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HomeMy WebLinkAboutBLD2011-00316 • • 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 #: BLD11-00316 Received Date 11/22/2011 SITE ADDRESS: 21 FOXFIELD DR Issue Date 11/22/2011 PORT TOWNSEND, 98368 APPLICANT: JOSEPH W NUTSFORD PHONE: 360-385-0521 JOEEN M NUTSFORD 21 FOXFIELD DR PORT TOWNSEND WA 98368-9524 1 SUBDIVISION: KALA POINT#1 Block: Lot: PARCEL NUMBER: 964700001 Section: 34 Township: 30N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 p) 3 Contractor's License SUNSHP*077QP Expires 11/((33 67/20825 -5875 OWNER, JOSEPH W NUTSFORD PHONE: 360-385-0521 if different: JOEEN M NUTSFORD 21 FOXFIELD DR PORT TOWNSEND WA 98368-9524 PROJECT DESCRIPTION: A/G 120 GAL PROP TANK, HEAT STOVE &GENERATOR 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 11/22/2012. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalA peo val: I �j ' t f 7 ,a k 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 APPLICATS1 BLD11-00316 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD11-00316 Received Date: 11/22/2011 SITE ADDRESS: 21 FOXFIELD DR PORT TOWNSEND, 98368 OWNER: JOSEPH W NUTSFORD PHONE: 360-385-0521 JOEEN M NUTSFORD 21 FOXFIELD DR PORT TOWNSEND WA 98368-9524 KALA POINT#1 SUBDIVISION: Block: Lot: 1 PARCEL NUMBER: 964700001 Section: 34 Township: 30 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, HEAT STOVE & GENERATOR TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2009 HEAT BASE: HEAT TYPE: OCCUPANCY: OCCUPANCY: UNHEATED: #OF STORIES: 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 11/22/11 128350 Total: $213.00 • SITE VISIT REPORT W �l (PLOT PLAN) JOB ��'e-� J��� ��S \Of DATE : i t 1 O h i . CONTACT: ADDRESS 2_\ F x -1 P PHONE #: DIRECTIONS FAX #: Email PLANNER: •1. /QM L, 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. 0 Yi 3X SUL Erg l Sr;N3 LFs<gro ro r La(Am ✓ L,\vt r`ry avv1 J �1 ID 3/4 B.I. ZOO t- n1E.Q,o`TOfZ GU t Y t!01/ 2 2 2011 / frFERSON COUN I Y Or r: • 'I INI?Y DFVFI.OPMENT . ��¢,SON COS JEFFERSON•UNTY W 1 \,� �3 DEPARTMENT OF COMMUNITY DEVELOPMENT I F' r.° ` 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-44m5 Fax gs�N�,sO� www.co.jefferson.wa.us/comdevelopment Master Permit Application MLA: 1' (14.{ 0E0 t b. Project Description (include separate sheets as necessary): CX4\,,K1 c'.1 pi pc4A0,,.._. ---i- dAtkrid-br, 5-6(.;_e....- r_e_ Tax Par6e1 /,-, / Property "L Number: �LC IOC jt7 ` Size: (acres/square feet) Site Address and/or Directions to Property: zl •oq....1 aA) fie - ?%-T w 4D Property Owner(s)of Record: -1 gi"--h l---) k)It j DIZ--1,0 Telephone:,_ 5 - Fax: email: Mailing Address: Applicant/Agent(if different from owner): S u-NS H I Al E P Ro PA N E Telephone: 3635-57 17 Fax: 38S SO'7S email: INFQ SL J3H/NEProP41-7P. Mailing Address: I OS53 RHODy D e• f el--. 14613 LOCk 1 10 R- 9 13 33 ' cor+-t What kind of Permit? (Check each box that applies ❑Building 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use[C(a C(d),1fl C-1--L7 11 h 0 Single Family 0 Garage Attached/Detached Discretionary"D"or UnnarhJ fi I a ' ❑ Manufactured Home 0 Modular ❑ Special Use(Essential Ptjblic- aci i le 0 Commercial* 0 Boundary Line Adjustmerttt • 0 Change of Use ❑ Short Plat** , )1 ' t, flt/ ) 2 0 Address 0 Road Approach 0 Binding Site Plan** I 1 0 Home Business 0 Cottagelndustry 0 Long Plat** J L Propane 0 Planned Rural Resi ntial me is** 0 Sign 0 Plat Vacation/Alterat on** COUN ❑Allowed"Yes" Use Consistency Analysis 0 Shoreline Master Program Exe ** ❑ Stormwater Management 0 Shoreline Management Substantial Development** 0 Site Plan Approval Advance Determination (SPAAD)* 0 Shoreline Management Variance ❑ Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment 0 Wireless Telecommunication * 0 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: �')(ec DESIGNATION OF AGENT \ I hereby designate c5l.{�S I4 I N E Ply P to act as my agent in matters relating to this application for permit(s). ~�WNER SIGNATURE CO* \Ar. •-' ( Uat-e J / /^ / 0 - /I By signing this application orm,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 iiabiiities,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 U 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 applicati that he or she wants prior notice. ign-a-- -- Date) f ) - lv - // The action or actio 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 1-), 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 nonAransfe a respo ability for 'ng to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. CSignature: ` J 1/4/1^ Date: //1 /© ^ G:APermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc 1! • BUILDER ST • ATEMENT 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: SMQH 10E P20 paste (360) 3S5- 5797 ( 36o) 385-5875 MAILING ADDRESS: )0 853 t�.{}-O o y n f f.U e_ !�. EMAIL: I n- SU✓1s{-1 'ie. PCo P -)e 6 C OM CONTRACTOR'S LICENSE ( WAINS NUMBER: 1,(0s7. P+ c7q p P NUMBER ARCHITECT/ENGINEER: PHONE( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: C1 New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: 1 1 Individual System i , Repair El Masonry SEP Permit# CI Demolition C! Other: Bedrooms: Water Supply: Existing: Setback: i_i Private well C Two Party Type of Heat: Proposed: I i Public Total: Name of System: If this is a Commercial Proiect 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 • a Installation ermit mark all items below that apply: 1 • d Tank Above ground�aal Size of Propane Tank: 1�� — le i Heat Stove i Cook Stove i Woodstove I Fireplace Insert I Hot Wate k I Pellet Stove I Other G /p Is is appliance being installed in a Manufactured/Mobile Home? Ye 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 ;Foi',OfficetUseOnly .z; Tarr r . . -t1 � t, ,�,v' k^ai.1, , Main Floor Heated EH Bld App Review: 2nd Floor Heated Consistency Review: Other Heated Base fee: Mezzanine 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: $ c)qI 3 Receipt Number: Lai 2.D ,,,.= . . _ Cash/Check Number: J 2f(0 73 ESTIMATED COST(REQUIRED) Date: 11 •Fair market value of all labor and materials foundation to finish �--\f� Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc di 3 J6