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Home My WebLink AboutBLD2007-00540 • 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 #: BLD07-00540 Received Date 10/12/2007 SITE ADDRESS: 51 TALA SHORE DR Issue Date 10/12/2007 PORT LUDLOW, 98365 APPLICANT: MARTHA H MC MAHON PHONE: ROBERT W FARR PO BOX 65304 PORT LUDLOW WA 98365 17 SUBDIVISION: TALA SHORES #2 Block: Lot: PARCEL NUMBER: 998200214 Section: 22 Township: 28N Range: 01E CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTP198306 Expires 9/26/2008 OWNER, MARTHA H MC MAHON PHONE: if different: ROBERT W FARR PO BOX 65304 PORT LUDLOW WA 98365 PROJECT DESCRIPTION: 550L� 90ApGRRAL A//G PROP TANK, HEAT STOVE & HOT WATER TANK- NO Directions SEE MAP& DIREC'hiU1! P LE To Site: 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 10/12/2008. REQUIRED INSPECTIONS: Tank/Line/Appliance: ' rqk-`=' a f`-- ki 0'7 a FinalApproval: DA -c&i^ -c111a /(-Z I' !'PO / 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 ILDING PERMIT APPLICATPN BLD07-00540 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00540 Received Date: 10/12/2007 SITE ADDRESS: 51 TALA SHORE DR PORT LUDLOW, 98365 OWNER: MARTHA H MC MAHON PHONE: ROBERT W FARR PO BOX 65304 PORT LUDLOW WA 98365 TALA SHORES #2 SUBDIVISION: Block: Lot: 17 PARCEL NUMBER: 998200214 Section: 22 Township: 28 N Range: 01 E CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTP198306 Expires 9/26/2008 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOF 500 GAL A/G PROP TANK, HEAT STOVE & HOT WATER TANK- 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: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: ^ t � ' Type Amount Paid Bv: Date: Receipt: Approved/Date Propane Tanks/Stoves $153.00 AMS 10/12/07 S3408 Total: $153.00 (14\64 17)41V( 6-01,__ j 1 Ta (cK 1 d �• hJ(ck.u, (Ail A- OCT 1 2 2007 36 37— C7 -77 BON COR RYEJCi) -Vt>6e- It-f/tAr-to,pktO F'P l`St MMF ilH Y✓1 1'1C t Vow c�µ� - - - - - Y � . ti Qi ft, OVA S 'moo Pr4 t A-i\,JQ " �` ,-c \T" t,v ey/ l�\� ( v/ ike 4, °Nit , �O JEFFERScOUNTY III_� DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax 4q �p s '4' www.co.jefferson.wa.us/commdevelopment iiNG jj Master Permit Application MLA: no --l(, yell)C-I Project Description(include�+separate sheets as necessary): 2-v -t new/lu+-ded---A t 3 4'—f' p pa-i---,. �'F �^ ,./.),_,,:,c. -.fir,,- 5tc,.i-,Xtt• , i c--7)ftLe y- (7/Xi Si(b� l✓Q Ay-- LV-G4 ' ev.--1 $1W� IM.SRXX I a (( JI J to Tax Parcel ci�l J� ( I Property Number: c } Size: (acres/square feet) Site Address and/or Directions to Property: SI T°-f'� Sk r4 •�`' �'" £ (tw I-✓ t Sb J: O � L /Sad AcQ inw`=n-vy ,Mac--- to .. 2'4 lAu w,t a*- ( Property Owner(s)of Record: ^^'t'1.-0— ,-- t.'h o4 HH-4'KI )04."6-e-rP uC- -' Telephone: `r5 7.. t 7 7 7 Fax: email: Mailing Address: Po Ke,, hS-Sal`/ 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 ❑Special Use(Essential Public Facilities)** El Commercial* ❑Boundary Line Adjustment El Change of Use ❑Short Plat** ❑ Address ❑ Road Approach El Binding Site Plan** ❑Home Business El Cottagelndustry ❑ Long Plat** IWPropane ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑Sign El 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)* El Shoreline Management Variance ❑Temporary Use ❑Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* El 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 to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: 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,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 application nthat he or she wants rior notice. Signature:`6114�^'1�-- k �--G �7 Date: i 6 1 Z (.: 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. 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-transf rable responsibility f r adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature VIA-'P1-- n t f 1„,,' Date: 1 G '• 1 Z Li (::\Documents and Settings\caral\Local SettingsVremporary Internet Files\0LK86\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: /11 c.vv--. ��r,�� ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: I New I Wood Existing: i Sewer Addition Steel Proposed: Bank Community System I Alteration/Remodel I Concrete Total: Height: 1 Individual System 1 Repair Masonry SEP Permit# Demolition Other: Bedrooms: Water Supply: Existing: Setback: Private well I Two Party Type of Heat: Proposed: (1 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: ❑Underground Tank CaAbove ground Tank Size of Propane Tank: YU' J``i' ESHeat Stove 0 Cook Stove 0 Woodstove 0 Fireplace Insert C Hot Water Tank 0 Pellet Stove 0 Other Is this appliance being installed in a Manufactured/Mobile Home? Yes I l01 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"tl Floor Heated Consistency Review: Other Heated Base fee: 'j3 p" 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: $ 153 ` L) Receipt Number: CI 34 0 Cash/Check Number: al �+,, ESTIMATED COST(REQUIRED) Date: TO 0 ) 'Fair market value of all labor and materials foundation to finish 1 I �J Initials: // C:\Documents and Settings\caral\Local Settings\Temporary Internet Files\01.KSG\Master Permit Application 12-19-2006.doc