HomeMy WebLinkAboutBLD2007-00058 •
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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 #: BLD07-00058 Received Date 2/15/2007
SITE ADDRESS: 232 FERN WAY Issue Date 2/15/2007
CHIMACUM, 98325
APPLICANT: JEFFERSON COUNTY PHONE:
COURTHOUSE
PO BOX 1220
PORT TOWNSEND WA 983680920
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901113007 Section: 11 Township: 29N Range: 01W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2008
OWNER, JEFFERSON COUNTY PHONE:
if different: COURTHOUSE
PO BOX 1220
PORT TOWNSEND WA 983680920
PROJECT DESCRIPTION: NO MLA REQ'D INSTALLING AN A/G 120 GAL PROPANE TANK
AND GAS LINES TO RV
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 2/15/2008.
REQUIRED INSPECTIONS:
Tank/Line/Appliance:
FinalApproval:I k(9- Li N ";-,,Q3t -21-1.-z_r
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
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BLD07-00058
SILDING PERMIT APPLICATION Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD07-00058 Received Date: 2/15/2007
SITE ADDRESS: 232 FERN WAY
CHIMACUM, 98325
OWNER: JEFFERSON COUNTY PHONE:
COURTHOUSE
PO BOX 1220
PORT TOWNSEND WA 983680920
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901113007 Section: 11 Township: 29 N Range: 01 W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*0 77QP Expires 11/17/2008
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP NO MLA REQ'D INSTALLING AN NG 120 GAL PROPANE TANK AND
GAS LINES TO RV
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 By: Date: Receipt: Approved/Date
Permit $153.00 DJK 02/15/07 87221
Total: $153.00
• ROIrEi‘; ► A1P
• SITE VISIT REPORT-
(PLOT PLAN) FEB 15 2007
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CONTACT: ►'Y1t=rti- T`,dam
ADDRESS a 3.3, FEJJ U31 PHONE #:
DIRECTIONS N• S. CAo11 FAX #:
Email
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DEPARTMENT OF COMMUNITY DEVELOPMENT
•` 621 Sheridan Street • Port Townsend •Washington 98368 FEB 1 5 2007
360/379-4450 • 360/379-4451 Fax Il
4.qs pP. www.co.jefferson.wa.us/commdevelopment ���'t�,U �UUNIYU�U
Master Permit Application MLA: 0 6 MLA
\
Project Description(include se arate sheets as necessary):
P ,12 r-A-- ( ge---0 (3
Tax Parcel Property
Number: ( j ( DU Size: ?j� Q/CA—k l_ cres/1quarefeet)
Site Address and/or Directions to Property: c) 3 0- F-en(' , L.J\
Property Owner(s)of Record: e- 1-Q--✓---S ( o(----,----1--) — . J• K(0/( /- /'/L.
Telephone: ,?cis- 9/a- Cj Fax: co-4- . n'Id 7---
Mailing Address: PO 13 ox 0 76 r [D7- . -7-0L..)0se,--0, c.Jit,
Applicant/Agent(if different from owner): . S7_h S7`f/N ✓ 9/l
e go/2 )e
oo
Telephone: 3 S S 7lc' 7 Fax: ,? Q,S-Se ?S email: /A/FO ,5-1411 w//"IC_ple),qA1 .
I Mailing Address: ('0 F._ /C17 V o y 6R. /,J /V f7/-C-D C/c, (-l)4-- 9 3 F I c°eel
Vyhat kind of Permit?(Check each box that applies)
Building ❑Variance(Minor,Major or Reasonable Economic Use)
❑ Demolition Permit ❑ Conditional Use[C(a),C(d),or C]**
❑ Single Family ❑ Discretionary"D"or Unnamed Use Classification
❑ Garage Attached/Detached ❑ Special Use(Essential Public Facilities)**
❑ Manufactured H6me ❑ Boundary Line Adjustment
❑ Modular ❑ Short Plat**
❑Commercial* ❑ Binding Site Plan**
❑ Change of Use ❑ Long Plat**
❑Address ❑ Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments**
g 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)* ❑ 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:
/' • SIGNATIO ' GENT
I he -•y . ,�/ gent i att.
+ is M:f ion (s).
dll 'Air
•w - •r " :ate:
By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,isAfEle 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 inspections.Access and right of entry to this property shall be requested and shall occur only during regular business
hours.
ei Signature: Date:
l (j
The action or actions Applicant will undertake as a result o e 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-transferable r ponsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
7 ....:
Signature: Date: 271il, fi
G:\PemutCenter\FORMS\DRD FORMS\Master Permit Application 7- .doc
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OWNER BUILDER STATEMENT 1
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:
SuhShi/AiE P2373A-n1 € (360) 38S-s797 (366) 38s - S87_s
MAILING ADDRESS: !/ 4 0 S /E � O 0 y 0 i& EMAIL: 1 h Fo�5 ris- -//n e PRa pate . cO�
CONTRACTOR'S LICENSE WAINS
NUMBER: E(,f /\J S/f JO iK 0'7 7Q P NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
IA) oject Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
New ❑ Wood Existing: ❑ Sewer
Addition ❑ Steel Proposed: Bank ❑ Community System
O Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System
O Repair ❑ Masonry SEP Permit#
❑ Deriioiitiori ❑ Othei: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type of Heat: Proposed: ❑ 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 `g.Above ground Tank Size of Propane Tank: / - ) -e---
❑ Heat Stove ❑ Cook Stove 0 Woodstove ❑ Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove ''Other ,r P 2
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No V
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 ,t, 4 , � ,,
Current I Proposed - Atrioiln "
Main Floor f Consistency Review:
n`"t a X
2rru Floor sk(V-X) : base fee. •,. h r ,',1
'‘.4k$ 7
3ra Floor `` ...=A'dditional-Section: `. <t*
Mezzamino: Ma_ Check fee
Heated Basement '`vIS' `
`( t�` � ' State Surcharge fee:
�Unheated Basement O'i\\14\
Pot Water Review fee: ?; Jc�Y'
,',.- t t AVM •4 1A 4" .
Other Unheated � 911/Rd Approach fee. ,, +JJ
Garage/Carport .'"i a:
TOTAL $ e „
Decks Fta, r ,. ,W
• Receipt Number 4s � ,q { i u.''4
7
Other Cash/Chegc',N0t A ,, Y' w,a '4; *" '.
x
ESTIMATED COST(REQUIRED) Date -, nor-°,Y- - ' *;'"�`'
•Fair market value of all labor and materials foundation to finish AA k — .
Initials: �i r� , . '.,
i ti
G:\PennitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc