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HomeMy WebLinkAboutBLD2005-00707 • • 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 #: BLD05-00707 Received Date 11/14/2005 SITE ADDRESS: 541 CHURCH RD Issue Date 11/14/2005 BRINNON, 98320 APPLICANT: JEFFREY A COREY PHONE: (360) 796-4817 PO BOX 73 BRINNON WA 98320-0073 SUBDIVISION: Block: Lot: PARCEL NUMBER: 602352024 Section: 35 Township: 26N Range: 02W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 09/07/2006 OWNER, JEFFREY A COREY PHONE: (360) 796-4817 if different: PO BOX 73 BRINNON WA 98320-0073 PROJECT DESCRIPTION: A/G 250 GAL PROPANE TANK, GAS PIPING AND FREESTANDING PROPANE FIREPLACE 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 11/14/2006. REQUIRED INSPECTIONS: Tank/Line/Appliance: I I-(la—A S FinalApproval: l( `16-0‘. 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£ GILDING PERMIT APPLICATT N BLD05-00707 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00707 Received Date: 11/14/2005 SITE ADDRESS: 541 CHURCH RD BRINNON, 98320 OWNER: JEFFREY A COREY PHONE: (360) 796-4817 PO BOX 73 BRINNON WA 98320-0073 SUBDIVISION: Block: Lot: PARCEL NUMBER: 602352024 Section: 35 Township: 26 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 09/07/2006 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr A/G 250 GAL PROPANE TANK, GAS PIPING AND FREESTANDING PROPANE FIREPLACE 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 11/14/05 777335 Total: $49.00 JEFFERSill c_QUNTy _ , ti 1 DEPARTMENT O'FC MMUNITY DEVELOPMENT 621 Sheridan Street- PortTownsend • Washington 98368 ,4. 360/3719-4450 • 360/379-4451 Fax �4`gF1INc- c www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Project Description (include separate sheets as necessary): ./.- .'li %AFL P. Fft 4/1-' ` "' PLACE FIEF_ Tax Parcel '� Si,9rrD1t,E" I/,t Fci Visit,— • PC A�'E tIvE T zK Number: 6 D,2 3 s a o y Property Size: S tit, L t'{ (acres/square feet) Site Address and/or Directions to Property: 5 / CNuct/ kp, -' NNor✓- R _ Property Owner(s)of Record: r FF E' A , o US F ,�, C yo��N Telephone�,�C OJ 7�j�C _ L� E ��'1 7 Fax: Mailing Address: P•C, �3y X email: �' h/; (niwor✓ 573.E D oc 73 Applicant/Agent(if different from owner) Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) 40 Building ❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) 0 Single Family ❑ Conditional Use[C(a), C(d),or C]** ❑Garage Attached/Detached ❑ Discretionary"D"or Unnamed Use Classification 0 Manufactured Home ❑Special Use(Essential Public Facilities)** ❑ Modular [1Boundary Line Adjustment ❑Commercial* ❑ Short Plat** 0 Change of Use CIBinding Site Plan** ❑ Long Plat** ❑Address Li Road ApproachPropane ❑ Planned Rural Residential Development(PRRD)/Amendments** 0 Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis ❑ Allowed Stormwater Management 7 Shoreline Master Program Exemption/Permit Revisions** ❑ Site Plan Approval Advance Determination SPAAD I 1 Shoreline Management Substantial Development** ❑Temporary Use ( ) i] Shoreline Management Variance ❑Wireless Telecommunication* 11 Comprehensive Plan/UDC/Land Use District Map Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium f 1 Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference Please identify any other local, state or federal permits required for this sproposalc if knownation : I hereby designate DESIGNATION OF AGENT 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: 'V , " -fig ------ Date: f/". y —(")— 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-transfefable responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and�signs and dates it below. Signature: Date: f / — (7 —l)j G.\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc 1 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 ass ming the responsibility of the General Contractor for the proposed project. f��yl '' G( ( '-t ' Date: 1/' /11 Signature: PHONE: FAX: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: ( ) ( ) C E NC X EMAIL: MAILING ADDRESS: WAILS CONTRACTORS LICENSE NUMBER NUMBER: PHONE ( ) Fes'( ) ARCHITECT/ENGINEER: EMAIL MAILING ADDRESS: Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ Sewer Bank 0Community System 0 New ❑ Wood Existing:Proposed: 0 Addition ❑ Steel Total: Height: 0Individual System ❑ Alteration/Remodel ❑ Concrete SEP Permit# ❑ Repair ❑ Masonry❑ Demolition ❑ Other. Bedrooms: Water Supply: Existing: Setback:— ❑ Private well ❑ Two Party Proposed: ❑ Public T e of Heat: Total: Name of System:___ Q 'Aver— If this is a Commercial Project you must answer the following Number of ADA Parking Spaces:Proposed Number of Parking Spaces: Current: Proposed:_— Number of occupants(includes owners,tenants,employees,etc) Current Will you have Food Service? Yes / No IBC Occupancy:.___ IBC Type of construction: If this is a Pro ane Tank andlor A liance Installation ermit mark all items below that a 5 G H CC ❑ Underground Tank �'6.1 Above ground Tank --"t Size of Propane Tare ! ❑ Heat Stove [I Cook Stove ❑ Woodstove ❑ Fireplat 4nsect ;❑ Hot Water T\a k ❑ Pellet Stove ❑ Other Is this a Hance bein installed in a Manufactured I Mobile"Fro"m?-Yes / No When applying for a permit to install a propane tank you must also sub it a site e plan howldings and septic systemng all of the gsomppropes� lines, tank location and size,distances from the propane tank to all pr rtY includin a the reserve area. 11111111111 S•uare Foota•e For Office Use Only Amount Current Pro•osed Consistency Review: '9/ C D Main Floor Base fee: L 1 9 ��0 2,. Floor Additional Section: 3' Floor Plan Check fee: State Surcharge fee: Heated Basement Pot Water Review fee: Unheated Basement Other Unheated 911/Rd Approach fee: TOTAL: $ "13 c j Garage/Carport Decks Receipt Number: Cash/Check Number: Ci Y Other it ESTIMATED COST(REQUIRED) Date: t ,, J) •Fair market value of all labor and materials foundation to finish Initials: 69 G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc Nam) •-O ,�0 D ' 13 Z a o TM 3 ,, a -.1 0. 3.) a w rn yl; r o * / . e, ril Lr1m 1I` ,Po -ca . o n m �� �n ,, c N • W • T. V/ u °0 � 41 Vj XJ J • 0 I ,J O v V,J v 0 -I r m CO 0 3 • r m 0 d p i , v ''(N P m n v1 Q Vt a � ;0• ♦ 0 -.me 41N... 1 \ K. m ' ' Z Pi w W h % N N %r.,c • `",4 rd e --,,, , tA. , 4, • 0 „„ z b ,,... . .,.. , ,, -Cet.t" mTR ; l. 3 . • . co) o a c a � (11 3© rt - — 'r• a � � IXG ; Ate- a.tir/EL bi ' "- -:: ? R •*,. '-. Z. x • )s.) A ; g -c:-. i. v,\-- z r o. ;k,4' ,r i ff,, v 0 ok,s& Y . r c` .1 \) ,,, 1/4....-.--,T.,_-- .),. - - _t ,