HomeMy WebLinkAboutBLD2011-00033 •
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 #: BLD11-00033 Received Date 2/14/2011
SITE ADDRESS: 220 MACHIAS LOOP Issue Date 2/14/2011
PORT LUDLOW, 98365
APPLICANT: SUSAN OGIL POSEY PHONE: 360-437-0416
JAMES C POSEY
220 MACHIAS LOOP
PORT LUDLOW WA 98365-8705 87
SUBDIVISION: PORT LUDLOW NO. 1 AREA 4 Block: Lot:
PARCEL NUMBER: 990400483 Section: 9 Township: 28N Range: 01 E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339 ((33 pp 338g55
Contractor's License SUNSHP*077QP Expires 11/67/�012-5875
OWNER, SUSAN OGIL POSEY PHONE: 360-437-0416
if different: JAMES C POSEY
220 MACHIAS LOOP
PORT LUDLOW WA 98365-8705
PROJECT DESCRIPTION: A/G 120 GAL PROP TANK, LINES & HEAT STOVE
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 2/14/2012.
REQUIRED INSPECTIONS:
Tank/Line/Appliance:
FinalApproval: ; :3/i///
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
IJ ILDING PERMIT APPLICAN BLRD1e 00033
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD11-00033 Received Date: 2/14/2011
SITE ADDRESS: 220 MACHIAS LOOP
PORT LUDLOW, 98365
OWNER: SUSAN OGIL POSEY PHONE: 360-437-0416
JAMES C POSEY
220 MACHIAS LOOP
PORT LUDLOW WA 98365-8705 PORT LUDLOW NO. 1 AREA 4
SUBDIVISION: Block: Lot: 87
PARCEL NUMBER: 990400483 Section: 9 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 11/17/2012
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr A/G 120 GAL PROP TANK, LINES & HEAT STOVE
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION
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 02/14/11 123203
Total: $213.00
6 SITE VISIT REPORT i
�- (PLOT PLAN)
JOB �1 r'\ E. S I�i S GI,V\ 65 2- / I
DATE : i/ �(o ( D
CONTACT:
ADDRESS 2 20 WO LN I I4 S LO DT rrLv Dt1)UA PHONE #:
•
DIRECTIONS 014I.1, SA p . 't'0 W►aLIL2yLAJICk-1\ FAX #:
l O C LN l A S LD Email
PLANNER: -hyt V�2 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.
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JEFFERSONNOUNTY II/4-orrmioi-''iM°N
DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street • Port Townsend •Washington 98368
\4t, jpsf:1„:,sy 360/379-4450 • 360/379-4451 Fax
rq www.co.jefferson.wa..us/commdevelopment
Master Permit Application MLA: Iw nk CM tl
Project Description (include separate sheets as necessary -
Tax Parcel Number: 9 90 - goo - 7 cP,3 Property Size: (acres/square feet)
Site Address and/or Directions to Property:
C=2c.0 `YY) a-c-i-t_ --J-- ap
Property Owner(s)of Record: jay cf. Stud ,I p
Telephone: Y-31- 04.11(0 Fax: v email:
Mailing Addressk,56 i
Applicant/Agent(if different from owner): \;,4 '/4-1—,.' . AL.4->e A.,..... "'
Telephone: .Ye5 - S7 7 Fax: Jg 5 875 email: k/y cS�'` `dl-,-,-e-,/i-4) ct-re J - ,c.,.a,•,,
Mailing Address. /O1.5.3 ./-/ Q. ii . //R-th-O c% i-d/
What kind of Permit?(Check each box that applies- 0 Lot or Road Segregation
❑Building 0 Critical'Areas Stewardship Plan
0 Demolition Permit D Variance(Minor, Major or Reasonable Economic Use)
❑ Single Family C 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)**
G Change of Use 0 Boundary Line Adjustment
O Address 0 Road Approach . 0 Short plat**
❑ Home Business 0 Cottage Industry _ 0 Binding Site Plan**
*propane 0 Long Plat** -
❑ Sign 0 Planned F<ut'al R idential Development(PRRD)/Amendments** '
0 Allowed"Yes"Use Consistency Analysis _A-- •0 Plat Vacatiorf/ ration**
0 Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions**
❑ Site Plan Approval Advance Determination (SPAA)) * 0 Shoreline Management Substantial Development**
El Temporary Use FE�J chg e�(Iplllanagement Variance
0 Wireless Telecommunication* r rjComprehensive Plan/UDC/Land Use District Map Amendment
0 Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment
*May require a Pre—Application Conference �� �`��7 iir it request
Ll jJ! / -! IPre-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).
,,,Sl WNER SIGNATURE "XtrDate: 14///
By signing this application form, the owner/agent attests th t 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 pro 'de access and ri ht of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application
review and any req i d later inspecti S. Staffs access and right of entry will be assumed unless the applicant Informs t e County in writing at the
r time of the appli h or he r'or n ice.
` nature Date 3 L/
` The action or actions Applicant will undertake as a result of the Issuance of this perrnitmay negatively Impact
ct upon one or mote 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 yo re in complian with the Jefferson County development code.The Applicant acknowledges that he, sh or it holds individual
and non-transfera • ility f ,. . . -nd complying with the ESA. The Applicant has read this disciaiiimeer a d yns and dates it below.
Signature: % Date: 1 r
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it22( 3
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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:
Data:
GENERAL CONTRACTOR ER:
PHONE: FAx:
Sr i S it t h e tic' i°� v`� (24d ) 3 es- s 7 T 7 ( 3 66) 3 d'S- I P 7S
MAILING ADDRESS:
CONTRACTOR S LICENSE 0 3 �� + V r / • (y EAAAIL:
NuMaBR: WAINS
SLA. NS * (;1/27Q NuMeeR
ARCHITECT/ENGINEER: �` PHONE — —
MAILING ADDRESS: ( ) Fes'( )
EMAIL
Project Type: Frame Type: Bathrooms:
0 New Shoreline: Type of Sewage Disposal:
0 Wood Existing: 0 Sewer
0 Addition 0 Steel Proposed: Bank
0 3
g 0 Alteration/Remodel 0 Concrete Total: Height: Individual
stemm
El Repair ❑ Mason System
0 Demolition 0 Other: ry Bedrooms: SEP Permit# ____
Existin Water Supply:
g Setback: Private well J Two party
Type of Heat: Proposed:
Total: I.] 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
• IBC Occupancy: IBC Type of construction
Will you have Fotid SerOice? Yes / No No
Jf this is a Prop ne Tan a d/or A pliare Installation permit,mark all Items below that apply:
I Und-,.:..:- .. Tank 1 bove ground T Size of Propane Tank: /101-0
4 Heat Stove Cook Stove 1 Woodstove I Fireplace Insert 1 Hot Water Tank 1 Pellet Stove Other �j,0--e- ,o c�L
Is Is appliance being installed in a Manufactured/Mobile Home? Yes / No v f
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 1., �'. E, 66t ••
' �„
Main Floor Heated ' � �` r z Y
?"',, EH Bld App Review;
h1 `}�� — —
Zd Floor Heated Consistency Review:
; is ,1,
Other Heated "� t�l h
' x,," Yi + Base fee: 5�
Mezzanine t' 't`" Additional Section:14.3
�q�i tt' h
Heated Basement,,,'I'` Plan Check fee: - -
Unheated Basement ti " State Surcharge fee:
Other Unheated -_ ---—
z Pot Water Review fee:
Garage/Carport t:: SUBTOTAL
F
Decks
L 911/Rd Approach fee: ---
riki�1 t
s'Other `k —
TOTAL: $cg l5�
ll(f' f
tai Receipt Number (933t3
,u $ , f
Cash/Check Number: ,�'g
ESTIMATED COST(REQUIRED) Date:
•Fair market value of all labor and materials foundation to finish1711111111'
Initials:
GAP emvtCenter\###FORMS###\DAD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc