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Home My WebLink AboutBLD2007-00102 0 • 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 #: BLD07-00102 Received Date 3/15/2007 SITE ADDRESS: 2001 OLD GARDINER RD Issue Date 3/15/2007 SEQUIM, 98382 APPLICANT: BENEDICT M GRACZ PHONE: 360-797-7311 PATRICIA A GRACZ 2001 OLD GARDINER RD SEQUIM WA 983828750 SUBDIVISION: Block: Lot: PARCEL NUMBER: 002341034 Section: 34 Township: 30N Range: 02W CONTRACTOR: OWNER/BUILDER PHONE: OWNER, BENEDICT M GRACZ PHONE: 360-797-7311 if different: PATRICIA A GRACZ 2001 OLD GARDINER RD SEQUIM WA 983828750 PROJECT DESCRIPTION: NO MLA REQ'D REPLACING CURRENT FREESTANDING DIRECT VENT PROPANE STOVE W/ PROPANE FIREPLACE 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 3/15/2008. REQUIRED INSPECTIONS: Tank/Line/Appliance: f4(� -97 FinalApproval: ;rC.r 2—--ram-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 • BLD07-00102 IIIPUILDING PERMIT APPLICATION Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00102 Received Date: 3/15/2007 SITE ADDRESS: 2001 OLD GARDINER RD SEQUIM, 98382 OWNER: BENEDICT M GRACZ PHONE: 360-797-7311 PATRICIA A GRACZ 2001 OLD GARDINER RD SEQUIM WA 983828750 SUBDIVISION: Block: Lot: PARCEL NUMBER: 002341034 Section: 34 Township: 30 N Range: 02 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTION NO MLA REQ'D REPLACING CURRENT FREESTANDING DIRECT VENT PROPANE STOVE W/ PROPANE FIREPLACE TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2003 HEAT BASE: HEAT TYPE: OCCUPANCY: OCCUPANCY: UNHEATED: # OF STORIES: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid Bv: Date: Receipt: Approved/Date Permit $51.00 DJK 03/15/07 89619 Total: $51.00 riii6 ggON i JEFFERSOSOUNTY • i\\i I `%r 1�,�i �� `p`�-4 DEPARTMENT OF COMMUNITY DEVELOPMENTbliaz '"' : "4 621 Sheridan Street • Port Townsend • Washington 98368 MAR 15 2007 I� ' 360/379-4450 • 360/379-4451 Fax www.co.jefferson.wa.us/commdevelopment ISNC69 tJ Itfifli �1'S�p,AIn)IyI )4I11:1 Master Permit Application MLA:• Project Description(include separate sheets as necessary): /Ji/,'S-Ct t,5w /7i/j/=cr (/ Air /1'1E/1'6 //t"C CC149I t.dt/r f7 cST4 vd/tiV p/,,'oAfA'L srvvt w/T// IP,Yo;''1,1e r-4436- 4cc Tax Parcel It Property / �� t Number: 0 O cif 3 4 i U 4- Size: /kcet 476 Sp% (acres/square feet) Site Address and/or Directions to Property: tot p L O 6/kt2 0 I /J6A2 tR 0 6A-l?0 I iv L t t_v f l Property Owner(s)of Record: 13 IV l D 1 C-T 4- 7 I*T t?t C /H 6.4)A C Z Telephone:340 19'1 - 'l'v I I Fax: email:pArGR A C Z ecolimCtw Mailing Address: cQ.00I CZt_0 6A-t? DiI4C ? pp C�'t=CJ viAt W/k 9i(3 R'. - g7S0 Applicant/Agent(if different from owner): #7fi Telephone: //Fax: email: Mailing Address: yyhat kind of Permit?(Check each box that applies) wilding t Variance(Minor, Major or Reasonable Economic Use) I Demolition Permit I Conditional Use[C(a), C(d),or C]** 1 Single Family i Discretionary"D"or Unnamed Use Classification Garage Attached/Detached I Special Use(Essential Public Facilities)** i Manufactured Home 1 Boundary Line Adjustment 1 Modular 1 Short Plat** I Commercial* i Binding Site Plan** Change of Use I Long Plat** %.74A Address I Road Approach I Planned Rural Residential Development(PRRD)/Amendments** Propane i Plat Vacation/Alteration** I Allowed"Yes"Use Consistency Analysis I Shoreline Master Program Exemption/Permit Revisions** I Stormwater Management I Shoreline Management Substantial Development** (Site Plan Approval Advance Determination(SPAAD)* i Shoreline Management Variance i Temporary Use I Comprehensive Plan/UDC/Land Use District Map Amendment 1 Wireless Telecommunication* i Jefferson County Shoreline Master Program Amendment I 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: 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. Staffs ac ess and right of entry will be assumed unless the applicant informs the County in writing at the time of the appli ion that he she ant prior n Signature: Date: 3///C 7 The action or actions Applicant will undertake as a result 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 th Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-trap rable res n '•'•'ty for adh to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signatur y�� Date: 5//3/C 7 G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 07-14-2006.doc • 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 bed ing the rersponn.�s// 1ibilityy,of the ta neral Contractor for the proposed project. Signature: , !�� ilr+X V Il , Date: 3/�.3 /C '`7 GENERAL CONTRACTOR OR MANUFACTURED HOME I TALLER: (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: *F.4, New Li Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank 0 Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well I 1 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: 1 Underground Tank Above ground Tank 21 Size of Propane Tank: I ' . o Cil c ~Heat Stove 1 Cook Stove 1 Woodstove I pI - 1 Hot Water T nk 1 Pellet Stove 1 Other Is_this appliance being installed in a Manufactured/ obile Home? Yes / lo` 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 Base fee: r3—1 Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $ 5-1 Receipt Number: Z 9 tO `1 Cash/Check Number: xs l9 ESTIMATED COST(REQUIRED) Date: IS to •Fair market value of all labor and materials foundation to finish r t/ Initials: 1— \C G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 07-14-2006.doc Z1 1" -‘ . 0 III b c- � rn --0 ryz o > v N...,. rn a, A�m v, G. T - h• c% b rri --ft , rn o 7t o _I 0 :71 -. ( (� rn _ 1 t- o > t-4 \_._ 03 O in t7 CID DTI z d Li a O17 L t r o III , x '° D Z_r:1114n LC N if; A • � co - 4 n y yV, RkRi 3 � a b0 � ('`. 0 •rn .-y oco C Xi PC? - 0 Gv -n -o 0 v � � G1� r Poi V> z cl,� 0 • . C _._._ a s .. v G