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Home My WebLink AboutBLD2006-00299 BLD06-00299 RILDING PERMIT APPLICATTN Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00299 Received Date: 5/31/2006 SITE ADDRESS: 81 HILLER DR PORT HADLOCK, 98339 OWNER: JACK S CLOGSTON PHONE: 360-385-3365 PO BOX 1075 PORT HADLOCK WA 983391075 HILLERS WF TR INC TL SUBDIVISION: Block: Lot: PARCEL NUMBER: 960300007 Section: 7 Township: 29 N Range: 01 E CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTP198306 Expires 9/26/2006 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION REPLACE FAILING HEAT STOVE - NO MLA REQ'D TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC 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 LYK 05/31/06 81384 Total: $51.00 • • PROPANE/PELLET/WOOD STOVE & TANK INSTALLATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD06-00299 Received Date 5/31/2006 SITE ADDRESS: 81 HILLER DR Issue Date 5/31/2006 PORT HADLOCK, 98339 APPLICANT: JACK S CLOGSTON PHONE: 360-385-3365 PO BOX 1075 PORT HADLOCK WA 983391075 SUBDIVISION: HILLERS WF TR INC TL Block: Lot: PARCEL NUMBER: 960300007 Section: 7 Township: 29N Range: 01 E CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTPI983O6 Expires 9/26/2006 OWNER, JACK S CLOGSTON PHONE: 360-385-3365 if different: PO BOX 1075 PORT HADLOCK WA 983391075 PROJECT DESCRIPTION: REPLACE FAILING HEAT STOVE - NO MLA REQ'D THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 5/31/2007. REQUIRED INSPECTIONS: Tank/Line/Appliance: /g6PL/ A4IFJr f1Ejqt .totar & ' `O/VAd FinalApproval: 0� -C'— -Dina,/ /Df4 BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:00 a.m. -4:30 p.m. HOT LINE AVAILABLE 24 HOURS A DAY I:\F_BLD_Permit_Propane.rpt 10/29/19 • . P-4/4 • 4----- A . . ..._......1 54•Ku$s wow riatitR, , 54,2u a5 ., 4.- A , PeoLitiviviNeez ( l v 1 . i 1 /8 / < Z2- —> 54-0‹ POAC# 1 ( 4-414 ,—,,,,--- . i ....... : , 4. . Fieo#1 1—t- k IT CPfels1 , ,____ f,. , ic , I P4oPeA,M V 1 1 ACtiti 1 1 Hog Se Lor 1 ---f--- I i1 (ftar14) k4N, I 1 21, 443 ' 1 11 __ I q3.6,0117,4$2, • Livi(Aid) to , I oZoosv) • • • qois-6, , , H- -- . I I • i , 4 7 H 1 < i f 1 I I , , ! I i , . il I • F---goArr-[ Pocc#1 i i i 1 1 _ li `T- • ,. 1 i 1 11 I I ; , .,- •, .- 1 , 1 . , - r-1 r - 1; \ L 1,'-7.1 v.-±_i___-___-_-:_-___Th...-,, . i. i 1 ' 'Fl?E4- i ) I i• '' r—t— 1 i• i, 1 , 1 1 1 l' i--1,t 1 16 r . 1 'mg 3 1 2006 I; ' • , , . 1 ; 1 1 ; , 1 ; i 1 . ', ! Rg.ws W "TPR-4'#N7 7;e$4(..75 i 1 / 1 Sf tiAdelf 2. , , 1. 1 ,�r06t' °if C , JEFFERSO•OUNTY i rziDEPARTMENT OF COMMUNITY DEVELOPMENT �' 'C 621 Sheridan Street • Port Townsend • Washington 98368 , �` - r:r ' 360/379-4450 • 360/379-4451 Fax . 'I I 1 0$ www.co.jefferson.wa.us/commdevelopment ' t 1 MAY 3 1 2006 . '; . Master Permit Application MLA:1 1 Project Description (include separate sheets as necessary): 'WC-A C L- F4l L-//U C7 O PA/V 6 1-1.s.1T .37e UE ' ��O3L Property Tax Parcel Number: >0UL) Size: S2$�7 .5�-�-t (acres/square feet) Site Address and/or Directions to Propd�errtty: at /-1/LL E OR/UE / /Oi r ,4 4LL k— Property Owner(s)of Record: cJ'�c-�C SC07T CL06STON Telephone: % 385-33r'5- Fax: i20rlt° email: /?pile Mailing Address: P . t3C1X 077 Pot X 1006Ock 04.. gjg33c: 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),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** Li Change of Use ❑ Long Plat** ❑ Address ❑ Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** P-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 later inspections.Access and right of entry to this property shall be requested and shall occur only during regular business hours. 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 are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non- transferable responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: Date: G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc SBUILDER 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 CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: 68g3 FAX: /y/L)L tU 1,13 ► 4 (366 )34- -683 ( ) MAILING ADDRESS: 2 ( -4/AMIC4AvI /Z irr L EMAIL: CONTRACTOR'S LICENSE �Uu.(rr?/ 70304. WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX: ( MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: ii Sewer ❑ Addition ❑ Steel Proposed: Bank Height: Community System ❑ Alteration/Remodel ❑ Concrete Total: l I Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: i Private well I 1 Two Party Type of Heat: Proposed: I I 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: VHeat Stove 11 Cook Stove ❑ Woodstove I I Fireplace Insert ❑ Hot Water Tank I i Pellet Stove ❑ 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 BId App Review: 2' Floor Heated Consistency Review: Other Heated Base fee: JI • C5() Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL • Decks 911/Rd Approach fee: Other TOTAL: $ Receipt Number: 3b(-1- Cash/Check Number: (2CA ESTIMATED COST(REQUIRED) Date: , �l ,,f •Fair market value of all labor and materials foundation to finish y� iCD Initials: G:\PermitCentcr\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc