HomeMy WebLinkAboutBLD2011-00173 •
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 #: BLD11-00173 Received Date 7/6/2011
SITE ADDRESS: 170 SUNSET BLVD Issue Date 7/6/2011
PORT TOWNSEND, 98368
APPLICANT: KRISTINE EASTERDAY PHONE: 206-779-1773
JAMES M HECKINGER
1614 32ND AVE
SEATTLE WA 981223318 5
SUBDIVISION: CAPE GEORGE COLONY DIV 2 Block: 3 Lot:
PARCEL NUMBER: 938100305 Section: 12 Township: 30N Range: 02W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17 2085 5875
OWNER, KRISTINE EASTERDAY PHONE: 206-779-1773
if different: JAMES M HECKINGER
1614 32ND AVE
SEATTLE WA 981223318
PROJECT DESCRIPTION: NEW PROPANE HEAT STOVE & NEW 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 7/6/2012.
REQUIRED INSPECTIONS:
Tank/Line/Appliance:
FinalApproval: 7 / 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
R
ILDING PERMIT APPLICAT BLD11-00173Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD11-00173 Received Date: 7/6/2011
SITE ADDRESS: 170 SUNSET BLVD
PORT TOWNSEND, 98368
OWNER: KRISTINE EASTERDAY PHONE: 206-779-1773
JAMES M HECKINGER
1614 32ND AVE
SEATTLE WA 981223318 CAPE GEORGE COLONY DIV 2
SUBDIVISION: Block: 3 Lot: 5
PARCEL NUMBER: 938100305 Section: 12 Township: 30 N Range: 02 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 NEW PROPANE HEAT STOVE & NEW 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:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: 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 $142.00 LYK 07/06/11 123677
Total: $142.00
• SITE VISIT REPORT •
(PLOT PLAN)
JOB DATE : 7411f, .
CONTACT: .
ADDRESS PHONE #: .
RECTIONS AQ-eG--'eor -t R8, '7o LAP-& C--Qt) & 11:, FAX #: .
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. m-&QU.SIT �tl SonS.c.,�-?D/wtl. ?o 44/70 DNR4-,Email .
PLANNER: ',L.RM/1
LOA .
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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oN °� JEFFERSO(V•NTY 0
I - ' \� ` DEPARTMENT OF COMMUNITY DEVELOPMENT
'N o a 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 36O/379-4451 Fax
0 www.co.jefferson.wa.us/commdevelopment ,
Master Permit Application MLA: Lt ('t/l PerLA
ProjeI Descnptio (include separate sheets as necessary): 1
Tax Parcel Number: ` r 3 j �JZ) v,5 Property.Size:
(acres/square feet)
Site Address and/or Directions to Property:
170 5►) 1
Property Owners)of Record: c,G{✓}h } j .k1r1. '�'� ]�,�/7� 5 }`-9,y
Telephone: '( �`1�l i�� Fax: - l '4 Yj email:
Mailing Address:
Applicant/Agent(if different from owner): .. Q . t2 >
Telephone: ,�a5 S7,7
79 7 Fax: -875 mail: ......
S` SA-•-. r,�a-.-e ,c.,.,,.L,
Mailing Address: / 8,5,E ,�f/o y OP. PT• //&OLa c% ,-)A Gy
What kind of Permit?(Check each box that applies ❑Lot or Road Segregation
DSuilding 0 Critical Areas Stewardship Plan
❑ Demolition Permit ❑Varianc{e(Minor,Major or Reasonable Economic Use)
❑ Single Family 0 Garage Attached/Detached .I:Conditional Use[C(a), C(d),or C)**
❑ Manufactured Home . .0 Modular - 0 Discretionary"D" .. .- -- • .t.a.,�
❑ Commercial* rq�
0 Special;Use(Esse tit. I .. i ;:, A.J l5
❑ Change of Use 0 Boundary Line Adj Stn\
❑ Address . . . .❑ Road Approach 0 Short Plat**
❑ Home Business 0 Cottage Industry ❑Binding Site Plan i 11
'ropane l7 Long Plat** , �Vt 6
❑ Sign
0 Planned Rural Res on 1 Development(PRRD)/A : is**❑Allowed"Yes"Use Consistency Analysis 0 Plat Vapation/Alter idn
O Stormwater Management 0 Shoreline Master P ogram Exerkftf8 b'' J-- s**
❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Manage ent Sigttggtereili IiG1:4. t 3 �"4i.iy
❑Temporary Use ❑Shoreline Manage anance
❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium o Jefferson County Shoreline Master Program Amendment
*May require a Pre—Application Conference 0 Tree Vegetation Request
**Rewires 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).
p
•,i •WNER SIGNATURE
Date: ,�///'�/G� / (
By signing this application form,the owner/agent attests tha.the information provided herein,and in any attachments, is true and correct to the best of -
his,her or its knowledge. Any material falsehoodor 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 pr,v e access and r' t)of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any re 'ed laterinspe ons/Staffs access and right will be assumed unless the applicant Informs the County in writing at the.
r time of the applica n that he or s wah s pr'' r notice,
•nature: ' ` ,� C'
t OP 1 L err �u X( Date: �/
The action or acti ns Applicant will undertake as a result of the issuance of this permitimay 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
"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 y re in complianoo•ifth the Jefferson County development code,The Applicant acknowied es that he,she or it holds individual
and non-transfer responsibilit or adherin t and complying.with the ESA. The Applicant has read this disc r n jsigns and dates it below.
Signature: /1 � � 1�
li
Date:
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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:
SDI., Z.ft I n e 2_A-- PA-v (26o ) 3 Fs- .r 7 /7 (3 644 3 ifS-S a' 7S
MAILING ADDRESS: !I O 5 r i pr P, (( EMAIL:
CONTRACTOR'S LICENSE
WAINS
NUMBER:
SLAI'' Ski, >k 2rij7Q0 NUMBER
ARCHITECT/ENGINEER:
PHONE ( ) FAX:( )
MAILING ADDRESS:
EMAIL.
Project Type: Fr me Type: Bathrooms
❑ New ,Wood Shoreline: Type of Sewage Disposal:
Existing: ❑ Sewer
❑ Addition 0 Steel Proposed: Bank
❑ Alteration/Remodel 0 Concrete Total: ❑ Community System
0 Repair 0 Mason Height; 0 Individual System
o Demolition CI Other:ry Bedrooms: SEP Permit*
Existing: Setback: Water Supply:
Type of Heat: Proposed: ❑ Private well D Two Party
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
IBC Occupancy: Proposed
P y IBC Type of construction: • Will you have Food Service? Yes / No
If this is a Propane Tan nd/or AD iliance Installation permit,mark all items below that apply:
1 er round Tank I Bove gro nd Tan', Size of Propane Tank:
Heat Stove I Cook Stove Woodstove I Fireplace Insert i Hot Water T I.Pellleet�ove l Other
Is is 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 lercatlop and size, distances from the propane tank to all property lines,buildings and septic system components,
including the.reserve area. T }�
.- '•��4 7p?�''k�.h ^�i) y YF'' C<'y� i{�l M+Av .. b 4 N.-4� F .�? 4��:�+il� k ! d,'.
^��}yjp l A y `J' ,�1+Sheµ c '3,,,„,i,,,,A T��i^1 -, f1 a, , r�Ertl 6 1 „',Ito;S•uare.Foota•e Current Pro•o&ed 1 Y® �+ K� 7y(, __yy YM1 ply, ""�^y'vr`tilt;vie ., .` y y 7�r'T
Main Floor Heated .fit ,.,H ygg,A .ink ,,,i 3 ;.g,,,,,v ,p..�,l�li. f` d,R��;?�J:',�,il°,� yx` ` ,
liwi, EH Bid App Review: '
l '"�fi Y
2r Floor Heated li . .a� 1
a,1% � nx r fi Consistency Review:
t,t��y In-
Other Heated
Base fee. 1
Mezzanine !,41 `1�
w ;"st,k , Additional Section:
Heated Basement y'f , , -.
��3 ;, 4,' Plan Check fee:
°
Unheated Basement L F . :0 ��
,� ,, i ? State Surcharge fee:
Other Unheated i IF • ter
4 r OW Pot Water Review fee:
,¢ t,, t:
Garage/Carport ' ys, l: SUBTOTAL
Decks � "` •a 911/Rd Approach f
i
Other r{ t fZ I
TOTAL: $ l
, i, Receipt Number: i bloke 7 7
Lora° 1F�A`, �. t �E' .
l�,y,�Y}}jj -..� ,, Cash/Check Number:. 48
ESTIMATED COST(REQUIRED) Date: ,�.
•Fair market value of all labor and materials foundation to finish �-t
Initials: - - --
G:\PermitCenter\###FORMS###\DRD FORMS\Current bRD Porms\Master Permit Application 5-29-08.doc