HomeMy WebLinkAboutBLD2011-00255 •
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 #: BLD11-00255 Received Date 9/15/2011
SITE ADDRESS: 11-B N CHANDLER CT Issue Date 9/15/2011
PORT LUDLOW, 98365
APPLICANT: DONOVAN HOLTZ
11B N CHANDLER CT PHONE: 360-437-7833
PORT LUDLOW WA 98365-9537
SUBDIVISION: INNER HARBOR VILLAGE CONDO 7-B
Block: Lot:
PARCEL NUMBER: 961600701 Section: 17 Township: 28N Range: 01 E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339 (3 p
Contractor's License SUNSHP*077QP Expires 11/67/�013825
-5875
OWNER, DONOVAN HOLTZ PHONE: 360-437-7833
if different: 11B N CHANDLER CT
PORT LUDLOW WA 98365-9537
PROJECT DESCRIPTION: A/G 120 GAL PROP TANK FIREPLACE INSERT& 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 9/15/2012.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: /O"/23//
FinalApproval: /a� //
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
eview
1PUILDING PERMIT APPLICAT1t'�N R00255
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD11-00255 Received Date: 9/15/2011
SITE ADDRESS: 11-B N CHANDLER CT
PORT LUDLOW, 98365
OWNER: DONOVAN HOLTZ PHONE: 360-437-7833
11B N CHANDLER CT
PORT LUDLOW WA 98365-9537
INNER HARBOR VILLAGE CONDO
SUBDIVISION: Block: Lot 7-B
PARCEL NUMBER: 961600701 Section: 17 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 DESCRIPTIOP A/G 120 GAL PROP TANK FIREPLACE INSERT & 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:
GARAGE: SHORELINE:
CONST TYPE: SETBACK:
DECK:
SEWAGE DISPOSAL: BANK HEIGHT:
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 09/15/11 128134
Total: $213.00
•
SITE VISIT REPORT II
D� I I (PLOT PLAN)
.I..JOB ) /-1 0 L-7-2.. DATE : 131301/1
CONTACT: •
ADDRESS i t— 11 N, ci-IAN r L24" Gi' PHONE #:
DIRECTIONS FAX #:
Email LoN—V'oN—lu relS Nt COn
PLANNER: Q4v1,tt../ .
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.
l
CD c-og'6ii°
C. , ..\. *.
i --0
TA-it D
/ G CIEE' 1/2 13,Z G.5,1.0 .-- 1::
1
0
CigANavi
,V _.1 -f7
r- 4.41150 -ivrtf
A„_.--.
ECEOVIE \-
c.) G--1A aAk€ I��
„- iJ IA _ U
JE' ERS� '
DEPT.OFCO'1Ml1N ' '^._�!;-;i'MENT
Here--s
(ZoV TANK 12.011 1,)4 ark -boLL1 s I. T ?lp 1 SI
ON c4 •
1.04 JEFFERSON COUNTY •
. ' \ DEPARTMENT OF COMMUNITY DEVELOPMENT
' ..a 621 Sheridan Street• Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
' p"l` www.co.jefferson.wa.us/commdevelopment
Master Permit Application
MLA; 00 i)(A1,A' CPO*b
Project D Gtiption(include separate sheets as/
.� /
Tax Parcel Number:
6 l• 6 0 Q 70/ Property.Size: (acres/square feet}
Site Address and/or Directions to Prope y:
// c `
Property Owner s)of Record: 1).0 Ai,
/iAJ 51/aLTZ
,_2 7J3.3 Fax: email:
Telephone: _
Mailing Addre s:� �� - '
Applicant/Agent(if different from owner): -r, pA....1r/A-,--4_...---
Telephone: 385 - 57 7 Fax: .38 5 `.;875; email: soty-dA 4-,:A-ipyQ-.e `
Mailing Address: /0 d'S 3 k./-/o 6 y ,OP. Pi . //R O co c% 1,J A
Segregation
Se re Road or Lot
What kind of Permit?(Check each box that applies 0 � 9 g.
❑Building 0 Critical Areas Stewardship Plan
❑ Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use)
❑ Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]**
0 Discretionary"4"or U ,
❑ Manufactured Home .Q Modular . pi 0 Special Use(Esse tiat Ii
❑ Commercial* � � �)� V
❑ Change of Use 0 Boundary Line Adjtitm 1--
• Address 0 Road Approach 0 Short plat** 11 i!
❑ Home Business 0 Cottage Industry 0 Binding Site Plan , _,/,
ropane ❑Long Plat** i 1Li, . 1,,5
❑ Sign 0 Plat Va 0 Planned Rural Resid`ential:Development(PRRD)/A nts**
❑Allowed"Yes"Use Consistency Analysis �tion/Alteretrdn:x* evasions**
O Stormwater Management 0 Shoreline Master Progra el e
❑ Site Plan Approval Advance Determination(SPAAD)* C]Shoreline Managerijlent ,4 1 fotelo,rffirtittn.
❑Temporary Use ❑Shoreline Manage
❑Wireless Telecommunication* 0 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 Pro-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 t' s application for permit(s).
Vr ' 2/2 2c --� Date:
_, 7
'� WNER SIGNATURE By signing this application form,the owner/agent attest at 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 attorneys 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 info i the County in writing at.the.
t time of the applica' rithathe:or she wants prior ' tics. 7L___ /
° - �r Date: ll
- Al .'.nature: .
The action or actions Applicant will undertake as a result of issuance of this permit may negatively impact upon one or mote 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 i compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transferable re onsibility for adhering to complinytaithe'ESA. The Applicant has read this disclaf er an signs and dates it below:
` Signature: 1 — Date: / l/
r:\Prm,itc,rrr\###Foams###\rwn pan M.C\Cm-rPnrrlRT1 F.....,•\N4,,,r»,p.... a^^v^^^^^S on no.+.... 7)-5
• •
BUILDER STATEMENT
The signer of this statement does ereby certify that they are the Owners of the parcel referenced herein,that they are not licensed
they will be assuming the responsi•ility of the General Contractor for the proposed project. 'Signature: contractors and that
Date:
GENERAL CONTRACTOR
ER: PHONE:Stc_I-, ��l n C' pc) � t°,�-y� FAX:
/ (MA0 ) ES` -r 7 (3 r;l� 3 t S'J TS
MAILING ADDRESS: O r, 5 r
P. (� EMAIL:
CONTRACTOR'S LICENSE
NUMBER: 1 WAINS
ARCHITECT/ENGINEER: S S Q NUMBER
MAILING ADDRESS: PHONE ( FAx:( )
Project Type: Frame Type:
❑ New Bathrooms: Shoreline: Type of Sewage Disposal:
0 Addition 0 Wood Existing:
❑ Alteration/Remodel 0 Steel Proposed: 0 Sewer
0 Concrete Bankig0 Community em
❑ Repair Total: ___._ Height:
❑ Demolition ❑ Masonry S Individual System
0 Other: . Bedrooms. SEP Permit#
TypeExisting: Water Supply.
of'Heat: Setback:
Proposed. 0 Private well ❑ Two Party
Total: ❑ Public
Name of System:��
If this is a Commercial Project ou must answer the followin :
Number of Parking Spaces: C Trent:
Proposed: Number of ADA Parking Spaces:
Number of occupants(includes wners,tenants, employees, etc) Current
IBC Occupancy:: . Proposed
IBC Type of construction:
Jf this is,a P o are Tan and/ r A liance Installatio ermit mark atl itemss blelow that Food Serwce? yell No
. * i Underground Tank o Abwe ground Tanker at a I' :
I Heat Stove I Cook Stove I 1 ze of propane Tank; c7
Woodstove Fireplace Insert I Hot Water Tank I Pellet.Stov: t
Is this a fiance.bean installed in a Manufacture: , •. es Other
When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,al
' lines, tank location and size, distances from the propane tank to all property lines,buildings and septic system
includin• the reserve area. g ( I property
Y components
.S•care.F I ts5 }p P i iM'7 p `t� l r ,
oota•e Current Pro p osed i tips why e ,%'T 4L. •:. 4gry h M F, .
Main Floor Heated ` cif` ,1 � i ' � ,tip t y
A f � it ^v'cai. t 7!!0� €.I!V ,"sa +w.�i,;�JY�.�.°���:4k-S� �,'k t u
,� x + � EH Bld App Review:
2 ` Floor Heated F'ven •
s ,y`It. . '' Consistency Review:
Other Heated s IIIMIIIIIIIIIIIIIIIIII
'
All' ri
sY°T
Mezzanine ," t
tf"5,,,.."' Additional'Section:
Heated Basement �F . 1111111.11
k
�/ Plan Check fee:
Unheated Basement `�` ' `�
1.11110,74,: 37:44-0, State Surcharge fee: 111111111.01111111.....1
Other Unheatedre'i's a ` ' ''S"'
Ari e y_ + Pot Water Review fee:
Garage/Carport tfi liq r 14
t 'i
E b 4i SUBTOTAL
�.c�t�u
Decks �� 9 n � r111111111111111111111
IP'':Po�✓ Yf t
°�, + 911/Rd Approach fee:
Other 5
'_
r< "'r �°:•�,a.;ph= TOTAL: larjnlillpIIIIIIIIIIIIIII
'j a1t :
r ?, Receipt Number: lrEIEZIIIIIII
ESTIMATED COST(REQUIRED)
a�fr:, ',r Cash/Check Number
•Fair market value of all labor and materials foundation to finish Date: .
Initials: 11111 .11111=ela
c__
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Poems\Master Permit AppIicafiion 5-29-08.doc