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Home My WebLink AboutBLD2012-00023 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 #: BLD12-00023 Received Date 1/25/2012 SITE ADDRESS: 1133 PARKRIDGE DR Issue Date 1/25/2012 PORT TOWNSEND, 98368 APPLICANT: KAREN E LAUZON PHONE: 360-385-7378 1133 PARKRIDGE DR PORT TOWNSEND WA 98368-2816 52+ SUBDIVISION: WOODLAND HILLS#2 PHASE 2 Block: Lot: PARCEL NUMBER: 999900152 Section: 27 Township: 30N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17 2082-5875 OWNER, KAREN E LAUZON PHONE: 360-385-7378 if different: 1133 PARKRIDGE DR PORT TOWNSEND WA 98368-2816 PROJECT DESCRIPTION: REPLACEMENT WATER HEATER (TANKLESS) 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 1/25/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: Cy", el) 3 — � s - 3 / Z FinalApproval: �C l 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 APPLICATION Review Type: Jefferson County Department of Community Development BLDI2-00023 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD12-00023 Received Date: 1/25/2012 SITE ADDRESS: 1133 PARKRIDGE DR PORT TOWNSEND, 98368 OWNER: KAREN E LAUZON PHONE: 360-385-7378 1133 PARKRIDGE DR PORT TOWNSEND WA 98368-2816 WOODLAND HILLS#2 PHASE 2 SUBDIVISION: Block: Lot: 52+ PARCEL NUMBER: 999900152 Section: 27 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 REPLACEMENT WATER HEATER (TANKLESS) 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 $74.00 LYK 01/25/12 131397 Total: $74.00 co41# JEFFERSOt UNTY (r?soN ,eroo A DEPARTMENT OF COMMUNITY DEVELOPMENT ''4 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax �q p. . www.co.jefferson.wa.us/commdevelopment 81N Master Permit Application MLA: N O (y) Q- e1\ Project Description(include separate sheets as necessary): . ._ U.JC��er (—�2aJ—e r i e71 e 6/ Tax Parcel Number: emci lop(5 Z. Property Size: iI. , j, it tife6 (acres/square feet) Site Address and/or Directions to Property: 113 Ni'V )e-lie IVA\,/< f)c)(1- vTowilzrc d, "J R t'.5(0t Property Owner(s)of Record: 1(.4.rei^, E., t_ci i' ZC>r i Telephone: 3(,O _3 05 -tj 713 Fax: email: 4�k4✓4Y)I cam Mailing Address: 1133 1:74_r,rlieRie DnVe_ Pork ' l J) Y 5er',9„ \NA" `-3f?"(‘)11, Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies 0 Lot or Road Segregation IlBuilding 0 Critical Areas Stewardship Plan / 0 Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family 0 Garage Attached/Detached 0 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 0 Boundary Line Adjustment ❑ Address 0 Road Approach_ 0 Short Plat** ❑ Home Business 0 Cottage Industry 0 Binding Site Plan** ❑ Propane ❑ Long Plat** ❑ sign 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration*"` ❑ 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 VaSiance__, ❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Lan Ue st klA nc ❑ Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County ShorelineiMa e—Program Amendment �^ May require a Pre—Application Conference 0 Tree Vegetation Request I i, **Requires a Pre-Appliclattor Conference Pledbe identify any other Iucal,state of federal t?eri tiles required fur thin piut)osdt if known. Li L1, J ! DESIGNATION OF AGENT JEFFERSON COUNTY I hereby designate to act as my agent in matters relating toltFitt fitiOliditititilfafeceffliej 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 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 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 application that he r she wants prior notice.Signature: LAtrePil a l-40V12 1---- �{/Y — Date: � 1 _ / 2 7'i `� 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-transf rable�bility for adhering to and complying with the ESA. The Applicant has read this discla imer and signs and dates it below. �.-Signature: lf" Z1v - Date: J KA \ Z, j <<-'i 2 G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc 0 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: _ G1FNERAL CONTRACTOR OR MANI1FAC RED HOME INSTALLER: PHONE: FAX: )•.-ne ( ) ( ) y1RAILING ADDRESS: 13( EMAIL.: CONTRACTORS LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New ❑ Wood Existing: C Sewer ❑ Addition D Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: _ Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# _ D Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ 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: i Underground Tank i Above ground Tank SizR of Propane Tank: i Heat Stove i Cook Stove i Woodstove i Fireplace InsertIot 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 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 [ urrent Proposed For Office Use Only Amount Revision Main Floor Heated EH Bld App Review: 2"d Floor Heated Consistency Review: Other Heated Base tee: --- 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: 4 , Receipt Number: i 3 I3a1 Cash/Check Number: 221,0 ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish ,,,- Initials: ---__� G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc