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Home My WebLink AboutBLD2005-00424 • i 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 #: BLD05-00424 Received Date 6/27/2005 SITE ADDRESS: 267 FARRELL RD Issue Date 6/27/2005 QUILCENE, 98376 APPLICANT: JAMES E PIPER PHONE: (360)765-4429 SUZANNE PIPER 1754 NE MESFORD ST#51 B POULSBO WA 983708532 D SUBDIVISION: PIPER SHORT PLAT Block: Lot: PARCEL NUMBER: 701271012 Section: 27 Township: 27N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2006 OWNER, JAMES E PIPER PHONE: (360)765-4429 if different: SUZANNE PIPER 1754 NE MESFORD ST#51 B POULSBO WA 983708532 PROJECT DESCRIPTION: 9$414NO 16 AND HEATING 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 6/27/2006. REQUIRED INSPECTIONS: Tank/Line4pliance FinalApproval:)& Os 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 !UILDING PERMIT APPLICA*N BLRD05-004eview pe24 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00424 Received Date: 6/27/2005 SITE ADDRESS: 267 FARRELL RD QUILCENE, 98376 OWNER: JAMES E PIPER PHONE: (360)765-4429 SUZANNE PIPER 1754 NE MESFORD ST#51B POULSBO WA 983708532 PIPER SHORT PLAT SUBDIVISION: Block: Lot: D PARCEL NUMBER: 701271012 Section: 27 Township: 27 N Range: 01 W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2006 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr GAS PIPING AND HEATING 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: 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 By: Date: Receipt: ate Propane Tanks/Stoves $49.00 PRB 06/27/05 73453 A p 0AV6Dia/// Total: $49.00 jUN 2 7 2005 Jefferson County Planning /)4 1 & Department ` Fott. Firler5S + 'A. *SITE VISIT REPORT • (PLOT PLAN) JOB teP (Z- DATE: (.QI310r CONTACT: ADDRESS PHONE ##:_ DIRECTIONS FAX #: Email: PLANNER: ��— i i e.__ t _1 LI JUN 2 7 2005 JEFFEi �:r uNTy DEPT. OF COMML:," 1 sroVE ASK / .J' q0 The-) u P Throocik xtsri►.x.� " \c _- S44ove r t PE- -it, TOP , `ltP IS 10 CIO Cl Ti L� � ` �I -4 [ '' ►�SONc . lt� Lt fe/ • 06. JEFFERSON •UNTY 444044,4 elk DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend •Washington 98368 AN i i 7 )Q05 360/379-4450 • 360/379-4451 Fax 4/ OP" www.co.jefferson.wa.us/commdevelopment S»>;.. 8N ERE RE Master Permit Application MLA: Project Description(include separate sheets as necessary): _ d4 'lfr// - 20 J� Tax Parcel �� `1 Property Number: o� n 1 )- Size: (acres/square feet) Site Address and/or Directions to Property: - ,'7 F -- p 1} . i ,g (�(,-,'7 ,Lt Q__ „. Property Owner(s)of Record: -) I Al--, et t° 0- -__ - Telephone: -5'L 0 --/' ,S L/4/-- Fax: email: Mailing Address: 17 S 1L k;t- Al ESF3 al) s7 -46 Pot4 L 3 t. U (t'_i 7(.-, Applicant/ (If different from owner): _Si e --L_/, , p et-c:) €-- - Telephone: C 3 1 S 7 S 7 Fax: email: Mailing Address: J What kind of Permit?(Check each box that applies) 1; Building ❑Variance(Minor,Major or Reasonable Economic Use) ❑ Demolition Permit 0 Conditional Use[C(a),C(d),or C)** ❑ Single Family ❑ Discretionary"D"or Unnamed Use Classification ❑ Garage Attached/Detached 0 Special Use(Essential Public Facilities)** 0 Manufactured Home ❑ Boundary Line Adjustment ❑ Modular ❑ Short Plat** 0 Commercial* ❑ Binding Site Plan** 0 Change of Use 0 Long Plat** ❑Address li Road Approach 0 Planned Rural Residential Development(PRRD)/Amendments** Propane ❑ Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** ❑ Stomiwater Management ❑ Shoreline Management Substantial Development** 0 Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance ❑Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment 0 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 h reb ignate to a my a nt in m r rela' g to thi plica'on for permit(s). O ER SI TURE ucit�: By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,istnie 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 gerue 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 in ctions.Access and right of entry to this property shall be requested and shall occur my during gular business hours. / Signature: Date: (te Occ The action or actions Ap i nt 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"E " efferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will n• violet: 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 • plian th the Jefferson County development code.The Applicant acknowledges that e,she or i holds individual and non-transferable res..--'.'lity f adhering to and complying with the ESA. The Applicant has read this disc 'me and si nd dajes.it below. Signature: Date: Z4 0_5 G:\PermaCenter\FORMS\DlD FI S\Master Permit Application 7-8-04.doc • Gvv piER 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: GENE L CONTRACTOR R: PHONE: FAx: n -- ,/. (i _ ( ;�: ) 4,fj f777'( ) MAILING ADDRESS: /U s 3 /`/ / Lair- — r _„l, L A_ )&- CONTRACTOR'S LICENSE WAINS / ( < e NUMBER: (J'/ii,.4 /77°X O 7 7 Q id NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAx:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: Li New ❑ Wood Existing: 0 Sewer ❑ Addition ❑ Steel Proposed: Bank 0 Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: 0 Individual System 0 Repair 0 Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well 0 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 and/or Appliance Installation permit,mark all items below that apply: i Underground Tank ❑ Above ground Tank Size of Propane Tank: 4 Heat Stove Cook Stove Woodstove i_l Fireplace Insert Hot Water Tank Pellet Stove Other I ❑ ❑ 0 ❑ . 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: r M\ 3f0 Floor , - tc/� 1`_ au- Additional Section: S Mezzanine: E Plan Check fee: Heated Basement -, State Surcharge fee: Unheated Basement Pot Water Review fee: Other Unheated 911/Rd Approach fee: Garage/Carport . - -- TOTAL: $ 4a 6 Decks -3s5 Receipt Number: Other Cash/Check Number: ' ESTIMATED COST(REQUIRED) Date: =Fair market value of all labor and materials foundation to finish tp12,Z 10 5 IInitials: f(26 .., .. ,PermitCenter\FORMS\DRD FORMS\Master Pemut Application 7-8-04.doc