HomeMy WebLinkAboutBLD2011-00325 •
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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 #: BLD11-00325 Received Date 12/5/2011
SITE ADDRESS: 121 VICTORIA LOOP Issue Date 12/5/2011
PORT TOWNSEND, 98368
APPLICANT: LEE C JENSEN PHONE: 360-379-9630
PENNY JENSEN
121 VICTORIA LOOP
PORT TOWNSEND WA 983689400 9
SUBDIVISION: CAPE GEORGE COLONY DIV 1 Block: 1 Lot:
PARCEL NUMBER: 937800109 Section: 12 Township: 30N Range: 02W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 1 (31760/ 1385-5875
OWNER, LEE C JENSEN PHONE: 360-379-9630
if different: PENNY JENSEN
121 VICTORIA LOOP
PORT TOWNSEND WA 983689400
PROJECT DESCRIPTION: INSTALL 2 GAS HEATERS & PIPING TO EXISTING PROPANE TANK
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 12/5/2012.
REQUIRED INSPECTIONS:
/ p i
Tank/Line/Appliance: / 3 / A p �-
FinalApproval: t 1 - 1 —1`z
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
tILDING PERMIT APPLICA•N BRDew00325
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD11-00325 Received Date: 12/5/2011
SITE ADDRESS: 121 VICTORIA LOOP
PORT TOWNSEND, 98368
OWNER: LEE C JENSEN PHONE: 360-379-9630
PENNY JENSEN
121 VICTORIA LOOP
PORT TOWNSEND WA 983689400 CAPE GEORGE COLONY DIV 1
SUBDIVISION: Block: 1 Lot: 9
PARCEL NUMBER: 937800109 Section: 12 Township: 30 N Range: 02 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 DESCRIPTION INSTALL 2 GAS HEATERS & PIPING TO EXISTING PROPANE TANK
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 By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $142.00 LYK 12/05/11 128375
Total: $142.00
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!~ ���, ON cob, JEFFERSON WUNTY •
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�► WI \,o r3 DEPARTMENT OF COMMUNITY DEVELOPMENT
�' �� RI 621 Sheridan Street • Port Townsend • Washington 98368
360/379-4450 • 360/379-4451 Fax
..441INCi`SC) www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: __NO MLA- '!
Project Description (include separate sheets as necessary): t
T--nsT G 6-.01, ,r's c PiPse - ( )u7mj o
Tax Parcel �.�1 � (� (� � �� — Property
Number: Size: (acres/square feet)
Site Address and/or Directions to Property:
1 Z I VI C..TD CG tom; L—O o p, .�2 i 16�J 6 S -3
Property Owner(s)of Record: 1-- e-- 1✓ �jk; f 1. 5L
Telephone: 3CS 5 —0L.- - Fax: p email:
Mailing Address: I )- V' 1('=force 1-cDp 1 J H- "� lt, r7S21''QI 1
Applicant/Agent(if different from owner): S LC MS H I N E P Ro PA N E
Telephone: 395-5717 Fax: 38S.- 5S7S email: INFO@$uJJ5N/NE Prop ie.
Mailing Address: I E853 RHODy D 2. / . Hip Lock LJ A_ 9 833c7 con,
What kind of Permit? (Check each box that applies
❑Building 0 Variance(Minor, Major or Reasonable Economic Use)
❑ Demolition Permit 0 Conditional Use[C(a), C(d),or CJ**
❑ Singie Family ❑ Garage Attached i Detached U Discretionary"D"or Unnamed Use Classification
❑ Manufactured Home ❑ Modular 0 Special Use(Essential Public Facilities)**
❑ Commercial* ❑ Boundary Line Adjustment
❑ Change of Use 0 Short Plat**
❑ Address ❑ Road Approach ❑ Binding Site Plan**
❑ Home Business ❑ Cottagelndustry 0 Long Plat**
Propane ❑ Planned Rural Residential Development(PRRD)/Amendments**
❑ Sign ❑ Plat Vacation/Alteration**
❑Allowed"Yes" Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions**
❑ Stormwater Management ❑ Shoreline Management Substantial Development**
❑ Site Plan Approval Advance Determination (SPAAD)* 0 Shoreline Management Variance
❑ Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* ❑ 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:
(, ,,,
DESIGNATION OF AGENT
f\ I hereby designate 5 S H I N1E PRO P,-1-, o act as my agent in matters relating to this application for permit(s).
~�NER SIGNATURE _ t,e, [ bk Q C? : (Dates )Ij °-. ' 1 11
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. II rr I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,d u eo- WL e le`eftto 1fe ;nd
expenses which may in any way accrue against Jefferson County as a result of or in consequence ef�the ranting of this permit.
7lllli, I further agree to provide access and right of entry to Jefferson County and its employees, represertta• or agents for the sole ur ose of
ll p p p�lication
review and any requir ater inspections. Staffs access • o entry will be assumed unless'tha plicate ltri'o s the County in witi at the
time of the a plication at he or she wants prior e.j
lignre: ;,1_ r2pe �S.--e That 11 ✓�/ I 1
The action or actions Applicant will undertake as a result of the issuance of this permitmay negatively�ne ativel o (,OJMA
im l�¢t;upon one of rnpreit[nmtred or
endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federaTla r-k-own 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
action(s)even if y are in compliance with the Jeffers y development code.The Applicant acknowledges that he, she or it holds individual
and nonAcansf abl responsi ility for adhe ' o and complying with the ESA. The Applicant has read this disclaim r and si n and dates it below.
'A Signature: „P o�-- Date: v I dZ tom_
G:APennitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc
• BUILDER STATEMENT •
A
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:
isS' ii t P2opane (360) 35- 57T1 ( 36O) 3B5-5875
MAILING ADDRESS: )0 853 .00 t/ O J U C- P i-I. EMAIL: 0 n-St,(✓LsilivIt` PI/ CAA
Pan e b C o
CONTRACTOR'S LICENSE nn (1 WAINS
NUMBER: �u hs'N 10 1 7 p NUMBER
ARCHITECT/ENGINEER: PHONE( ) FAX: (
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New ❑ Wood Existing: ❑ Sewer
Li Addition ❑ Steel Proposed: Bank LI Community System
❑ Alteration/Remodel ❑ Concrete Total: Height: 1 Individual System
C Repair ❑ Masonry SEP Permit#
❑ Demolition Cl Other: Bedrooms: Water Supply:
Existing: Setback: i] Private well C Two Party
Type of Heat: Proposed: 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:
Underground Tank i Above ground Tank Size of Propane Tank:
1 Heat Stove 1 Cook Stove 1 Woodstorrit Fireplace InseD i Hot Water Tank i Pellet Stove 1 Other p( 2
Is this appliance being installed in a Manufactured/Mobile Home? Yes No �" p
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.
r
Square Footage Current Proposed °Foi3Office'Use,Only, Revision' ;,
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/Carpoil SUBTOTAL
Decks 911/Rd Approach fee:
Other TOTAL: $ 1/ 2 e"
Receipt Number:
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