HomeMy WebLinkAboutBLD2006-00489 • I
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 #: BLD06-00489 Received Date 8/23/2006
SITE ADDRESS: 61 GAMBLE LN Issue Date 8/23/2006
PORT LUDLOW, 98365
APPLICANT: ROBERT K CHESNEY PHONE: 360-437-0738
WENDY L CHESNEY
PO BOX 65049
PORT LUDLOW WA 983650049 14
SUBDIVISION: PORT LUDLOW NO 1 Block: Lot:
PARCEL NUMBER: 990400114 Section: 9 Township: 28N Range: 01 E
CONTRACTOR: OWNER BUILDER PHONE:
OWNER, ROBERT K CHESNEY PHONE: 360-437-0738
if different: WENDY L CHESNEY
PO BOX 65049
PORT LUDLOW WA 983650049
PROJECT DESCRIPTION: NO MLA REQUIRED -WOODSTOVE
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 8/23/2007.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: I,y jk-y `, TALLED f 6k /O/z4J24#
FinalApproval: ( --2y, -)i r1.Q'1i L�' �3 O7L%
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:0() a.m. -4:30 p.m.
HOT LINE AVAILABLE 24 HOURS A DAY
I:\F_BLD_Permit_Propane.rpt 10/29/19f
MIL DING PERMIT APPLICATIPN BLD06-00489
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD06-00489 Received Date: 8/23/2006
SITE ADDRESS: 61 GAMBLE LN
PORT LUDLOW, 98365
OWNER: ROBERT K CHESNEY PHONE: 360�37 0738
WENDY L CHESNEY
PO BOX 65049
PORT LUDLOW WA 983650049 PORT LUDLOW NO 1
SUBDIVISION: Block: Lot: 14
PARCEL NUMBER: 990400114 Section: 9 Township: 28 N Range: 01 E
CONTRACTOR: OWNER BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI NO MLA REQUIRED - WOODSTOVE
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:
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $51.00 CJZ 08/22/06 81449
Total: $51.00
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+ 06 JEFFERSON COUNTY
Ikzi ' \\ DEPARTMENT OF COMMUNITY DEVELOPMENT
`4 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
www.co.jefferson.wa.us/commdevelopment
1
�$INO
Master Permit Application
MLA:
Project Description(include/ se��arr�to sheets as necessary):
t �700e s/263T/o!7
Tax Parcel 4
Number: / 90 y00// Property 3
/ Size: / 3 s' c re (acres/square feet)
Site Address and/or Directions to Propert •
Property Owner(s)of Record: e By L.S`leP
Telephone: .oO 7-/73' Fax: Sa vfr /
Mailing Address: P, lox 6SO1' go r Zu DP email: k
Applicant/Agent(if different from owner): �� `���
Telephone: -- Fax:
email: �'
Mailing Address: ;
/=
What kind of Permit?(Check each box that applies)
❑Building ❑Variance(Minor,ii Demolition Permit Major or Reasonable Economic Use)
d
Single Family ❑Conditional Use[C(a),C(d),or Cj**
Discretionary"D"or Unnamed Use Classification
❑Garage Attached/Detached Q Manufactured Home °Special Use(Essential Public Facilities)**
Cf Modular °Boundary Line Adjustment
Q Commercial* °Short Plat**
Q Change of Use °Binding Site Plan**
°Long Plat**Q Address i Road Approach °Planned Rural Residential Development(PRRD)/Amendments**
.gr-riopzne MPle( OPlat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisions**
❑Stormwater Management OShoreline Management Substantial Development**
OSite 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
OForest Practices Act/Release of Six-Year Moratorium
*May require a Pre—Application Conference
**Requires
Please identify any other local,state or federal permits requiredfor this proposal, if knownfence
I hereby designate DESIGNATION OF AGENT
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 require. - •r inspections. Staffs access and right of entry will be assumed unless the applicant infor the Cou in writing at the
time of the appli . on •r h i she . r notice.
Signature: ,- / / D zZ
Date:
The action or ac ons Applicant will undertake as a resu of the issuance of this permit may negatively impact upon one or more threatened or
endangered species and could lead to a potential"tak of an endangered species as those terms are defined in the federal law known as the
"Endangered Species Act"or"ESA."Jefferson County akes 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, rou or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)even if you are in compliance wit the J erson puny development cod4-The Applicaritacknowledges that he,she or it holds individual
and non-transfera s nsi T f e o and co r lyin with the ESA. The Applicant has read this disclaimer a d signs d tes it below.
Signature: _
/ _ Date: g z
D:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05-2.doc y
L— ;EVFLOPMENT
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BUILDER STATEMENT
The signer of this stateme9oes hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be assu p.. eI"' spun . ili n I Contractor for the proposed project. /�
Signaturo. / Date: 7
0
GENERAL C,NTRACTOR OR MANUFACTURED HOM I ALLER: PHONE: FAX:
( ) ( )
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
Total: Height: I Individual System
❑ Alteration/Remodel ❑ Concrete SEP Permit#
❑ Repair ElMasonry
Other: Bedrooms: Water Supply:
❑ Demolition 0 Existing: Setback: ❑ Private well 0 Two Party
Proposed: 0 Public
Type of Heat: 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 Tank and/or Appliance Installation permit,mark all items below that apply:
[]Underground Tank 0 Above ground Tank Size of Propane Tank:
❑Heat Stove ❑Cook Stove 0 Woodstove ❑Fireplace Insert In 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:
2ntl Floor Heated Consistency Review:
Other Heated Base fee:
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: 2 ( 1-kvl
Cash/Check Number: 11 1
ESTIMATED COST(REQUIRED) Date: 5(a 06
.Fair market value of all labor and materials foundation to finish Initials: 'mil
(1.-5/'
D:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05-2.doc