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HomeMy WebLinkAboutBLD2011-00123 . • 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 #: BLD11-00123 Received Date 5/17/2011 SITE ADDRESS: 691 BLACK BEAR RD Issue Date 5/17/2011 PORT TOWNSEND, 98368 APPLICANT: RANDAL C KELLEY PHONE: 360-385-1960 PENELOPE A KELLEY 691 BLACK BEAR RD PORT TOWNSEND WA 98368-9733 TX 28 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001294010 Section: 29 Township: 30N Ranqe: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17 2082-5875 OWNER, RANDAL C KELLEY PHONE: 360-385-1960 if different: PENELOPE A KELLEY 691 BLACK BEAR RD PORT TOWNSEND WA 98368-9733 PROJECT DESCRIPTION: A/G 120 GAL PROP TANK, HEAT STOVE, & 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 5/17/2012. REQUIRED INSPECTIONS: Tank/Line/Appliance: 10--I 11 FinalApproval: (' 1 11 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 Ii ILDING PERMIT APPLICA BLD11-00123 N Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD11-00123 Received Date: 5/17/2011 SITE ADDRESS: 691 BLACK BEAR RD PORT TOWNSEND, 98368 OWNER: RANDAL C KELLEY PHONE: 360-385-1960 PENELOPE A KELLEY 691 BLACK BEAR RD PORT TOWNSEND WA 98368-9733 SUBDIVISION: Block: Lot: TX 28 PARCEL NUMBER: 001294010 Section: 29 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 DESCRIPTIOF A/G 120 GAL PROP TANK, HEAT STOVE, & GAS PIPE TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2009 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE SHORELINE: GARAGE: SETBACK: CONST TYPE: 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 05/17/11 123510 Total: $213.00 SITE VISIT REPORT (PLOT PLAN) JOB Pe-1vO T; Noy,\\ 41v DATE : 5 ti ohI1 CONTACT: ( v ADDRESS PHONE #: • DIRECTION R `2_ ° .0 �W^ b FAX #: . 12DL.A64L ob,p,(� , I`• T, TO <aci 1 dN Email PLANNER: `D-yaV 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. 00 .L _--—-: vssz._ V i fv__ / O U r� l 3 cs _> i>5 1_1—'717-) 2� ri- 1 _______ E I Ili MAY 172011 IEFFERSON COUNTY T (`'T 0�C r,i, 2c2 14 Qa\\ I r4 biNbo L�. ':D`r\\\ —Ch1Ru -BY IC- < �Qmno VJe. -W V-2rT"Se. b . 2)\\Vv\iB. cUJ A o'er-- S?o ._ •0 �,sorr c " o ii JEFFERSON COUNTY i . - III! DEPARTMENT OF COMMUNITY DEVELOPMENT 1 • V ` 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax gyp' www.co.Jefferson,wa.us/commdevelopment $INS Master Permit Application MLA: MO nrY JA- (€ ON Project Description(include se arate sheets as necessary): _ >/Z C2-'- 7 -iceic-- & - e'er-/ 6-7G Tax Parcel Number: CO I (.1-- d/ v Property Size: (acres/square feet) Site Address and/or Dire`�cti�ons��tolPrope y: _ )„ �) • Property Owner(s)of Record: ar� ",-..-1 A..-..-d-- - c,7 Telephone: .3 aS (% 6 o J Fax: Mailing Address: ---C==- �- P./7g)- email: S Applicant/Agent(if different from owner): /t�,,�J,.c ,� . o,-)-_,�_____-, Telephone: ..?e - 5 7 7 Fax: J 8 S- ..;8 7 5 email: -Q�S` d ;`O,r ayJa,-e. , ` Mailing Address: /o&5.3 kf/c 6" 6R. Pi //f o c% What kind of Permit?(Check each box that applies ❑ Lot or Road Segregation ❑Building ❑ Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family ❑ Garage Attached./Detached ❑ Conditional Use[C(a), C(d),or CI** 0 Manufactured Home ❑ Modular ❑ 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** e Business 0 Cottage Industry 0 Binding Site Plan** opane ,. . 0 Long Plat** sign 0 Planned Rural Residential Development(PRRD)/Amendments** 0 Allowed"Yes" Use Consistency Analysis • 0 Plat Vacation/Alteration** O Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions*" 0 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 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). Il !,0 0WNERSIGNATURt - 7:47:- J= Date: ' ikt fit By signing this application form, the owner/agent attests that the ' f �'- n h ents, is true and correct to the best of his, her or its knowledge. Any material falsehood or any omission o it t 'af i f t a h tit respect to this application packet may result in this permit being null and void. �" I further agree to save,indemnify and hold harmless Jefferson Coon a ihsall y g t liabilities,Judgments, c• •. ts, reasonable attorneys fees and expenses which may in any way accrue against Jefferson County al a reault of QrtiRlonleq�fetntf the: - of this permit. I further agree to provide access and right of entry to Jefferson Court'ari01 its employees, representative': • g Ms review and any required later inspections, Staffs access and right of eni ,will be assumed unless the a!- ' n ofrms the Comy in w iting at the time of the ap llcatio,that he or she wa is prior notice. �� .nature .�cy JEFFERSON COUNTY ` i _ P PT.OF COMMUNITY{JEVFLOP�IflKl' 1 ' 1 l l The action or actions Applicant will undertake as a resu f the issuance of this permit maynegatively impact 9 y p ac t 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-transferable responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below, Signature: - ` c --,•: _- Date: S.f IC. (I ` 1 (:\PPrrnlrf'rr,r'r\###FORM'###\DR F(IR MC\f',,,YP„r rlRfl Fr....,,\h.{.,,,.,u...',.,,, A,.,e..,.:,..,c '' no a.,,. • • 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: 5(-4-t- S ilt t n e co r� 10,4-r-e_ (? d ) 3 is- .r ? 17 ( 3 46) 3 es-S"P 7.S MAILING ADDRESS: I(�9 P C ' p t f cf EMAIL: CONTRACTOR'S LICENSE 1- WAINS NUMBER: S to V1 S 2* Yr7 7 Q I% NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ 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 n Repair 0 Masonry SEP Permit# O Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: 0 Private well U Two Party Type of Heat: Proposed: --- 73 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 Tank and/or Appliance Installation permit,mark all items below that apply: I U d grind Tank I Above ground Tank Size of Propane Tank: /-J O I Heat Stove I Cook Stove I Woodstove I Fireplace Insert 1 Hot Water Tank I Pellet Stove l Other `-e- . iance being installed in a Manufactured/Mobile Home? Yes / No Q 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. l,E V�ti �� ` qr"' . V� 1!Y� pw k '. P5° Pp ;;�,4:} 1 ka£ ,, ili Square Footage Current Proposed ,u t .. ,l,n.,1 i^ ?, <; , ti£� �;� ; ,,d, -..v :i° ' �� ?� Main Floor Heated 4'K :.NExr 1 ; EH Bld App Review. 2'd Floor Heated r� Consistency Review: Other Heated �f1. iR{ ;, r Base fee: Mezzanine FrAq .4,' - (9 (-3 . . � �" L Additional Section: Heated Basement 1�,,,;, i"1 ' , ' Plan Check fee: Unheated Basement Ear"r �?< i'' State Surcharge fee: Other Unheated ' y A;9 t F Pot Water Review fee: . , Garage/Carport — '3 SUBTOTAL rel r< Decks ,, ,(,F ,s, 911/Rd Approach fee; tlr i h e :1 Other " C4.. L r' TOTAL: $ 0 13 ,1"Ii,4 Receipt Number: 35�'� 1'r ,• , Cash/Check Number: 3(01-1 Lf" ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish Initials: C _____S 1 G,\Perini-Center\###FORMS###\DRD FORMS\Current DRD Fortes\Master Permit Application 5-29-08.doc