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Home My WebLink AboutBLD2005-00614 • • 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 #: BLD05-00614 Received Date 9/22/2005 SITE ADDRESS: 111 HAYDEN ST Issue Date 9/22/2005 PORT HADLOCK, 98339 APPLICANT: OTTO J M SMITH PHONE: APRIL R SMITH 111 HAYDEN ST PORT HADLOCK WA 983399521 1-5+ SUBDIVISION: PHILLIPS ADDN TO IRONDALE Block: 5 Lot: PARCEL NUMBER: 986400501 Section: 2 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, OTTO J M SMITH PHONE: if different: APRIL R SMITH 111 HAYDEN ST PORT HADLOCK WA 983399521 PROJECT DESCRIPTION: INSTALL PROPANE LINE AND 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 9/22/2006. REQUIRED INSPECTIONS: Tank/Line/Appliance: 4r. 7,,2 i':ec,F'L'N� f/� S Ol< 1 /5 , FinalApproval: 9 a,3-0Ca 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 lit UILDING PERMIT APPLICAION B RDOe 00614 Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00614 Received Date: 9/22/2005 SITE ADDRESS: 111 HAYDEN ST PORT HADLOCK, 98339 OWNER: OTTO J M SMITH PHONE: APRIL R SMITH 111 HAYDEN ST PORT HADLOCK WA 983399521 PHILLIPS ADDN TO IRONDALE SUBDIVISION: Block: 5 Lot: 1-5+ PARCEL NUMBER: 986400501 Section: 2 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 DESCRIPTIOP INSTALL PROPANE LINE AND COOK STOVE TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: CODE EDITION: 1997 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 PRB 09/22/05 76641 APPROVED Total: $49.00 �✓ SEP 2 2 2005 Optfprsr r County Planning 0 ec„Department • SITE VISIT REPORT (PLOT PLAN) BILLING CUSTOMER DATE JOB NAME CONTACT ADDRESS PHONE # DIRECTIONS FAX # Email PLANER t\ �o 1 Z� 5 O) JT fir--- —\ l VZ 5 ST • S 6 /oli eAtsr)Nq -120V r ��-E EXIscfl & �ll ,v �, f:.. ..; oIZO JI tutu.) C T -To f ;u e -4- w r-r t7L. ATt-2 71..sON �o,. JEFFERSOUNTYIII / `IA DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend •Washington 98368 SEP 2 L ^- 360/379-4450 • 360/379-4451 Fax �� ' ,0 www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Project Description(include separate sheets as necessary): ��"" Tax Parcel C Property Number: /)) ( )10<- SC) ( Size: (acres/square feet) Site Address and/or Directions to Property: /7/ /✓C-ei ,JC . P— AL -e..cy.Y_i Property Owner(s)of Record: :. j n a.G, /_ C1-7171u 'I.,5,12/2.---1/ Telephone: ! -7 1 L-,_'3 Fax: email: . Mailing Address: /'-)c_ 6 c . /l,r/ / /' / - 774-t na-gy p L J Applicant/Agent(if different from owner): St(/z1/{/f-'c-7 7)12 0/ ,4 n. E Telephone: , ' A 5 - r 7 7 Fax: email: Mailing Address: / C) f.? X)/ '' lC Pr, / / -/_e -1 What kind of Permit?(Check each box that applies) ❑ Building 0 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 0 Boundary Line Adjustment ❑Modular 0 Short Plat** 0 Commercial* ❑ Binding Site Plan** ❑Change of Use ❑ Long Plat** }0 Address LI Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** Propane CI Vacation/Alteration** 0 lowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management ❑ Shoreline,Management Substantial Development** ❑ Site Plan Approval Advance Determination(SPAAD)* 0 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: • DESIGN ION OF AGENT • I he esi ct as my e n matt rs relatin • licatio permit(s). TURE \\ 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 knowl:•ge. 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 .: it being null and void. I further agree •<. e,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorneys fees and expenses whi•.gr, in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agr::`.A• •vide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application Nreview and a. :.il ired later inspections.Access and right of entry to this property shall be r quested and shall r on y during regular business il hours. a Signature:'A I,' I Date: ,16i ill $ The a .'I. 3.-. -Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endange :• _.« and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the lilit "Enda r .:•��11,,�. Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has • 1t `• will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endan Bred species regarding your action( imi if • are in compliance with the Jefferson County development code.The Applicant acknowledges at e,she or it holds individual and • ,.; e -ale responsibility for adhering to and complying with the ESA. The Applicant has read this d' ime and signs and dates it below. Signa /j Date: . N G:\Peumi I .\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc I • OWNER BUILDER STATEMENT 1111 h The signer of this statement does hereby certity 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 MANUFACT RED HOME INSTALLER: PHONE: FAX: FL-2� ,/z- rit'p -..z—__ ( ) ?(Y-f s 7 y‘7 ( ) MAILING ADDRESS: /0e_512 426 LC4t _0. EMAIL: CONTRACTORS LICENSE ( WAINS NUMBER: r)/ /) , /) ( 7 2 ( 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 Li Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry ____ SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: Li Private well C 1 Two Party Type of Heat: Proposed: ❑ Public Total: Name of System: If this is a Commercial Protect 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: [1 Underground Tank Li Above ground Tank Size of Propane Tank: ❑ Heat Stove Cook Stove Ll Woodstove L_1 Fireplace Insert LI Hot Water Tank ❑ Pellet Stove \KOther j r `p e- 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 Consistency Review: 1D Floor 22 Base fee: 3`°Floor - Additional Section: .-------- . Mezzanine: Plan Check fee: ...------i Heated Basement State Surcharge fee: .--------- Unheated Basement Pot Water Review fee: / Other Unheated 911/Rd Approach fee: e...---'../ — Garage/Carport TOTAL: $ 4Ql`00 ' Decks Receipt Number: 76,cc-i-t Other Cash/Check Number: �2Z ESTIMATED COST(REQUIRED) Date: �ZZ(OS .Fair market value of all labor and materials foundation to finish Initials: 0.4 ;# :`,PermitCenter\FORMS\DRD FORMS\Master l'ennit Application 7-8-04.dvc