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HomeMy WebLinkAboutBLD2011-00029 • 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 #: BLD11-00029 Received Date 2/7/2011 SITE ADDRESS: 2021 EGG & I RD Issue Date 2/7/2011 CHIMACUM, 98325 APPLICANT: PHILIP VOGELZANG PHONE: 206-270-8900 KATHLEEN MC COY 1926 7TH AVE W SEATTLE WA 981192878 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901354005 Section: 35 Township: 29N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/(3 67/) 085 5875 OWNER, PHILIP VOGELZANG PHONE: 206-270-8900 if different: KATHLEEN MC COY 1926 7TH AVE W SEATTLE WA 981192878 PROJECT DESCRIPTION: A/G 250 GAL PROP TANK, GENERATOR, GAS 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 2/7/2012. REQUIRED INSPECTIONS: Tank/Line/Appliance: s-4;1/4.;k- L,h,;£ �) �I FinalApproval: — __ )6'—(Z— l` j 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 4111UILDING PERMIT APPLICAtN evie 00029 Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD11-00029 Received Date: 2/7/2011 SITE ADDRESS: 2021 EGG & I RD CHIMACUM, 98325 OWNER: PHILIP VOGELZANG PHONE: 206-270-8900 KATHLEEN MC COY 1926 7TH AVE W SEATTLE WA 981192878 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901354005 Section: 35 Township: 29 N Range: 01 W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2012 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI A/G 250 GAL PROP TANK, GENERATOR, GAS 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: CONST TYPE: OTHER. SHORELINE: CONST TYPE: GARAGE. SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid Bv: Date: Receipt: Approved/Date Propane Tanks/Stoves $213.00 LYK 02/07/11 120439 Total: $213.00 410 J '+ ON co. JEFFERSON COUNTY • 1 . ' \g DEPARTMENT OF COMMUNITY DEVELOPMENT " .a' 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4461 Fax '.tg C • www.co.jefferson,wa.us/commdevelopment Master Permit Application • MLA: Ot3i r Y A-eLL t Project Description (include separate sheets as necessary): — 2 5c • lo r cry f 6-r--v /" Tax Parcel Number: D / .15Y- 0 QS Property Size: (acres/square feet) Site Address and/or Directions to Property: • 2 oa i e � -• C / a . ?cf.) " Property Owner(s)of Record: Z Telephone: Zm` - 32l -4-888 Fax: email: • Mailing Address:,St -- Applicant/Agent(if different from owner); <._-,...,)-Gt-t-,_ 0jr---11)o/-,__,z___ - Telephone: 5'85 - 57 7 Fax: 38 .$- 875' email: /)"1-2)/-(:= s dl•-,-.- e`O,raya,-e ,e•),�. Mailing Address. /0 a' 3 k/ c PT . t/ /1 o c/( i' What kind of Permit?(Check each box that applies 0 Lot or Road Segregation ❑Building 0 Critical Areas Stewardship Plan r[ 1 i ' , . i 0 Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) 0 Single Family 0 Garage Attached./Detached 0 Conditional Use[C(a), C(d), or C]** ❑ Manufactured Home .❑ Modular - ❑ Discretionary"D"or Unnamed Use Classification. O Commercial* 0 Special Use(Essential Public Facilities)ith U 2QT1 ❑ Change of Use 0 Boundary Line Adjustment ❑ Address ❑ Road Approach 0 Short Plat** 0 Home Business 0 Cottage Industry . 0 Binding Site Plan** JLf f EILSsON COUNTY Il f' ropane 0 Long Plat** ++ +u COUNTY 0 Sign ❑Planned Rural Residential Development(PRRD)/Amendments** ' ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vapation/Alteration** ❑ Stormwater Management ❑Shoreline Master Program.Exemption/Permit Revisions** O Site Plan Approval Advance Determination (SPAAD) * 0 Shoreline Management Substantial Development** © Temporary Use 0 Shorelihe Management Variance U 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 hereby designate to act as my agent in matters relatingto pis ap lication for permit(s). � { • .,) OWNER SIGNATURE � • ,. �\ ,9 .,, Date: By signing this application form,the owner/a9ent 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 liabilitles,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•uir:d later inspections. Staffs access and right of entry will be assumed unless the applicant I form the County in writing at the r time of the appli n at he or ,' ants prior notice. ` (Al -'•nature: t,Lm� Date: \\ \ ` The action or actions Applicant will undertake as a result of the issuance of this permitmay 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-transf sponsibility for adhering to and complying with the ESA. The Applicant has read this discfaijm r a d s" ns and dates it below, ' Signature: -y Date: i� r, (:•\Prm irCenrer\# R tttwnRms###\nnn Frwmc\r„rrN„r T1r1 F n.•\nT a,v,. n., c �n nv a., 1 ' ` • • 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 CONTRACTOR ER: PHONE: FAX: .SlA—V, Z f+I n e co(2-0 PA-v`--( /� (94d ) 3 es- -r 7 f 7 ( 3 6e)i 3 �S-S a' 75 I MAILING ADDRESS: I 0 E 5C 3 1 if P. (1' EMAIL: CONTRACTORS LICENSE WAINS NUMBER: S LA S -Y >t Yp'q 7 Q NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: 0 New 0 Wood Existing: 0 Sewer o Addition 0 Steel Proposed: Bank 0 Community System 0 Alteration/Remodel 0 Concrete Total: Height: 0 Individual System ❑ Repair 0 Masonry SEP Permit# 0 Demolition 0 Other: Bedrooms: Water Supply: pp y' Existing: Setback: ❑ Private well D Two Party Type of Heat: Proposed: Total: ❑ Public 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 4IBC 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: I Underground Tank Above ground Tank Size of Propane Tank: Q-50 I Heat Stove I Cook Stove 1 TNoo sod ove I.Fireplace Insert 1 Hot Water Tank I Pellet Stove 1 Other p r p a ere rc-( Is this appliance being installed in a Manufactured I 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. xy pl�., 7 Y t• �YJ'iS'�Y( 7' R Sq,e � f A 'ZY ';i �• t3 x!\ Y: d �.f�� 11.774T 4 1 iS' ,` /> 153 t t4 Vk 'Square Footage Current Pro posed 'Z , $� a e ",rif + y` `r 'a.te?� rasa '¢^H M C rr, 4��.ib d �, ,!,/. klii'�` �.:� .Jra9tt i•�u`z> d .'n,x�S., PO,3:�'�!.Fl4,s�? o�„e1 a,����o^F tit k J d� ��9 Main Floor Heated .i. ,. EH BId App Review: IYA., f '1>c 3'1' FJ'f' f 2`"Floor Heated : 4 �« �' •M` C i' Consistency Review: 4;;454si,:,.1..;,.4i..,,. Other Heated } uV>„* Base fee: 22 g 'S A ya c13...._ Mezzanine ;y Additional Section: i , ,, Heated Basement it a 'i , Plan Check fee: air Unheated Basement ''rc �,k State Surcharge fee: 4r,� Other Unheated • logt�>rt„x k Pot Water Review fee: Garage/Carport ^"' ° SUBTOTAL Decks ''h wt'' 4 r 911/Rd Approach fee: Other t f ,1 TOTAL: $ a ' ,� ,^ . Receipt Number: I ao(45c . L ' , 11 ` ' .,h Cash/Check Number: ESTIMATED COST(REQUIRED) Date: ���' .Fair market value of all labor and materials foundation'to finish Initials: ` :\PermitCenter\###FORMS###\DRD FORMS DRD Fortes\Master Permit Application 5-29-08.doc G ' -0 SITE VISIT REPORT (PLOT PLAN) JOB \JP51- ' 7-ctiI�zl1KSe�(I'FIF�'J DATE : — I�-(CONTACT: � p ADDRESS 7j Z( Cyyd. KaC PHONE #: 206—321- WeY.T DIRECTIONS Jl FAX #: Email PLANNER: L Include all street names adjacent to property,property lines,tank, appliance&piping locations,distances of tank to property lines and buildings, septic,wells,wetland areas,distance to water bodies. E. ?AC2 Zeivi 5 f� T4 1:CEry D 6t,c `I FEB 0 7 2011 JtFFER ON COUNTY DO