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Home My WebLink AboutBLD2007-00419 • • 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 #: BLD07-00419 Received Date 7/31/2007 SITE ADDRESS: 11 LAUREL ST Issue Date 7/31/2007 PORT HADLOCK, 98339 APPLICANT: JOHN T MARTIN PHONE: 360-385-3190 11 LAUREL ST PORT HADLOCK WA 983399720 SUBDIVISION: PORTAGE BAY PARK 26+ Block: Lot: PARCEL NUMBER: 989100036 Section: 1 Township: 29N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2008 OWNER, JOHN T MARTIN PHONE: 360-385-3190 if different: 11 LAUREL ST PORT HADLOCK WA 983399720 PROJECT DESCRIPTION: GAS FIREPLACE & 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 7/31/2008. REQUIRED INSPECTIONS: Tank/Line/Appliance: -Reef,' `C rAl Fie"en..4 cc 8>7/67jF FinalApproval: cr ritui 6/0/47 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 QUILDING PERMIT APPLICA.N BL Revviewiew T Ty419 ype: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00419 Received Date: 7/31/2007 SITE ADDRESS: 11 LAUREL ST PORT HADLOCK, 98339 OWNER: JOHN T MARTIN PHONE: 360-385-3190 11 LAUREL ST PORT HADLOCK WA 983399720 PORTAGE BAY PARK SUBDIVISION: Block: Lot. 26+ PARCEL NUMBER: 989100036 Section: 1 Township: 29 N Range: 01 W 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 DESCRIPTIOI` GAS FIREPLACE & 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: GARAGE: SHORELINE: CONST TYPE: 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 Total: • • SITE VISIT REPORT • (PLOT PLAN) JOB ---So .\rJ 'E- (_,A kt Y Q riJ DATE : /2-(110-R- • CONTACT: • ADDRESS PHONE #: • • DIRECTIONS FAX #: Email • PLANNER: • CQ� ao idi 4.,_ EMSTI 6 �,2. I mac' 1 ("). 4...) li `o\V1r 1 f 1 1RECEIV1:I1 I 6 °N C t iiA '/ �� ..,k4;4 O� JEFFERSOWOUNTY ` DEPARTMENT OF COMMUNITY DEVELOPMENT • 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax iy�, N�,�O� www.co.jefferson.wa.us/commdevelopment tiliNI IN1� ;I Master Permit Application MLA: �SO (Y1C/s_ ' N Project Description (include separate sheets as necessary): /9 S 7�C re j/cam.- £ G� l ` Tax Parcel 60 /�V ?/ Property Number: ��11 Size: J /CJ QJb (acres/square feet) Site Address and/or Directions to Property: / / kg ar-eS If. )0(. L<Je yo/ Property Owner(s)of Record: `J d H71/41 6- T 7 Telephone: 3,5 - 3 / O Fax email: Mailing Address: 'S/%"C--- Applicant/Agent(if different from owner): S U..NS H I IV E P Ro PA N E Telephone: 3a5-579 7 Fax: 33S'5.87S email: INF Mailing Address: 10853 R HOp D Q SUrJsN/NE ProPHti'i�. y . fl' Nl90 t_°ck, W A g 833'7 e.om What kind of Permit?(Check each box that applies ❑Building ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit 0 Conditional Use[C(a), C(d),or C]** ❑Single Family 0 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** 0 Address ❑ Road Approach ❑ Binding Site Plan** ome Business Propane ❑ Cottagelndustry ❑ Long Plat** 0 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 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* ❑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: ipteY designate �l(t�S N 11.1E Pry P DESIGNATION OF AGENT �'I hereb ,,,,�� /�� to act as my agent in matters relating to this application for permit(s). tVWNERSIGNATURE�I � , y V 7 Date: j 7 c:-' — �' By signing this application firm,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. \ v 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 re reef` ter inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the a plic fo I he o nts notice. i nature: H f � -7- 56 V -1 Dte: 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 5\ 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 i compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-ransferabl e p nsibiljt” adhe and complying with the ESA. The Applicant has read this disclaimer and si ns and dates it below. Signature: Date: " --v 7 „ G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc • BUILDER STATEMENT 0 The signer of this statement does hereby-:edify 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: SIM\S914 INS Pko page (360) 3S5- S797 ( 360) 3B5-5875 MAILING ADDRESS: )0 8,53 *ki.0 o 1/ n Ia(U e a H. EMAIL: i n ,S1 Y SHW(�e Pro Pane 6 C e CONTRACTOR'S LICENSE ( WAINS NUMBER: I(hs'14 P{ a*T7 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: Li 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 olners,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 1 Aboveground Tank Size of Propane Tank: �c / / g i Pellet Stove �'Othe" !�/ i Heat Stove Cook Stove Woodstove Fireplace Insert Hot Water Tank k Is this appliance being installed in a Manufactured/Mobile Home? Yes / No ,�r ' When applying for a permit to install a propane tank you must also submit a site plan showing all of th uildi gs, 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: — - 2 Floor Heated Consistency Review: Other Heated Base fee: Mezzanine Additional Section: Heated Basement a it Plan Check fee: . Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Iag . Decks 911/Rd Approach fee: Other TOTAL: $ I Or Receipt Number: Ci,./ 93) Cash/Check Number: �^Q ESTIMATED COST(REQUIRED) Date: � 1(J •Fair market value of all labor and materials foundation to finish T ^. ) T) Initials: c_ G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc