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HomeMy WebLinkAboutBLD2006-00073 0 0 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 #: BLD06-00073 Received Date 2/22/2006 SITE ADDRESS: 251 N VICTORY AVE Issue Date 2/22/2006 PORT TOWNSEND, 98368 APPLICANT: RETO FILLI PHONE: 360-385-6429 JANA M DAUBENBERGER-FILLI 2023 MCNEILL ST PORT TOWNSEND WA 983687856 1-4 SUBDIVISION: IRONDALE Block: 142 Lot: PARCEL NUMBER: 962114201 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, RETO FILLI PHONE: 360-385-6429 if different: JANA M DAUBENBERGER-FILLI 2023 MCNEILL ST PORT TOWNSEND WA 983687856 PROJECT DESCRIPTION: NO MLA U.G. 1000 GAL. PROPANE TANK 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 2/22/2007. REQUIRED INSPECTIONS: Tank/Line/Appliance: / IA►JK 13uR1z.1E6 -To ,DEp // I N&tzEEF02 g Zou1JD w4Sz� DES Oa 41_0 A W �)2 AY G//}1, Nous it.. DarAE. FinalApproval. 22_0-7 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 • BUILDING PERMIT APPLICATION BL v Reviewiew T Ty073 ype: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00073 Received Date: 2/22/2006 SITE ADDRESS: 251 N VICTORY AVE PORT TOWNSEND, 98368 OWNER: RETO FILLI PHONE: 360-385-6429 JANA M DAUBENBERGER-FILLI 2023 MCNEILL ST PORT TOWNSEND WA 983687856 IRONDALE SUBDIVISION: Block: 142 Lot: 1-4 PARCEL NUMBER: 962114201 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 DESCRIPTIOI NO MLA U.G. 1000 GAL. PROPANE TANK TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: CODE EDITION: 2003 ADD'L: HEAT TYPE: PRO 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 Dater Type Amount Paid Ely: Date: Receipt: Approved/Date Propane Tanks/Stoves $51.00 SLE 02/21/06 78998 Total: $51.00 0 SITE VISIT REPORT 0 (PLOT PLAN) , i i / / / JOB /,/.---P--' A '":e'il ,. y 7-6>.f&P 5/t/7. / ;', DATE : CONTACT: ADDRESS PHONE #: DIRECTIONS /:—//2.r-i,:f.'*(-'/, /,'---e1r:e ./1)7,%t i „air. FAX #: , , 1:-/--7--„, --,--( ,A,,..,,i t, Email , ... 7 /7‹:- -;:;,),n,. .: .:<, 7e-e-44-8.. , PLANNER: --- _ , -/-e-r-ixte.e Pr Y.2"/ ! „/ fiez175 1 , ' Il'0,eicer( +C5'57- I I : , , , 1 \.i \ la ixr-at 67.-(41'e -6\- . , . 1 -iti irA,r _ 4tiloo€A-4 '.','' 1 to,te-_,,,----N,.1 R,2447e 1:-..-1• -6/‘;,i, --rh/.., -( ' S' 8 , i I 12:'a,(Qaoz 67 roc(c ,i ,7 -63 , i •a ( .c--,:-/T ; ' ,,,.• : le'? i\nimtcc , III 4ON cor,� JEFFERSON C�NTY ' A DEPARTMENT OF COMMUNITY DEVELOPMENT `'d 621 Sheridan Street • Port Townsend •Washington 98368 _�,,� 360/379-4450 • 360/379-4451 Fax 5 1'9II 1N Gp www.co.jefferson.wa.us/commdevelopment 8 Master Permit Application MLA: Project Description (include separate sheets as necessary): Q. G. t O 0 o G 11 . r' , 7a,-,- - Tax Parcel q(eal 14 Doi �ttagpiptyroperty Number: Size: (acres/square feet) Site Address and/or Directions to Property: 5/ V / G . Property Owner(s)of Record: l e 740 r C/ n t / Telephone: f612-5- yl`/ i Fax: email: Mailing Address: e?v .23 n. c l212--4.L/ eir. /2/ . /p`�},, (/d. Applicant/Agent(if different from owner): .T�r/jl///it/c p/e-Opel-..l E.- Telephone: Jd'.S -.S f . _Fax: email: Mailing Address: /DES 3 `yp,y -. pi• �� �,�j�. f�� What kind of Permit?(Check each box that applies)li Li Building 0 Variance(Minor, Major or Reasonable Economic Use) Li Demolition Permit ❑ Conditional Use[C(a),C(d),or C]** ❑ 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** ❑Address ❑ Road Approach_ ❑ Planned Rural Residential Development(PRRD)/Amendments** 'ropane ❑ Plat Vacation/Alteration** Cl Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management ❑ Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment Cl Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment f l 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: D GNATION OF AGENT I he by d Ig to to act gent i ters rel ' o this a ' lion for permit(s). 0 NER SIGN RE Date: By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,istrae 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 attomey'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 req • later inspe ' rY:ess and right of entry to this property shall be requested and shall occur only during regular business hours. Signature: / e',":il Date: �2©D6 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 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' lia I e erson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferable re ponsi •i f adher a d complying with the ESA. The Applicant has read this discr er nd sign and dates it below. Signature: _ Date: 0/ (,� G:\PemutCenter\FORMS\DRD FORMS\Master Permit Applicauon 7-8-04.doc • 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 assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENE CONTRACTOR OR MANUFAC RED HOME INSTALLER: PHONE: FAX: C i1ir� (360 )J -f7?7 ( ) / MAILING ADDRESS: s� o 6 rl el, /oc/ EMAIL: CONTRACTOR'S LICENSE /� WAINS NUMBER: _r(�Nf/MA077 &_la NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# 11 Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: [7 Public Total: Name of System: If this is a Commercial Project 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 ❑ Above ground Tank Size of Propane Tank: /o 0 o 6-,9. • I! Heat Stove ❑ Cook Stove Li Woodstove l.; Fireplace Insert l-1 Hot Water Tank ❑ Pellet Stove A Other C z r Pip 1 is this appliance being installed in a Manufactured/Mobile Home? Yes /J 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, Lincluding the reserve area. Square Footage For Office Use Only _ Current Proposed Amount' Main Floor Consistency Review: 25 'S(7) 214D Floor Babe fee: Proff e . t ' (O 3r8--Floor Addi'onal 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: $ -7(B .1:,)i Decks — — —— Receipt Number: -1 gcCt FS- Other Cash/Check Number • u ESTIMATED COST(REQUIRED) Date: ! •Fair market value of all labor and materials foundation to finish /a I /C✓4' Initials: CZ G.\PermitCenter\FORMS\DM)FORMS\Master Permit Application 7-8-04.doc