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Home My WebLink AboutBLD2007-00078 • • 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 #: BLD07-00078 Received Date 2/28/2007 SITE ADDRESS: 50 W COLUMBIA ST Issue Date 2/28/2007 QUILCENE, 98376 APPLICANT: BRUCE S MUNN PHONE: 360-301-4026 PO BOX 54 QUILCENE WA 983760054 SUBDIVISION: HAMILTON'S 5AC TRACTS Block: Lot: PARCEL NUMBER: 956100039 Section: 13 Township: 27N Range: 02W CONTRACTOR: OWNER/BUILDER PHONE: OWNER, BRUCE S MUNN PHONE: 360-301-4026 if different: PO BOX 54 QUILCENE WA 983760054 PROJECT DESCRIPTION: NO MLA REQ'D INSTALLING WOOD STOVE 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 2/28/2008. REQUIRED INSPECTIONS: Tank/Line/Appliance: gLA ,ep, iie We* itleteE-ar AR_ hS7, IL, A/� FinalApproval: ,g . � (13 bird 3//7 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 WILDING PERMIT APPLICAN B RDOe 00078 Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00078 Received Date: 2/28/2007 SITE ADDRESS: 50 W COLUMBIA ST QUILCENE, 98376 OWNER: BRUCE S MUNN PHONE: 360-301-4026 PO BOX 54 QUILCENE WA 983760054 HAMILTON'S 5AC TRACTS SUBDIVISION: Block: Lot: PARCEL NUMBER: 956100039 Section: 13 Township: 27 N Range: 02 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTION NO MLA REQ'D INSTALLING WOOD STOVE 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 $102.00 DJK 02/28/07 87235 Total: $102.00 6c,DO ? --ry / ON COS. JEFFERScOUNTY ) 1 ,rEiv -, AL a DEPARTMENT OF COMMUNITY DEVELOPMENT Et) in T *4 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax F E U 2 8 2i�7 qs .0 www.co.jefferson.wa.us/commdevelopment $ING ,J tItU wJN Y 1 O Master Permit Application MLA: O. 1(1 \1Q Project Description(include se sheets as�necessary • Tax Parcel- SOT\� Property Number: 956100039 Size: 0.3 acres (acres/square feet) Site Address and/or Directions to Property: 50 W. Columbia St. Quilcene WA 98376 Property Owner(s)of Record: Joesph R. FunkkBruce S. Munn • ,.o vt4-- C,r•?er>) Telephone: 360-301-4026 Fax: 360-765-3122 email: bmunn@olypen.com Mailing Address: POB 54 Quilcene WA 98376 Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: AW t kind of Permit?(Check each box that applies) wilding ❑Variance(Minor, Major or Reasonable Economic Use) 'm emolition Permit ❑Conditional Use[C(a), C(d), or C]** ��iingle Family 1t it 4UY) G`` ►5 � — ❑ Discretionary"D"or Unnamed Use Classification eeee'"'❑____Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** ❑ Manufactured Home ❑ Boundary Line Adjustment ❑ Modular ❑ Short Plat** ❑ Commercial* ❑ 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)* ❑ 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 0 Tree Vegetaion Request *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 t e County)n writing at the time of the application that �r she wants .er otice. /' Signature: l��-� i , 2 :---Z� Date: v v c-t.) L�' 7 The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon on or more t reatened 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 ,she or i holds individual and non-transferabl onsibility fo d ering to aril complying with the ESA. The Applicant has read this disclaim / disclaimer and sign ,�d dues it below. Signature: Date: L ! { 0 C:AI)ncumcnts and Settings\carat\1.ocal Settings\Temporary Internet Files\O1.Kfi(\N1aster Permit;Application 12-19-211116.di,e • w BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,tha they are not . s con ractors and that they will be assuming the responsibility of the General Contractor for the proposed project. --�� )) \ A i Q Y( i Signature: Date: O Z lib O J�a �./ L1�� GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: FEB 8 2 2007 ( ) ( ) MAILING ADDRESS: EMAIL: J!IL U stip ni yucy CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL P ject Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ew - Wood Existing: Sewer - Addition - Steel Proposed: Bank Community System - Alteration/Remodel - Concrete Total: Height: - Individual System Repair - Masonry SEP Permit# - Demolition - Other: Bedrooms: Water Supply: Existing: Setback: - Private well r Two Party Type,o HeatProposed: - Public V-' 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: ❑Underground Tank ❑Above ound Tank Size of Propane Tank: 0 Heat Stove El Cook Stove oodstove 0 Fireplace Insert ❑Hot Water Ta k 0 Pellet Stove ❑Other Is this appliance being ins ailed 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: Other Heated `IAl — Base fee: Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL I O Decks 911/Rd Approach fee: Other TOTAL: $ \0 Receipt Number: Q--) -� Cash/Check Number: N W ESTIMATED COST(REQUIRED) Date: �� 4 .Fair market value of all labor and materials foundation to finish O Initials: c C:ADocunxnts and Settings\caral\Local Settings\Temporary Internet Files\(NJ:fi6\iAlaster Permit Application 12-19-2(I(I6.doc • • RIPPSWE0 FEB 282N7 atoms ri, Wcti 1) %eJi v st`i,t'-co(ictelli:t1 . c s6100037 C�J .2_ \ / \ , ,JLI V J1 ' S , , .zt, 0 • , , . , ., ,,,„_, ex.i5i,o, ____, ; F.,__,, ci,,,„.vi ,,, �, . ch, n 3 ,,,„4,„,t 1,,,,* \\ ,,,. ., ---.L----cac,‘vi i vL)liAl vle/uj oPy WK