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HomeMy WebLinkAboutBLD2012-00112 • 0 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 #: BLD12-00112 Received Date 4/10/2012 SITE ADDRESS: 400 BEE MILL RD Issue Date 4/10/2012 BRINNON, 98320 APPLICANT: NANCY A JONES PHONE: RUTH M MC CRADY 104 E 3RD ST CLE ELUM WA 989221114 TX 3+ SUBDIVISION: Block: Lot: PARCEL NUMBER: 602133011 Section: 13 Township: 26N Range: 02W 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, NANCY A JONES PHONE: if different: RUTH M MC CRADY 104 E 3RD ST CLE ELUM WA 989221114 PROJECT DESCRIPTION: A/G 120 GAL PROP 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 4/10/2013. REQUIRED INSPECTIONS: Tan Line/Appliance: FinalApproval: �I ,�-�I Ziy 474- J 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 IJ ILDING PERMIT APPLICA1N BLD12-00112 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD12-00112 Received Date: 4/10/2012 SITE ADDRESS: 400 BEE MILL RD BRINNON, 98320 OWNER: NANCY A JONES PHONE: RUTH M MC CRADY 104 E 3RD ST CLE ELUM WA 989221114 SUBDIVISION: Block: Lot: TX 3+ PARCEL NUMBER: 602133011 Section: 13 Township: 26 N Range: 02 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 DESCRIPTION A/G 120 GAL PROP TANK TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2009 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: 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 04/10/12 131621 Total: $222.00 04/'10/?01'? 15: 12 509E743800 PAGE Fit;'Ft; JEFFERSON COUNTY erl; DEPARTMENT OF COMMUNITY DEVELOPMENT ti21 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 . 360/379-4451 Fax www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: N� I fCA- Project Description(include separate sheets as necessary): - CtIDCAi r�rcon(S cro (,rt� '' \' Tax Parcel Number: Lon.,I p �.. ro rtY Size: ti %,acre, 1111%44 (acres/square feet) Site Address and/or Directions to Property: u 00 '3 E ti^R.•L V740 A r) Y�ItNh3Cn WrIT Cl`r3n7..0 Property Owners)of Record: t.lAti,c,\ Telephone: Sbq toy ec62-g Fax email: SoNcs "1 k li r„sr\,Co en Mailing Address: tom ram' - d C LEe ki,LA c1 p y'Z2- Applicant/Agent(If different from owner): Telephone: Fax email: no '5 7 ki it n15 r ,(crn Mailing Address: oq - Ln urn rrt �tE+ 2 What kind of Permit?(Check each box that applies ❑Building O Critical Areas Stewardship Plan 0 Demolition Permit 11 Variance(Minor,Major or Reasonable Economic Use) ❑Single Family 0 Garage Attached/Detached 0 Conditional Use jC(a),C(d),or C] O Manufactured Home 0 Modular ©Discretionary"D"or Unnamed Uee Classification ❑ Commercial* 0 Special Use(Essential Public Facilities) ❑ Change of Use ID Boundary Line Adjustment © Address. ❑Road Approach 0 Short Plat"* ❑Home Business 0 Cottage Industry ❑Binding Site Plan" 'si&Propane O Long Plat" O Sign 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed*Yes"Use Consistency,Anaiysis 0 Plat Vacation/Alteration" 0 Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions" O Site Plan Approval Advance Determination(SPAAD)* in Shoreline Management Substantial Development"* ❑Temporary Use ❑Shoreline Management Variance Q Wireless Telecommunication* O Comprehensive Plan/UDC/Land Use District Map Amendment ❑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 Pro-Application Conference _ Please Identify any other local,state or federal permits required for this proposal,if known: I hereby designate o� DESIGNATION of AGENT to act as my agent In matters relating to this application for perrnit(s). OWNER SIGNATURE /74 (�f.-+y� '2G r0i rrw) f Date: /U r (yrZ I Li+1.2 By signing this application form,the owner/agent attests that the Information provided herein,end in any attachments,is true and correct to the best of MS,her or Its knowledge. Any material falsehood or any omission of a material fact made by the ownerlagent with respect to this application packet may result in this permit being null and void. I further agree to save,indemnity 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 application that he or sh wants prior notice. Signature; kw • 71.tn ... Date; /0 /4P/7,IG GA6/.2 The action or ectl ns 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"lake"of an endangered species as those terms are defined in the federal law known as the 'Endangered Species Act*or' SA,"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 pan file a lawsuit on behalf of an endangered species regarding your action(s)even tf you are in compliance with the Jefferson County development code,The Applicant acknowledges that he,she or it holds individual and non-tre bie rasporrsib lily for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature^ / • . 4 t Date: Lo /4/Pat IL- , GAecrieitCenterVee0FORMWfre DRD FORMS\Master Permit Application 5-29.08.dc4 04/10/7012 15: 12 5096743800 PAGE 021'0: • • 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 ass eng the r nsibility of the General Contractor for the proposed project, Signature: /s //4 �I;--� Date; to f r%4r-,r_ ,>»i2_ -GENERAL/CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: lFAX: (3r�) 3a I MAILING ADDREss: �^ EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENINEER: PWONE ( ) FAX:( ) MAILING ADDRESS: EMAIL - Project Type:— Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: 0 New ❑ Wood Existing: ❑Sewer ❑ Addition ❑ Steel Proposed: Bank 0 Community System 0 Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# CD Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: 0 Private well C Two Party Type of Heat: Proposed: ❑ Public _____ Total: Name of System: If_this is a Commercial Pro,ect you must answer the folirattogl Number of Parking Spaces: Current._ Proposed; Number of g f q Parking Spaces:__,,,_ Number of occupants(includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? es / No If this Is a Pwnane Tank arid/o Hance Installation permit,ma rk_all items below tt apply: 1 Underground Tank' lbove ground Tank Size of Propane Tank: l 7-0 I Heat Stove 1 Cook Stove 1 Woodatove I Fireplace Insert 1 Hot Water Tank I Pellet Stove 1 Other 11,this appliance beinsJnstajjed in a Ma ectured/Illlgbito 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 ell property lines,buildings and septic system components, including the reserve area. ..�_ it •ly h �, i , I t 1I tli E� f Y uare Foote a Current Pro need I 1 ' 1 G t 5..t,� e .. 1lyA r'1 `�,I� � 11 ' 7 st I' 1 ,,i e¢i 1ir,.g'Li:I. h. ,.4,P•k� tit Id ',,' �liu,,�,.ISt. a[1,.k,Main Floor Heated l,, L ':'' ,.'' EH Bid App Review: 2 Floor Heated �I , 1�I Consistency Review: I Other Heated '; tC,' --1 I Base fee: I'I Mezzanine • , I Additional Section: ; , Heated Basement > { M ' ,�� Plan Check fee: Unheated Basement State Surcharge fee: ' Other Unheated h Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rci Approach fee: Other TOTAL: $ ♦• J'' Receipt Number: Caah/Chieck Number: ESTIMATED COST(REQUIRED) ,'` IaiM1 .Fair market value of all labor and materiels foundation to fnistr Date: 4 -- Initials: G:\ParentCcatcr\###FO.RMS## \D1tD FORMS\Matter Permit Application.5.29-08.dot 04/10{2012 15:12 509E743800 F';GE 03/0:3 • • A . N knok4--\\ d a J t8 1--„ - ------ ''''''''''''""--,„,,,, itiKi2 \\N.„--I.,:„_ lti,r� .... k0.1 Opray, s ippf ?Rc>PAr. ria•NK TzeRAciikAr),Yc . Ab,,-,r,s {v�m,cs-t "ts,,, 'bet Lill.% 0G'15- F'A Q,C el, N L.nn iZG Q ip cZ I-6-5 01 t M:C.2.0,Em, e urtt U4OD ice. MN.GA_ (2,0(NrT2 100, 6- 'V"tt, r �tiNA7h,w, \0 A C,AA7r� G �l-�w� t,,,,,�0.1t7� 1