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Home My WebLink AboutBLD2011-00311 • 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 #: BLD11-00311 Received Date 11/15/2011 SITE ADDRESS: 4677 CENTER RD Issue Date 11/15/2011 CHIMACUM, 98325 APPLICANT: SPANKIE SCHMIDT PHONE: PO BOX 714 PORT HADLOCK WA 98339-0714 2 SUBDIVISION: JOHNSTON SHORT PLAT Block: Lot: PARCEL NUMBER: 801034014 Section: 3 Township: 28N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 (360 Contractor's License SUNSHP"077QP Expires 11 17/�3 185-5875 OWNER, SPANKIE SCHMIDT PHONE: if different: PO BOX 714 PORT HADLOCK WA 98339-0714 PROJECT DESCRIPTION: A/G 120 GAL PROP TANK, LINES & 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 11/15/2012. REQUIRED INSPECTIONS: Tank/Line/Appliance: r1 FinalApproval:f— l i-Z.q-1 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 •UILDING PERMIT APPLICA•N BLD11-00311 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD11-00311 Received Date: 11/15/2011 SITE ADDRESS: 4677 CENTER RD CHIMACUM, 98325 OWNER: SPANKIE SCHMIDT PHONE: PO BOX 714 PORT HADLOCK WA 98339-0714 JOHNSTON SHORT PLAT SUBDIVISION: Block: Lot: 2 PARCEL NUMBER: 801034014 Section: 3 Township: 28 N Range: 01 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 DESCRIPTIOP A/G 120 GAL PROP TANK, LINES & HEAT STOVE TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2009 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: 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 $213.00 LYK 11/15/11 128326 Total: $213.00 SITE VISIT REPORT (PLOT PLAN) JOB ZJRCX) I v DATE : h CONTACT: ADDRESS 4-7T7 G2�N'te�L l_,\ vY\f\I ir'n PHONE #: DIRECTIONS s R-- k 7- -44:77 FAX #: o N L' T Email PLANNER: 7,LQ 3 . rzdI la �!t� \-rcv�\ L g (Zoom F-- 10G � ) 0b L T\L , \ OD • / Lees 1 dNov 15 I • DFPT or EFFERSON LtjrrM • • UN1, OUivr DFVF!r)pMr 1 �¢�0N Cod,. JEFFERSOFUNTY • ti W \� DEPARTMENT OF COMMUNITY DEVELOPMENT �' "'� `� 621 Sheridan Street • Port Townsend • Washington 98368 40. 360/379-4450 • 360/379-4451 Fax qs'ZIINC6p'� www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: NC CnLiA Ct C t 1) Project Dion (include separate sheets as negessary): /ate , pip(Arcir & �av-e� Tax Parcel / Property Number: I �. � (-/ ____ Size: (acres/square feet) Site Address and/or Directions to Property: t `R0 7 -7 C ►J` -- e _ Ci-1 ( it--tint ca t--(- c_v a Property Owner(s)of Record: SPA1\145I; j('tJM I or -r )170 Telephone: - Fax: email: v Mailing Address: 7 77 ( 1 Z eL G- ,�i{c tCi/, c,v{, 983a Applicant/Agent(if different from owner): S u-NS H I N E P R.0 PA iN E Telephone: 395-579 7 Fax: 3BS 5-07S email: INFOSUwL5H/NE proeAY7e. Mailing Address: 10853 R Flo y De• / fl i � l. Nl ck 1 O q g g 33 corn What kind of Permit? (Check each box that applies DBuilding ❑Variance (Minor, Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use [C(a), C(d),or CI** • Singie Family ❑ Garage Attached/Detached u Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home ❑ Modular 0 Special Use(Essential Public Facilities)** ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use 0 Short Plat** ❑ Address ❑ Road Approach ❑ Binding Site Plan** ❑ Home Business ❑ Cottagelndustry ❑ Long Plat** Propane ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑ Sign ❑ Plat Vacation/Alteration** ❑ Allowed"Yes" Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** ❑ 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 * ❑ Jefferson County Shoreline Master Program Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium 0 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 t DESIGNATION OF AGENT • \.1 hereby designate i S H I,NE PR-0(�>4rl� to act as my agent in matters relating to this application for permit(s). WNER SIGNATURE 'C"��— lDate / ( - I-- k l B signing this application form,the owner/agent attests Y 9 9 PPg st 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 I further agree to save, indemnify and hold harmless Jefferson m ounty a ,,ii i t , rj costs, reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as' t1 .' i�r4e a ranting of this permit. t\ I further agree to provide access and right of entry to Jefferson gatinty and its employees, represent i e or agents for the sole purpose of application review and any required later inspections. Staffs access and ri htof entry will be assumed unless t a Ilcant informs the County in writing at the time of the a pli that.he or she wants prior notice. I ignature: --. L • : I ( (t t The action or actions Applicant will undertake as a result of the is uancetofttT r�¢gptively impac upon one or more threatened or endangered species and could lead to a potential"take"of an en angered spy ,,I,s 1 '�l�ttglr iFIR ldefine in the federal law known as the "Endangered Species Act"or"ESA."Jefferson County makes no cnesf, eapp'trcanttt atfhe 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 J 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 nonAran le res nsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: �� / (_ \ _f ` Date:�--+ G:\PennitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc - 13.00 • • i BUILDER STATEMENT The signer of this statement does hereby certify 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: SO QH NE P2.opane (360) 385- 5797 ( 360) 385-5875 MAILING ADDRESS: 10853 .4-0 0 Y f)e j U e P. I-I. EMAIL: a n Q�St,(vlsfli(/�'t Pro Pane 6 c on1 CONTRACTOR'S LICENSE nn !1 WAINS NUMBER: 5(,(y1SI'I P+ 1 p P NUMBER ARCHITECT/ENGINEER: PHONE'( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: L' New ❑ Wood Existing: i 1 Sewer [I Addition ❑ Steel Proposed: Bank i 1 Community System C Alteration/Remodel ❑ Concrete Total: Height: i i Individual System L Repair CI Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well Li Two Party Type of Heat: Proposed: 1 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 and/or Appliance Installation permit,mark all items below that apply: I Underground Tank • •ove ground an'. Size of Propane Tank: l,D4:75 ct`Heat Stoves I Cook Stove i Woodstove I Fireplace Insert I Hot Water Tank I Pellet Stove t Other Is this 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 sf a 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 For OfficefUse:Only , 0 .+', . Amount ``I, Revi fop' ,.: Main Floor Heated EH Bld App Review: 2f1 Floor Heated r a Consistency Review: Other Heated Base fee: Mezzanine ,s '`; 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: $ a • Receipt Number: I a ),i (e_, ,_, . _,- St Cash/Check Number: JJ ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish I \ ( 7_..I ( > Initials: G:\PennitCentcr\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc