HomeMy WebLinkAboutBLD2007-00200 • •
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 #: BLD07-00200 Received Date 5/8/2007
SITE ADDRESS: 100 CEDAR DR Issue Date 5/8/2007
PORT TOWNSEND, 98368
APPLICANT: PATRICIA A FOLEY PHONE: 360-385-3724
KATHY J MACHMER JTWROS
411 RIDGE DR
PORT TOWNSEND WA 983689495 61
SUBDIVISION: CAPE GEORGE VILLAGE DIV 3 Block: Lot:
PARCEL NUMBER: 940500060 Section: 13 Township: 30N Range: 02W
CONTRACTOR: ALL ABOUT GAS INC PHONE: 360-681-5474
970 RIVER RD
SEQUIM WA 98382
Contractor's License ALLABAG9510T Expires 9/30/2007
OWNER, PATRICIA A FOLEY PHONE: 360-385-3724
if different: KATHY J MACHMER JTWROS
411 RIDGE DR
PORT TOWNSEND WA 983689495
PROJECT DESCRIPTION: SWAP OUT EXISTING PROP TANK W/(2) 10 GAL PROP TANKS,
LINES & COOK 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: /Air i.1,i /Gc/_ 07 SMpu,'"�ANrcS Ole 4/(2-/d7A
FinalApproval: �K —cGy ( 4/12/,-71
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 -1OURS 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
Ii ILDING PERMIT APPLICATON BLD07-00200
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD07-00200 Received Date: 5/8/2007
SITE ADDRESS: 100 CEDAR DR
PORT TOWNSEND, 98368
OWNER: PATRICIA A FOLEY PHONE: 360-385-3724
KATHY J MACHMER JTWROS
411 RIDGE DR
PORT TOWNSEND WA 983689495 CAPE GEORGE VILLAGE DIV 3
SUBDIVISION: Block: Lot: 61
PARCEL NUMBER: 940500060 Section: 13 Township: 30 N Range: 02 W
CONTRACTOR: ALL ABOUT GAS INC PH
970 RIVER RD NE: 360 681 5474
SEQUIM WA 98382
Contractor's License ALLABAG9510T Expires 9/30/2007
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr SWAP OUT EXISTING PROP TANK W/ (2) 10 GAL PROP TANKS,
LINES & COOK STOVE
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY:
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:
C
r
Type Amount Paid Bv: Date: Receipt: Approved/Date
Propane Tanks/Stoves $153.00 LYK 05/08/07 89938
Total: $153.00
��0.SON c06,� JEFFERSONIOUNTY •
W \,' DEPARTMENT OF COMMUNITY DEVELOPMENT
P., v ' '4 621 Sheridan Street • Port Townsend • Washington 98368
360/379-4450 • 360/379-4451 Fax
�qsp� www.co.jefferson.wa.us/commdevelopment
IIINGe
Master Permit Application MLA: �k µ( c l6,
Project Description (include separate sheets as necessary):
5kit/2 46er:1 r.,7(i)1/nq pi-ap, 7 'i L wf7)i0 �u/,p/d✓o -7` i�Si /..�,r/� e'r.»s s' ..r7;
Tax Parcel J / Property ' _
Number: 1-�� D,1 ) to 6 Size: UUQ 51 J�-� (acres/square feet)
,�
Site Address and/or Directions to Property.
00 qr.. !', eGp- C---ea VtLmac,!G--/-
Property Owners)of Record: f 4'J'`,e/6/4 . 20'1.2' / J'yj /•c yyj
Telephone: g 5—O 7 c'2 / Fax: email: —
Mailing Address: .S-/a/a
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit? (Check each box that applies
Vuilding 0 Variance(Minor, Major or Reasonable Economic Use)
❑ Demolition Permit 0 Conditional Use[C(a), C(d),or C]**
❑ Single Family 0 Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification
❑ Manufactured Home 0 Modular 0 Special Use(Essential Public Facilities)**
❑ Commercial* 0 Boundary Line Adjustment
❑ Change of Use 0 Short Plat**
❑ Address ❑ Road Approach 0 Binding Site Plan**
0 Home Business ElCottagelndustry ❑ Long Plat**
ropane 0 Planned Rural Residential Development(PRRD)/Amendments**
Sign 0 Plat Vacation/Alteration**
0 Allowed"Yes" Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions**
0 Stormwater Management 0 Shoreline Management Substantial Development**
0 Site Plan Approval Advance Determination (SPAAD)* 0 Shoreline Management Variance
0 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 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:
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 req 'red later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the -•, - ion that he r she wantsnt priorpr notice. _
Signature: " /tom "�'L -2f4 z � Date: �d� >� (�
The action or actionsicant will undertake as a result of the issuance of this permit may negatively impact upon one dr 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 yo are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transfer a res ons' ility fora herig t and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: Date: //7Q 7
G:\PermitCenter\###FORMS###\DRD FORMS\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 assuming the responsibility of the General Contractor for the proposed project.
Signature: Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
// Aeowi cgs (3W lag/-.sy-7 V( )
AILING ADDRESS: 9 -7D le_`w to r led EMAIL:
CONTRACTOR'S LICENSE gre�jkint / //�/ 9i,3 g�. WAINS
NUMBER: / v� NUMBER
ARCHITECT/ENGINEER: - PHONE ( ) FAX: ( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New fl Wood Existing: ❑ Sewer
❑ Addition I I Steel Proposed: Bank LI Community System
L I Alteration/Remodel ❑ Concrete Total: Height: i i Individual System
C, Repair L Masonry SEP Permit#
Water Supply:
i i Demolition ILl Other: Bedrooms: Pp Y:
Existing: Setback: i I 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 bel that apply:
i Underground Tan Above ground Tank Size of Propane Tan : A::, ii ..!: /#n 74Z n/15
i Heat Stove Itook Stove i Woodstove i Fireplace Insert i Hot Water Tan - 'ellet Stov- i 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 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: A31.
153
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL 153°°
Decks 911/Rd Approach fee:
Other TOTAL: $ 1530
Receipt Number: 3 995S
Cash/Check Number: 5
ESTIMATED COST(REQUIRED) Date: lC 0-7•Fair market value of all labor and materials foundation to finish O
Initials:
C-----"--:---
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc C
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