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Home My WebLink AboutBLD2007-00234 0 • 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 #: BLD07-00234 Received Date 5/16/2007 SITE ADDRESS: 4671 CENTER RD Issue Date 5/16/2007 CHIMACUM, 98325 APPLICANT: TIMOTHY F HAMMOND PHONE: 360 732 0643 STACEY SOUZA 4671 CENTER RD CHIMACUM WA 983259758 4+ SUBDIVISION: JOHNSTON SHORT PLAT Block: Lot: PARCEL NUMBER: 801034021 Section: 3 Township: 28N Range: 01W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2008 OWNER, TIMOTHY F HAMMOND PHONE: 360-732-0643 if different: STACEY SOUZA 4671 CENTER RD CHIMACUM WA 983259758 PROJECT DESCRIPTION NEW 250 GAL A/G PROPANE TANK AND APPLIANCES 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 5/16/2008. REQUIRED INSPECTIONS: Tank/Line/Appliance: i,k(,_L,)Nii: LT/ K (o- j (7,", AN,inNLE bye 7/4/67A FinalApproval: £f' for -CI yled ,/s.d,* BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:0C) a.m. -4:30 p.m. HOT LINE AVAILABLE 24 HOURS A DAY I.\F_BLD_Permit_Propane.rpt 1 0/29/19c 0234 BUILDING PERMIT APPLICA'ON BL view Type: Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00234 Received Date: 5/16/2007 SITE ADDRESS: 4671 CENTER RD CHIMACUM, 98325 OWNER: TIMOTHY F HAMMOND PHONE: 360-732-0643 STACEY SOUZA 4671 CENTER RD CHIMACUM WA 983259758 JOHNSTON SHORT PLAT SUBDIVISION: Block: Lot: 4+ PARCEL NUMBER: 801034021 Section: 3 Township: 28 N Range: 01 W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN"9790Z Expires 9/7/2008 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION NEW 250 GAL A/G PROPANE TANK AND APPLIANCES 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 $51.00 CJZ 05/16/07 89982 Total: $51.00 k��¢SON co�� JEFFERSC.OUNTY • 4 ,.3 DEPARTMENT OF COMMUNITY DEVELOPMENT ~' '4 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax 1,sN O www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Project Description(incl separate sheet, as.nece'ss /1 �l,,y - 1 .r)3\ agCrl e, `c l S) )� 104 � \\-1).4/6-61-69'; Tax Parcel 8 //�� f�`� r� Property Number: V ��`ll�� Size: (acres/square feet) Sitp A dress and/ r Dire tions to Pr e 6. 114)1-1 . % YA IM-1)in Oh gLD45 Property Owner( )of Record: Telephon Fax: ,em I: Mailing Address: (� , ( �y�± t.0 (�) _� — Applicant/Agent(if different from owner): �� Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies ❑Building ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit ❑ 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* El Boundary Line Adjustment ❑ Change of Use 0 Short Plat** ❑ Address ❑ Road Approach 0 Binding Site Plan** ❑ Home Business 0 Cottagelndustry El Long Plat** P'repane El Planned Rural Residential Development(PRRD)/Amendments** ❑ Sign ❑ Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management El Shoreline Management Substantial Development** 0 Site Plan Approval Advance Determination (SPAAD)* ❑ Shoreline Management Variance ❑ Temporary Use El Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* El Jefferson County Shoreline Master Program Amendment El Forest Practices Act/Release of Six-Year Moratorium ❑ 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,�gainst Jefferson County as a result of or in consequence of the granting of this permit. I further agree to p, vide access and r' ht of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application review and any r duired later insp cti ns. ffs access and right of entry will be assumed unless the applicant informs the CountEfT in writing at the time oft 1 t s notice. \ Signatur 7.. Date: ET)--- The 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 pote ial"take"of an endangered species as those terms are defined in the federal law known as the "Endangered Speci "Act"or"ESA."Jeffers n County makes no assurances to the applicant that the actions that will be undertaken because this permit has been is ed will not violate the SA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if y u are in compliance it the Jefferson a my development code.The Applicant acknowledges that he,she o ' olds individual and non-tra r le r ^p nsibiilityr forr a r' and comply ng with the ESA. The Applicant has read thi disclai e'and sigfi9, r ,dates it below. Signature: vDater �i 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: GENE CONTRACTOROR O�R MANUFACTURED HOME INSTALLER: PHONE: FAX: �i �C�� ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: LI New ❑ Wood Existing: ❑ Sewer 0 Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: I I Individual System Repair ❑ Masonry Bedrooms: �E ePeSrLmit# Demolition ❑ Other: 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 Tan and/or Appliance Installation permit,mark all items below that a I . I Undergrou Tank Love ground Tank Size f Propane Tank:below 1,�/'�` Heat Stove Cook Stove I Woodstove I Fireplace Insert , of Water Tank I Pelletftove 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: 2na Floor Heated Consistency Review: Other Heated Base fee: 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: $ Receipt Number: 18C Cash/Check Number: cot f ESTIMATED COST(REQUIRED) Date: `)t •Fair market value of all labor and materials foundation to finish 5( Ili ( 0 Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc • • q rig I I I 11.._.._.. 356.bl'PROPERTY LW - ....„-- • 1 , ,,,,, 1 1 N t m I. t hI-a g I Ir-----\\ i 161' I I i0 If N7. \ cA 1 • 4 k%ssh. c. / i 1lo 1 b4 c F� Z.....s... \ i I .I) \\ --\-- -- \-- li I IQ ...JJJ 'I 1 li j r I I I z I i - I . I -z2, 1 , ► it •. - . . . . c _ . _ _ - _ _____ \ r - :1,62.,....;) . 1 i x§ fo ?F i 2 2 § 2 I hi , co -I - '' F i i ig 3 5 I! 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