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HomeMy WebLinkAboutBLD2011-00300 • 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 #: BLD11-00300 Received Date 10/31/2011 SITE ADDRESS: 11-A N CHANDLER CT Issue Date 10/31/2011 PORT LUDLOW, 98365 APPLICANT: MILTON K LUM PHONE: 360-457-5143 DORIS F LUM 11A N CHANDLER CT PORT LUDLOW WA 98365 7-A SUBDIVISION: INNER HARBOR VILLAGE CONDO Block: Lot: PARCEL NUMBER: 961600702 Section: 17 Township: 28N Range: 01 E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 ((33 p 3g5 Contractor's License SUNSHP*077QP Expires 11/67/2012-5875 OWNER, MILTON K LUM PHONE: 360-457-5143 if different: DORIS F LUM 11A N CHANDLER CT PORT LUDLOW WA 98365 PROJECT DESCRIPTION: A/G 120 GAL PROP TANK, PIPING & HEAT STOVE 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 10/31/2012. REQUIRED INSPECTIONS: Tank/Line/Appliance: 4,, LC_ (, „Li r 14 1-� °` Qr�1� (2 ` // l FinalApproval: ( 1 / 1,2_ ' 7475 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 APPLICAN BLD11-00300Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD11-00300 Received Date: 10/31/2011 SITE ADDRESS: 11-A N CHANDLER CT PORT LUDLOW, 98365 OWNER: MILTON K LUM PHONE: 360-457-5143 DORIS F LUM 11A N CHANDLER CT PORT LUDLOW WA 98365 INNER HARBOR VILLAGE CONDO SUBDIVISION: Block: Lot: 7-A PARCEL NUMBER: 961600702 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 DESCRIPTION A/G 120 GAL PROP TANK, PIPING & HEAT STOVE 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 $217.00 LYK 10/31/11 128291 Total: $217.00 SITE VISIT REPORT I ,,l 1 •, (PLOTNn PLAN) I JOB I. VV e �1. JO`T-LS t ' 1 DATE: i€4io Jr 1 . CONTACT: ADDRESS PHONE #: IRECTIONS -cf,► Ii,�/ 'T WJD •Pi4tr l \.SR,B4_ FAX #: K),P 1-0 Se t N NAA11 'r t ,`7-D N ,GI-1,fqN1DI.e.r2 L Email L)1M$m1 C.NI 1 C=©1-(\ PLANNER: 411:> LEN\AL . 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. 2 O CS 0 Lwr Na C. Pro oirsA r, 1--\ I F.p. o .. 1 '�—, ` GI 1T' o o .. 7 7 G I la C.caWA d_52. , 5, Fo c F-+�?vR-e.vI S o E t, WINDOW , • [E, 0 V l ‘ 11 2011 Ad ._ COUNTY 'FVFIOPMFNT 30 I"t l ao v —P:Tl CAL:714NK, /2t '�i,ACALIYcN t► er oc .. F,,c-e9V c t ) riS-ef �- . Veav�- 1..t .5I"t3 '1CIAL..V-e V \'T l 0S-12. :A SS imp,L'7/ ��¢,gON co,, JEFFERSON•UNTYIII W \ to DEPARTMENT OF COMMUNITY DEVELOPMENT �' � .�� • 621 Sheridan Street • Port Townsend • 360/379-4450 • 360/379-4451 • ,ss.,_ 0 www.co.jefferson.wa.us/commd , Master Permit Application OCT 3 1 2011 No mC� Project Descriptionpty (include separate ,,heeets a necessary): 'h n� )/ PIP/f1 J ) /'i at lP— JEFFERSON COUNTY Tax Parcel C i, .1 DEFT.OF Number: t tC I(L`'U' L 1 u _ Size: (acres/square feet)_ Site Address and/or Directions to Property: 1 k - A 0 < ► L ?c-)12-i' h.l.i 6u1 f IJJA Property Owner(s)of Record: t 1 L-TO f )L,4 21 ►JL UU . Telephone: '/ 1 5 / L a- Fax: email: Mailing Address: ) - • • )A A KJ 01.-- )f2TT Lu D L-D i.,J, u...)19 o q, `;J Applicant/Agent(if different from owner): S U MS H IN P Ro PA N E Telephone: 395'5-717 Fax: 35S" 5-07S email: I14F0eSurJS1-(/n1E ProP4Y7e, Mailing Address: I D 53 R RoD D e• / i. 1- J Lock l)A- 9 B 33.7 corn What kind of Permit? (Check each box that applies ❑Building ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use [C(a), C(d), or Cj** Singie Family ❑ Garage Attached/Detached Li Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home ❑ Modular 0 Special Use(Essential Public Facilities) ** ❑ Commercial* ❑ Boundary Line Adjustment ❑ Change of Use ❑ Short Plat** ❑ Address 0 Road Approach 0 Binding Site Plan** ❑ Home Business ❑ Cottagelndustry ❑ Long Plat** Propane ❑ Planned Rural Residential Development(PRRD)/Amendments** 0 Sign 0 Plat Vacation/Alteration** ❑Allowed"Yes" Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management ❑ Shoreline Management Substantial Development** 0 Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance ❑ Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication * 0 Jefferson County Shoreline Master Program Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium ❑ Tree Vegetaion Request *May require a Pre-Application Conference **Requires a Pre-Application Conference Please identify any other local, state or federal permits required for this proposal, if known: 1‘ oeDESIGNATION OF AGENT -)N,I hereby designate 3U,f,IS H I 1.)E PRo P to act as my agent in matters relating to this application for permit(s). ~ wNER SIGNATURj Gt1-Gi-- / Date: /c �-C .7t i( 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 it's 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 1 ) UUU 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 a plication that he or she wants�(prior no ice. igiriignature a tit MIA"-, 'I`, (/i-& 'V---- (Date:I C 2-(% 1C i l The action 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 4 action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual Z..' \ and nontansfera) iu4-w e responsibility for adheri to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. ', Signature: "K 1,,L(,/^,—_� Date: )O ' - J-c) ( G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc 0 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 OR MANUFACTURED HOME INSTALLER: PHONE: FAX: SO INS2H IN t P2o (and (360 ) 3�35- 57T1 ( 360) 3B5-587s MAILING ADDRESS: )08.53 }} o y 3 i U € f• -1. EMAIL: 0 n Suv\siltV(t pro Pane a C on CONTRACTOR'S LICENSE WAINS NUMBER: Sl-(hSN P+ D 1 n�(7 (Q P NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: i i Sewer LI Addition LI Steel Proposed: Bank ..1 Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ii Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: f.1 Private well ❑ Two Party Type of Heat: Proposed: Li 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 If this is a Propane Tank anrt/nr Appliance Installation permit, mark all items below that apply: 1 ound Tank Above ground Tank 3 Size of Propane Tank: / Q�/'Ce((t'WI — I Heat tove 1 Cook S ave t vvoodsfo—v—e 1 Fireplace Insert 1 Hot Water Tank I Pellet Stove Other 6 ,. frrrs appf'ance 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, a property lines, tank location and size, distances from the propane tank to all property lines, buildings and septic system components, including the reserve area. Square Footage Current Proposed :Foi Q.ffice.Use;Only ., 5,, ,- ,. , tl '_.`. Amount ,. Revjsjon;,;. .. Main Floor Heated EH Bld App Review: 2fa Floor Heated Consistency Review: Other Heated Base fee: ^'1 r Mezzanine Additional Section: �f Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Carage/Carpoi t SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $a '7 Receipt Number: 1 a3at1 I - Cash/Check Number: / ' , ^ ESTIMATED COST(REQUIRED) Date: ����� .Fair market value of all labor and materials foundation to finish Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc