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Home My WebLink AboutBLD2012-00265 • 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#: BLD12-00265 Received Date 8/27/2012 SITE ADDRESS: 11 N PALMER DR Issue Date 8/27/2012 PORT TOWNSEND, 98368 APPLICANT: JOYCE A CARDINAL PHONE: 360-379-2636 11 N PALMER DR PORT TOWNSEND WA 98368-9489 1 SUBDIVISION: CRESTHAVEN SUBDIVISION Block: Lot: PARCEL NUMBER: 946100001 Section: 12 Township: 30N Ranqe: 02W CONTRACTOR: OWNER/BUILDER PHONE: OWNER, JOYCE A CARDINAL PHONE: 360-379-2636 if different: 11 N PALMER DR PORT TOWNSEND WA 98368-9489 PROJECT DESCRIPTION: A/G 120 GAL PROP TANK, LINES, COOK STOVE & HEAT STOVE 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 8/27/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: "% ,'�i x 92 yas-i2— 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_Permit_Propane.rpt 8/27/2012 RILDING PERMIT APPLICAT!I B Review 0265 Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD12-00265 Received Date: 8/27/2012 SITE ADDRESS: 11 N PALMER DR PORT TOWNSEND, 98368 OWNER: JOYCE A CARDINAL PHONE: 360-379-2636 11 N PALMER DR PORT TOWNSEND WA 98368-9489 CRESTHAVEN SUBDIVISION SUBDIVISION: Block: Lot: 1 PARCEL NUMBER: 946100001 Section: 12 Township: 30 N Range: 02 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr A/G 120 GAL PROP TANK, LINES, COOK STOVE & HEAT STOVE(2) 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: 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 Propane Tanks/Stoves $222.00 LYK 08/27/12 135144 APPRovEr Total: $222.00 AUG Z7 2012 Jefferson County Planninc & Building Department \\firlcmor4\rInfn\forme\F RI n Ann PIA rnf p/77/7/117 (--s .,.._ °N °G°Ga. JEFFERSON WJNTY f ' rpi DEPARTMENT OF COMMUNITY DEVELOPMENT 1-2 ` `4 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax �qsIIIN G 0 www.co.jefferson.wa.us/commdevelopment Master Permit Application ,� MLA: NO MLA Project Description(include separate sheets as necessary):—�% LI i,�-Ora a BCD gee iv) gfir UL.0/AB p R ,�}i.1��Gt b l�� t ioQ bi D�& f Ic/ /i5ToVt 5 ►-ifGti S reVE Tax Parcel Number: WO I COO On I Property Size: ' (acres/square feet) Site Address and/or Directions to Property: $ V/9//06/2 1 - • 1 P o r2.T lhi ) £:,p W - 9 8', c/ .Property Owner(s)of Record:_ ) i 1. Q' - 'ar is Q/ Telephone: ��%OD �/00 ` 3L� Fax: email: i C.&C�J /IQ/1.r'e/,- M ailing Address: .4}-jy = 3bo 'fa P4-379-21034( fE) -1 y / Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit? (Check each box that applies 0 Lot or Road Segregation Building 0 Critical Areas Stewardship Plan Tit E Demolition Permit 0 Variance(Minor, • ❑Single Family 0 Garage Attached/Detached 0 Conditional Use[ ,(h , , ❑ Manufactured Home .0 Modular - 0 Discretionary"D"driJr� r�jl , ' • ❑ Commercial* 0 Special Use(EssOljtial,P0blic Facilities)** • Change of Use 0 Boundary Line Ad 'st lent ❑ Address 0 Road Approach_ 0 Short Plat** AUG 2 / 2012 f ❑ Home Business 0 Cottage Industry 0 Binding Site Plan'`*LJ L Propane ❑ Long Plat** n 3iyn 0 Planned Rural REIsidential Deliele t}$b(1R�RD)/ mena ents** ❑Allowed"Yes'Use Consistency Analysis 0 Plat Vacation/Alt,ratio& ?OF COMMUNITY DEVELOPMENT ❑ Stormwater Management 0 Shoreline Master Program Exemption/Perm) e * ❑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 i] 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: r^ /�, / DESIGNATION OF AGENT I hereby designate " " `-1 /' !e/)��°�i,,( ` L L t-i-✓ to act as my agent in matters relating to this application for permit(s). �QWNER SIGNATURE , (,if. Date: Va/7/v By signing this applicati 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 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 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 app. that ee o sshe ww is prior tice. �'3ignature: L ,0�, 6( ` t'C� ' &V)& Date: / ,///2_ The action or ac ons 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-trap le responsibility adhe ' to ra,�d-gomplyin ith the ESA. The Applicant has read this disclaimer and si s and dates it below. � gnature: (' (��'Y� Date: Y/ /7/ 2. c.\n....,,;,-C,,«.,.\ttttliFllRMClltttt\IIRTI 1-7(1P M \c,,..P, TIR TI P....--\1\.f„.«o,A....,:« A....1:,-,.«:,—c 10 na a,.,. BUILDER STATEMENT III 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 ass ming the responsibility of the General Contractor fo for �/the proposed project. Signature: ge a . at% Date: d /c.;e7/7_ GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTORS LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: ❑ Sewer U Addition ❑ Steel Proposed: Bank E Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System O Repair ❑ Masonry SEP Permit# _ Bedrooms: Water Supply: L Demolition D Other: pp Y: Existing: Setback: ❑ Private well ❑ 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 • If this is a Propane Tank and/or Appliance Installation permit,mark all items below that�apply: i Underground Tank 'Above ground Size of Propane Tank: Meat Stove Cook Stove i WoodstoveTank I Fireplace Insert i Hot Water Tank i Pellet Stove i 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 For Office Use Only Amount Revision Main Floor Heated EH Bld App Review: 2nd Floor Heated Consistency Review: Other Heated Base fee: JC)3 Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $�cQ Receipt Number: 'J5 14- Cash/Check Number: I ESTIMATED COST(REQUIRED) Date: c 7,i� •Fair market value of all labor and materials foundation to finish j_ Initials: C-c_____________.--D G\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc