HomeMy WebLinkAboutBLD2012-00317 I
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#: BLD12-00317 Received Date 10/8/2012
SITE ADDRESS: 665 PINECREST DR Issue Date 10/8/2012
PORT TOWNSEND, 98368
APPLICANT: ELAINE JONES PHONE: 360-813-1435
4031 MOUNTAIN VIEW DR
BREMERTON WA 98310-4359
404
SUBDIVISION: KALA POINT#7 Block: Lot:
PARCEL NUMBER: 965000262 Section: 27 Township: 30N Range: 01W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 1a602012-5875
OWNER, ELAINE JONES PHONE: 360-813-1435
if different: 4031 MOUNTAIN VIEW DR
BREMERTON WA 98310-4359
PROJECT DESCRIPTION: REPLACE 2 120 GAL PROP TANKS -SAME SIZE & LOCATION
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: ` 0^ 3 a — I Z
FinalApproval: 10- 36 - I 16
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_Perm it_Propane.rpt 10/8/2012
tILDING PERMIT APPLICA•N BLD12-00317
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD12-00317 Received Date: 10/8/2012
SITE ADDRESS: 665 PINECREST DR
PORT TOWNSEND, 98368
OWNER: ELAINE JONES PHONE: 360-813-1435
4031 MOUNTAIN VIEW DR
BREMERTON WA 98310-4359
KALA POINT#7
SUBDIVISION: Block: Lot: 404
PARCEL NUMBER: 965000262 Section: 27 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 DESCRIPTIOP REPLACE 2 120 GAL PROP TANKS - SAME SIZE & LOCATION
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:
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 $74.00 LYK 10/08/12 135282 Total: $74.00 APPROVE:
au . s 2012
Jefferson County Plannin,
& Building Department
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SITE VISIT REPORT •
(PLOT PLAN)
JOB E24.1/N 07»6S DATE: /e//�/
CONTACT:
ADDRESS el N Ce PHONE #: 3c.® 0'/3 /yjr
DIRECTIONS fT 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 8 2012
JEFFERSON COUNTY
\\Sunshinel\E\BUSINESS\FORMS\PROJECT PLANNING\SITE VISIT REPORT-PLOT PLAN.doc DEPT.OF COMMUNITY DEVELOPMENT
ON ca JEFFERSONCOUNTY •
i - ' •\,% DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4461 Fax
'' * www.co.jefferson.wa..us/commdevelopment ,
Master Permit Application MLA: No in(
Project Description(include separate sheets as necessary):
'Pr oPauwt . �lq, js .
Tax Parcel Number:R(96 00a 20 2__ Property Size: (acres/square feet)
Site Address and/or Directions to Property:
(DU c jP11�c2f5T 1 cs+-c 'Tr-)00 t tip) c A 01%- 2c4,
Property Owner(s)of Record_- (.PI►lJ S
Telephone:3 D`<13.- I L(35 Fax: - email:
Mailing Address: go-i /loam I /0 Vi rv�P M02 DrJ el 3/(t
Applicant/Agent(if different from owner): \v _,A Coos.,--.�__
Telephone: ye5 - S7,7 Fax: -3 b'5--,5 8 751 email: S`�`d -.-<. a-,-e
Mailing Address: /O 85 3 kH 0 aay CP. Pi,, IV R-Dt o c% ij A Gy tea''
What kind of Permit?(Check each box that applies 0 Lot or Road Segregation
DBullding 0 Critical Areas Stewardship Plan
O Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use)
❑ Single Family ❑ Garage Attached/Detached ❑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**
ropane 0 Long Plat**
o Sign - 0 Planned Rural Residential Development(PRRD)/Amendments** .
O Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration**
0 Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions**
❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development**
❑Temporary Use ❑Shoreline Management Variance
0 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 aegent in matters relating to this application for permit(s).
1 11 a WNER SIGNATURE Date: b e) -Z l 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 T 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 of 11 p se off ap{Jicatlon
review and any required later inspections. Staffs access and right of entry will be assumed unless In p i 1 h t
1 time of the a n that she wants prior notice, O�} at the
• v
,t +� -'.nature:
, i fD. 2 —
The action or actions Applic nt will undertake as a result of the issuance of this permit may negativeliy itrtpact upon one or more.threate.e o
endangered species and could lead to a potential"take."of an endangered species as those teens arp defined in the federal law known a$th
"Endangered Species Act"or"ESA,"Jefferson County makes no assurances to the applicant that thei actigns that-will be undertaken be th s
permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit:on b-(4i'd'flof an Andan tired spode,'ragardind your
action(s)even if you are in compliance with the Jefferson County development code.The:Applicant 4knowledgesahritlielN h ibPit holds individoil
and non-trans rable res nsibility for adhering to and complying.with the ESA. The Applicant has read thipmbtssylltJ altihtl16i l °las it below.
` Signature ` .�� Date; ' /U -2— —/L_
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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 assumi the responsbility of the General Contractor for the proposed proje
Signature: Date:, t t9I.2'1 112--
GENERAL CONTRACTOR ER: PHONE: FAX:
Sru„ Shin e v.2 P ( 6(1 ) 3 aS- -r 7 I ( 364 3 irS-S) 75
MAILING ADDRESS: /0 R$3 r Pt p. ('' EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: S LA lel S *.9(1j 7 Q O NUMi3R
ARCHITECT/ENGINEER; PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
0 New 0 Wood - Existing: 0 Sewer
0 Addition 0 Steel Proposed: Bank 0 Community System
0 Alteration/Remodel 0 Concrete Total: . Height: 0 Individual System
0 Repair ❑ Masonry SEP Permit#
0 Demolition 0 Other: . Bedrooms: Water Supply:
Existing: Setback: 0 Private well 0 Two Party
Typo,of- lead Proposed: 0 Public
Total: ;.......a...L 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 Foot!Service? Yes / No '
f this Is.a P a e Tank and/or tia CO Ins llation permit,mark all Items below that apply:
I Underground Tank ove round T Size of Propane Tank: 4.P•-x._t.Z o
I Heat Stove I Cook Stove I Woodstove I Fireplace Insert I Hot Water Tank I.Pellet.Stove. I Other
Is this appliance,being installed in a Manufactured i Mobile Home? Yes / No
When applying fora 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.fines,buildings and septic system components,
including the reserve area.
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"h"WWI
.�t,A,yq,�a mXu- rig ��r �y w T.
Square Footage Current Proposed r I 4 ,7 "^�� t„u{ e t?I'i rn yyyr�,c �r ,F4 ` ?�" °.
Main Floor Heated ': EH Bid App Review:
i+,f. 1.441471. .,(
2"°Floor Heated % i,,„ ..gs rs : Consistency Review:
Other Heated ,,�,.
rh s � Base fee.
. Mezzanine .- w 64:,11 Additional Sec tion:
kr a35 Y,4
Heated Basement rig, ' 6y .:'. Plan Check fee:
' as i,.
Unheated Basement ',k, "'I�S State Surcharge fee:.
'`'r F4,Y A ,,�,; .J
' Other Unheated. . ` tAf ` _ ,� e�,Pot Water Review fee:
Garage/Carport ti..„.44,.;,7.il �`� SUBTOTAL
Decks , r 40F., s, ' 911/Rd;Approach fee:
Other a,j� c
A,T•
i � ; xxt . TOTAL:
�" 474 ;"A 4L; Receipt Number:
0'
�' .�b Cash/check Number:.
ESTIMATED COST(REQUIRED) Date:
•Felrmarket value of all labor and-materials foundation to finish.
Initials:
G:\PetmitCenter\###FORMS###\DRD FORMS\Current DRD Roam\Master Permit Anb'.ica inn 5-M-ntt ar,-