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Home My WebLink AboutBLD2006-00482 • • 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 #: BLD06-00482 Received Date 8/21/2006 SITE ADDRESS: 181 ROBIN LN Issue Date 8/21/2006 PORT LUDLOW, 98365 APPLICANT: STEVEN J KELLY PHONE: (360)437-2828 PAMELA M KELLY 181 ROBIN LN PORT LUDLOW WA 98365-9522 15 SUBDIVISION: BRIDGEHAVEN DIV 8 Block: Lot: PARCEL NUMBER: 935900015 Section: 9 Township: 27N Range: 01 E CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTPI983O6 Expires 09/26/2006 OWNER, STEVEN J KELLY PHONE: (360)437-2828 if different: PAMELA M KELLY 181 ROBIN LN PORT LUDLOW WA 98365-9522 PROJECT DESCRIPTION: INSTALL A/G 250 GAL PROPANE TANK, GAS PIPING AND FREESTANDING PROPANE STOVE 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 08/21/2007. REQUIRED INSPECTIONS: Tank/Line/Appliance;W /NSr1QtL,rriou di< gRafr E1er�/ , F,dtt.Qtl� 614,klE ekrPrito gEeiG/RED thaCi t 4pz.,,q,rlfsreac.uT 5144, FinalApproval: 2K - ?,r -4 441/' /2TJ7a 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 10/29/19f IJ ILDING PERMIT APPLICATIN BL Revviewiew T Ty482 ype: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00482 Received Date: 8/21/2006 SITE ADDRESS: 181 ROBIN LN PORT LUDLOW, 98365 OWNER: STEVEN J KELLY PHONE: (360)437-2828 PAMELA M KELLY 181 ROBIN LN PORT LUDLOW WA 98365-9522 BRIDGEHAVEN DIV 8 SUBDIVISION: Block: Lot: 15 PARCEL NUMBER: 935900015 Section: 9 Township: 27 N Range: 01 E CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTP198306 Expires 09/26/2006 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr INSTALL A/G 250 GAL PROPANE TANK, GAS PIPING AND FREESTANDING PROPANE STOVE 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: Routinq Date: \.a \ lbiar Type Amount Paid Bv: Date: Receipt: Approved/Date Propane Tanks/Stoves $51.00 KAS 08/21/06 83986 Total: $51.00 oN 0 • 4i ap JEFFERSON COUNTY k' `; } DEPARTMENT OF COMMUNITY DEVELOPMENT ~' = 'C 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax �q t .p� www.co.jefferson.wa.us/commdevelopment BING Master Permit Application MLA: Project Description(include separate sheets as necessary): / ��1)1,('2J V.IiJ f r l• ,31e-'a/7.t' n�.,�/It n kid , i n 4lai ern (reefila' % '`0 C^e I lei f . Tax P cel Property Number: ci r lC C Pro ert A'/+ + Size: (acres/square feet) Site Address and/or Directions to Property: / `�'n Lafn(I� ,( 1��J% r f a aye / I' Property Owner(s)of Record: �j >vl7 1- /J?C'b Kelly q Telephone: t� —4 a fj; Fax: email: Mailing Address: /gi f2,^k •(1 )G112 Q 07) Lr.r 17,c) 1JJJA 8?3l;<5 Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: W at kind of Permit?(Check each box that applies) What DVariance(Minor, Major or Reasonable Economic Use) E!Demolition Permit ❑Conditional Use[C(a), C(d),or C]** d Single Family ❑Discretionary"D"or Unnamed Use Classification ❑Garage Attached/Detached ❑Special Use(Essential Public Facilities)** Q Manufactured Home °Boundary Line Adjustment d Modular °Short Plat** ❑Commercial* °Binding Site Plan** Q Change of Use 0 Long Plat** El ddress i Road Approach °Planned Rural Residential Development(PRRD)/Amendments** Propane OPlat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisions** ❑Stormwater Management DShoreline Management Substantial Development** ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Variance OTemporary Use ❑Comprehensive Plan/UDC/Land Use District Map Amendment :Wireless Telecommunication* °Jefferson County Shoreline Master Program Amendment ❑F ore st 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 prove access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any requir d later insp tions. Sta s access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applirfiah that her he w n r n tic . Signature: ' 7 Zi72�Z_. (e' Date: / /J�p The action or actions Applicant will undertake as a`esult 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 Speci Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issu 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 re in compli ce with the J fferson County development code.The Applicant acknowledges that he,she or it holds individual ,,, and non-transf r responsibili for to�a.h••d/�omplying with the ESA. The Applicant has read this disclailap er an signs and dates it below. Signature: �(�,;z�2C 1 Date:9 O l2lP /// f D:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05-2.doc • • BUILDER STATEMENT The signer of thi tate ent does hereby certify t t they are the Owners of the parcel referenced herein,that they are hot IiceDdiporAractors and that they will be as min he respor/j bility oft Ge ral C ntractor for the proposed project. / / x ff�m ii �L•• Signature: '7)5ZeZZ Date: d /67(� GEIAERAL CONTRACTO�R MANUFACTURED HOM ,S,T�+LLER: PHONE: _ JtrrEr1 NCOUNTY in ✓n oun fae MO .L ?i 4 Uj l f12iewn (10)38.5 (Dge 3 ( ) 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 ❑ Wood Existing: 0 Sewer ❑ Addition 0 Steel Proposed: Bank ❑Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: cl Individual System O Repair ❑ Masonry SEP Permit# O Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: D Private well 0 Two Party Type of Heat: Proposed: 0 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 Propane Tan and/or Appliance Installation permit,mark all items below that apply: []Underground Tank Above ground Tank Size of Propane Tank: -4 Jt)get`4793 J °Heat Stove 0 Cook Stove 0 Woodstove ❑Fireplace Insert 0 Hot Water Tank 0 Pellet Stdve [Other l r10 Is this appliance being installed in a Manufactured/Mobile Home? Yes /®o J 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: . 5 -CV Other Heated Base fee: 5 )(( VQ Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL '7/0_ Sa Decks 911/Rd Approach fee: Other TOTAL: $ 07 L 50 Receipt Number: Cash/Check Number: ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish Initials: D:\PemutCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05-2.doc U k At x CI; �- tri -0 cn • '_ vA N 3 % , -a IA V h'S (� e. 6. \0 1 tee ` $ `° is w y = Sri IQ .--s------,,X N Q_ III I.L z a N ~-___ P r•-1z 7\; v 8- 0 3 lO --I • m ``__. tea,- ` `��` m r• c I 0 11 • nn tm D X m 0 cn 90 ra- -_ _ 0 z m III z c E co • rn 7J �O f- m • v) O z - 73 P. D � wZ O G • T Tl �1 T I co Oo