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HomeMy WebLinkAboutBLD2012-00234 • • 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#: BLD12-00234 Received Date 7/31/2012 SITE ADDRESS: 702 WOODLAND DR Issue Date 7/31/2012 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 1T/((33 167M5-5875 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: NEW PIPING 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: ' - /Z / FinalApproval: /4--/ 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 "kJ ILDING PERMIT APPLICA1IN BLD12-00234 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD12-00234 Received Date: 7/31/2012 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 NEW PIPING TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2009 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: 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: Approved/Date Propane Tanks/Stoves $74.00 LYK 07/31/12 135051 APPROVEP Total: $74.00 2 12 Jefferson County Plannint & Building Department \\+ir+cmor4\rin+o\forme\C RI fl Ann Rlr+rn+ 7/11/7f1l7 (SON co JEFFERSON COUNTY• . ° \4 `1 DEPARTMENT OF COMMUNITY DEVELOPMENT 4\ 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450. 360/379-4451 Fax www.co.jeffetsan.vv } ja ; l' 1N_Wd', ,\ A71fl�u • h1Nf103 NOS1:13ij3f • Master Permit Application • MLA; S 'ILA- )Description(i c de separate sheetsi asineces-Aary): , E I n r Tax Parcel Number. 6 ) -`1 ZTmo1. Size: (acres/square feet) Site Address and/or Directions to Property: _ 1 DO,_ (.0 J-,'H'► - De— - ----d L-0 1S ro Property Owner(s).of Record; 10 I tom-I;A M ,-ps.41- AA 1 t-� 6EtZ__ - Telephone: 3 ? t—1 Fax: email: Mailing Address: —7 D a 1.Ob J 1-tel Az , , Applicant/Agent(if different from owner): �� �Telephone: , ' 5 - 57, 7 Fax: J85--,�875i PA--zr>d,-)---e--- email: S`#"d -o- a,•-( Mailing Address: /0853 , .Noby OP. , PT• //4119c.oc/ i„)A . What kind of Permit?(Check each box that applies 0 Lot or Road Segregation QBuilding 0 Critical Areas Stewardship Plan El Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) 0 Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a), C(d), or C]** ❑ Manufactured Home 0 Modular - 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* El Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment ❑ Address . . .❑'Road Approach .0 Short plat** ❑ Home Business 0 Cottage Industry ❑Binding Site Plan** , propane ❑ Long Plat** ❑Sign • "' • ❑Planned Rural Residential Development(PRRD)/Amendments"* ' • O Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** D 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 Pro-Application Conference Please identify any other local; state or federal permits required for this proposal, if known: DESIGNATION OF AGENT I ereby designate -<✓-1- ro✓e . i../19-- to act as my agent in matters relating to this application for permits . P 5�I'/0 •WNER SIGNATURE Date //-7J/ZI)(�� 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 costa, 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 CounCounty'and its employees,representatives or agents for the sole purpose of application review and any required I ter inspe ss and right of entry will be assumed unless the applicant info s the County in writing at the r time of the application t t he or she wants Rrior notice, i' 1 ` i - •nature: - \ Date-. 7 ()2-0 (Z 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 lake."of an endangered speoies 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 .` the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferable responsibility .• ad-eying to and complying with the ESA. The Applicant has read this disciai rand yigns and dates it below: Signature: (--\! Date: 7/_?b/Z.a/ Z_- 9 1 / r;•\PrmirCrnrrA###F(IRMS###\r)Rfl F(IRM.C1r,,.,-,.nrMT)F.,.,,,,\r,f,,,..,p....,:,A....t:,..,.:,..,c no nv 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 pro . Signature: f a dater.., 7 2 a/ /2— . • GENERAL CONTRACTOR ER: PHONE: FAX: S .-, Z tl I.in e fP I2 y,A-v`& (06a ) 3 FS- -r 7 Y? (3 66) 3 eS-S P 75 MAILING ADDRESS: /C7 g 5 3 t(7O„ ._ /)1 Pt p. (� EMAIL: CONTRACTOR'S LICENSE `�" WAINS NUMBER: 5 L&Vl S 7> p/t7 7 Q 0 NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New 0 Wood Existing: 0 Sewer O Addition 0 Steel Proposed: Bank 0 Community System O Alteration/Remodel 0 Concrete Total: Height: 0 Individual System O Repair 0 Masonry SEP Permit# ❑ Demolition C] Bedrooms:Other: . Water Supply: Existing: Setback: O Private well 0 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 ' _ 4-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: I Heat Stove I Cook Stove I Woodstove 1 Fireplace Insert I Hot Water Tank I.Pellet Stove. Ot 15, 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, ti Square Footage Current Proposed l':c,, '-i : V�l cofIA..0N_tttg. ,. a,%"Fs tl��*.i , �,y 14Xtg:r�'e pp Main Floor Heated �' ' }'s EH Bld A Review. 2"0 Floor Heated � ,4i °s`' r, `'�N= Consistency Review Other Heated 1,l 5.. r,�yx,` Base.fee: Y v tig _ J Mezzanine ;� ,, Additional Section: Heated Basement 3 „ a Plan Check fee: Unheated Basement ,,-'1� '� State Surchar a fee: 1, z? 9 Other Unheated '�'1° �; e Pot Water Review fee: Garage/Carport iff o ''0z s`� ' it SUBTOTAL Decks,aj lax 911/Rd Approach fee: ,4 , Other ;f , TOTAL $ pit r �;:', ,, Receipt Number: rr ..F,tip a��qq�- -'' Cash/Check Number.:. ESTIMATED COST(REQUIRED) Date: . '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