HomeMy WebLinkAboutBLD2006-00127 •
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 #: BLD06-00127 Received Date 3/20/2006
SITE ADDRESS: 134 SAN JUAN DR Issue Date 3/20/2006
PORT TOWNSEND, 98368
APPLICANT: LARRY D COUPE PHONE: (360) 379-1246
LAURA C GALLO
134 SAN JUAN DR
PORT TOWNSEND WA 98368-9440 37
SUBDIVISION: CAPE GEORGE COLONY DIV 3 Block: 5 Lot:
PARCEL NUMBER: 938400536 Section: 12 Township: 30N Ranqe: 02W
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, LARRY D COUPE PHONE: (360) 379-1246
if different: LAURA C GALLO
134 SAN JUAN DR
PORT TOWNSEND WA 98368-9440
PROJECT DESCRIPTION: INSTALL A/G 120 GAL PROPANE TANK, GAS PIPING,
COOKSTOVE AND BBQ
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 03/20/2007.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: . /Ai c-i" yA66
FinalApproval: 91- /2l 1%
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
1 JILDING PERMIT APPLICATC BLD06-00127
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD06-00127 Received Date: 3/20/2006
SITE ADDRESS: 134 SAN JUAN DR
PORT TOWNSEND, 98368
OWNER: LARRY D COUPE PHONE: (360) 379-1246
LAURA C GALLO
134 SAN JUAN DR
PORT TOWNSEND WA 98368-9440 CAPE GEORGE COLONY DIV 3
SUBDIVISION: Block: 5 Lot: 37
PARCEL NUMBER: 938400536 Section: 12 Township: 30 N Range: 02 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 DESCRIPTIOr INSTALL A/G 120 GAL PROPANE TANK, GAS PIPING, COOKSTOVE
AND BBQ
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 03/20/06 80863
Total: $51.00
1:i1/4: 0N
c JEFFERS.000NTY •
ARTMENT
g' � 621PSher Sheridan SttrF COMMUNITY reett • Port TownsDend. Wsh ngt ori- 8 68 ' ill
360/379-4450 • 360/379-4451 Fax
Is, Noo www.co.jefferson.wa.us/commdeveloprnerI , R 2 0 2006
Master Permit Application ����HH MLA:
Project Description (include separate sheets as necessary): JEFFERSON CU{1I\I E 1 C'
4-P S TALL I 24 c3AL ID( IOpA J& TA I i(c 4- Z A P Pu A1UCE5
Property
Tax Parcel Number: Y ri LlOo — S3(a Size: (acres/square feet)
Site Address and/or Directions to Property: llC-i �A0 J UAiJ Dl` II aT T wk.)S.1v1 i R c:a36, }
Property Owner(s)of Record: L.aPJQ� Co—Pe 4 LAuct G c L
Telephone: C3Ccr,' 37g— (2'- Fax: email: (cc C C (E5P0121.ccn,-)
Mailing Address: (1-f Siu J04•u jOR 1 Pcu -r TCx.eita5(�Dt C ge368
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies)
1 Building ❑ Variance(Minor, Major or Reasonable Economic Use)
❑ 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 I 1 Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments**
'(Propane ❑ Plat Vacation/Alteration**
❑ 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
❑Wireless Telecommunication* ❑ 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 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 er inspec. s.Ac ss and right of entry to this property shall be requested and shall occur only during regular business
hours. / / � v�
Signature; L Date: J/F. 2G 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"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 violat9 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 compliaith th fferson County development code.The Applicant acknowledges that he,she or it holds individual and non-
transferable responsi for adh g d complying with the ESA. The Applicant has read this disclaimer and si s a d dates it below.
Signature: �N`%—e Date: 3 el 2096
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc
• BUILDER STATEMENT •
The signer of this stateme does here certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be assuming t Oil
ity f General Contractor for the proposed projects. •
Signature: `�`� _ Date: 5/7�-26V‘'
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
'LAL x ( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: ALL #4AOv! aAS NUMBER
ARCM .114 PHONE ( ) FAX: ( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New ❑ Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank Height: ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: ❑ Individual System
❑ Repair ❑ Masonry SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well i 1 Two Party
Type of Heat: Proposed: ❑ Public
Total: Name 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: 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 kf Above ground Tank Size of Propane Tank: 126 +a
❑ Heat Stove 1_4 Cook Stove ❑ Woodstove ❑ Fireplace Insert 0 Hot Water Tank ❑ Pellet Stove i't. Other . •
Is this appliance being installed in a Manufactured/Mobile Home? Yes / ND
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 Current Propoaed For Office Use Only Amount Revision
Main Floor Heated EH Bld App Review:
2nd Floor Heated Consistency Review:
Other Heated Base fee:
-V(0Vcu - bl D(
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement f l� State Surcharge fee:
Other Unheated 16 F ' 0 rim AR
Pot Water Review fee:
Garage/Carport SUBTOTAL
JU1LRS��I i 'U'U+I D( "911/Rd Approach fee: ��
Decks
Other TOTAL: $ -"1 .50
tC1l�
Receipt Number: % _'<D
Cash/Check Number: C • t.\
ESTIMATED COST(REQUIRED) Date: �� 0
.Fair market value of all labor and materials foundation to finish (G'
Initials: Cr\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc LJ
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DESIGNED B 1114'''r'om,,irl ,, -(
Y; .:L'.,-
..,Qut-)E/GALLO ADDITIO \
LARRY D. COUPE, P.E.
SITE ' t: 'N 0
134 San Juan Drive
134 SAN JUAN DRIVE
Port Townsend. WA PR:36R