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Home My WebLink AboutBLD2006-00420 • 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 #: BLD06-00420 Received Date 7/20/2006 SITE ADDRESS: 422 RHODODENDRON DR Issue Date 7/20/2006 QUILCENE, 98376 APPLICANT: FREDRICK B GREEN PHONE: 360-765-3508 422 RHODODENDRON DR QUILCENE WA 983769679 SUBDIVISION: Block: Lot: PARCEL NUMBER: 701344045 Section: 34 Township: 27N Range: 01W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2006 OWNER, FREDRICK B GREEN PHONE: 360-765-3508 if different: 422 RHODODENDRON DR QUILCENE WA 983769679 PROJECT DESCRIPTION: REPLACE A/G 250 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 7/20/2007. REQUIRED INSPECTIONS: Tank/ ine/Appliance: DK 4 /i," , FinalApproval: 7/ -�OT' i1cal $01, 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 RILDING PERMIT APPLICATIPN BL vTy420 Reviewiew Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00420 Received Date: 7/20/2006 SITE ADDRESS: 422 RHODODENDRON DR QUILCENE, 98376 OWNER: FREDRICK B GREEN PHONE: 360-765-3508 422 RHODODENDRON DR QUILCENE WA 983769679 SUBDIVISION: Block: Lot: PARCEL NUMBER: 701344045 Section: 34 Township: 27 N Range: 01 W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2006 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr REPLACE A/G 250 GAL PROPANE TANK 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: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: �-. 1Ilcik-r Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $51.00 LYK 07/20/06 83843 Total: $51.00 • R*E VED 44N col, JEFFERSON COUNTY \ �' DEPARTMENT OF COMMUNITY DEVELOPMENT ''° y 621 Sheridan Street• Port Townsend • Washington 98368 JUL 0 2006 360/379-4450 • 360/379-4451 Fax �q www.co.jefferson.wa.us/commdevelopment JEFFERS N sNa�s° 0 COUNIY DCD Master Permit Application MLA: f;;('. (l'll E / , !` Project Description(include separate sheets as necessary): //t `� c 9P/24"I` ,�,4 Tax Parcel X� Property Number: 7 � �'5 '( 1( Size: (acres/square feet) Site Address and/or Directions to Property: �Zy , .i 74 --e/.-1 PR-- 4vi LGC.---,./E- Lc_-__ Property Owner(s)of Record: - Cx- g �� iJ Telephone: T6U 7c., S —S'S U Fax: email: Mailing Address: 5/ ,�� Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: hat kind of Permit?(Check each box that applies) uilding ❑Variance(Minor, Major or Reasonable Economic Use) Demolition Permit OConditional Use[C(a),C(d),or C]** d Single Family ❑Discretionary"D"or Unnamed Use Classification ❑Garage Attached/Detached ❑Special Use(Essential Public Facilities)** ❑Manufactured Home 0Boundary Line Adjustment ❑Modular °Short Plat** El Commercial* ❑Binding Site Plan** Q Change of Use °Long Plat** Q .ddress Road Approach [Planned Rural Residential Development(PRRD)/Amendments** ropane OPlat Vacation/Alteration'"' Allowed"Yes"Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisions** Stormwater Management ❑Shoreline Management Substantial Development** OSite Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Variance ❑Temporary Use ❑Comprehensive Plan/UDC/Land Use District Map Amendment OWireless 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. S ffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applicaf th a or e w rior e. Signatur • 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 erson County development code.The Applicant acknowledges that he,she or it holds individual and non-transfeca ponsibili for e o and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Sign Date: cl i-ai 7-".> er i D:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05-2.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 CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: CE—A--�� ( ) ( ) 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: ❑ New 0 Wood Existing: ❑Sewer ❑ Addition 0 Steel Proposed: Bank 0 Community System ❑ Alteration/Remodel 0 Concrete Total: Height: 1;1 Individual System ❑ Repair 0 Masonry SEP Permit# ❑ Demolition 0 Other: Bedrooms: Water Supply: Y: Existing: Setback: 0 Private well 0 Two Party Type of Heat: Proposed: ❑Public Total: Name of System: 0 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 Propan an and/or Appliance Installation permit,mark all items below that a ' p []Underground Tank bove ground Tank Size of Propane Tank: c/ 0 Heat Stove 0 Cook Stove 0 Woodstove ❑Fireplace Insert 0 Hot Water Tank 0 Pellet Stove p 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: 2nd Floor Heated Consistency Review: Other Heated Base fee: — I CID Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL J< C % Decks 911/Rd Approach fee: Other TOTAL: $ ))1 c13 Receipt Number: 3 Cash/Check Number: n -7�yC1 ESTIMATED COST(REQUIRED) Date: ��jj .Fair market value of all labor and materials foundation to finishbC7 - Initials: <j D:\PemritCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05-2.doc m -" z D gr'. .. . n N --7, ..,„ ,,„, \ D p \„n rn r 0 • n m 0 c • -‘ * 4 . _, v) i., _ m 7-71 r rn CO r n z \ A a P. v v m ifcn !; s 0 z \\ Crn H i z D D a f