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Home My WebLink AboutBLD2013-00255 tUILDING PERMIT APPLICAN BLD13-00255 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD13-00255 Received Date: 8/20/2013 SITE ADDRESS: 450 FRANK BECK RD QUILCENE, 98376 OWNER: JEFFERY CONLEY PHONE: 360-531-2237 BILLIE JO MEYERS 450 FRANK BECK RD QUILCENE WA 98320-9608 SUBDIVISION: Block: Lot: PARCEL NUMBER: 702134031 Section: 13 Township: 27 N Range: 02 W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2013 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION SWAP OUT 120 GAL PROPANE TANK 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: Type Amount Paid By: Date: Receipt: Approved/Date Permit $76.00 MEB 08/20/13 142407 APPROVED Total: $76.00 AUG 2 0 2013 Jefferson County DCD \\+irlcmor4\rlo+o\fnrrnc\F RI n Ann RL+rn+ Ar)nr,N4 Point& Pay - Create Order • Page 1 of 1 • Thank you for your payment! This service has been provided by Jefferson County Dept of Community Development, WA and Point& Pay. We value your business. Please keep this receipt for future reference. You have made a payment to Jefferson County Dept of Community Development, WA , your payment was processed at Dept of Community Development office . Jefferson County Department of Community Development thanks you for your payment. For questions about your account, please call 360-379-4452 Name: BILLIE J MEYERS Address: 70 palomino LN, Brinnon WA, US, 98320 Contact: 3605312237 Comments: Payment ID: 11176910 Date: 08/20/13 02:04 PM Subtotal: $76.00 Fee: $2.50 Total: $78.50 Method: Credit or Debit Card(************4383) Item Purchased Transaction Description Account Amount Residential Applications Jefferson Co C D GOV $76.00 Signature: Date: By signing this receipt you agree to the terms and conditions of this service. You will see one line item on your credit or debit card statement indicating the amount you paid and will be identified as Jefferson Co C D GOV. If you have any questions about the charges please call 1-888-891-6064. Print Receipt Close Window https://agent.pointandpay.net/pointandpay_counter/viewReceipt.do?method=viewPayment... 8/20/2013 „ ,,`°o r JE RSQN COUNTY DEPARTMENT OF MM [ DEVELOPMENT ”' 621 Sheridan Street I Port Townsend,WA 98368 I Web:www.co.jefferson.wa.us/communitydevelopment �9-AriNG-° Tel:360.379.4450 I Fax:360.379.4451 I Email:dcd@co.lefferson.wa.us Building Permits&Inspections 1 Development Consistency Review/Long Range Planning 1 Watershed Stewardship Resource Center Master Permit Application MLA: Project Description(include separate sheets as necessary): ?RoPAN& T4l. Sc,d4P Tax Parcel Number4 '7D a- 13 44 0 3 ( Property Size: , 8' (acre quare feet) Site Address and/or Directions to Property: Property Owner(s)of Record: 6 IL,I E Z me-(EL S A N n f F EJ A-L it-N CO N L EY Telephone: 2(oO- sat - a237 -e 3(4-S31- I"7 - email: rw��1 PXS cawleHC�iP-w+bgr�wtg.,.CO►, Mailing Address: 450 FtLAN1L 1 i-C-I4. 2.0, Qur I.ceNE. , (AA• 9$'3'7(0 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** ,Propane ❑Long Plat** ❑Sign ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑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 inspections. Staff's access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applicatio th he or she .nts prior notice. Signature: j�1tt1►w1 / Date: 7 //3 if The action or a tions Ap.7.nt will nderta - 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 r- pon ibility for adhering to and complying with the ESA. The Applicant has read this disci imer and signs and dates it below. Signature: vv/, ilk ci-\ �- Date: $/90/i 3 If 7 /41 07/24/2013 • 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: s _ GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: (DL.) 5t4((4 P9-0PAOQ ( ) ( ) 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 iy1) Q 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 Propane Tank and/or Appliance Installation permit,mark all items below that apply: i Underground Tank 1 Above ground Tank Size of Propane Tank: Heat Stove Cook Stove 1 Woodstove 1 Fireplace Insert i Hot Water Tank 1 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. 1 - r 4 4 # __Square Footage Current Proposed Far U� fy ` i Main Floor Heated EH Bld App Review: " I m 2"0 Floor Heated Consistency Review: Other Heatedw Base fee: x Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement 1 State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport " SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $ Receipt Number: .Vi , Cash/Check Number: ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish Initials: 07/24/2013 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#: BLD13-00255 Received Date 8/20/2013 SITE ADDRESS: 450 FRANK BECK RD Issue Date 8/20/2013 QUILCENE, 98376 APPLICANT: JEFFERY CONLEY PHONE: 360-531-2237 BILLIE JO MEYERS 450 FRANK BECK RD QUILCENE WA 98320-9608 SUBDIVISION: Block: Lot: PARCEL NUMBER: 702134031 Section: 13 Township: 27N Range: 02W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 �) 3g5 Contractor's License SUNSHP*077QP Expires 1'f/((33 167/2013-5875 OWNER, JEFFERY CONLEY PHONE: 360-531-2237 if different: BILLIE JO MEYERS 450 FRANK BECK RD QUILCENE WA 98320-9608 PROJECT DESCRIPTION: SWAP OUT 120 GAL PROPANE TANK 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 8/20/2014. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: 213-13 '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 8/20/2013 1 f1 ' 0 • • •Ni‘ -3\-4? Lt./L r A `4.0■i<jF `fie ; .t Date sj?‘ time received q 3 Z' (`j'/ pm Mon. la.Wed: Thur. - Fri, BLD: 13 0255 Date:__ LVZ 7 OWNER: I �;L ET • Contact Name: ADDRESS: 4-5 �£e..< odt Contact Number:360 3 6 -5'797 Notes: 'c ?I�It�F ��I • 41JdC 206 • Foundation Piulq. • Framin — Propane Tank Mechanical ' • Setbacks — Under-ground Framing Footing Rough In g Under ground Furnace Sooting l _ Hydron In Air seal Above ground _• Gas Straps Exterior shear Exterior lines Oil . Post Straps interior _ Interior lines • Ducts • Ventilation Underfloor Appliance • Man-,Homes Gas/wood stove_ Setbacks Insulation - Foundation Final inspection , floor _wall ceiling. . 'f tV Block&Tie Address Posted • i