HomeMy WebLinkAboutBLD2012-00216 •
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 #: BLD12-00216 Received Date 7/11/2012
SITE ADDRESS: 702 WOODLAND DR Issue Date 7/11/2012
PORT TOWNSEND, 98368
APPLICANT: WILLIAM W PUTNEY III TRST PHONE: 360-379-2687
GAIL C RODGERS TRUSTEE
702 WOODLAND DR
PORT TOWNSEND WA 98368-9576 3
SUBDIVISION: MADRONE RIDGE SHORT PLAT Block: Lot:
PARCEL NUMBER: 001273008 Section: 27 Township: 30N Range: 01W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 1 /17/ 0$5-5875
OWNER, WILLIAM W PUTNEY III TRST PHONE: 360-379-2687
if different: GAIL C RODGERS TRUSTEE
702 WOODLAND DR
PORT TOWNSEND WA 98368-9576
PROJECT DESCRIPTION: A/G 250 GAL PROP TANK -SAME SIZE & LOCATION
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 7/11/2013.
REQUIRED INSPECTIONS:
Tank/Line/Appliance:
FinalApproval: T AIJV 7I2_4/L
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
\\tidemark\data\forms\FBLD_Permit_Propane.rpt 7/11/2012
INJILDING PERMIT APPLICATI Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD12-00216 Received Date: 7/11/2012
SITE ADDRESS: 702 WOODLAND DR
PORT TOWNSEND, 98368
OWNER: WILLIAM W PUTNEY III TRST PHONE: 360-379-2687
GAIL C RODGERS TRUSTEE
702 WOODLAND DR
PORT TOWNSEND WA 98368-9576 MADRONE RIDGE SHORT PLAT
SUBDIVISION: Block: Lot: 3
PARCEL NUMBER: 001273008 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 DESCRIPTION A/G 250 GAL PROP TANK - SAME SIZE & 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 Bv: Date: Receipt: A P P M EL
Propane Tanks/Stoves $74.00 LYK 07/11/12 134983
Total: $74.00 JUL 11 2012
Jefferson County Planning
Ri Building Department
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SITE VISIT REPORT
(PLOT PLAN)
JOB
1.11 ?,/-+1 DATE : qf/0
CONTACT:
ADDRESS '1_ VIV0DA
PHONE #:
r DIRECTIONS FAX #:
Email
PLANNER:
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.
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JEFFERSON COUNTY
DEPT,OF COMMUNITY DEVELOPMENT
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ieON cO JEFFERSON COUNTY
k I . ' \., .. DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street• Port Townsend•Washington 98368
360/379-4450.• 360/379-44ra1 Fax
www4. ;°" -'51c.,
.co.jefferson.wa..us/commdevelopment
Master Permit Application MLA II' A-
Project Deipription(include separate sheets as necessary):
1(L - dDr°)a..(.Gm-,
Tax Parcel Number: 00 I a,`1-6OO9 Property.Size:
(acres/square feet)
Site Address and/or Directions to Pro rty;
`_l.a 2- 06001AKIDi v Yet- -�o 0
Property Owner(s)of Record; —(' L_ (,•—{,-
Telephone: Zia` 7--(2g1 Fax: email:
Mailing Address:1 Od- W 00 f fi72z Th t tJ,c�i 0
Applicant/Agent(if different from owner): mac,,j � p/L4--,d,,,,,,..____-
ii.Telephone: ,� 5 5 7 7 Fax: J 8 5 -.5 875; email: vY S`4'4A�.t- i-trga-.-e ,w,-
Mailing Address: /b e 3 kf-/o 6 OR Pi //R-flc.o c/c r.,.)R.
What kind of Permit?(Check each•box that applies ❑Lot or Road Segregation
QBuilding 0 Critical Areas Stewardship Plan
O Demolition Permit 0 Variance(Minor, Major qr filiikk Rr , l _:
❑ Single Family 0 Garage Attached/Detached 0 Conditional Use(C(a), �(ci) I LI l c;
O Manufactured Home .0 Modular . - 0 Discretionary"D"or Unpan1 Use Classification
o Commercial* El Special Use(Essential IP i Facilities)**
1 j
❑ Change of Use 0 Boundary Line Adjust eirit'Iil
(J L 1 i : 0i2
❑ Address 0 Road Approach ❑Short plat** III I
❑ Home Business 0 Cottage'Industry ElBinding Site Plan** u u,
Propane 0 Long Plat** JEFFERSON C .UN i
GI
0 Planned Rural Reside tial I ents;**
O Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Aiteratio "" � ���
0 Stormwater Management 0 Shoreline Master Program.Exemption/Permit Revisions**
0 Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development**
Temporary Use ❑Shoreline Management Variance
Wireless Telecommunication* 0 Comprghensive 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
**Requires a Pre-Application Conference
Please identify any other local,state or federal permits required for this proposal, if known
DESIGNATION OF AGENT
I ereby designate to act as myagent in matters relating to this application for permit(s).
C WNER SIGNATURE . - �-
Y1 _ Date: - z / 2
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 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 she wants prior notice.
c` ,r - nature
Date: 7 /
ate: l /�/. ='/2
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-transferable responsibility for adhering to and complying.with the ESA. The Applicant has read this disclaimer and�signs and dates it below.
' Signature: _ Date: ,/,/ '�( ..k. (
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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 resppon�si�bility of the General Contractor•for the proposed proj ct.
Signature: ( L,%L_a Date:, . 11LPl 12 •
GENERAL CONTRACTOR ER:
PHONE: FAX; 1
_ .r.morrc"c' ,,vrvic irvaTxct
Stet--, s t n e d°2--4.- 1°ze1`e (?l a ) 3 Fs- -r 7 17 (3 Ge 3 es-,s-a) 7S
MAILING ADDRESS: L21,52 r p (.1 EMAIL:
CONTRACTOR'S LICENSE ' WAINS
NUMBER: S 1-4H. SCE I7 7 Q 0 NUMBER
ARCHITECT/ENGINEER: / PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
0 New ❑ Wood Existing: 0 Sewer
❑ Addition ❑ Steel Proposed: Bank ❑ Community System.
❑ Alteration/Remodel 0 Concrete Total: Height: ❑ Individual System
o Repair 0 Masonry SEP Permit#
o Demolition o Other Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type of Heat: Proposed:
Total;- ❑ Public
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
4• IBC Occupancy: . IBC Type of construction: • Will you have Food'Service? Yes / No '
___ f this is a Pro ane Tank and/or Appliance Installation permit,mark all items below that apply:
1 Underground Tank I Above ground Tank Size of Propane Tank:
i Heat Stove l Cook Stove t Woodstove I.Fireplace Insert I Hot Water k I Pellet Stove. 1 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.
Square Footage Current Proposed
Main Floor Heated 'L't EH Bid Al*Review: .
Y ;"Y.t a .
2'Floor Heated 4„ _ �A•'t ConsistencyReview:
Other Heated •
g . , ; , + Base fee:
Mezzanine itri� Additional:Section:
Heated Basement ' p°� -�t '' , `
��t, ,, j,i Plan Check fee:
Unheated Basement i, ,f State Surcharge fee:
Other Unheated' r���:";r�°„t' Pot Water Review fee:
Garage/Carport , ;t -i u t SUBTOTAL
Decks ?c �,r 7. 911/Rd Approach fee:
Other lit:
TOTAL:
-1 r` ,i t. Receipt Number:
, '', , s Cash/Check Number;Ai .
'AO'452,d , , ..s}
ESTIMATED COST(REQUIRED) bate:
'Fair market value of all labor and materials foundation to finish
Initials:
•
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Por ns\Master Pemtit Application 5-29-08.doc