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HomeMy WebLinkAboutBLD2006-00629I • • 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 #: BLD06-00629 Received Date 11/3/2006 SITE ADDRESS: 1283 THORNDYKE RD Issue Date 11/3/2006 PORT LUDLOW, 98365 APPLICANT: ROBERT E CROOKER PHONE: 437-9876 MICHAELYN A CROOKER 1305 THORNDYKE RD PORT LUDLOW WA 983659530 41+ SUBDIVISION: TRAILS END HOMESITES Block: 03 Lot: PARCEL NUMBER: 950100339 Section: 16 Township: 27N Range: 01 E CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2008 OWNER, ROBERT E CROOKER PHONE: 437-9876 if different: MICHAELYN A CROOKER 1305 THORNDYKE RD PORT LUDLOW WA 983659530 PROJECT DESCRIPTION: NO MLA REQ'D A/G 120 GAL PROPANE TANK ALSO ADDING A HEAT STOVE TO SHOP 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 11/3/2007. REQUIRED INSPECTIONS: Tank/Line/Appliance:�G� c.�N k 1/y�11[ t Sro v0" 94--t 1-4 -mb FinalApproval: ll-41 -79 Cp 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 10/29/19 �UILDING PERMIT APPLICA�ON B RDO-00629 Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00629 Received Date: 11/3/2006 SITE ADDRESS: 1283 THORNDYKE RD PORT LUDLOW, 98365 OWNER: ROBERT E CROOKER PHONE: 437-9876 MICHAELYN A CROOKER 1305 THORNDYKE RD PORT LUDLOW WA 983659530 TRAILS END HOMESITES SUBDIVISION: Block: 03 Lot: 41+ PARCEL NUMBER: 950100339 Section: 16 Township: 27 N Range: 01 E CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**979DZ Expires 9/7/2008 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION NO MLA REQ'D A/G 120 GAL PROPANE TANK ALSO ADDING A HEAT STOVE TO SHOP 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 Permit $51.00 DJK 11/03/06 85199 Total: $51.00 �/- /z4/s K r a m • RE '2FJ) NOV o320 116, C.'"... CX _____ofggliamiv4p____,)i 1 /Y' __' � 7$ __ Q v 44 1 ilR r vLr iiy k 91, 8(64,4. PPP tl'vie MI -4 w fi N 'fy - ;2g` pp,c e fL i o fl e 0 tjcd(4, Ale $ Sf,,(ap Rio' . Ne ri �o• i _ ON E, • • Ij Li' I , i1 \' . C o iJEFFERSON COUNTY\ DEPARTMENT OFCOMMUNITY DEVELOPMENTNOV 0 c�- ' 621SheridanStreetPortTownsendashington 98368 y 2006 www.c9-4450 • .wa.0 /com Fax �� 111W/� ������IiING�p www.co.jefferson.wa.us/commdevelopment Permit Application MLA: Vkes No^ 6 �.q Project Description(include separate sheets as necessary): P46PAti'E 57-e ✓e jDR PGZi 6ii,t 0/4v6 5//4,P IPI6boc GI(tOuv o )aX \ t Tax Parcel C Property Number: / 5 Q/fir' 3 j I Size: / ),-D X / 2 o ' (acres/square feet) Site Address and/or Directions to Property: /X, 8 3 Ts/'/D R fv n y ki RD. Property Owner(s)of Record: Reg,iz.r L L . C l2 6-6 K E A_ A 0.9 0 414 1 U/A,' yA) C`ZovIrix Telephone: 3 6 D - 7-987e Fax: email: _-,Mailing Address: / 30 c- T/1ARIvoykx 2n Po2T Lt,FL.o `vA, 92.34,s Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: hat kind of Permit?(Check each box that applies) u_ilding ❑Variance(Minor, Major or Reasonable Economic Use) Demolition Permit ❑Conditional Use[C(a), C(d),or C]** d Single Family DDiscretionary"D"or Unnamed Use Classification 13 Garage Attached/Detached ❑Special Use(Essential Public Facilities)** ❑Manufactured Home °Boundary Line Adjustment d Modular °Short Plat** Q Commercial* °Binding Site Plan** Q Change of Use °Long Plat** Q Address i Road Approach °Planned Rural Residential Development(PRRD)/Amendments** Propane ❑Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisions** ❑Stormwater Management ❑Shoreline Management Substantial Development** OSite Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Variance ❑Temporary Use ❑Comprehensive Plan/UDC/Land Use District Map Amendment DWireless Telecommunication* °Jefferson County Shoreline Master Program Amendment OForest 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 n to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE /` e--J--e,i G L .-L—L. Date: 1/ - 3 -e 6 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 applicatio that h or she wants prio notice. Signature: a�,. Date: i/ — D (, 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-transferab resp nsibility for adherin nd to a co plying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: ). � Date: // - T —O G 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 MANUFACTURED HOME INSTALLER: PHONE: FAX: C H (.; ( ) ( ) 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 a Wood Existing: ❑Sewer ❑ Addition 0 Steel Proposed: Bank 0 Community System ❑ Alteration/Remodel 0 Concrete Total: Height: ci Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: 0 Private well 0 Two Party Type of Heat: Proposed: ❑Public p kb P4.t%E 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: Cl Underground Tank Above ground Tank Size of Propane Tank: /2 t 76Ieat Stove ❑Cook Stove 0 Woodstove ❑Fireplace Insert 0 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: 2nd Floor Heated Consistency Review: a 5, SO Other Heated Base fee: S f • © 0 Mezzanine Additional Section: l Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL / 5 O Decks 911/Rd Approach fee: l� Other TOTAL: $ -7 ( ,5 0 Receipt Number: SSt -lcj Cash/Check Number: CAA\ ESTIMATED COST(REQUIRED) Date: 1\"3'O 1, .Fair market value of all labor and materials foundation to finish \ 1 Initials: (, St(--- D:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05-2.doc