HomeMy WebLinkAboutBLD2012-00138 •
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 #: BLD12-00138 Received Date 4/30/2012
SITE ADDRESS: 191 RIDGE DR Issue Date 4/30/2012
PORT TOWNSEND, 98368
APPLICANT: JANET R FREEMAN PHONE:
191 RIDGE DR
PORT TOWNSEND WA 98368-9435
8
SUBDIVISION: CAPE GEORGE VILLAGE DIV 4 Block: Lot:
PARCEL NUMBER: 940800008 Section: 13 Township: 30N Range: 02W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339 p 3 5
Contractor's License SUNSHP*077QP Expires 1 (3(367/�082 5875
OWNER, JANET R FREEMAN PHONE:
if different: 191 RIDGE DR
PORT TOWNSEND WA 98368-9435
PROJECT DESCRIPTION: SWAP OUT A/G 500 GAL PROP TO A/G 250 GAL PROP TANK -
Directions SAME LOCATION
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 4/30/2013.
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
BLD12-00138
IPIJILDING PERMIT APPLICAN Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD12-00138 Received Date: 4/30/2012
SITE ADDRESS: 191 RIDGE DR
PORT TOWNSEND, 98368
OWNER: JANET R FREEMAN PHONE:
191 RIDGE DR
PORT TOWNSEND WA 98368-9435
CAPE GEORGE VILLAGE DIV 4
SUBDIVISION: Block: Lot: 8
PARCEL NUMBER: 940800008 Section: 13 Township: 30 N Range: 02 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 DESCRIPTIOF SWAP OUT A/G 500 GAL PROP TO A/G 250 GAL PROP TANK - SAME
LOCATION
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 04/30/12 131688
Total: $74.00
SITE VISIT REPORT
(PLOT PLAN)JOB � - 0k DATE : 1 1•t(6I 1 Z
CONTACT:
ADDRESS I C\ p A E- C PHONE #: 3 ci-62.1 .
DIREgTIONS �P e-C�a � ���s)� Rd FAX #:
TO 10,1 ‹21.1 . Email
PLANNER: Tck\IJQ., L
Include all street names adjacent to property,property lines,tank,appliance&piping locations, distances of tank to property lines and
buildings,septic,wells,wetland areas,distance to water bodies.
T i Ic
Ex 5 0 o w C, T10►•�1L
I( T )( S4T 20 we ? NIL.
Goss ,�
1s
1
,G c vale
skof
• 1
1 1 1\11
HOOS —C.
K T.-� I,rs nr5
r-) E i]V \)j
ZS-o Boo,f,r\ > ` 3 u 201Z
JEFFERSON COUNTY
DEPT OF COMMUNITYDEVELAPIT
•
\\Sunshine1\E\BUSINESS\FORMS\PROJECT PLANNING\SITE VISIT REPORT-PLOT PLAN.doc
c41 JEFFERSON COUNTY •
•
14:prolii-ac'N
\ ` DEPARTMENT OF COMMUNITY DEVELOPMENT
'`� -a 621 Sheridan Street • Port Townsend•Washington 98368
360/379-4450 • 360/379-4451 Fax
K.,,,,Op
www.co.jefferson.wa.us/commd.evelopment
Master Permit Application MLA: �O m P '�h
Project Description(include separate sheetsas necessary):
Tax Parcel Number: Al Li D 1 v OOO Property Size:
(acres/square feet)
Site Address and/oADirections to Property:
q/ -I 0 CT c oei tic:.
Property Owner(s)of Record: v%q��-r- -F72. -1 t9
Telephone: Fax: - email:
Mailing Address: t q l Riif---)6 ---F'c 2'r i a W ,oJp..) I,�»1 4."�.
Applicant/Agent(if different from owner): `4`'�i_-`—,-- 4 1_r 1#c-_-,e
Telephone: .?e5 - 57 7 Fax: 38 S.-,.18 75:: email: /y S` d�-•--if,r oVa-,-e. ,c,,,,i
Mailing Address: /O&53 kf-/ 'O FOP Pi //R-0co c/c A
•
What kind of Permit?(Check each box that applies 0 Lot or Road Segregation
❑Building 0 Critical Areas Stewardship Plan
0 Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
❑ Single Family 0 Garage Attached./Detached ❑Conditional Use iC(a), C(d), or C] *"
❑ Manufactured Home .0 Modular - 0 Discretionary"D"or Unnamed Use Classification
❑ Commercial* 0 Special Use(Essential Public Facilities)**
❑ Change of Use 0 Boundary Line Adjust
❑ Address . . 0 Road Approach 0 Short Plat** i I 0
❑ Home Business 0 Cottage Industry 0 Binding Site Plan** I
,Wpropane 0 Long Plat*" . ,r ,
0 Sign. - 0 Planned Rural Residential Development(PRRD)/Arne , :n s**
❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration**
0 Stormwater Management 0 Shoreline Master Program.Exemption/Permit Revisio
❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Managemerit Stl" . a - •.-. **
0 Temporary Use ❑Shoreline Management VariancelEri ERSCiT C UNTY
❑Wireless Telecommunication* 0 Comprehensive Plan/UDCVL`:aind Me', ' t
O 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
**Requires a Pre-Application Conference
Please identify any other local, state or federal permits required for this proposal, if known:
. DESIGNATION OF AGgNT
, I ereby designate / to act as my agent in matters relating to this application for permit(s).
5l'41 OWNER SIGNATURE )t 9 C c' /c. Date: , -
J ,
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 attorneys fees and
expenses which may in any way accrue against Jefferson County as a result of or in cohsequence 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
•
r time of the application that he she wants prior notice,
'•nature: •1, t� f. Date:
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 riot 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-transferable responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: ,
` Date:
7 t
(:•\Pr,+,,;rr.,-,tPr\##iiFflRMS###\RRn PfRMc\r,,,-rPnrr n F,,,,,,,Am„,,--n-.,,,,,a,,.,t:...,.:,,.,G on no a,._
, .
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 pro1ect
Signature: Date:
GENERAL CONTRACTOR ER: PHONE: FAX:
5L. fr-, s-0ine rP(2 Pfrr . 06d ) .3 FS- X 7 y7 ( 3Ge)) 3eS-,s-P 7-5-
MAILING ADDRESS: 1 O E 5? 1 pr p ('( EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: S L-VI 5 rj 7 Q r NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: • EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
0 New 0 Wood• Existing: 0 Sewer
O Addition 0 Steel Proposed: Bank 0 Community System
0 Alteration/Remodel 0 Concrete Total: Height: 0 Individual System
O Repair ❑ Masonry SEP Permit#
❑ Demolition 0 Other: . Bedrooms: Water Supply:
Existing: Setback: ii Private well U 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
*-)f this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply:
1 Underground Tan Above •round an• Size of Propane Tank: .: 5-7)
I Heat Stove 1 Cook Stove i Woodstove 1 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 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.
jttyx.,rW V; Y s N�,,�,3 s�ft+^�s���,�j� �,� "d�`�' "i' f'` �,�e4�,, x'+a.> as
'Square Footage Current Proposed �,� 1,,rid �1 i;� , a ti fp r,.'p ,is �
Main Floor Heated t c . a s. "` .
43sg+k�+N `4 EH Bld App Review: .
Pr 3;r , r
26°Floor Heated t k "� 4: Consistency Review:
Other Heated r� 'ft.,3t!*1` Base fee.
;st
Mezzanine ui '��' Additional Sac-Aron!
Heated Basement galit,!:1A
, �,
I , t Plan Check fee:
Unheated Basement y �i k State Surcharge fee:
r , ,
Other Unheated
1 v ,� 0 Pot Water Review fee:
!tl
Garage/Carport 5 „ M SUBTOTAL
Decks ',*l;z ar4� ,? 911/Rd Approach fee:
;A.
Other t° t , TOTAL: $ Ili
• py &sl ; " Receipt Number:• 1 3 I LP g Ic
', '' ,,, Cash/Check Number: ( r
ESTIMATED COST(REQUIRED) Date:
•Fair market value of al/labor and materials foundation to finish 33 12 ,
Initials:
G:\PemritCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Annliret inn 5.,h.fR a,.,-