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Home My WebLink AboutBLD2007-00016 • • 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 #: BLD07-00016 Received Date 1/23/2007 SITE ADDRESS: 183 AERIE LN Issue Date 1/23/2007 PORT TOWNSEND, 98368 APPLICANT: SUNSHINE PROPANE PHONE: (360) 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 T 40+ SUBDIVISION: Block: Lot: PARCEL NUMBER: 901081006 Section: 8 Township: 29N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*C77QP Expires 11/17/2008 OWNER, DAVID A B BURROWS TRSTE PHONE: (360) 379-3941 if different: J VELDA BURROWS TRSTE 183 AERIE LN PORT TOWNSEND WA 98368-8712 PROJECT DESCRIPTION: GAS PIPING AND GAS LOG SET 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 1/23/2008. REQUIRED INSPECTIONS: Tank/Line/Appliance FinalApproval:( 4'V/ 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 it ILDING PERMIT APPLICA•N BLD07N00016 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00016 Received Date: 1/23/2007 SITE ADDRESS: 183 AERIE LN PORT TOWNSEND, 98368 OWNER: DAVID A B BURROWS TRSTE PHONE: (360) 379-3941 J VELDA BURROWS TRSTE 183 AERIE LN PORT TOWNSEND WA 98368-8712 SUBDIVISION: Block: Lot: T 40+ PARCEL NUMBER: 901081006 Section: 8 Township: 29 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: SUNSHINE PROPANE PHONE: (360) 385-5797 10853 RHODY DR (360) 385-5875 PORT HADLOCK WA 98339 PROJECT DESCRIPTIOP GAS PIPING AND GAS LOG SET 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: 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 Bv: Date: Receipt: Approved/Date Propane Tanks/Stoves $51.00 INT 01/23/07 87094 Propane Tanks/Stoves $51.00 INT 01/23/07 97094 Total: $102.00 SITE VISIT REPOR JOB b mit 1 - V 1..f�4 Buie"'DATE d l ce / 7 '. ADDRESS ` f9 ,��1 ./ L tie_ BY / ! PHONE Draw a simple plot plan: include property lines and proximity to lines, tanks, wells, driveways, shrubs & trees, exhaust vents, air inta e, combustible sources, relevant windows and doors. In Clallam County, include septic. House Mobile Home Commercial ,R) �i vi n� REIC(F411 (PAII )) -601 y cD off, J, 2 3 2007 JEFtEflS11Ai+:oliNive S i 1&-e- _ eco-t • Description: �w4'SON cow JEFFERSO�OUNTYIII 4 `T 4 DEPARTMENT OF COMMUNITY DEVELOPMENT V ti 621 Sheridan Street • Port Townsend •Washington 98368 R)(',�I IF lI A 1t .,if )� 360/379-4450 • 360/379-4451 Fax �qS4/1N61‘. 0 www.co.jefferson.wa.us/commdevelopment JAN 2 3 2007 Master Permit Application M [ . , �� ' I Project Description(include separate sheets as necessary): Tax Parcel q p Property Number: ( 0 a / 0 , Size: (acres/square feet) • Site Address and/or Directions to Property: I e 3 A e 2.l e. L Pi.T Property Owner(s)of Record: DAi/ 'era 4.4" Lau re"o...I Telephone: Fax: email: Mailing Address: ,S1 7`2._ Applicant/Agent(if different from owner): _s.(/'1,rAf//V e ✓ieQP/�-A/Q Telephone: 3 eS S 79 7Fax: ,F g,5---58 '7S email: /N FO ,5-WisN/0'Ic_p/o/,AnI Q I Mailing Address: /0 eS /c fft?o y 4J2. P 7 1V 477,Co C/c Lc)/ -• 9 d' .. -3 9 c o What kind of Permit?(Check each box that applies) ❑ Building []Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit C] Conditional Use[C(a),C(d),or C]** ❑Single Family C] Discretionary"D"or Unnamed Use Classification ❑Garage Attached/Detached C] Special Use(Essential Public Facilities)** ❑ Manufactured Home ❑ Boundary Line Adjustment ❑ Modular CI Short Plat** ❑Commercial* CI Binding Site Plan** ❑ Change of Use ❑ Long Plat** ❑Address ❑ Road Approach Cl Planned Rural Residential Development(PRRD)/Amendments** ,1‹Propane CI Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis CI Shoreline Master Program Exemption/Permit Revisions'"` ❑ Stormwater Management CI Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination(SPAAD)* CI Shoreline Management Variance ❑Temporary Use ❑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: I he -. .(': : /' �� SIGNATIO 6�F gGENT .Y ./ .ct as .gent i att- : a • : is . w.)ion • (s). 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 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 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 inspectio lns.Access and right of entry to this property shall be requested and shall occur only during regular business \II hours. . 4. / �1 Signature: ✓ JC ✓t'�' Date: ` —/$ C' 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 lake"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 and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. ,7 Signature: 'j�j� &.,...„, Date: i9/ - ( (7y/� 1 -,--� c- G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc V" • OWNER 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: ,Su h .Shzi4E pR_ 3 i J € (360) 38S's777 (360 38S • .S875 MAILING ADDRESS: / 0 P S ? ,/f O 0 (v 012 EMAIL: I h Fo 5L.V1stNh e PRap(4-rte . coif\ CONTRACTOR'S LICENSE < WAINS NUMBER: S.y /\1 s If-10 , o'7 7a la NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: 1 Shoreline: Type of Sewage Disposal: ❑ New 0 Wood Existing: O Sewer O Addition ❑ Steel Proposed: I Bank ❑ Community System ❑ Alteration/Remodel 0 Concrete Total: I Height: ❑ Individual System ❑ Repair ❑ Masonry I SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: 1 0 Public Total: Name of System: 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: . ❑ Underground Tank El Above ground Tank Size of Propane Tank: ,z„:4, O Heat Stove ❑ Cook Stove ❑ Woodstove ❑ Fireplace Insert ❑ Hot er,Tank ❑ Pellet Stove y 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 submita 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: 2NU Floor Base fee: 3ro Floor _ Addi cca"Cat,t,r.: ! a F Q \ � t Mezzanine: 11 °I� "' Plan Check:fee: l Heated Basement State Surcharge fee,i `il Unheated Basement Pot Water`Review f' Other Unheated JEEFE�St l" 'I111N�V Ili • 911/Rd `fee ,', ,-.�5 ,,.'. 5., Garage/Carport `O AL'' - k5", t, Decks Receipt Number: 't` � `/1` r k Other Cash/Check Number k-� ,y° p�r a'< -f" ESTIMATED COST(REQUIRED) Date: "a ti . . , .Fair market value of all labor and materials foundation to finish ,f r Initials: ,, , G:\PernvtCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc