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Home My WebLink AboutBLD2011-00317 • • 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 #: BLD11-00317 Received Date 11/22/2011 SITE ADDRESS: 120 WINDSHIP DR Issue Date 11/22/2011 PORT TOWNSEND, 98368 APPLICANT: DANIEL A HOLME PHONE: 360-379-4138 CHRISTINE E HOLME 120 WINDSHIP DR PORT TOWNSEND WA 98368-2513 45 SUBDIVISION: KALA POINT#1 Block: Lot: PARCEL NUMBER: 964700045 Section: 26 Township: 30N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 0� Contractor's License SUNSHP*077QP Expires 1 1��67/ 18 -5875 OWNER, DANIEL A HOLME PHONE: 360-379-4138 if different: CHRISTINE E HOLME 120 WINDSHIP DR PORT TOWNSEND WA 98368-2513 PROJECT DESCRIPTION: A/G 120 GAL PROP TANK 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 11/22/2012. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: ; ) .,\2-\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 RUILDING PERMIT APPLICA BLD11-00317 N Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD11-00317 Received Date: 11/22/2011 SITE ADDRESS: 120 WINDSHIP DR PORT TOWNSEND, 98368 OWNER: DANIEL A HOLME PHONE: 360-379-4138 CHRISTINE E HOLME 120 WINDSHIP DR PORT TOWNSEND WA 98368-2513 KALA POINT#1 SUBDIVISION: Block: Lot: 45 PARCEL NUMBER: 964700045 Section: 26 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 DESCRIPTIOI A/G 120 GAL PROP TANK SWAP OUT - SAME SIZE & LOCATION 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: 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 Bv: Date: Receipt: Approved/Date Propane Tanks/Stoves $71.00 LYK 11/22/11 1283541 Total: $71.00 • • SITE VISIT REPORT (PLOT PLAN) JOB D L . DATE : CONTACT: ADDRESS '1"-C) LA-)1 I f p - PHONE #: DIRECTIONS FAX #: Email PLANNER: 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. ►s ��----�► MC tiV I id° P 1)R. L i, JEFFERSON COUNTY • •(,,IMIJN!1Y DFVF 1.OPMFN erm*4 JEFFERSON•UNTY •' \ DEPARTMENT OF COMMUNITY DEVELOPMENTV`a 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax .4 0 ' www.co.jefferson.wa..us/commdevelopment Master Permit Application MLA: mciia Project Description(include separate sheets as necessary): T 0u -- A�� rip - .� bC0. Tax Parcel Number !` (it -) o ( , ) Property Size: p Y (acres/square feet). Site Address and/or Directions to Property: -).0 IA tab t•-1 t P oe_ ?oe-T. K\)a-A= 0 Property Owner(s)of Record; Da. N 1 O L n-1 e Telephone: 3 i - I - `Z, Fax: email: Mailing Address: 1ge-)O LA),.005 7 .)t<'L Applicant/Agent(if different from owner): \ /i Telephone: Y@5 -- 7 Fax: 8 5- 8 75: email: ?/›'' °�S`4`dk .c-//r a R,-e. Mailing Address: /O 8.5 3 kf/o oy CP. Gi. // 11 0 c% r,J What kind of Permit?(Check each•box that applies 0 Lot or Road Segregation OBuliding 0 Critical Areas Stewardship Plan n 0 Demolition Permit 0 Varian a Minor,;Ma or ❑ Single Family El Garage Attached/Detached 0 Conditional Use[C(a1 t`(d , r IL ❑ Manufactured Home t7 Modular " �=me O Discretionary D or W�tna IasSitication' D Commercial 0 Special Use(Essential Public Facilities)** O Change of Use 0 Boundary Line Adjustment Address 0 Road Approach 0 Short Plat** ❑ Home Business 0 Cottage Industry 0 Binding Site Plan!** , .J ,ropane 0 Long-Plat** i 0 Sign. •• : 0 Planned Rural Residential DeV4160 e ,mend ents** 0 Allowed"Yes"Use"Consistency Analysis ❑Plat Va;cation/Alteratioril** T`' '' _'*9 n,,— ❑ Stormwater Management 0 Shoreline Master Program.Exemption/Permit Revisions** Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development** ❑Temporary Use 0 Shoreline Management Variance ❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference 0 Tree Vegetation Request **Requires a Pre-Application Conference Please identify any other local,state or federal permits required;for this proposal, if known: DESIGNATION OF AGENT , I ereby designate to act as my a0ent in matters relating to this application for permit(s). 14 •'AMER SIGNATURE C•:/ •--1 /0 1� Date: !ih(--//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 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 attorneys fees and expenses which may in any way accrue against Jefferson County as a result of or in cohsequence 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 r time of the appli that he or sh wants prior notice, . .nature: C'� L -4 (� Date: I rhy/ir 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 riot 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-transfer esponsibilit or adhering to and complying,with.fhe'ESA. The Applicant has read this disclaimer.and signs and dates it below: Signature: ((r 1 I Date: f 1 ��✓rr I c; Prrmir(inter\###RORMS###\ TI P likfcl :n.YP.,r T1Rll F�.,.,�\AT��r.. P-...,:r 4....1:...,.:,.,,S'n no a.... • • 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: Bates GENERAL CONTRACTOR . ER: PHONE: FAX: Sit-, Zi+ine eQ 10 (A6a ) 3FS- -r7I7 ( 3G4 3 es-sa, 75 MAILING ADDRESS: I 0 g $C 3 ,,-i°2"1 pr p. (,./ EMAIL: CONTRACTOR'S LICENSE 1 WAINS NUMBER: LA . , p//7 7 Q NUM13ER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: 0 New 0 Wood Existing: 0 Sewer O Addition 0 Steel Proposed: Bank 0 Community System ❑ Alteration/Remodel 0 Concrete Total: Height: 0 Individual System ❑ Repair 0 Masonry SEP Permit# Bedrooms:Demolition 0 Other Water Supply: Existing: Setback: 0 Private well 0 Two Party Type of Heat: Proposed: ❑ Public Total: Name of Systeem:. • If this is a Commercial Project you must answer the following: Number of Parking.Spaces: Current: Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food'Service? Yes / No ' 2-1f this is a Propane Tank a.n /or Ap Hance Installation ermit,mark all Items below that apply: I Underground Tank Above ground Ta Size of Propane Tank: )�(!) f Heat Stove I Cook Stove i Woodstove t Fireplace Insert I Hot Water .nk I Pellet Stove I Other Is this appliance being installed in a Manufactured/Mobile Home? Yes When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines, tank location and size, distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. yy t�� ch t C nut t � V 5 Ey si�; r 4 v a r'i 1 'Square Footage Current Proposed , 'l•t c S. w I ;, 1 �,4n:kr� 3,1if ..•,s v 01 .: , Main Floor Heated ,$' fit EH Bld App Review: rip'>r,,,t u,11 t 2° Floor Heated �tF r'•.1•,-- Consistency Review'• ,0�,*11 lay s Other Heated �4i.'j}'z A.',K Base fee: - Mezzanine ;�y p';1 � :kl' Additional'Section: h o ';p.fi 1�f e}'''k Heated Basement ,�;�;.}t, , W ;�; Plan Check fee: ir4t.yi, trr 1, Unheated Basement `'� ��• x State Surcharge fee: ' Other Unheated rkf' '' y t' Pot Water Review fee: a . �,:N i Garage/Carport ;,t SUBTOTAL ;r y Decks it, c� �� ,.4 + 911/Rd Approach fee: Other G , : TOTAL $ - P7 J 5 ,!''1 'n R „b Receipt Number: x4•,-v3i i-jf g'A ,r ' Cash/Check Number: e l :rt , , ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Fomis\Master Permit Application 5-29-08.doc