HomeMy WebLinkAboutBLD2012-00373 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#: BLD12-00373 Received Date 11/15/2012
SITE ADDRESS: 2094 ANDERSON LAKE RD Issue Date 11/16/2012
CHIMACUM, 98325
APPLICANT: JENNIFER LOGUE PHONE: 253-459-5258
9402 187TH ST E
PUYALLUP WA 98375-6301
2
SUBDIVISION: FINNERTY-HANSEN SHORT PLAT Block: Lot:
PARCEL NUMBER: 901103011 Section: 10 Township: 29N Range: 01W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 1T/1602012-5875
OWNER, JENNIFER LOGUE PHONE: 253-459-5258
if different: 9402 187TH ST E
PUYALLUP WA 98375-6301
PROJECT DESCRIPTION: A/G 250 GAL PROP TANK SWAP OUT
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 11/16/2013.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: /44..1K 5044V G4tr die /07#/51
FinalApproval: oy -Yrr -Q\,E;c2—( 16//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 HOURS A DAY
\\tidemark\data\forms\F_BLD_Perm it_Propane.rpt 11/16/2012
ILDING PERMIT APPLICA N BLD12-00373
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD12-00373 Received Date: 11/15/2012
SITE ADDRESS: 2094 ANDERSON LAKE RD
CHIMACUM, 98325
OWNER: JENNIFER LOGUE PHONE: 253-459-5258
9402 187TH ST E
PUYALLUP WA 98375-6301
FINNERTY-HANSEN SHORT PLAT
SUBDIVISION: Block: Lot: 2
PARCEL NUMBER: 901103011 Section: 10 Township: 29 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 250 GAL PROP TANK SWAP OUT
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 $74.00 LYK 11/15/12 139753
Total: $74.00
NOVI( 1 2
Jefferson County Planning
& Building Department
firlcmarlr\rlaf�\forme\F RI fl a,,r% Rlrl rr,f 11/1R/9M9
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ON CO
JEFFERSON COUNTY
Ird \ DEPARTMENT OF COMMUNITY DEVELOPMENT
'\: 621 Sheridan Street • Port Townsend•Washington 98368
360/379-4450 • 360/379-4451 Fax
144*, , www.co.jefferson.wa,.us/commdevelopment
Master Permit Application MLA: rio Mca
Project Desc• tion(include separate sheets as necessary):
Tax Parcel Number:. Ut v Q Q 1 l Pfopertysize: iF (acres/square feet)
Sit- Address and/or Directions to Property: .
q mono a 6 d.�.�&t • 149 t e- ) I,/t .i W !.',_fl S 3A1
Property Owners)of Record: ----.1101J
Telephone:dFJ -- .--(1.--- Fax' 1L , ( em l
Mailing Address: q
° (.�' 1 � • PLC a_t --� T
Applicant/Agent(if different from owner): • cr
Telephone: ,385 - S7� 7 Fax: 38 5 ...1)-875 `email: />' -514414 .L/D .c.•),,,
Mailing Address: /a 8,5 3 • kii 0 6I 'OP. Kr. t/419 c o c%, ,„.)A. ,
What kind of Permit?(Check each box that applies 0 Lot or Road Segregation
OBuilding 0 Critical Areas Stewardship Plan
❑ 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
❑ Commercial* 0 Special Use(Essential Public Facilities)**
❑ Change of Use ❑Boundary Line Adjustment
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 * '
❑Allowed"Yes"Use Consistency Analysis 0 Plat.Vacation/Alteration**
0 Storrnwater Management 0 Shoreline Master Program.Exemption/Permit Revisions**
0 Site Plan Approval Advance Determination(SPAAD)* 0 Shorelihe Management Substantial Development**
El Temporary Use o Shorelihe Management Variance
❑Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium ❑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 hereby designat( I to act as my agent in matters relating to this application for permit(s).
{; ••WNEF SIGNATURE7 Date \ , t ly I
By signing this applicat on form,the owner gent 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 access and right of to Jefferson County and its employees,representatives or a9ents for the sole purpose of application
review and y required ter inspection Staff a s and right of entry will be assumed unless the applicant informs the County in writing at the
' time of the application at he or she w ntt nor tide
�t +� '•nature: {_{ �L( . ` Date: 111S 1
The action or act ns Applicant will undertake as a result of the suance.of this permit may negatively impact upon one or mote threatened or
endangered species and could lead to a potential`take."of an endangered spades as those terms are defined irrthe federal law known as the
"Endangered Species c or"ESA,"Jefferson.County makes no assurances to the applicant that.the actions that will be undertaken because this,
permit has be issued will •t violate the •. Any dividual,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)e n if you are in ••mpiiance wit -'J ffe n County development code,The Applicant acknowledges that he,she or it holds individual
and non- ansferable res."risibility for,-• • • t• = • the ESA. The Applicant has read this disc a .7- n lens and dates it below.
Signature: LLLU", I Date:
(-:•\Prrrnit genre,\0-##Fr1RMC###\T)Rr)F(IR M.C1 C,,,- t T1RT1 F.,,-,-"A N f..•r..,n.,,,,:.A.,..t:...,«,..,c no no.a,,..
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The signer of this statement does hereby certifyBUILDER.STATEMENi�
they wig b®a g.the res that they are the Owners of the parcel' f rented herein,that the are
pgnsibil' .of the Gene7al Contractor for the proposed prole
Signature: Y not licensed contractors and that
GENERAL CONTRACTOR Date.. /:. ,( i.• •
ER:, f f
Slc Ly cS ln C' OQ -43 10 ONE: FAX:
7-5-
MAILING ADDRESS'
0 le/ (�6d ) 3Es- s7 l36� ?
CONTRACTOR'S LICENSE r ✓ eS'S" ?S
NUMBER: p ( EMAIL:
ARCHIEEGT/�N6INEER: W.INS
.:„.A.
i Q h raaEl
MAILING ADDRESS: PONE
Project Type: FM:
0 New Frame Type; EMAIL.
0 Wood Bathrooms:
Addition Existing: Shorelia Type of Sewage Disposal:
C] Alteration/Remodel 0 Steel Proposed: 0 Sewer
o Repair 0 Concrete -„ i� Bank
o Demolition 0 MasonryTotal: ght: . 0 Community Systern
•
Hei
0 Other: Bedrooms: �� jp System
Type*afleaEi
Individual
Sl Permit.#'
Existing: ---_• Setback: I Water Suppiy;
Proposed: I Private well 0 Two Party:
Total: I ❑ Public
If thisas.a Commercial Pro Oct ,ou - Name of System: •
Number of i'arki ust answer the foltowin c `"_____
Spaces:. Current:
:Number of occupants Proposed• upants(includes owners;tenants, employees, Number OfA
IBC Occupancy .: etc) Current Parking$paces;
• f this 1s.a a .. IBC Type of construction: � P Opaaed . '
i. .a eTan :. • . .rA.. ia ceIns.:'I.tiol .ermi mat, alli _m` lflyouhaveFoi •
i Underground Tank _ .,•c!' arvice? '. •
--round Tan below ,at ,
i Heat Stove l Cook Sto Size of Propane ankh
J Heat I ant beta insta\ stove I.Pirepiace.�lt�sert t
le n a Manufactured/Mobile Home?t Yes l Qater :k I.pellet;9tA e. ;
Wien ep�'lg,t�r•a peririlt to install a propane tank you must also submit Other
ty
irnee tank lacattar�ape init distances a from the tank
must al o
•lines,ta. l o ad n a area.
hmlt site; n ,plan sho rig and septic
the ystemgs apononta
, props lines,buildings and se tic s
S•uare Focta.e Current •. r ' �` �r'y, ,+�; system components,
Matrj::Floor Pro•osed n��* c 1:0 `' l 's J,4 41- 11 p ,
Heated a�ey���r .fz, � i�' � a y�� F r
�"'" '�{"i '!,'.,f,:,,:
Tp•' �.' f L' .r J.�� v .7�U'' a'�t S !Y�
2' Floor N � r .,�1��'�; +�;:EH Bid App R=flew: -^x,.te�1,(l�:�n�r a P, � .5�. i k
Heated � � '«, * .��
�Y ,.,��« Consistency R: _
Other Heatedni
7,e. r ,.i .,
antil
Ifil
I
< ' Additional Se. on: "�
l
Unheated Basement
` State Sur'char a fee:iiiiiiiiillini
.. ; 4..-, gl
Other: nheatei! ` # # a Y '.Pot Water Rev"ew fee:
Garage/Carport
.i. r'4, _ .
r 'SUBTOTAL
4t rCQCC$ ` ` `
'.
9111Rd Approa fee;
s Other
4
fTOTiQL. EINIMmillimin.
_ . a�
ir a"; '' Receipt Nu
tuber:
WI
1111MVPi;;;(yY kf' Cash/Check Number:.
ESTIMATED COST(R QUI EQ) AI ,NI I m�
Date:
•Fairmarkst value-of all laborand materials foundation::to`finishIND ELUI_PIAIlaullIllMll
"
f
Initials: ` -.-....
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rinsWaater'Pemvt Alsbliesitioir 5-Z�.4-08.doc
SITE VISIT REPORT
(PLOT PLAN)
JOB �!l�I 6 (Z6 ce DATE: . CONTACT:
ADDRESS aOQ i.1 b`V 1M PHONE #:
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.
{C �,
,; , • 2vl �� NOV 2012 II
JEFFERSON COUNTY
DFPT.OF COMMUNITY DEVELOPMENT
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