it below, l Signature; Date: �5 / „PTM vglif �I ,:.\ nir('r•nrer\###FORM.C###\ )Rn MR MC\(',,,- ,,rTIRn Rn.,,,,\AA.,,n P-,,,,:, A,,,,l;_,,.,,,-S no no A-- - • le, 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 bility of the General Contractor for the proposed project Signature:, Date; /05,//t) GENERAL CONTRACTOR ER: PHONE: FAX: 5i-Lt--,_S 14 t n e (2-A-' PA- (94d ) 3 es- -r 7 r ' ( 3 G� 3 es-3 ' 75 MAILING ADDRESS: I 09 5? �'.p� ,,,"n Dr. f) (,y' EMAIL: CONTRACTOR'S LICENSE _ WAINS NUMBER: S L.t, V 1 S T(Xr?7 Q 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 0 Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: 0 Individual System ❑ Repair 0 Masonry SEP Permit# 0 Demolition ❑ Other: Bedrooms: Water Supply: Existing: • Setback: ❑ Private well 0 Two Party Type of Heat: Proposed: 0 Public Total: Name of System:. ' u.-_I If this is a Commercial Project you must answer the following: Number of Barking Spaces: Current: Proposed: 1 Number of ADA Parking Spaces:-_____,,,, Number of occupants (includes owners,tenants, employees, etc) Current if. Proposed IBC Occupancy: IBC Type of construction: Will you have Food'Service? Yes / No 4...... f 's is a P e < d/ I Installation permit,mark all items below that apply: i U d Tank Above ground Tank Size of Propane Tank: i Heat Stovemj Cook ove Woodstove Fireplace Insert i Hot Water Tank i Pellet Stove. Other 1� Is this appliance being installed in a Manufactured/Mobile Home? Yes / No ,----i-- 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 propertylines, buildings and septic system components, including the reserve area. '.k '`jW,r i, . /Av,k {m!,VZI 7^�ht�A 4,4"0, s p k� r,�1 E��6 i • V �j�7ri.U. i'ii 'w ,• Square Footage Current Proposed �"'� .i.txa 0.. �,, ,,i,,qz +teen)6,AV24il w ,a ,. '4 at.."t .,F'' .,x. ,%iyr-iYa„%vtlir s' 's Main Floor Heated ' , ' i ,� ,,�t�,,,��, EH gld App Review: 2 Floor Heated a,,,t j`t. it I: Consistency Review: x , Other Heated i , A * Base fee: • Mezzanine r" . Additional Section: ' ' Heated Basement �,m`; }"cNvi;,y Plan Check fee: gy' 't;Jrj i+ C .. v Unheated Basement r ; x{ %',�., State Surcharge fee: "` ' Other Unheated. ' ' t '; ,,6 Pot Water Review fee: • Garage/Carport `'p , .,�t, t j SUBTOTAL r Decks ii 911/Rd Approach-fee: t. Other a , „ < Y TOTAL: $ 1 r, ,t; y , •`x. Receipt Number i4,,, r Cash/Check Number: ESTIMATED COST(REQUIRED) Date: 'Fair market value of all labor and materials foundation to finish Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Current bRD Form\Master Permit Application 5-24-08.doc