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Home My WebLink AboutBLD2005-00735 PILDING PERMIT APPLICATI.1 BLD05-00735 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00735 Received Date: 11/23/2005 SITE ADDRESS: 330 E ARDEN ST PORT HADLOCK, 98339 OWNER: MATTHEW C ELDER PHONE: (360) 385-7186 ABIGAIL G ELDER PO BOX 2092 PORT TOWNSEND WA 98368-0260 IRONDALE SUBDIVISION: Block: 25 Lot: 5-8 PARCEL NUMBER: 961802502 Section: 35 Township: 30 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 DESCRIPTIOr 250 GAL A/G PROPANE TANK, GAS PIPING, HEAT STOVE AND COOK STOVE 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: Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $49.00 KAS 11/23/05 77529 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 #: BLD05-00735 Received Date 11/23/2005 SITE ADDRESS: 330 E ARDEN ST Issue Date 11/23/2005 PORT HADLOCK, 98339 APPLICANT: SUNSHINE PROPANE PHONE: (360) 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 5-8 SUBDIVISION: IRONDALE Block: 25 Lot: PARCEL NUMBER: 961802502 Section: 35 Township: 30N 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, MATTHEW C ELDER PHONE: (360) 385-7186 if different: ABIGAIL G ELDER PO BOX 2092 PORT TOWNSEND WA 98368-0260 PROJECT DESCRIPTION: 250 GAL A/G PROPANE TANK, GAS PIPING, HEAT STOVE 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 11/23/2006. REQUIRED INSPECTIONS: Tank/Line/Appliance: 0,itL re--- AND II4.--C.•c, p424511 - , FinalApproval: /kl)-- :- 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 10/29/19c • Ip- , 1LMc ,cv I � q LA • 1 ~ - Z /J co� JEFFERSON CCU NTY •l/w N ' `* DEPARTMENT OF MMUNITY LpP EF]T —(—{ ' 621 Sheridan Street • PortTNolwr nd!Washington J8388 360/379-4450 • 360/379-4451 Fax 4{� O�OS. www.co.jefferson.wa.us/commdevelopmertt,•V 2 2 "�i7N rite 2005 I :; 1 , Master Permit Application MLA: Project Description(include separate sheets as necessary): /� �� 44I cam- Pf 11-9- r t S ue Tax Parcel Property/ Number: 9 6 ( 8 0 )_ 5 d Size: (acres/square feet) Site Address and/or Directions to Property: 3 30 A-i- d.e_r__, w _ T7 Property Owner(s)of Record: /1-f A? 7' ,4 Telephone: 3 iJ - 7/c19 6 Fax: email: Mailing Address: PO ,,dig , a b Applicant/Agent(if different from owner): 54--n S /41 h L l°2o1Cf}-n E Telephone: 34,0 3 es S7 5 7 Fax: 3 S 5 5 8 75 email: Mailing Address: 1 O Q,,,5 R h o d fOc. Iy i . tl/ c o_ i c, What kind of Permit?(Check each box that applies) i 1 Building ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use[C(a),C(d),or Cj** U 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** (I Address 0 Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** ropane ❑ Plat Vacation/Alteration** Allowed"Yes"Use Consistency Analysis LI Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management ❑ Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Variance 0 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 here de 'gnat y age ' teFslelating to ' ' lion for permit(s). OWN IGNATURE 8 �_- 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 attorneys fees and N. expenses which may in any way accrue against Jefferson County as a result of or In consequence of the granting of this permit. C 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 in ctions.Access and right of entry this property shall be requested and shall occur only during regular business hours. _-/��+ 1�� — — IVIDate: / > Li e* r i 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 I 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 corn fiance with the Jefferson County development code.The Applicant acknowledges that he,she or It holds individual I and non-transferablA r pons. ility for eh to a illioo ignature: yi g with the ESA. The Applicant has read this disclaimer and signs and dates it below. w�c- Date: ///7 Z/rJ_S- `l'e mitCentcr\FORMS\ RD FORMS\Master Permit Application 7-8-04.duc rI3 OWNER BUILDER STATEMENT I The signer of this statement does hereby certify tha y are the Owners of the parcel referenced herein,that they will be assuming the responsibility of the General Contractor for the proposed Project Y are not licensed contractors and that . Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: MAILING ADDRESS: /0 U p /�/ Q�f EMAIL:0 ! 7 a S S 7 f 7 ( ) CONTRACTOR'S LICENSE n /? ` WAINS NUMBER: -f fS/-1 d77 Q r NUMBER ARCHITECT/ENGINEER: PHONE ( FAx ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: 0 New 0 Wood Existing: 0 Sewer ❑ Addition 0 Steel Proposed: Bank ❑ Alteration/Remodel ❑ Concrete Total: Height: mu l S System g � �` � Ir�di �#uaI S tpm= 0 Repair 0 Masonry F'=Pe t#Ys L � E 0 Demolition ❑ Other:___-- Bedrooms: -Y r�uPP y. "� Existing: Setback: Type of Heat: Proposed: ❑ Private well 0 Two P Total: ❑ PublioiV 2 2 2005 'Li, 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: ❑ Underground Tank y,Above ground Tank Size of Propane Tank: .0 St'U x __et t stove 'I Cook Stove ❑ Woodstove ❑ Fireplace Insert 0 Hot Water Tank 0 Pellet Stove Other e Is is pliance being Installed in a Manufactured/Mobile Home? Yes /0 o 9 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 ' , i_7 +f Y V'F r=,I i t ��K Current Proposed " * t'r t a r;it7S eµ Main Floor , 'Consistency Review: , , , s i ?` ,_ v 2 Floor — ' , „-�'�`�,�`� � �� Base fee: ,fir ii,:.,,..„,..i Floor : t V . ., '� HUanionai Section: r �, Mezzanine: Plan Check ` "'1: -�fee: ., '-i I" Heated Basement State Surrttarge fee: iti,A,:k.::• " �t :� s k z • , Unheated Basement :: `'1`° `r` Pot Water Review fee'1. `';r"7' '. W Other Unheated 911/Rd Approach foe: Z �{y4 w• 4!� {` r, '�,i� ^^ll.',i k� 1 1 Garage/Carport - - - I S ,: $ „ . r t ._. TOTAL; $ , fe�.: C-, Decks , i --'4-3i - -- ' it, a iv Receipt.Number R ; : : Other Cash/Check Number: `' '•' - ; - i ESTIMATED COST(REQUIRED) �,. ,, Date: •Fair market value of all labor and materials foundation to finish . fit^, ' ,� ��. Initials: �' Vic; \Perm,tCertter\FORMS\DRll FORMS\blaster Permit Applicatio f-8-o4.doc