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Home My WebLink AboutBLD2006-00201 Ii ILDING PERMIT APPLICATJ BLD06-00201 Jefferson County Department of Community Development Review Type: 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00201 Received Date: 4/25/2006 SITE ADDRESS: 1050 IRONDALE RD PORT HADLOCK, 98339 OWNER: JOHN F KEEGAN PHONE: (360) 301-1888 PO BOX 681 PORT HADLOCK WA 98339-0681 SUBDIVISION: CORREIA'S ADDN TO IRONDALE 1 PARCEL NUMBER: 945000103 Section: 2 Township: 29 Btock:N Range: 01 W Lot: 6 CONTRACTOR: C H S INC PO BOX 518 PHONE: 360-681-5474 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 09/07/2006 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOt 120 GAL A/G PROPANE TANK, GAS PIPING, SPACE HEATER AND COOKSTOVE 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: CONST TYPE: OTHER: CONST TYPE: GARAGE: SHORELINE: DECK: SETBACK: SEWAGE DISPOSAL: BANK HEIGHT: 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 04/25/06 81089 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 #: BLD06-00201 Received Date 4/25/2006 SITE ADDRESS: 1050 IRONDALE RD Issue Date 4/25/2006 PORT HADLOCK, 98339 APPLICANT: JOHN F KEEGAN PHONE: (360) 301-1888 PO BOX 681 PORT HADLOCK WA 98339-0681 6 SUBDIVISION: CORREIA'S ADDN TO IRONDALE Block: 1 Lot: PARCEL NUMBER: 945000103 Section: 2 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, JOHN F KEEGAN PHONE: (360) 301-1888 if different: PO BOX 681 PORT HADLOCK WA 98339-0681 PROJECT DESCRIPTION: 120 GAL A/G PROPANE TANK, GAS PIPING, SPACE HEATER AND COOKSTOVE 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 04/25/2007. REQUIRED INSPECTIONS: Tank/Line/Appliance: Fin alApproval: 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. --1.050 IRONDALE RD BLD06-201 KEEGAN ‘144 ,1 t Y\ �--- - rT3 Approv la s ReqafPrrci LDOr _l to Final Inspection SEP ?Co CLQ)k-LcuLti RAP S ?e(sPA, \---} ZaNv DPW (4.‘----ON C06, JEFFERSO�OUNTY • W DEPARTMENT OF COMMUNITY DEVELOPMENT ~' 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax q�, N0�0'7 www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: V`—. 1 Project Description 'nclud se arat s,eets aw frip i.4. 1 i 1‹....,t° lam- Y l�j , ►73V ��-� �, 11 )t T Y` Property I Tax Parcel Number: t • 0 lir� Size: �, - � ( (acres/square feet) Site Address and/or Directions to Property: Property Owner(s)of Record: G Telephone: I. ;v 0 Fax: p mail: Mailing Address: Its �,� OAiKae aTNrfW. =' r Applicant/Agent(if different from owner : Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) ❑ Building ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use[C(a),C(d)j or Q]** ❑ Single Family ❑ Discretionary"D"or Unnam4rcf 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)/Arnendments** propane ❑ Plat Vacation/Alteration** ''' ' ` ❑ Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** Li 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 [I 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 ' h may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further a ee to ess and right of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application review and r ui r i ctions.Access and right of entry to this property shall be requested and shall occur only during regular business hours. 4.i 6 Signature: Date: 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 ar in com fiance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non- transferable re s lity ring to and complying with the ESA. The Applicant has read this disclaimer and'�' ns Oates it . Signature: Date: (��` G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc • 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: GENERAL CONTRAC R MA UFACTURED HOME INSTALLER: PHONE:) FAX: MAILING ADDRESS: / —"L9 1%ta yteAIL: ( ) CONTRACTOR'S LICENSE ` 6WAINS ` !! NUMBER; J `�a ` NUMBER A PHONE ( . ...44( : ( 9 ...1)...---) MAILING HDDRESS: (112 9 7) Rw.e,I.,�J 1 , ` EMAIL Project Type: Frame Type: ///� \� j�_j Bathro st Shoreline: Type of Sewage Disposal: U 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: 1 1 Private well 1 1 Two Party Type of Heat: Proposed: 0 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!pRly6 ^, 1 i Underground Tank '!t Above ground Tank Size of Propane Tank: ��u'"))`` 5�IIJ 11 Heat Stove •t Cook Stove i Woodstove Fireplace Insert I Hot Water Tank i 1 Pellet Stove I Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / No 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 Proposed For Office Use Only Amount Revision Main Floor Heated EH Bld App Review: 2"a Floor Heated Consistency Review: G Other Heated Base fee: r�rG �� /,\l�O Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport ., , ,itsr i ;Th1 [111NII uLSUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $ 1�, ,0 Receipt Number: `6 L()9 (� Cash/Check Number: GI( �t� ESTIMATED COST(REQUIRED) Date: �y � .Fair market value of all labor and materials foundation to finish LI �5 0(/) Initials: G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc