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HomeMy WebLinkAboutBLD2007-00371 • • 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 #: BLD07-00371 Received Date 7/12/2007 SITE ADDRESS: 60 MACHIAS LOOP Issue Date 7/12/2007 PORT LUDLOW, 98365 APPLICANT: ROBERT L AZEN PHONE: 360-437-9677 PO BOX 65495 PORT LUDLOW WA 983650495 93 SUBDIVISION: PORT LUDLOW NO 1 Block: Lot: PARCEL NUMBER: 990400489 Section: 9 Township: 28N Range: 01 E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2008 OWNER, ROBERT L AZEN PHONE: 360-437-9677 if different: PO BOX 65495 PORT LUDLOW WA 983650495 PROJECT DESCRIPTION: A/G 120 GAL PROP TANK, HEAT STOVES W/GAS PIPE - 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 7/12/2008. REQUIRED INSPECTIONS: Tank/Line/Appliance: fiiAue i L.11ES 7-- FRee iJC $-rm6S O - 06.4-7 GL FinalApproval: Oe_-cot-(1),ad! $/LWpb 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 Review 0371 R !UILDING PERMIT APPLICAT!N B Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00371 Received Date: 7/12/2007 SITE ADDRESS: 60 MACHIAS LOOP PORT LUDLOW, 98365 OWNER: ROBERT L AZEN PHONE: 360-437-9677 PO BOX 65495 PORT LUDLOW WA 983650495 PORT LUDLOW NO 1 SUBDIVISION: Block: Lot: 93 PARCEL NUMBER: 990400489 Section: 9 Township: 28 N Range: 01 E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2008 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr A/G 120 GAL PROP TANK, HEAT STOVES W/GAS PIPE - NO MLA REQ'D TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: CODE EDITION: 2006 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 D e: n i\a 0") C4,./J Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $153.00 AMS 07/12/07 91480 Total: $153.00 IP • SITE VISIT REPORT (PLOT PLAN) JOB (-1. ii`)E P_.T A ©J DATE : 7/o 6467 CONTACT: . ADDRESS PHONE #: . DIRECTIONS FAX #: . Email . PLANNER: .sue . A `- I ' i a 4.. '"s lV pi � o�� � I_ ti7' 1 I I _1 g°4( I 1 I i \/ 1 9 ,------ 6. 0Q4,ic 4„a ' '''' 91R4 IFIA-441 )) . i ON o© JEFFERSO UNTY DEPARTMENT OF COMMUNITY DEVELOPMENT _ 1-, ` -1621 Sheridan Street • Port Townsend •Washington 98368 JUL 1 1 2007 �, ma, 360/379-4450 • 360/379-4451 Fax .4 �p www.co.jefferson.wa.us/commdevelopment ti,��;''f tt f)Ij r� N J V EI' Master Permit Application MLA: Kt e) Y'v1 LG v`-C 6'lC\ Project Des ription (include separate sheets as necessary): �// &67 Q,� ra ; p e ; ) IA tea, Tax Parcel Property Number: 9 9 0 1/° ° /�y Size: (acres/square feet) Site Address and/or Directions to Property: CPS ? t ,� �oo� P 7 . Lt,_ �., � CJ3. Property Owner(s)of Record: 4 Co G2?' IA Telephone: 3 7.— 9' 7 7 Fax: email: Mailing Address: fD ,eepZ (aSl9-5- Pr 0 LDC)1 (..J 4- 9 4'3 Gam$ Applicant/Agent(if different from owner): S(.l._NS I I I N E P Ro ?A N E Telephone: 385 571 7 Fax: 38S S875- email: IN Foe SUAISN/NE ProP,W2e. Mailing Address: 104353 RHODy D 2• � fl i KF}0 Eck, l.J A- 9 83.E cool 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 ❑ Short Plat** ❑ Address 0 Road Approach 0 Binding Site Plan** ❑ Home Business 0 Cottagelndustry 0 Long Plat** ,Propane 0 Planned Rural Residential Development(PRRD)/Amendments** ❑ Sign ❑ 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: 44), Suds H INE" N ADESIGNAtTION OF AGENT I hereby designate / �j� to act as my agent in matters relating toto this application for permit(s). `�WNER SIGNATURE ✓ / `A " �at j / / <7L/' 07 By signing this application fo ,the o r/agent attests that the information provided herein,and in any attachments,is true d correct to the best of his,her or it's knowledge. Any matey falsehood or any omission of a material fact made by the owner/agent with respect t 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. G�� 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 U review and any required later inspecti s. Staffs access and right of entry will be assumed unless the applicant informs the oun in writing at the time of the a plication e she w grior tp ice. // �J 1 ignature: t� Date: L v 7 The action or actions Appli ant will u d ake as a result of the issuance of this permit may negatively impact upo or m e -' eatened or endangered species and c uld lead t potential"take"of an endangered species as those terms are defined in federal �dVVl11111��nown 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 pecies regarding your (-,e action(s)even if you are in corn fiance, ith the Jefferson County development code.The Applicant acknowledges that he,sh or it do individual and non-ransferable re n 'bi' f ' he'n to and ompfying with the ESA. The Applicant has read this disci,"an gns n t7below. '44 Signature: Date: 7 ������ffffff 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: S ,tsi NE Qteo pane 11/� I (360) 385- 5797 ( 36o) 385-5875 MAILING ADDRESS: )O 853 \}-o 0 y ej U e- 1(3• fI• Ewa : (fl f(k) (,(ylsf f(v' pro pan(? a C o(t1 CONTRACTOR'S LICENSE t WAINS NUMBER: 5uh s'14 P) Dr7r1 Q P NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: O New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# O 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 and/or Appliance Installation permit,mark all items below that apply: i Underground Tank ('f Above ground Tank Size of Propane Tank: 1-2.c� CZfj--• • (Heat StoveY Cook Stove i Woodstove i Fireplace Insert i Hot Water Tank i Pellet Stove i Other )0 � Is his 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. 4 i a Square Footage Current Proposed frtu ` �- a'i,!� . ..; .;. a Main Floor Heated '"• t,, EH Bld App Review: r 2nd Floor Heated ` Consistency Review: Other Heated , ` ', Base fee: 1 "3 EO Mezzanine , ,,, • Additional Section: Heated Basement - , Plan Check fee: Unheated Basement ' f State Surcharge fee: Other Unheated b Pot Water Review fee: Garage/Carport C SUBTOTAL t� tj� I J Decks ,F. f 911/Rd Approach fee: Other TOTAL: $ •cj 3 ')i.) .y Receipt Number: Cj J �3) xri , _ , Cash/Check Number: ESTIMATED COST(REQUIRED) Date: j ('t-1 •Fair market value of all labor and materials foundation to finish1 I Initials: CI G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc