HomeMy WebLinkAboutBLD2012-00250 • •
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 #: BLD12-00250 Received Date 8/16/2012
SITE ADDRESS: 94 EDGEWATER CT Issue Date 8/16/2012
PORT HADLOCK, 98339
APPLICANT: MICHAEL D CHESLEY PHONE: 360-385-7737
GRETCHEN F CHESLEY
PO BOX 29
PORT HADLOCK WA 98339-0029 25
SUBDIVISION: VILLAS BY THE SEA Block: Lot:
PARCEL NUMBER: 997900025 Section: 1 Township: 29N Range: 01W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 1 1/16/2012-5875
OWNER, MICHAEL D CHESLEY PHONE: 360-385-7737
if different: GRETCHEN F CHESLEY
PO BOX 29
PORT HADLOCK WA 98339-0029
PROJECT DESCRIPTION: WATER HEATER
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 8/16/2013.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: 9, - l Z
FinalApproval: lam- G ` [ Z- ic
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_Permit_Propane.rpt 8/16/2012
/ ON cod JEFFER.V COUNTY, •
y I DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street • Port Townsend•Washington 98368
360/379-4450 • 360/379-4451 Fax
0 www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: re 11 1c/4
Project Description(include separate sheets as necessary):
j-A F2 i46R-r e I IJs7 w' -ri D�
Tax Parcel q Property
Number: cj,e(,'1 U 2- 5 _ Size:
(acres/square feet)
Site Address and/or rDirections to Prooertv: (� n
i
Qq Cao\QA0eLkir Q.D.�r� O 0
Property Owner(s)of Record: HI 1-£J 63
Telephone: -6%S -l`[3-1 - Fax: 1: erMile 1 6 2012 I
Mailing Address: •7 �O� a Y`i0 t j J I
Applicant/Agent(if different from owner): S U_N,S H I N P Ro A N -----__+�'
Telephone: 3a5 S7 9 7 • Fax: ...fl Ln,,,,IV R,
38S 5-37S I, gf-Drorraif:-INF 4.tliN Et-ProP�m.
Mailing Address: IOS51 SHDDy D 2• / P .. HRflLock, (0fa_ crg j
What kind of Permit?(Check each box that applies
❑Building 0 Variance,(Minor, Major or Reasonable Economic Use)
❑ Demolition Permit ❑ Conditional Use[C(a),C(d),or C]**
❑Single Family Garage Atffachea IDetached----I_T6iscretionary°D'r or Unnamed-Use Classification
❑ Manufactured Home ❑ Modular 0 Special Use(Essential Public Facilities)**
❑ Commercial* ❑ Boundary Line Adjustment
O Change of Use ❑ Short Plat**
❑ Address 0 Road Approach 0 Binding Site Plan**
❑ Home Business 0 Cottagelndustry 0 Long Plat**
Propane 0 Planned Rural Residential Development(PRRD)/Amendments**
❑Sign ❑ Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions**
❑Stormwater Management 0 Shoreline Management Substantial Development**
❑ Site Plan Approval Advance Determination (SPAAD)* ❑ Shoreline Management Variance
❑Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* 0 Jefferson County Shoreline Master Program Amendment
❑Forest Practices Act/Release of Six-Year Moratorium 0 Tree Vegetaion Request
*May require a Pre-Application Conference **Requires a Pre-Application Conference
Please identify any other local, state or_federal.permits..requ-iredfor this proposal, if known:
• DESIGNATION OF AGENT
�L 'I herebydesignate L &.iS 11JE Pry A-ri to act as myagentin\ 9 �^\� �( P matters relating to this application for permit(s).
��WNER SIGNATURE '\_ J ' Date: �J ^ ' Z� 2
b
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 it's 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-liafsilities;judgments,court costs,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 ' of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any re ired I er inspe tions.. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the applica tk h ors wants prior notice.__
ig i-1.—: (Date: 3 -"Z�7 1 2
The action or actions Applicant will underta 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 w'II 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 i compli c with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
� and non-ransfer I r sibili for, hering -and complying with the ESA. The Applicant has read this disclai er and signs and dates it below.
J Signature: ' Date: ) ` I _-?el C � 1
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc 1 1
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 OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
tS14r si4 iNt P2o pane (360) 385- 6797 ( 36o) 385-5875
MAILING ADDRESS: )0 8S3 0 Y 0 'u E- (-, 1.1. EMAIL: 1 n-fop3tAv\s}livve pro pam e 6 C CA\
CONTRACTOR'S LICENSE WAINS
NUMBER: S'1-(1/151-1 P+ l.1 rTjr7 P NUMBER
ARCHITECT/ENGINEER: l `'( PHONE',( ) FAX: ( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
O New ❑ Wood Existing: ❑ Sewer
❑ Addition 0 Steel Proposed: Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System
O Repair ❑ Masonry SEP Pemiit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type of Heat: Proposed: ___`_ 0 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
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 i Fireplace Insert(1 Hot Water Tan i Pellet Stove Other % ,,,,� r L'2--�—
Is this appliance being installed in a Manufactured/Mobile Home? Yes I o
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 ® 1FL `,V4 Z `� s.r.:� � on�t �� ,Rent lo �.
Main Floor Heated K .:,:*.,:lT EH Bld App Review:
2nd Floor Heatedy
Consistency Review:
i ,. i
$
Other Heated -4 A < la f Base fee: //vim
Mezzanine .a Additional Section:
Heated Basement .�� j, + Plan Check fee:
Unheated Basement t- '°41; State Surcharge fee:
Other Unheated ""*� � i Pot Water Review fee:
a
Garage/Carport "r"'‹,.. SUBTOTAL
�
Decks �' i t .. < 911/Rd Approach fee:
Other Ep i�_n,,p,
It , , TOTAL: $ (�a
'"4 Receipt Number: (. 1Cg
-�; ? Cash/Check Number:
.--lq I
ESTIMATED COST(REQUIRED) Date:
•Fair market value of all labor and materials foundation to finish ____— L--6---(2-a
Initials: �'
•
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc