HomeMy WebLinkAboutBLD2012-00279 • •
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#: BLD12-00279 Received Date 9/10/2012
SITE ADDRESS: 140 COOK AVE Issue Date 9/10/2012
PORT TOWNSEND, 98368
APPLICANT: JOHN K SAGER PHONE: 206-406-8781
PAMELA J SAMPEL
5911 47TH AVE SW
SEATTLE WA 98136-1408 1-10
SUBDIVISION: TIBBALS LAKE PARK Block: 38 Lot:
PARCEL NUMBER: 999003801 Section: 4 Township: 30N Range: 01W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 1'f/1602012-5875
OWNER, JOHN K SAGER PHONE: 206-406-8781
if different: PAMELA J SAMPEL
5911 47TH AVE SW
SEATTLE WA 98136-1408
PROJECT DESCRIPTION: NG 500 GAL PROP TANK, PIPING & FIREPLACE INSERT
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 9/10/2013.
REQUIRED INSPECTIONS:
Tank/Line/Appliance:TA23t( 0 u/G- L)ri+ 04 a_ cr2?-)Z
FinalApproval: l 0' = /,S_ / - 6-1>
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 HOURSA DAY
\\tidemark\data\forms\F_BLD_Permit_Propane.rpt 9/10/2012
WILDING PERMIT APPLICATS BLD12-00279
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD12-00279 Received Date: 9/10/2012
SITE ADDRESS: 140 COOK AVE
PORT TOWNSEND, 98368
OWNER: JOHN K SAGER PHONE: 206-406-8781
PAMELA J SAMPEL
5911 47TH AVE SW
SEATTLE WA 98136-1408 TIBBALS LAKE PARK
SUBDIVISION: Block: 38 Lot: 1-10
PARCEL NUMBER: 999003801 Section: 4 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 DESCRIPTIOI A/G 500 GAL PROP TANK, PIPING & FIREPLACE INSERT
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:
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 $222.00 LYK 09/10/12 134183 APPROVEr
Total: $222.00
SEP 10 2012
Jefferson County Plannin1
& Building Department
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SITE VISIT REPORT
(PLOT PLAN)
JOB -ZI Y\ 5-p�t.Q`C DATE : 71442, .
CONTACT: J
ADDRESS 14 O Ct\OVN AJ Q, '3C T + PHONE #: 2010-4'010-$78 1.
DIRECTIONS 1-6,„S4t-10 y... a.V-e '111 e60 V- A s fi-sc r FAX #:
D N • Email ?US PE1-:& t`Al4\L,Cb lv\
PLANNER:}-42-1-,
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.
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S E P 1 0 2012
I JEFFERSON COUNTY
MO DEPT.OF COMMUNITY DEVELOPMENT
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��1\1. Cob JEFFERSOCOUNTY,
1 A IA DEPARTMENT OF COMMUNITY DEVELOPMENT
`' "4\ ` ` 621 Sheridan Street •Port Townsend•Washington 98368
" 360/379-4450 • 360/379-4451 Fax
sz� www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: (o ( A
Project Description(include separate sheets as necessary):
TCOFY -rrx.�.te_, e i P, ,.\ fi 1,--.�p1a�,
Tax Parcel Property
Number: etq C1 ?DO 3Ro 1 — Size: (acres/square feet)
Site Address and/or Directions-to Property:__
(4.0 CbQIc--AV- . �`iC.l
Property Owner(s)of Record: v p 9 5t9 bEe-£ PA1..t(:4_,Pt Pt w1 / ,
Telephone:o)Oo - �. (0.7P �'[%[ • Fax: email:
Mailing Address: _ c1 Li `C rlk 5co --f 55 W ii 6b
Applicant/Agent(if different from owner): S C,L N}S I� I IV E p[�p'j A N E
Telephone: 385-579 7 • Fax: Lp 5- email: IN FCe SUA1S y/NE ProP4r7e..
Mailing Address: 10853 R{1ODY D 2•
3 i Nip k r [OR c.
9 833'1 c
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-Attached[Detached- LTDiscretionary"boor Unnamed Use Classification
❑ Manufactured Home 0 Modular 0 Special Use(Essential Public Facilities)**
❑ Commercial* 0 Boundary Line Adjustment
❑ Change of Use 0 Short Plat**
❑ Address ❑ Road Approach ❑ Binding Site Plan**
❑ Home Business 0 Cottagelndustry 0 Long Plat**
Propane 0 Planned Rural Residential Development(PRRD)/Amendments**
❑Sign 0 Plat Vacation/Alteration**
0 Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master.ProgrerrrE ,iN rri -r leis;*
❑Stormwater Management 0 Shoreline Manag t t a i �e e\J +`*•mil
❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Manage e
0 Temporary Use 0 Comprehensive PI a C/Land Use District Map Amendment
❑Wireless Telecommunication* 0 Jefferson County S ine Master Program Amenc m sn:
❑ Forest Practices Act/Release of Six-Year Moratorium 0 Tree Vegetaion Re u at
*May require a Pre-Application Conference
**Requires a trig' lication Conference --,j
Please identify any other local,state_or fedeTal permits required_for this_prapo ,'E i DuNTY
•
DEPT.OF COMMUNITY DEVELOPMENT -_
iDt6e DESIGNATION OF AGENT
\ I hereby designate Su 4s H 11\1E ti-0 p Pic to act as my agent in matters relating to this application for permit(s).
(15.1;NER SIGNATURE Date: 1(.4 z
By signing this application fo ,the ow ter/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 lialiiiities,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.
\GC('.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 ounty in writing at the
time of the a plication th t he wants prior notice.
ignature / 1 ii- I'L(Date:
The action or actions Ap ' ant will ndertake 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
S, 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-ransferable respo il'y or a ering to and complying with the ESA. The Applicant has read this disclaimer nd igns and dates it below.
ignature:
Date: /f(—t---
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc
0 BUILDER STATEMENT •
The signerof doesthe
this statement hereby certify that they are 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:
S'I1t 2I4II\L" Pko pace (360) 3S5— 577 ( 36O) 385-5875
MAILING ADDRESS: )0 853 Q y f e y a 1.1. EMAIL: L fl-f b AVs1IIvIe pro Pane a C c(Y\
CONTRACTOR'S LICENSE WAINS
NUMBER: C3UV\SN P+ DTP p NUMBER
ARCHITECT/ENGINEER: PHONE`( ) FAX: ( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New ❑ Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System
❑ Repair ❑ Masonry SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
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 Pro ane Tank and/or Appliance Installation permit,mark all items below that apply:
I Underground Tan l ove ground Tank Size of.Propane Tank: Ica
I Heat Stove I Cook Stove I Woodstove Fir eplace 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.Offic�e Use Only ;..� M � .'<.v Amount Revision ,
Main Floor Heated Iw'''• EH BId App Review:
2na Floor Heated 3... Consistency Review:
Other Heated Base fee: 9 N) -
Mezzanine ; Additional Section: �l
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee:
Other Unheated a;. Pot Water Review fee:
Garage/Carport- - 1 SUBTOTAL
Decks M' ,11I1* 911/Rd Approach fee:
Other TOTAL: $ ac9,—
Receipt Number: _0 5 I O _5
. - " "r Cash/Check Number: ,[__� Q'��5
t I 1: - l UV
ESTIMATED COST(REQUIRED) Date: l_ _
.Fair market value of all labor and materials foundation to finish
Initials: :— --------D_'
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc