HomeMy WebLinkAboutBLD2010-00390 • •
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 #: BLD10-00390 Received Date 11/17/2010
SITE ADDRESS: 340 SUNSET BLVD Issue Date 11/17/2010
PORT TOWNSEND, 98368
APPLICANT: BARBARA E GLENN PHONE: 206-784-3734
SUSAN H NIVERT JTWROS
342 NW 79TH ST
SEATTLE WA 98117-4015 14
SUBDIVISION: CAPE GEORGE COLONY DIV 2 Block: 3 Lot:
PARCEL NUMBER: 938100313 Section: 13 Township: 30N Range: 02W
CONTRACTOR: OWNER/BUILDER PHONE:
OWNER, BARBARA E GLENN PHONE: 206-784-3734
if different: SUSAN H NIVERT JTWROS
342 NW 79TH ST
SEATTLE WA 981 1 7-401 5
PROJECT DESCRIPTION: A/G 120 GAL PROP TANK, LINES & FIREPLACE 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 11/17/2011.
REQUIRED INSPECTIONS:
Tank/Lin e/Appliance:: 11-3
v
FinalApproval: 1l'30 \a
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
SUILDING PERMIT APPLICA•N B RD�1 w00p390
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD10-00390 Received Date: 11/17/2010
SITE ADDRESS: 340 SUNSET BLVD
PORT TOWNSEND, 98368
OWNER: BARBARA E GLENN PHONE: 206-784-3734
SUSAN H NIVERT JTWROS
342 NW 79TH ST
SEATTLE WA 98117-4015 CAPE GEORGE COLONY DIV 2
SUBDIVISION: Block: 3 Lot: 14
PARCEL NUMBER: 938100313 Section: 13 Township: 30 N Range: 02 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION A/G 120 GAL PROP TANK, LINES & FIREPLACE INSERT
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 11/17/10 120276
Total: $213.00
.3 Cmacf . _
v ± .( ki1
/ ,gym
-1-4---- --
1h
l
' .H1 ----
i i rldifitr 21141Y11 '' . ...
goo -
. yhri-0/101 , t,ivikty12,D,orli :, _ :„.
r---1 Pvyane ivi>ly, ---;--> --c.. .\
-
. ' W)vtdei t! C) 0 ) .-5 C..--7-, .....-- , I*
r. . . ,
1 . \ 0 : -vo
NOV ' n,
DA
1 i '' ..--..) --7 03 t—t3';}
`::::\t 1
i . 4 :
, , 1. *: \:\_i__VVO\ r: ,_, ,...&:_.,--
'''4:1-5-----1-/:_:._ j_._-_-:---)Y'i---5-9 . "----' -.7°-.7: ---; .'
Dr 1.ve,tA) • ,, -77
t/./ t ( , t ' (—\,,4_, t_
c t ILL___L_ ,.,
Csre,U-e--/
IR octal
r F
ea Lfi x
r • b(6 .:v im\. :ft Li � .�
g
ram• _:...
4
j-w
.
t
V,
�� t. . CLE•V ,i2 JS
o cPC1779,)K<''aM)_- /oo
7
0
DRP1fJS
. a ,.......--,.....-. ,,,,,„y?e,... . .
14\1 --,v 1 T]oC
14 ou. c
\ .i 16 •
.52Ld.'3 i.r' 1
I Li
/t'U j '/a/ 3 y' `C1;,. -; 2e..:..•-
III
ON L, •
�, ° JEFFERSON COUNTY
rt ie DEPARTMENT OF COMMUNITY DEVELOPMENT
''� 621 Sheridan Street • Port Townsend • Washington 98368
4 A p,,: , 360/379-4450 • 360/379-4451 FaxztiN
www.co.jefferson.wa.us/commdevelopment
.,..
Master Permit Application MLA: NO Mjt Gel)ib
Project Description(include separate sheets as necessary): H Ai P I P r IJCr
1-
,\'401--)1..>, -:I) stiEi:► IN x (is 1 in)G Ft ('Lnet_ f RJhcil)e, �'1;eoN) VkePi t& iAIk •
Tax Parcel Number: q 3`i.- &s o .-3/3 Property Size: (acres/square feet)
Site Address and/or Directions to Property:
:.1.4v Yuma\Li_ t�►A N9
Property Owner(s)of Record: t�
,()F�j� (-r L( Ai PJ '' - 1 J,; f t.; f\ t V s= .T
Telephone:, C ( 1 Y'3l 3 i Fax: ,_� email:tkr_i q ctti\e...ctU c(l:�rlinct,i,Nc 7)
Mailing Address: ��y� IV,S.) ICl/IA i'I- y i� �-' -c- I 1 '1 S 1 11 -Lib 1
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies 0 Lot or Road Segregation
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 Harmed Rural Residential Development(PRRD)/Amendments**
0 Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration**
0 Stormwater Management 0 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* 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 0 Tree Vegetation Request
**Requires a Pre-Application Conference
Please identify any other loca ,state or Jederal permits required for this proposal, if known:
1- DESIGNATION OF AGENT
I hereby designate I I 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 requ'ed later ins ons taffs acce s and right of entry will b assumed unless the applicant informs the County in writing at the
time of the applica' ta,t ei r a s pri tt
i
Y... Signature: � .1 j
Ji4t / lt - Date: I i /' I (0
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 re in complian wit e•Jefferson,County development code. he Applicant acknowledges that he,she or it holds individual
and non-transfers resp ns'•ilit r d n t a d c plyi with thh'ESA. The icant has read this disclaimer an signs and dates it below.
� _ Signature: 4l 1' . � !"111 m'��- C� til 9Date: jI 1 (0
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Peiuut Application 5-29-08.doc
• •
BUILDER STATEMENT
The signer of this 4atement does her by ify that they re the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be ass n h re pon ' it y o General Co tractor for the proposed project.Signature: D tfr./„ Oh 4 I 1 CJ
yGENERAL CONTRACTOR OR MANUFACTURED HOME I LLER: PHONE: FAX:
( ) ( )
MAILING ADDRESS: 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: 0 Individual System
❑ 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 Project 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:
L i Underground Tank 1 ove ground Tank Size of Propane Tank: i x'.1 (.-, r1i...-L IN; -�
i Heat Stove i Cook Stove I Woods a-Te Q Fireplace Insert i Hot Water Tank i Pellet Stove i Other
Is this appliance being installed in a Manufactured FM-6We 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 Footagq____ Current Proposed For Office Use Only AmoUnt Revision
Main Floor Heated EH Bld App Review:
2nd Floor Heated Consistency Review:
Other Heated Base fee: 13
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: $a I )
Receipt Number: I aeO -P
- Cash/Check Number: I ��
ESTIMATED COST(REQUIRED) Date: �t
•Fair market value of all labor and materials foundation to finish ( I- J-I C.
Initials:
G:\PemutCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc