The URL can be used to link to this page

Home My WebLink AboutBLD2007-00542 • . . . . ;.: 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 #: BLD07-00542 Received Date 10/15/2007 SITE ADDRESS: 274 SMITH RD Issue Date 10/15/2007 NORDLAND, 98358 APPLICANT: JOHN DERN JR PHONE: 360-385-7458 SARAH J DERN PO BOX 55 NORDLAND WA 983580055 SUBDIVISION: Block: Lot: PARCEL NUMBER: 921051036 Section: 5 Township: 29N Range: 01 E CONTRACTOR: DOUBLED ELECTRICAL INC PHONE: 360-385-1130 PO BOX 957 PORT HADLOCK WA 98339 Contractor's License DOUBLDE982PD Expires 1(0369/4�008385-5761 OWNER, JOHN DERN JR PHONE: 360-385-7458 if different: SARAH J DERN PO BOX 55 NORDLAND WA 983580055 PROJECT DESCRIPTION: 500 GAL U/G PROP TANK, & 18 KW GENERATOR- NO MLA REQ'D Directions 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 10/15/2008. REQUIRED INSPECTIONS: Tank/Line/Appliance: /6-1 3—el Z ,r FinalApproval: I p i 7 -,y 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 GILDING PERMIT APPLICATIN BLD07-00542 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00542 Received Date: 10/15/2007 SITE ADDRESS: 274 SMITH RD NORDLAND, 98358 OWNER: JOHN DERN JR PHONE: 360-385-7458 SARAH J DERN PO BOX 55 NORDLAND WA 983580055 SUBDIVISION: Block: Lot: PARCEL NUMBER: 921051036 Section: 5 Township: 29 N Range: 01 E CONTRACTOR: DOUBLED ELECTRICAL INC PHONE: 360-385-1130 PO BOX 957 PORT HADLOCK WA 98339 Contractor's License DOUBLDE982PD Expires 10/4/2008 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION 500 GAL U/G PROP TANK, & 18 KW 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: 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: �� .� "II' L )/ y Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $153.00 AMS 10/15/07 93414 Total: $153.00 • R i=i-t,,---,,,,-, . ,r- ' .---N\ • ,.¢SON cO& JEFFERSOCOUNTY ' \ 3 DEPARTMENT OF COMMUNITY DEVELOPMENT oAr ' ` `'4 621 Sheridan Street • Port Townsend •Washington 98368 0 C s 1 3 2007 360/379-4450 • 360/379-4451 Fax % p" www.co.jefferson.wa.us/commdevelopment JEFr 11r�O sa COUNTY 0.0� Master Permit Application MLA: nip (y\ ( O` t^t' Project Description(include separate sheets as necessary): r•S-t-a.l I 1 n U ae t +o t2 Tax Parcel rt, C V /. Property Number: "I dI Q' O 3 b n Size: (acres/square feet) Site Address and/or Directions to Property: 79 '1)1 t Rd� t\ 0 f" l a k()l . Property Owner(s)of Record: Jbh h c 3' rah. b e.rIA Telephone:.3/ t --38 5-7g5g' Fax: 3 •-3 /,303 email: Mailing Address: ;7 '74t �5yyvi i-i-i Rd • Applicant/Agent(if different from owner): t40(iiL)I P D E_I ELrive ac I Telephone: 360-.35I-5-//30 Fax: 3bO -3N - 571vi email: viciclel odd 0603- Icad, Mailing Address: P.O t PAC X 95.1- Pi- . 1-hail ock__1U.) 96 331 CD ill• 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 Discretionary"D"or Unnamed Use Classification ❑Garage Attached/Detached 0 Special Use(Essential Public Facilities)** ❑ Manufactured Home 0 Boundary Line Adjustment ❑ Modular 0 Short Plat** ❑ Commercial* 0 Binding Site Plan** ❑ Change of Use ❑ Long Plat** ❑ Address ❑ Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** $..Propane 0 Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** ❑Stormwater Management 0 Shoreline Management Substantial Development** ❑Site Plan Approval Advance Determination(SPAAD)* ❑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: g \C '^1 \ e t -fj DF�SIGN act OF AGENT I herebydesignate 1>yUuu E l� ��1��j Ccc..(�� to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE_�'I,Ve ii cJl/_.l,(/1 Date: ICE/I�)`r) 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 applicatiga'fhat he or w is prior,,notice. _ Signature: ` ..,2,:�k�� '��l t ��i�i,'C /' in 7 Date: /r-'//�j/G7 The actior?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-transferable sponsibility_f9r aging and co plying with the ESA. The Applicant has read this disclai r and signs and dates it below. Signature:��y, �C,� y / c17/er PAX«k.--6 Date: /& S/o7 C:\llocuments and Settings\carat\Local Settings\'Temporary Internet Files\OLK86\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 as ing the respoonsibpity of the General Contractor for the proposed project. Signature: -Cam?-��G Date: 10/s77 GENER CONTjlAQTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: 6��M g,,,4Lp�/rGir,`L (3[s0) 3gS- 1(3o (36v) 38S376J MAI ADDRESS: 7O064E EMAIL: CONTRACTORS LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: Po 60A (75 7 PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: • New ❑ Wood Existing: ❑ Sewer • Addition 9 Steel Proposed: Bank Community System U Alteration/Remodel ❑ Concrete Total: Height: 1 Individual System Repair ❑ Masonry SEP Permit# 9 Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: U Private well 9 Two Party Type of Heat: Proposed: 9 Public Total: Name of System: I 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: , ,21 Underground Tank ❑Above ground Tank Size of Propane Tank: fit? ❑Heat Stove ❑Cook Stove 0 Woodstove ❑Fireplace Insert ❑Hot Water Tank ❑Pellet Stove . .Other le Ne r(6 6 Is this appliance being installed in a Manufactured/Mobile Home? Yes C 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: 2na Floor Heated Consistency Review: Other Heated Base fee: C- 3 dU Mezzanine Additional Section: 1 7 Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL (5eSD Decks 911/Rd Approach fee: Other TOTAL: $ I�3 Receipt Number: 61 3,-1 I t_( Cash/Check Number: 6 ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish 101 n al Initials: C:\Documents and Settings\caral\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.doc �� 0 \ _. - c6 -- = OCT 1 5 2007 1.1 i 4 .... \ c.) 0 c'. Jo... , :,,, ‘ SZ /0LI • /'..) t IN