HomeMy WebLinkAboutBLD2005-00755 ANN
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#: BLD05-00755 Received Date SITE ADDRESS: 187 LLAMA LN 12/7/2005
Issue Date 12/7/2005 PORT HADLOCK, 98339
APPLICANT: JEFFREY GRAHAM
CONNIE GRAHAM PHONE: 541-504-1569
P.O. BOX 450
TERREBONNE OR 97760
SUBDIVISION: T 40
Block: Lot:
PARCEL NUMBER: 001343040 Section: 34 Township: 30N Range: 01W
CONTRACTOR: OWNER/BUILDER
PHONE:
OWNER, JEFFREY GRAHAM
if different: CONNIE GRAHAM PHONE: 541 504 1569
P.O. BOX 450
TERREBONNE OR 97760
541-504-8076
PROJECT DESCRIPTION: INSTALL REPLACEMENT WOODSTOVE
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 12/7/2006.
REQUIRED INSPECTIONS:
Tank/Line/Appliance:
FinalApproval: r
SIC (( cqe.
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:1F_BLD_Permit_Propane.rpt
10/29/19
MILDING PERMIT APPLICATI• BL Review T Ty755
ype:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
'ERMIT #: BLD05-00755 Received Date: 12/7/2005
;ITE ADDRESS: 187 LLAMA LN
PORT HADLOCK, 98339
)WNER: JEFFREY GRAHAM PHONE: 541-504-1569
CONNIE GRAHAM
P.O. BOX 450
TERREBONNE OR 97760
SUBDIVISION: Block: Lot: T 40
PARCEL NUMBER: 001343040 Section: 34 Township: 30 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP INSTALL REPLACEMENT WOODSTOVE
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 SLE 12/07/05 77562
Total: $49.00
S / 505 13:23 3603734451 Jt1-r w u.L . ..._
/:"'---.' 4,. F
DEP OFkiiiiivA �I Ban Street•'Fart Townsend-Washington 9B368 ! 1` - fit.�,1
3601379-4450. 360/379-4451 Fax
„OP"
Or-
Master Permit Application MIA
Ptujwt DI-24-411/2)6ViOndllide Flevarate sheets as n y):
-I-&MTh l,L A.6-pc AC.. -M(-& (A) OD b cTO q e-
Tax Panel Property
Number OoL34 30`F0 size: U c, (acrilstscpare feet)
Site Address andfor Directions to Property: I$7 Loll', A LA) Po(T To N s.ENA W -
Property Ownsi s)of Record; ,e F F2€-i W W. bore Cp NAJi • C�-i A-►fa-avl -T
Telephaite;. 5 wL Es J$ 6 9 Fmc 5W - soli -goZ4o emal: :jQ GI.a_ccem e, es.coM
Mailing Address:J,0. 16o)'_ 4 So 4 TE2QE 2Q N N C-. 0/2 g 77 6 0
Applici it/Aent of dffllerent from owner): -, -_., _ _
Telephone: _ Faic - tom_
Haling Address:
-
What kind of Permit?(Cheek each box That dies)
0 V'sriacxe(Minor,Major or Reasonable Econon*;Use)
�Permit 0 Conditional use Re),0(d).or Cl*1
0 Siff Family 0 Discretionary'D or Unnamed Use Classification
0 Garage Attached I Detached 0 !Public Fag:Mies)
0 Manufactured Morrie 0 Bourviarit the
0 ModrAar 13 Short Pt '*
0 Commercial" 0 guiding Site Plan
0 Change of Use O L.OngPlat.""
0 Andress 0 Jed Approecti 0 Planned Rural Reskiential art XAmentirnent
Iteacapaaisk 0 Plat Vaeatiofl/Aloeratlon"
Av❑ owed`Yes Ursa Co � 0 Shoreline Master Program EcemppoI%l rmit Revisions"
❑Sionnwater Management nt 0 Shoreline Management StAttlaralit De ".
0 Site Pion Approval Advarun Determination(SRAAD)* 0 Shore*kkirtenernent Variance.
0 Temporary Use 0 Cnnipnithensiee PlanitIOCAand't,Use tautck Map Aniendment
❑Wireless T ' 0 Jefferson County Shoetree Master Amendment
❑Forest Practices Act/Release of Six-Year Moratorium
_ *liar rergairlr a Pi Conferatott "Rep,Aw a Condom ce
Please identify,any other local,state or federal permits required for this proposal,If known:
DESIGNATION—OF AGENT
I hereby designate 1 t M Le& 4. T i e y - to act ea my agent in matters relsttng to this application for permit(s).
�� —
j, W . Date: /Z�r�S;7C�
t SIGNATURE_ —
By signing Ills appacorton .the kwiagent attests that the 6 fronneMno prodded heroin,and In any atlactiments,is true and correct to the best of
his.her or Ws knowie6ge. Any material falsehood or any omission rut a maimed tam made by the connedagent withraect to Sib appicatiO9 pacttA
may result in this pefm t being null and wild
I further agree to save.indemnify end hold harmless Jefferson County against al lkablnes.Judgments,Mat ObetS.reasonable attorneys tees and
expenses which may in any way ao rue against Jefferson County as a result of or in ocskseguence tithe granting of this t
I iurtaerurgree m pox de access and right of entry b Jef on County and ire employees,represenoatives or agents for the sole purpose of application
review and any rriquired later tncpecttons.Access and right of entry to Iris property shall be requested and styes 000er only during regular business
hours. .. ^
Signature: IIW- Chile: / Z/OC✓/Q S ._
The action Of alone Applicant we undertake as a rescdt of the Issuance et this permit may(*Oho*ink upon one Or more Sweetened or
endangered Weds*and could lead in a p M nthe eke'of an endangered species as twee teens are defined in the federal law known as the
Spat or ."Jeer County snakes no aas+eanoes to the applicant that the actions that we be undertaken because this
permit has been issued we not iofaciate the ESA My IndividtiaL gaup ar agency can file a lawsett on behalf of an andanger'ad species r'agarsAng your
ac lion(s)even it you are in compliance*Oh,IM.Iaffer'eon County development,code.The Minicar*aduowriedges that he.she eft iholds ndivadoal
and end With the ESA The Applicant has read this disclaiew*Mxand dagrs it below.
Sigrtal:ow • tom: I �O-S <
G-\Permitr racer\FatisSSV,PDFORMSWesterY,,.=¢u.AppGcstion7-ireirloc
12/05/2005 13:23 3603794451 dEFF- 66 t5C.b PAGE 03
The 61 aims Jim aimeR suLDER STATEMEhrr 0
gner
theywitl be
the responibsility ot ccitr- 40tutt'e-r)eir=six toe pr 1m
conedortuniol"-:*-1-113
&tomeAre; iectrenOW berein.tea evej:ars.rzt k-Afiled
r",..14--• / ?-10-C/0,...5 ----_______
_ antralaires and Mot
r GENERAL CCAuRAcTORbR huNtifF,Acrupteo HomE insTALim _
Psicwir: —
FAX —
( ) ( )
IiIMUNG ADDRESS: —
r-911"41-:._
CoernAcroe's tx:Ekee ------------ WAINS
NUMBER;
NUMBER
—
AecntrEpriEtinteEet —
PHONE( ) FAX(
—
MAKING ADDRESS: - _
Project Type:. , FrArne Type: Bathrooms: Shorethse: Type of Smentso turaposet:
o New LI Wood Etsling: 0 Sewer
CI Act:Rjon 0 Sieni PA/posed: Bank Ci COMML-InitY-"Slorn
0 AlWatiOrdRiarrtel 0 CC410feik:
i TrAal: Height 0 iriciAtiairdi Systwn
0 Repair 0 igaw..ry ________ SEP Permit# I
U bermiltion 0 Ott- .-. I 004ncens: Water Stippki: 1
Ficstav: SE0-7-3k-.. 0 Prtimit we% 1.1 Iwo Parly
Time of eirrat. - Fsoposect: — 0 Ptibrric
Tow. Name of Criezr,t
_ __
_ __ .......
ifiblyis•Crirrimorda
Number ef Parking Spaces: Canuev Fk6w).*ri: Wm-Wm-of AEA Parting Spaoas:
Number of owes(includes celnr-;475,renarft,employees 1 Curnrart Proposed _
IBC 0ocuitatcv: ifv:Tyve of izet-Iforftw wrti 1.--au neve Food Srvice? Yes f jig
ittftfAle a . TLagkAn_4213..Atio— error betelletionmine- etiipply
0 Underground Ter* fl Above.Tetaid Tmlk Ste et Propane T -i'0 Hen SMv0 n Gook Stmve )1_Woodet,,,--ve el Fberk3ce Insert CI Hot W Tank ': Pellet Stove c 0110.4
hi._pileerxflwg._ nst1sd rfiri( I4 ieNne? Ye5 No si
When epplyinff kw*pent tei ineteg sr prr-pe- kr-nit r..A.I.m.r. t also sabetit a it't$,Fin shavilog RH Cif Use bilikark"&O.~Of*
lineit,an*.41altalt flan end the,olkittap.c.vt:s fre fr I tiM p r U :-S ..7-74-$5 Ag pft-g-4,.---_-;i ffittz.,buThays and swag*yawn Darriponeigs,
thetear
F Square Footspe ----444'43iiiy - - - -4 --, • 7-4- • ••• . - . ...: .... ..., ,...•.,
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Current Preees ..
ed ,r• ',.:,;: . ".- •- 1-,"::;,:':_ 1.''1 ''::"-. .':'•,,:.: ' I, 41- : ;,',7r,..„
main Floor '-';'-•1'::.' - -'77''''' -- ' -`.....t?"1'.--)"9'-'-'-. '`'..f.'--'.1,.-..-:', f-:, -7,1.-;;'0';-1-: •:'....- '-A
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Heated Ban ent
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JAN - 3 2006
LLOPMENT