HomeMy WebLinkAboutBLD2005-00086 •
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 #: BLD05-00086 Received Date 2/14/2005
SITE ADDRESS: 192 BRIDGEVIEW PL Issue Date 2/15/2005
PORT LUDLOW, 98365
APPLICANT: OLY HOMES INC PHONE:
19860 VIKING AVE NW
POULSBO WA 98370
8+
SUBDIVISION: BRIDGE VIEW ESTATE TRACTS Block: Lot:
PARCEL NUMBER: 821355008 Section: 35 Township: 28N Range: 01 E
CONTRACTOR: SUBURBAN PROPANE PHONE: (360) 385-5096
P 0 BOX 989
PORT TOWNSEND WA 98368
36Q) 598-5716
Contractor's License SUBURPL044DA Expires 0 /1L2/2005
OWNER, VIVIAN G CARD PHONE: (360) 340-1251
if different: THURMAN W LOWANS JTWROS
PO BOX 3792
SILVERDALE WA 98383-3792
PROJECT DESCRIPTION: A/G 350 GAL PROPANE TANK, HEAT STOVE, HOT WATER TANK,
BBQ AND GAS PIPING
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 02/15/2006.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: /ArrEkto' ' EerE- Paof.xAus I'! J Conc Zions OA
6/➢N/� S ble S//o/oS I/PPu f ,AJ E S OK s//D/6S
FinalApproval: '/< t'or Q,Ms! S/iD/oScW
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_Permit_Propane.rpt 10/29/19c
IIJILDING PERMIT APPLICATOL BLD05-00086
Review
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD05-00086 Received Date: 2/14/2005
SITE ADDRESS: 192 BRIDGEVIEW PL
PORT LUDLOW, 98365
OWNER: VIVIAN G CARD PHONE: (360) 340-1251
THURMAN W LOWANS JTWROS
PO BOX 3792
SILVERDALE WA 98383-3792
SUBDIVISION: BRIDGE VIEW ESTATE TRACTS Block: Lot: 8+
PARCEL NUMBER: 821355008 Section: 35 Township: 28 N Range: 01 E
CONTRACTOR: SUBURBAN PROPANE PHONE: (360) 385-5096
P 0 BOX 989
PORT TOWNSEND WA 98368 ll 559g8g 5577
Contractor's License SUBURPL044DA Expires(3603/12/20056
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr A/G 350 GAL PROPANE TANK, HEAT STOVE, HOT WATER TANK,
BBQ AND GAS PIPING
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW
VALUATION MAIN:
CODE EDITION: 2003 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
Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $49.00 KAS 02/14/05 71394
Total: $49.00
¢SON Cpr, JEFFERSOUNTY •
��
4 ' 4'' DEPARTMENT OF COMMUNITY DEVELOPMENT
N `'4 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 •
p� www.co.jefferson.wa.us/commdev360/379-4451Faxelopment ,
..`...., S F t d 14 2005
Master Permit Application MLA:
Project Description(include separate sheets as necessary):
.5 Fes- Z-- 6r2/1"-ivs C ,-ci , •
Tax Parcel F�-! 3.5� Property O� Q�Number: �� Size: (acres/square feet)
Site Address and/or Directions to Property: /1a7-Zoe /L4c) .
Property Owner(s)of Record: i J, 4 u Ze ee}I7V s a°mu/ C Ll' d
Telephone: 3 PO- Va—/Z c/ Fax: email:
Mailing Address: 37a 9 Gt'r P 9'F3 8'3
Applicant/Agent(if different from owner): Ivey -er,-5� ./<-' .
Telephone: O SDI 7' F :36 -c137/6 email:
Mailing Address: /7 liO' U�/ C. 1/LJ / /
What kind of Permit?(Check each box that applies)
I.1 Building ❑Variance(Minor, Major or Reasonable Economic Use)
❑ Demolition Permit ❑ Conditional Use[C(a), C(d),or C]**
❑ Single Family 0 Discretionary"D"or Unnamed Use Classification
❑ Garage Attached/Detached ❑ Special Use(Essential Public Facilities)**
❑ Manufactured Home 0 Boundary Line Adjustment
❑ Modular ❑ Short Plat**
❑Commercial* ❑ Binding Site Plan**
❑Change of Use ❑ Long Plat**
■ '.dress I I Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments**
s Propane ❑ Plat Vacation/Alteration**
❑All.wed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions*"
❑ Stormwater Management ❑ Shoreline Management Substantial Development**
❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance
❑Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium
*May require a Pre-Application Conference **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 it's 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 attomey's fees and
expenses which may in any way e a. inst Jefferson County as a result of or in consequence of the granting of this permit.
I further agree to provide a s nd %.,l of e; to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any required lat spe, So'/�► . and right of entry to this property shall be requested and shall occur only duringgg egularrrr business
hours. /ly
Signature: Date: Z�Y O
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 or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this
permit has been issu ill 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 yo in pliance with the Jefferson County development code.The Applicant acknowledges that he,she o holds individual
and non-trans I ibility for adhering to and complying with the ESA_ The Applicant has read this disclaim . i s and dates it below.
Or
Signature: Date: '
G:\PeimitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
III
OWNER 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 ONTRA TOR OR MANUFACTURED HOM INSTALLER: PHONE: FAX:
drte5, ��G /� ,�, 4•cie (tea )19�-3"Taz (J , ) SW-S--761:1
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: O ��L ' %7 / NUMBER
ARCHITECT/ENGINEER: pc,„„) 6,4447i7O PHONE ( ) FAX: ( )
MAILING ADDRESS/I 14�,N,, A. J/ ) EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New Li 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: L 1 Private well [1 Two Party
Type of Heat: Proposed: ❑ Public
Total: Name of System:
If this is a Commercial Proiect 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 nd/or Appliance Installation permit,mark all items below that apply:
I i Underground Tank y-\Above ground Tank Size of Pr pane Tank:
Heat Stove I I Cook Stove I I Woodstove I I Fireplace Insert Hot -r Tank ❑ Pe let Stove ii 6/50Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes l •
When applying for a permit to install a propane tank you must also sub - plan showing all of the buildings,all property
lines, tank location and size,distances from the propane tank to all prop,t� nes,buildings and septic system components,
including the reserve area.
Square Footage For Office Use Only
Current Proposed Amount
Main Floor Consistency Review:
3,.-1A2NU Floor Base fee: L1�' .,I
-YCV1Vftat �. j
31tl Floor Additional Section:
Mezzanine: Plan Check fee:
Heated Basement State Surcharge fee:
Unheated Basement Pot Water Review fee:
Other Unheated 911/Rd Approach fee:
Garage/Carport -- TOTAL: $ l� :- ,C-.)
c)
Decks 4 2005 Receipt Number: 1 I q'L
Other Cash/Check Number: (pV
ESTIMATED COST(REQUIRED) Date: \ 1
•Fair market value of all labor and materials foundation to finish '" ) -\L 1 l t
Initials: ( ,
G:\PemutCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
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