HomeMy WebLinkAboutBLD2007-00182 • •
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 #: BLD07-00182 Received Date 4/30/2007
SITE ADDRESS: 132 GAMBLE LN Issue Date 4/30/2007
PORT LUDLOW, 98365
APPLICANT: BRUCE G KRAMER PHONE: 831-277-8106
CARLA KRAMER
132 GAMBLE LN
PORT LUDLOW WA 983658707
SUBDIVISION: PORT LUDLOW#1 AREA1 Block: Lot:
PARCEL NUMBER: 990400103 Section: 9 Township: 28N Range: 01 E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2008
OWNER, BRUCE G KRAMER PHONE: 831-277-8106
if different: CARLA KRAMER
132 GAMBLE LN
PORT LUDLOW WA 983658707
PROJECT DESCRIPTION: A/ 120 GAL PROP TANK, GAS PIPE & HEAT STOVE - 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 4/30/2008.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: d0K dk 9/26/07G FRE 5177 12104 Star /zo/o7Ø
/rur mie Awes ok t/20/a7 PJ�C rd us6 SrGVr� 9/=6/07
FinalApproval: ET J i Cm 9120107 - r;, P#
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
BU•ING PERMIT APPLICATION. BLRDOe 00182
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD07-00182 Received Date: 4/30/2007
SITE ADDRESS: 132 GAMBLE LN
PORT LUDLOW, 98365
OWNER: BRUCE G KRAMER PHONE: 831-277-8106
CARLA KRAMER
132 GAMBLE LN
PORT LUDLOW WA 983658707 PORT LUDLOW#1 AREA1
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 990400103 Section: 9 Township: 28 N Range: 01 E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2008
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr A/ 120 GAL PROP TANK, GAS PIPE & HEAT STOVE - 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: _ J
/100)0
Type Amount Paid By:-J Date: Receipt: Approved/Date
Propane Tanks/Stoves $153.00 LYK 04/30/07 89916
Total: $153.00
RITE VISIT REPORT •
(PLOT PLAN)
JOB 42• tA k2vAVv\ 2 DATE : 41.//0-7.
CONTACT:
ADDRESS PHONE #:
DIRECTIONS FAX #:
Email
PLANNER:
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Aiiiko-rivi JEFFERSON COUNTY
`�� DEPARTMENT OF COOJNITY DEVELOPMENT * T- 621 Sheridan Street • Port Townsend •Washington 98368 L 1
360/379-4450 • 360/379-4451 Fax �' !"�
46, CI
www.co.jefferson.wa.us/commdevelopment
�IN APR 3 0
Master Permit Application �;
MLA:. j)Cj m _ram Project Description(include separate sheets as necessary): �Ot'fdEtA
r��Y — is / G , e7.,,=_/ 6" rP- _-
Tax Parcel ll�� Property
Number: I /l/ �V ®3
Size: (acres/square feet)
Site Address and/or Directions to Pr perty: / 7/9 2/jam jA/ ,� �ifD( O�
Property Owner(s)of Record: /Lt:/(� c_ re �]"Z'
Telephone: '3( - .Q77- X/O` Fax: email:
Mailing Address: ) 3 2 4,5/ ,e L-.1.4, P"i Lt` r
Applicant/Agent(if different from owner): �r-c.»S /4)h c_ P2-Ol'Jr4t-7 L.
Telephone: .3(3 O 3 es S7' 7 Fax: 395 S 8 75 email:
Mailing Address: )O 216 3 R h o d ci ,fir. p? . 1-(ftip Lo C f Lai 9 83 3 S
What kind of Permit?(Check each box that applies)
u Building ❑Variance(Minor, Major or Reasonable Economic Use)
❑ Demolition Permit 0 Conditional Use[C(a),C(d),or C]**
0 Single Family 0 Discretionary"D"or Unnamed Use Classification
0 Garage Attached/Detached 0 Special Use(Essential Public Facilities)**
❑ Manufactured Home 0 Boundary Line Adjustment
❑ Modular ❑ Short Plat"
0 Commercial* El Binding Site Plan"
❑Change of Use ❑ Long Plat"
0 Address ❑ Road Approach 0 Planned Rural Residential Development(PRRD)Amendments**
ropane ❑ Plat Vacation/Alteration*"
Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions"
El Stormwater Management ❑ Shoreline Management Substantial Development"
0 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
0 Forest Practices Act/Release of Six-Year Moratorium
*Ma -.ulre a Pre-A..lication 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 her6.......
de 'gnat iy age •'• :lating•to �'•� ' .lion for permit(s).
O'4'NIGNATURE -# /.
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 attorneys 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.
1) I further agree to provide access and fight of entry to Jefferson Countyand its employees,representatives or agents for the sole u
review and anyrequir late � purpose of application
.sii
eqinspe ons.Access and right of entry to this property shall be requested and shall occur only during regular business
hours.
i 'i
�ignature: —
liSli�.' — Date: q/ 2C/�A� 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
N.. "Endangered Species Acr 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
iii4j10
action(s)even if you are in compliance ith the Jefferson County development code.The Applicant acknowledges that he,she or It holds individual
and non-transf rable pons' ility fo adhering to and complying with the ESA. The Applicant has read this disci mer and igns and dates it below.
ignature: Date: y "2 �(,-/
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►53`5')
C. t1.R BUILDER STATEMENT
The signer of this statement does hereby ilk that they are the Owners of the parcel referenced hin,that theyare not licensed con
they will be assuming the responsibility of the General Contractor for the proposed project.
tracxors and that
Signature:
Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE:
Sici2S`I/i't—e (
MAILING ADDRESS: /o F /1 e n C E�O: ) a �`� ! / ( )
CONTRACTORS LICENSE U n 7%1^7CGy (/ WaNS
NUMBER: fS/�P,? -o! 7 Q(' NUMBER
ARCHITECT/ENGINEER: PHONE
( ) FAX: ( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type ySe of Sewage Disposal:
New ❑ Wood Existing:
0 Addition ❑ Steel Proposed: Bank 0 Sewerm
0 Alteration/Remodel 0 Concrete Total: Height: 0 Community stemm
❑ Repair 0 Individual Sysfnm
Pa ❑ Masonry SEP Permit#
0 Demolition 0 Other: Bedrooms: Water Supply:
Existing: Setback:
Type of Heat: Proposed: 0 Private well 0 Two Party
Total: 0 Public
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 applx
`❑�nderground Tank Above ground Tank Size of Propane Tank: / Z U
)(Heat Stove 0 Cook tove 0 Woodstove 0 Fireplace Insert 0 Hot Water Tank ❑ Pellet`Stove Other
Is this appliance being Installed 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 For Office Use Only ,T;.
Main Fbor Current Proposed y�t�fy s
fy 'y?`.4� 4. ,
'Consistenpy.;Review: :Sxr4 s.e-v
2x0 Floor — — Base fee: '';,' . .3. ,.,14
3td Floor Additional Section. '! $ .. _"
Mezzanine: Plan Check fee:
-- 1 k Heated Basement
State Surcharge fee: , k
Unheated Basement Pot Water Reyiew,fee;
b
Other Unheated 7 f 4
911/Rd Approach fee' F r, x , y�4ppyyjj� ,
Garage/Carport - r �+5»}� � oiE
TOTAL; $ - � }�{it
Decks — .,— {]]tt °"i 4/ i.Y�41J 4 1 , •
�4 agrrtu�� z1j?a< o
Receipt Number: �� ,�t< c
Other Cash/Cheek Number: ww t7 n- ftf yk: .s< '
ESTIMATED COST(REQUIRED) `" ' "` 1,#r-y„ Y,q ZY�
Date: w,,,rear v.k :�,
.Fair market value of all labor and materials foundation to finish `'
Initials: ,, :� < l;}ems �.-.}4;` . , t
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