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Home My WebLink AboutBLD2006-00014 • 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 #: BLD06-00014 Received Date 1/13/2006 SITE ADDRESS: 734 WINDRIDGE RD Issue Date 1/13/2006 CHIMACUM, 98325 APPLICANT: MICHAEL C TYLER PHONE: -1(d)-30c SUZANNE M TYLER 1102 E WASHINGTON ST SEQUIM WA 98382 + SUBDIVISION: Block: Lot: PARCEL NUMBER: 901281005 Section: 28 Township: 29N Range: 01W CONTRACTOR: C H S INC PHONE: 360-681-5474 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 09/07/2006 OWNER, MICHAEL C TYLER PHONE: if different: SUZANNE M TYLER 1102 E WASHINGTON ST SEQUIM WA 98382 PROJECT DESCRIPTION: INSTALL A/G 120 GAL PROPANE TANK, GAS PIPING AND KITCHEN 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 01/13/2007. REQUIRED INSPECTIONS: Tank/Line/Appliance.40k 1.60 dK /e/oz, GAS LIAJEDK 1/01, FinalApproval: .n</ 4 r- 4 n.a 1//7 OLal 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 SJILDING PERMIT APPLICAlON BLD06-00014 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00014 Received Date: 1/13/2006 SITE ADDRESS: 734 WINDRIDGE RD CHIMACUM, 98325 OWNER: MICHAEL C TYLER PHONE: SUZANNE M TYLER 1102 E WASHINGTON ST SEQUIM WA 98382 SUBDIVISION: Block: Lot: + PARCEL NUMBER: 901281005 Section: 28 Township: 29 N Range: 01 W CONTRACTOR: C H S INC PHONE: 360-681-5474 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 09/07/2006 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI' INSTALL A/G 120 GAL PROPANE TANK, GAS PIPING AND KITCHEN STOVE 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: 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 $51.00 KAS 01/13/06 79006 Total: $51.00 --SON r, • 4w�' G,r,. JEFFER DUNTY J ▪ DEPARTMENT OF COMMUNITY DEVELOPMENT - 621 Sheridan Street• Port Townsend •Washington 98368 , 1 360/379-4450 • 360/379-4451 Fax \ l's, 'Sz www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Project Descrip.tipn Include separate sheets as cases t ,k%v_ )6tyckt v\ AOL,4_,12 tizo Tax Parcel c{/ Property _ ,[� f)ph� / Number: ��if0 ZOI Size: 0 r 1(1,P (acres/squa a feet) 4q.,14I ,JA, Site Address and/or Directions to Prope Loa 1 -C 4U p. -,i,-,, PropertyOwners of Record:+ Grn l_ r� Telephe: 04,�)'' O 346, Fax: �Dg r'�1� � email: W t 1.1)0Ai2'SIGJ(III/ ,y,1,16 `, p — I Mailing Address-TT,0, .71)Y r�7 Z J(�-�l�-.,' � 1Q.�� Applicant/Agent(if different from owner): V 3 Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each�,�,th t _'li ) r;. T 1 Building `I' '' ! r \- LVa nce i(Minor,Major or Reasonable Economic Use) U Demolition Permit ,1,, ndT, ' r V nditiiotral Use(C(a),C(d),or CI** U Single Family 1 i—),I U Discretionary"D"or Unnamed Use Classification U Garage Attached/Detached I l III, JAN 1 3 2006 U Bpur ry LutEssential Public e Adjustment Facilities)** U Manufactured Home U Modular I U Short Plat"" U Commercial* to ding Site Plan** U Change of Use U Long Platr Address I Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments*• (Propane U Plat Vacation/Alteration'"' U Allowed"Yes"Use Consistency Analysis U Shoreline Master Program Exemption/Permit Revisions** U Storimvater Management U Shoreline Management Substantial Development** U Site Plan Approval Advance Determination(SPAAD)* U Shoreline Management Variance U Temporary Use U Comprehensive Plan/UDC/Land Use District Map Amendment U Wireless Telecommunication* U Jefferson County Shoreline Master Program Amendment U 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: A/)/f 7 b id-- ,___-- DESIGNATIONOF 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 inspections. ss and right of entry to this property shall be requested and shall occur only during regular business hou rs. / /O Signatur • Date: (W 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 .yy . i the Jefferson County development code.The Applicant acknowledges that he,she r it holds individual and non-transf-.r•.rlC spun-...r `,T : ' _ . . . . _ ' .with the ESA. The Applicant has read this disclaiorper ds sdnd/tliates it below. Signature:C �_ iiii Date: !�� `(( C:\Documents and Settings\mochil\Desktop\Master Permit Application 7-8-04.doc • • OWNER BUILDER STATEMENT The signer of this statemen hereby ce . at they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be a ing th sponsi ' o the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR ANUFACTURED HOME INSTAI I FR: PHONE: FAX: ALL 1113, as, 1 ( )bl-- /7? ( ) MAILING ADDRESS: 170 imailram« Rid S EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: �/ G I(-1 NUMBER PtROH rP" (V / (?� PHONE ( ) FAX:( ) MAILING ADDRESS: l � EMAIL Project Type: name'.ype: Bathrooms: Shoreline: Type of Sewage Disposal: J New x Wood Existing: __.._.. Li Sewer Addition IJ Steel Pro z;, ; (Oian r IJ Community System )1 Alteration/Remodel u Concrete I of k'.r L it _,*lei _.' 1 ' a Individual System J Repair u Masonry ,' y. ' j SEP Permit# J Demolition Ll Other: Bedroorr,s:r 1 3 Water Supply: Pro Existing! osed: ' JAN ' ack:; LI Private well LI Two Party Type of Heat p Total: Public (Jame 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: WII you have Food Service? Yes / No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that ap Iv // 1 Underground Tank Above ground Tank Size of Propane Tank: / Ljt�`(Oh 47.61 1 Heat Stove ook Stove 1 Woodstove 1 Fireplace Insert 1 Hot Water T. k 1 Pellet Stove` 1 Other 7 Is this appliance being installed In a Manufactured/Mobile Home? Yes e_ 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 Current Proposed Amount Main Floor Consistency Review: 3 ` 2""Floor Base fee: � 51 . 1 V0 (C) n� 3r°Floor Additional Section: Mezzanine: Plan Check fee: Heated Basement State Surcharge fee: Unheated Basement Pot Water Review fee: Other Unheated 911/Rd Approach fee: Garage/Carport TOTAL: $ ----1 i _ 50 Decks Receipt Number: lG lJ Other Cash/Check Number: ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish Initials: C:\Documents and Settings\mochil\Desktop\Master Permit Application 7-8-04.doc isri `2 z a c m 1 • -...- a C) m r E 1 i m v v m y ct" irre./ re6., ..- -1,,&//,‘. ____________;_______________:_. ...._ ,._________ ______ ___________ ____ . ,,,$) .......„__ - 1 ) . , i_____, ,_ .,,,r--d) 5,,,,67 4.1. Eli (/,_,- zwlin ig V _.1 L--' ,s70c-f, f're. 1. 414' f'''-fji"----- -----").5 V 1:2 ' VI .. )v).-Q__ 12°5j1°v1 . 6r1--- 1 c- - 2 ---: ,,, /pp qicl a lion ---,______j n z f ` m J a (�D m y N %. 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