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Home My WebLink AboutBLD2011-00040 • 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 #: BLD11-00040 Received Date 2/22/2011 SITE ADDRESS: 792 PIONEER DR Issue Date 2/22/2011 PORT LUDLOW, 98365 APPLICANT: WILLEM SCHAAFSMA TRUST PHONE: 360-437-7759 HELEN SCHAAFSMA TRUSTEE 792 PIONEER DR PORT LUDLOW WA 98365-9622 231 SUBDIVISION: PORT LUDLOW NO 2 AREA 3 Block: Lot: PARCEL NUMBER: 990603231 Section: 9 Township: 28N Range: 01 E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 ((33 p Contractor's License SUNSHP*077QP Expires 11/67/ 01gg 9 5875 OWNER, WILLEM SCHAAFSMA TRUST PHONE: 360-437-7759 if different: HELEN SCHAAFSMA TRUSTEE 792 PIONEER DR PORT LUDLOW WA 98365-9622 PROJECT DESCRIPTION: NG 100 GAL PROP TANK SWAP OUT 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: FinalApproval: p}- .r/<*- 2- 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 ItILDING PERMIT APPLICA•N BLPD1e 000e40 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD11-00040 Received Date: 2/22/2011 SITE ADDRESS: 792 PIONEER DR PORT LUDLOW, 98365 OWNER: WILLEM SCHAAFSMA TRUST PHONE: 360-437-7759 HELEN SCHAAFSMA TRUSTEE 792 PIONEER DR PORT LUDLOW WA 98365-9622 PORT LUDLOW NO 2 AREA 3 SUBDIVISION: Block: Lot: 231 PARCEL NUMBER: 990603231 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 DESCRIPTIOt A/G 100 GAL PROP TANK SWAP OUT 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 $71.00 LYK 02/22/11 123224 Total: $71.00 • • SITE VISIT REPORT e (PLOT PLAN) JOB W 1 )I 347 & DATE : CONTACT: _ ADDRESS '%SZ Pi , P 1 ,„,.) PHONE #: DIRECTIONS FAX #: Email PLANNER: 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. N 100 �.o • C 1 * • • • e ,oN oo JEFFERSON COUNTY rl DEPARTMENT OF COMMUNITY D'EVEi_OPMENT 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax .41.4 .S7irrig# , www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: LY3 rrnJ tl1). Projec Description (include separate sheets as ne ssary): Tax Parcel Number: / O - 6 O 3 — o?3/ Property Size: (acres/square feet) Site Address and/or Directions to Property: _ �f 7 V-- ,/e92�r .fir'�.e Property Owner(s)of Record: /// gC�jl •YJ-r1G-----, Telephone: f3 7" 7 7.5, Fax: email: Mailing Address: Applicant/Agent(if different from owner): -f_-� a .�- Telephone: ,'�5 - S 7' 7 Fax: -38 S -. 875 �j��j..email: S d r-�.fO�y�a,-e // CO c/c ii G� c�., 3 �f. o o Mailing Address. /O<FS y' .R PTWhat kind of Permit?(Check each box that applies 0 Lot or Road Segregation ❑Building 0 Critical'Areas Stewardship Plan ❑ Demolition Permit 0 VarianSe(Minor, Major or Reasonable Economic Use) 0 Single Family ❑ Garage Attached,/Detached ❑ Conditional Use[C(a), C(d), or C] ** ❑ Manufactured Home . ❑ Modular - 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* ❑Special,Use (Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment ❑ Address ❑ Road Approach 0 Short Plat** FEB 2 2 21,1 ,Zome Business 0 Cottage Industry _ 0 Binding Site Plan** ropane 0 Long Plat** ❑ Sign • 0 Planned Rural Residential Dkelopment(PRRD)/Amendl'ttents** ' ' ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** • • , , : : u ut1 ❑ Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions** ❑ Site Plan Approval Advance Determination (SPAAD) * 0 Shoreline Management Substantial Development** 0 Temporary Use ❑Shoreline Management Variance ❑Wireless Telecommunication* ❑ 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-Applicatlon 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 appl' tion for permit(s). W `�NER SIGNATURE J , k ' 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 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 uired la Inspection Staffs access and right of entry will be assumed unless the applicant Info s the ounty in writing at the r time of the app ca'on tha e o she wan s prior notice. 1 ill 2 3 // S Pate: The action or ctions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered soles 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..a e i0 complian ith the Je rson County development code,The Applicant acknowledges that he,she or it holds individual and non-transferable r spKlibility r actkiLiz to d complying with the ESA. The Applicant has read this disclaimer end si• s and dates It below. Si 1 e► Date: 2—13 / f Signature: .5 , f:,\Prrm;rrrnrrr\#is#PoRMR###\i JRn PfIRMR\rn.Trnr rlRrl Rn.,.,.,\ne"..rr.n....,,;, A,,,,I.,.,,.;,,,,c no n°a.... • • ii ' 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: Sck_t est+tine cP I0 (94d ) 3is- s7y ( 366) .3 es-sP7S MAILING ADDRESS: j O ,E 53 p f r, hiEMAIL " CONTRACTORS LICENSE WAINS NUMBER: S t� S (* !7 r7 Q 14 NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) - -_ MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: d New 0 Wood Existing: 0 Sewer 0 Addition 0 Steel Proposed: Bank 0 Community System 0 Alteration/Remodel d Concrete Total: Height: 0 Individual System ❑ Repair 0 MasonrySEP Permit# 0 Demolition 0 Other; Bedrooms: Water Supply: -- Existing: Setback: . Private well •.i Two Part Type'of Heat: Proposed: Y 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 IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No Jf this is a Propane Tank and/or A fiance Installation nermit,mark all items below that apply: l Underground TankAbove group an Size of Propane Tank: /Q d I Heat Stove I Cook Stove I Woodstove I Fireplace Insert I Hot Water Tank I Pellet Stove l Other Is this appliance being installed in a Manufactured/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, Square Footage Current Proposed 6 i i' i,` j l ,t,i � 1:1 ii Main Floor Heated r� EH Bld App Review ,Yt 21tl Floor Heated • ��`,:,' a fin, Consistency Review: irr `,�+,��r Other Heated r„Kr'r ' Base fee: '� °� ' " } I ....._ Mezzanine y'. 0 V` 1 Additional Section: i 1 Heated Basement 1:41':':"'!..'•,,,'" Plan Check fee: „t�ir ; Unheated Basement 4 '' '"_ .0-„,v State Surcharge fee: i ntt' n` - Other Unheated a ,� .a' — - . Pot Water Review fee: Garage/Carport r ;F'' :1 SUBTOTAL Decks �' �� r 911/Rd Approach.fee: Other �` t-� 1.r' TOTAL: / t Receipt Number: la 33,9 I- . ,., ;� , Cash/Check Number: �l.Pqq g ESTIMATED COST(REQUIRED) 3 4 � .G- Date: - •Fair market value of all labor and materials foundation to finish Initials: L_ G,\PermitCenter\###FORMS###\DRD FORMS\Curren IRD Forms\Master Permit Application 5-29-08-doc