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HomeMy WebLinkAboutBLD2005-00322 1OUILDING PERMIT APPLICAAN B Review Type: ype: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 • PERMIT #": BLD05-00322 Received Date: 5/20/2005 SITE ADDRESS: 80 W LUDLOW POINT RD PORT LUDLOW, 98365 OWNER: REED C ULMER PHONE: 360-437-9871 KATHY A ULMER • 80 W LUDLOW POINT RD PORT LUDLOW WA 98365-8786 LUDLOW POINT TRACTS SUBDIVISION: Block: Lot: 1+ PARCEL NUMBER: 969300001 Section: 16 Township: 28 N Range: 01 E CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 • Contractor's License MOUNTPI98306 Expires 09/26/2006 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI INSTALL UNDERGROUND 500 GAL PROPANE TANK, HEAT STOVE, COOK STOVE HOT WATER TANK 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: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid Bv: Date: Receipt: Approved/Date Propane Tanks/Stoves $49.00 KAS 05/20/05 73087 Total: $49.00 • • • 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 #: BLD05-00322 Received Date 5/20/2005 SITE ADDRESS: 80 W LUDLOW POINT RD Issue Date 5/20/2005 PORT LUDLOW, 98365 APPLICANT: REED C ULMER PHONE: 360-437-9871 KATHY A ULMER 80 W LUDLOW POINT RD PORT LUDLOW WA 98365-8786 1+ SUBDIVISION: LUDLOW POINT TRACTS Block: Lot: PARCEL NUMBER: 969300001 Section: 16 Township: 28N Range: 01 E CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTPI983O6 Expires 09/26/2006 OWNER, REED C ULMER PHONE: 360-437-9871 if different: KATHY A ULMER 80 W LUDLOW POINT RD PORT LUDLOW WA 98365-8786 PROJECT DESCRIPTION: INSTALL UNDERGROUND 500 GAL PROPANE TANK, HEAT STOVE, COOK STOVE HOT WATER TANK 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 05/20/2006. REQUIRED INSPECTIONS: Tank/Line/Appliance: 4 4Aff, Fin alApproval: • 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 �oiv c ! JEFFERSO OUNTY W ' \ A DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend •Washington 983----, 360/379-4450 • 360/379-4451 F p www.co.jefferson.wa.us/c mmd velopment NAY 2 0 2"5 Master Permit Application MLA: i3'-O(6-CZ ? i Project Description(include separate sheets as necessary): r►S��LL 00-10er2 SOV CAA Przt;Pna-,t : TnsjK,. t.. 2 RU Tax Parcel Property Number: CACCt 3 CC C 0 Size: L..i t c 5 r (acres/square feet) Site Address and/or Directions to Property: Z,Q �," L uf�(_v�,, (eG\r\.►- PUrZ Property Owner(s)of Record: et") tir jC(a i l\ u-1t✓(� Telephone: -a- jt0.0 1 Fax:?,L V `{ 1 - email: Ci'k r`-<L I)v",nlfaILc�:� Mailing Address: ".L .. Lip`ow Qr- 2O, f u(2 i Lv O�� w,� Lcy,c > Applicant/Agent(if different from owner): 5 r`\ Telephone: Fax: email: Mailing Address: 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 ❑ Discretionary"D"or Unnamed Use Classification 0 Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** ❑ Manufactured Home ❑ Boundary Line Adjustment ❑ Modular Li Short Plat** ❑ Commercial* 0 Binding Site Plan** ❑ Change of Use ❑ Long Plat** 0 Address I I Road Approach 0 Planned Rural Residential Development(PRRD)/Amendments** f',Propane ❑ Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management 0 Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance ❑Temporary Use 0 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 agr to provid a right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and an requir d I ins c on .Access and right of entry to this property shall be requested and shall occur only during regular business hours.Signature: Date: CI.; - 1.- 2.-LL3S 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 lake"of an endangered species as those terms are defined in the federal law known as the "Endangered Speciest"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has • en issued Aii •• violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)ev-n if yqu are' •- Pliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-tra,sferai - re. on-ibinty for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: A �• Date: j' ��-`V :i G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc • OWNER BUILDER STATEMENT • The signer of this to erl does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assum' g e esponsibility of the General Contractor for the proposed project. Signature: Date: ‘C\`(..)i GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: (j PHONE: l� F IA-Q N e. rs'?t.- ` P\,j..),C l } 1--) i c,0 .‹ ( 4' , (3(,0) 6L'us"1 9) r3 MAILING ADDRESS: )VIS- C t a t 01()C.&iy RO• I t' aT t-1(-\0,o Q(EMAIL: Y'y\ULkt•A to tni Y420PA64 i ,CQN\ CONTRACTOR'S LICENSE WAINS NUMBER:C ( r((LL�tt�� t Y1 tJU i P I f-\ 30(L NUMBER ARCR11 i. PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank LI Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: I 1 Individual System ❑ Repair ❑ Masonry - SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: I I Private well I 1 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: 'c Underground Tank I 1 Above ground Tank Size of Propane Tank: 'C.C) c c, 1 .F4, Heat Stove isT Cook Stove I 1 Woodstove 1 i Fireplace Insert PS Hot Water Tank I I 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 all property lines,buildings and septic system components, including the reserve area. Square Footage For Office Use Only Current Proposed `_._ ____- Amount Main Floor __. Cpnsistency Review: , 'j 50 2"U Floor Base �� MAY 2 0 2� fee: I' Try A CI.l I, ( 3rd Floor I '^'Additional Section: Mezzanine: I Plan Check fee: Heated Basement State Surcharge fee: Unheated Basement Pot Water Review fee: Other Unheated 911/Rd Approach fee: Garage/Carport TOTAL: $ 15 Decks Receipt Number: �� 7� / Other Cash/Check Number: (t/ ESTIMATED COST(REQUIRED) Date: �d l lJ( •Fair market value of all labor and materials foundation to finish (C)C) Initials: G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc T 0O00£696 :# 13D'JVd XVI •ATj uosJaJ}a[ Jo spJoDa.l '9 abed S9£86 `dM 'Mo1Pnl llod 'sleld Jo 17 awnlo/ .lad P2i '1d MoIPn1 •M 08 :SS32ida`d spae.11 ;u1od Mo1Pni T 101 TL86-L£17-09£ :3NOHd :NOIldI'JJS3a 1b'J31 2i3W1f1 AHlb71 18 a33'd :2i3NMO SOOZ-T0-£0 :jlva „0-18Z =„T NVld DLIS 2i]1SVW DNIaiinoif1O avO21 1NIOd M010n1 1S3M : DDNDGISTd 1:ID 1 • A313 ,t8'£OT „9-,54'A313 2131314 2131VM • I 0V021 W021d>I0V913S.OZ ! � SOX O Z Adiv -wz-Z'Z-E of JeleEl"uodolLmq I eq Aew tete Auedold 6uppipe p eug JO 6upgnq weuodwl ue O • r II 0 L omit seal eq gays Jeupwoo plxiaCuepun ue w tied oN Z etbNih, 1 �y� '(t)Z-Z'Z-s of lea• ozefetul ile uotiellueA Ieolue4oew JO'saouell - 1 1 ,� wen p owl Owedo'uolgueg to mamas J0110130 Aue was ' O� u 01 Iseel to eq isnw,euletueo eta a uogaeuuoo wen e6ne6!anal-0 U b ' wnwlcw Pexgg p! 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