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Home My WebLink AboutBLD2005-00180 • 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 #: BLD05-00180 Received Date 3/24/2005 SITE ADDRESS: 141 BLUE RIDGE RD Issue Date 3/25/2005 PORT TOWNSEND, 98368 APPLICANT: PETE DUFFY PHONE: (360) 643-3553 808 17TH PORT TOWNSEND WA 98368 SUBDIVISION: DISCOVERY BAY RIDGE DIV IV Block: L 24 Lot: PARCEL NUMBER: 001305024 Section: 30 Township: 30N Range: 01W CONTRACTOR: BLUE HERON CONSTRUCTION CO PHONE: (360)379-6977 PETE DUFFY PO BOX 718 PORT TOWNSEND WA 98368 Contractor's License BLUEHCC109D8 Expires 08/19/2006 OWNER, SUSAN FLEMING PHONE: (385-9889 if different:. 454 REINIER RD NORDLAND WA 98358-9675 PROJECT DESCRIPTION: A/G 250 GAL PROPANE TANK, GAS PIPING, HEAT STOVE, COOK • STOVE 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 03/25/2006. REQUIRED INSPECTIONS: Tank/Line/Appliance:/L- FinalApproval: ,g04-/Z0%0,1 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_Permityropane.rpt 10/29/19£ ItUILDING PERMIT APPLICAN BLD05-00180 Jefferson County Department of Community Development Review Type: 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00180 Received Date: 3/24/2005 SITE ADDRESS: 141 BLUE RIDGE RD PORT TOWNSEND, 98368 OWNER: SUSAN FLEMING 454 REINTER RD PHONE: (385-9889 NORDLAND WA 98358-9675 SUBDIVISION: DISCOVERY BAY RIDGE DIV IV Block: Lot 24 PARCEL NUMBER: 001305024 Section: 30 Township: 30 N Range: 01 W CONTRACTOR: BLUE HERON CONSTRUCTION CO PETE DUFFY PHONE: (360)379-6977 PO BOX 718 PORT TOWNSEND WA 98368 Contractor's License BLUEHCC109D8 Expires 08/19/2006 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP A/G 250 GAL PROPANE TANK, GAS PIPING, HEAT STOVE, COOK STOVE 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: CONST TYPE: GARAGE: SHORELINE: DECK: SETBACK: SEWAGE DISPOSAL: BANK HEIGHT: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $49.00 KAS 03/24/05 71758 Total: $49.00 �r��s�ly CO JEFFERSO OUNTYIII Ler/INVA � DEPARTMENT OF COMMUNITY DEVELOPMENT----... 621 Sheridan Street • Port Town$end •Washington 98368 ,4. 360/379-4450 • 360/379-4451 Fax Is NGA-O www.co.jefferson.wa.us/commd veto ent am 24 2005 E; : Master Permit Application 1 MLA: ' Project Description (include separate sheets as necessary): -r rI - Tax Parcel Property Number: Size: (acres/square feet) Site Address and/or Directions to Property: Property Owner(s)of Record: Telephone: Fax: email: Mailing Address: Applicant/Agent(if different from owner): Telephone: e 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 CI Long Plat** ❑Address 17 Road Approach LI Planned Rural Residential Development(PRRD)/Amendments** LI 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* ❑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 ins tions.Access and right of entry to this property shall be requested and shall occur only during regular business hours. Signature: Z .___' _ Date: 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 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-transferabl responsibilit y for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: �i7 Date: 'S/ `j/6 S G:\PermlitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc I. 411 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 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 ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: 0 Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: I i Private well I l Two Party Type of Heat: Proposed: I i 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 I Underground Tank ❑ Above ground Tank Size of Propane Tank: LI Heat Stove 17 Cook Stove I 1 Woodstove 11 Fireplace Insert I i Hot Water Tank IJ Pellet Stove i 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 a1.Property lines,buildings and septic system components, including the reserve area. Square Ltage For Office Use Only Current Proposed Amount Main Floor Consistency Review: ,. 2""Floor Base fee: -4'7/ 3rd Floor Additional Section: Mezzanine: Plan Check fee: Heated Basement State Surcharge fee: Unheated Basement Pot Water Review fee: Other Unheated 911/Rd Approach fee: G� Garage/Carport TOTAL: $ 6 l'� � �. Decks Receipt Number: Other Cash/Check Number: y 5 1.10) ESTIMATED COST(REQUIRED) Date: Il y) I� •Fair market value of all labor and materials foundation to finish +cac7 l Initials: ' t G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc r7 , ,, , , -,, ,,.. L . , . c�_, _ , iii iiiuiiiiI litaiwarammuisiist it-SIMAINWaraitiMb-Ria I NlltiHlSQIIIMINEEMSFjrlrymprmrmmmtwm 1.„. dien 11 lielliii111112"40110hhaRisimmummilm ■ N1■■■ fi ■mmuA 1 _siN►p■ 1 ■ ■■■■■ iiiiiiiii 1111r1IMPIORtniii■■ om■■■ _ � b Num. ' null iiili II t 11110111■■■ ■u llii pilrriidlkllti..E.ERIMMHMIMEI ■ 11151 ■UiUil■■■■■■IIIfil�1■ ■■ ■■I1[1iit.`��I�■■1R�■11■■ ■■■ .'d minommummeman ■ ■xa■ '.+.`.. d 1®I■11■■■■■■■R IIII IIIIIENI Aldrikilimi 11311 II Illikilll Ammillesill P1114 IL: NI . ' : -1 lig' ' . ' , ' 1nRilts ... -‘,-, ' .% 11 1 1 16. 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