HomeMy WebLinkAboutBLD2012-00366 • S.
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 #: BLD12-00366 Received Date 11/8/2012
SITE ADDRESS: 40-2 UPPER BLUFFS DR Issue Date 11/9/2012
PORT TOWNSEND, 98368
APPLICANT: JAMES R ERICKSON PHONE: 360-385-3653
KAREN F ERICKSON
40-2 UPPER BLUFFS DR
PORT TOWNSEND WA 98368 3033
SUBDIVISION: THE BLUFFS BLDG 17 Block: Lot:
PARCEL NUMBER: 965300033 Section: 26 Township: 30N Range: 01W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339 Contractor's License SUNSHP"077QP Expires 1T/((33
16020125-5875
OWNER, JAMES R ERICKSON PHONE: 360-385-3653
if different: KAREN F ERICKSON
40-2 UPPER BLUFFS DR
PORT TOWNSEND WA 98368
PROJECT DESCRIPTION: A/G 120 GAL PROP TANK, FIREPLACE & 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 11/9/2013.
REQUIRED INSPECTIONS:
Tank/Line/Appliance:`1 K c Li rJg i 1-I'
FinalApproval: _ 1U"-IZ^1 j C,--11 V
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 11/9/2012
WILDING PERMIT APPLICA1IN BLD12-00366
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD12-00366 Received Date: 11/8/2012
SITE ADDRESS: 40-2 UPPER BLUFFS DR
PORT TOWNSEND, 98368
OWNER: JAMES R ERICKSON PHONE: 360-385-3653
KAREN F ERICKSON
40-2 UPPER BLUFFS DR
PORT TOWNSEND WA 98368 THE BLUFFS BLDG 17
SUBDIVISION: Block: Lot: 3033
PARCEL NUMBER: 965300033 Section: 26 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 DESCRIPTION A/G 120 GAL PROP TANK, FIREPLACE & PIPING
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 Bv: Date: Receipt: Approved/Date
Propane Tanks/Stoves $222.00 LYK 11/08/12 135390 PROV E D
Total: $222.00 4�.-
ta *2 2012
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SITE VISIT REPORT
(PLOT PLAN)
JOB S",,M ERLC*SD N
DATE: /01 I45112.
CONTACT:
ADDRESS 4o — 2 u.epux B\(AWSa)R "PT. PHONE #: 35S —3453 .
DIRECTIONS FAX #:
• Email
PLANNER: aea,v-e-- L , .
Include all street names adjacent to property,property lines,tank,appliance&pipingiocations,distances of tank to property lines and
buildings,septic,wells,wetland areas,distance to water bodies.
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I
ON •
001 JEFFERSON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
kiiii 621 Sheridan Street • Port Townsend•Washington b8368
360/379-4450 • 360/379-4451 Fax
d www.co.jefferson.wa..us/commdevelopment
Master Permit Application MLA: . lb
Project Description
p(include
separate sheets as necessary);
Tax Parcel Number: q'(05' *-_Cc*- _CCI)g Property.Size:
(acres/square feet}
Site ,Address and/or Directions to Property;
Property Owner(s)of Record;
Telephone: '�-)1c4 co Fax: v email:
Mailing Address; *-U-PP�'c fZ. 6t-lA PS 4)2 . T � p
Applicant/Agent(if different from owner): .c,,� �,, Q ~ p(14-ye.,......4_,_,
Telephone: 9415 57,7 • Fax: .38 5- 875; email: vY -s `dti,',..7p44aya,-e •c.e,,_
Mailing Address: . /0 d'S 3 kN a.d y -.60. P%,. //,L.v c% J..)A
What kind of Permit?(Check each-box that applies 0 Lot or oad Segre ation
DBuilding ❑Critical Areas Stewardship Plah
0 Demolition Permit 0 Variance(Minor,.Maaj or or sonable Economic Use)
0 Single Family 0 Garage Attached./Detached .❑Conditional U e[C a),.C d), r v
❑ Manufactured Home. ;0 Modular - 0 Discretionary 10 or Unnanje ta�sl ttl#n�
❑ Commercial* 0 Special,Use,( ssential Publie;�,
❑ Change of Use 0 Boundary Line AdjUstmeht '-`'
0 Address 0•Road Approach • 0 Short plat** I
❑ Home Business 0 Cottage Industry _ ❑Binding Site P an :% 2012 r
Propane 0 Long Plat** • i Li ,I
❑Sign 0 Planned Rural Res dential-DetrefopmeRt s.* . '
O Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/ Ite:'tion i • , ;(_ ! °,;iv
O Stormwater Management .
g 0 Shoreline Masi er P ogram ExeMption/Perntit Revisimsnir
0 Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Marag.e ent Substantial Development mr""- ------)
O Temporary Use 0 Shoreline Management Variance
0 Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment
O 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
**Requfre ,a Pre-Application Conference
Please identify any other local,state or federal permits required;for this proposal, if known;
+. j
DESIGNATION OF AGENT
I ereby designate to act as my agent in :attars relating to thi application for permit(s).
l' o WNER SIGNATURE
i� + Z t✓`/ -ti Date: V
i
By signing this application form,the owner/agent attests that the information provided herein; nd in any attachments,is true and correct to the best of
his, her or its knowledge Any material falsehoodor any omission of a material fact made by t e owner/agent with respect to this application packet
may result in this perrnitbeing null and void
I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,Jud men s,court costs, reasonable attorney's`fees and
expenses which. .ay in any accrue against Jefferson County as a result of or in c9nsequ nee cif the granting of this permit,
I further agree to • •vide access and right of entry to Jefferson County and its employees,rep asentatives or a9ents for the sole purpose of application
review and any re• red late inspe s. Staffs access and right of entry will be assumed unless the applicant inf s the County.in writing at the
r ,time of the appiicaio that or sh w2nts prior notice.
tr •nature: Date: ii Q /hJ
The,action or a, ion-Applicant will undertake as a result of the issuance of this permit'may,ne atively impact upon one.or more threatened or
endangered spe• : and could lead to a potential;"take."of an endangered species as those to ms a e defined in the federal law known as the
"Endangered Sp.cles Act"or"ESA,"Jefferson County makes no assurances to the applicant t at.the actions that,will be undertaken because this ,
permit has been I•sued wil not violate the ESA. Any Individual,group or agency can file a law;
uit;on behalf of an endangered species regarding your
aetion(s)even if u are I complia with the Jefferson County development code.The Applicant acknowledges th t he,s e or it holds individual
and non-transfer=C le resj.nsibility adhering to:and complying with the ESA. The Applicant has read this d I is I and dates it below.
Signature: ��ases,w. Date: / f U/
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BUILDER STATEMENT 1
The signer of this statement does hereby certify that they are the Owners of the parcel re1fgrenced herein,that they are not licensed contractors and that
they will be assuming the responsibility of the General Contractor for the proposed projet
Signature: Date:. ,
GENERAL CONTRACTOR ER: PHONE: FAX:
St c..t„ s t+t h e 2 P e� (A6d) 3 FS- -r 7 17
( 364 3es-Sa' 7S
MAILING ADDRESS.: /O E 5? —�,t- a P f p. (.ti EttIAIL:
CONTRACTORS LICENSE WAINS
NUMBER' SL-kNS- `T7 7 Qr NWMRER
ARCHITECT/ENGINEER: 7 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 I 0 Community System
0 Alteration/Remodel 0 Concrete Total: Height: 0 Individual System
o Repair o Masonry SEP Permit*
0 Demolition 0 Other: . Bedrooms: '; Water Supply:
Existing: Setback:
Type of Heat: Proposed: 0 Private well 0 Two Party
Total: Public
Name of System:
If this:is a Commercial Project you must answer the following: I
Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces:
Number of occupants(includes owners,tenants, employees, etc) Current Proposed
4• IBC Occupancy:, . IBC Type of construction: `Hill you have Food Service? Yes / No
—jf this is,a Propane Tan end/orl4ppliance Ins Ilatiorl permit,mark all items below that apply:
I Underground Tank Bove around Ta Size of Propane Tank:
I Heat Stove I Cook Stove l Woodstove Fireplace Insert I Hot Water Tank I:Pellet Stove. I Other
Is this appliance being installed in a Manufactured l Mobile Home? Yes / No I
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 prope lines,buildings and septic system components,
Including the reserve area.
"S•uare Foote•a Current Pro•osed a �'°c. �tk 1 `g}� i�i Atrr c5!L _ t N.tll `u . .l<. % i ..�(q pyElr{,, `l',,,piM� t rf:.
i f���� .\8@ 6 'IhC R ��� —�aN�S`d�"..'Sd < W7}Yvh.l �
Main,Floor Heated l I •
,010,r, i.. EH BId App R
fit tS.,!el•G.doh)
2` Floor Heated ; s
°` .Olfr r� K ti Consistency R
Other Heated �� + 7z �} Basefee: 1111 4911/Rill
Mezzanine 3
e, A. x"�ai.AgN Additional Soklion:
Heated Basement ta`,,, ,x ' Plan Check fee:
Unheated Basement4,0:7i.,,v,,„', State Surcharg-;fee
rk4 �f ;i
Other Unheated. . t 4
�. a, � ,ti �Pot Water Review fee:
Garage/Carport ,• fm� i,i.@y ` $' SUBTOTAL
94
Decks ;- mil ' sta 911/Rd;Approach fee: I
Other „ ,
TOTAL: 111111
r'e 1 ,ki'" , Receipt Nun* • i . ..
�"`' is Cash/Check Number: •
YY�h- i -2-1. `/ (.0
ESTIMATED (REQUIRED) Date:
•Fair market value of all labor and materials foundation to finish l
Initials
C I -
G:\PennitCenter\###FORMS###\DRD FORMS\Current bRD Pomas\Master Permit Applicriltio I 5-24 08.doc