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HomeMy WebLinkAboutBLD2012-00254 • 0 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#: BLD12-00254 Received Date 8/20/2012 SITE ADDRESS: 280 N BAY WAY Issue Date 8/20/2012 PORT LUDLOW, 98365 APPLICANT: ALBERT M ABRAMS TRUSTEE PHONE: 360-437-9464 280 N BAY WAY PORT LUDLOW WA 98365-9452 19-21 SUBDIVISION: OAK BAY WATERFRONT Block: Lot: PARCEL NUMBER: 976800009 Section: 29 Township: 29N Range: 01 E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 1'f/1602012-5875 OWNER, ALBERT M ABRAMS TRUSTEE PHONE: 360-437-9464 if different: 280 N BAY WAY PORT LUDLOW WA 98365-9452 PROJECT DESCRIPTION: NEW GENERATOR& 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 8/20/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: a A _ ItcY f d -2-?`/ 2 fi ') FinalApproval: c " -7- I Z- (cT( 7) 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 8/20/2012 BLD12-00254 IMILDING PERMIT APPLICATI i' Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD12-00254 Received Date: 8/20/2012 SITE ADDRESS: 280 N BAY WAY PORT LUDLOW, 98365 OWNER: ALBERT M ABRAMS TRUSTEE PHONE: 360-437-9464 280 N BAY WAY PORT LUDLOW WA 98365-9452 OAK BAY WATERFRONT SUBDIVISION: Block: Lot: 19-21 PARCEL NUMBER: 976800009 Section: 29 Township: 29 N Range: 01 E 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 GENERATOR & PIPING TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW 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 By: Date: Receipt: Approved/Date Propane Tanks/Stoves $148.00 LYK 08/20/12 135120 p p! (.J V 1 ' ' Total: $148.00 AUG ./.:A2 Jefferson County Planning & Building Department \\+irlcmorlArlofa\forme\C RI Il 4nn Rlrl rnf R/9lV9lN9 ' r ' i • 0 SITE VISIT REPORT (PLOT PLAN) JOB P'cre)RAPI\c DATE: I CONTACT: ADDRESS (M3 W 734? vviAy Pr LLeiloAi 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 buildings,septic,wells,wetland areas,distance to water bodies. , . t1 206014 K ohlf/\ oet&Q_Aet-kb.r- . (1Kck s4-Ay, remcke vet*. ii., , 3( 4 C. : A 8."co?-1-ecit 1 f 14 1 1 PrC , : I `bto,zilL SNA " 5T5' ' ictt o invv.56 0 ex1511 19-0 I J I ) ,_, I ,1 AUG 2 0 2012 I L Ul ..:2) JEFFERSON COUNTY ! • ,- • DEPT.OF COMMUNITY DEVELOPMENT . • i /. 1, ; i -----,. I c. I 'I'\-, t :; .' 1, 4iiiiriN*--t1 I •JEFFERSON COUNTYf ` DEPARTMENT OF COMMUNITY DEVELOPMENT � .= 621 Sheridan Street• Port Townsend •Washington 98368 44 4 360/379-4450 • 360/379-4451 Fax LN www.co.Jefferson.wa.usfcommdevelopment Master Permit Application MLA: . No m( jir1- Project Description(include separate sheets as necessa ): • Tax Parcel Number 97 6-, S76 C) --U 0 � (acres/square feet) Site Address and/or Directions to Property: aao A1 . a AUG_ w- , ,hf AUG 2 0 2012 Property Owner(s)of Record: Telephone: 'V) - `/cq Fax: i ZEFFRSON COURTNail: Mailing Address: J�%E _ DFP7.OF COMMUNITY DEVECOPME. Applicant/Agent(if different from owner): Telephone: gel5 - 571 7 Fax: 38 S-- 875 email: Gy 'S`4`d tiOryQ-.-e ,c_.�. Mailing Address: /a e5 3 k/-/( V OP. PT //4-Ot-0 c/ r--)A What kind of Permit?(Check each box that applies 0 Lot or Road Segregation oBuilding 0 Critical Areas Stewardship Plan 0 Demolition Permit 0 Variancle(Minor, Major or Reasonable Economic Use) ❑ 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* 0 Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment Address 0 Road Approach 0 Short Plat** ❑ Home Business 0 Cottage Industry ❑Binding Site Plan** Propane ❑Long Plat** ❑ Sign 0 Planned Rural Residential Development(PRRD)/Amendments** ' O Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** o Stormwater Management O Shoreline Master Program Exemption/Permit Revisions** 0 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 0 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-Appfication Conference Please identify any other local; state or federal permits required for this proposal, if known: DESIGNATION OF AGENT , I ereby designate ,,U ' 5.Li i A.; Q 0 /,SNP to act as my agent in matters relating to this application for permit(s). 51'14 •WNER SIGNATURE t te/"-- Date: V /ZO 12_. ay 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 requir •later Inspecti s. Ste a ss and right of entry will be assumed unless the applicant info s the County in writing at the. r time of the applicati t� tJ e r s ants pri oft '"nature: C ` h l -- Pate: r L. Cj 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 y y are in compliance with a Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transfe blue resp nsib' y or adh r o and complying.with the ESA. The Applicant has read this d' cl mer an .signs and dates it below: Signature: (. �� t` ! �� Date: / i (:•\Prrrn;rCenrrr\###FORMS###\TlRT1 POP Mc\(',,.,•P„rr1Rn Rn.r,�\m.,",.,P.,,,,:.A....1:,.,,.:,..,r;on no,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 ER: PHONE: FAX: Sr._t„ Z ii t n e fP 2.-e PA-v^- (2 d ) 3 FS- -r 7 17 ( 3 Ge4 .3 eS-S"P 75 MAILING ADDRESS: / 0 E 5 3 i/. d /1 S••1 � e- r io. (1 EMAIL: CONTRACTOR'S LICENSE '� F� WAINS NUMBER: 5 L�VI 5 r �`* (.17 7 Q (,0 NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: 0 New 0 Wood Existing: 0 Sewer ❑ Addition 0 Steel Proposed: Bank 0 Community System 0 Alteration/Remodel 0 Concrete Total: Height: 0 Individual System 0 Repair 0 Masonry SEP Permit# 0 Demolition 0 Other: . Bedrooms: Water Supply: Existing: Setback: 0 Private well 0 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 4IBC 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: t I Underground Tank I Above ground Tank Size of Propane Tank: I Heat Stove I Cook Stove I Woodstove I Fireplace Insert I Hot Water Tank I Pellet Stove Other yc-g___,/e LIs 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. kn r hvy ' R`T , �wi5,' h y, y Square Footage Current Proposed = X ` }'c i . f ' Main Floor Heated p' ,�' ,';; EH Bld App Review. il.'Y,C* TM Y 2' Floor Heatedld ,, 'of •dEy"f pk Consistency Review: Other Heated 'ii: '', ¢,SS� #n are Base.fee: i Mezzanine ",; t't t `,t5 �r,yt Additional Section' Heated Basementkr: { �'' Plan Check fee: Unheated Basement "f t 5' r ., i State Surcharge fee: Other Unheated Mw. 01;i1..,,,"= - - J. f Pot Water Review fee: Garage/Carport ° " SUBTOTAL Decks Litt,ijr gar ,;41, .0 ,•. 911/Rd Approach fee: Other 4, r 'ile 1 , `t'' TOTAL $ I�n icy r�; ,�'L g', Receipt Number: 1 �t 2D 04 h�� 3A x Cash/Check Number: Z ESTIMATED COST(REQUIRED). � � J Date: 'Fair market value of all labor and materials foundation to finish �l __� Initials: ,