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Home My WebLink AboutBLD2011-00148 • 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 #: BLD11-00148 Received Date 6/13/2011 SITE ADDRESS: 7323 BEAVER VALLEY RD Issue Date 6/13/2011 CHIMACUM, 98325 APPLICANT: KAROLYN BARTMAN PHONE: 360-732-4903 7323 BEAVER VALLEY RD CHIMACUM WA 983258734 TX 10 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901243013 Section: 24 Township: 29N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 60 38 5-5875 Contractor's License SUNSHP*077QP Expires 1 (317/ 1 OWNER, KAROLYN BARTMAN PHONE: 360-732-4903 if different: 7323 BEAVER VALLEY RD CHIMACUM WA 983258734 PROJECT DESCRIPTION: A/G 250 GAL PROP TANK, HEAT STOVE & PIPING 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 6/13/2012. REQUIRED INSPECTIONS: Tank/Line/Appliance: /" (— ,,b FinalApproval: 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 ILDING PERMIT APPLICA1IN B Review 00148 Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD11-00148 Received Date: 6/13/2011 SITE ADDRESS: 7323 BEAVER VALLEY RD CHIMACUM, 98325 OWNER: KAROLYN BARTMAN PHONE: 360-732-4903 7323 BEAVER VALLEY RD CHIMACUM WA 983258734 SUBDIVISION: Block: Lot: TX 10 PARCEL NUMBER: 901243013 Section: 24 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 DESCRIPTION A/G 250 GAL PROP TANK, HEAT STOVE & PIPING 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 06/13/11 123587 Total: $213.00 SITE VISIT REPORT (PLOT PLAN) OB ` N 14 A0.7 JIA DATE : 5\2S\ 1 CONTACT: ADDRESS '1 3 23 'B.-RAN-QC: VA 1 KG , PHONE #: 7 3Z 49 63 DIRECTIONS " s AN- Lf \t A.st.N kV) Tit R FAX #: , Email PLANNER: Z)/*v-e- 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. sIED j CT7 6611 — 111) TrAN • nowt4 tic c $ STCANIZ t- '''') / OO yams k d< sx 1st'1 'MA 0 0EII-Mfg ro JUN 1 3 2011 — �RI l JEFFERSON COUNTY DFPT OF COMMUNITY DFVFI OPMENT 2Ssv rC /claNc /f--.v prik JEFFERSON •COUNTY , 14, DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street . Port Townsend . Washington 98368 IIII 360/379-4450 . 360/379-4451 Fax K.,.1.1&,,41 VI www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: P) MLAeon 1,6 Project pescription (include separate sheets as ne scary): �--- 'Tax Parcel Number: �U / .---2V-1 6''7 _3 Property Size: (acres/square feet) Site Address and/or Directions to Property: V) h Ze,' -cam-'" /" �' Property Owner(s)))ofRecord: -"" e-,y� %ey,C,,J ' Telephone: /.�o2 T /O 3 Fax: v email: Mailing Address: -Stz--0-} - G4--a--/ : -C 2 _ Applicant/Agent(if different from owner): `Ji-c- -L,..„. A_- 12/1.--rf/ --- Telephone: ye 5 - 5 7 7 Fax: J 8 $ - 8 7 S email: -c S`�`d -�/O-yJa-•-e ,c.a,,_ Mailing Address: /0 c..5 3 k.ff<6 .OP, 1 T . /// C 0 c/ ,,,,)A What kind of Permit?(Check each box that applies 0 Lot or Road Segregation T ❑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[C(a ' d) ._C.- 0 Manufactured Home 0 Modular • 0 Discretionary"D"or r(i L- • tattpiii4 ❑ Commercial* 0 Special Use (Essenti I - '' - 0 Change of Use 0 Boundary Line Adjus rI O Address 0•Road Approach 0 Short plat** JUN 1 3 2411 tEl Home Business 0 Cottage Industry ❑ Binding Site Plan** m,lreropane 0 Long Plat*" ❑ Sign •• ❑ Planned Rural Resi ntial =: - -----= ---• ••"- me s** ' ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alterat on** 1E FERSON OUNiY 0 Stormwater Management 0 Shoreline Master Pr gra►WUrn0F Ml lUYrflEIVROPMCsNis** 0 Site Plan Approval Advance Determination (SPAAD)* 0 Shorelihe Management Substantial Development** 0 Temporary Use 0 Shorelihe Management Variance 0 Wireless Telecommunication * 0 Comprehensive Plan/UDC/Land Use District Map Amendment O Forest Practices AcVRelease 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). 6) • WNER SIGNATUREce C-2/dY- ,r/ Date: -10 - /U / / By signing this application form, the ow er/agent attests thatthe 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 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 I ti tt that he or she`f' is prior notice. nature: -& Date: 49 — /0— / / P . : — The action or actions Applicant will undertake as a result of the issuance of this rmi pe tmay 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 angered 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-tra sf abl responsibility fora eying ttg and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature:'. P-44-C r- 4 L4Ziii-z-e t Date: 6 In_ / ` � (:\p,,,-,---, �\###PORM.4###\aRrl FOR MC\(',1,-P„r LIRA R(..-,,.\n4.,,,,,.,u,.,,,,:, a,...t:_..,,,..,c -,n(,) ,.... ,j - • • 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: dater., GENERAL CONTRACTOR ER: PHONE: FAX: 51-Li- s t rn e rP PA-v"-=e; (266) ) 3 FS- X 7 f 7 ( 3 0 3 es -S"P 7S MAILING ADDRESS: 'O E JC 3 " f Pt. r"nn. (ti EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: S LA v $ ' * 947 7 Q 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 O Alteration/Remodel 0 Concrete Total: Height: . 0 Individual System O Repair 0 Masonry SEP Permit# O Demolition 0 Other: Bedrooms: Water Supply: Existing: • Setback: 0 Private well 0 Two Party Type of Heat: Proposed: 0 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 -Jf this is a Propane Tank and/or Appliance installation permit,mark all items below that apply: 1 Undemound Ta ,XApove ground Tan Size of Propane Tank: a.v5D , - --- r C1 Heat S I Cbdk Love s ove 1 Fireplace Insert 1 Hot Water Tank 1 Pellet Stovff Other L/2 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 al/property lines,buildings and septic system components, including the reserve area, go iF R _`u-� ,r:7 v S�tr , y r�i1TF '�peer '5 .,�.. , T, ,,I.R. �jf '� Square Footage Current Proposed A.r, . �,'0..:,:, • „a i s s: Main Floor Heated `k'�•, EH Bld App Review: it �,kief l k, 2""Floor Heated , i' Consistency Review: Other Heated1,,,N,:,r11Base .fee Mezzanine 0 r �, 1A{�t Additional Section: �I Heated Basement Plan Check fee: Unheated Basement i,,, 'l'•es State Surcharge fee:40 J Z k :, ,t_ ', Other Unheated . $ T, t_�. e s 1,.!::":!,`•i Pot Water Review fee: Garage/Carport SUBTOTAL_ Decks ,1.e rw4' W 911/Rd Approach-fee: Other ,0 e ;fi";z TOTAL: $a 15� r I S7 ',,-"A:2;g, '` Receipt Number:' ' ti Cash/Check Number: 2 J l- f.r ESTIMATED COST(REQUIRED) Date: _1 _„ .Fair market value of all labor and materials foundation to finish Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Fodns'\Master Permit Application 5-29-08.doc