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HomeMy WebLinkAboutBLD2007-00180 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 #: BLD07-00180 Received Date 4/27/2007 SITE ADDRESS: 210 CAMERON DR Issue Date 4/27/2007 PORT LUDLOW, 98365 APPLICANT: GLENN J WALDENBERG PHONE: (360)437-9733 PHYLLIS R WALDENBERG 210 CAMERON DR PORT LUDLOW WA 98365-9713 6 SUBDIVISION: SOUTH BAY#2 Block: Lot: PARCEL NUMBER: 995600006 Section: 21 Township: 28N Range: 01E CONTRACTOR: ALL ABOUT GAS INC PHONE: 360-681-5474 970 RIVER RD SEQUIM WA 98382 Contractor's License ALLABAG9510T Expires 9/30/2007 OWNER, GLENN J WALDENBERG PHONE: (360)437-9733 if different: PHYLLIS R WALDENBERG 210 CAMERON DR PORT LUDLOW WA 98365-9713 PROJECT DESCRIPTION: INSTALL GAS LINES AND NEW COOKSTOVE TO A/G 25 GAL PORTABLE 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 4/27/2008. REQUIRED INSPECTIONS: Tank/Line/Appliance: A.7717Pio4 1i4)£1 0.X 4/3D/7J✓ /41diew 0/ De FinalApproval: 4. //or", 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 tILDINGBLD07-00180 PERMIT APPLICAT�N Review Type: l Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00180 Received Date: 4/27/2007 SITE ADDRESS: 210 CAMERON DR PORT LUDLOW, 98365 OWNER: GLENN J WALDENBERG PHONE: (360) 437-9733 PHYLLIS R WALDENBERG 210 CAMERON DR PORT LUDLOW WA 98365-9713 SOUTH BAY#2 SUBDIVISION: Block: Lot: 6 PARCEL NUMBER: 995600006 Section: 21 Township: 28 N Range: 01 E CONTRACTOR: ALL ABOUT GAS INC PHO 970 RIVER RD NE: 360 681 5474 SEQUIM WA 98382 Contractor's License ALLABAG9510T Expires 9/30/2007 REPRESENTATIVE: ALL ABOUT GAS INC PHONE: (360)681-5474 JERRY KOONZ 970 RIVER RD PROJECT DESCRIPTIOP INSTALL GAS LINES AND NEW COOKSTOVE TO A/G 25 GAL PORTABLE PROPANE TANK 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: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: 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 KAS 04/27/07 89867 Total: $153.00 44*- s / O :I �q ,1 DEPARTJEFFERSMENTNOFCOMMU DEVENT� 621 Sheridan Street UN• Port Townsend NITY •WashingELOPM ton 98368 360/379-4450 • 360/379-4451 Fax q p www.co.jefferson.wa.us/commdevelopment S`�NOZ Master Permit Application MLA: Project Description(include separa},e sheets as necessary): & K e_ _1_: RA-k e. 6--A , p i a k'y Tax Parcel q� -/� / Property l� Number: / �0 V� V Size: (acres/square feet) Site Address and/or Directions to Property: Q1qy.7,C•,- B;q-c j To AL,y 1, 1 it e. ZIP Q �� - T� ~6e, pg_ -- Property Owner(s)of Record: �3'-/ei- Gtis,���P.r, -.�, Telephone: y?j 7' l 7 3 Fax: email: _ Mailing Address: 'Z/© C -//&../c9- \ 2 if T 4.Dc'tow i:,- 4- Applicant/Agent(if different from owner): A// 4 �t G-, �hc_ Telephone: 6Y / " 51174/ Fax: email: Mailing Address: 4770 Ne..4- &�v;IA. 4_2 7+ What kind of Permit? (Check each box that applies ❑Building 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit 0 Conditional Use[C(a), C(d),or C]** ❑ Single Family ❑ Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home ❑ Modular ❑ Special Use(Essential Public Facilities)** ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use 0 Short Plat** ❑ Address ❑ Road Approach 0 Binding Site Plan** ❑ Home Business ❑ Cottagelndustry ❑ Long Plat** Propane ❑ Planned Rural Residential Development(PRRD)/Amendments** Sign 0 Plat Vacation/Alteration** ❑Allowed"Yes" Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management 0 Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination (SPAAD)* 0 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 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: €SIGNATION OF AGENT I hereby designate �A I�M,- to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: 716'7 By signing this application form,the owner/ag ttests 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 falseh od 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 application tht'h or she wa9t5 i'ior notice. Signature: - 7(/(, .. � . Date: ilk*? The action or actions Applicant will and e 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 incompliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferable s nsibi'ty or dhering to and complying with the ESA. The Applicant has read this disclaer and signs and dates it below. Signature: c Date: KlG7/87 G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc 0 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 assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: 4// 4& � Z,1r ( ) 61Y 3 ( ) MAILING ADDRESS: -(�j7e:> A ILGR..ieC't Jc�^— ,c�. ,,, EMAIL: CONTRACTOR'S LICENSE / WAINS NutpiE)R AZz, i4846 ?5 f/T NUMBER fkrct: i G /IQrva2;t: 67e--42-1 'KCc>y!-? , PHONE ( ) FAX: ( ) MAILING ADDRESS: 43 v EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ 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 ❑ 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: I Underground Tank i Above grour1 nk) Size of Propane Tank: Z 5 c{e\k v1 "-TA0e: Trt+^IG t Heat Stove C ook S_ove'� i Woodstove I Fireplace Insert I Hot Water Tank i Pellet Stove i Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / V0 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"tl Floor Heated Consistency Review: Other Heated Base fee: �r007/L L 55-CO Mezzanine Additional Secti n: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL t53 . ho Decks 911/Rd Approach fee: ---- Other TOTAL: $ 1 53 Receipt Number: q"l g(7 Cash/Check Number: ad5 . ESTIMATED COST(REQUIRED) Date: a.1 C I O� •Fair market value of all labor and materials foundation to finish I Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc O -12 n 1 Z a f rn a UDC) 1 m %* m � a v v 7 12,7„)?1 -r T n r 4 ÷-----H: ei , • 1 , 'iov' --,, ) ri v r 1 r 0 0__I G-- IG ___I- . _7, :712 ? 7------- ' ) ,.? 3 c) 0 ) 1\ --,1 C _.1 -:, m 0 co O / fi (- ? N 0 ' !) pi / I/ 2._ or a m �� ( vfp. _J R113 ) r ccii), II \ L ti z m Z II _ m a ' - z i'v ; z 0 :r.::: .. :t'