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HomeMy WebLinkAboutBLD2011-00257 • C 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#: BLD11-00257 SITE ADDRESS: 500 SAND RD Received Date 9/19/2011 PORT TOWNSEND, 98368 Issue Date 9/19/2011 APPLICANT: JUDITH FRENCH SCOTT PO BOX 323 PHONE: 360-385-3510 PORT TOWNSEND WA 98368-0323 SUBDIVISION: TX 26 Block: Lot: PARCEL NUMBER: 001184026 Section: 18 Township: 30N Range: 01W CONTRACTOR: C H S INC PO BOX 518 PHONE: (360)732-4585 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2012 OWNER, JUDITH FRENCH SCOTT if different: PO BOX 323 PHONE 360 385 3510 PORT TOWNSEND WA 98368-0323 PROJECT DESCRIPTION: A/G 250 GAL PROP TAMK SWAP OUT-SAME SIZE & LOCATION 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 9/19/2012. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: _- gq5-20/ 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 APPLICATft B 0257 Jefferson County Department of Community Development Re Re view view Type: 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD11-00257 Received Date: 9/19/2011 SITE ADDRESS: 500 SAND RD PORT TOWNSEND, 98368 OWNER: JUDITH FRENCH SCOTT PHONE: 360-385-3510 PO BOX 323 PORT TOWNSEND WA 98368-0323 SUBDIVISION: Block: Lot: TX 26 PARCEL NUMBER: 001184026 Section: 18 Township: 30 N Range: 01 W CONTRACTOR: C H S INC PO BOX 518 PHONE: (360)732-4585 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2012 REPRESENTATIVE: PHONE PROJECT DESCRIPTIO1` A/G 250 GAL PROP TAMK SWAP OUT - SAME SIZE & LOCATION TYPE OF WORK NON SQUARE FOOTAGE NEW VALUATIONTYPEOFIMP MAIN: CODE EDITION: 2009 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: OTHER: CONST TYPE: GARAGE: SHORELINE: DECK: SETBACK: 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 $71.00 LYK 09/19/11 128142 Total: $71.00 N lk C ���� JEFFERSON•LINTY • 9 Pi��' DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 ���O www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: MO fYlc_A- 2 ,,)'..Project Description(include separate sheets as necessary): SL) P Cul" }PRoPAtkJt TA►t�lc To C-H4NGf �UPPLIf-I� Sirr �Tax Parcel Number. �/ )'>� Z ����� C' �r� U Cv Property Size: /D 4CQf S (acres/square feet) Site Address and/or Directions to Property: Soo SA 0 D Rog Property Own r(s)of Record: CIV D ► 1 -I reE A k 1-1 — SCoTT Telephone: �� SS'` 35/O t.oN foo 3ff - 376 Z Fax: email: brass 1 Mailing Address: Pp. Box- 3Z3 20 - TOWN �vlypert. cool > Srv1� W� �836$ Applicant/Agent(if different from owner): Telephone: Fax: Mailing Address: email: What kind of Permit?(Check each box that applies ❑Building ❑ Demolition Permit ❑Critical Areas Stewardship Plan o or Reason ❑Single Family ❑Garage Attached/Detached 0 Conditional Use[C(a)rC(d),or C;"able Economic Use) ❑ Manufactured Home 0 Modular 0 Discretionary"D"or Unnamed I se Classik _ ❑ Commercial* ❑ Change of Use 0 Special U ,qqII`� q� ) ❑ Address ❑ Road Approach 0 Boundary Line 5,''. 1 1--- V 1�, O Home Business ❑Cottage Industry ❑Short Plat M't )1 I�.PrO ane g ❑Binding Si �(In** p 0 Lon gPlat jin 1 9 ii1 0 Planned Rural Residential Development(P endments** ❑Allowed"Yes"Use Consistency Analysis 0Plat Vacatljoo/Atteration** ❑Stormwater Management ❑Site Plan Approval Advance Determination(SPAAD) 0 Shoreline Maste ermit Rev ions** ❑Temporary Use 0 Shoreline Mana gg# \Qp}{eieQment ❑Wireless Telecommunication* 0 Shoreline Manageni ❑Forests Re of Six-Year Moratorium 0 Comprehensive Plan/UDC/Land Use District Map Amendment *May require a Pre_A ❑JeffersTree eg County Shoreline a Master Program Amendment PP►/capon Conference ❑Tree Vegetation Request **Requires a Pre-Applition Conference Please identify any other local, state or federal permits required for this p op sal,if known: I hereby designate DESIGNATION OF AGENT to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE 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 attomey'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 time of the ication that he or sh wants prior notice. Signature/ C ,� i f �/ Date: . 1 2c2 The actiir or actions Applicant will undertake as a result of the issuance of this permit may 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 you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-tran rable responsibility r adhering to an icon) I ' with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature:• C. Lai/k.ak ` Date: pt /`rlj) 2 // • 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: -' ENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: G'�N • - MAILING ADDRESS: 3i� flt5 'l J 2. _ 1� i 5- ( ) CONTRACTOR'S LICENSE l Y ��l V� ( f ��f�L U/v� EMAIL: NUMBER: WAINS ARCHITECT/ENGINEER: NUMBER MAILING ADDRESS: PHONE ( ) FAX:( ) EMAIL Project Type: Frame Type: Bathrooms: Shoreline: ❑ New i1 Wood Type of Sewage Disposal: ❑ Addition Existing: [J Sewer J Steel Proposed: Bank❑ Alteration/Remodel Ll Concrete Total: ❑ Communitya Systemm ❑ Repair Height: ❑ Individual ❑ Masonry ❑ Demolition ❑ Other: Bedrooms: SEP Permit# Type of Heat: Existing: Setback: Water Supply: Proposed: I I Private well 0 Two Party ❑ Public Total: Name of System:_ If this is a Commercial Pro ect ou must answer the followin : Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current IBC Occupancy: IBC Type of construction: Proposed you have Food If this is a Pro ne Tank and/or A fiance Installation rmit mark all items elow that apply Service? Yes / No I Underground Tank i 1 bove ground Tank I Heat Stove I Size of Propane Tank: 2Sb gam Cook Stove I Woodstove I Fireplace Insert I Hot Water Tank -I Is this a liance bein 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 sho ng a o i e a I lines, tank location and size,distances from the propane tank to all property lines,buildings and septic s ,,. `/ ' Property includin. the reserve area. `l onents, S•uare Foota•ePro. .,,;.. -- :;K. �,. _ Current Pro.osed For Office Use Onl Main Floor Heated A�qq_I, " `- ' EH Bid App Review: �� ": Er f 2 ' Floor Heated ERSOV COON Consistency Review: Other Heated — _-! ... Base fee:iii __ EMI Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated — Pot Water Review fee: Garage/Carport SUBTOTAL Decks — 911/Rd Approach fee: Other _ TOTAL: ilinill 9 Receipt Number: 1 I L 2 Cash/Check Number: ESTIMATED COST(REQUIRED) 1 .Fair market value of all labor and materials foundation to finish Date: Initials: C r.7-e•-•-7"-1.,..---"L•i ,...,..i.,,_.,:__.i: . . .,. I 1 j - ._ . -- - _. _ _ — - • - - 1 r . I ► -- - - i - , 7 i „ - .------- .,,.....: .. .___:__ n p E C.f— 1 ZZTT� . ._ f --- -- - ( i 1EFfERS©N GOl1WTY" I { i --— f EPT'f�F COMMUNITY DEVELOPMENT t t. } - '.� . t f 1 i___-__."-_-_ __.____.._.._ .___.-.._. } STOR s Nita To�•r TIL) C i •• t G�..y,. � �'�- gP9�J� TIN.• g7 _ STunia1 S(ii[7aNtf —i i - D1d tit. .- 23 j - - I I I 3.RM10 -DPAINI , . Ji ----- -_ — 17 23� ; — — — a'T(�T_. _ --� /!OO 54. FT i Cop&A Ff -r ..,co-D. i ---"— /a `}c'24 ief.� - - 7. r4 U 3�r' - - ,