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Home My WebLink AboutBLD2007-00330 • • 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 #: BLD07-00330 Received Date 6/19/2007 SITE ADDRESS: 75 MARTINGALE PL Issue Date 6/19/2007 PORT LUDLOW, 98365 APPLICANT: MICHAEL H THOMPSON PHONE: 360-437-8117 LETITIA M THOMPSON 75 MARTINGALE PL PORT LUDLOW WA 983659559 43 SUBDIVISION: BAYVIEW VILLAGE DIV 3 Block: Lot: PARCEL NUMBER: 931900043 Section: 16 Township: 28N Range: 01 E CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTP198306 Expires 9/26/2008 OWNER, MICHAEL H THOMPSON PHONE: 360-437-8117 if different: LETITIA M THOMPSON 75 MARTINGALE PL PORT LUDLOW WA 983659559 PROJECT DESCRIPTION: A/G 120 GAL. PROP TANK W►APPLIANCES 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 6/19/2008. REQUIRED INSPECTIONS: Tank/Line/Appliance: /A)fe.2/AE As `j,usc Die /7, PJPA.c.E--1:4 Auto 4/2-2 FinalApproval: 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 APPLICAT!N BLD07-00330 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00330 Received Date: 6/19/2007 SITE ADDRESS: 75 MARTINGALE PL PORT LUDLOW, 98365 OWNER: MICHAEL H THOMPSON PHONE: 360-437-8117 LETITIA M THOMPSON 75 MARTINGALE PL PORT LUDLOW WA 983659559 BAYVIEW VILLAGE DIV 3 SUBDIVISION: Block: Lot: 43 PARCEL NUMBER: 931900043 Section: 16 Township: 28 N Range: 01 E CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTP198306 Expires 9/26/2008 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION A/G 120 GAL. PROP TANK W/ APPLIANCES NO MLA REQ'D TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2003 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: OCCUPANCY: 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 $153.00 AMS 06/19/07 91189 Total: $153.00 I 6. JEFFERSON•UNTY`' 4' DEPARTMENT OF COMMUNITY DEVELOPMENT '4 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax iS, N-,.s9� www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: i� (' t CC( Kt Project Description (include eparat Bets as necessary): I< C) C ..) - A Tax Pa cel Property Natter: q l ci Do C) )-- - Size: a ', Z.-D- (.4_<s_4-.(---- (acres/square feet) Site Address and/or Directions to Property:-1 NA r T1 t•Z \F� P)4A-e-e, �`-&•;'�LAA C )t)vV" , WA ci cU i✓t.J Property Owner(s)of Record:2.)M 1 0_}Z,,,__.e_) �� . - ,," TeleP 4 7 .ri!) i ] Fax: Mailing Address: 'T j --7 email:lm C-l- .r -?, (�R y� o t� Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies ❑Building 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit 0 Conditional Use[C(a), C(d),or C)** ❑ Single Family ❑ Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home 0 Modular 0 Special Use(Essential Public Facilities)** ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use 0 Short Plat** ❑ Address ❑ Road Approach ❑ Binding Site Plan** ❑ Home Business ❑ Cottagelndustry 0 Long Plat** l$Propane 0 Planned Rural Residential Development(PRRD)/Amendments** 0 Sign 0 Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management 0 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 ❑ 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 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:-. taffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applion that he or she wants p`r' r notice. Signature. _ -- � t_12:1.-. 2_c.`—`—. Date: (</lC''i)t•-J 7 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 you are in compliance- 'h the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transf rable responsibility for adhe ' g to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. ignature: -i r-c=--.--4 t-� — Date: bo J]�J I(D 7 'ermitCenter\###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: ( ) ( ) 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 ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: C7 Individual System ❑ MasonrySEP Permit# II De Bedrooms: Water Supply: ❑ Demolition ❑ Other: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: ❑ Public Total: Name of System: If this is a Commercial Proiect 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 Ap IiianceInstallation permit mark all items below that apply: i Underground Tank Above ground Tank • Size of Propane Tank: l a-L') ) • i Heat Stove i Cook Stoves_ i Woodstove _ : i Hot Water Tank i Pellet SoQe i Other_, l-_* }�r- Is this appliance being installed in a Manufactured/Mobile Home? Yes No builings,all property lines, tankllocation and size, distanhen apping for a permit to ces l a f romathene tpr pane tank to all property lines,ank you must also submit a site )bu)dings and sepan showing all of t c system components, including the reserve area. Square Footage I Current Proposed For Office Use Only Amount Revision Main Floor Heated EH Bld App Review: 2nd Floor Heated Consistency Review: Other Heated Base fee: i, 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 TOTAL: $ Receipt Number: 9 ( l a \ Cash/Check Number: ^ C)k0 ESTIMATED COST(REQUIRED) Date: �/ G/y�� •Fair market value of all labor and materials foundation to finish Initials: L L _`1 V G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc