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HomeMy WebLinkAboutBLD2005-00176 • • 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 #: BLD05-00176 Received Date 3/24/2005 SITE ADDRESS: 2339 W VALLEY RD Issue Date 3/24/2005 CHIMACUM, 98325 APPLICANT: HEATH H BOE PHONE: ELISA A BOE 2339 W VALLEY RD CHIMACUM WA 983259747 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901271007 Section: 27 Township: 29N Range: 01W CONTRACTOR: OWNER, HEATH H BOE PHONE: if different: ELISA A BOE 2339 W VALLEY RD CHIMACUM WA 983259747 PROJECT DESCRIPTION: WOODSTOVE INSTALLATION 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 3/24/2006. REQUIRED INSPECTIONS: Tank/Line/Appliance: Sr+ot, c 023 -ems—' FinalApproval: (1'023'4:4_5"' 42 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 10/29/19 ItUILDING PERMIT APPLICAJN BLD05-00176 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #:. BLD05-00176 Received Date: 3/24/2005 SITE ADDRESS: 2339 W VALLEY RD CHIMACUM, 98325 OWNER: HEATH H BOE PHONE ELISA A BOE • 2339 W VALLEY RD CHIMACUM WA 983259747 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901271007 Section: 27 Township: 29 N Range: 01 W CONTRACTOR: PHONE: PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTION WOODSTOVE INSTALLATION 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: CONST TYPE: OTHER: SHORELINE: CONST TYPE: . GARAGE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $50.00 PRB 03/24/05 71581 ;aRRR Total: $50.00 !4 ' MAR 2 3 2005 Jefferson County Planning Buildin Bep rtment ,ONc 4 OO JEFFERSON COUNTY A ' ,; DEPARTMENT OF COMMUNITY DEVELOPMENT MAR 2 4 2005 *' `` P4 621 Sheridan Street • Port Townsend •Washington 98368 • - 360/379-4450 • 360/379-4451 Fax gS,IIING�p www.co.jefferson.wa.us/commdevelopment I Master Permit Application MLA: Project Description(i/Iclude separate sheets as necessary): /'5 c�/L,.F i2t. „oo -b rmai �:/ ? ro exx�fji� c ii,»we/, Tax Parcel © �-7 Property r /� / Number: �! O I ,7 1 OO / Valley Sizee:,�/// 0,,►►/A v aches /� (acres/square feet) Site Address and/or Directions to Property: 2 33q Wet Vall y Kd. Ckmacum, WA Property Owner(s)of Record: Heath • E/;s& $Oe /Telephone: 360.73 2."Oa 6( Fax: email:PiliktklBoe c faAdo.COprt Mailing Address: 2339 Wast act nay Rd. Ch,';mews , wA 993a?�" Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) Building Variance(Minor,Major or Reasonable Economic Use) Demolition Permit Conditional Use[C(a),C(d),or C]** Single Family Discretionary"D"or Unnamed Use Classification Garage Attached/Detached Special Use(Essential Public Facilities)** Manufactured Home Boundary Line Adjustment Modular Short Plat** Commercial* Binding Site Plan** Change of Use Long Plat** Address 1 Road Approach Planned Rural Residential Development(PRRD)/Amendments** Propane Plat Vacation/Alteration** Allowed"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* 1 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 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 inspecti ns.Access and right of entry to this property shall be requested and shall occur only during regular business hours. `�.2/y� Signature: Date: /Qr r l/ W 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 co pliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transfe I- re •o . •ilityi•��,,apddhering to and complying with the ESA. The Applicant has read this • claimer and a and signs an dates it below. Signature: 1/� 1' /vV Date: ecm i /�eo. C:ADocuments and Settings\mochil\Desktop\Master Permit Application 7-8-04.doc • 0 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 r sponnsibilit of the General Contractor for the proposed proj/flc. / ��jj /� Signature: - Zg Date: ////(� �1 ilJ, �(/0'1✓- GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAx: ( ) ( ) MAILING ADDRESS: EMAIL: MAR 2 4 2005 CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) I 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 1 Two Party Type of Heat: Proposed: 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 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 i Above ground Tank Size of Propane Tank: i Heat Stove j Cook Stove XWoodstove i Fireplace Insert I Hot Water T k i 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. Square Footage For Office Use Only Current Proposed Amount Main Floor Consistency Review: 2Nu Floor Base fee: 50.00 3ftl 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: $ 5000 Decks i ✓5�vg Receipt Number: t O 1 Other Cash/Check Number: 2-0 1 ESTIMATED COST(REQUIRED) Date: 3 2.�(05 .Fair market value of all labor and materials foundation to finish Initials: C:ADocuments and Settings\mochil\Desktop\Master Permit Application 7-8-04.doc , �/