HomeMy WebLinkAboutBLD2007-00197 •
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 #: BLD07-00197 Received Date 5/8/2007
SITE ADDRESS: 72 EVANS LN Issue Date 5/8/2007
PORT LUDLOW, 98365
APPLICANT: RONALD R KLETTI PHONE: 262-664-6658
MARY L KLETTI
108 E WASHINGTON ST
SLINGER WI 530869584 51
SUBDIVISION: PORT LUDLOW#1 AREA 3 Block: Lot:
PARCEL NUMBER: 990400351 Section: 8 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, RONALD R KLETTI PHONE: 262-664-6658
if different: MARY L KLETTI
108 E WASHINGTON ST
SLINGER WI 530869584
PROJECT DESCRIPTION: REPLACE A/G 120 GAL PROP TANK - 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 5/8/2008.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: piva LDC. 4 77.4tr`agjrr Ok ,SAle7"/"
FinalApproval: dk .n- ccend-i 5/0'7,
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
BLD07-00197
•UILDING PERMIT APPLICAllION Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD07-00197 Received Date: 5/8/2007
SITE ADDRESS: 72 EVANS LN
PORT LUDLOW, 98365
OWNER: RONALD R KLETTI PHONE: 262-664-6658
MARY L KLETTI
108 E WASHINGTON ST
SLINGER WI 530869584 PORT LUDLOW#1 AREA 3
SUBDIVISION: Block: Lot: 51
PARCEL NUMBER: 990400351 Section: 8 Township: 28 N Range: 01 E
CONTRACTOR: SUNSHINE PROPANE 10853 RHODY DR PHONE: 385-5797
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2008
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP REPLACE A/G 120 GAL PROP TANK - 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: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total:
Routing ate: ---'
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $51.00 LYK 05/08/07 39935
Total: $51.00
• 0
SITE VISIT REPORT
VLET-1-- 7 (PLOT PLAN)
JOB (�fJt. DATE : S/4=VO .
CONTACT:
ADDRESS L101.-0‘..1-1 PHONE #:
DIRECTIONS _ FAX #:
Email .
, PLANNER: .
Nl
e%)) L'k RE(A/EIV :I)
JEFFFR le iNiY OCD
U�
L.,/0,
it.Ap
117
441(
4
, . 6._,
i ?,(D.
i
1
SAP q, J 4-i 10101 W i777 f4 I ✓P/CE /5 A/E dry E� +:4
100110ot] 3N'ddOHd 3NIHSNfS 9L8998E09E H'dd UZ: - - LOOZ/80/90
05/03/2007 11: 53 4142287561 BVI< y°AGE �02
05/03/2007 09: 42 FAX 300005• SUNSHINE PROPANE • lJ 002/005
�'� JEFFERSON COUNTY ECE v E i ) ��-
41110 l]EPARTMI:N:IF:OMhiUNITYDEVEtAPM11=NT p 621 Sh®rfden • Port Tawnaend • W$shington 98 B
�� 3i301379�450. 3130/379-4451 FEW l� 5/
,.` r.1 wow.co.jefferson.wa,us/oomrndevelopment'
Master Pe it Application
'hll�l� 4r MLA:
ProfecADesd ii•..n(include Separate sheets as necessary): s
Tax P-reel Property
Nu •en 6190 70 O 3 5 / Stze: (acres/squarr3feet)
Site Address an.or Diregbons to P Parer •2 .�/6,,,,vs L A_ P �16 /--d 0/
Property owner(e)of iR000rd: /COh14 L.Iv y9 2,-7 4.8-- T-T i -
Telephone: -(oticf-�e,..5---a Fax: emelt:
Mailing Address: / &> t
G1/ f4/fnG rid,' f[. -4-/"/6'erd-- 141f. .1"..Od)6
r
Appllc ntVAgent(if different from owner): . ;.f'.."1,1; .,"e 0P/9--iv Q
a
Telephone! T_ sf.c S75 '7 Fax: ,_?g,5 —5Q7' email: /• /PO(SG e7.577/r1C__pfJ/1,9Ne.
Mailing Address: 0 ? 0 /'f' �,q &) C& a 9v _3-3 ( cc
•
What klnd at Pettit?(Chock oath box that applies)
C Banding 0 Variance(Minor,Major or Reasonable Economic Use)
d Demolition Permit 0Conditioner Use(C(s),C(d),or Cl
p Single Family ❑Discretionary"D"or Unnamed Use Classification
0 Garage: Attached/Detached 0 special Use(Essential Public Facilities)'"
0 Manufacturtad Home ❑ Boundary tine Adjustment
D Modular 0 Short Plat'"
❑Commercial* p Binding Site Plan'"
0 Changes of Use ❑ Long Plat
0 Address 0 Road Ap rosetl ❑Planned RUral Residential Development(PRRD)/AmendmentS"'
oliPropane ❑ Piet Vacation/Alteration"
iitiwod"Yes' Use Consistency Analysis 0 Shoreline Master Program Bxemption/Permk Revisions'"'
o$barmwatsr Management o Shoreline Management Sulastantiel Development**
❑Site Plan Approval Advance Determination(SPAAD)' 0 61-rorelinc Management Veriarl:e
0 TernpOrervAUse 0 Comprehensive Plan/UDC/Land Use District Map Amendment
0 Wireless T lecomfnunication` 0 Jefferson County Shoreline Master Program Amendment
0 Forest Pr 4.Act/Release of Six-Year Moratorium
IMO re a Pro ADpficet'larrConference "R•+ulnas s Pro-• . dd[hhnConference
Please idar t fy any otiher local,state or Federal permits required for this proposal,if known:
j71
ATEG GENT
111_ "y001.1 eta entl a l ion (6)
ray- ' r-T ate
cystoning thisjappUraHon bun,the ownerlagentattests that the Information provided herein.and In any attachmenta.is-lase and correct to the bit of
hie,her or Ira knowledge. My material talxahood or any omistslon of a malarial Fact made by the ownadapent with respect to this applleation Packet
may result hi His welt being null and void.
I further wive to save,Indemnify end hold harminee Jafferoort County against all liabilities,Judgments,court costs,reasonable attorney's fees and
raroon000 which may in any way Aacorue against Jeffereon County as a result of or in C4n&rquance or the psantnd bf this rarmit.
IISIN
I further agree to Provide access and tight of entry to Jefferson County and Its employees,representatives or agents for the sole purpose of eppitcsuon
review end any re4rirnd later Inapaations.Arms and right/' of entry to this property shell be rev:Nested and shall occur only during regular business
Hoare. 7Q?4, 4' \` 7
r`�Signature: � TDar:e: ���� v f
t The action or a,�� elite
actions Applicant w111 undertake as a result Issuance of this permit may negatively rnpeot upon ono or more threatened or
e
endangered species and could lead to a potential take'er an ertcatlgored species as Mose terms era defined In the federal law known no the
"Endangered -peoes Act"or"ESA."Jefferson County MAkea no aeeuranma to the spptltant that the actions that will be undertaken because this
- Vparr*hag.:. Issued will not vldela the ESA. Any Individual,group or agency can file a lawsuit on behalf of ein endangorod epodes regarding your
aotton(o)rsvdn f yuu era fro compliance with the Jefferson County development rode.The Applicant advrowlodgss that ne,she or it motels Individual
'.. and non-Iran its •• ••-•• =Iblllty y aid c d and plying wan the EISA. Tile Applicant has road this disclaimer and signs and dates tt below.
Signature: , tite Dale: 5-3 `07
G:\y' ter\FOA.MS1EIRD POI $\bbistcr Permit Application 7-8.04.doc
J • OWNER 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:
Suh .rhiAJE P2 3 -/J (360) 3 8S-s 797 (366) 8S 5 7S
MAILING ADDRESS: / 7 S ? ,f� /F O l y i)r& EMAIL: t n Fa @si r stf�h e f�R)p rt
CONTRACTOR'S LICENSE / WAINS
NUMBER: (4 N S If- 1O 7K a 7 7 /3 NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:(
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New ❑ Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank ❑ Community System
❑ Alteration/Remgdel ❑ Concrete Total: Height: ❑ Individual System
❑ Repair ❑ Masonry SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well I:] 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 Taqk and/or Appliance Installation permit,mark all items below that apply:
❑ Underground Tank bove ground Tank Size of Propane Tank: / _2 C ,�{
❑ Heat Stove CI Cook Stove ❑ Woodstove ❑ Fireplace Insert ❑ Hot Water Tank CI Pellet Stblre ❑ 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 Fpr Office Use Only
Current Proposed Amount
Main Floor Consistency Review:
2`"'Floor Base fee: fi 5 � Wa$3� wt
Ya Floor Additional Section: *''
Mezzanine: Plan Check fee:
Heated Basement State Surcharge fee:
Unheated Basement Pot Water Review fee:
Other Unheated 911/Rd Approach fee:
Garage/Carport TOTAL: $
Decks G
Receipt Number t,' �`Aa 4 4` 4 ''
Other Cash/Check Number
ESTIMATED COST(REQUIRED) Date:
•Fair market value of all labor and materials foundation to finish
Initials:
G:\Per mtCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc `