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HomeMy WebLinkAboutBLD2012-00409 0 • MECHANICAL AND DEMOLITION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD12-00409 Received Date 12/19/2012 SITE ADDRESS: 130 COLMAN DR Issue Date 12/19/2012 PORT TOWNSEND, 98368 APPLICANT: ANN E HUETER TRUSTEE PHONE: 360-379-4663 ANN HUETER REVOCABLE TRST 130 COLMAN DR PORT TOWNSEND WA 98368-9409 43 SUBDIVISION: CAPE GEORGE COLONY DIV 7 Block: 14 Lot: PARCEL NUMBER: 939601442 Section: 13 Township: 30N Range: 02W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 1//1602013 5875 OWNER, ANN E HUETER TRUSTEE PHONE: 360-379-4663 if different: ANN HUETER REVOCABLE TRST 130 COLMAN DR PORT TOWNSEND WA 98368-9409 PROJECT DESCRIPTION: A/G 120 GAL PROP TANK, HEAT STOVE & LINES 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 12/19/2013. REQUIRED INSPECTIONS: 1 Tank/Line/Applianc\1 `L ) O'' ') _/ FinalApproval: 1 ( ------( 1 5 ° BUILDING INSPECTION HOT-LINE 379-4455. REQUESTS MUST BE RECEIVED BY 3 PM THE DAY BEFORE THE INSPECTION IS NEEDED. Office Hours 9:00 a.m. -4:30 p.m. Monday-Thursday HOT LINE AVAILABLE 24 HOURS A DAY \\tidemark\data\forms\F_BLD_Permit_Propane.rpt 12/19/2012 •UILDING PERMIT APPLICA N BRD12-00409 view Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD12-00409 Received Date: 12/19/2012 SITE ADDRESS: 130 COLMAN DR PORT TOWNS END, 98368 OWNER: ANN E HUETER TRUSTEE PHONE: 360-379-4663 ANN HUETER REVOCABLE TRST 130 COLMAN DR PORT TOWNSEND WA 98368-9409 CAPE GEORGE COLONY DIV 7 SUBDIVISION: Block: 14 Lot: 43 PARCEL NUMBER: 939601442 Section: 13 Township: 30 N Range: 02 W 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 DESCRIPTIOF A/G 120 GAL PROP TANK, HEAT STOVE & LINES 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: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: 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 $222.00 LYK 12/19/12 139835 A P��®� Total: $222.00 t ULI, Jefferson County Planning & Building Deoartmer° 1\+irlom�r1ArJofo\fr.rmc\C RI fl 4nn PIA rr.+ 19/10Mr119 e • . . . .. i SITE VISIT REPORT (PLOT PLAN) A N N .k 1r DATE: /ZI1b1)-2— TACT: .4PDRESS i 30 C.01-e-WNAN` PHONE #: 'IRECTIQNS eb-V-e.°S�6Yh�'1J1\N.R. TO N. po.\y tisl( FAX #: Tb Q0- a,v\, or\ RT. Email PLANNER: T.,- . 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. i I 1 ( < 6D 1 I \\ L,v1►vv1 i 1 , i I cio ' 9 ii2fJo�� tv' / JEE'ERSON COUNTY V ,I OF C� MUNITY DEVELOP(�,Fb•�T l Z. t F, � z. � '' r I /�1� 41i2 C2-ogr Sh�lile Yoo►c- , 4epr Tad I-us V T-avnl&Lust, se-7 Shown aowN 1.0. e14 S ov-e.., 1M 0` v LAf N 0 Mw-oT1 LO N LY C Fov N po\ l D f`>> • • \\Sunshine1\E\BUSINESS\FORMS\PROJECT PLANNING\SITE VISIT REPORT-PLOT PLAN.doc 1 ,ON_0 •JE FE • 1 F. RSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend•Washington d8368 4! 1.. tto., 360/379-4450_• 360/379-44a5 1 Fax www.co,jefferson.wa.us/commdevelopment • Master Permit Application MLA: 1Q, (''lam Project Description(include separate sheets as necessary): T4'h- -1 S7D f f fP i n, n . Tax Parcel Number: '3 �f ;6 p / ,y yam_ Property.Size:^ (acres/square feet), Site Address and/or Directions to Property: 13 b Co( -, • 0 R Pi--, J p4)r/ - 6jn Property Owner(s)of Record: -Y1 n / Telephone: 3 7 I- I-1‘Co .3 Fax: email: Mailing Address: .S/ r-e. Applicant/Agent(if different from owner) Vic ,,, .t_.... h,.,A_____, Telephone: 385 S75 7 • Fax: .Jg 5--.5875 email: Y Sw4'444,..alpare a,-e. ,c,,,,,, Mailing Address: . /.ad'$3 kf-/a d y• .FOR. Pi. t/41-Dc.O ck A What kind of Permit?(Check each•box that applies 0 Lot or Road Segre ation [Building 0 Critical Area's Ste .rdship Plan • O Demolition Permit 0 Variance(Min r, M jor or Reasonable Economic Use) O Single Family 0 Garage Attached./Detached 0 Conditipnal U e[C(a)., C(d).,or C]** O Manufactured Home • .0 Modular 0 Discretionary D"or Unnamed Use Classification O Commercial 0 Special Use( ssential Public Facilities)** ❑ Change of Use t�stment g 0Bounds Lin Add ❑ Address O Road Approach ❑Short Plat O Home Business 0 Cottage Industry 0 Binding Site P an** � ,ropane . 0 Long Plat** ❑Sign .• 0 Planned Rural Res dential-Development(PRRD)/Amendments** O Allowed"Yes"Use'Consistency Analysis 0 Plat.Vecation/ Iter tion** ❑ Stormwater Management 0 Shoreline a em lion/Permit Revisions'*" ❑Site.Plan Approval Advance Determination(SPAAD)* 0 Shoreline Ma n opment** ©Temporary Use 0 Shoreline Ma j 1 ❑Wireless Telecommunication* 0 Compr he S • � DC ` �, , ,I�n/U n p Amendment. O Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson Epu 'ty,Shoreline Master Progra 'A dment *May require a Pre-Application Conference 0 Tree Vegetati n Request ¢**Re fir a Pre•Applicatlpn Conferenal Please identify any other local;state or federal permits required If f r thi al, if known '` fpr .JEFFERSON COUN I • DESIGNATION OF AGENT C01f • Mun7IYDfYFLOP.. ' I ereby designate • . to actas my agent in afters relating:to • n for permit(s). 9.0 •WNER SIGNATURE ,_ Date: p j� By signing this application form,the owner/agent attests that the information provided herein, nd in any attach nts,is true and correct to the best of his,her or its knowledge. Any material falsehood-or any omission of aMaterial fact made by t e o ner/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,Jud men s,court costs, reasonable attorneys fees and expenses which may in any way accrue against Jefferson County as a result of or in consequ rice f the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employees,reprasen atives or agents for the sole purpose of application review and any requir ter inspections. Staffs a s and right,of entry will be assumed unless the applicant Inf mist e County.in writing at.the.' . .;time of the applies at he:or swan r no. - •nature: ! �v� � Z y fr I. Date: f' J The action or actions Applicant will undertake as a result of the issuance of this permitmay negatively impact upon one,or more threatened or endangered species and could lead to a potential."take"of an endangered species as those terns are defined in the federal law known as the "Endangered Species Act"or"ESA,"Jefferson County makes no assurances to the applicant that the actions that will'be undertaken because this _ permit has been issued will not violate the ESA. Any individual,group or agency can file a law uit;on behalf of an'endangered species regarding your action(s)even if you are in compliance with the Jefferson County development code:The Applicant acknowledges that he,she or it holds individual and non-transferable respo ility for adhering to nd co plying,with the ESA. The Applicant has read this disciar er i'ns and dates it below. Signature: � ,����� . �s-7� � L�.ui(� Date: �? �` it � � (:•\P,,,,,h m-0.,\tkotth RMC###\DRT.)hohN,rc\(,,,-,-TIP Fr.r..,•\A,r„•r..rn.....:r 4.,..1:,..,.:..,,c'0 n .7,.., I 0 t I BUILDER.STATEMENT The signor 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 project: Signature: Dater GENERAL CONTRACTOR ER:• PHONE: FAX: Sc`v, s t+l n e °i2 P"h?"4(• ('�,36d ) 3 Fs- .r 7 y 7 ( 3 44 3 eS-3.-P 75 MAILING ADDRESS: /O g S 3 " i pt p. (�( MAIL: CONTRACTOR'S LICENSE WAINS NUMBER: 5 CA.Ii 5- .,\G pfi 7 Q r NUMBER . ARCHITECT/ENGINEER: • PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: i Shoreline Type of Sewage Disposal: 0 New 0 Wood Existing: iI I ❑ Sewer 0 Addition 0 Steel Proposed: 4 Bank I 0 Community System 0 Alteration/Remodel 0 Concrete Total: Height: ! 0 Individual System 0 Repair ❑ Masonry SEP Permit# ❑ Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: 0 Private well 0 Two Party Type of Heat: Proposed: Total:- 0 Public Name of System:. • !I 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 4• IBC Occupancy: IBC Type of construction: Will you have Food'Service? Yes / No Jf this is.a Propane Tank and/or A Hance Ins ` latio ermi ma all item' below that a I Under round Tank Above ground Tank] . Size of Propane ank: l Heat Stove 1 Cook Stove I Woodstove 1.Fireplace Insert I Hot Water Tank 1:Pellet Stove "t Other , tp.�� nce being installed In a Manufactured/Mobile Home? Yes / No0 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. Square Footage Current Proposed g;.,!��'c, F�,� `i�� � '; tw, r4 " } x Main Floor Heated pt`I y sx:;'4. :, f �",:a{, h �s�^ . k g, ;, EH Bld App R view: 2 Floor Heated § ;` '`" l' , Kk ems Consistency R view: Other Heated I; ,r ,''','It';!. ,ti;.i, Base.fee: Mezzanine `';i1.� � Additional.Section: r►ti tit � .,. . . .i,..- Heated Basement ., • " , Plan Check fee. iP �N S 7}fit '' 4 , Unheated Basement ,, ,' ' State Surchar e.1 fee: 4 Other Unheated' ` , ,, !, r Pot Water Review fee: Garage/Carport F ,.oti.l,If SUBTOTAL ' "t l' 41' ,'Mf Decks k e,W t1 , , ac x 911/Rd,Approach fee: Other `, r„� TOTAL >$ ,P,,0= r,r�, Receipt Numb r. ( "35 ' tt;R 1 , ,;: cash/Check NUmberc. ESTIMATED COST(REQUIRED) Date: L-' _ 'Fair market value of all labor and materials foundation to finish ' Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Current bRD Foams\Maxrer Permit Annl;ed«,,.,c_1e_na A—