HomeMy WebLinkAboutBLD2011-00039 • •
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 #: BLD11-00039 Received Date 2/22/2011
SITE ADDRESS 90 OAK SHORE DR Issue Date 2/22/2011
PORT TOWNSEND, 98368
APPLICANT: STANTON K STEVENS PHONE: 360-379-1236
SABRINA BROWN
90 OAK SHORE DR
PORT TOWNSEND WA 98368-9534 348+
SUBDIVISION: KALA POINT#5 Block: Lot:
PARCEL NUMBER: 965000171 Section: 27 Township: 30N Range: 01W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
0
Contractor's License SUNSHP*077QP Expires 1 i 1367/ 3 185-5875
OWNER, STANTON K STEVENS PHONE: 360-379-1236
if different: SABRINA BROWN
90 OAK SHORE DR
PORT TOWNSEND WA 98368-9534
PROJECT DESCRIPTION: A/G 250 GAL PROP TANK, FIREPLACE & GAS LINES
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 2/22/2012.
REQUIRED INSPECTIONS:
Tank/Line/Appliance:
FinalAp proval: 1:115 11 F ADi>R CI v l
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_Prcpane.rpt 10/29/19
ItILDING PERMIT APPLICA•N BLRD1e 00039
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD11-00039 Received Date: 2/22/2011
SITE ADDRESS 90 OAK SHORE DR
PORT TOWNSEND, 98368
OWNER: STANTON K STEVENS PHONE: 360-379-1236
SABRINA BROWN
90 OAK SHORE DR
PORT TOWNSEND WA 98368-9534 KALA POINT#5
SUBDIVISION: Block: Lot: 348+
PARCEL NUMBER: 965000171 Section: 27 Township: 30 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 DESCRIPTIOr A/G 250 GAL PROP TANK, FIREPLACE & GAS LINES
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 02/22/11 123223'
Total: $213.00
• SITE VISIT REPORT
l (PLOT PLAN)
JOBn4/ 6 r o c�- -) DATE : 2— `—\\
CONTACT:
ADDRESS 9 O pa •e /: �7(�, P PHONE #:
DIRECTIONS V--./,W fo i rvQ' P. Q-O i FAX #:
`TO OA1LG1-11(t,2 Email
PLANNER: -TQV2, LLUWA\
Jnclude 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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914401 JEJEFFERSON•UNTY •
11
° DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street r Port Townsend r Washington 98368
44 ,a, 4 360/379-4450 . 360/379-4451 Fax
.� www.co.jefferson.wa.usIcommdevelopment
Master Permit Application MLA: k f latc- 1)
Project Description (include separate sheets as necessary):
Tax Parcel Number: _(o , ----- O O Q 17/ Property Size: (acres/square feet)
Site Address and/or Directions to Prope :
9 o CDCLL . 1.--("71___e_ /9 0 tA_L pr. 1 0;_47)-1,4_.2.0...‘o (k,,,___64907.14i)
Property Owner(s)of Rec • Py/- -ro 4 3�4//A) /21^e-)4.4-17.-,_)
Telephone:.?,' 1.)-_. Co Fax: email:
Mailing Address. -S/ T-., .
Applicant/Agent(if different from owner): \../i,,c.- —r- v pz-L,1)---„•,,--0-....._--
Telephone: 3e5 - s7, 7 Fax: J 8 S- 8 75' email: Gy i S dti-h--L//44,0,-•-e ,e.,,,,
Mailing Address. /0 85 3 , .f/t'by 'OR. �T . //i-t2 c/� i.,)R
What kind of Permit?(Check each box that applies ❑ Lot or Road Segregation
❑Building 0 Critical'Areas Stewardship Plan
0 Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use)
0 Single Family 0 Garage Attached./Detached 0 Conditional Use a}rC(d},,or.,CJ **
❑ Manufactured Home 0 Modular 0 Discretionary"D lnnamed Use Classificatlbn
❑ Commercial* ❑ Special Use(Es ial Public Facilities)**
❑ Change of Use 0 Boundary Line Adjustment
❑ Address 0 Road Approach 0 Short Plat** DEB 2 c 2r�1
0 Home Business 0 Cottage Industry _ 0 Binding Site Plan**
ropane 0 Long Plat**
0 Sign 0 Planned Rural Residential pev I m `t P D)/Amendments** '
0 Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alte tion"F'' 'R
0 Stormwater Management ❑Shoreline Master ogram ate l�n'/P r Revisions**
0 Site Plan Approval Advance Determination (SPAAD) * ❑ Shoreline Management Substantial Development**
El Temporary Use 0 Shoreline Management Variance
0 Wireless Telecommunication* ❑ Comprehensive 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 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 ereby designate to act as my agent in matters relating.to this application for permit(s).
I WNER SIGNATURE Date: a//r]///
,
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 rts 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 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 a , ication that ors e/want p'or notice
nature (� "hate: 1/ //
^�l 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 speoies 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 �a re r spoisibilitY r ad ering to and complying.with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: ""L�^ ( 4- -e-eh Date: (j./i 7/ 1/
j `
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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: Date:
GENERAL CONTRACTOR . ER: PHONE: FAx:
Sit-, sfitne rP2, I0A,^_e__ (26O ) 3 FS- s717 ( 3G4 3 es-sP75
MAILING ADDRESS:
CONTRACTOR'S LICENSE WAINS
NUMBER: 5 LA Kt S * /7 r� 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
0 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:
Existing: Setback: pp y'
� Private well 'i Two Party
Type of Heat: Proposed: Li 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
4....Jf this is a Propane Ta . _ . ...:r nstallation permit,mark all items below that apply:
I Underground Tank I Above ground Tank Size of Propane Tank: 0,50 5-o j r
I Heat Stove I Cook .•: •, ova Fireplace Ins I Hot Water Tank 1 Pellet Stove
5-0—t Other y2/-6' L/ �
is this appliance being installed In a Manufacture obile Home? Yes / No U
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.
'!`4 i " 1 { P':I e tr� a l t ? y�y ' 00
Square Footage Current Proposed ' t a .Main Floor Heated
h i;��4r ,�,�,� EH Bld App Review:
2`d Floor Heated 44� r '4 ____
�ti ,`= Consistency Review:
Other Heated 1 '>�`: Base fee: —313 —"
Mezzanine r , ' Additional Section:
"S S4'i
Heated Basement ` Plan Check fee:
Unheated Basement " State Surcharge fee:
L��
Other Unheated' " ' Pot Water Review fee:
Garage/Carport g' , :,, xj SUBTOTAL ""
Decks a, K'f
911/Rd Approach fee:
Other i� ,e r�. a. TOTAL: $ 15—
' 't Receipt Number:
�",' Cash/Check Number: cza,Li t� —
ESTIMATED COST(REQUIRED) Date: ��
'Fair market value of all labor and materials foundation to finish
Initials: --_�
C
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G:\PermitCenter\###FORMS###\DRD FORMS\Current ORD Forms\Master Permit Application 5-29-08.doc