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HomeMy WebLinkAboutBLD2006-00504 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 #: BLD06-00504 Received Date 8/30/2006 SITE ADDRESS: 21 E HEMLOCK ST Issue Date 8/30/2006 PORT LUDLOW, 98365 APPLICANT: MADELINE BRODIE PHONE: (360)437-0193 21 E HEMLOCK ST PORT LUDLOW WA 98365-9742 3-4 SUBDIVISION: PARADISE BAY ESTATES Block: 5 Lot: PARCEL NUMBER: 983400504 Section: 22 Township: 28N Range: 01 E CONTRACTOR: SUBURBAN PROPANE PHONE: (360) 377-7647 351 CHICO WAY NW BREMERTON WA 98312 (336Q) 373 6756 Contractor's License SUBURPL044DA Expires 0 /1L2/2007 OWNER, MADELINE BRODIE PHONE: (360)437-0193 if different: 21 E HEMLOCK ST PORT LUDLOW WA 98365-9742 PROJECT DESCRIPTION: REPLACEMENT PROPANE TANK 120 GAL A/G 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 08/30/2007. REQUIRED INSPECTIONS: Tank/Line/Appliance: AMY- OK g/34,OG 6i/ FinalApproval: OK -cot- -c'g yi1,( 5 3D/O,4 /i BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:00 a.rn. -4:30 p.m. HOT LINE AVAILABLE 24 HOURS A DAY I:\F_BLD_Permit_Propane.rpt 10/29/19f GILDING PERMIT APPLICATS BLD06-00504 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Pori: Townsend, WA 98368 PERMIT #: BLD06-00504 Received Date: 8/30/2006 SITE ADDRESS: 21 E HEMLOCK ST PORT LUDLOW, 98365 OWNER: MADELINE BRODIE PHONE: (360)437-0193 21 E HEMLOCK ST PORT LUDLOW WA 98365-9742 PARADISE BAY ESTATES SUBDIVISION: Block: 5 Lot: 3-4 PARCEL NUMBER: 983400504 Section: 22 Township: 28 N Range: 01 E CONTRACTOR: SUBURBAN PROPANE PHONE (360) 377-7647 351 CHICO WAY NW BREMERTON WA 98312 Contractor's License SUBURPL044DA Expires 03/12/2007 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP REPLACEMENT PROPANE TANK 120 GAL A/G TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2003 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: 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 KAS 08/30/06 84810 Total: $51.00 / i i 3/06-lieRECEIVED )\-1 21 E , H-rn l c k i- AUG 3 0 2Q06 Gov+ Lac( I OvN , \/A JEFFEllSON C0 STY BCD ti -_6ioo ._(-, 1 -Kt 1,()I jpo.h Y" - t 1 1 v v i)4,1 vuj Ave. . tA.v\i • iij o k,--rt-1 e..., -��. 1 =zo) 11-1 , r3 , r 7. : T s 1 4 1 (._,_ I vi- „ , ,, ____„_ ....., , _ , -1 - . K ,� . , t - i t: r S , v ? 1 -71--. ' .1 3- 't- 1 i pa,vewm-li 1 (;:: %, , AnD,sr,,�'.SP/0(Q I 7 ON �, • • RLt,;�CETITED ,t4 off, JEFFERSON COUNTY c at �ti DEPARTMENT OF COMMUNITY DEVELOPMENT �p 2006 '"�` 621 Sheridan Street•• Port Townsend •• Washington 98368 360/379-4450 •• 360/379-4451 Fax his ,�o$ www.coJefferson.wa.us/commdevelopment JEFFERSON COUNTY n DCD Master Permit Application MLA: Project Description(include separate sheets as necessary): i ep f G e t,qe.,0 r t=7,, Q lme___ .72—f t k 1..?D (''4 L , A 7G- ax Parcel Number: Property �3 �O© 5 D Size: is C x (C c_: (acres/square feet) Site Address and/or Directions to Property: -2 I E.(--E(Ai i d+Clc..; c-t A L( Property Owner(s)of Record: ,1,/i1. ) I / i// 1 3 R 0 20 f Telephone: G I± 7 J c, . Fax: /� _ email: y Mailing Address: }r4.4. 1 y , 9 a ______' - 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) [j Demolition Permit ❑Conditional Use C a , C d ,or C]** d Single Family ( ( ) ( ) Q Garage Attached/Detached Discretionary"D"or Unnamed Use Classification Q Manufactured Home Special Use(Essential Public Facilities)** C� El Modular Boundary Line Adjustment Q Commercial* ClShort Plat C1 Er Change of Use Binding Site Plan** ❑Long Plat** g Address i Road Approach °Planned Rural Residential Development(PRRD)/Amendments*'` �4 Propane ❑Plat Vacation/Alteration** DAllowed"Yes"Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisions'"' OStormwater Management ❑Shoreline 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 OForest Practices Act/Release of Six-Year Moratorium *May require a Pre-Application Conference **Requires Please identify any other local, state or federal permits required for this proposal, if known: rence 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. Staff's access and right of entry will be assumed unless the applicant informs the County in writing at the time of the application that he or she wants pr or notice. Signature:j f��;' Ltd-- .,2-e.'--e/C --- Date: ca" - 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 9nd complyi g with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature:nature:/ ma ,-(7�. self---_.. >-___ .`- -G. rS Date: �--- G��? • D:\Perm1tCenter\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: S' ,t✓ 1,4 2 ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE /1 WAINS NUMBER: .,3()/3 v 1 P L p / f- -PA NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type SewerofSewage Disposal: ❑ New ❑ Wood Existing: ❑ Addition ❑ Steel Proposed: Bank 0 Community System ❑ Alteration/Remodel 0 Concrete Total: Height: p Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ 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 I No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: 0 Underground nk i "Above ground Tank Size 9f Propane Tank: /10 ❑Heat Stove ElvrCook Stove ❑Woodstove OFireplace Insert j Hot Water Tank 0 Pellet Stove p Other 2 Is this appliance being installed in a Manufactured/Mobile Home? es / 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"°Floor Heated E ILAIt \ J��r } Consistency Review: Other Heated Base fee: Mezzanine AUG 3 0 Z006 Additional Section: Heated Basement JEFFERSON EOUNTYfIf.Ei 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: Cash/Check Number: ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish Initials: D:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05-2.doc