HomeMy WebLinkAboutBLD2007-00241 •
•
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 #: BLD07-00241 Received Date 5/18/2007
SITE ADDRESS: 7180 FLAGLER RD Issue Date 5/18/2007
NORDLAND, 98358
APPLICANT: THOMAS C ROSE PHONE: 360-379-5471
SUSAN M ROSE
PO BOX 233
NORDLAND WA 983580233
SUBDIVISION: NORDLAND Block: 4 Lot:
PARCEL NUMBER: 976200401 Section: 33 Township: 30N 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, THOMAS C ROSE PHONE: 360-379-5471
if different: SUSAN M ROSE
PO BOX 233
NORDLAND WA 983580233
PROJECT DESCRIPTION: A/G 120 GAL PROP TANK,WALL HEATER & GAS PIPE
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 5/18/2008.
REQUIRED INSPECTIONS:
Tank/Line/Appliance:d(0r-‘ ?ii2t:✓ &T1_Co-2 -07 C�44K -o-7
FinalApproval: OK .par ct;,ift,, 4l 2-i J'o 0
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
itUILDING PERMIT APPLICAAN BL Revviewiew T Tyy241
pe:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD07-00241 Received Date: 5/18/2007
SITE ADDRESS: 7180 FLAGLER RD
NORDLAND, 98358
OWNER: THOMAS C ROSE PHONE: 360-379-5471
SUSAN M ROSE
PO BOX 233
NORDLAND WA 983580233 NORDLAND
SUBDIVISION: Block: 4 Lot:
PARCEL NUMBER: 976200401 Section: 33 Township: 30 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 DESCRIPTION A/G 120 GAL PROP TANK, WALL HEATER & GAS PIPE
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:
CONST TYPE: OTHER:
GARAGE: SHORELINE:
CONST TYPE: SETBACK:
DECK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total: �� /�
Routing DaterI Ir, 1
'
) CL `
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $153.00 AMS 05/18/07 91014
Total: $153.00
SITE VISIT REP ` ' 1� (I IE;'? Aff. )' i
4 REPORT
(PLOT PLAN) KAY 1 ,. 211117
JOB a m 4-- Sv t i�oS t DATE : J d I 03
CONTACT:
ADDRESS �R�o��D �OST �� ��� PHONE #:
io
DIRECTIONS FAX #:
Email
PLANNER: r,� ..,
it!
N
,5 ---
11)
1 -- ___ - �i_ 'Iz c.ssr.
D
q
()3
0„SON lili
•6 M�� \�
,i; JEFFERSCOUNTY IK
%iti
,-�j DEPARTMENT OF COMMUNITY DEVELOPMENT
�Q 621 Sheridan Street • Port Townsend Washington 98368 ,RIO
���f
Si
360/379-4450 • 360/379-4451 Fax �11N 1 8
�'gS,�NO.o www.co.jefferson.wa.us/commdevelopment
aly goilHai
Master Pe it Application MLA: EA
Project Descrip on(include separate sheets as necessary): -
Taii0i reel ,o, M 2 0 0 l�0/ Property
Num•er: `1 / �` I Size: II 'acres/square feet)
Site Address an. or Directions to Property: 71 C) F La esuc- ( , Nal(�c (l' ria .,,, .Property Owne (s)of Record: I C v 1 0e-
Telephone: 3 7 9 —S 4'7( Fax: email:
Mailing Addres • P 0 (3 o)<_ a 3
Applicant/Age t(if different from owner): _S4/ ,rff//V e I Jgo/,/¢-Ai e
Telephone: 3 4i s-5 75' 7 Fax: ,"? p,S -S '7C email: /N Po�7%-fnsf/,i�-I /�)(v/r9n., .
Mailing Addres / 0 �S P re DO y ,Q/Z /9 /y L8 c/c L!)f4-. 9 --.3 ' c,
What kind of P=rmit?(Check each box that applies)
❑ Building ❑Variance(Minor, Major or Reasonable Economic Use)
❑ Demolitio Permit ❑ Conditional Use[C(a), C(d),or C]**
❑ Single Fa ily ❑ Discretionary"D"or Unnamed Use Classification
❑Garage 'ttached/Detached ❑ Special Use(Essential Public Facilities)**
❑Manufactu ed Home ❑ Boundary Line Adjustment
❑ Modular ❑ Short Plat**
❑Commerci:I* ❑ Binding Site Plan**
❑Change o Use ❑ Long Plat**
❑Address ❑ Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments"*
x(Propane ❑ Plat Vacation/Alteration**
❑Allowed"Yes Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions**
❑Stormwater anagement ❑ Shoreline Management Substantial Development**
❑ Site Plan App oval Advance Determination(SPAAD)* ❑ Shoreline Management Variance
❑Temporary U•.e ❑ Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Tele •mmunication* ❑Jefferson County Shoreline Master Program Amendment
El Forest Practi•-s Act/Release of Six-Year Moratorium
*May r-. ire a Pre—Application Conference **Requires a Pre-Application Conference
Please identi y any other local, state or federal permits required for this proposal, if known:
SIGNATIO► e GENT
' he Gay ' ,■�/ • act as ••- _gent i artyit- , . c .. •-
1w - '^rT Ir"I'S is �.,�u+:jion per (s).
•ate:
By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,istrtie and correct to the best of
his,her or it's kno edge. 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 .ermit being null and void.
I further agree to -aye,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attomey's fees and
expenses which ay in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit.
I further agree to„rovide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any r..uired later inspections.Access and right of entry to this property shall be requested and shall occur only during regular business
hours.
CI� Signature: r %� — Z Date: 5 c Z- P -7
rJ/
\, The action or acti�'ns Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or
- endangered spe -s and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the
"Endangered Sp- 'es Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this
permit has been i ued 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 y.0 are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transfera•le esponsibili ,for adh ng to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
�? Signature: I` .1 . 7V` ' ,- Date: c - I?- 6
G:\PermitCenter\FO' S\DRD FORMS\Master Permit Application 7-8-04.doc
153°1?
• OWNER BUILDER STATEMENT
The signer of this sta-ment does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be assumin a the responsibility of the General Contractor for the proposed project.
Signature: Date:
GENERAL CONTRA OR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
Sunsf// C /02 3p4frJQ (360) 38Ss777 (; (5) 383 . 5c?75
MAILING ADDRESS: / 0 r,c ? /f7-0 c y O k EMAIL: I n Fo ..1- ri s--t/In(.pg ai,,,fr coM
CONTRACTOR'SWAINS
NUMBER:MBER: 'S LICE SE S� AV' I�)0 7K a,7 7a f NUMBER
ARCHITECT/ENGINE:R: 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/Rem•del ❑ Concrete Total: Height: ❑ Individual System
❑ Repair ❑ Masonry SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water 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 Tank and/or Appliance Installation permit,mark all items below that apply:
❑ Underground Tank Above ground Tank Size of Propane Tank: I a 94,s CA)ail
❑ Heat Stove LI Cook Stove ❑ Woodstove LiFireplace Insert ❑ Hot Water Tank ❑ Pellet ve Other hearer y'ft°
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No p i/°e-
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
Current Proposed Amount
Main Floor Consistency Review:
2NU Floor Base fee:
3m Floor Additional Section:
Mezzanine: Plan Check fee:
Heated Basement State Surcharge fee: a,r' M .. 4,.; V. ,,,
Unheated Basement Pot Water Review fee: `
Other Unheated 911/Rd Approach fee: 's.
I. • . w�,
Garage/Carport TOTAL: $ i
Decks Receipt Number: I
Other Cash/Check Number: ;-` sw .
ESTIMATED COST(REQUIRED) Date: x ..
•Fair market value of all labor and materials foundation to finish
Initials: '...
,
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc