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Home My WebLink AboutBLD2012-00103 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 #: BLD12-00103 Received Date 3/28/2012 SITE ADDRESS: 71 CHICKADEE LN Issue Date 3/28/2012 QUILCENE, 98376 APPLICANT: CARL F SMITH PHONE: 360-765-3692 PO BOX 868 QUILCENE WA 98376-0868 7 SUBDIVISION: QUILCENE BAY VISTA Block: Lot: PARCEL NUMBER: 701205007 Section: 20 Township: 27N Range: 01W CONTRACTOR: OWNER/BUILDER PHONE: OWNER, CARL F SMITH PHONE: 360-765-3692 if different: PO BOX 868 QUILCENE WA 98376-0868 PROJECT DESCRIPTION: A/G 120 GAL PROP TANK, LINE & FIREPLACE INSERT 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 3/28/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: -..3TE`"v(5::-/T)ri-V--/ -tit! I2- ( v / FinalApproval: �- 3 i 2— 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 APPLICATS BLD12-00103 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD12-00103 Received Date: 3/28/2012 SITE ADDRESS: 71 CHICKADEE LN QUILCENE, 98376 OWNER: CARL F SMITH PHONE: 360-765-3692 PO BOX 868 QUILCENE WA 98376-0868 QUILCENE BAY VISTA SUBDIVISION: Block: Lot: 7 PARCEL NUMBER: 701205007 Section: 20 Township: 27 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr A/G 120 GAL PROP TANK, LINE & FIREPLACE INSERT 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 $222.00 LYK 03/28/12 131586 Total: $222.00 JEFFERSONCOUNTY • p DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax 1'9 p www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: N0 mUA VEVE Project Description(include separate sheets as necessary): L ./ r// et` cve `�f ,Uke{�py'cp ikC-f/C Cm ei r'S I re1�/a ee /If56, nftr /o lC'C'heei/ Tax Parcel Number: 70/Z c)C vU 7 Property Size: $eicreS (acres/square feet) Site Address and/or Directions to Property: 7/ C/%!cc'/emu Cit. Gc/GtC 4 ti /CCGr C Gt114 % 7( Property Owner(s)of Record: Gear/ 5-4 t i fA Telephone: 3o�' /6S—3l %L Fax: email: L i:re{Sri4/7.�:'l efl hi(•Cowk Mailing Address: P. c' >;c X g"- • S Liu//C.ek e �TG Applicant/Agent(if different from owner): N/A. Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies ❑Building ❑ 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 Cj** _ ❑ Manufactured Home 0 Modular ❑ Discretionary"D" t ❑ Commercial* ❑Special Use(Essential m \!I l r ❑ Change of Use ❑ Boundary Line Adjus m ---� ❑ Address ❑Road Approach ❑ Short Plat** II 'I 1 ❑Home Business ❑Cottage Industry 0 Binding Site Plan I ,Propane ❑ Long Plat'"' II, ' ❑Sign ❑ Planned Rural ResIdenipl Development(PRRDNAmq is** ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration'" -- _--' ❑Stormwater Management 0 Shoreline Master Program Exe visims ' ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management SuIrst8fitiatJl"eve1 -- ❑Temporary Use 0 Shoreline ManagemenTVariance ❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment 0 Forest Practices Act/Release of Six-Year Moratorium ❑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: tiv,.J DESIGNATION OF AGENT I hereby designate /(///4 to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: ` _ 2-4/' 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 inspectio tr s access and right of entry will be assumed unless the applicant informs the County in writing at the time of the application hot he or once. Signature: Date: 3/2 C/2c r• Z 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 complian i the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferable/ewonsibir gcadh n to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: ( ,-' , ' Date: 3/ / 1 (i:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc • 111 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 assume he resp sibiI ::General Contractor for the proposed project. Signature: cam Date: j/Z S'f 2c- Z GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: Fax: ( ) ( ) 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: U New ❑ Wood Existing: [i Sewer O Addition ❑ Steel Proposed: Bank 0 Community System Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual�tem__I ❑ Re air ❑ Mason _. p O Demolition ❑ Other:Masonry Bedrooms: r Existing: ° p--Pnvate well—' Two Party Type of Heat: Proposed: I. 0 Public Total: i 11 r1� M A f,Name of System 1 I `i If this is a Commercial Protect you must answer the following: l' IL IL1 L_ of Number of Parking Spaces: Current: Proposed: Number AD/tNtiligefiii : Number of occupants(includes owners,tenants,employees,etc) Current PrIrraPOSOMINty i'r\InOPMFNT— 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 ).Above ground Tank Size of Propane Tank: !?4- < I I Heat Stove i Cook Stove I Woodstove Fireplace Insert I Hot Water Tank 1 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 properly lines,buildings and septic system components, including the reserve area. kF c r r 31 Square Footage Current Proposed For OfficeUseOnly Amount , `;Re,Sitsion Main Floor Heated EH Bld App Review: 2"0 Floor Heated Consistency Review: Other Heated Base fee: CCC 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: $ °a c9c. ...- * r. Receipt Number: ( 31 '7� Cash/Check Number: -40 a Z ESTIMATED COST(REQUIRED) Date: ., ,1� .Fair market value of all labor and materials foundation to finish Initials: �____=> G:\PernritCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-O8.doc 0 • -v? eiv iesr,,,,.- , ,, - ,.: Access • road ---44 .'` * Property - r w �„ line %, 3 4. :# it Property line . I Proposed �� . * r. ; t a•` location of ~' ;^ r + . Propane Tank ."1 J • r, M 1 Ail �F• r • Approxr 60' 44 ` ..v are, ' 'f,+ . : ,► Y Approx. 48' + 1 glillie • A ' , 4‘4,., . • .,qF, r M1 40 bDistance to drain field- , ,r, +, , .'4::: approx. 60' Nip °� to, image U S" i„e:44,1oil,,,clal.Sp: y. a - s 410 4. R ,,11;b ;202Google ,` Distance to water well "t earth x head-approx. 200' Imagery Date 430, 0r• ''08. s�9"2 50'3 P72"W •1 05 ft Eye a11,, 643 tt t* Smith Residence Proposed Above-ground Propane Tank Installation 3/28/2012 Site Address: 71 Chickadee Lane, (P.O. Box 868) Quilcene, WA 98376 Owner/applicant: Carl F. Smith Home phone: 360 765-3692/Cell: 425 761-3010 Parcel number: 701205007 \ -pEoligvi : --\\ ilL„) ,, fl MAA 2 8 LJ i JEFFERSON COUNTY DIRT OF COMMUNITY DEIFLOPMENT