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HomeMy WebLinkAboutBLD2005-00666 • • 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 #: BLD05-00666 Received Date 10/20/2005 SITE ADDRESS: 713 FOREST DR Issue Date 10/20/2005 BRINNON, 98320 APPLICANT: SPENCER H KEENE PHONE: S JILL KEENE 713 FOREST DR BRINNON WA 98320 3 SUBDIVISION: AKER SHORT PLAT Block: Lot: PARCEL NUMBER: 502313044 Section: 31 Township: 25N Range: 02W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**979OZ Expires 9/7/2006 OWNER, SPENCER H KEENE PHONE: if different: S JILL KEENE 713 FOREST DR BRINNON WA 98320 PROJECT DESCRIPTION: CHANGE OUT 250 A/G PROPANE TANK- NO CHANGE IN LOCATION 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 10/20/2006. 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 BUILDING PERMIT APPLICA•ON BLD05-00666 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00666 Received Date: 10/20/2005 SITE ADDRESS: 713 FOREST DR BRINNON, 98320 OWNER: SPENCER H KEENE PHONE: S JILL KEENE 713 FOREST DR BRINNON WA 98320 AKER SHORT PLAT SUBDIVISION: Block: Lot: 3 PARCEL NUMBER: 502313044 Section: 31 Township: 25 N Range: 02 W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2006 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr CHANGE OUT 250 A/G PROPANE TANK- NO CHANGE IN LOCATION TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2003 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: OCCUPANCY: 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: \ç:: ) Dc..-- �� Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $49.00 PRB 10/20/05 7 7170 APPROVED Total: $49.00 OCT 2 0 2005 Jefferson County Planning uildi partment 10;ON c. or,� JEFFERSON COUNTY ,A DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax p www.co.jefferson.wa.us/commdevelopment �`HING� Master Permit Application MLA: Project Description(include epparate sheets as necessary Swcrc_4o _r t= Fl ci 5 tF- Tt�N�c -res pUtZct tA.SG0 -04\314. oNA GEIJE.X. . Tax Parcel Property Number: S O Z •)y 1 3 0 +4 Size: 1 . b 1 acres quare feet) Site Address and/or Directions to Property: -7 I' potzgST c> 1U . SRA tJ I.JbI.J , WAS- 5 d•>z o Property Owner(s)of Record: 5 PEIVice e. Kt: Nh_ A. S. J IL.L. Telephone: -V.c7• 1 ` • o 44 g. Fax: email: Mailing Address: 5A Mr Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) 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 Garage Attached/Detached Special Use(Essential Public Facilities)** Manufactured Home Boundary Line Adjustment Modular Short Plat** Commercial* Binding Site Plan** Change of Use Long Plat** Address Road Approach Planned Rural Residential Development(PRRD)/Amendments** "-Propane Plat Vacation/Alteration** Allowed"Yes"Use Consistency Analysis 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* 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: r """ Date: /a �(� O A"J 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-transferable responsibility f r ering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: Date: /o AA-)/a 5� C:ADocuments and Settings\mochil\Desktop AMaster Permit Application 7-l-114.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. r Signature: Date: l O (i 15 Iv 1 GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ce-6.1Ex (36c) 13l-4S$S ( ) MAILING ADDRESS: ,3 I S Rt-to DoD DPaat., DV-We EMAIL: — CONTRACTOR'S LICENSE C.f-ItNA(CUM.r uj A. WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: / Type of Sewage Disposal: New pG Wood Existing: , Sewer Addition Steel Proposed: Bank / Community System Alteration/Remodel Concrete Total: Height: / r Individual System Repair Masonry / SEP Permit# Demolition Other: Bedrooms: Water Supply: Existing: Setlack: Private well Two Party Type of Heat: Proposed: / .f Public p�P,,rs� Total: Name of System: ('QOt?t+4.4e, Tb+J� SW L 1t-t-CrE 1,T P212U)V L.le,AREA -T P4i To PUt2L1-+1,c4to.-v I AelPEZ lc— 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 andJpr Ap ante Installation permit,mark all items below that apply: i Underground Tank Lye ground Tan Size of Propane Tank: 2.5 v G AA._ s UJ 1 T4"at4 T eat Stove - Cook Stove r ove i fireplace lose4 i Hot Water Tank i Pellet Stove I Other Is 1 eing installed in a Manufacture o 1 e ome? Yes / No'D When applying for a perniit-fo-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: 2""Floor Base fee: / -co 3f0 Floor Additional Section: Mezzanine: Plan Check fee: Heated Basement / State Surcharge fee: Unheated Basem t Pot Water Review fee: Other Unhea d 911/Rd Approach fee: Garage/ arport �`OO TOTAL: $ De s Receipt Number: 11 110 Other Cash/Check Number: ZOO ESTIMATED COST(REQUIRED) Date: ©f�D ©� .Fair market value of all labor and materials foundation to finish Initials: C:Allocumcnts and Settings\mocha\Desktop AMaster I'crmit Application 7-8-04.doc SW,24 3005-05:J):J)9,tEfNE-q�agq[c1S�PMOPEMn.o'�C ,1T0 7 ,4d 9 Y ;I yy 15 R ' ,a1171 / ilik / 0 7 / / \ \ \ N N ` \ \ 0 C I ~ N \ N \ Co \ \N \ ` \ N \ Pil s . \ %.\ , ,,,„ \ ,., N \\ N N \ \ \ N \ \ \ \ s, \ -`r�,p `i� \ \ \ s \ \ \ �O N \ \ \ � i0 N N \ �\ \ \ N \ N .t,. 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