HomeMy WebLinkAboutBLD2006-00611 • •
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 #: BLD06-00611 Received Date 10/24/2006
SITE ADDRESS: 214 EAGLE VIEW LN Issue Date 10/24/2006
PORT LUDLOW, 98365
APPLICANT: WILLIAM C ROTHERT TRUSTEE PHONE: 437-0783
MARY C GALBREATH TRUSTEE
214 EAGLEVIEW LN
PORT LUDLOW WA 983659519 T 16+
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 721093019 Section: 9 Township: 27N Range: 01 E
CONTRACTOR: FERRELL GAS PHONE: 360-877-5311
646 3RD AVE
SEQUIM, WA 98382
Contractor's License FERRELP055LH Expires 9/6/2008
OWNER, WILLIAM C ROTHERT TRUSTEE PHONE: 437-0783
if different: MARY C GALBREATH TRUSTEE
214 EAGLEVIEW LN
PORT LUDLOW WA 983659519
PROJECT DESCRIPTION: NO MLA REQ'D Replacing A/G 250 Gal Propane Tank with a 500
Gal Propane tank to service a pool heater
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 10/24/2007.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: frFpLA/CEAft-N� --7;10e. "6/67,1/
FinalApproval: -9v0- _ j ,I 1p/3-70
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
1:1F_BLD_Permit_Propane.rpt 10/29/19
.
SON CO • • lRJ1CIa]IvJEJf)JEFFERSON COUNTY
kj' ' ��� ,�,.} DEPARTMENT OF COMMUNITY DEVELOPMENT
~' s `4 621 Sheridan Street• Port Townsend • Washington 98368 OCT 2 4
360/379 4450 • 360/379-4451 Fax
*q www.co.jefferson.wa.us/commdevelopment AR GO)Efl ,
s�N�` ° SUN CUUNf Y OCD
Master Permit Application MLA: (141) t6 — 6\,1
Project Description include separate sheets as necessary):
T-L t azz (1.6?A-t..t . l Elt-tvk I..2tCL.1'('%.ty N
Tax Parcel Property
Number: Z 0..,` oc4, a` ck Size: .0 k ([acres quare feet)
Site Address and/or Direction to Property: q.,\+- \/ s1/4„,_3\_,.‘4 ` Qcik\L ag
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Property Owner(s)of Recor jh.a. ,,, • a n c (rtsAl Ne
Telephone: c L, ‘A.3-1,-(Str6 Fax: Ni
Mailing Address:ilAck 4e\t‘le•-k...) Ott..- Pd L ,,`kLL1 w lk st -rj
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
hat kind of Permit?(Check each box that applies)
►c uilding ❑Variance(Minor, Major or Reasonable Economic Use)
d Demolition Permit ❑Conditional Use[C(a),C(d),or C]**
d Single Family °Discretionary"D"or Unnamed Use Classification
Q Garage Attached/Detached ❑Special Use(Essential Public Facilities)**
Q Manufactured Home °Boundary Line Adjustment
Ci Modular °Short Plat**
Q Commercial* °Binding Site Plan**
Q Change of Use °Long Plat**
;vinEl Address i Road Approach Planned Rural Residential Development(PRRD)/Amendments*"
ropane ❑Plat Vacation/Alteration*"
Allowed"Yes"Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisions**
❑Stormwater Management ❑Shoreline Management Substantial Development**
❑Site 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. Staff's access and right of entry will be assumed unless the applicant informs the County in writing at the
time of th licatipP,that he or sh nor no•ce.
Signature: `\\w\ll.`,'o x.4%. Date: k.�1 ,�\ .00L
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- f at ,responsibility for a ering t and co ng with the ESA. The Applicant has read this disclaimer a d signs and dates it below.
Signature: \�\\7\+L����
p O 1
Date: l ��/),..43 CL
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 M UFACTURED HOME INSTALLER: PHONE: FAX:
(3() (g 3-q 0 q ( )
MAILING ADDRESS: (D s 'Y` 4:\\le—, 41VIA EMAIL:
CONTRACTOR'S LICENSE L qg SS2.WAINS
NUMBER: F E�g E L f b SS \-\ 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 ❑Community System
E Alteration/Remodel 0 Concrete Total: Height: Q Individual System
❑ Repair ❑ Masonry SEP Permit#
❑ Demolition 0 Other: Bedrooms: Water Supply:
Existing: Setback: ❑ 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 Tank and/or Appliance Installation permit,mark all items below that apply:( `
o Underground Tank Above ground Tank Size of Propane Tank .)c� \Ne�b.c‘N e' r ,
❑Heat Stove 0 Cook Stove ❑Woodstove ❑Fireplace Insert 0 Hot Water Tank 0 Pellet Stove 1 O er .
pp
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No YO0 .G
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"tl Floor Heated Consistency Review: C,C-0
Other Heated Base fee: 51 .U O
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: $ 7 b .S3
.)O C r Receipt Number: W l' 1
Cash/Check Number: #6 Li b 0
ESTIMATED COST(REQUIRED) Date: 1n'�l J y�/
•Fair market value of all labor and materials foundation to finish `j�C.. "! V l�
i-.. ,-, Initials: C \(
D:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05-2.doc
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06-00611
• BUILDING PERMIT APPLI ION BL ReviewType:
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD06-00611 Received Date: 10/24/2006
SITE ADDRESS: 214 EAGLE VIEW LN
PORT LUDLOW, 98365
OWNER: WILLIAM C ROTHERT TRUSTEE PHONE: 437-0783
MARY C GALBREATH TRUSTEE
214 EAGLEVIEW LN
PORT LUDLOW WA 983659519
SUBDIVISION: Block: Lot: T 16+
PARCEL NUMBER: 721093019 Section: 9 Township: 27 N Range: 01 E
CONTRACTOR: FERRELL GAS PHONE: 360-877-5311
P 0 BOX 67
HOODSPORT WA 98548
Contractor's License FERRELP055LH Expires 8/1/2004
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION NO MLA REQ'D Replacing A/G 250 Gal Propane Tank with a 500 Gal
Propane tank to service a pool heater
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 2003
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 DJK 10/24/06 85179
Total: $51.00