HomeMy WebLinkAboutBLD2007-00309 • •
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 #: BLD07-00309 Received Date 6/12/2007
SITE ADDRESS: 442 FOXFIELD DR Issue Date 6/12/2007
PORT TOWNSEND, 98368
APPLICANT: CRAIG H SOMES PHONE: 360-385-3087
LAURIE A SOME
S
1240WSIMS WAY PMB72
PORT TOWNSEND WA 983683058 91
SUBDIVISION: KALA POINT#4 Block: Lot:
PARCEL NUMBER: 965000085 Section: 27 Township: 30N Range: 01W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI983O6 Expires 9/26/2008
OWNER, CRAIG H SOMES PHONE: 360-385-3087
if different: LAURIE A SOMES
1240 W SIMS WAY PMB 72
PORT TOWNSEND WA 983683058
PROJECT DESCRIPTION: A/G 120 GAL PROP TANK, LINES, FREESTANDING GAS 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 6/12/2008.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: It.t' llA.sa 0 k. - lb -4'—Q l
FinalApprovala—I 0 `2Z- l
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
�ILDING PERMIT APPLICATION RDOe 00309
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD07-00309 Received Date: 6/12/2007
SITE ADDRESS: 442 FOXFIELD DR
PORT TOWNSEND, 98368
OWNER: CRAIG H SOMES PHONE: 360-385-3087
LAURIE A SOMES
1240 W SIMS WAY PMB 72
PORT TOWNSEND WA 983683058 KALA POINT#4
SUBDIVISION: Block: Lot: 91
PARCEL NUMBER: 965000085 Section: 27 Township: 30 N Range: 01 W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI983O6 Expires 9/26/2008
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP A/G 120 GAL PROP TANK, LINES, FREESTANDING GAS STOVE
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 LYK 06/12/07 91226
Total: $153.00
cgs t^o& JEFFERSON COUNTY : ) \ _i V.
BA )11
;�4 ' 'i:_ 4 DEPARTMENT OF COMMUNITY i ' OPMENT
al
'n - "4 621 Sheridan Street• Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
l-p' ' www.co.jefferson.wa.us/commdevelopment
1`SBING� ,1A ` ,it: A: kb M LA- P�c?tD
Master Permit Application �ttt
Project Description Include separate sheets as necessary): c _/C��C, ,C ��n�c�,,L_vn
. .totz. Pyovane ton A" and ee fark,,, yC Tf e,
Tax Parcel / ,�T� E� Property �5-p.56 t (acres/square feet)
Number: 6 640 Size: b
Site Address and/or Directions to Property:
42 Fox-PieI 01, 1'0v —FYWfl�; Ind, I4J( - q8e16 ff
Property Owner(s)of Record: S�
; A
Telephone: 3 S �k
Fax: a ail: V c v dl'1L! -mil
Mailing Address: yy7_ i�f_Y PV . SZ• Part inLi%ilseifyi1 IIi16 . (IRAC
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 Cj*"'
❑Single Family 0 Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification
❑ Manufactured Home ❑ Modular ❑Special Use(Essential Public Facilities)**
❑ Commercial* ❑Boundary Line Adjustment
❑ Change of Use 0 Short Plat'"'
❑ Address ❑Road Approach ❑Binding Site Plan**
❑Home Business ❑Cottagelndustry ❑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 ❑Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* El Jefferson County Shoreline Master Program Amendment
❑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:
-m DESIGNATION OF AGENT
I hereby designateJCa r)tatiL- eD frejkto act as my agent in matters relating to this application for permit(s).
,
OWNER SIGNATUF�k`��'��� '(Jh / 11-. YL,L �J) Date: er /Z d,7
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 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 inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the appli ti at he or*he wan s jrior notice. Jt
Signature: 11 � l/Z Date: e
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"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 y re in compliance with Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-tran responsibility for adhe g to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signat A. Date: (-,-/2 -0-7
C:\Documents and Settings\canal\Local Settings\T'emporary Internet Files\OLK86\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 assum the responsibility �1�Genneral Contractor for the proposed • • :•.
Signature/.�/ELL- ,„��/ Date: r ��{I� / 2 C��Q�
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
�/I, /y AlOartia/ ��a� IL) .-bgg3 )
MAI ING ADDRESS: c- C ( tir)()('f'm� Cl�
CONTRACTOR'S LIC NSE 2 r. cy( /r.�j O e 1 /, ��;, WAINS
NUMBER: /�Z5 L �NCUCYL K�i (.L/L( NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
i New [1 Wood Existing: L I Sewer
Li Addition ❑ Steel Proposed: Bank ❑ Community System
[i Alteration/Remodel [1 Concrete Total: Height: [i Individual System
❑ Repair [1 Masonry SEP Permit#
[, Demolition [1 Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well Li Two Party
Type of Heat: Proposed: i 1 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 XAbove ground Tank Size of Propane Tank: /
Meat Stove 0 Cook Stove 0 Woodstove 0 Fireplace Insert 0 Hot Water Tank 0 Pellet Stov' ❑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 Bid App Review:
2na Floor Heated Consistency Review:
Other Heated Base fee: 1 ,—
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL �)
___
Decks 911/Rd Approach fee:
Other py,C)ctiL TOTAL: $
9t ectnL-
%>L-_ t f p Receipt Number: q
J160.60 Cash/Check Number: ass
ESTIMATED COST(REQUIRED) Date: •f�(,
.Fair market value of all labor and materials fo ndation to finish D1 0-1
Initials:
(...._,:,
---J-566/ 1-0 c
C:\Documents and Settings\carat\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-19-2OO6.doc
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