Loading...
HomeMy WebLinkAboutBLD2007-00251 • 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 #: BLD07-00251 Received Date 5/22/2007 SITE ADDRESS: 1473 OLD GARDINER RD Issue Date 5/22/2007 SEQUIM, 98382 APPLICANT: GEORGE C DE BRUYN PHONE: (360) 797-7981 1473 OLD GARDINER RD SEQUIM WA 98382-8775 TX 38 SUBDIVISION: Block: Lot: PARCEL NUMBER: 002342014 Section: 34 Township: 30N Range: 02W CONTRACTOR: FERRELLGAS PHONE: (360) 683-9029 646 SO 3RD AVE SEQUIM WA 98382 Contractor's License FERRELP055LH Expires 9/6/2008 OWNER, GEORGE C DE BRUYN PHONE: (360) 797-7981 if different: 1473 OLD GARDINER RD SEQUIM WA 98382-8775 Same as phone PROJECT DESCRIPTION: SWITCH OUT A/G 120 GAL PROPANE TANK TO A/G 500 GAL PROPANE TANK NEW LOCATION ALSO INSTALL GAS PIPING AND CONNECT TO EXISTING FIREPLACE AND NEW BBQ 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 5/22/2008. REQUIRED INSPECTIONS: Tank/Line/Appliance: 1.1 i 4 Ik(r L-10 & Li-5 -c 7 FinalApproval: Ole-4 -Vou.-1 411i DB f r 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 BLD07-00251 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Fort Townsend, WA 98368 PERMIT #: BLD07-00251 Received Date: 5/22/2007 SITE ADDRESS: 1473 OLD GARDINER RD SEQUIM, 98382 OWNER: GEORGE C DE BRUYN PHONE: (360) 797-7981 1473 OLD GARDINER RD SEQUIM WA 98382-8775 SUBDIVISION: Block: Lot: TX 38 PARCEL NUMBER: 002342014 Section: 34 Township: 30 N Range: 02 W CONTRACTOR: FERRELLGAS PHONE: (360) 683-9029 646 SO 3RD AVE SEQUIM WA 98382 Contractor's License FERRELP055LH Expires 9/6/2008 • REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP SWITCH OUT A/G 120 GAL PROPANE TANK TO A/G 500 GAL PROPANE TANK NEW LOCATION ALSO INSTALL GAS PIPING AND CONNECT TO EXISTING FIREPLACE AND NEW BBQ 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: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: 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 05/22/07 91111 Total: $153.00 .¢.sON moo. JEFFERSOlibUNTY • RIFCIIVIRII. )) W DEPARTMENT OF COMMUNITY DEVELOPMENT `' ` 621 Sheridan Street • Port Townsend •Washington 98368 MAY 2 2 360/379-4450 • 360/379-4451 Fax s q t-ZING2 www.co.jefferson.wa.us/commdevelopment IEF NSUNIMN11901 Master Permit Application MLA: Project Description(include separate sheets as necessary): ,ALSO 2a.4 A/TA" 1 63 5-‘01('Tail e c.'7-. /92.49////- '77)-x,' -''''d-geoci /20 d Tax Parcel _ • Property F Number: Q CZ 3'F 2 0 l T Size: (acres/square feet) Site Address and/or Directions to Property: / �'3 ��`� 'L`�`V�'� '� Q i tii c X #(64'0,0-/ /0/ 77‘04.1/ %«/,`T o v,6>ie?/uo c t 4 Al- L,�f c94J Oka, > (i 'a. Property Owner(s)of Record: o _ - - ti ../ICr� , • ,v Telephone: 3 6© — 717- 77 S2/ Fax: ,9-*.v email: i.'m ._ -.42ei ea-) Mailing Address: 0/13 Clt2 alit-Dff.rt14 ,fir/ 5Z4. ,'f4 9' r2 c c , .Ater-' Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies ❑Building 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit D 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 ❑ Special Use(Essential Public Facilities)** ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use ❑ Short Plat** ❑ Address 0 Road Approach 0 Binding Site Plan** ❑ Home Business ❑ Cottagelndustry 0 Long Plat** Propane ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑ Sign 0 Plat Vacation/Alteration** ❑Allowed"Yes" Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management ❑ 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* 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 t * it tt 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 pro id access and right of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application review and any req ired later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applical n that t90 he wants pri lice. Signature: Date: .5-- -2/ /Z ©7 The actionror 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 "or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been iss d ill 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 you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferab respgryibili for adherin to and complying with the ESA. The Applicant has read this disclaimer,and sir sad dates it below. Signature: J Date: s ( 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: l6�9 z4.e I<--_ c C .L' ( ) ( ) 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: ❑ New ❑ Wood Existing: ❑ Sewer Li Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System 0 Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: 0 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 lsonnliance Installation permit,mark all items below that apply: i Underground Tank C Above ground Tani) Size of Propane Tank: Sc^/l Z— i Heat Stove i Cook Stove I Woodstove i Fireplace Insert i Hot Water Tank i Pellet Stove i Other Z /5 9°E" Is this appliance being installed in a Manufactured/Mobile Home? Yes / No ce'h r?4. -6) EX(.5;ivc tee,.cercri,_ When applying for a permit to install a propane tank you must also submit a site plan showif►g 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"0 Floor Heated Consistency Review: Other Heated Base fee: VYit -rilil/YiPt 1.6r CD Mezzanine - 4",kAik 1,,r Additional Section: Heated Basement Plan Check fee: _y .f ail fre Unheated Basement pi `�_O State Surcharge fee: Other Unheated ;���0\ Pot Water Review fee: 1i �\11� Garage/Carport SUBTOTAL t 5 Decks 911/Rd Approach fee: l" ' Other TOTAL: $ IF5 3 .00 Receipt Number: CI 1 I I I Cash/Check Number: _ 1 O , i ESTIMATED COST(REQUIRED) Date: )/1 •Fair market value of all labor and materials foundation to finish 5 I U Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc v ti house. -jLA\��' N /7S� V\ ' rt 1. 1 ::.) fil ...1._ , , t. ___1 oNi t ` I I 4 �I I I ! I ! i . I. N y Zl 1 I I I r . `.I\ 1 , Ls y I I W °o : � I i i I ! I i I "� I je , , /I I � I I • N ;� /+Ia I ,CQ l i b . . .. _.... . _ I f . `�' fit ; y�iN , I ! n • , -T4.vs :jh1 ._ cC)-' I% U fr -',/ f? i ."5--- I I I ,; -1/4::fri' . :41- -I ' ! ' ' 1 b I F 1 1 I ' 1 i.N. I • • i 1._.... _.... _..-..�. la .. .. i ' '‘‘:.H:-',. — T. i T i r-- ,.„ i • 1 . , 1 I , I i' 1._ W (� ,ei I I i i ' a. , i 1 1 , i • i_ _i_ __I i I __L. ..", .: .. . , ;I 1 I 1 .�� I I L I `�I �9CAG /O 'CA'en{ Mm i:vi�;. . X bap r 4 _.__L. J._ i;__ y I • • 1-is I rN i)c i. 1 , ; . 4.. -. .;',.\; . ,, ` I .•� I,lcI 1 I I I I v _. Y U .. r /VU i 1 , • I I b �._...__...._._.. I iv 1 J 1-1 •I I I .._ I ... i -.._.... . I I i I 1 1 I jI , • 11 ztND .a •