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Home My WebLink AboutBLD2007-00081 • • 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 #: BLD07-00081 Received Date 3/5/2007 SITE ADDRESS: 33 SAYWARD LN Issue Date 3/5/2007 PORT LUDLOW, 98365 APPLICANT: VERNON PERRYMAN PHONE: 360-437-0425 PATRICIA L PERRYMAN 33 SAYWARD LN PORT LUDLOW WA 983659640 15 SUBDIVISION: PORT LUDLOW NO 1 AREA 3 Block: Lot: PARCEL NUMBER: 990400315 Section: 8 Township: 28N Range: 01 E CONTRACTOR: OWNER/BUILDER PHONE: OWNER, VERNON PERRYMAN PHONE: 360-437-0425 if different: PATRICIA L PERRYMAN 33 SAYWARD LN PORT LUDLOW WA 983659640 PROJECT DESCRIPTION: A/G 120 GAL PROP TANK, LINES & GENERATOR - NO MLA REQ'D 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 3/5/2008. REQUIRED INSPECTIONS: Tank/Line/Appliance: p'A jE II.aK 1--de- 4. I IV SrA 1-tA•i'i ok 3/13/b7, Ei -r PR.oaA,v6- LINE 9k 3/3J4 4 FinalApproval: SEA ea/JD rrkW) O —cor -ci h j W11/07174 BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 FOURS 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 tUILDING PERMIT APPLICAT N BLD07-00081Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00081 Received Date: 3/5/2007 SITE ADDRESS: 33 SAYWARD LN PORT LUDLOW, 98365 OWNER: VERNON PERRYMAN PHONE: 360-437-0425 PATRICIA L PERRYMAN 33 SAYWARD LN PORT LUDLOW WA 983659640 PORT LUDLOW NO 1 AREA 3 SUBDIVISION: Block: Lot: 15 PARCEL NUMBER: 990400315 Section: 8 Township: 28 N Range: 01 E CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: DOUBLE D ELECTRICAL PHONE: 360-385-1130 PO BOX 957 PORT HADLOCK WA 98339 PROJECT DESCRIPTION A/G 120 GAL PROP TANK, LINES & GENERATOR - NO MLA REQ'D 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 Propane Tanks/Stoves $153.00 LYK 03/05/07 89517 Total: $153.00 fi# 5pN C • t ?,14 \ �tA`i �,� ar, JEFFERSON COUNTY W ' \, y DEPARTMENT OF COMMUNITY DEVELOPMENT '� `� 621 Sheridan Street • Port Townsend •Washington L 98368 360/379-4450 • 360/379-4451 Fax p www.co.jefferson.wa.us/commdevelopment �� 1� 11' all�l�V lit Master Permit Application Project DescripPtion(include separate sheets as necessary): I a 0 G �1 '' n,4 9 Rn;pa nit. 44 Ilk 6 416 - iv€ -F k- Ner,) �enp t 2r Tax Parceq l 9Q.�3/Jl-- Property Number: / 7 Size: (acres/square feet) Site Address and/or irections to Property: C' UY. Ca - i Po ts+ LAX ell O(.c) --c. O G 0 E Q. cr , Propert�i Owner(s)of Record: V4-1'Y�o l�l aY1-ck. Pei_ R1 Clad pQr(' yria rt- Telephone: 31'D.- 437` a Fax: email: Mailing Address: 33 3ou_ o(I A ice- 1 POR- &u/D(.t), t & 9836S Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) ❑Building ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit 0 Conditional Use[C(a), C(d), or C]** ❑ Single Family ❑ Discretionary"D"or Unnamed Use Classification ❑ Garage Attached/Detached 0 Special Use(Essential Public Facilities)** ❑ Manufactured Home ❑ Boundary Line Adjustment ❑ Modular 0 Short Plat** ❑ Commercial* ❑ Binding Site Plan** ❑ Change of Use ❑ Long Plat** ❑ Address ❑ Road Approach 0 Planned Rural Residential Development(PRRD)/Amendments** Propane ❑ Plat Vacation/Alteration** ❑Allowed"Yes'Use Consistency Analysis 0 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: DE IGNATION OF AGENT I hereby designate �OJJC kV i .E(CC 1-R- cal • to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE W,�<:n- .-it Date: 3- 7—D 7-- 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. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the app,95a)ion that he or,he wants prior notice. Signature: .1-•1--"•- ,: / vim- Date: >-Z--CY 7- 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-transfer le responst • for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. signature: — `� Date: 3 2 —O C:\l)ocurnents and Settings\carat\Local Settings\'l'emporary Internet Files\OLK86\Master Permit Application 12-19-2006.doc • • BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel referenced erein,that they are not licensed contractors and that they will be assumi he r s nsi ility of the General Contr ct r for th, roposed project. Signature: Dat S/� GENERAL CONTRACTOR OR MANUFAC RED HOME INSTALLER: PHONE: FAX: ( ) ( ) 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 LI Wood Existing: Sewer Addition Steel Proposed: Bank Community System Alteration/Remodel l Concrete Total: Height: Individual System Repair Masonry SEP Permit#Bedrooms: Water Supply: Demolition Other: pp Y: 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 S.Above ground Tank Size of Propane Tank: /vZO 9 a.,I 1,(4)R19 ❑Heat Stove ECook Stove ❑Woodstove ❑Fireplace Insert ❑Hot Water Tank El Pellet Stove ❑Other�q e n e'.( TC� Is this appliance being installed in a Manufactured/Mobile Home? Yes /0° cJ 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: 2na Floor Heated Consistency Review: Other Heated Base fee: II5�Cif Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL 153 Decks 911/Rd Approach fee: Other TOTAL: $ I'3& Receipt Number: Oq5k Cash/Check Number: ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish Initials: C:\llocuments and Settings\carat\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.doc • • I 6)Ck F/C G SO O 0 Septic Tanks Heat Oump e Proposed a( Generator Location 9F} is O Proposed Je �� Propane Tank Location e . e, I ( Lot 15) 33 Sayward Lane