HomeMy WebLinkAboutBLD2005-00751 • •
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 #: BLD05-00751 Received Date 12/5/2005
SITE ADDRESS: 151 E COLUMBIA ST Issue Date 12/5/2005
QUILCENE, 98376
APPLICANT: MARI PHILLIPS PHONE: (360) 765-0688
PO BOX 878
QUILCENE WA 98376
SUBDIVISION: HAMILTON'S 5AC TRACTS 4+
Block: Lot:
PARCEL NUMBER: 956100001 Section: 13 Township: 27N Range: 02W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI983O6 Expires 09/26/2006
OWNER, MARIE E WORTHINGTON PHONE: (360) 765-0688
if different: PO BOX 395
QUILCENE WA 98376-0395
PROJECT DESCRIPTION: (2) 120 A/G GAL PROPANE TANK INSTALLATION, GAS PIPING
AND
PROPANE FURNACE
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 12/05/2006.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: /N `Csr LIt't'z tZ— 13 -O ---5 1.5e, Pi_At u v QV 2//3 a1
FinalApproval: Ok cex- -c„A,A V/3/07
I
gr
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
10/29/19f
IllUILDING PERMIT APPLICAAN BLD05-00751
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD05-00751 Received Date: 12/5/2005
SITE ADDRESS: 151 E COLUMBIA ST
QUILCENE, 98376
OWNER: MARIE E WORTHINGTON PHONE: (360) 765-0688
PO BOX 395
QUILCENE WA 98376-0395
HAMILTON'S 5AC TRACTS
SUBDIVISION: Block: Lot: 4+
PARCEL NUMBER: 956100001 Section: 13 Township: 27 N Range: 02 W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI983O6 Expires 09/26/2006
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION (2) 120 A/G GAL PROPANE TANK INSTALLATION, GAS PIPING AND
PROPANE FURNACE
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 Bv: Date: Receipt: Approved/Date
Propane Tanks/Stoves $49.00 KAS 12/05/05 77478
Total: $49.00
12/20/05 15:27 FAX 36068 085 Peninsula Heat fJ01
ON
. ' f , .,
��` c��, JEFFERS(7N COUNTY
( DEPARTMENT OF COMMUNITY DEVELOPMENT
) `• •-•b *� 621 Sheridan Street• Port Townsend •Washington 98368 DEC 2 0 2005 '
\• fikecz. k. 360/379-4450 - 360/379-4451 Fax
„9� p www-co.jefferson_wa.us/commclevelopment
�7N
Master Permit Application MLA:
)escription(include separate sheets as necessary): h / r
r...'i et ham ra / Ter NV11÷ a.T'n�t
tax Numbe parcer. Sl q)4[DO OD I Pro perty
ize: (acres/square feet)
Site Address and/or Directions to Pr arty: 1 �!Zr P e., / (A
JA-
Property Owner(s)of Record: ut A I �o rt I Mu� _
Telephone: 7(05 - D(e gg Fa : email:
VailingAddress: /.y 1 I Jt.lvr]!�r f� J l ) Celt j IA)A- C '3 "76
<,',p!icant/Agent(if different from owner,.(I I art Of leQ1a1- o- ")
T_atephone: te.fS i- K333 '- Fat: &S/)-, x!9$to email:
Mailing Address: 2 F.r�[ rM - r �r �� ���',r+a� l^) Q Z
"tat kind of Permit?(Check each box that applies)
Building 0 Variance(Minor,Major or Reasonable Economic Use)
D Demolition Permit n Conditional Use[C(a)-C(d),orC]"
❑ Single Family 7 Discretionary"D'or Unnamed Use Classification
❑ Garage Attached I Detached D Special Use(Essential Public Facilities)'"
❑ Manufactured Home 0 Boundary Line Adjustment
In Modular a Short Plat••
'Commercial' 0 Binding Site Plan"
D Change of Use D Long Plat**
❑ Address I Road Approach 0 Planned Rural Residential Development(PRRD)/Amendments"
1 Propane ❑ Plat Vacation/Alteration"
't!oWed"Yes"Use Consistency Analysis n Shoreline Master Program Exemption/Permit Revisions"
3tornwater Management ❑ Shoreline Management Substantial Development"
• Site Plan Approval Advance Determination(SPAAD)' L Shoreline Management Variance
-.-ay L'se a Comprehensive Plan/UDC/Land Use District Map Amendment
. • e as Telecommunication• u Jefferson County Shoreline Master Program Amendment
i orest Practices ACt/FieIeese 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:
L -- -- - - - -
DESIGNATION•OF AGENT
I hereby designate - A I aWiff
.a _ . to act as my agent in matters relating to this application for permit(s).
/Ovvfv!R SlsNATUfEE •�`� Date: 4,_i—
3v signing Ibis application form,the owner/agent atlestt ihar e 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 • •- ission of a material fact made by the owner/agent with respect to this application packet
may result in this permit being null and void-
:'.•',^r 3gree to save,indemnify and hold harmless Jefferson County against all liabilities,Judgments,court costs,reasonable attomey's fees and
• -a3s which may i any way accrue against Jefferson County es a result of or In consequence of the granting of this permit.
I further agree to • - .. access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any requi ,d I.-ter inspections.-c - d right of entry to this property shall be requested and shall occur on, during regular business
hours. /
Signature: I �,... _ � Date: AP A.. ' .
msem
mmorm
The action or actions Applicant will undertake as a result of y'suance of this permit may negatively impact upon one or more threatened or
' e^dangered spe es and could lead to a potential'take'of an endangered species as those terms are defined in the federal law known as the
"-^d?^tiered Sp des Act•or"ESA_"Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this
----^';',es bee• r:.will not via. o the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
rc_or(s)a r. if - in compll nee •ith the Jt. o ..n ounty development code.The Applicant acknowledges that he,she or it holds individual
1 and non :nsfer. resp•nsibility dhering le . . n,.• pl ' g with the ESA. The Appli�rnt has read this disclaimer a (signs an datQ�it bebw.
.ep'_ e,- .. ' If� / i Date: �� �(/C l 015
C\Documents and Settings\mochii\Deskcnp\Maxter Perm. Guinn 7-8-('sine
12/20/05 15:27 FAX asos885 Peninsula Heat F � (� y, 11 VI—(�l�j( � I
l4. L J�
'! - OWNER BUILDER STATEMENT DEC 2 0 250T ; t
'Ile Sign= • is:+ enl does -reb -•.i that t.ey are the Owners of the parcel referenced herein,that they are not licensed contractors and Met '
t~ey w' be assumi =responsibi /n- al c nlractor For the proposed project, _^�
S g ,lure: / - `�r ..�-,. .,. Date: //l/ ,
1
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
vt;NSuIg. I-IOa.- - 771.C...__. (MO ) 611-333 &d )61) 2.0e,
MA UNG ADDRESS: g _ EMAIL:
CowTRACToR's LICENSE 5ie u i,v W A clifc3��,'. WAINS
'�VEER�: L /V ) � ` C,(,,,����V NUMBER
- ARCHrTECT/ENGINEER: PHONE ( ) FAX:( )
;:AILING ADDRESS: EMAIL -- -- — --]
Project Type: Frame Ty
pe:yp Bathrooms: Shoreline: Type of Sewage Disposal:
0 New ❑ Wood Existing: ❑ Sewer
• l't.on ❑ Steel Proposed; Bank 0 Community System
AVration/Remodel 0 Concrete Total: Height: : Individual System
Repair 0 Masonry SEP Permit It
❑ Demolition U Other: Becrooms: Water Supply:
Existing: Setback: U Private well ❑ Two Party
Type of Heat: - Proposed: ❑ Public
J.P fia rr,ar r- Total: Name of System:
If this Is a Commerdal Proiectyou 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
' 's i a Propane Tank and/or Appliance Installationpermlt,mark all Items below that apply;
- erpround Tank 1 Above ground Tank Sizo of Propane Tank:
Heat Stove 1 Cook Stove 1 Woodstove I Fireplace Insert 1 Hot Water Tank 1 Pellet Stove I Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No
't^ren applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property
tines,tank location and size, distances from the propane tank to all property lines,buildings and septic systemcomponents,i
'','- 'dlrtg the reserve area. EGT 1
Square Footage For Office Use Only
Current Proposed Amount
Main Floor Consistency Review:
2''''Floor Base fee:
Additional Section:
?vezzanlne: Plan Check fee: 90,5
Heated Bas• ement State Surcharge fee: 4.5D
Unheated Basement Pot Water Review fee:
Other Unheated 911/Rd Approach fee:
Garage/Carport
TOTAL: $ ,- Li, a
Decks
Receipt Number:
"'' Cash/Check Number:
-TI-eA''ED COST(REQUIRED) Date: .
i " Fair mdtlret Virtue Of all labor end materials foundation to finish
D 75 f - initials:
j
C:\w'x.:menta and Settings\moch,i\O.Act i tirPermir-AppU uen 7.$-O'I,;lnc
kZ r;
Vi i i
1 N Aft Z
t
U
•
N
.
. •
c1/4 . i 1 '1 ,--
k* - pi ; 1 "4- ' -- - -_ ___ ---- -
% r
I i - . _ L_--. __ -f �r.vc k�,.. ,,O
,,z
, e
ft' 1 !
t i
. *b' (g 5)k
1.• 1 , .
1 1 1 , ; AA
, ! :
4g. , (:) ,
, 4. 4
,, ! '. , v,
, ,_ k 1 , ‘r 1 1
, .: c‘.:, 4 ,j,-.... . ''.--.)
�� �� �-I
-- ----_I, V r -N
r ..._/
. -7--:
� 9 , ,
f it
IjJ ii, ..,.
• 1 c,- ft- - C � � �, `, - 14
P 1 I
1 1 ( L
•
I
; .,c.'9 , ' a, Lt. _'. i [ -1‘
E I_ H
-3 d I Co iew _S t�/sAc.tiC, — —v
r
e.7 h f
.1
i
v
cJ
-- 1 /I/Tst
.>
0.
cr,
i .-,.-.,..-,
,"
f