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HomeMy WebLinkAboutBLD2014-00211 - MECHANICAL • BUILDING PERMIT APPLI•ION BL 211 Revv iew iew T Tyype: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00211 Received Date: 6/13/2014 SITE ADDRESS: 73 PONDEROSA PL NORDLAND, 98358 OWNER: CAROL BROWN PHONE: 360-732-1170 73 PONDEROSA NORDLAND WA 98339 GARDEN CLUB ACRES SHORT PLAT SUBDIVISION: Block: Lot: 2+ PARCEL NUMBER: 921092028 Section: 9 Township: 29 N Range: 01 E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2014 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION NEW PROPANE TANK OF 250 GALLON INSTALL TANK AND PIPING FOR WATER, HEATER & STOVE TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC VALUATION MAIN: CODE EDITION: 2012 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: 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 Permit $228.00 SRE 06/12/14 148742 Total: $228.00 APPROVED JUN 13 2014 Jefferson County DCD \\tidemark\data\forms\F_BLD_App_Bld.rpt 6/13/2014 40"' co ON' p ,. JEFFERSON COUNTY i DEPARTMENT;OF.COMMUNITY DEVELOPMENT i } 621 Sheridan Street• Port Townsend•Washington 98368 1 J U N,; 2014 il ► 360/379-4450 . 360/379-4451 Fax J ,. www.co:efferson.wa.0 ) ...co sJcomrrtdevelopment 41$,gz. , ° JEFFERSON COUNTY OrPT.OF COMMUNITY OEVELO•MENT Master Permit Application MLA: P ro scription(inGUdg separate sheets as n-:• sssryp f i cc ft/0—(AI (A ) : 1.Q ..�,,;,t✓ 4/-n qL Tax Parcel Number `, s d Property Size (acres/square feet) Site Add ss and/ irections toProperty; Property Owners)of Record: (\ro t` U.-) Telephone: .-7 • —1 I a, F- I email: Mailing Address: I © 0 5 c� �,; __ �• Applicant/Agent(if different from owner): ° e ®� Telephone: ` T Fax:, 3Y a , email:; Mailing Address: . What kind of Permit?(Check each box that applies OBuilding ❑Critical Areas'Ste rdship Plan ❑ Demolition Permit ' ❑Variance(Minor, ajo'r or Reasonable Economic Use) ❑Single Family ❑Garage Attached/Detached '❑Conditional Fuse[ (a);C(d),or C]** ❑ Manufactured Home ❑ Modular O Discretionan/"D r Unnamed Use Classification ❑ Commercial* 0 Special Us (Ess ntiai Public.;Facilities)"" ❑ Address 0 Road Approach O Short Plat*" a Adjustment O Change of Use ❑Boundary L� Tj O Home Business ❑Cottage Industry a ❑Binding sit IL, O Propane 0 Long Plat*'1 O Sign {. 0 Planned Rural Residential Development(PRRDyAmendments*" Q Allowed'Yes"Use Consistency Analysis 1 ❑Plat Vacation/Alteration'* ❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions** O Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development'" [7Temporary Use l 0 Shoreline Management Variance o WIreless Telecommunication* I , 0 ComprehensivePlan/UDC/Land Use District Map Amendment O Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson C tnty Shoreline Master Program Amendment *May regulre a Pre-Application Conference 0 Tree Vegetation Request "(logo res a Pre-Application Conference Please identify any other local,state or federa'permits required for his proposal,If known: DESIGNATION OF AGENT I hereby designate 1e.'Eft' to act as my agent n matters rel atiting'to this application for permit(s). OWNER SIGNATUheaf � P �Y" — O + C� -AD - i Date. By signing this application form,theowner/agen attests that tie information provided hereifi,and in any attachments,is.true and correct to the best of his,her or its knowledge. Any material falsehood or any'oinission`of a material fact made b r 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, udgments,court costs,reasonable attorneys fees arid expenses which may in any way accrue against Jefferson County as a result of or in conseiuence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employees,;3presentatives or agents for the sole purpose of application review and any required later inspections. Staff's access and,right of entry will be assume unless the applicant informs the County in writing at the time of the a••Iication that he or she wants prior notice. Signature: 1.r,.� Date: permit may negatively impact upon one or more The action wns:Applicant will undertake as.a result of issuance of this 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 tour action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she ortt holds individual and non-tra -t-rabie responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer ands and dates It below. Signature: D ` Cam--- f idiO Date: `b �" G:\PemritCenter\###FORM$###\DRD FORMS\Master Permit Application 5-29-08.doc • BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel'referanced•herein,that they are nOt licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed project. _, Signature: Date: ( L'i Ii ii GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ` ( ) . ( ), MAILING ADDRESS: EMAIL? CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Typed Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: O New 0 Wood Existing: ❑ Sewer O Addition 0 Steel Proposed: Bank ❑ Community System .0 Alteration/Remodel ❑ Concrete Total: Height: 0 Individual System 0 :Repair ❑ Masonry SEP Permit# O Demolition 0 Other: Bedrooms: Water Supply: . :. Existing: Setback: ❑ Private well 0 Two Party Type of Heat Proposed: Public Total Name of System: If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current I Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No ° If this is a Propane Tank and/or Appliance Installation Permit.mark all items below that apply: I Underground Tank Above ground Tank Size of Propane Tank: b I Heat Stove I Cook Stove I Woodstove I Fireplace Insert Ciliot Water TfnkT\I Pellet Stove I Other Is this appliance being installed in a Manufactured!Mobile Home? Yes / No When applying fora permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. .�.: ... ....` .�. . a. +S•WareFOOta!e Current IT$nt Pro•O$ed 4''' d�e, 4t.w „J�1:, ',�' "' V uAtkN al'fre 'J.I' ' c .:' ki i s : Main Floor Heated a< : EH Bid App Review: l'rt 1 2"0 Floor Heated '''" v t { Consistency Review: Other Heated ;' a Base fee: V-CO Additional Section: - Heated Basement 1 „ ,5i �� Unheated Basement 1<.1.1F A „ 1., Plan Check fee,' E- K - x , State Surcharge fee:t. Other Unheated 4 :a 'Y -+k 1 Pot Water Review fee. Garage/Carport ,i' z -444; SUBTOTAL { Decks 4. "".' 911/Rd Approach fee: Other , .' L TOTAL: $ a1 n , , 3 Receipt Number. Cash/Check Number: ci ESTIMATED COST,(REQUIRED) Date: ` , I i LI •Fair market value of all labor and materials foundation to finish 1 11 1 I Initials: ' ' • G:\PermitCenter\###FORMS###\DRD FORMS\Master Pennit Application 5-29-08.doc Y C SITE VISIT REPORT C [� (PLOT PLAN) i 0/ JOB e_TvA D W DATE: ,°r\30\1 1 l' j JUN 1 2 p014 CONTACT: u f ADDRESS .43 '1-30 NOR-A a SG PHONE #: DIRECTIONS .1 \A.`�' '(L� `�'U G-v �2k3 G`Ob FAX #: JEFFERSON COUNTY D 190 l� s bSQ o'? Lec1", Email t_ F_P . DT 8 . F COMMUNITY D ELOPMENT PLANNER: A\)'-R- L 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. f a) { New of?sTacS ' ;, '; 'A 0000.10 eAS03,9tle 20.,G 91010-e, Ep f2'g�Z, f © 0 �rs ,s 6-paS ( b� p�'T F Y�ACI�QWiI• rIc. eAX ex z45Z 4 ) bbf • • • • \\Sunshinel\E\BUSINESS\FORMS\PROJECT PLANNING\SITE VISIT REPORT-PLOT PLAN.doc Screen: 01 REAL PROPERTY MASTER Mode: INQUIRY 111 Auto Roll : OFF Parcel # 000921092028 Geo Cd 292109203211 GARDEN CLUB ACRES SHORT PLAT Nbhd Cd 3220 LOT 2 S/EASE Loc ID * Taxpayer Cd BROW 0476 BROWN, CAROL J T/P Chg Dt 6/11/2014 * Title Owner T/P Chg Usr JA Tax Code 0211 Status TX TAXABLE Land Use 1100 RES-SINGLE Affidavit 121318 Vol/Page / C/U Code COMPLETE ADDRESS WINDOW Taxpayer BROW0476 CAROL J BROWN PO BOX 1535 PORT HADLOCK WA 98339-1535 Search Key CMD 6: End Window CMD 7: End of Job 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#: BLD14-00211 Received Date 6/13/2014 SITE ADDRESS: 73 PONDEROSA PL Issue Date 6/13/2014 NORDLAND, 98358 APPLICANT: CAROL BROWN PHONE: 73 PONDEROSA NORDLAND WA 98339 2+ SUBDIVISION: GARDEN CLUB ACRES SHORT PLAT Block: Lot: PARCEL NUMBER: 921092028 Section: 9 Township: 29N Range: 01E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 ((gg Contractor's License SUNSHP*077QP Expires 1'f/160j2 -5875 OWNER, CAROL BROWN PHONE: 360-732-1170 if different: 73 PONDEROSA NORDLAND WA 98339 PROJECT DESCRIPTION: NEW PROPANE TANK OF 250 GALLON Directions INSTALL TANK AND PIPING FOR WATER, HEATER&STOVE 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 6/13/2015. REQUIRED INSPECTIONS: Installation per Manufacturer Specifications/CO2: Tank/Line/Appliance: Final Approval9 _Z(2.-V/y 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 6/13/2014 • Co °? JEFFERSON COUNTY DEPARTME. OF COMMUNITY DEVELOP ENT -,SHI N...c) Date: 7/2Sfime Received: // 70 C::Jpm Tue. Wed. Thur. Fri. Date: 1 -2' BLD: j q'al r/ Contact Name: Owner: Contact Number: 360 s79h Address: 7 3 Pp y ,, 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 JEFFERSON COUNTY bco NO. 148742 DATE ( i)2J 1 LI n RECEIVED FROM LL 4\t V P- t oparie DESCRIPTION BARS# AMOUNT CURRENCY uJ 14)te 6 OO COIN ,1J IC) 'D° E CHECKS ,' - , POri(tcrei-SCL, o ' a I -tea -o of o 0 RECEIVED BY TOTAL _4q4-7--- h 0