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Home My WebLink AboutBLD2007-00340 • S 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 #: BLD07-00340 Received Date 6/25/2007 SITE ADDRESS: 193 CAMBER LN Issue Date 6/25/2007 PORT LUDLOW, 98365 APPLICANT: BRADFORD L HART PHONE: 360-437-9947 POLLY HART 193 CAMBER LN PORT LUDLOW WA 983658781 SUBDIVISION: LUDLOW POINT VILLAGE DIV 4 Block: Lot: PARCEL NUMBER: 969800018 Section: 17 Township: 28N Ranqe: 01 E CONTRACTOR: ALKI STOVE & SPA PHONE: (360)732-4585 9445 SILVERDALE WAY NW SILVERDALE WA 98383 Contractor's License CHSIN**9790Z Expires 9/7/2008 OWNER, BRADFORD L HART PHONE: 360-437-9947 if different: POLLY HART 193 CAMBER LN PORT LUDLOW WA 983658781 PROJECT DESCRIPTION: NEW 120 GAL A/G PROPANE TANK& FIREPLACE 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 6/25/2008. REQUIRED INSPECTIONS: Tank/Line/Appliance: INK 1,0c Q/r 7/j /i r ass Imo- opt 7k, . Fe-PLAc& I SEPT Ok ROIc7 FinalApproval: - -"c- -�t,.ICJ qe770.7 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 t 0/29/19c ItUILDING PERMIT APPLICA�JN BRLD07N003340 Type:I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00340 Received Date: 6/25/2007 SITE ADDRESS: 193 CAMBER LN PORT LUDLOW, 98365 OWNER: BRADFORD L HART PHONE: 360-437-9947 POLLY HART 193 CAMBER LN PORT LUDLOW WA 983658781 LUDLOW POINT VILLAGE DIV 4 SUBDIVISION: Block: Lot: PARCEL NUMBER: 969800018 Section: 17 Township: 28 N Range: 01 E CONTRACTOR: ALKI STOVE & SPA PHONE: (360)732-4585 9445 SILVERDALE WAY NW SILVERDALE WA 98383 Contractor's License CHSIN**9790Z Expires 9/7/2008 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP NEW 120 GAL A/G PROPANE TANK & FIREPLACE 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 CJZ 06/25/07 91195 Total: $153.00 ��¢g O cO JEFFERSOSOUNTY 0 W \q ,a DEPARTMENT OF COMMUNITY DEVELOPMENT --- `.' ' 621 Sheridan Street • Port Townsend • Washington 98368 t. 1- ' _ 360/379-4450 • 360/379-4451 Fax ,.yS NG ° www.co.jefferson.wa.us/commdevelopment L.,„,, ! ) I Master Permit Application MLA: No n'1,Lil- Project Description (in a separate sheets a necess k Co/a Q0CDAA (344p1)(--4,9-4.—c--TA.,4— tcec•lax. _ Tax Parcel � Property '� `�`� Number: .'7.g O •+ 6 Ie> Size: 3/c- /4-7 C 46_ (acres/square feet) Site Address and/or Directions to Property: 1 q�3 Cr bar jot n-c TO rt Lt-t d (c lk) , 014 c W 3 &-5 Property Owner(s)of Record: j j c6 r( I_,, ao d -Po it y (4w 1-- Telephone: ,3(GC /-( '2)1 - ci ci 1 Fax: email: [Poppy S pi ci ce @.a01,Corn Mailing Address: I 1 3 Co — j-xl i b Port 1-4,.c(lo W , tut+ go,/ CJ 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 ❑ Discretionary"D"or Unnamed Use Classification 0 Manufactured Home 0 Modular 0 Special Use(Essential Public Facilities)** ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use 0 Short Plat** ❑ Address 0 Road Approach 0 Binding Site Plan** `❑r ome Business ❑ Cottagelndustry 0 Long Plat** Propane 0 Planned Rural Residential Development(PRRD)/Amendments** sign 0 Plat Vacation/Alteration** 0 Allowed"Yes" Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** 0 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 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 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. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the appllicatiion that he or she wants prjoi noti . Signature: f\mod- ,.,i12 Date: (p ,,Z,SI-C '7 --T 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 with the Jefferson Count development code.The Applicant acknowledges that he,she or it holds individual and non-trap erable r sponsibility for adhe ' g to a com ly g wi the ESA. The Applicant has read this disclaimer and signs and dates it below. Signatures m / L /< -G- f� _ Date: {c' - � G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc 0 BUILDER STATEMENT IP „. ______Th . The signer of this statemefif 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 oposed project. Sign lure: —N E L g../ r I CO—, Date: GEN AL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: p ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTORS 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: ❑ 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: i Underground Tank I Above ground Tanl< Size of Propane Tank: )2v )c\I i Heat Stove i Cook S ove oodstove i Fireplace Insert i Hot Water Tank I Pellet Stove i Other c o , 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 Bld App Review: 1 130 d 2"0 Floor Heated Ni 4. Consistency Review: Other Heated N' Base fee:et Mezzanine �� Additional Section: — Heated Basement N f A Plan Check fee: Unheated Basement 300 d State Surcharge fee: Other Unheated 1 A Pot Water Review fee: Garage/Carport 4110 d SUBTOTAL Decks N i 4 911/Rd Approach fee: Other TOTAL: $ Receipt Number: c I1 c c 1 _ casbicheck Number: 6 i v1 ESTIMATED COST(REQUIRED) I P"t 5 2��b� ICI J/ 5 ` 0 j *Fair market value of all labor and materials foupa tiptllto finalN LJ N Initials: Ch . 1 G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc J'9 `�• O • rn (t 0 " ' '\ F r m -. x "\") n o m gr .___Qm v r .-S. 'S oE't--- 4 Y.,- _ E -I GI m rn co Cl1UJ C., '� r _. i rIi X, -33.% Z m -,. Z I n m �co \ ---: G i o 1 Z \,..) \,......., fi o \ .�► o— �• 1 m �� t 0 ►- _ lit LAI ?" J E. � \ 0 r __.._,/ — z \ _ vv -o OJ le ,. . C.riti e/LT G,%r/e