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Home My WebLink AboutBLD2006-00659 • • 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 #: BLD06-00659 Received Date 11/20/2006 SITE ADDRESS: 184 COUGAR RIDGE RD Issue Date 11/20/2006 PORT TOWNSEND, 98368 APPLICANT: KARL T BOETTCHER PHONE: 385-3959 MARILYN J BOETTCHER PO BOX 95 PORT TOWNSEND WA 983680095 6 SUBDIVISION: PIONEER ACRES Block: Lot: PARCEL NUMBER: 001175006 Section: 17 Township: 30N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*0770P Expires 11/17/2008 OWNER, KARL T BOETTCHER PHONE: 385-3959 if different: MARILYN J BOETTCHER PO BOX 95 PORT TOWNSEND WA 983680095 PROJECT DESCRIPTION: NO MLA REQ'D Swapping out 120 Gallon A/G Propane Tank Same Size,Same Location 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 11/20/2007. REQUIRED INSPECTIONS: Tank/Line/Appliance: 2 al FinalApproval: 7 Sjc- -16 a.I l V2-2-AZ 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 41bILDING PERMIT APPLICA1I Review T Ty659 N BL vype: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00659 Received Date: 11/20/2006 SITE ADDRESS: 184 COUGAR RIDGE RD PORT TOWNSEND, 98368 OWNER: KARL T BOETTCHER PHONE: 385-3959 MARILYN J BOETTCHER PO BOX 95 PORT TOWNSEND WA 983680095 PIONEER ACRES SUBDIVISION: Block: Lot: 6 PARCEL NUMBER: 001175006 Section: 17 Township: 30 N Range: 01 W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2008 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr NO MLA REQ'D Swapping out 120 Gallon AIG Propane Tank Same Size,Same Location 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: 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 11/20/06 86816 Total: $51.00 • I SITE VISIT REPORT (PLOT PLAN) JOB ,AV,..L ZOE- TTC.Nt2 DATE : I/io/Dc , CONTACT: . ADDRESS PHONE #: • DIRECTIONS FAX #: . Email . PLANNER: . op S - _ 5°' >p RECE1IVE1 NOV 2 0 2046 JtfftHSUN?UUNI Y UCII rial 0 ICY rpAI I \oD St.-) A-10 01n.:4-. ISL,OO - ( 59 d.k Co6. JEFFERSOIIIOUNTY i V ��j� DEPARTMENT OF COMMUNITY DEVELOPII�EF '1 \y AD I.04 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax , , �"o www.co.jefferson.wa.us/commdevelopment Iv Y 4 '� i+itia 87N Et U J ��n Master Permit Application lifilli11IN iAI�i �J m(� Yn LA ,a_E Q` 0 Project Description(include separate sheets as necessary): 1 -'-)K- (5£ J , o % - ,34 -e 5/2.2 __571 l L' L- 04- //a-- Tax Parcel 00 ` n Property Number: 06(Q Size: 5 3 cun, (acres/square feet) Site Address and/or Directions to Property: 1 0� (_C �4- -- (2 i C) G. E l p I_ u;�G L Property Owners�j of Record: Kr) 2 L_ �j CC E 1 7- C H <'L__ Telephone: 3 6 S 3 c(S 7 Fax, f email: Mailing Address: l O "( COCAEr A. �- I r G t I L 0 . Applicant/Agent(if different from owner): _ rG+/?J"/(/A/e !9i 'QP4-A)t Telephone: , e 75 7 Fax: ,F g,5---58 7f email: /A/FO ? ._52- .57- 3s S 07�l,)//vve . Mailing Address: / 0 �c_2 /2 DrJ y OR p�iv W cz /c LJ 4, 9 ci, - -,3y c ov What kind of Permit?(Check each box that applies) ❑ Building 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use[C(a),C(d),or C]** 0 Single Family 0 Discretionary"D"or Unnamed Use Classification ❑Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** ❑Manufactured Home ❑ Boundary Line Adjustment ❑ Modular 0 Short Plat** ❑Commercial* 0 Binding Site Plan** ❑Change of Use ❑ Long Plat** ❑Address ❑ 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** ❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Variance ❑Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless 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: y ' ' • SIGNATIO ef-�GENT I he : .ct is dell- ion a •er '(s). 'IA/ T /f � :ate: By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is_tride 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 attomey'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 pro ' access andmrJg f entry to Je erson County and its employees,representatives or agents for the sole purpose of application review and any r ired later) o .Access a g of entry to this property shall be requested and shall occur only uring regular business \II hours. � el Signature: 7-- Date: (O 1'U� • O� QJ \. 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 ''1 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 yell 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 ar6 in compliance ' the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual ,. and non-transferable nsiblli hering nd complying with the ESA. The Applicant has read this disclaimer an signs and dates it below. Signature: //„j/f' , eji3-7-- 1M' Date: ! �O � y(�:\ ermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc • OWNER BUILDER STATEMENT • t 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: Sun . -61./AiE p2 3PA1J e___ (3&0) ? 8S-s 797 (366) .383- S87_5 MAILING ADDRESS: / 0 P,S ? /17L o d ( 'J t EMAIL: In Po @ J[.{11s7f/h e 13Rap1 -rte . c-0i11 CONTRACTOR'S LICENSE `'I A $ / ) "7 7Q f3 NUMBERWAINS "1 O NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: o New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System 0 Repair 0 Masonry SEP Permit# O Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: ❑ Public Total: Name of System: If this is a Commercial Protect 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: S ❑ Underground Tank *Above ground Tank Size of Propane Tank: /L 6 6-4- O Heat Stove ❑ Cook Stove ❑ Woodstove ❑ Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove ❑ 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 For Office Use Only Current Proposed Amount Main Floor Consistency Review: , 2""Floor Base fee: t r %,' `, # ,ry - ,1 7 ; A , - .f , Floor Additional Section: . , Mezzanine: Plan Check fee: — , Heated Basement State Surcharge fee: Unheated Basement Pot Water Revi ee: Other Unheated 911/Rd Approach fee: Garage/Carport TOTAL: $ Decks Receipt Number: • .., Other )FI/Lheck Numberh 4 ' +i 11t ESTIMATED COST(REQUIRED) Date: K """`�` .Fair market value of all labor and materials foundation to finish ~: l Initials: '' fr�. G:\PennitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc