The URL can be used to link to this page

Home My WebLink AboutBLD2006-00076 RILDING PERMIT APPLICATI& BLD06-00076 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00076 Received Date: 2/24/2006 SITE ADDRESS: 34 TIMBER RIDGE DR PORT LUDLOW, 98365 OWNER: KEES BOUTERSE PHONE: 360-437-8082 TRIX BOUTERSE 34 TIMBER RIDGE DR PORT LUDLOW WA 983659734 TIMBERTON VILLAGE PHASE II SUBDIVISION: Block: Lot: 58 PARCEL NUMBER: 998500058 Section: 17 Township: 28 N Range: 01 E 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 PROPANE SWAP OUT- 120AIG SWAP OUT TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: PRO 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: aLE /Cco Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $51.00 SLE 02/24/06 79166 Total: $51.00 • • 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 #: BLD06-00076 Received Date 2/24/2006 SITE ADDRESS: 34 TIMBER RIDGE DR Issue Date 2/24/2006 PORT LUDLOW, 98365 APPLICANT: KEES BOUTERSE PHONE: 360-437-8082 TRIX BOUTERSE 34 TIMBER RIDGE DR PORT LUDLOW WA 983659734 58 SUBDIVISION: TIMBERTON VILLAGE PHASE II Block: Lot: PARCEL NUMBER: 998500058 Section: 17 Township: 28N Range: 01 E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2006 OWNER, KEES BOUTERSE PHONE: 360-437-8082 if different: TRIX BOUTERSE 34 TIMBER RIDGE DR PORT LUDLOW WA 983659734 PROJECT DESCRIPTION: PROPANE SWAP OUT- 120A/G SWAP OUT 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 2/24/2007. REQUIRED INSPECTIONS: Tank/Line/Appliance: -*(}PiQi)L ;it)k 7 —0 6 FinalApproval: 7 4))._ va ( .sAz j71-' 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 . 0 SITE VISIT REPORT • (PLOT PLAN) JOB r-e-e.S BD Lf T'f'12 S--P DATE : 02/2/Ab CONTACT: ADDRESS iA 7i- e 2 fi406_, A, PHONE #: y37— 8'c.D8 DIRECTIONS rc,t L,,p c , t-,- FAX #: Email PL NNER: GL~ -- A) / pc?, t '‘,,,tiev 1 id-)6 1) ,Y — - PicLc 7 T /v t' l iv' tr— C c-..6 7—m/, C -- . oN c V 06. JEFFERSON CNTY • 1 �+ VDEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax �q p� www.co.jefferson.wa.us/commdevelopment S NG" Master Permit Application MLA: Project Description(include separate sheets as necessary): Tax Parcel (� Property Number: q ( L50 66sd Size: (acres/square feet) Site Address and/or Directions to Property: 3 / /f��L7 / //.9 C_ ••-•- GL f/FLU-C„ Property Owner(s)of Record: - Trz/A- •,O 6( F- er�s� Telephone: /3 7 _ f c5' 2— ' Fax: email: . Mailing Address: 75'V 7/h-v/5 E=/2--2_/0 6 C ,n(-. /9 L.:1i/], J Applicant/Agent(if different from owner): c S�� ,.,7 /-_,--A._ wrw e-ng______ Telephone: 3 _5 - ?`l 7 Fax: email: Mailing Address: /l- LT-. 1'��- L� What kind of Permit?(Check each box that applies) ❑ Building LI Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit L l Conditional Use[C(a), C(d),or C] *" ❑ Single Family I I Discretionary"D"or Unnamed Use Classification 0 Garage Attached/Detached [I Special Use(Essential Public Facilities)** ❑ Manufactured Home i I Boundary Line Adjustment 0 Modular I; Short Plat** ❑Commercial* [I Binding Site Plan** ❑ Change of Use 1 I Long Plat** ❑Address 0 Road Approach a Planned Rural Residential Development(PRRDyAmendments** )ropane ❑ Plat Vacation/Alteration** L Allowed"Yes" Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management 0 Shoreline Management Substantial Development** 0 Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Variance Li Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* 0 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 designa to act a ent in rs relating to this application for permit(s). l Ow IGNATURV Date: By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is3ree 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 re *red later inspections.Access and right of entry to this property shall be requested and shall occur only during regular business Hours. Signature: D _ Date: c? j D 6 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 lake"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 compliance with the Jefferson County development code.The Applicant acknowledges that he,she or It holds individual kilo and non-transferaab ponsibility for adhe'ig to and complying with the ESA. The Applicant has read this disclaimer and signs and da it below. Signature: r U L ---. G r_ Q_-,,-L€_ Date: '-/ /. ( - F) G:\PermitCenter\FORMS\Dull FORMS\Master Pernut Application 7-8-04.doc • OWNER BUILDER STATEMENT • . I 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: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: 0 New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank [1 Community System 0 Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System 0 Repair ❑ Masonry _—__,__ SEP Permit# 11 Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: a 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 7KAbove ground Tank Size of Propane Tank: ,�'r C �•-// Ia Heat Stove I i Cook Stove a Woodstove LI Fireplace Insert U Hot Water Tank ❑ Pellet Stove ❑ Other Is this appliance being installed in a Manufactured/Mobile Home? Yes Noi 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: 2Nu Floor Propane. &IND MI `jL' O() P-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: $ 51 00 Decks Receipt Number: let I L Other Cash/Check Number: 1 ESTIMATED COST(REQUIRED) _ Date: �.'_ J .Fair market value of all labor and materials foundation to finish Initials: t;:\PennitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc