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Home My WebLink AboutBLD2007-00119 11110 I 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 #: BLD07-00119 Received Date 3/22/2007 SITE ADDRESS: 120E FAIRWAY LN Issue Date 3/22/2007 PORT LUDLOW, 98365 APPLICANT: KENNETH A CLOSE PHONE: (360)437-7783 LORETTA J CLOSE PO BOX 65455 PORT LUDLOW WA 98365-0455 UN 5E SUBDIVISION: FAIRWAY VILLAGE Block: Lot: PARCEL NUMBER: 951500502 Section: 21 Township: 28N Range: 01 E CONTRACTOR: ALL ABOUT GAS INC PHONE: 360-681-5474 970 RIVER RD SEQUIM WA 98382 Contractor's License ALLABAG9510T Expires 9/30/2007 OWNER, KENNETH A CLOSE PHONE: (360)437-7783 if different: LORETTA J CLOSE PO BOX 65455 PORT LUDLOW WA 98365-0455 PROJECT DESCRIPTION: ADDING PROPANE COOKSTOVE AND EXTENDING EXISTING PROPANE LINE TO COOKSTOVE EXISTING 100 GAL A/G PROPANE TANK 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 3/22/2008. REQUIRED INSPECTIONS: Tank/Line/Appliance: 41725 k JQ I/NEr fW 4/0-15/o7," -colt 5T6NE dK ' /r7/07 FinalApproval: e5A tar -Pi ha J 4/7/a7, 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 IUILDING PERMIT APPLICAN BLD07-00119 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00119 Received Date: 3/22/2007 SITE ADDRESS: 120B FAIRWAY LN PORT LUDLOW, 98365 OWNER: KENNETH A CLOSE PHONE: (360)437-7783 LORETTA J CLOSE PO BOX 65455 PORT LUDLOW WA 98365-0455 FAIRWAY VILLAGE SUBDIVISION: Block: Lot: UN 5E PARCEL NUMBER: 951500502 Section: 21 Township: 28 N Range: 01 E CONTRACTOR: ALL ABOUT GAS INC PHONE: 360-681-5474 970 RIVER RD SEQUIM WA 98382 Contractor's License ALLABAG9510T Expires 9/30/2007 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION ADDING PROPANE COOKSTOVE AND EXTENDING EXISTING PROPANE LINE TO COOKSTOVE EXISTING 100 GAL A/G PROPANE TANK TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2003 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: OCCUPANCY: 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 $102.00 KAS 03/22/07 89481 Total: $102.00 0. cb� JEFFERSO OUNTY BUiWE1{) ti DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend •Washington 98368 + `� 7 " ' -v 360/379-4450 • 360/379-4451 Fax �iril\ E� rs r�� p� www.co.jefferson.wa.us/commdevelopment S11NC VUCU Master Permit Application RAJFFFiiUI\ llllN1 Project • / Descript) n(include separate sheets as necessary): H j rJ d t fiopa.wZ tided s/':�► &K.d C'a Fein l"I n f e�X/S (Ay Pari;el Property Number: 1 s l 5 00 3-0 . Size: /6 /0 (acres/square feet) Site Address and/or Directions to Property: / f� / •� r=a ;r�.tJ y oS a e /o l pi'u d t J l te)/9- gY36-S'- Property Owner(s)of Record: /lee rt yr r ) ii 1q. 1DS Telephone: 360 V3 7- 7 7,-3 Fax: email: XC iose 'O/)79? •CO1 "l Mailing Address: f'D ie GS%S,S /9)v‘tj v/4. (J kw j t J4- 9.7 Sr Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies ❑Building 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use[C(a), C(d), or C]** ❑Single Family 0 Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home ❑ Modular 0 Special Use(Essential Public Facilities)** ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use ❑Short Plat** ❑ Address 0 Road Approach 0 Binding Site Plan** ❑ Hpme Business 0 Cottagelndustry ❑ Long Plat** ®'Propane Add r,47•4),4 af kf-%r j ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑ Sign ❑ 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 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* 0 Jefferson County Shoreline Master Program Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium ❑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. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applicat' s otice. Signature: L%1. Date: 3/fiG i 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-transfe a 'respg r ad epng to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: ,t wo. i (�,, •�-_ Date: .j�Q, 7 C:\Documents and Settings\caral\Local Settings\Temporary 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 herein,that they are not licensed contractors and that they will be assumi the es onsibility of the General Contractor for the proposed project. VD Signature: d 6. Date: / 7 GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: "Iavvy A/ct el l. :l,zI. .4J,&A-1 ve: }) (JLG) e ( - .S y /9 ( ) MAILING ADDRESS: ? e� '7D/ ,4 v-X c' 5e a;„yI er r3 y-? EMAIL: CONTRACTOR'S LICENSE / G G WAINS NUMBER: A L I. 6646- Y 5-1 CtT NUMBER ARCHITECT/ENGINEER: 144. PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: _ Shoreline: Type of Sewage Disposal: New .1-Wood Existing: Z;S i-+-8twer ! I addition r i Steel Proposed: 2: s Bank i i Community System t"-Alteration/Remodel L, Concrete Total: z . <— Heh�i Individual System i Repair i Masonry /V!" SEP Permit# Demolition r Other: Bedrooms: Water Supply: Existing: Z Setback: ❑ Private well Cl Two Party Type of eat: Proposed: Ll-Public f/rc�r1 Total: Z i `4- Name of System:�il,u,�t 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: ;F* 4d d,-7.� A etf e cs K'i%C J ❑Undergrounw.+:. a.ove ground Tank Size of Propane Tank: r00-t I 7 '{;,.t/n h z/,'n . •---� ❑Heat Stov- 13 Cook Stove'❑ Woodstove 0 Fireplace Insert 0 Hot Water Tank ❑Pellet Stove 0 Other Is this appliance being installed in a Manufactured/Mobile Home? Ye 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: 2"0 Floor Heated Consistency Review: ,r Other Heated Nt Base fee:,WU W n./� t� �4 t- L Mezzanine e Ylt' Additional Section: Heated Basement I Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: - Garage/Carport SUBTOTAL 0 . 00 Decks lK I ,',k 1'4 vl Fi 4 t ) 911/Rd Approach fee: Other TOTAL: $ I Da.W Receipt Number: 0' l 6 I ESTIMATED COST(REQUIR=ft D)'LHtU IJ"U drill Date:Cash/Check Number: 56(3.14 'Fair market value of all labor and materials foundation to finish LC) Initials: '"ll C:\Documents and Settings\caral\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.doc . •R 11.4„, flA li A I 'Ali ,IffftliSt$11111/4/V 111'1 ... 4...-..... -Th .1....ti. ,, ,f• \4---- 1") -. c r- j c...4...„...„ c.,,,...r., _,.,,... t.,......„ •••r--- t.- <-47 .......__,---• —5:. 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