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HomeMy WebLinkAboutBLD2007-00195 • •. 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 #: BLD07-00195 Received Date 5/8/2007 SITE ADDRESS: 320 GARDEN CLUB RD Issue Date 5/8/2007 NORDLAND, 98358 APPLICANT: NORDLAND GARDEN CLUB PHONE: (360) 385-4859 PO BOX 131 NORDLAND WA 98358-0131 TX 1+ SUBDIVISION: Block: Lot: PARCEL NUMBER: 921092014 Section: 9 Township: 29N 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, NORDLAND GARDEN CLUB PHONE: (360) 385-4859 if different: PO BOX 131 NORDLAND WA 98358-0131 PROJECT DESCRIPTION: INSTALL A/G 250 PROPANE TANK, GAS LINES AND HEAT STOVE 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 5/8/2008. REQUIRED INSPECTIONS: Tank/Line/Appliance: /ur t7f 41A/4V /drr *f Ler Liics Sf g/G7 Apt hsve - di< 5/g/c7, FinalApproval: sm/G7 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 •UILDING PERMIT APPLICA N BLD07-00195 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00195 Received Date: 5/8/2007 SITE ADDRESS: 320 GARDEN CLUB RD NORDLAND, 98358 OWNER: NORDLAND GARDEN CLUB PHONE: (360) 385-4859 PO BOX 131 NORDLAND WA 98358-0131 SUBDIVISION: Block: Lot: TX 1+ PARCEL NUMBER: 921092014 Section: 9 Township: 29 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: SUNSHINE PROPANE PHONE: (360) 385-5797 10853 RHODY DR (360)875 PORT HADLOCK WA 98339 PROJECT DESCRIPTION INSTALL A/G 250 PROPANE TANK, GAS LINES AND HEAT STOVE 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 KAS 05/08/07 89891 Total: $153.00 • R F(IIVVEli ) { SITE VISIT REPORT (PLOT PLAN) <:� . # �-:;t JOB 06 LAt'(J A eADE.PJ C I\3. , jt�p ;� �:�� IIINIA'ii: 4 /0 7 '('��NTAT . ADDRESS PHONE #: . DIRECTIONS FAX #: . Email . PLANNER: . JP w < 'S1 - - I yo' _t h r I L ©- iv e. s 14° � � 3/y poly GOAT iIC cl- CCS o )(;a1, IV 6- prormS, V s ►\C -e.,-ON\ Roof ' vv\ASo P 2-rr2,o K rr l ✓l A `1' P E-EO 70 r; &.-. CI-- m mot ' A Pi44r . ( A PP Ro)( 4 4 ,, G,,30E R.E;kx..k CIA i m 1.atki 1 s i eA N'Pct. v);11 t3c .U 7O Lapp t-UOO�e, . AcAigsr To 1?ePU- -ro? OF CI,1+ rn0c1 . le°,14 cod JEFFERSON C NTY 1t ,,�vlf1����`71 11 , dRiion% DEPARTMENT OWMMUNITY DEVELOPMENT ^�` 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 0/ i . A p� www.co.jefferson.w36 a.us/c379-4451ommdevFax elopment V%iirnial `III II'I 1 Master Permit Application MLA: (Li I LIW�114�r��N�Y�iii. Project Description(include separate sheets as necessary): / e`-4- 2-71 , l"(10-2/4-1^,L_. Cr-c`-r-k/ fr 1. Tax Parcel Property Number: 501 O y� — D/7 Size: (acres/square feet) Site Address and/or Directions to Property: _3.2 0 nu/K (L (�/3 /2--, 2 /l(1Y 1'�-k(� Property Owner(s)of Record: z C' L Telephone: 3efS .- VS-5- i Fax: email: Mailing Address: �c Ze Applicant/Agent(if different from owner): 5-g-<-n S HI h L P2-0Ptel-t-7 L Telephone: 36.O 3 es S7 1 Fax: 3 V 5 S 8 7S email: Mailing Address: i 0 2S 3 1 h o d y Or. P r . trr-t'f0 L-o Cie, (,019 S 83 3 7 What kind of Permit?(Check each box that applies) 0 Building 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use[C(a),C(d),or C]** ❑ Single Family 0 Discretionary"D"or Unnamed Use Classification ❑ Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** ❑Manufactured Home 0 Boundary Line Adjustment 0 Modular 0 Short Plat** ❑Commercial* 0 Binding Site Plan'"' ❑ Change of Use 0 Long Plat** 0 Address 0 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** 0 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 0 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 here de 'gnat age ge :.: slating to j .1 .tion for permit(s). OWN IGNATURE 6 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 its 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 Nil N. expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. n I further agree to pro de access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any req r id later inspections.Access and right of entry to this property shall be requested and shall occu during regular busi ess hours. �� N/y C \ Date: / /O 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 vl 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 yo are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transfe a responsibili�erin d comp yin nth e ESA. The Applicant has read this disGai rand s'gns and tes it below. ignaturg: ' A... ,j/Yt. / Date: j `,.I'emutCe-nter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc OL/NLiR BUILDER STATEMENT • The signer of this statement does herebycertifyth ey 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: Sa)25A P71 ap 4,--tsg-- (360 ) 3 8 =57? 7 ( ) MAILINGADORFSS: /0 D53 i 4 ed )C EMAIL: CONTRACTORS LICENSE �i'U n 1 -7 7!/�(/ WAINS NUMBER: c hs�/�,t o< ! W e NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) EMAIL Project Type: Frame Type: Bathrooms: Shoreline:❑ Type of Sewage Disposal: New ❑ Wood Existing: 0 Addition ❑ Steel Proposed: Bank 0 Sewer 0 Community ❑ Alteration/Remodel ❑ Concrete Total: Height: Systemem ❑0 Repair ❑ Masonry Individual 0 Demolition ❑ Other: Bedrooms: SEP Permit# Existing: Setback: Water Supply: Type of Heat: Proposed: 0 Private well 0 Two Party ❑ Public Total: Name of System: If this is a Commercial Proiect 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 ' Above ground Tank Size of Propane Tank: c2 SO leCHe4''b`tove 0 Cool( 0 Woodstove 0 Fireplace Insert 0 Hot Water Tank 0 Pellet Stove Pther r 5 thi 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 w ,'"4:+ l s v, /, Current Proposed 4 a ii r, ,ryfO"r Main Floor 'Consistency Review: r Ir T x 2 Fbor 11-ttiei\Vi ' i h ti nN fl�t`� j r Base fee: 44 f S ) py-owint_.,: qAti.,A,3 A Additional Section: ', Mezzanine: 'n� t Plan Chgck:fee: 1,'O • i, , ;), to - Heated Basement 10` '� xt State Surcharge fee: It„� 44;L Ni a Ar`s' Unheated Basement.Jt1�LJIM1IV�;HDNTYOCD 4I.:. ti�x5 i Pot Water Review fee,, sf eta :r��ti � ^W ,, Other Unheated '` ' r f 4 1 *,4 I.; 911/Rd Approach fee: M r. t,,ern Garage/Carport - f ,,rr �. , $ , ', ^�, Decks TOTAL.: , ,k`A Wit.„rt � ,}✓ 1 O -r..F 4,1, ��� _ Receipt.Number: *'Ny 3 QCigq r Other Cash/Check Number:r t ��y;t r — C� / ESTIMATED COST(REQUIRED) AIN'` "4 1t ^`i tJS i Date: ,• ,, et• a:. •Fair market value of all labor and materials foundation to finish ' �j Jp V7 r L 1 `J/o/ Initials: ,r ; G:\YermaCenter\FORMS\Dull FORMS\Master I'auut Applicauuti_o_lW.:;uc