HomeMy WebLinkAboutBLD2012-00207 THIS BUILDING IS
NOT FINALED .
PERMIT WAS CANCELLED
PRIOR TO RECEIVING ALL
INSPECTIONS AND HAS NOT
BEEN ISSUED A CERTIFICATE
OF OCCUPANCY.
1111UILDING PERMIT APPLICAAIN BRLD1e 002p07
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD12-00207 Received Date: 7/9/2012
SITE ADDRESS: 431 RHODODENDRON LN
BRINNON, 98320
OWNER: PATRICIA L ELWELL PHONE: 360--301-5256
431 RHODODENDRON LN
BRINNON WA 98320-9738
PLEASANT TIDES DIV 2
SUBDIVISION: Block: Lot: 18
PARCEL NUMBER: 988600018 Section: 15 Township: 25 N Range: 02 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOV A/G 250 GAL PROP TANK SWAP OUT
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: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total:
Routing Date:
Type Amount Paid By: Date: Receipt: AIP1OVEr
Propane Tanks/Stoves $71.00 LYK 07/09/12 134972
Total: $71.00 JUL )2
Jefferson County Planning:
& Building Department V
\\+irlcmor4\rle+o\fnrmc\F RI Il Ann PIA rn+ 7/0/711l7
03/08/2011 08:28 3603794451
DCD JEFF CO PAGE 01/0', •
0 •
ON 0
.
eP000, .6 JEFFERSON COUNTY
DEPARTMENT OF•COMMUN DEVELOPMENT _
ITY DEVELO
- . •
.. 63 2 01 1 Sheridan g4e r i d4a5no 3e6 St e0t1.3. 944
Port Townsend-Washington 98368
6
4.is:74,4111114107.40. www.cojeffersorima..us/cOmmdevelopment
.et . •
Master Permit Application . MLA:
Project Description(include separate shoots as eecessary):
_...."--> 4
m
Tax Parcel Number: . gV 00 a.1. ' Property.Size: NMI/. / acres/square feet)
i 0 ,t,A,) ae-5 42.- 0
Site Address and/or Directions to Pro , Di u /7 Perty:.
, . .
0 ,.,. 1 .
,, ( • 0 ot _ / ,/ - v1/10 ,
• ,
Property Owner(s)of Record: • : c.. A ." ". tw.).4- ,
) . ..;.. ..... ...„,__...___..................____............ .... ...,,
. . P
...
r_
Telephone: ,., , / • . Fax:
Mailing Address: "13/ X--A,1
Applicant/Agent(If different from o
Telephone3 4 17 0 - -5..2.-S.
, 'Mailing Address:
de owner)::old.te-att.)): trieLr-P-02--lex- L---ax,Fax: . .
r . . - 00
. , email:
. .
. .
.._.--- ...-- ---,-,-.... .
..._____ . . email:'__________--
• . . _ 7,
4.e
0
N
What kind of Permit?(Check each box.that applies 0 Lot or Road Segregation ' • .
cFn3uilding •
. 0 Critical Areas Stewardshi. pl.., • •
Demolition Permit . 0 Varia e4r1 V I 1.,... 4,,,:,..r ii....„.:i::;4•j•-;...,--Flo lo Use)
0 Single Family 0 Garage .Attached/Detached 0 Cond', .1-IH, L. ■*.„,„, f.r 0
O Manufactured 1-lome:.: .0 ModUlar. . ..,° • ... •• , 0 More":1, . -; .. .. • . .--..•Ise .a.,;.- ..,,■on . •
D Commercial* • . . 0 Speci., ii , ssential Public Facilities1 •
O Change of Use . • in Bound-. rte Adtyorent 9 az ' '
O Address . . 0• oad Approach, 0 Short '1: , 1
,
Home Business 0 Cottage Industry . 0 Bindin! ,4 i - Han'`I___::„.' • .....,_.....,...i. 11-Ii
,
I
Long ..
Propane ' 0 •.
sign ' - • eilI
.• •• 0 Plann=• Rural Resitkritif4tWpmeht(Pa .WAmendments**
GI Allowed'Yes"Use Consistency:Analysis• • CI Plat V4c00__Ibillittc0Fattlell/NITY DEVELOPMPIL__
0 Stomiwater Management . 0 Shorelfaste715F—ograM Exemption/Permit RevisiOns**
0 Site Plan Approval Advance Determination( PAAD)* ' 0 Shoreline Management SUbetandal Development,* . • .
0 Temporary Use . . . . 0 8hereline Management V.ariance• 0 . • • • •
0 Wireless Telecommunication* . . • 0 ComprehensivePlan/UDC/Land Use.District Map Amendment
0 Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment
*May require a Pro-Application Conference .• 0 Tree Vegetation:Request . . • •
,
• **Requires a*PreAppriCarion Conference
. .
Please identify any other local;state or federal permits required for this propcisal,.if known:
. •
' . • . • . • . .
• . . . . . .
• . .
' DESIGNATION OF AGENT • . . .
I hereby designate . • . 0 act as my agent in matters relating to this application for perritit(s).
• . .
, .
.OVVNVt IFIGNANRE . . .. .Date:. . ' . .
. . •
. - • .
By signing this application form,the owner/agent attests that the inforMatipn provided herein,and in any attachments,is tale 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 respeceto.this application packet
may result in this permit being null and void. , ., S • • •
I further agree to save,indemnify and hold hariniesS Jefferson County against all liabilities.judgments,own 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 . . Ide access and right of entry to..leffettOn'eounty and its employees,representatives or agents for the sole purpose of application
review and any - .•.later inspections. .Staff's access and right of entry will be assUmed unless the applicant informs the County in writing at the
• time of the -•p 7_70. qat he gr she wants pri• notice / . . . . ' 0 •
. I _...,___ .,-:.. . . '
‘`- Signature: Alprr, .. ____......._ / Data:__________________________
, • ' •
The action or actions Applicant will undertake aa'a result of the issuance cif.this permit may negatively impact upon one or Merelltitaatened or • .
endangered.species and could wad to a potential,'lake"of an endangered species as.those terms are detined.ln•the federal law known as the
'Endangered Species Act or'ESA"Jefferson County makes no assiganoesto the applicant that the Actions that will be undertaken because this
permit has been F•,-d will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding.yourp
• action(s)even if, • re in compliance with the Jefferson County development Code,The Applicant acknowledges that he,she or It holds Individual
and non - a -0:-:• ,,i;-po%bility for:8140,-, 1 to and . plying with the ESA. The Applicant has this disclaimer and signs and datesitbein
,,.. /
Signature: . . :. _ .■10 • . Date: . •
03/081'2011 08:28 3603794451 DCD JEFF CO) PAGE 02f02
sUILDERSTATEMENT •
The signer of this. . -rent does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed ntraotors'and•that
the responsibility of neral Contractor for proposed protect.
they will be ° % `�I
Signature: 1 _ _ _ - _
�Pl�t+t�:; FAX:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: ( )
( . ) '
• EMAIL: '
MAlu to Avat�ss: WAINS '
CONTRACTORS LICENSE NUM61=R
NUMBER:
ARCHITECT/ENGINEER: PHONE '( .FAX:( )
MAILING ADDRESS: .
Project Ty.Pe: Frame.Type: Bathrooms!,,. Shoreline Type of Sewage Disposal:
0 Wood ' Existing: 0 Sewer
O New Proposed: ., p'Community System
O Addition ' . o Steel. Height 0 Individual System
Total:
t:
p AtteraUoNFdemodel Q :Concrete 'SEP Permit.#
O Repair • d .Masonry
0 Other. .' Bedrooms: Water Supply:D pentolition. .. Existing: Setback: ' p: private wen 0 TWO Party
• : P Poe
�� b Rtablio
Type of Heat Total: Name Qf.System:• ' •
1 .,isi: aC.. e la - ustanew folio.,an•i.
•
Number of Parking Spas: Current: Proposed: Number'of DA Parking Spaces: •
Number of occupantts'(iicludes awnem,tenants,.employees,etc) Current. proposed . .
IBC Occupancy:.: IBC.Type of construction: Will you have FOod1S rvioe?.Yes /• N ,•No -`
�,-- . Jf this_I9 a Pronane Tank and/or t dlanee-It thllatio -mi me , all Item ..low . .;. :,.1*: '
r 1 Urid:a•'. d Tank. e - Size of Propane Tank _S d Je_,
Woodstove .t.Fireplace.Insert I Hot Water Tank , ,..-• •
Fleet Stoy=
is ; is . ••I _n• . !, i.: .:I ad In ,. _n i_,.. . •bile H. 1, Yes / No .
When applyin g for ti penult to install,
.propane tank you ou must also sU!im
lt a a ltep a z, ..N•N r
`/. ,J L='
,. iipr
opben
y •
lines,tank location and size,distances front he propane tank to all property I s - . . . �, -Porants,
inclUdln t the reserve a . A i
$,}�� � � z t ,.,:.:.,:4:45:,,,,,.,,,,,--f: y S f ,til�Q j ,E b,- J ,+.'fi .r 5~
S•uare =oot,.a. Current Fro.. � r ! -�a "§tit; f
Main Floor Rested, U s t , EH nit a dit
en az
.-. i MY.` M a.ky n
°' 3 Consistency R: ew: . 1'. RSONCe N .Igis
2 ' Floor Heated w E D •T. F COMMUNITY DEVEtO•
• Other Heated y A' �y` : _
Mezzanine .N.:4--.!-Y4- f "3; Additional.Section •
z
Heated :asemept , > °� "" Plan Check fee:' ,°r
> rte " State Surcharge fee:
Unheated Basement': >» „�x.. .
Other. hheat.: ' ti :v
; Pot Water Review feet
' ;�
Gatage/Carpott, ` a �z
Decks ;1,,,W 911/Rd Approach fee:.
r
TOTAL: 1311M111111 '
iiiimmi A'','4w��'°x ,,� Receipt Number:•• 1111111 ' 1z
Cash/Chepk Number••r,' t.... ,Z . v 1...- ,
FigQUIRED Date: fir I"i
ESTIMATED COST(, •� � .:
.Fair market value df aillebvrand materials foundation'to finish Initiells: '
. ...... --.fl, --'-"-S,.r,,,..0%M:_—...e 1lDr,T...w...\,tr,..N.Pn.m:r A.,.,lir..,v,n 5,.904l11 rinn
■
.•
• er
,
,.
A), -/,./( trLic,Po.'(
e
K. k.. „i-
v -.N.) 9
t -,-...
----r.
1 ,
(N.
, .( N. -3--
('
Y
_z___
N
o
, ,
:,-.
ffi
0
c:, -r,
i g 1---
ti
Z
vo c y
Z
r*
� � N O
UYU
•
PROPANE/PELLET/WOOD STOVE & TANK INSTALLATION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT#: BLD12-00207 Received Date 7/9/2012
SITE ADDRESS: 431 RHODODENDRON LN Issue Date 7/9/2012
BRINNON, 98320
APPLICANT: PATRICIA L ELWELL PHONE: 360--301-5256
431 RHODODENDRON LN
BRINNON WA 98320-9738
18
SUBDIVISION: PLEASANT TIDES DIV 2 Block: Lot:
PARCEL NUMBER: 988600018 Section: 15 Township: 25N Range: 02W
CONTRACTOR: OWNER/BUILDER PHONE:
OWNER, PATRICIA L ELWELL PHONE: 360--301-5256
if different: 431 RHODODENDRON LN
BRINNON WA 98320-9738
PROJECT DESCRIPTION: A/G 250 GAL PROP TANK SWAP OUT
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 7/9/2013.
REQUIRED INSPECTIONS:
Tank/Line/Appliance:
FinalApproval:
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:00 a.m. -4:30 p.m.
HOT LINE AVAILABLE 24 HOURS A DAY
\\tidemark\data\forms\F_BLD_Permit_Propane.rpt 7/9/2012