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Home My WebLink AboutBLD2007-00298 • 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 #: BLD07-00298 Received Date 6/8/2007 SITE ADDRESS: 65 SUTTER ST Issue Date 6/8/2007 PORT TOWNSEND, 98368 APPLICANT: PETER B RHINES PHONE: 360-379-1457 LINDA S RHINES 5753 61ST AVE NE SEATTLE WA 981052037 SUBDIVISION: TIBBALS LAKE PARK Block: Lot: PARCEL NUMBER: 999006704 Section: 33 Township: 31N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP"077QP Expires 11/17/2008 OWNER, PETER B RHINES PHONE: 360-379-1457 if different: LINDA S RHINES 5753 61ST AVE NE SEATTLE WA 981052037 PROJECT DESCRIPTION: A/G 120 GAL. PROP TANK, GAS LINES & HEAT STOVE - 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 6/8/2008. REQUIRED INSPECTIONS: Tank/Line/Appliance. - 24/off FinalApproval: 7 25lo 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 APPLICATIN BLD07-00298 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00298 Received Date: 6/8/2007 SITE ADDRESS: 65 SUTTER ST PORT TOWNSEND, 98368 OWNER: PETER B RHINES PHONE: 360-379-1457 LINDA S RHINES 5753 61 ST AVE NE SEATTLE WA 981052037 TIBBALS LAKE PARK SUBDIVISION: Block: Lot: PARCEL NUMBER: 999006704 Section: 33 Township: 31 N Range: 01 W 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 A/G 120 GAL. PROP TANK, GAS LINES & HEAT STOVE - 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: 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: G ti/O-) 60 httA) Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $153.00 AMS 06/08/07 91262 Total: $153.00 (( a SITE VISIT REPORT , (PLOT PLAN) JOB r?E R \--,»0A ')1-\ DATE : 3/0110' CONTACT: ADDRESS (.0 TEL. ie,A, PHONE #: DIRECTIONS FAX #: Email _PLANNER: �L—-- `Jew e < <60 Leu it >W Q IQ"C v_ 1 • TTAL/4 3.E' Fr Pg. ,.9,06- 3E la.& cvH/72 772.yn 6o, . c p 17-1-► ?t*P e l o-r O u 4 Imo'. N y4. •. JEFFERSOTCOUNTY } if (I vl�;1I4t1 1110 vo DEPARTMENT OF COMMUNITY DEVELOPMENT Aii) . 621 Sheridan Street • Port Townsend •Washington 98368 . ,.p 360/379-4450 • 360/379-4451 Fax LUQ7 gSNO,p www.co jefferson.wa.us/commd elopment -trI "el lei Cflii/ Master Pe it Application MLA: ProjecttDescrip on(include separate sheets as necessary): Prot) 14 l( G 9.i Fi p e/ G 4.1' 14 Sbb - Tax P.rcel ni�if Property Num•er: 00 l 7 ( v Size: (acres/square feet) Site Address an. or Directions to Property: 5 5 Ll T T e I2--- Property Owne (s)of Record: ?kg—T/2—( /i- d ry /A/ L S Telephone: 3 r7 q - I LI.5 7 Fax: email: Mailing Addres 57 5 3 6- /S r A IJ(- , Ai z , , S c'G-z'(-L.-- I,✓4 Applicant/Age t(if different from owner): _S/'4$ (//V E i. ,e0P!9--AJ' Telephone: ,3 a S S 75 7 Fax: ,F g,5 —5& 7f email: /A/F0 ,-57 i/riSi/rlcp/cf/erJ Mailing Address: / 0 FS 7C o c/ ,0 re , PT Jr/ �o c/c (..()/ - 9 3 cj What kind of Permit?(Check each box that applies) 0 Building ❑Variance(Minor, Major or Reasonable Economic Use) El Demolition Permit ❑ Conditional Use[C(a),C(d),or C]** ❑Single Family 0 Discretionary"D"or Unnamed Use Classification ❑Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** ❑Manufactured Home ❑ Boundary Line Adjustment ❑Modular ❑ Short Plat** ❑Commercial* 0 Binding Site Plan** ❑Change of Use 0 Long Plat** ❑Address ❑ Road Approach 0 Planned Rural Residential Development(PRRD)/Amendments** X Propane ❑ Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management El Shoreline Management Substantial Development" ❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance ❑Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment O Forest Practices Act/Release of Six-Year Moratorium *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: SIGNATIO a GENT I he ••y d': t as .gent i att- : - a i is . '..0: ion (s). •w." T ' .�:ate: 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 knoMedge. 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 attomey'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 required later ins ctions.Access and right of entry to this property shall be requested and shall occur only during regular business hours. f / (� � cl Signature: ,'i'/� 44- 3 Date: / /) &GC1 / pi ;2/W/ 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 potential lake"of an endangered species as those terms are defined in the federal law known as the "Endangered Spe:ies 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 ypu are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferabl responsibili" for adherinn to d complying with the ESA. The Applicant has read this di mer and sins and dates it below. 7 Signature: v( �( 5 f�',' "_—'L2 Date:��V 1 p `� / G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc OWNER BUILDER STATEMENT • t 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. the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRA OR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: Sun .fhl/ t p20P tJ (36a) 38SS797 (366) 38s • S87s MAILING ADDRESS: / Q 3 2`S ? fil.-Q 0 v 0 r< EMAIL: 1 n Fo ft..?r1c- ,h e pg a p i-t . c oM CONTRACTOR'S LIC: SE ` A \ WAINS �' NUMBER: J (I/ ,V' S/JO c 0/7 7a P NUMBER ARCHITECT/ENGINE:R: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: ❑ Sewer O Addition 0 Steel Proposed: Bank ❑ Community System O Alteration/Rem•del 0 Concrete Total: Height: ❑ Individual System O Repair ❑ Masonry SEP Permit# O Demolition 0 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 X_Above ground Tank Size of Propane Tank: / a C q,/L Heat Stove ❑ Cook Stove ❑ Woodstove ❑ Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove Other - /P� 1s 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 For Office Use Only Current Proposed Amount Main Floor Consistency Review: 4 : 2Nu Floor Base fee: 3`°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 Receipt Number: ( 1 r 41, ` Other 4ash/Check Number: ;- ; ,1 ESTIMATED COST(REQUIRED) Date: i �� ` •Fair market value of all labor and materials foundation to finish' ..I Initials: ( G:\PemritCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc