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Home My WebLink AboutBLD2005-00562 IIJ ILDING PERMIT APPLICATIN BLD05-00562 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00562 Received Date: 8/29/2005 SITE ADDRESS: 280 KENNEDY RD PORT HADLOCK, 98339 OWNER: IRENE ANDERSON PHONE: (360) 379-5591 PO BOX 57 PORT HADLOCK WA 98339-0057 SUBDIVISION: Block: Lot: + PARCEL NUMBER: 901032009 Section: 3 Township: 29 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 DESCRIPTION 250 GAL A/G PROPANE TANK, GAS PIPE AND GAS FIREPLACE INSERT 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: Routinq Date: Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $49.00 KAS 08/29/05 76496 Total: $49.00 • • PROPANE/PELLET/WOOD STOVE & TANK INSTALLATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD05-00562 Received Date 8/29/2005 SITE ADDRESS: 280 KENNEDY RD Issue Date 8/30/2005 PORT HADLOCK, 98339 APPLICANT: SUNSHINE PROPANE PHONE: (360) 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901032009 Section: 3 Township: 29N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2006 OWNER, IRENE ANDERSON PHONE: (360) 379-5591 if different: PO BOX 57 PORT HADLOCK WA 98339-0057 PROJECT DESCRIPTION: 250 GAL A/G PROPANE TANK, GAS PIPE AND GAS FIREPLACE INSERT THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 08/30/2006. REQUIRED INSPECTIONS: Tank/Line/Appliance: 1,Q��,L1E-/p,U,tC AN&, /Lte_ k/oer 6' A0A5� ,riRA—pL-.aeE /o/$ i$Z FinalApproval: Q/ 4,or -f tia,/ io/(9/6's 614 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£ • SITE VISIT REPORT (PLOT PLAN) JOB .E-).)t )NO6-12..so-) (e T 1) DATE : $iS o CONTACT: ADDRESS 3010 Kt- .4t.,5`1 PHONE #: DIRECTIONS FAX #: • Email PLANNER: � � tQOi ��') '0 S' J ch.41,M.,if— fre....... tN w A 4o tricl. �_ /,J 9.i L�,A,,.,r..4o kusv.,i. ,..„ taLt Axf"iltrew k4 ‘41 \-:\\ ,� 1 c�.c;,,,. v A g1 haz Qa o U �-� a NA OT (g 1 61) �� S [� (� C 000� `AO� 0,N' yri.) �t� IP 1 AUG 2 9 2405 -r,s i .f s°N c0& JEFFERSON CIINTY A DEPARTMENT OF COMMUNITY DEVELOPMENT : 621 Sheridan Street• P ri:wriegriNasitilinS _ 360/379-4450 • 360/37 +f/lax(� L .gS,�NG�O www.co.jefferson.wa.us �deve opme • 1, AUG 2 9 2005 Master Permit Application MLA: Project Description(include separate sheets as neQessary): - 2so 6aL_ Pro pf Q 1 a41J • / a-c, A,�1— Tax Parcel Q /� p perty 1 3 V Q '7 Size: (acres/square feet) Site Address and/or Directions to Property: 2 go K�� I � - �j' k s L 0l 1t 5 =F1 a....._Property Owner(s)of Record: --faP .Q 1L.{s p� Telephone: "31 S SS `1/ Fax: email: Mailing Address: r O Q �a pC„.- /j6:5,Q,o CI( G/ c_ Applicant/Agent(if different from owner): • s Telephone: 3 e.S- 5-7' 7 Fax: email: Mailing Address: /0.fS,3 /Oy /J/i , /j, il ,o e..,J/f What kind of Permit? (Check each box that applies) ❑ Building 0 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 0 Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** ❑ Manufactured Home 0 Boundary Line Adjustment 0 Modular ❑ Short Plat** 0 Commercial* ❑ Binding Site Plan** ❑ Change of Use ❑ Long Plat** ❑Address i 1 Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** Propane ❑ Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis 0 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 0 Wireless Telecommunication* 0 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: I[ DESIGNATION OF AGENT hereby esign 2 to my gent rel 'ng to • ap icat' or p mit(s). OWN GNATURE D 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 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 inspections.Access and right of entry to this property shall be requested and shall occur only during regular business hours. (� ) /J Signature: `OJS� r12i1 / n (_2 i 1 ./Li,�(, 2t Date: / 2 hf- L 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-transfe ble responsibility for adpering to and complying with the ESA. The Applicant has read this disclaimer and signs nd dates it below. Signature: r 1 'U. -2-e /il) 1, LAY,cL�eJ�+--t ._ Date: l�cc %1 f� (i:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc • OW'i_It BUILDER STATEMi :,I 1 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: St-.s , �--(90 0",--02____ (36a) KJJ7�7 ( ) MAILING ADDRESS: /OYS 3 /-Q_'/? A-- EMAIL: CONTRACTOR'S LICENSE � WAINS NUMBER: Suh r/t70 0'77 Q P NUMBER ARCHITECT/ENGINEER: uTT 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: ❑ Individual System U Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: [1 Private well ❑ 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: U Underground Tank ,,Above ground Tank 6-AS Size of Propane Tank: & S c. ' • [2. Heat Stove 17 Cook Stove U Woodstove j Firepla Insert ❑ Hot _Alik-,.-r Tank ❑ Pellet St vb e Other p -E. Is this appliance being installed in a Manufactured/Mobile Home? Yes AIM 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 , ( FLir O 14000 ' Current 1 ie"' 4"'-- -- Amotint- Main Floor 1 C¢ ncy Review: - Atu; 2 9 2 4), 4,�•. 2""Floor Additionali (' 3`°Floor .i r `. - Section: A. - Mezzanine: Plan Check fee: Heated Basement State Surcharge fee: • Unheated Basement Pot Water Review fee: •, . Other Unheated 911/Rd Approach fee: , Garage/Carport TOTAL: $ { G y Decks Receipt Number: j,jl, q Other Cash/Chock Number: f t S ;,f ESTIMATED COST(REQUIRED) Date: /,, .Fair market value of all labor and materials foundation to finish lJ Initials: G:\I'cntutCcnter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc