HomeMy WebLinkAboutBLD2006-00592 i 110
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 #: BLD06-00592 Received Date 10/16/2006
SITE ADDRESS: 7470 OAK BAY RD Issue Date 10/16/2006
PORT LUDLOW, 98365
APPLICANT: DAVID R PEDERSON PHONE: (360)437-9860
MARGE L PEDERSON
7470 OAK BAY RD
PORT LUDLOW WA 98365-9445 1+
SUBDIVISION: GREEN SHORT PLAT 1.00 AC Block: Lot:
PARCEL NUMBER: 978900130 Section: 4 Township: 28N Range: 01 E
CONTRACTOR: EVERWARM INC PHONE: (360)452-3366
257151 HWY 101
PORT ANGELES WA 98362
Contractor's License EVERWI*083NL Expires 08/17/2008
OWNER, DAVID R PEDERSON PHONE: (360)437-9860
if different: MARGE L PEDERSON
7470 OAK BAY RD
PORT LUDLOW WA 98365-9445
PROJECT DESCRIPTION: INSTALL WOOD FIREPLACE INSERT
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 10/16/2007.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: /osE,QT /0 7-444 41-,o,) /0/l G#
FinalApproval: 41/'t �� na-, /a/26/a
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 10/29/19c
b ILDING PERMIT APPLICATJ BR Review Ty
592
ype: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD06-00592 Received Date: 10/16/2006
SITE ADDRESS: 7470 OAK BAY RD
PORT LUDLOW, 98365
OWNER: DAVID R PEDERSON PHONE: (360)437-9860
MARGE L PEDERSON
7470 OAK BAY RD
PORT LUDLOW WA 98365-9445 GREEN SHORT PLAT 1.00 AC
SUBDIVISION: Block: Lot: 1+
PARCEL NUMBER: 978900130 Section: 4 Township: 28 N Range: 01 E
CONTRACTOR: EVERWARM INC PHONE: (360) 452-3366
257151 HWY 101
PORT ANGELES WA 98362
Contractor's License EVERWI*088NL Expires 08/17/2008
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP INSTALL WOOD FIREPLACE INSERT
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:
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 Bv: Date: Receipt: Approved/Date
Propane Tanks/Stoves $51.00 KAS 10/16/06 85119
Total: $51.00
le/e9/2006 13: 19 3603794451 JEFF CO PERMITCENTER PAGE 02/03
fox 0 •
�� JEFFERSON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street• Port Townsend•Washington 98368
Q� 360/379-4450. 360/379-4451 Fax
'Y%N�,tp www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA:
Project Description(Include separate sheets as necessary):
j-r✓e,Riau.‘ .1-rt Sc-6/t titiC(J
Tax Parcel •1 Property ��
Number: 1 r `Lc%(3U Size:
(acres/square feet)
Site Address and/or Directions to Property: -1 , , • .a,-1---4 ._, lie— �-'ff `7%74y
Property OWner(s)of Record: ``
Telephone: G L y 3 7- i'g 4 1 Fax: email: ct* p✓c /
"^�` lr Mailing AdAddress:__ fihrt� V �7
Applicant/Agent(if different from owner):
Telophono: Fax: _
Mailing Address: email:
What kind of Permit?(Check each box that applies)
OBuilding OVariance(Minor,Major or Reasonable Economic Use)
Id Demolition Permit ❑Conditional Use[C(a),C(d),or C]**
d Single Family ODiscretlonary"D"or Unnamed Use Classification
Cl Garage Attached/Detached °Special Use(Essential Public Facilities)**Q Manufactured Homo [Boundary Line Adjustment
Cl Modular
Q Commercial* ❑Short Piat""
Q12:O LoriMinding Site Plan**
El Long Plat**
El Addressdress. I Road Approach _ []Planned Rural Residential Development(PRRD)Amendments**
�Ci Prop"Yes"Use Analysis OPlat Vacation/Aiteratlon**
°AtomwaYes"Use Consistencynsi OShoreline Master Program Exemptii�n/Permit Revisions"
°Site Plan Approval Advance Determination(SPAAD) fJShoreline ManagementVarianceial Development*"
(°Temporary Lite ) �Shorlirt®Management Variance
DComprehenslve Plan/UDC/Land Use District Map Amendment
L�Vllireless Telecommunication*
❑Jefferson County Shoreline Master Program Amendment
>]Forost Practices AcUReleese of Six-Year Moratorium
May require a Pro—Application Conference **R tree a Pm-A cation 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 SIGNATUR$
Date:
Sy signing this application form,the owner/agent attests that the Information provided herein,and in any attachments,is true and cornet 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 perrhit being null and void.
I further agree to save,Indemnify and hold harmless Jefferson County against all liabilities,Judgments,court costs,reasonable attorneys fees end
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 mogul later Inspections. Staffs access and right of entry will be assumed unless the applicant informs the County In writing at the
time of the appllcatl n hat h�e!�r Sh tg p r notice.
Signature' Ate fQ J`
________.
Date: �4 The action or actions Applicant will undertake as a result of the issuance of this milt may hrened or
endangered Spccles and could lead to a potential"take"of An endangered species as those terms are defined In thponone
federal law tknown 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 Its ed will not violate the ESA. Any Individual,group or agency can file a lawsuit on behalf of an endangered species
actions)even If are in compliance with the Jefferson County development code.The Applicanthholds regarding g al
and nen•transfc ble�responQ,�lllly for t andApplicant acknowledges that he, or end individual
it below.
g/" � emptying with the ESA, The A Ilcant has read this disclaimer a Big dates it below.
signature; Date:—
.0 /
DArermitami:r\FORMS\DM)FORMS\Muter Ptunit Application 12-3p_p5.2,dnc
10/09/2006 13: 19 3603794451 JEFF CO PERMITCENTER PAGE 03/03
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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 bo assuming the responsibility of the Gonerel Contractor for the proposed protect,
Signature: — Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE:
etrCyi �ILC% FAX:�_
�.�� 11 ( ) ( )
MAILING ADDRESS: •2 • "
CONTRACTOR'S LICENSE �� /� EMAIL:
NUMBER: WAINS
Li E !tJ t ! L NUMBER
ARCHITECT/ENGtNFER: PHONE
MAILING ADDRESS: -- ! ) FAx:( )
EMAIL Project Type: Frame Type: Bathrooms:
Shoreline: Type of Sewage Disposal:
D New 0 Wood
❑ Addltion 0 Steel Proposed: 0 Sewer
O Alteration/RemodelBank ri Community System
0 Concrete Total: Height: �I Individual System
❑ Repair ❑ Masonry
Cl Demolition
❑ Ott Bedrooms: Water SEP Permit#
Existing: Setback: Supply:
Type of Heat: Proposed. ❑ Private wet ❑Two Party
Total: ❑Public
Name of system:
If this is a Commercial pro u.rrtust answer the following: _
Number of Parking Spaces: Current: Proposed: Number of AIM Parking Spaces:
Number of occupants(Incitides owners,tenants,employees,etc) Current
osed
IBC Occupancy: IBC Type of construction: PoFood Service?
If this is a Propane Tank and/or Appliance Installation and• mark all Items below tyou hatapply:Service? Yes / No
b Underground Tank 0 Above ground Tank
S¢6 of Prppane Tank: _
°Heat Stove ❑Cook Stove O Woodstove OFireplace Insert 0 Hot Water T
oot Is this alpllance being Installed in a Ma ufactured/Moblid Home? Yes / Cl Pellet Stove [)Other i c^v q „zt r2 rie t
When applying for a •�3c-tzj
lines, a tank yingH andp psient*
distances from propane
tank you must also submit a site plan showing all of the buildings,
the propane tank to aftseptic systemcomponents,
property
y
including the reserve area. property lines,buildings and
S.care Foote•e Current P • . •
Main Floor Heated •sect :,Cot-u`nteeitteaoh ,: . . t • i ll^'
EH Bid Ape Review I ,
2 Floor Heated Consistency Review:
NMI
Other Heated
Base fee:
Mezzanine
Additional Section:
Heated Basement
Plan Check fee:
Unheated Basement
a= State Surcharge fee:
Other Unheated Pot Water Review fee:
Garage/Carport
SUBTOTAL
Docks •
911/Rd
Approach fee:
Other
TOTAL: S /. al)
' Receipt Number.
Cash/Chock Number. IIIIIIIIII
ESTIMATED COST(REQUIRED)
'Fair Market value of all labor and rhatsrlals foundation to finish Date:
Initials:
D:\PctmirCentcr\FORM$\DRD Pr]RMS\Meter Pctmit Application 12-V-05-2doc