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Home My WebLink AboutBLD2012-00117 • • 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 #: BLD12-00117 Received Date 4/12/2012 SITE ADDRESS: 95 BLOSSOM LN Issue Date 4/12/2012 PORT TOWNSEND, 98368 APPLICANT: ROBIN A ROGERS PHONE: 360-379-4884 SCOTT ROGERS 95 BLOSSOM LN PORT TOWNSEND WA 98368-9086 TX 29 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001203007 Section: 20 Township: 30N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 ((3 pl 3g5 Contractor's License SUNSHP*077QP Expires 11367/2012-5875 OWNER, ROBIN A ROGERS PHONE: 360-379-4884 if different: SCOTT ROGERS 95 BLOSSOM LN PORT TOWNSEND WA 98368-9086 PROJECT DESCRIPTION: GENERATOR& PROPANE LINES TO EXISTING 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 4/12/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: 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 S UILDING PERMIT APPLICAI•N BLD12-00117 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD12-00117 Received Date: 4/12/2012 SITE ADDRESS: 95 BLOSSOM LN PORT TOWNSEND, 98368 OWNER: ROBIN A ROGERS PHONE: 360-379-4884 SCOTT ROGERS 95 BLOSSOM LN PORT TOWNSEND WA 98368-9086 SUBDIVISION: Block: Lot: TX 29 PARCEL NUMBER: 001203007 Section: 20 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 DESCRIPTION GENERATOR & PROPANE LINES TO EXISTING 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: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: 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 $148.00 LYK 04/12/12 131633 Total: $148.00 (<:,.. 0N-c-••\.__� ei. JEFFERSO1 UNTY • ' ; DEPARTMENT OF COMMUNITY DEVELOPMENT `' ` `4 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax 4,..1 ' p� www.co.jefferson.wa.us/commdev � IIINC% elopment Master Permit Application MLA: (X inLA?,. ) Project Description (include separate sheets as ne;:essary): qQAtI).Y0A-Ox-- 1 f ipCluve_ 1 Q c1S'r" AA �So � lit• • Tax Parcel Number: c;C71 Z,_(y-7- eb'j Property Size: COS' • (acres/square feet) Site Address and/or Directions to Property: Property Owner(s)of Record: )t 1•z ab, '5 - WIMP_ TelephoneP. ` 4�T=2 .4 r Fax: email: — 1.. 411b • t Mailing Address: 4 fl G- 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 wilding ❑ Critical Areas Stewardship Plan Demolition Permit 0 Variance(Minor, Major or R4as 0 Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a), C(d),f or G f 0 Manufactured Home .0 Modular 0 Discretionary"D"or UI nam d'Us a ❑ Commercial* 0 Special Use(Essential Publ#c Facilities)** ❑ Change of Use 0 Boundary Line Adjustment ; . 0 Address _ 0 Road Approach_ 0 Short Plat** I tJ Home Business 0 Cottage Industry ❑ Binding Site Plan** ' , Li 'Propane G ch.4_r Jo( L.;vx e S 0 Long Plat** • ❑ �iyn 0 Planned Rural Residential eve~qwe F �fdments** El Allowed"Yes" Use Consistency Analysis El Plat Vacation/Alteration** ' Q jITY DfVFtOPMENT ❑ Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions** ❑ Site Plan Approval Advance Determination (SPAAD)* 0 Shoreline Management Substantial Development** 0 Temporary Use 0 Shoreline Management Variance ❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference 0 Tree Vegetation Request **Re•uires a Pre-A..lication Conference Please identify any other local, state or federal permits required for this proposal, if known: Z—r��e ei _(ZleA. , 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 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. Sta cress and right of entry will be assumed unless the applicant info s the Co my in writing at the time of the application that he or she wants prior noe. L_...47 �,l ignature: ( Date: G ii— i The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon ne 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 enda ered species regarding your action(s)even if you are in compliance.witrttT€Jeffers County development code.The Applicant acknowledges that e,she or it holds individual and non-transferal r nsibility f adhering to co p y. ith the ESA. The Applicant has read this disci ime and sign and dates it below. ignature: �� Date: . G:\PermitCenter\###FORMS###\DRD FORMS\Current 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. n(Signature: Date: GENERAL CONTRACTOR UFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) AILING 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 J Wood Existing: E Sewer Addition ❑ Steel Proposed: Bank ❑ Community System 7 Alteration/Remodel ❑ Concrete Total: _ Height: ❑ Individual System Repair ❑ Masonry — SEP Permit# _ Demolition ❑ Other: Bedrooms: Water Supply: Existing: _ Setback: Private well ❑ Two Party Type of Heat: Proposed: U 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 Size of Propane Tank: c4— i Heat Stove i Cook Stove i Woodstove i Fireplace Insert i Hot Water Tank i Pellet Stove i Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / No ,a,yLQr r 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: 2nd Floor Heated —Consistency Review: Other Heated Base fee: l Q2 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: $ . l LI�> Receipt Number: 131 053 Cash/Check Number: l 153 ESTIMATED COST(REQUIRED) Date: _ 2/%2 •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 • U g E I > o i 2 s m a N Z Z N-El O oD s A a D N r❑i r ( .il '\ N i _., \ ki--\ ❑o i 1 J r 3pz,si,.b5 _ _ o o-D tl -----r--------------. ------- 0 --_ „S L'b Zb 1 Sd 1 1N3VI35V3 a i i d12115211tJ ` 3a M SB g 1 1 11 \ 1 1 01 Y I / DE 1 ._.4.54, \ � I i wir „,„-- _ I 1 .._„...,. ,_ ,,,,, vii. 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