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HomeMy WebLinkAboutBLD2012-00232 • 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#: BLD12-00232 Received Date 7/31/2012 SITE ADDRESS: 596 SNAGSTEAD WAY Issue Date 7/31/2012 PORT TOWNSEND, 98368 APPLICANT: CELIA M MARQUIS PHONE: 360-385-1966 2023 E SIMS WAY PORT TOWNSEND WA 98368-6905 1 SUBDIVISION: DOE RUN Block: Lot: PARCEL NUMBER: 001295004 Section: 29 Township: 30N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 1T/((33 16V$5-5875 OWNER, CELIA M MARQUIS PHONE: 360-385-1966 if different: 2023 E SIMS WAY PORT TOWNSEND WA 98368-6905 PROJECT DESCRIPTION: WATER HEATER REPLACEMENT 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 7/31/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: C/ r Z /77 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 \\tidemark\data\forms\F_BLD_Perm it_Propane.rpt 7/31/2012 JILDING PERMIT APPLICATON BLDI2-00232 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD12-00232 Received Date: 7/31/2012 SITE ADDRESS: 596 SNAGSTEAD WAY PORT TOWNSEND, 98368 OWNER: CELIA M MARQUIS PHONE: 360-385-1966 2023 E SIMS WAY PORT TOWNSEND WA 98368-6905 DOE RUN SUBDIVISION: Block: Lot: 1 PARCEL NUMBER: 001295004 Section: 29 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 WATER HEATER REPLACEMENT TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC 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 Permit $74.00 LYK 07/31/12 135048 A P P R O V E Total: $74.00 �+ JUL 5 1 2012 Jefferson County Planning & Building Department \\firfomorL\rlofo\fnrrne RI n Ann PIA rn4 7IZ9/9f199 iirift4 ,orr CO JEFFERSON!OUNTY ` DEPARTMENT OF COMMUNITY DEVELOPMENT 4\ • . 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/370-4451 Fax 1 www.co.jefferson.wa.us/commdevelopment , 4 .1& 1NO Master Permit Application MLA: t iC, i l( i Project Description(include separate sheets as necessary): e- - - . c, z , si_€_.,,- Tax Parcel Number: 0 0/ . 9 5 0© Property Size: j + ( ek: - e t) Site Address and/or Directions to Property: j ,--,S 596 SNA 05ri6 teJkej le)7 . 70 ,�-,. e.:, �' 'il 3 0 ;n12 Property Owner(s)of Record; C e Li a. 4,20 u fs r u Li Telephone: 3 Y5-/, Fax:6 I �1email: 1FFF€R ONCOIINIy Mailing Address: of 0. C i7'7 f W �t p 7- To a; gf Applicant/Agent(if different from owner): � / Telephone: 385 57S7 Fax: 385-- 875 email: /y °@S`r'nd /Dtioyla►-e ,c,b..., Mailing Address: . /0 e . 3 kf/c 6 'OP. Pi. //fl-0L0 c/ i,,,)ii What kind of Permit?(Check each box that applies 0 Lot or Road Segregation ❑Building 0 Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family 0 Garage Attached/Detached 0 Conditipnal Use[C(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 Adjustment Address .❑ Road Approach 0 Short plat** ❑ Home Business 0 Cottage Industry 0 Binding Site Plan** :Propane 0 Long Plat** E] Sign 0 Planned Rural Residential Development(PRRD)/Amendments** ' O Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** ❑ Stormwater Management ❑Shoreline 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 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 my agent in matters relating to this application for permit(s). C 1' •WNER SIGNATURE C--„t.S�-�_-� ,,'-Y1 t> .....4,..1... Lc 'Z J IV ` Date: .2407 By signing this application form,the owner/agent attests that the information provided herein,and in any attachments, is rue 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 appli t Informs the County in writing at the. time of the application at he or she wants prior notice. ct to -'"nature: r\-Thc- (-" Date: 2I cC The action or actions Applicant will undertake as a result of the issuance of this permitrmay 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 Acr 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 disclai r and signs and dates it below: Signature: i ,�. Date: 2 / (:•\P"mircfnrrr\towPoRMC###\r-gm P.m MC\C,,,rP rTlRTl Fl....,r\TT.,,r.rn....,:r A.,..t,...,.:,,,,c nn noa,.,. • • 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 proj ct. Signature::._'•J.s..L(t LI,Q \ Date:. . —1 al II 1.-V . GENERAL CONTRACTOR ER: PHONE: FAX: Sr k_k, s 14 t r e Prs-r -e (26o ) 3 FS- -r 7 17 (3 66) 3 ifs-s' 7S MAILING ADDRESS: I 0 E 5 3 ei-I ..-211 Pt P. (j EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: S Vl $- * (T 11 7 Q r NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New 0 Wood Existing: 0 Sewer 0 Addition 0 Steel Proposed: Bank 0 Community System 0 Alteration/Remodel 0 Concrete Total: Height: 0 Individual System ❑ Repair 0 Masonry SEP Permit# ❑ Demolition 0 Other . Bedrooms: Water Supply: Existing: Setback: ❑ Private well Cl 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 _ F1f this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: 1 Underground Tank 1 Above ground Tank Size of Propane Tank: 1 Heat Stove 1 Cook Stove 1 Woodstove I Fireplace Insert 1 Hot Water Tank 1 Pellet Stove. 1 Other Oe►r np IJ61i` Is this appliance being installed in a Manufactured/Mobile Home? Yes / No 7kiC'A-Le-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. ryg( Square.Footage Current Proposed PT. i I. r' li ), y , st '' `• A , t Aaw�, 1 41.t�°1�):!4"" : 4 Main Floor Heated - ' -416r,r,*F EH Bid App Review. '432r4 Floor Heated " ,, Consistency Review: Other Heated ')otl�y ° Base fee 21 i Mezzanine ` ` x Additional Section: Heated Basement t r Plan Check fee: 1`Ace ° Unheated Basement ,t � 4 State Surcharge fee: 4 / q _- ' Other Unheated - ' - '; it,4y ' ' Pot Water Review fee: I. e , Garage/Carport 'ro "+^ 1 % i SUBTOTAL as,jifk,I. r Decks t trt 911/Rd Approach fee: Other ,t "� .- a E TOTAL: $ �- 4• ,;, a, Receipt Number: 1 3 9 Cash/Check Number:. l_r7c,_ ESTIMATED COST(REQUIRED) Date: �� •Fair market value of all labor and materials foundation'to finish 11-- ^/� Initials: �`` --� G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forme\Master Permit Application 5-29-08.doc