HomeMy WebLinkAboutBLD2013-00164 - MECHANICAL iBUILDING PERMIT APPLICAON BRLD13-001164
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD13-00164 Received Date: 5/28/2013
SITE ADDRESS: 3361 PARADISE BAY RD
PORT LUDLOW, 98365
OWNER: WILLIAM D SHARP TRUSTEE PHONE: 831-325-8651
CHERYL L SHARP TRUSTEE
3361 PARADISE BAY RD
PORT LUDLOW WA 983658740 PARADISE VIEW ESTATES
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 984000109 Section: 22 Township: 28 N Range: 01 E
CONTRACTOR: PHONE:
PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOt New 500 gallon propane tank &appliances -cook stove, fireplace
insert, hot water tank.
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 By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $228.00 CJZ 05/28/13 142126
Total: $228.00
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4 ot JEFFERSOPI COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT U
ECEIVED
` 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 . 360/379-4451 Fax MAr 2 2013
S. Np�p www.co.jefferson.wa.us/commdevelopment
Master Permit Application ML JEFFERSON COUNTY
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Project Description(include separate sheets as necessary):
1ProG x1 A-o. . -
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Tax Parcel Number: 2.:11_2(10. ( Property Size: (acres/square feet)
Site Address and/or Directions to Property:
3C , 26.-.2,4-(S-c, >?.,,Q 47.1_ Lai •L o v+ 1n)A. $3 {o
Property ner(s of Record: J-rl. ° .- -T12.0 SS" W , (-I-,n- •,-- d. Caf rte., /-rte-a,�'
Telephon e ' �-� , �)_I Fax: email: s\--)ary,L,Q S\o C blob'A .+Ne.r
Mailing Address: ,.c
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies ❑Lot or Road Segregation
❑Building ❑Critical Areas Stewardship Plan
❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use)
❑ Single Family ❑Garage Attached/Detached ❑Conditional Use(C(a),C(d),or C]'""`
❑ Manufactured Home .❑ Modular • - - ❑ Discretionary"D"or Unnamed Use Classification
❑ Commercial* ❑Special Use(Essential Public Facilities)**
❑ Change of Use ❑Boundary Line Adjustment
❑ Address ❑Road Approach ❑Short Plat**
❑ Home Business ❑Cottage Industry ❑Binding Site Plan**
XPropane ❑Long Plat**
❑Sign ❑Planned Rural Residential Development(PRRD)/Amendments**
O Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration**
❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions**
❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development**
❑Temporary Use ❑Shoreline 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 ❑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 designate to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE Date:
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 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,representatives or agents for the sole purpose of application
review and any required later in-•-ctions. Staff's access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the application that he or - , -M -•-,.o otice. r�
Signature: �' Date: S� 13
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 lake"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 hering t mplying with the ESA. The Applicant has read this disclaimer nd signs nd dates it below.
Signature: Date: * �'i,��)'�
• IL
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: __ • I
GENERAL CONTRACTOR OR MANUFACTURE OME 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:
❑ New ❑ Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System
❑ Repair ❑ Masonry SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type of Heat: Proposed: ❑ Public
Total: Name of System: '
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
- IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No
If this is a •ro•ane T-,11 �-:.--,t•;',_,:.. Installation •=rmit mark all items below that a••I :
S Underground Tank 4IPMMIRMII, Size of Propane Tank: Cori
I Heat Stove)ook Stove I Woodstove XFireplace Insert '(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,
including the reserve area.
Square Footage Current Proposed OOf_fice Use �� Amount - Revision
Main Floor Heated EH Bld App Review:
2`"Floor Heated Consistency Review: -
Other Heated Base fee: 4 ,,E
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee:
' Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL]a a g Decks 911/Rd Approach fee:
Other TOTAL: $
Receipt Number: IA ,ae'
Cash/Check Number: O r CJ
ESTIMATED COST(REQUIRED) Date: 6.Z- 3
•Fair market value of all labor and materials foundation to finish
Initials:
• 1
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#: BLD13-00164 Received Date 5/28/2013
SITE ADDRESS: 3361 PARADISE BAY RD Issue Date 5/28/2013
PORT LUDLOW, 98365
APPLICANT: WILLIAM D SHARP TRUSTEE PHONE: 831-325-8651
CHERYL L SHARP TRUSTEE
3361 PARADISE BAY RD
PORT LUDLOW WA 983658740
SUBDIVISION: PARADISE VIEW ESTATES Block: Lot:
PARCEL NUMBER: 984000109 Section: 22 Township: 28N Range: 01E
CONTRACTOR:
OWNER, WILLIAM D SHARP TRUSTEE PHONE: 831-325-8651
if different: CHERYL L SHARP TRUSTEE
3361 PARADISE BAY RD
PORT LUDLOW WA 983658740
PROJECT DESCRIPTION: New 500 gallon propane tank&appliances-cook stove,fireplace
Directions insert, hot water tank. 1404,sideted
To Site: /%�f ' /
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 5/28/2014.
REQUIRED INSPECTIONS:
an Line ppliance: c)-(9-1- I '7 9
`�— ;' le&1i a 6/47141W
FinalApproval: �1�, ° C lu -6 - )J( 742/3
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Atev.4 ok 7/f j e, z5K 4r0r 04 44
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
4
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Site Plan Checklist
A Site Plan. All site plans shall be drawn with a straight edge
& features shall be to scale using an engineer scale.
For Residential Applications
A site plan printed on 11 X 17 to scale(if on larger paper please submit 7 copies) Please show the following on all
site plans.
O North arrow
O Title block with the project name, address, drawing title, tax parcel number, &the name/address/phone of
the person preparing the drawing.
❑ All Property boundaries, dimensions, total parcel acreage or square footage dimensions.
O Building footprint square footage for all proposed"cexisting structures [for Site Plan Approval Advance
Determination (SPAAD) applications show buildable area rather than building footprint]
❑ Environmentally sensitive areas such as ravines, seasonal creeks, bodies of water, wetlands, steep slopes,
etc.
❑ On-site septic system location or sewer lines (existing or proposed) Show measurement from foundation to
septic tank, drainfield, & reserve area. Show transport line.
O Well location &water lines. Show 100' radius around well.
O Impervious surfaces such as driveways or patios. Show driveways all the way to access road, not just to
the property boundary.
❑ Setback distances from property boundaries to structures, distance between structures, &distances from
structures to environmentally sensitive areas such as wetland, shorelines, steep banks, etc.
❑ Location of any easements&encumbrances such as utility or access easements.
O Method & location of stormwater disposal facilitates such as drainage swales, tightlines, dry wells, curtain
drains, etc.
❑ For applications on marine or river shorelines show ordinary high water mark, top of banks& heights of
banks.
❑ Locate the Propane Tank, Size of tank, A/G or U/G &distance from nearest bld.
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