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Home My WebLink AboutBLD2005-00590 ItILDING PERMIT APPLICATION BL ReviewType: Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00590 Received Date: 9/13/2005 SITE ADDRESS: 413 BISHOP HILL CIRCLE CHIMACUM, 98325 OWNER: MARK R MILLER PHONE: (360) 732-0483 DENISE M MILLER 413 BISHOP HILL RD CHIMACUM WA 98325-9709 BISHOP RIDGE DIV II LONG SUB SUBDIVISION: Block: Lot: 4 PARCEL NUMBER: 933400004 Section: 35 Township: 29 N Range: 01 W CONTRACTOR: PETERSON'S PHONE: (360) 426-6370 941 VALLEY RD SHELTON WA 98584 Contractor's License PETER**954K5 Expires 05/25/2007 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP FREESTANDING WOOD 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: 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 $49.00 KAS 09/13/05 76679 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 #: BLD05-00590 Received Date 9/13/2005 SITE ADDRESS: 413 BISHOP HILL CIRCLE CHIMACUM, 98325 Issue Date 9/13/2005 APPLICANT: MARK R MILLER DENISE M MILLER PHONE: (360) 732-0483 413 BISHOP HILL RD CHIMACUM WA 98325-9709 SUBDIVISION: BISHOP RIDGE DIV ll LONG SUB 4 Block: Lot: PARCEL NUMBER: 933400004 Section: 35 Township: 29N Range: 01W CONTRACTOR: PETERSON'S 941 VALLEY RD PHONE: (360)426-6370 SHELTON WA 98584 Contractor's License PETER**954K5 Expires 05/25/2007 OWNER, MARK R MILLER PHONE: (360) 732-0483 if different: DENISE M MILLER 413 BISHOP HILL RD CHIMACUM WA 98325-9709 PROJECT DESCRIPTION: FREESTANDING WOOD 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 09/13/2006. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: 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£ ��¢�oiv cad JEFFERSOUNTY • •c DEPARTMENT OF CO NITY DEVELOPMENT `� 621 Sheridan Street • o s iwton 98368 4, 3 �,— � 360/379-4450 • 360/3 `Fail 14 G d (� q p www.co.jefferson.wa. /pp mdeve op LS SHING� f ] Master Permit Application I �fP 32005 B MLA: Project Description(include separate sheets as necessaryj�"�--__. R--u, WOOd i Tax Parcel Property Number: q 3 3�-CD 004 n Size: I. 2�U (acres/square feet) Site Address and/or Directions to Property: �F t�J �'IS ) �I`I Gr C�c_ Property Owner(s)of Record: 'C.NC\Ox K- .A ' -cr t,s . Vyrk f t-cji' Telephone:3(4 -.32- O4' j3 Fax: email: Mailing Address: D [aj I ,t 41 R GC Clv Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) ILf.Building ❑ Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit LI 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 [1 Long Plat** ❑Address I I Road Approach I l Planned Rural Residential Development(PRRD)/Amendments** ❑ Propane CI Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis [I 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* LI 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 inspections.Access and right of entry to this property shall be requested and shall occur only during regular business hours. ( � �� Signature: I r nyti Date: l- i'-uJ 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-tr erable respo ibili for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: ' ., AA i Cr_______:____ c Date: '"( )-- C3 G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc 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: NERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: .i PHONE: FAx: Sal 5 SI AS (340 )42-Le - 5LP7D ( ) MAILING ADDRESS: c5hCitGY� \k3 EMAIL: CONTRACTOR'S LICENSE ^ WAINS �NUMBER: (C•/� ,e—e. --)e g(4440,0 NUMBER ARCHITECT/ENGINEER: CtS4. "'S PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New 0 Wood Existing: ❑ Sewer ❑ Addition 0 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: ; 1 Private well I i Two Party Type of Heat: Proposed: 1 Public Total: Name of System: If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current: ( p sed�T''a_ f ADA Parking Spaces: Number of occupants(includes owners,tenants,empl 90 &,t`I 1 111 Proposed IBC Occupancy: IBC Type of construe (ri Will y Food Service? Yes / No If this is a Propane Tank and/or Appliance Installa oh hermit,mark all items belo apply: ❑ Underground Tank [I Above ground Tank Size of Propane Tan I i Heat Stove l i Cook Stove ;V Woodstove i i Fireplace Insert ❑ Hot Water Plank I❑ Pellet Stove 1 i Other Is this appliance being installed in a Manufactured/Mobile Home?es t 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 prop-Say—litres,buildings and septic system components, including the reserve area. Square Footage For Office Use Only Current Proposed Amount Main Floor Consistency Review: 2N0 Floor Base fee: j t r, , tt VIIA()v‘, 3f1 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: $ LI - Decks l/ j O j q Receipt Number: G�lf�-7 l Other Cash/Check Number: I%54- ESTIMATED COST(REQUIRED) Date: C� }� •Fair market value of all labor and materials foundation to finish _{ 1,1</N J Initials: ( , G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc Tf 1. 1„ Pr Nuit &ef Rifint4 it-- (6_ bc.) r! at J341 Ve- ate ci-ek 7na:11) , L , NMI ( ( (71 413 BISHOP HILL CIR. BLD 05-590 —MILLER Approvals Req'd:Prior to Firra'Inspection SEP RAP ZON SIPZ DPW r / a — II Q L�"V