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Home My WebLink AboutBLD2011-00305 • 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 *: BLD11-00305 Received Date 11/3/2011 SITE ADDRESS: 63 EXPLORER LN Issue Date 11/3/2011 PORT LUDLOW, 98365 APPLICANT: ELMER L FILIPPINI TRSTE PHONE 360-437-1105 E L FILIPPINI REV LIV TRS 63 EXPLORER LN PORT LUDLOW WA 98365-9616 136 SUBDIVISION: PORT LUDLOW NO. 2 AREA 3 Block: Lot: PARCEL NUMBER: 990603136 Section: 9 Township: 28N Range: 01E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 ((33 pp)) 338g55 Contractor's License SUNSHP*077QP Expires 11/167/2012-5875 OWNER, ELMER L FILIPPINI TRSTE PHONE: 360-437-1105 if different: E L FILIPPINI REV LIV TRS 63 EXPLORER LN PORT LUDLOW WA 98365-9616 PROJECT DESCRIPTION: A/G 120 GAL PROP TANK, LINES & GAS HEATER 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 11/3/2012. REQUIRED INSPECTIONS: Tank/Line/Appliance: / fr- // i i3 FinalApproval: l / )( 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_Perm it_Propane.rpt 10/29/19 WILDING PERMIT APPLICA•N BLD11-00305 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 ERMIT #: BLD11-00305 Received Date: 11/3/2011 SITE ADDRESS: 63 EXPLORER LN PORT LUDLOW, 98365 )WNER: ELMER L FILIPPINI TRSTE PHONE: 360-437-1105 E L FILIPPINI REV LIV TRS 63 EXPLORER LN PORT LUDLOW WA 98365-9616 PORT LUDLOW NO. 2 AREA 3 SUBDIVISION: Block: Lot: 136 'ARCEL NUMBER: 990603136 Section: 9 Township: 28 N Range: 01 E ;ONTRACTOR: SUNSHINE PROPANE PHONE 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2012 ;EPRESENTATIVE: PHONE: 'ROJECT DESCRIPTION A/G 120 GAL PROP TANK, LINES & GAS HEATER -YPE OF WORK NON SQUARE FOOTAGE: -YPE OF IMP NEW MAIN: 'ALUATION ;ODE EDITION: 2009 ADD'L: HEAT TYPE: )CCUPANCY: HEAT BASE: HEAT TYPE: )CCUPANCY: UNHEATED: #OF STORIES: ;ONST TYPE: OTHER: SHORELINE: ;ONST TYPE: GARAGE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: 3EDROOMS: BATHROOMS: Exist: Exist: 'rap: Prop: Total: Total: Routing Date: "ype Amount Paid Bv: Date: Receipt: Approved/Date propane Tanks/Stoves $213.00 LYK 11/03/11 128299 Total: $213.00 11/03/2011 09: 17 FAX 3603855875 SUNSHINE PROPANE 2002,,002 • • SITE VISIT REPORT 7 (PLOT PLAN) JOB 8 w \\L t t w ( DATE : l I\; � ) ) , CONTACT: ADDRESS 4.3 S [p L.O('- v i,,of , PHONE #: . DIRECTIONS , _ FAX #„ �yN500011 6LQ, 'T`t> FAT' -FP pt6V-Q-' Lh3 Email .j L '..� PLANNER: -1-)/s . k:; Include all street names adiacent La orciiperty,property lines,tank,apo1j nce&piping locations,distances of tartkjQproperty lines and buildin4If s septic-wells. wetland areas,distance to water bodies. ''1 f 40 \lJ 5- ,---- v Op 0 'Kt i t_,-k T 11113 ENTr1______ -. .L___.........„..."„ 1,1 , _ ,--n) EscEvgi \- all � ', NOV - 3 2°i� , '\-\\I J ��(7------ i 11�21J a� IEFFE RSON COUNTY DEPT.OF COMMUNITY DEVELOPMENak ' Sit.).T_(_.A �x_- --�.() v.4 - sip �.L. s (:)Nr- -_ ��.¢goN CQ� • JEFFERSON�NTY al, ' r3 DEPARTMENT OF COMMUNITY DEVELOPMENT_ � � ' "4 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax q�,�NG,sc5 www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: No Itn,A. ?f 'o Project Description (include separate sheets s n sary)'; x �/, •�- Ta4Src [/�/„ �/ ` Y -e--r P K�?G-rL2 T k Parcel Number: -t I 6 CO 0 3 I- Property Size: (acres/square feet) Site Address and/or Directions to Property: 6 3 _ 1Cp I o tr" L. Property Owner(s)of Record: E—11-j e--J2 F-y `/ Pr(N Telephone: y,� - //0.5' - Fax: Mailing Address: _ ' email: _ I Applicant/Agent(if different from owner): S CI-MS J P Ro Telephone: 3a5-57 9 7 Fax: 3 BS S�r7S ' I Mailing Address: I Dg53 R}}OD email: INF(SNAj�giNE propgy-ic, y E . Pi—. Ni9flwck; .- ,'wR. 953 c7 �m What kind of Permit? (Check each box that applies ❑Building 0 Variance Min tNj Major or Reasonable Fran mic Use) ❑ Demolition Permit 0 Conditional Use C a Singie Family ❑ Garage Attached/Detached 0 Discretionaryf OTtrl tS9I .4 ' ❑ Manufactured Home 0 Modular (Essential l Facilities)** ation ❑ Commercial* ❑ Special USe Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment 0 Short Plat** ❑ Address ❑ Road Approach ❑ Binding Site Plan** ❑ Home Business ❑ Cottagelndustry 0 Long Plat** Propane 0 Planned Rural Residential Development(PRRD)/Amendments** ❑ Sign 0 Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** 0 Stormwater Management 0 Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance ❑ Temporary Use 0 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 Pre-Application Conference Please identify any other local, state or federal permits required for thisaproposal, if known: hereby designate rs({�S H 111E Pry DESIGNATION OF AGENT — I I' '- P to act as my agent in matters relating to this application for permit(s). WNWNER SIGNATURE w&vL (- (Date: ) OA— Z}L "L U II 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, reasonab:e 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. '1 further agree to provide access and right of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application i ew and any required later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the eev time of the a plication hat he or she wants prior rnotice ..r , ignature: l/blL,- e �� Y Date: -) act--'-4-, Z 0 Ll The action or actions Applicant will undertake as a result of the issuance of this permit may negatively i�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 ,,c( 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 nonlransferabl responsibilit fo herig to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: �t-�ll•� � �i-„c.. Date: # /.-O G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc 0 BUILDER STATEMENT • The signer of this statement does hereby oertifv that they are the Owners of the parcel refe enced 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: SvitS'H NE P2o pane (360) 385- 5797 ( 360) 385-5875 MAILING ADDRESS: )0853 jo tl n e `f e P. F1. EMAIL: (n�3t,(AsWW'WV1 Pbo Pane a corn CONTRACTOR'S LICENSE ( WAINS NUMBER: 51,0/15,4 Pt 07r1Q P NUMBER ARCHITECT/ENGINEER: PHONE( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: CI New O Wood Existing: 11 [1 Addition ❑ Steel Proposed: Bank i i Community System CI Alteration/Remodel ❑ Concrete Total: Height: L 1 Individual System LI Repair ❑ Masonry SEP Permit# Demolition CI Other: Bedrooms: Water Supply: Existing: Setback: Li Private well U 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 an_d/or Ap•liance Installation permit,mark all items below that a I : 1 Under round Tank 1 Above ground Tank Size of Propane Tank: Heat Stove 1 Cook Stove "oo•s ove 1 Fireplace Insert 1 Hot Water Tank 1 Pellet Stov 1 Othe s ' ce being installed in a Manufactured I 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 all property lines, buildings and septic system components, including the reserve area. Square Footage Current Proposed `Fora Office Use:Only • d :: Amount' , fte.Y1 on;, Main Floor Heated EH Bld App Review. 2n0 Floor Heated Consistency Review: Other Heated Base fee: a 15 Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Carage/Carport SUBTOTAL • Decks 911/Rd Approach fee: Other TOTAL: $ 15_ Receipt Number: I 0 c `Ici Cash/Check Number: (gplp ESTIMATED COST(REQUIRED) Date: 1�_ t .Fair market value of all labor and materials foundation to finish Initials: --;-__ G:APermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc