HomeMy WebLinkAboutBLD2004-00223I
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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 #: BLD04-00223 Received Date 4/5/2004
SITE ADDRESS: 6516 BEAVER VALLEY RD Issue Date 4/5/2004
CHIMACUM, 98325
APPLICANT: JERRALD WEIDNER PHONE:
PO BOX 40
CHIMACUM WA 98325
2
SUBDIVISION: HEAVY METAL HILL SHORT PLAT Block: Lot:
PARCEL NUMBER: 901251022 Section: 25 Township: 29N Range: 01W
CONTRACTOR: C H S PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CHSIN**9790Z Expires 09/06/2004
OWNER, CHARLES BRODERS PHONE: (360)385-2441
if different: 4503 OLD GARDINER RD
PORT TOWNSEND WA 98368
PROJECT DESCRIPTION: 500 GAL ABOVE GROUND PROPANE TANK
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 04/05/2005.
REQUIRED INSPECTIONS:
[ ] Tank/Line/Appliance: l.,- -() c--71 K\f.1)14)Li,
{[1 FinalApproval .(1s
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
I:\F_BLD_Perm it_Propa ne.rpt 10/29/19
11113UILDING PERMIT APPLIC BLD03-00399 N Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD04-00223 Received Date: 4/5/2004
SITE ADDRESS: 6516 BEAVER VALLEY RD
CHIMACUM, 98325
OWNER: JERRALD WEIDNER PHONE:
P 0 BOX 40
CHIMACUM WA 98325
SUBDIVISION: HEAVY METAL HILL SHORT PLAT Block: Lot: 2
PARCEL NUMBER: 901251022 Section: 25 Township: 29 N Range: 01 W
CONTRACTOR: C H S PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CHSIN**9790Z Expires 09/06/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr 500 GAL ABOVE GROUND PROPANE TANK
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW
VALUATION MAIN:
CODE EDITION: 1997 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: PARCEL TAGS: YES NO
BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA
Exist: Exist: Wetland Erosion
Prop: Prop: Seismic Streams
Total: Total: Flood Way Floodplain
Routing Date: F&W Landslide
cS o Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $48.00 ZAN 04/05/04 64205
Total: $48.00
JEFFERSON COUNTY COMMUN.EVELOPMENT,621 SHERIDAN ST,PORT TOWIDD WA 98368 PH: (360)379-4450
INSTALLATION PERMIT APPLICATION-- Nam) Se
MARK ALL ITEMS BELOW THAT PERTAIN TO THIS INSTALLATION
Underground PROPANE TANK* Above Ground PROPANE TANK* SIZE OF PROPANE TANK coo
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HEAT STOVE HOT WATER TANK WOODSTOVE FIREPLACE INSERT PELLET STOVE
COOKING STOVE OTHER(Please Specify)
Is this appliance (woodstove, htg stove, hot water tank,furnace, etc.) to be installed in;a Manufactured/Mobile
Home?
YES NO
SITE ADDRESS(911#/Road Name): S t j {,A- ` D
()SO
C11 t vykOt Cvt ZIP
9 DIGIT PARCEL ID NUMBER (AN G 5-1- Oa Z
Legal Description:
Subdivision Name Block Lot(s)
Section Townshipo� North, Range WM
'�v 'APPLICANT
`e.(t N-^4L-�' y�-1,t-ik_b PHONE
MAILING ADDRESS 1 V `✓671N LI 0
k1 M.01.Cu VvV ZIP 'S32 J,
PROPERTY OWNER PHONE
MAILING ADDRESS
1 ZIP nn
CONTRACTOR ` c PHONE APR - 5 2W4
MAILING ADDRESS
ZIP
STATE LICENSE# EXP.DATE
FEDERAL I.D.#
By signing the application form,the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. Any material falsehood or
any omission of a material fact made by the applicant/owner 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 it's employees,representatives or agents for the purpose of application review and any required later
inspections. Access and right of entry to the a property or structure shall be requested and shall occur during regular business hours.
APPLICANTS SIGNATURE ?)(3-11'.'ra/— DATE / } / 6/V
FOR OFFICE USE ONLY /L
BASE FEE $48.00 RECEIPT# (Q` ra.O S
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CONSISTENCY REVIEW $24.00 CASH/CK# C
TOTAL 7 ,t"D DATE /S/
Propane Tank applications require additional information to be submitted. OVER
Please contact our office at 360-379-4450 if the back of this application is blank.
G:\PermitCenter\FORMS\BLDG FORMS\install-revised 01-26-04.DOC
All Props. Tank Application Requiiments
When applying for a permit to install a propane tank you must submit the following:
1. Site plan showing all of the buildings, all property lines, tank location, distances from the
propane tank to all property lines and buildings, septic system components including the
reserve area. Indicate the size of the tank and whether or not it is above ground or below
ground.
2. An additional fee of$24.00 for Consistency Review is required. The total amount due at time
of application is $72.00.
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G:\PermitCenter\FORMS\BLDG FORMS\install-revised 01-26-04.DOC