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Home My WebLink AboutBLD2013-00368 iltUILDING PERMIT APPLICIN BLD13-00368 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD13-00368 Received Date: 11/20/2013 SITE ADDRESS: 660 SCHWARTZ RD NORDLAND, 98358 OWNER: MARLENE L CARROLL TRSTEE PHONE: M L CARROLL LIVING TRUST 660 SCHWARTZ RD NORDLAND WA 983589606 SUBDIVISION: Block: Lot: PARCEL NUMBER: 021282006 Section: 28 Township: 30 N Range: 01 E CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**979OZ Expires 9/7/2014 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP INSTALL 120 GAL PROPANE TANK TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION ADD'L: HEAT TYPE: 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 $228.00 MEB 11/20/13 145564 APPROVED Total: $228.00 NOV 2 0 2013 Jefferson n County DCD N+IrmmnrLNrlo+o\fnrmc\C RI Il Ann Rid rn+ 11/)rV9l114 r4i.SON oo JEFFERSO OUNTY I' v " 4� , f DEPARTMENT OF COMMUNITY DEVELOPMENT ►C 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax itsvzirm p• www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Project Description(include separate sheets as necessary): 2N 54 ! 121) 9_61,1M pgag n e -E-a'1 k Tax Parcel Number: Q a 12 g a co& Property Size: (acres/square feet) Site Address and/or Directions to Property: LGO ,5011 a�-t Rd tvordlati4, 1,tiPr q''35R Property Owner(s)of Record: Marlene CArrol l Telephone: 3t 1 374 3l 5,3 Fax: email: Mailing Address: /o(p D S CA ala r-tZ red /v-ar lava) 01 418 3s( Applicant/Agent(if different from owner): (.11 P,r9 l_ I.,ei/iY1 S 4Y) Telephone: 6,- �i Fax: r9 email: Mailing Address: to t/p 0 5 a/4 d f Z- Ems/ Ara rdlak- i (i 9- Gj e3s 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** ❑Siyn ❑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 p�(_fl P Yy) UpLkr , - to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE ,�/l ke,o( .�C.�G(✓A/ Date: // .'.0/9 01 L /3 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 appli ion that he or she wants prior notice. Signature: l Vt4YI Date: a0 A70V1 3 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"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-transfersple�responssiibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: (rM t. < afrk Y] Date:- .2 O /YOi/ a2 lam( G:\PermitCenter\###FORMS###\DRD FORMS\Current 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 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: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: Ca?e i-- Gh(7VL-d 'F�(vY� ( ) ( ) 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# L Demolition ❑ Other: Bedrooms: Water Supply: Existing: - Setback: ❑ Private well ❑ Two Party Pro osed: Type of Heat: p 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 • ■3C 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: 1 Heat Stove 1 Cook Stove i Woodstove i Fireplace Insert 1 Hot Water Tank i Pellet Stove 1 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 For Office Use Only Amount Revision Main Floor Heated EH BId App Review: 22 Floor Heated Consistency Review: Other Heated Base fee: Mezzanine Additional Section: l/ Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $ Receipt Number: J Cash/Check Number: 10 C3 ESTIMATED COST(REQUIRED) Date: " ),� (� •Fair market value of all labor and materials foundation to finish 11 Initials: 1 G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms Master Permit Application 5-29-08.doc • O H _ O' U. _0 Z LL O H O � O -- -- Nt 4- O - .- W O -O - CY) .J O O L C9 -0 X CC -O +-0 CA Z C C� C! = H W O 0 CO +' "0 H = O I •- O -C -C -C CO r- ex -G U U U W Z O CC O J Cl. 0- g � � U I- I- O O O CU CA -O = O C� CO CC J "O W I- O w C = 3 W 00 CO 3 I- Z W (0 �. o I-- = 0) O O7 H Z J U O CO CC I -0 CL CO • CO W z CC 1- CO C O CA O N J I-I I- LID - X W CO CC � C, CO 3 '- N W J CO X Q J Z CO I- CO Z Q X OD J H 07 -0 Ct_ O U - , I- W O7 O > O C W CV • • LI- - J W CC I-I = W d CO CO O O GM W CO CC CC J Q O N I CO - W Q CI Q N X •- C C � W CO O O I- X � cp U J I- C.O a N %- Z O N co Q ¢ J CC O C= v 1- CC I- J O Q O _J CO CU w X 1- w Cr X o = Q O ¢ I- w CC x M C� W -O Cr) f- L- I- J x W Z Q U Q CC U I- J O J I- N J LU U CD J - CD O CA CL. 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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#: BLD13-00368 Received Date 11/20/2013 SITE ADDRESS: 660 SCHWARTZ RD Issue Date 11/20/2013 NORDLAND, 98358 APPLICANT: MARLENE L CARROLL TRSTEE PHONE: M L CARROLL LIVING TRUST 660 SCHWARTZ RD NORDLAND WA 983589606 SUBDIVISION: Block: Lot: PARCEL NUMBER: 021282006 Section: 28 Township: 30N Range: 01E CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2014 OWNER, MARLENE L CARROLL TRSTEE PHONE: if different: M L CARROLL LIVING TRUST 660 SCHWARTZ RD NORDLAND WA 983589606 PROJECT DESCRIPTION: INSTALL 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 11/20/2014. REQUIRED INSPECTIONS: Tank/Line/AppiiaFtee: � —10 -6 3 FinalApproval: 2 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 11/20/2013 ( ..,e,f 112c1,-,ir$.-, i ¢kw$ON :o°Gy JEFFERSON COUNTY Q9S> DEPARTMENT OF COMMUNITY DEVELOPMENT ‘./ Date: 4.272,//3 Time Received: if'00 am/'a Mon. Tue. Wed. Thur. Fri. n c� Date: 1� _ I. BLD: ►Pj Lb 13 d��'v Contact Name: t' ® � n-'', I' 'Owner: J)1c r �te n e. / Contact Number: 5-3/- 391')- Address: 206 Notes: „„ 1) _, ,,, .. c, 0 L,, e_ ,4.,i G 0// ,■ 1- &!vt'1V` / 1, rYlcer t . 11, •i, / Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Under ground Furance Footing Rough In Air Seal Above ground "/2 G-gd, 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