HomeMy WebLinkAboutBLD2012-00316 • •
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 #: BLD12-00316 Received Date 10/8/2012
SITE ADDRESS: 6950 OAK BAY RD Issue Date 10/8/2012
PORT LUDLOW, 98365
APPLICANT: WILLIAM K DOWLING TRUSTE PHONE: 360-437-0545
DOROTHY M DOWLING TRUSTEE
6950 OAK BAY RD
PORT LUDLOW WA 98365-9440 TX 23
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 821051017 Section: 5 Township: 28N Range: 01 E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/ u12 5875
OWNER, WILLIAM K DOWLING TRUSTE PHONE: 360-437-0545
if different: DOROTHY M DOWLING TRUSTEE
6950 OAK BAY RD
PORT LUDLOW WA 98365-9440
PROJECT DESCRIPTION: WATER HEATER& 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 10/8/2013.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: '�`i/�--� (\r ( d ( — ( 3 I"1
�"
FinalApproval: r ;
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 10/8/2012
•UILDING PERMIT APPLICA N BLDI2-00316
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD12-00316 Received Date: 10/8/2012
SITE ADDRESS: 6950 OAK BAY RD
PORT LUDLOW, 98365
OWNER: WILLIAM K DOWLING TRUSTE PHONE: 360-437-0545
DOROTHY M DOWLING TRUSTEE
6950 OAK BAY RD
PORT LUDLOW WA 98365-9440
SUBDIVISION: Block: Lot: TX 23
PARCEL NUMBER: 821051017 Section: 5 Township: 28 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 DESCRIPTIOr WATER HEATER & NEW PIPING-4- OEMSk5iz✓
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 $148.00 LYK 10/08/12 135281 ifAHHIO V
ETotal: $148.000C! ZC12
Jefferson County Planning
& Building Department
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SITE VISIT REPORT
(PLOT PLAN)
JOB Week `-bck..".I11 DATE
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CONTACT:
ADDRESS 4`73-0 0 AK a� PHONE #: 437—p,5-5 .
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.
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OCT - 82012 +' •
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JEFFERSON COUNTY
DEPT.OF COMMUNITY DEVELOPMENT
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JEFFERSON COUNTY
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' \� `� DEPARTMENT OF COMMUNITY DEVELOPMENT
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ozv 621 Sheridan Street• Port Townsend •Washington 98368
K360/379-4450 • 360/379-4451 Fax
� (5 www.co.jefferson.wa.usfcommdevelopment ,
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Master Permit Application MLA: AO L
Project Description(include separate sheets as necessary):
Tax Parcel Number l 0 JC—J 01---) A et
Property.Size: (acres/square f( q e }
•
Site Address and/or Directions to Property:
Coa 50 C'�•A14, : `tom I t G`64S-
Property Owner(s).of Record: L Z,u L/ l
Telephone: L/3-j_ °5---- 5 Fax: email:
Mailing Address:
•
Applicant/Agent(if different from owner): 'L,,- ,h 0 PA--dy --
Telephone: y@5 S7, 7 Fax: 3 g . - 8 7,5 email: G›- -tee S`4-4A-,-,LiDwa,-e ,c.,,,
Mailing Address: /d853 .Ncby .6Q. PT. //R-c.oc/c i.)A•
What kind of Permit?(Check each box that applies 0 Lot or Road Segregation
❑Building 0 Critical Areas Stewardship Plan.
0 Demolition Permit 0 Variance(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
o Commercial* 0 Special Use(Essential Public Facilities)**
❑ Change of Use 0 Boundary Line Adjustment
0 Address ❑ Road Approach 0 Short Plat**
❑ Home Business 0 Cottage Industry 0 Binding Site Plan**
, .Fropane 0 Long Plat**
o Sign 0 Planned Rural Residential Development(PRRD)/Amendments** .
O Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration**
❑ Storrnwater Management 0 Shoreline Master Program.Exemption/Permit Revisions**
O Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development**
0 Temporary Use 0 Shorelipe 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 Pre-Application Conference
Please identify any other local, state or federal permits required;for this proposal, if known:
DESIGNATION OF AGENT
I ereby designate to act as my agent in matters relating to this application for permit(s).
C-Yl''Il •WNER SIGNATURE Date: 10- 2-- 't Z
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 factmade 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 pro ide access and right of entry to Jefferson County and its employees,representatives or ag6nts fn jipiication
review and any requi ter inspections. Staffs access and right of entry will be assumed unless prft tli n i at the
• time of the apAicati _e or she wants prior notice. •
-.nature:
cam - r al}e: Z• t Z
tw The action or actions Applicant i I i ct pp cant will undertake as a resu' if the issuance of thishi ,permit may negative i pt upon one or mote threate e
endangered species and could lead to a:potential"take.'!of an endangered species as those terms ar ll4e ined in the federal law known i t
"Endangered Species Act"or"ESA,"Jefferson County makes no assurances to the applicant that the I,�i <�s that will be undertaken be th s
permit has been ed will riot violate the ESA. Any individual, group or agency can file a lawsuit onlltehaf cies regarding your
action(s)eve if • - . in compliance with the Jefferson County development code,The Applicant abknowledgesiif4 s er, ,ftp jndivid al
and non-tra/ferab/_ ;nsibiiity for:herig to and complying.with the ESA. The Applicant has read this'diaela below,
Signature: .. �i--l - (' 2 C.Z
S �` Date
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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 re on ibility of the General Contractor for the proposed project.1')í
Signature: ''' '`'g date: to In—
GENERAL CONTRACTOR ER: PHONE: FAX:
St._v, s i+l n e fP PA--1 (?(,d ) 3 Fs- -r 7 17 ( 3 44 3 eS-S P 75
MAILING ADDRESS: J O 5? i7 f p. (y EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: 5 LA k'l S ` 7`>k (;)rl 7 Q lO NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New o Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank d Community System
❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System
D Repair 0 Masonry SEP Permit#
❑ Demolition 0 Other: Bedrooms: Water Supply:
Y:
Existing: Setback: 0 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 FoodService? Yes / No
—)f this is,a Propane Tank and/or Appliance Installation permit,mark all items below that apply:
T Underground Tank i Above ground Tank Size of Propane Tank:
1 Heat Stove 1 Cook Stove i Woodstove 1 Fireplace Insert C Hot Water Vitt i Pellet Stove 7 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,
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�` Yn� '1V� 4 pry f 1.- y ' t-iu^ .'"�I :'y4, P f`�'" "+fit." +..,�{r 1, ,A .,lit t*' ,fi 1 4 N.7N�,',fg '£,• k 9'a
S•uare Foote.e Current Proposed ` „ aa .,u' + 6jdfl�f.' < iA A� vet")'' , r yah N't 71% . 'v*r`y , "w'le hyy'. .. r".
- -` ap r�t�i4' R. .,.3.. 8� . �, it..,� J,}.e p�'�e.4'n.. nn.C1.@QFb����4F�:Y� •��dj�j o 1�*4 �",�i„l� .yi�?�'x
Main Floor Heated I ,fr EH Bid App Review:
1Yfa i
2'Floor Heated .1.'4„� `_Arl; p� , Consistency Review:
h t.
-1,
It
Other Heated f ,!' .v Base fee:
yd
Mezzanine ` $ � fti z�#y\,li Additional Section:
Heated Basement t4.:r a�, { < <h Plan Check fee:
Unheated Basement Iiw*k 4 ,' State Surcharge fee:
h; ,; l , cs _
Other Unheated , .9 Pot Water Review fee:
Garage/Carport dl' 't1 ; SUBTOTAL
0 4f ttr.
Decks :4 ` i y„ 911/Rd Approach fee:
Of -�
Other }f�k, G
h,.,.) .. TOTAL: $ (LI p
r: ` , Receipt Number. • I
r_, ° 7 Cash/Check Number z-t[}/TJ
18
ESTIMATED COST(REQUIRED) Date:
•Fair market value of all labor and materials foundation to finish ' (7
Initials: �`''
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