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Home My WebLink AboutBLD2012-00415 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#: BLD12-00415 Received Date 12/27/2012 SITE ADDRESS: 831 OLELE POINT RD Issue Date 12/27/2012 PORT LUDLOW, 98365 APPLICANT: ELLEN C JOHNSON PHONE: PO BOX 566 PESHASTIN WA 98847-0566 TX M SUBDIVISION: OLELE POINT Block: Lot: PARCEL NUMBER: 977400014 Section: 28 Township: 29N Range: 01 E CONTRACTOR: AMERIGAS PROPANE L P PHONE: 425-219-9972 2831 74TH DR NE MARYSVILLE WA 98270 Contractor's License AMERIPL055LL Expires 7/23/2013 OWNER, ELLEN C JOHNSON PHONE: if different: PO BOX 566 PESHASTIN WA 98847-0566 PROJECT DESCRIPTION: A/G 120 GAL PROP TANK, LINES & HEAT STOVE 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 12/27/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: l—3— 13 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 12/27/2012 • BUILDING PERMIT APPLICCION BLD12-00415 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD12-00415 Received Date: 12/27/2012 SITE ADDRESS: 831 OLELE POINT RD PORT LUDLOW, 98365 OWNER: ELLEN C JOHNSON PHONE: PO BOX 566 PESHASTIN WA 98847-0566 OLELE POINT SUBDIVISION: Block: Lot: TX M PARCEL NUMBER: 977400014 Section: 28 Township: 29 N Range: 01 E CONTRACTOR: AMERIGAS PROPANE L P PHONE: 425-219-9972 2831 74TH DR NE MARYSVILLE WA 98270 Contractor's License AMERIPL055LL Expires 7/23/2013 REPRESENTATIVE: KELLEY SHIELDS INC PHONE: (360) 385-7156 DENNIS KELLEY (360) 385-3115 260 KALA POINT DR PROJECT DESCRIPTION A/G 120 GAL PROP TANK, LINES Sr. HEAT STOVE 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: 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 $220.00 LYK 12/27/12 139853 At ,)RG ,-- Total: $220.00 DECdr 2012 Jefferson County Plannin[. & Building Department \\firlcmnrlArfnfn\forme\F l I n Ann PIA rnf 1 /77/71117 rkzil-'4)24,4 JEFFER�COUNTY • DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 � - 360/37911450 • 360/379-4451 Fax 16231-140� www.co.jefferson.wa.us/commdevelopment t# Master Permit Application MLA: ID rn(,1 Project Description(include separate sheets as necess ry): 124 dart,- - • Tax Parcel Number. proper " 1 (acres/square feet) Site Address and/or Directions to Property: 1 \ ISLA- _Pr. %ab (77-. '4,0 Leto - t—Jithlt q 4:5 Property Owner(s)of Record: I: ems • • /J Telephone: -11 Sl.i Fax: emei: Mailing Address: 14 O� SIp +��`Si s "S'T7 N RSON T„7 - 1 Applicant/Agent(if different from owner):� 14 e S j4 1" D /ELOPMENT Telephone: - ( ( Fax: f email: _ Mailing Address: , 7 . Y//� r 7 _ wNSt7�-. 1 What kind of Permit?(Check each box that applies ❑Building 0 Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use) ❑Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a),C(d),or CI** ❑ 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*• 1;110Propane 0 Long Plat•' ❑Sign 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed'Yes'Use Consistency Analysis 0 Plat Vacation/Alteration•* ❑Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions*• ❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development** ❑Temporary Use 0 Shoreline Management Variance ❑Wireless Telecommunication• 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑Forest Practices Ad/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: DESI ATION OF AGENT I hereby designate / o act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE I r Date: Z 1.1 t 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,judgments,court costs,reasonable attorneys fcoc 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 sole purpose of application review and any required later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applicatlo that he or she wants,prior no Signature: A2 \ � Date: 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 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 lawsuit 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 responsibility for adhering to and C ying with the ESA. The Applicant has read this disclaimer a signs dates it below. Signature: (�. fit. T�'s Date: 17-L-'1) I '2- %:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-O8.doc • • 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 assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: U New [1 Wood Existing: i Sewer ❑ Addition I I Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel Li Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: r ° . ter S Existing: Setbaddc:,,7 r - '' Two Party Proposed: l �J 4 :rL— ill Type of Heat: - Total: 1 Name of If this is a Commercial Proiect you must answer the following: 2 'I„ Number of Parking Spaces: Current: Proposed: Number of ADA Parking Number of occupants(indudes owners,tenants,employees,etc) Current PPO pgsed IBC Occupancy: IBC Type of construction: Will you have FaOd le Jice?'Meat/ No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: i Unde •round Tank ove ground Tank Size of Propane Tank: It 'eat Stove I Cook —TTWoodstove i Fireplace Insert i Hot Water Tank I Pellet Stove i 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, includin• the reserve area. t S•uare Foote•e Current - •• ,.• F • � , Main Floor Heated EH Bld App Review: ea Floor Heated t { - ,� Consistency Review: Other Heated ' A', Base fee: Mezzanine - " Additional Section: Heated Basement ':- Plan Check fee: Unheated Basement , State Surcharge fee: Other Unheated r Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: fOt ' c , _ Receipt Number: 13 9 855 r ' ' Cash/Check Number. Li 7z4 ESTIMATED COST(REQUIRED) Date: �� _,� .Fair market value of all labor and materials foundation to finish Initials: r GAPemvtCenter\###FORMS###\ORD FORMS\Master Permit Application 5-29-08.doc bN it 0 PP‘ ''-c-P''''ki' __--•7 --' 12 ct. ' - -�-"—r' ,Af1 .... \ 4,/ .,\I\ °, ' • ' ifrJ \ "--- 4'4 I e 8's Parcel Number: 977400014 ,,E � % 2012 i J Owner Mailing Address: " '' � ELLEN JOHNSON JEFFERSON COUNTY PO BOX 566 FirnT.OF CO^.MU_'In�F"(LOPMFNT I'ESHASTIN WA988470566 Site Address: 831 OLELE POINT RD PORT LUDLOW 98365 Section: 28 School District: Chimacum (49) Qtr Section: SW1/4 Are Dist: Port Ludlow (3) Township: 29N Tax Status: Taxable Range: 1E Tax Code: 231 Planning areal Port Ludlow (7)