HomeMy WebLinkAboutBLD2012-00396 • 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 #: BLD12-00396 Received Date 12/6/2012
SITE ADDRESS: 481 THORNDYKE RD Issue Date 12/6/2012
PORT LUDLOW, 98365
APPLICANT: JANETADE DONATO PHONE: 206-786-2024
ROBERT W GRINDELAND
481 THORNDYKE RD
PORT LUDLOW WA 98365-9568 8
SUBDIVISION: ADMIRAL'S ROW Block: Lot:
PARCEL NUMBER: 721095008 Section: 9 Township: 27N Range: 01 E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/1602013-5875
OWNER, JANETADE DONATO PHONE: 206-786-2024
if different: ROBERT W GRINDELAND
481 THORNDYKE RD
PORT LUDLOW WA 98365-9568
PROJECT DESCRIPTION: NEW GAS 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 12/6/2013.
REQUIRED INSPECTIONS:
Tan Li` ppliance: 9` L 2` IZ !" }
FinalApproval: \yv I " 15--
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_Propa ne.rpt 12/6/2012
• BLD12-00396
ftILDING PERMIT APPLICATION Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD12-00396 Received Date: 12/6/2012
SITE ADDRESS: 481 THORNDYKE RD
PORT LUDLOW, 98365
OWNER: JANET A DE DONATO PHONE: 206-786-2024
ROBERT W GRINDELAND
481 THORNDYKE RD
PORT LUDLOW WA 98365-9568 ADMIRAL'S ROW
SUBDIVISION: Block: Lot: 8
PARCEL NUMBER: 721095008 Section: 9 Township: 27 N Range: 01 E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2013
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP NEW GAS PIPING
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP MEC MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 2009 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: # OF STORIES:
OCCUPANCY:
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 $74.00 LYK 12/06/12 139810 PHHCK
Total: $74.00
DEC G� ��
Jefferson County Planning
& Building Department
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SITE VISIT REPORT
(PLOT PLAN)
JOB DATE:
CONTACT:
ADDRESS PHONE #:
DIRECTIONS FAX #:
Email
PLANNER:
Include all street names adjacent to property,property lines,tank,appliance&piping locations,distances of tank to property lines and
buildings,septic,wells,wetland areas,distance to water bodies.
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JEFFERSON COUNTY
DEFT.OF TY DEVELOPMENT
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I
.ON • 0
ea JEFFERSON COUNTY
1 ' \ DEPARTMENT OF COMMUNITY DEVELOPMENT
'N o 621 Sheridan Street • Port Townsend•Washington b83613
360/379-4450 • 360/379-4451 Fax
www.co.jeffersan.wa.usLcommdevelopment
Master Permit Application MLA I f 1
Project Description(include separate sheets as necessary): `
10-4-1 Pe/61-2- — ( "% e----- 4e. --61-''--- --41-'> '6a7`t-fr;Iss — C -r-A-c... 7efr-drie-de--
Tax Parcel Number: 7,,2 / -4 9 S - D 0 Property.Size:
(acres/square feet}
Site Address and/or Directions to Property:
c/ (7 A-o—,>) ce: 6.0 i)1 4 g d1‘5
/
Property Owner(s)of Record; Wiz-,-, - 0f' o,v 4-
Telephone: 2.0 6.- 7 r6 ZD Z�,! .. 7` fZ//✓6 1.771}}s�/�
/ Fax: email:
Mailing Address: 7 2-o %h,--r& a-4-e . �' . S o b �-e_-�- f� G- P/ 6/
Applicant/Agent(if different from owner): \4___, r-.a-$ p4...iy„...,....2______
Telephone: ,�85 S7,7 Fax: ..3 5 r S'�8 7 email: y1-210@,5-`444h•t+.t-,/r-ayJa.•,-e. 'c.,,,,,,,
Mailing Address: . /d e.53 kN o 2 y 02. _ Pi. d/,to ck, ti
What kind of Permit?(Check each•box that applies 0 Lot or Road Segregation
OBuilding 0 Critical Areas Stew'.rdship Plan
❑ Demolition Permit 0 Varian i tid:- t n p E. •.0 is Use)
❑ Single Family 0 Garage Attached/Detached 0 Condit a ��+ 10
❑ Manufactured Home. :0 Modular 0 Discretiona `.I `
�® y�.. . ien
O Commercial* 0 Special;Use' .,ssential Public Facilities);
❑ Change of Use 0 Boundat)i Linz AdjUstment .,,, r
❑ Address . 0 Road Approach ❑Short Plat** I - ,'. u iL '
❑ Home Business Cl Cottage'Industry ❑Binding!Site,P an'"i i
)Eteropane 0 Long,Plat**b 1i i
❑Sign •. 0 Planned Rural Res ideritiat meht((PRRI)/Amendments** '
❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/ it i.°* :11Y tJ '. °•IF"1I
❑ Stormwater Management
�nl
0 Shoreline I�as er P ogram.Exemption/Permit Revisions**
❑Site Plan Approval Advance Determination(SPAAD)* Cl Shoreline Manager lent Substantial Development**
0 Temporary Use 0 a Ma Shoreli
0 Wireless Telecommunication* '- l? a9e►rent Variance
❑Comprehensi a Plan/UDC/Land Use District Map Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson,Cou ty Shoreline Master Program Amendment
"May require a Pre Application Conference 0 Tree Vegetation Request
Require;: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 act as myagent in lnatt a rs relating:to this application for permit(s):
•{;/d owNER SIGNATURE 4d( )ai2e/t.
't ,cGi . � Date: l I /3 o L---
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 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,Judgnie s,court costs, reasonable attorney's fees and
expenses which may in any way accrue against Jefferson County as a result of or in cpnsequa�jjnce f the granting.of this permit,
I further agree to provide access and right of entry to Jefferson County and its employees,rep?eesentatives or agents for the sole purpose of application
review and a fired later inspection 7 Staffs a s d right entry will be assumed u less the applicant inf rms:the County In writing at:.the
t time of the app ca' that :or e w prior no :;
/. nature: l i v (L
f l
9 . - pate:
The action or actions Applicant will undertake 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 a e defined in the federal law known as the
"Endangered Species Act"or*ESA,"Jefferson County makes no assurances to the applicant that th actions that will be undertaken because this
permit hasybeenf s 1=d will not violate the ,SA. Ahy individual,group or a ency can file a law uit:o behalf of an'.endangered species regarding your
action(s)even if yo ••re in co:pliance wiu . e Jefferson County develo • ent code.The Appli nt acknowledges th he,sh or it holds individual
and non-trap- res. ill . s g to an4 ;om ing:with:t ESA. The Applicant has read this disclar ;end si ns and dates it below.
ivtiSignature: ,C L (/ b -�
ST Date:
1
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BUILDER STATEMENT i
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 responsibility of the General Contractor for the proposed proje4
Signature: Date:
GENERAL CONTRACTOR . ER: HONE: FAx:
Sit-, s 1+t n e fP 2 1°r41^.: (!Z6 ) 3 Fs- -r 7 f 7 ( 3 66) 3 es-.5"p 75
MAILING ADDRESS: /O g, 3 .-i pt P. ("( EfvtAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: S to V1 S- (� (� Q I� . :'t14UMBER
ARCHITECT/ENGINEER: / PHONE ( ) FAx:( )
MAILING ADDRESS: EPInAIL
ect Type: k
Pro
J Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
0 New 0 Wood Existing: 0 Sewer
0 Addition 0 Steel Proposed: Bank 0 Community System
❑ Alteration/Remodel ❑ Concrete Total: Height: 0 Individual System
❑ Repair 0 Masonry SEP Permit#
❑ Demolition ❑ Other: . Bedrooms: I Water Supply:
Existing: Setback: pP y
0 Private well 0 Two Party.,
Type'of'Heati Proposed: 0 Public
Total: Name of System: •
If this is a Commercial Prolect 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 Fooi1 Service? Yes / No '
4--jf this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply:
1 Underground Tank 1 Above ground Tank Size of Propane Tank:
I Heat Stove I Cook Stove 1 Woodstove I Fireplace Insert 1 Hot Water Tank I,Pellet Stave 1 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.
4 r,4,,.' Pop-.K7<r ,v [y jcvey r,�,�, ,, c ro i f.,, yta •'•. 9 1 y�, t9 ,r.
y�x yy �:
�'�J t t7 4?s 'ef.+ S�� e + ,; x(M dIY r',M /FFh 4� 41 �� l�'� �F,F
'S•uare.Foota•a Current Pro•osed 1`�s,8,,E� . ,� ,4} r; K ; `•uk>,Vme N 6 TI l` ,1 4 c „4f.er i,s°'F . �� '
Main,Floor Heated ,,6P',,.„f01,,, EH Bid App R=view:
xMs ;,
2n1 Floor Heated lf,46'''"":cr;liT67,4`
,. Consistency R view:
Other Heated #�. 4, r b7, Base fee:
Mezzanine •�5 ' ; Iwo.,
Additional:Section
Heated Basement 1.;41 ,ro ARM Plan Check fee:
Unheated Basement 4,4 , ° State Surcharge fee ,
Other tnheated' pit **�.,y Pot Water Review fee: 1
� )Y
Garage/Carport 'tx' •,�;�.`� ' i ',
, a .4, �� , , SUBTOTAL
Decks k, �x, l ,,+ 911/Rd Approach fee:
(" 1
Other 5 �, '` LI
,24 ," '•,I` �4, Receipt Number: `: qg iV
Ire, scc
,,, Y� `. Cash/Check Number:
ESTIMATED COST(REQUIRED) Date: ,
aFair market value of all labor and materials foundation to finish I I �- _
Initials:
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