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HomeMy WebLinkAboutBLD2014-00228 BLD14-00228 BUILDING PERMIT APPLICSON Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00228 Received Date: 6/26/2014 SITE ADDRESS: 535 CANYON CREEK RD BRINNON, 98320 OWNER: DAVID GREE NIELSEN PHONE: 360-796-9957 RITA L NIELSEN PO BOX 970 BRINNON WA 98320-0970 POINT WHITNEY TRACTS SUBDIVISION: Block: Lot: PARCEL NUMBER: 601075008 Section: 7 Township: 26 N Range: 01 W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2014 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION NEW PROPANE PERMIT FOR 1000 TANK (UNDERGROUND TANK) WITH PIPING TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION ADD'L: HEAT TYPE: PRO CODE EDITION: 2012 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: ill Type Amount Paid By: Date: Receipt: Approved/Date Permit $228.00 SRE 06/26/14 148819 Total: $228.00 �' ... JUN 262014 Jefferson County DCD \\tidemark\data\forms\F_BLD_App_Bld.rpt 6/26/2014 SITE VISIT REPORT • (PLOT PLAN) I t OB ��'� ;• ' rt- s�. DATE: l07�1� . CONTACT: ADDRESS 53s- Y1 0C1 UC'%-e Q1 PHONE #: 7 9 c)-91S"--7. DIREc TIONS U .0`l 1'0 \\ `1-0 FAX #: . 01 %-c-e -V-*-1-D 53S- 00 L , 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. r- ' UN lA /" ► Ti4 ----,N. a An r---) ' ' j 4, ,. , _, r- 2 , , , , I' .. v..,.. , a rl ,.f 1 , , ,,,%, . i -rri ., ,, --N-4 ,i(N, V. /Doe, u, ;0 . " acx �5:, /4v2s4_,4 k-1 (1.1,‘ Z "c a b ( dt:r v.a yx 1'j JUN 2 6 2014 $ JEFFERSON COUNTY DEPT.OF COUP t.10NITY DEVEFOPME T I a-0 1�,Ct. T i k }moo L \-1‘54' SUV t, La r-. 1 re/ 'c�al.yt 11.1t r► 5 lJz.evaz • c it V E JEFFERSON COUNTY ' DEPARTMENT OF COMMUNITY DEVELOPMENT i i J 621 Sheridan Street• Port Townsend•Washiingtort 98368 J A ill,054. 360/379-4450. 360/379-4451 Fax JUN 2 6 2014 www.coJefferson.wa.us/commdevelopment Master Permit Application i ML_, JEFFERSON COUNTY Project Description(include separate sheets as necessary): I ' I'M1EM, Tax Parcel Number: (p D I v JO a ' ' Property Siz (acres/square feet) Sig Address and/or Directions to Property; , t31�1 > � n n i W►� a %32-0 t Property Owners)of Record: - a1 t t Ct e-G 0.� } iV) • Telephone: q(p qq,61 Fax: i email: Mailing Address:7J.© • (6C)V..., °l"1 0 i r"e.�t+00 i 1,0 r 2a 1 Applicant/Agent(if different from owner): (A/Yi� h i vt.v . r - f, • Telephone: .-3%S'—LS--1 9 Fax�:1 .. %5— email: t b✓GUA .e.�tt! .—, ----004--. ..0-451-1- Mailing Address: t t ct 3 '2-Inbc x -7 4 C ju 0%3"t What kind of Permit?(Check each box that applies" " ❑BuildinD ❑Critical Area s Ste rtiship'Plan ❑ Demolition Permit ❑Variance(Minor; ajor or Reasonable Economic Use) ❑Single Family ❑Garage Attached/Detached ❑Conditional Use[ (a),C(d),,or C] ,. ❑ Manufactured Home °0 Modular i ❑Discretiona r"D" r Unnamed Use Classification ❑ Commercial* , ❑Special Us (Ess" ntiai Public:Facilities)** -„ ❑ Change of Use O Boundary Line Ad ustinent ❑ Address . ❑Road Approach' ❑Short Plat ❑Home Business ❑Cottage Industry i 0 Binding Site Plan** MI Propane i ❑Long'Plat** O Sign " I. . ❑Planned Rural Residential Devel pment(PRRD)/Amendments** O Allowed"Yes*Use Consistency Analysis 1 ❑Plat Vacatidn/Alteration** ❑Stomiwater Management ❑Shoreline Master Program Exem tion/Permit Revisions `* CI Site Plan Approval Advance Determination(SPAA )* : 0 Shoreline Management Substan•al Development** 0-Temporary Use ' * 0 Shoreline Management Vane 0 Wireless Telecommunication I 0 Cgmprehen iv Plan/UDC/Land se Dii ram Amendment O Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson C ;n Shoreline Ma r P *May require a Pro-Application Conference i 0 Tree Veget tion Request "Requires a Pre-Application onference Please identify any other local,state or federal permits required for¶hlsrooiaI1 if k own: DESIGNATION OF AGENT I hereby designate to act as my agent n matters relating to this applicati•n for• rmit(s). r f ,VOWNER SIGNATURE „T.: /J O h l ^ -= ` i Date: „- ...) U 1 By signing this application form,the.owner/agent attests that the information provided herei ,and,In any attachments,is Mae and co -- 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. fi 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 to provide access and right of entry to Jefferson County and its employees, " presentatives or agents for the sole purpose of application review and any required later inspection Staffs a- -- a 0 right of ntry will be assume unless the applicant informs the Coun in at the time of the applicati•• .at he or sh, -y� prior ne;-. Signature: I.t _, LI ®i ® _ J cf 1 _ Date:” The action or actions Applicant will undertake as a result of th issuance of this permit may egatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an ndangered species as thus terms are defined in the federal law known as the "Endangered Species Act"or"ESA."Jefferson County makes fro assurances to the applica that the action that will be undertaken.because.this permit has been issued will not violate the ESA. Any individual,group or agency can file a lewsult on behalf of an endangered species regarding your action(s)even if you are in with the J fferso County devei•pment code.The Applicant acknowledges that he,she or it holds individual and non-transferabl ponsibility for ad j-ring}sand •• •ying wi Al e ESA. The Applicant has read this disclaimer and signs d dates it below. Signature: e.'0_ ` . ./ • 4 . "��.:..:-....+ • Date: 7 v U / _ 1 G:\PermitCenter\###FORM$###\DRD FORMS\Master Permit Application 529-08.doc " . dLD -2-Z • i 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 th responsibility of the Ge eral Contractor for the proposed project. // Signature: Date: � �5 GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: 7 «.., ( ) (! ) MAILING ADDRESS: EMAIL:. CONTRACTOR'S LICENSE WINS NUMBER: NUI iBER ARCHFTECT(E\NGINEER: PHONE ( ) FM:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: 1 ❑ Sewer ❑ Addition ❑ Steel Proposed: I Bank ❑ Community System • Alteration/Remodel 0 Concrete Total: —_ Height: o Individual System O .Repair. o Masonry SEP`Permih#' O Demolition 0 Other: Bedrooms: 1 Water Supply: Existing: Setback: ❑ Private Well 0-Two Party Type of Heat: Proposed: L ❑ Public Total: Name of System: If this Is a Commercial Protect you must answer the following: Number of Parking Spaces: Current Proposer! . Number of ADA Parking Spaces: Number of occupants(indudes owners,tenants,employees,etc) Current i Proposed IBC Occupancy: IBC Type of construction: ill you have Food Service? Yes / No f I- I 11.. . ..,. : k and/or A, •li:nee Installation •'-rmit mark . l items!bel•w h= , .1 nderground Tank Above ground Tank Size of Propane Tank: 10 O O 1 Heat Stove Cook Stove I Woodstove I Fireplace Insert I Hot Water Tnk 1 Pellet Stove I Other _) Is this appliance being installed in a Manufactured I Mobile Home? Yes / No When applying fora 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. S•uare Foota t e Current Pro•osed 1'1'.,�1, Il,„.',r,:, ''',11', " ' !u sic ,,f a LI 4 9 I` k't ,, EH Bid App Re iew: Main Floor Heated i 2 Floor Heated ' `,f; Consistency Review: Other Heated ;`,•..:,,,15'7,7a" Base fee: �(• l Mezzanine � ' Additional Section: . UQ i Heated Basement # a Plan Check fee, Unheated Basement A, 'd , ;; State Surcharge fee: Other Unheated '-"'',Tr',"': ,, � j Pot Water Revie w fee: Garage/Carport :',:2,-1,:'1,,': �1 " SUBTOTAL j Decks I y 911/Rd Approach fee: Other L_fi TOTAL: C � ,'-. 1 9 ': Receipt Num r: ` n Cash/Check Nmber• ESTIMATED COST;(REQUIRED) Date: 1 / 6,/ i f r i .Fair market value of all labor and materials foundation to finish I WI d4U/ Initials 1 S C L� • i G:\Pem itCenter\###FORMS###\ORD FORMS\Master Permit Application 5-29-08.doc , • 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#: BLD14-00228 Received Date 6/26/2014 SITE ADDRESS: 535 CANYON CREEK RD Issue Date 6/26/2014 BRINNON, 98320 APPLICANT: DAVID GREE NIELSEN PHONE: 360-796-9957 RITA L NIELSEN PO BOX 970 BRINNON WA 98320-0970 SUBDIVISION: POINT WHITNEY TRACTS Block: Lot: PARCEL NUMBER: 601075008 Section: 7 Township: 26N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 ((33 Contractor's License SUNSHP*077QP Expires 14/167%3 5-5875 OWNER, DAVID GREE NIELSEN PHONE: 360-796-9957 if different: RITA L NIELSEN PO BOX 970 BRINNON WA 98320-0970 PROJECT DESCRIPTION: NEW PROPANE PERMIT FOR 1000 TANK(UNDERGROUND TANK) Directions WITH PIPING 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 6/26/2015. REQUIRED INSPECTIONS: Installation per Manufacturer Specifications/CO2: �/`/� 7 9Al Tank/Line/Appliance: / :4 odd.. 7/01,4 Final Approval: OX Pot- 1 N4. , , 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 6/26/2014 . , ' . .... ?4,f•Stf,.: . ........„.;.......SN*61.6,4:,-..,--,.....- " • ;R:AilikitStIq.3411 - • . • - . qe-61 ,..,a. 17.*ir,:lt. - . . - .......-........==.r . _. Date_q___---__41– time received rp*:cS":(91 pm Mon. Tue . •1.1\1eclz• • .______1 .---3._ _tic ._ BLD: Date: Ot...... k, _L_ • OWNER: . -. e" • . Contact Narne;.. ctck. - ADDRESS: .,.. (X,A. kce...., Contact Number:360___MakSZ c( .,.. Notes: . 206 • . . • . _ Foundation Plur___:r Ilpir g? - Framing . Propane Tank Mechanical __— Setbacks Under-ground Framing Under-ground Furnace Footing ______ Rough in Air seal Above ground Gas _______ Sternwall Hydronic Exterior shear Exterior lines Oil _ Straps --- Interior shear Interior lines • Ducts S -- Post Hole Ventilation Appliance Underfloor — _ Gas/Wood stove Man-kiomes • Setbacks Insulation Final Inspection Foundation . Biook&Ile floor wall ceiling. Address Posted i g0\ �fF co,,, JEFFERSON COUNTY f, DEPARTMENT OF COMMUNITY DEVELOPMENT Date: -7 Jr Time Received: 7V 5 c.,,, wpm Mon. Tue. iiiiciVQ Thur. Fri. Date: BLD: i e Contact Name: p Owner: Contact Number: 360 Address: ���`� � . 6— C.4A--t,6�.1 206 Notes: Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Under ground Furance Footing Rough In Air Seal Above ground Gas Stemwall Hydronic Exterior shear Exterior lines �/ Oil Straps Hot Water Htr Interior shear Interior lines r" Ducts Post Hole Ventilation Appliance Underfloor Gas/Wood stove Man-Homes Insulation Final Inspection Setbacks Floor Foundation Wall Address Posted Block&Tile Ceiling O„SG co k % JEFFERSON COUNTY HSxt NG-cG� DEPARTMENT OF COMMUNITY DEVELOPMENT / J ` _ t Date: -7/°-� Time Received: 351 am/6m Mon. �`�I�iE' Thur. Fri. ((( } Date: 7 -• BLD: /3 -, /&(/ Contact Name: Owner: ( Contact Number: 360 5/c, 53 Z ( Address: '3 ,/ A 4-hce 184,/ 206 Notes: Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Under ground Furance Footing Rough In Air Seal Above ground Gas Stemwall Hydronic Exterior shear Exterior lines Oil Straps Hot Water Htr Interior shear Interior lines Ducts Post Hole Ventilation Appliance Underfloor Gas/Wood stove Man-Homes Insulation Final Inspection - Setbacks Floor Foundation Wall Address Posted Block&Tile Ceiling .,es ON 006.2 JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT ° '16.x/NG; t t i Date: C., 3 Time Received: _____cC)7 am pm Mon. Tue. Thur. Fri. Date: BLD: (3. l VI Contact Name: Owner: Contact Number: 360 Address: 33(01 F (S� 1gt 206 Notes: 5I-N' Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Under ground Furance Footing Rough In Air Seal Above ground Gas Stemwall Hydronic Exterior shear Exterior lines Oil Straps Hot Water Htr Interior shear Interior lines Ducts Post Hole Ventilation Appliance Underfloor Gas/Wood stove Man-Homes Insulation Final Inspection Setbacks Floor Foundation Wall Address Posted Block&Tile Ceiling t • • •- r - :1:, - • Date 51 L 1 3 time received /v•°U 4/ pm Mon. Tues. Wed°- Thur. -Fri. • BLD: 2 � 1 -5- • .` J c�` �Q�' Date: �J, al�� OWNER: �laC 2 cc�"laf P "33/ �j Contact Name: �j ADDRESS: I 1 Gl,c b G(,1- d 31-3x5-8'6�1 /1 Contact Number: •, �r LlJ '�c'. ?�av �( !!r` -- 1 Leh�� - 2()6 r� Notes: .Foundation Plumbing - Framing Propane Tank • Mechanical ' Setbacks _ Under-ground Framing Under ground Furnace Footing Rough In Air seal — Stemwali Hydronic Above ground Gas — — Exterior shear Exterior lines Oil Straps Interior shear Interior lines • Ducts V Post Hole V Ventilation . — Appliance _ Underfloor Gas/wood stove hian,Honies — Setbacks •_ • Insulation. Final Inspection Foundation— . Block&Tie floor wall ceiling `' c. 9 Address Posted . . . -• . . ...-„,.. s " .....--1 .44- • . •. "4::,,,,,er..-..5, " - • *314,111MY :74.[- • .• • • ite...pe ..,,,..7.4%.„.....!. :...f 4 . - • . .--...w. • .. .. . _. . _ . Date 9'0- time received /42/ ,t. -7 am /e0 Tue . •wed t- Thur. -Fri. - LD' B . ,I3 • — / V . . • Date: OWNER: • - - • Contact Name:. . . . ADDRESS: _ 5 3 62 I Pk/-4O i Ise-- Contact Number.360 2.5/-.??-37.PC7-5"-7 •-• - .. 206 i•:. Notes: • . — .:.3. . . • . . - • . . - • . , . .Foundation Plumbing -Framing' • . Propane Tank - Mechanical . . Setbacks Under-ground Framing Under ground Furnace Footing Rough in Air seal Above ground - Gas Stemwall Hydronic Exterior shear Exterior lines Oil • Straps Interior shear Interior lines . Ducts Post Hole . Ventilation Appliance Underfloor Gas/wood stove Man-Monies . Setbacks Insulation. • Final Inspection Foundation . ....;1. — . -4.-'• Biock&Tie floor _wall ceiling . Address Posted JEFFERSON COUNTY OCD NO. 148 519 DATE � � I Li OCO RECEIVED FROM DESCRIPTION BARS# AMOUNT CURRENCY ] ( SC. C1a5 U° COIN Sf , i' ailh P CHECKS 00„ Pr ' �?,vv c cn I o o (f, , '' ; , v\1 ft 3 RECEIVED BY J (,LAL `� TOTAL ___.?t-1-4- V u Ham' irffos + ZPz�ioL) a/rtadii Ca(eacel1bfl, w- aLDi4-- g8 elyea,aaYL-0- (f-69-(1c, ( '/e 710 f?),1 Pfn,e si?e41 136 0:796 5 99p, cre,d& For more certificate templates, visit 123Certificates.com. Tr templates, there are 1,000+template options, more formal styli