Loading...
HomeMy WebLinkAboutBLD2007-00426 • • 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 #: BLD07-00426 Received Date 8/3/2007 SITE ADDRESS: 2098 ANDERSON LAKE RD Issue Date 8/3/2007 CHIMACUM, 98325 APPLICANT:,- PHONE: PHONE: 4 SUBDIVISION: FINNERTY-HANSEN SHORT PLAT Block: Lot: PARCEL NUMBER: 901103013 Section: 10 Township: 29N Range: 01W CONTRACTOR: 4 DOUBLED ELECTRICAL INC PHONE: 360-385-1130 PO BOX 957 PORT HADLOCK WA 98339 3B l 385 Contractor's License DOUBLDE982PD Expires 1(0/4/2008 5761 OWNER, ALBERT J SCOTT PHONE: if different: 2098 ANDERSON LAKE RD CHIMACUM WA 983259761 PROJECT DESCRIPTION: A/G 250 GAL. PROP TANK.W/GENERATOR - 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 8/3/2008. REQUIRED INSPECTIONS: Tank/Line/Appliance: txT6-R/ug %w dk fr�b o7� �Rrflr' ZlioK Die RAP At Ga'ivEr2ATeP Ok 8/ J 7 G FinalApproval: OK-Per Pi na..J 8/6767 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 PN BLD07-00426 APPLICATIO Jefferson County Department: of Community Development Review Type: 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00426 Received Date: 8/3/2007 SITE ADDRESS: 2098 ANDERSON LAKE RD CHIMACUM, 98325 OWNER: CI1 <..-V - -01 PHONE. aOct cLoac.r5o r , G,Ic t Rd FINNERTY-HANSEN SHORT PLAT SUBDIVISION: Block: PARCEL NUMBER: 901103013 Section: 10 Township: 29 N F Lot: 4 �� 01 W CONTRACTOR: DOUBLED ELECTRICAL INC PO BOX 957 PHONE: 360 385 1130 PORT HADLOCK WA 98339 Contractor's License DOUBLDE982PD Expires 10/4/2008 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION A/G 250 GAL. PROP TANK W/ GENERATOR - 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: CONST TYPE: GARAGE: SHORELINE: DECK: SETBACK: SEWAGE DISPOSAL: BANK HEIGHT: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $102.00 AMS 08/03/07 91589 Total: $102.00 Aug 03 07 01 : 07p Double D Electrical Inc 3603855761 r •Tr' p. 1 +• •- i ,v.R • r , • • ` 4/ 1,0J- V J... V• ' • f •• • ' • it f+IV • e.�4. k � r ff0A,r • f 7 Rlivdmi-3eyxt rtae• a r •. la•e a�. • • • jL r," • 0 ` 1 "•.. ; Mrfr •1.f ,61,E OL&Uc)1/1 ; • • • • M y'• ^Rife *•. Q ^Y ai, s k • :..RP A,r • • ♦ Y _ VV • 4• •' • •re• e T f�` rat r ■.g ` • '��' R • tl. • •�. .; • 1 r Ike -�L', ram• �� wr , • ....101 - / .*. a 19L . i'21e ,d V . • r A` r - M ie'i PrC,� /19►%k „' «• +rr- - - . r • a ,�'' I••`, ,, `A, / - • ♦I A .,`r' • . f. "• L _. r " - e r yet _ re••L C f. i► . .,•, a ra •rr J. L • V t it: • � .' 4,,e1 JEFFERSON COUNTY • • ( `� DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend •Washington 98368 _ 360/379-4450 • 360/379-4451 Fax *I .\I) quit: '`) gN ,�p www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Project D scription(include separate sheets as necessary): Tax Parcel 9 / �, 6/3 Property Number: / (• J Size: (acres/square feet) �2G S ,4Yt verso t! kQ R© ' Site Address and/or Directions to Property: Q Gil O l"I l VA a P.L!'il Property Owner(s)of Record: beR,-� �Co ft- Telephone: �t'b - 73c - 0 3 Fax: —email: Mailing Address: t:�8 /7tti(ke.('SCYI. La*-4. 0 t: g1L1ryt, IA)Q 9&- 25 Applicant/Agent(if different from owner): %,6., 1 e'/. -,. Telephone: 3Yflc •3Sr- 11317 Fax: -38, -.S'7 C:/_ email: Mailing Address: /9/ Ch=..-ue t-.,..� ( VC/ 1t•A. 9C7 What kind of Permit?(Check each box that applies) ❑Building 0 Variance(Minor, Major or Reasons le Economic Use) ❑ Demolition Permit 0 Conditional Use[C(a), C(d), or C]W ❑Single Family ❑Discretionary"D"or Unnamed Use Classification ❑Garage Attached/Detached ❑Special Use(Essential Public Facilities)** ❑ Manufactured Home ❑Boundary Line Adjustment ❑ Modular ❑Short Plat** ❑ Commercial* ❑Binding Site Plan** ❑ Change of Use 0 Long Plat** ❑ Address 0 Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** $Propane ❑ 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 0 Temporary Use ❑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: .I,\ I ESIGNAtTION OF AGENT 1 I hereby designate L D E ��eC �q to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE - Date: g(/ el 7 By signing this application form,the owner/agent attests that the i ormation provided herein,and in any attachmee((nts,i rue and correct to the best of his,her or it's knowledge. Any material falsehood or any omissio 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 applic that he or ants/prior notice. Signature: .3e Date: "3 O The action actions App cant 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 County development code.The Applicant acknowledges that he,she or it holds individual and non-transferab responsibilijy for/adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: e.� /,CQ;% Dater c-17 C:Wocuments and Settings\carat\Local Settings\Temporary Internet Files\OI.K86\Master Permit Application 12-19-2006.doc 1 • • 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: GD,Rl)rc P .t.."L (3(sC�' ✓y J S-/l�?� ( ) MAILIN ADDRESS: /t© CONTRACTORS LICENSE / ' EMAIL' NUMBER: WAINS ARCHITECT/ENGINEER: NUMBER MAILING ADDRESS: PHONE ( ) FAX:( ) Project Type: EMAIL Frame Type: Bathrooms: New Wood Shoreline: Type of Sewage Disposal: Existing: Addition C.l Steel Proposed: Sewer Alteration/Remodel Bank CommunitySystem Concrete Total: Height: y Repair ❑ Masonry Individual System Demolition Bedrooms: SEP Permit l _Other: Water Su Existing: Setback: pply Type of Heat: Proposed: Private well Two Party Total Public Name of System:_ If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current: Proposed: Number of occupants(includes owners,tenants,employees,etc) Current Number of ADA Parking Spaces: IBC Occupancy: IBC Type of construction: Pooposed l you have Food If this is a Propane Tank and/or Appliance Installation permit,mark all items e ow that apply: Service? Yes / No ❑Underground Tank [above ground Tank Size of Propane Tank: sv , ❑Heat Stove ❑Cook Stove 0 Woodstove ❑Fireplace Insert ❑Hot Water Tank ['Pellet Stove ❑Other 6%& r-c.-t. 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 I Current Proposed For Office Use Only Main Floor Heated Amount Revision EH Bld App Review: 2 °Floor Heated Consistency Review: Other Heated Base fee: a C n Mezzanine Additional Section: C) ;-�C Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL ��ll11 Decks V of 911/Rd Approach fee: Other TOTAL: $ 1 0 a 005 Receipt Number: 6) / Q 5 P-9 Cash/Check Number: ESTIMATED COST(REQUIRED) Date: C •Fair market value of all labor and materials foundation to finish G 3 jj7 + � Initials: p l�v C:\llocuments and Settings\card\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.doc 1 rtfir1j1;) .11