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Home My WebLink AboutBLD2007-00438 • • 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 #: BLD07-00438 Received Date 8/7/2007 SITE ADDRESS: 50-4 HIGHLAND GREENS Issue Date 8/7/2007 PORT LUDLOW, 98365 APPLICANT: ERIC T ROBISON PHONE: 360-437-1152 305 BLUEBERRY HILL RD PORT LUDLOW WA 98365 SUBDIVISION: HIGHLAND GREEN CONDOS BLDG #1 Block: Lot: PARCEL NUMBER: 959500004 Section: 21 Township: 28N Range: 01 E CONTRACTOR: OWNER/BUILDER PHONE: OWNER, ERIC T ROBISON PHONE: 360-437-1152 if different: 305 BLUEBERRY HILL RD PORT LUDLOW WA 98365 PROJECT DESCRIPTION: 120 GAL A/G PROP TANK W/GAS STOVE - 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 8/7/2008. REQUIRED INSPECTIONS: Tank/Line/Appliance: J r/oir ,�/, 4k 4/S/D7.AZ �,Qiss' 5t4uD,Nt --revE 6 4/sf61 FinalApproval: — /ANK -gilegm fg v 4/7/07 a -Per .?,.a.i4 a7 7/6-7, 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 10/29/19 ItILDING PERMIT APPLICATTN BL vy438 Reviewiew T Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00438 Received Date: 8/7/2007 SITE ADDRESS: 50-4 HIGHLAND GREENS PORT LUDLOW, 98365 OWNER: ERIC T ROBISON PHONE: 360-437-1152 305 BLUEBERRY HILL RD PORT LUDLOW WA 98365 HIGHLAND GREEN CONDOS BLDG #1 SUBDIVISION: Block: Lot: PARCEL NUMBER: 959500004 Section: 21 Township: 28 N Range: 01 E CONTRACTOR: EMERALD HEARTH AND HOME PHONE: (360)779-7567 20714 SR 305 POULSBO WA 98370 Contractor's License EMERAHH975PO Expires 10/20/2005 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr 120 GAL A/G PROP TANK W/ GAS STOVE - 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 DateF 7 0 Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $153.00 AMS 08/07/07 91596 Total: $153.00 �¢gpx c�0 JEFFERSO OUNTY " 4.1,II \\I II-4',II I. 4 W ' DEPARTMENT OF COMMUNITY DEVELOPMENT '' PC 621 Sheridan Street • Port Townsend •Washington 98368 AUG 0 7 2"7 360/379-4450 • 360/379-4451 Fax �' p$ www.co.jefferson.wa.us/commdeveloprnent 4k\ '4S�INGS 1111 11! MINI! Master Permit Application MLA: Project Description(indude separate sheets as necessary): .] _ ij ti�4"c�1 1 roV7,...Te -t r2.' L ..i ( 3-lcof Tax Parcel Property Number: y_j 9 c'em('},l Size: (acres/square feet) Site Address and/or Directions to Property: 50 Highland Green Unit 4 Port Ludlow Wa. 98365 Property Owner(s)of Record: Eric Troy Robison Telephone:(360)437-1152 Fax: email: vickiedepudy1515@yahoo.com Mailing Address: 305 Blueberry Hill Rd.Port Lodlow Wa.98365 Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: 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 C]** ❑Single Family ❑Garage Attached/Detached ❑Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home ❑ Modular 0 Special Use(Essential Public Facilities)** ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use ❑Short Plat** ❑ Address ❑Road Approach ❑Binding Site Plan** ❑Home Business ❑Cottagelndustry 0 Long Plat** I Propane ❑Planned Rural Residential Development(PRRD)/Amendments** ❑Sign ❑Plat Vacation/Alteration** ❑Allowed"Yes" Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisions** ❑Stormwater Management ❑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: DESIGNATION OF AGENT I hereby designate Eric Troy Robison to ad as myagent in matters relatingto this application for permit(s). i� 9 PP P ( ) OWNER SIGNATURE L,_l f_ -, f'.4 Date: - .' _C y- 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,indemnity 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 try t Jefferson County and its employees,representatives or agents for the sole purpose of application review and any required later inspections. Sta s ccess and right of entry will be assumed unless the applicant informs the County in writing at the time of the application tht.Ae-ersisawants pri atice- _c� Signature: ' Date: d�--3 —0 R 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. incl. ual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in compliance w ith Jeff County development code.The Applicant acknowiedues that he.she or it holds individual 1 ;f non-tc-an f e rile ra. iF•i „„ r'qf t - ES to e ' t hasreadthis"s l d signs a ti bc,cw vpnrii;4 erc rp,y: �,Z;h the A. ^r�.ica^, r;,c s a �i9l1�1<!r�_ irr> --J� l intr' �' `D 1 Ill • 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: .rt'te ii jj!!11 GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: Eric Troy Robison ( 360) -1152 ( ) MAILING ADDRE . vickie 1515@ya . m E vickiadep 1515@yah . m CONTRACTORS LIC SE WAINS NUMBER: finegee- Ate_ • pc....., 41..G MBER ARCHITECT/ENGINEER: \ � � PHO 3l(0) 7 7 -,y C- g ' ,Cc-) T) •9-5 MAILING ADDRESS: .20-1./,,‘ S' �.- y 3�S t tii) h., .�� 3 EMAIL J Project Type: Frame Type. Bathrooms: Shoreline: Type of Sewage Disposal: New I/' Wood Existing: 2 ev Sewer Addition II Steel Proposed: Bank Community System Alteration/Remodel I Concrete Total: Height: Individual System Repair 1 Masonry SEP Permit# Demolition ' Other: Bedrooms: Water Supply: Existing: ,A, Setback: _ Private well ! Two Party Type of Heat: Proposed: tc Public Total: 2 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 Ta9k and/or Appliance Installation permit,mark all items below that apply: ❑Underground Tank la Above ground Tank Size of Propane Tank: a') Get.i ,, o Heat Stove 0 Cook Stove 0 Woodstove ❑ Fireplace Insert 0 Hot Water Tank ❑Pellet Stove Lf Other Gjct5 Stogie_. 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: 2'Floor Heated Consistency Review: Other Heated Base fee: I- - 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: $ l 5.3 63 Receipt Number: G I t�v! Q Cash/Check Number: (�n Y�� ESTIMATED COST(REQUIRED) Date: 4,rJ-) )61 Fair market value of all labor and materials foundation to finish U Initials: O ,° C:\Documents and Settings\caral\Local Settings\Temporary Internet Files\0I,K86\Master Permit Application 12-19-2006.doc 0 0 , _ . _ _ . _ _ _ __ • T _ __ _ ----i- — ---. _ r_o____—_,--___ ). SA L 1-----r—rr 11 1 .,4V 1, —1; , I zai ILI_ _ , , 1 ti i )-- •=t1 c 1 1.14 --y I I edi ,k-J —II '73 t <. !i c-i' li _ _ _ _ _ 1 11 1_ _r F , _ __.......1.......,i __ 1 .i I I A-- - i 1 --- Xit0 , 1.-4A '- .-t. 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