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Home My WebLink AboutBLD2011-00326 • 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 #: BLD11-00326 Received Date 12/7/2011 SITE ADDRESS: 74 HILTON AVE Issue Date 12/7/2011 PORT TOWNSEND, 98368 APPLICANT: AMY LEITMAN PHONE: 360-301-0262 521 SNAGSTEAD WAY PORT TOWNSEND WA 98368-9668 22+ SUBDIVISION: IRONDALE Block: 106 Lot: PARCEL NUMBER: 962110608 Section: 34 Township: 30N Range: 01W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2012 OWNER, AMY LEITMAN PHONE: 360-301-0262 if different: 521 SNAGSTEAD WAY PORT TOWNSEND WA 98368-9668 PROJECT DESCRIPTION: REPLACE A/G 100 GAL PROPANE TANK W/A/G 250 GAL PROP Directions TANK 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 12/7/2012. REQUIRED INSPECTIONS: Tank/Line/Appliance: / ( �" / FinalApproval: / /' / l 415 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 1 I:\F_BLD_Permit_Propane.rpt 10/29/19 GILDING PERMIT APPLICA•N BLD11-00326 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD11-00326 Received Date: 12/7/2011 SITE ADDRESS: 74 HILTON AVE PORT TOWNSEND, 98368 OWNER: AMY LEITMAN PHONE: 360-301-0262 521 SNAGSTEAD WAY PORT TOWNSEND WA 98368-9668 IRON DALE SUBDIVISION: Block: 106 Lot: 22+ PARCEL NUMBER: 962110608 Section: 34 Township: 30 N Range: 01 W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2012 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP REPLACE A/G 100 GAL PROPANE TANK W/A/G 250 GAL PROP 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 12/07/11 128379 Total: $142.00 741;7 c%, JEFFERSOUNTY � ' DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax �1 Sp www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: �� [Y r li Project Description(include separate sheets as necessary): I�C PL\&c I-0 (jkllc,,; ?RC,P4rti1: I ANK, 1..iij(i g.))J4II,„ fL,..[c. Tax Parcel Number ✓(�-L'0 )(G C Y) Property Size: r {1: G (acres/square feet) Site Address and/or Directions to Property: Ao6k6,1 ID 1 ie - I-K>` E1 I &L+ f�p)SE cn1 � L- c t-}-iLm,��r36 n Property Owner(s)of Record: El) /h.,1) /tivty Lc o c It/`n ) / Arm/ LE ImiA nJ Telephone: 301 -0742 Z_ Fax: email: aryl l e I+11t41A6i gl14ai t.CO m Mailing Address: 5-2.1 Snf(1/44 STe:Ar ) WAY P•T. Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies ❑Building 0 Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use) ❑Single Family ❑Garage Attached/Detached ❑Conditional Use[C(a),C(d),or C]'"' ❑ Manufactured Home 0 Modular ❑ Discretionary"D"or Unnamed Use Classification ❑ Commercial* 0 Special Use(Essential Public Facilities)** ❑ Change of Use ❑Boundary Line Adjustment El Address 0 Road Approach 0 Short Plat'"* ❑Home Business 0 Cottage Industry 0 Binding Site Plan** iil Propane ❑Long Plat'"' ❑Sign 0 Planned Rural Resi en• 1 De__ve ments** ❑Allowed"Yes'Use Consistency Analysis 0 Plat Vacation/Alteration 1 I. � I i ❑Stormwater Management ❑Shoreline Master Progra ' Exemption/Permit Revision) ❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management_, bstantial Development-- �1 I 1 ❑Temporary Use 0 Shoreline Management Variance • - i ❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amefl ❑ Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendme(tt- *May require a Pre-Application Conference ❑Tree Vegetation Request EFF RSON COUNTY **Requires a Pre-Applicalqn gpi , „r„. p I.. Please identify any other local,state or federal permits required for this proposal, DESIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: 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 attomey'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 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 applicationith at he or he wants prior,.nofts Signature: /(..c/ C '' r ` (:•'.... Date: /2 /T-t //2 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 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 non-transfers le responsibility for adh ing and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. ignature: ------ 4.�c " C i 2 6-L'--- {-,_ -- Date: /2-/ y /Z 1� / G:\PeimitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc • • 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: Date: GENER Co�I,TRACj()R OR MANUFACTURED HOME INSTALLER: PHONE: FAX: (J, ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New I i Wood Existing: :I Sewer ❑ Addition I I Steel Proposed: Bank C1 Community System ❑ Alteration/Remodel Li Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: I I Private well ❑ Two Party Type of Heat: Proposed: Li Public c t/A,.: C. 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 A liance Installation permit,mark all items below that apply: I Underground Tank Above ground Tank-- of Propane Tank: Z'`iC I Heat Stove I Cook Stove fifOOdSCiSGe I Fireplace Insert I Hot Water Tank I Pellet Stove I 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 sing . . , e_bji 1.- ,all property lines,tank location and size,distances from the propane tank to all property ,1:1( � � - ,cz; -1y components, including the reserve area. T, ` -II': f 't h t � °, 'Square Footage Current Proposed For OfCr ='E34 ' . ,:71s. .s =3-A, ctytnt - _ rHI i, ; p Main Floor Heated EH Bld App Review: I j ea Floor Heated Consistency Review 1 J Other Heated IFFFFRSON COUNTY Base fee: [ PFP' OF C I' r, TI FvFI OP FNI 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: $ 1 -IL-- .. tAa: Receipt Number: 1 a� —7`1 -r , Cash/Check Number: I 3 I ESTIMATED COST(REQUIRED) Date: ( � 1 .Fair market value of all labor and materials foundation to finish O) Initials: G:\Permite.enter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc �� --- • • Nlucbg pie j oo' -- ,?°,a,N0, I TA% ThwcL '' g62t16668 hvny t.Eltmto N661 3o1-OW7 1 i .,........\ 0 I Wb0o 5 h 4.1 N Fll / i _...-.7 4 1 ■ �� Novse "eRbPoSED 24io FROPI TartK I! tab sift lb' 41-0.r. 0-005e O vki-ic_ -----,..„) -,. D HcE ' v .---E c_ DRAtt4FteW I DEC - 7 99-�11 sep JEFFERSON COUNTY Ni 1Z,e7e9,16 SEA DEPT.OF COMMUNITY DEVELOPMENT