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HomeMy WebLinkAboutBLD2007-00406 • • 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 #: BLD07-00406 Received Date 7/24/2007 SITE ADDRESS: 741 FAIRMOUNT RD Issue Date 7/24/2007 PORT TOWNSEND, 98368 APPLICANT: PHONE: PHONE: SUBDIVISION: Block: Lot: PARCEL NUMBER: 902241010 Section: 24 Township: 29N Range: 02W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2008 OWNER, MARCIA PERLSTEIN TRSTE PHONE: 360-797-7755 if different: MARCIA PERLSTEIN TRUST 2261 OLD GARDINER RD SEQUIM WA 983828718 PROJECT DESCRIPTION: INTERIOR HEAT STOVE REPLACEMENT, SAME LOCATION - 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 7/24/2008. REQUIRED INSPECTIONS: Tan.k/Lin JAppliance: 7-/f- O g 4ipiej FinalApproval: 7� /' 1 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 i IPUILDING PERMIT APPLICATTN BLD07-00406 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00406 Received Date: 7/24/2007 SITE ADDRESS: 741 FAIRMOUNT RD PORT TOWNSEND, 98368 OWNER: PHONE: SUBDIVISION: Block: Lot: PARCEL NUMBER: 902241010 Section: 24 Township: 29 N : 02 W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2008 REPRESENTATIVE: SUNSHINE PROPANE PHONE: (360) 385-5797 10853 RHODY DR (360)875 PORT HADLOCK WA 98339 PROJECT DESCRIPTIOr INTERIOR HEAT STOVE REPLACEMENT, SAME LOCATION - 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 Date: ai,� i a,,t (07 Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $51.00 AMS 07/24/07 91567 Total: $51.00 47 c©6 JEFFERSONUNTY ' DEPARTMENT OF COMMUNITY DEVELOPMENT _ ,-.2 ` `d 621 Sheridan Street • Port Townsend •Washington 98368 JUL 2 4 Z u7 _' ' . . 360/379-4450 • 360/379-4451 Fax �g �r0 www.co.jefferson.wa.us/commdevelopment 'rfU\III (II( (Vr(I Master Permit Application MLA: Project Description(include separate sheet as necessary): Tax Parcel Property Number: 6 O 4.1-- V( / O Size: (acres/square feet) Site Address and/or Directions to Property: _ 7 /7i,�rno�h f Dr_ p l - i tJ rzrefri/J Gt/�4 Property Owner(s)of Record: M/ieC/,4 /0 -/2L!' T -'-/tt/ Telephone: 7 4 7- 77.SS Fax: email: Mailing Address: -2-1 =,/ 0 Lc( 6 0;AJ 871— Applicant/Agent(if different from owner): S(.L NS N I N E P Ro PA N E" Telephone: 3a5-579 7 Fax: 38S' SO`7S email: INFO SUn1SNnJEProP ie. Mailing Address: I O 53 RHODy D 2- / i. I'- IDck , W PI- 1833`f irk., What kind of Permit?(Check each box tflat applies ❑Building 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use[C(a), C(d),or Cj** ❑ Singie Family 0 Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home 0 Modular 0 Special Use(Essential Public Facilities)** ❑ Commercial* ❑ Boundary Line Adjustment ❑ Change of Use ❑ Short Plat** El Address 0 Road Approach El Binding Site Plan** ❑ Home Business 0 Cottagelndustry ❑ Long Plat** ropane 0 Planned Rural Residential Development(PRRD)/Amendments** ❑ ign ❑ Plat Vacation/Alteration** ❑Allowed"Yes" Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** 0 Stormwater Management 0 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 ❑ 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: 2 c • 3 is 11JE PIS DESIGNATION OF AGENT \ I hereby designate H to act as my agent in matters relating to this application for permit(s). ~�WNER SIGNATURE lam+ C13-at: By signing this application form,the owner/ag t 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. k 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 1.J U 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—plicatio at he or4she wa • r e. _ 7 b /B 7 ignature: fi"�/ CDate: , �// The action or actions Applicant will u ertake 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 L\ 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 J action(s)even if you are in compliance with th Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-ransferable ponsibilityi for adhe to mplying with the ESA. The Applicant has read this disclaim and gns and dates it below. SignaturE \. At � ��1.� Date: 7 r ette 7 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: SO t $l JNtE Poparle f• (860) 3�35- 5797 ( 366) 385-5875 MAILING ADDRESS: )08,53 y 0 l J�j i) e- ��• EMAIL: j n- Q),Q 4 \sf ole_ pro pane 6 C oo CONTRACTOR'S LICENSE [' WAINS NUMBER: '3 si4 P7` 0 1�7�!7 1 Q P 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: I ❑ 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 lndergrou�sflank i Above ground Tank Size of Propane Tank: Heat Stove i Cook Stove i Woodstove Fireplace Insert i Hot Water Tank i Pellet Stove i Other nce 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: 2nd Floor Heated Consistency Review: Other Heated Base fee: 00 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: $ I Receipt Number: ) Cash/Check Number: ESTIMATED COST(REQUIRED) Date: -� al •Fair market value of all labor and materials foundation to finish t cn Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc