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HomeMy WebLinkAboutBLD2012-00159 • • 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 #: BLD12-00159 Received Date 5/21/2012 SITE ADDRESS: 1452 WOODLAND DR Issue Date 5/21/2012 PORT TOWNSEND, 98368 APPLICANT: WILLIAM H ALL IV PHONE: TERESA A YSSELDYKE-ALL 1452 SOODLAND DR PORT TOWNSEND WA 98368-2590 11 SUBDIVISION: WOODLAND HILLS#2 PHASE 1 DIV2 Block: Lot: PARCEL NUMBER: 999900111 Section: 27 Township: 30N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 0A385-5875 Contractor's License SUNSHP*077QP Expires 1 (3167/ 1 OWNER, WILLIAM H ALL IV PHONE: if different: TERESA A YSSELDYKE-ALL 1452 SOODLAND DR PORT TOWNSEND WA 98368-2590 PROJECT DESCRIPTION: RELOCATE A/G 120 GAL PROP TANK& NEW LINES 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 5/21/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval 5/23I1Z i 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 ILDING PERMIT APPLICAT BLD12-00159Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD12-00159 Received Date: 5/21/2012 SITE ADDRESS: 1452 WOODLAND DR PORT TOWNSEND, 98368 OWNER: WILLIAM H ALL IV PHONE: TERESA A YSSELDYKE-ALL 1452 SOODLAND DR PORT TOWNSEND WA 98368-2590 WOODLAND HILLS#2 PHASE 1 DIV2 SUBDIVISION: Block: Lot: 11 PARCEL NUMBER: 999900111 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 DESCRIPTIOr RELOCATE A/G 120 GAL PROP TANK & NEW LINES TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 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: v Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $148.00 LYK 05/21/12 131744 Total: $148.00 • SITE VISIT REPORT • (PLOT PLAN) JOB DATE: CONTACT: ADDRESS /' y"L- �•�+..wm=P c_Avis D A- PHONE #: DIRECTIONS FAX #: Email PLANNER: Include all street names adjacent to property,property lines,tank,appliance&piping locations, distances of tank to property lines and buildin s,septic,wells,wetland areas, distance to water bodies. c 'e / /-4,..÷ '',.../ ern Jv� 3AI „ f,Pt, Ib'Piel. � ` �J r9LwT�DN � SttnsL1�� l�r°per wllIbe__ Pel6c1i1.5 —t4444 1-- F 0 lb 1 do j,1. IG9- Sr Asz �' 1 I4 We Wilt 11 MAY 2 1 2012 1� peprrzl'e #1..„4 r Ira lei a day IJErcEP nN MIINTY UPI cEl.RMMIIMTY nFV WPMENT , • \\Sunshine1\E\BUSINESS\FORMS\PROJECT PLANNING\SITE VISIT REPORT-PLOT PLAN.doc • ii;:erviimocoNc JEFFERSON !UNTY DEPARTMENT OF COMMUNITY DEVELOPMENT o 621 Sheridan Street• Port Townsend •Washington 98368 F 360/379-4450 • 360/379-4451 Fax ,cQ' www.co.jefferson.wa..us/commdeveiopment ,,,lio Master Permit Application MLA; i 1L (� �Lf} Project Description(include separate sheets as necessary): / ei ,Q 4 to c , t',.,-, , c 5-t,�✓ 740 ../c 1 . - (1), / ) Tax Parcel Number: �,/ 9 : 90 0 /(( Property.Size: (acres/square feet} Site Address and/or Directions to Property: Property Owner(s)of Record: i -a-,-ci 45 c -ecru/ Telephone: Fax: email Mailing Address: Applicant/Agent(if different from owner): ` .„., ,-)-._.+_____i Telephone: Y el5 5 7,7 Fax: J 8 S--1 8 7.5 email: S d , "-.-e . Mailing Address: /d 8,,a 3 kN o o/ .CO. Pr• ///6f-01-o c% r,)ti - , What kind of Permit?(Check each•box that applies 0 Lot or Road Segregation [Building 0 Critical Areas Stewardship Plan O Demolition Permit 0 Variance(Minor, MaJen virf waa iiablc E..v,lomie Use) ❑ Single Family 0 Garage Attached./Detached ❑ConditiOnal Use[C1(a),: ( W,'o *' r O Manufactured Home :0 Modular - 0 Discretionary"D"or Urn • ❑ Commercial* 0 Special;Use(Essential Public Facilities)** 1 ❑ Change of Use 0 Boundary Line Adjustment I Address 0 Road Approach El Short Plat** A i f�.l L i 2012 ❑ Home Business 0 Cottage Industry 0 Binding Site Plan** �� , 'ropane ❑Long Plat"* i I 0 Sign - 0 Planned Rural Residential-DeWekil t rt(i ftD)/Atnendments** O Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration!'"n' nr ,,I i\'I F:'-i nn"rNT O Stormwater Management 0 Shorelihe Master Program.Exemption/Permit Revisions * ❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development** ©Temporary Use 0 Shoreline Management Variance Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑ Forest Practices Apt/Release of Six-Year Moratorium 0 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: DESIGNATION OF AGENT I ereby designate 7-27ir'..1611147j to act as my agent in matters relating t�o this application for permit(s). C�{ l OWNER SIGNATURE /, / •7 `4 1'' / 2 0 12--- {IDates 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 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 forr the sole purpose of application review and any required later ins ctions. Staffs access and right of entry will be assumed unless the applicant informs:the County in writing at the t time of the applicati th • r notice. ` iii • .nature: ` /� : S Date: 1 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-transti6rab on sib kty r-adhering to and complying,with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: (T/r -.-. Date: (:•\Prrmireenrrr\###FORMS###\FATl FOR MC\Crronr TIP TI • • . .. 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:., GENERAL CONTRACTOR . ER: PHONE: FAX: ..S.L.ct--N €1tne tP 1 PA-v-& (9bd ) .3 FS- -r7 17 ( 3G4 3eS-SP7S MAILING ADDRESS: /O E 5? 0 Q„ �._ Pt p (/ EMAIL: CONTRACTOR'S LICENSE " WAINS NUMBER: S(-.l l'A S- * .)/1/7 Q N NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New O Wood Existing: 0 Sewer 0 Addition ❑ Steel Proposed: Bank 0 Community System 0 Alteration/Remodel 0 Concrete Total: Height: 0 Individual System D Repair ❑ Masonry SEP Permit# 0 Demolition 0 Other: . Bedrooms: Water Supply: PP Y: Existing: Setback: 0 Private well ❑ Two Party Type of Heat: Proposed: ❑ Public Total: Name of System:• • If this:is a Commercial Project you must answer the followinq: 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 FoodService? Yes / No _ :. -if this is a Propane Tank and/or Appliance Installation permit,mark ail items below that apply: i Underground Tank I Above ground Tank Size of Propane Tank: c X /2 0 , I Heat Stove I Cook Stove I Woodstove t Fireplace Insert I HotWater Tank I Pellet Stove i Other v nyl-t_ 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. y tv ie a• A' �° 7, F R}Am!o'�.,'�'Y , `F ", �pv� k`4tl',,'7 • ,37r'i?S )� 1° $t Square Footage. Current Proposed v r s,Ei, w £ � � ^i3._, i'r- Main Floor Heated ' "',5,,,ig „ EH Bld App Review: •^: 2"0 Floor Heated �� '„„„,,,���YY�.�<v;�� Consistency Review: • Other Heated 9 ;` Base fee: • Mezzanine to ` Y $j `�r.,• Additional'Section: Heated Basement f,.,t -A'<,, "a ` Plan Check fee: Unheated Basement State Surcharge fee:. a F . Other'Unheatetl ¢�, t', r e Pot Water Review fee: Garage/Carport .� "i?-t , ; SUBTOTAL I,r2,,p Decks its ` `- 911/Rd Approach fee: Other F r•1/06-4 " ,r I , �.(K k TOTAL $ I t� C v � Y S 4rat�x � ,' ;, Receipt Number: I/l ' k " F Cash/Check Numbers ESTIMATED COST(REQUIRED) Date: 4 ; •Fair market value of all labor and materials foundation to finish Initials: 0! G:\permit-Center\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc