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Home My WebLink AboutBLD2014-00122 .UILDING PERMIT APPLICASN BRD1e 001 2 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00122 Received Date: 4/8/2014 SITE ADDRESS: 24 TYEE LN PORT LUDLOW, 98365 OWNER: MONTE J PIERCE PHONE: 360-437-2148 MARY E PIERCE 20763 E BELLEVIEW PL CENTENNIAL CO 80015-6437 PORT LUDLOW NO. 1 AREA 3 SUBDIVISION: Block: Lot: 41 PARCEL NUMBER: 990400341 Section: 8 Township: 28 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 DESCRIPTIOI INSTALL 120 GAL TANK, PIPING AND RANGE TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW 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 04/08/14 148533 Total: $228.00 APPROVED r,t n y ;, .r Jefferson County DCD \\tidemark\data\forms\F_BLD_App_Bld.rpt 4/8/2014 1 OP°r JEFFERSON COUNTY Ljp _:,..,...tr, `` DEPARTMENT OF COMMUNITY DEVELOPMENT .I5 Date: a1 1 Time Received: j ( ,50 am/pm Mo Tue. Wed. Thur. Fri. Date: \„ Q(� BLD: A,;;).::, = = r T'Y\7 Vk-1at: ' Contact Name: Owner: 1Y-` J -4Vt`e 1-c Contact Number: 360 Address: 1- -rile-e,_ 206 2 Notes: �cQ _o \✓�Y -1 �(�- tr J ��J GJg�� Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Under ground ur�� Footing Rough In Air Seal Above ground 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 __.--- _____ ____ 44�,5°N `be, JEFFERSON COUNTY - ` DEPARTMENT OF COMMUNITY DEVELOPMENT 4�SHI NGC Date: Time Received: ?,l , am/pm. Mon. Tue. d^ Thug., Fri. /! / Date: CI 1 BLD: k, `4I 4 -3- ' Contact Name: Owner: 1( e 111 Contact Number: 3604:7 Address: Z�'�,,11i'T ,. (ra P 206 Notes: Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Under ground .- Furance Footing Rough In Air Seal Above ground fi 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 b * , NO. 148 DATE "t7V! 7' N RECEIVED FROM SY'Q1"- 2'�`'.,--L N DESCRIPTION BARS# AMOUNT CURRENCY 9W��i COIN SCrCl I 1-CHEC G_ C o m 33 O RECEIVED BY A 7- TOTAL 2 1--,' - ort e S 06 JEFFERSON COUNTY ` DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 : 360/379-4450 • 360/379-4451 Fax www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Project Description(include separate sheets as necessary): 1 Q 11 I rrl 1 F' v, l S`1' -) Tax Parcel Number: qg 0q 6D-3 `1 ) Property Size: (acres/square feet) Site Address and/or Directions to Property: / ��( i ►. , PO 2- ► 1 ?K c' Property Owner(s)of Record: 1M Oil 4c fi (h Telephone: ' a--td 3 - 6ss Fax email: Mailing Address: at-1 f z i /--Lt o f-b LOA 9-%50S- Applicant/Agent(if different from owner): <S c._nsh nUL, Pro -uL_. Telephone: 3(.0 0-- 3 i S— 5—)Gi Fax: email: Mailing Address: What kind of Permit?(Check each box that applies ❑Building ❑Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use) 'El 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 0 Shoreline Management Variance O Wireless Telecommunication* 0 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: (7— 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. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applicatio th t-hior she wants prior notice. Signature: y �- Date: . L— ( L- 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-transferable responsibility for adhering to a complying with the ESA. The Applicant has read this disclai C it and signs and dates it below. Signature: Date: ( L r L G;\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc 1 • • * , 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: ( ) ( ) 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 0 Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: 0 Individual System El .Repair ❑ Masonry SEP Permit# Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well 0 Two Party Type of Heat: Proposed: r❑ Public Total: Name of System: If this is a Commercial Protect 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: 1 Underground Tank '-Abgve ground Tank Size of Propane Tank: I 1 Heat Stove •ook St Woodstove I Fireplace Insert 1 Hot Water Tank 1 Pellet Stove 1 Other , Is this appliance einq installed in a Manufactured/Mobile Home? Yes I 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. s � �t Tj x ' n � � nap ti F ' " � ' � u� '41',74-- -,'„*'::::,�� S uare Foota a Current Proposed � o-a r ' �• y fF e� i :� h � . ,�_ e� � Main Floor Heated 1 �_Ot- EH Bld App Review. 2"tl Floor Heated 'X00 ' :R Consistency Review: Other Heated :.. :. `.y Base fee: li .Ado r Mezzanine �i L��:� �i t� Additional Section: 7011W:- Heated Basement '.ri.. ' Plan Check fee: Unheated Basement i x State Surcharge tee: Other Unheated 4''�'; l' ,i Pot Water Review fee: Garage/Carport rai 1: ,r- !' SUBTOTAL i Decks ,' r, ti, 911/Rd Approach fee: h6° aVr F F ON Other k � � i TOTAL: $ 'fin P I ` Receipt Number: oR Cash/Check Number: ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish Initials: ' G:\Pe itCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc • • SITE VISIT REPORT (PLOT PLAN) P JOB 1 ®fV 77 '� G4 ff� P I- : v. 0 /V CONTACT: ADDRESS aq�I (--t.:Q-e, PHONE #:YOY"-z� �L ''-'.r 'e7 DIRECTIONS f77 A2'-' FAX #: Email PLANNER: 4444 . 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. .4„,„ AI '4e0 I 0 I `a �` . ' • 1' /lam • • 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 #: BLD14-00122 Received Date 4/8/2014 SITE ADDRESS: 24 TYEE LN Issue Date 4/8/2014 PORT LUDLOW, 98365 APPLICANT: MONTE J PIERCE PHONE: 360-437-2148 MARY E PIERCE 20763 E BELLEVIEW PL CENTENNIAL CO 80015-6437 41 SUBDIVISION: PORT LUDLOW NO. 1 AREA 3 Block: Lot: PARCEL NUMBER: 990400341 Section: 8 Township: 28N Range: 01 E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 (301385-5875 Contractor's License SUNSHP*077QP Expires 11/17/2014 OWNER, MONTE J PIERCE PHONE: 360-437-2148 if different: MARY E PIERCE 20763 E BELLEVIEW PL CENTENNIAL CO 80015-6437 PROJECT DESCRIPTION: INSTALL 120 GAL TANK, PIPING AND RANGE 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 4/8/2015. REQUIRED INSPECTIONS: Installation per Manufacturer Specifications/CO2:/,� ,,QQ CJ a 5/4 Tank/Line/Appliance: ' /laN I /Ng" 6 K eo d e-L<-6o r ��f Final Approval: _at 'Crif,-( ? 41/(5 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 4/8/2014