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Home My WebLink AboutBLD2007-00566 • • 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 #: BLD07-00566 Received Date 11/2/2007 SITE ADDRESS: 81 JOAN ST Issue Date 11/2/2007 PORT LUDLOW, 98365 APPLICANT: MARIE R HENDREN PHONE: (360) 437-7711 PHILIP R HENDREN 81 JOAN ST PORT LUDLOW WA 98365-9720 12+ SUBDIVISION: SHINE 2ND Block: Lot: PARCEL NUMBER: 994600211 Section: 33 Township: 28N Range: 01 E CONTRACTOR: NW GAS SUPPLY LLC PHONE: (360) 394-2285 PO BOX 1241 POULSBO WA 98370 3(360) 394-2252 Contractor's License NWGASSL997BE Expires /24/ 0uu8 OWNER, MARIE R HENDREN PHONE: (360) 437-7711 if different: PHILIP R HENDREN 81 JOAN ST PORT LUDLOW WA 98365-9720 PROJECT DESCRIPTION: (2) AJG 7 GAL PROPANE TANKS, GAS LINES AND APPLIANCES Directions HEAD FOR FLOOD CANAL BRIDGE/RT ON UPPER SINE RD/RT ON JOAN ST/3 RIGHT TURNS 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 11/2/2008. REQUIRED INSPECTIONS: Tank/Line/Appliance: 7.-;',01e T �,d�L=1�4f�e¢T 7/7 fro /1,r7 /mot; t� FinalApproval: 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 IRILDING PERMIT APPLICATI BLD07-00566 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00566 Received Date: 11/2/2007 SITE ADDRESS: 81 JOAN ST PORT LUDLOW, 98365 OWNER: MARIE R HENDREN PHONE: (360)437-7711 PHILIP R HENDREN 81 JOAN ST PORT LUDLOW WA 98365-9720 SHINE 2ND SUBDIVISION: Block: Lot: 12+ PARCEL NUMBER: 994600211 Section: 33 Township: 28 N Range: 01 E CONTRACTOR: NW GAS SUPPLY LLC PHONE: (360) 394-2285 PO BOX 1241 POULSBO WA 98370 Contractor's License NWGASSL997BE Expires 3/24/2008 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP (2) A/G 7 GAL PROPANE TANKS, GAS LINES AND APPLIANCES TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2006 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: 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: Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $153.00 KAS 11/02/07 93400 Total: $153.00 �4gO1V col,. JEFFERSO• •COUNTY 4 W z A DEPARTMENT OF COMMUNITY DEVELOPMENT '' ` -' '� 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax 4' , (ci www.co.jefferson.wa.us/commdevelopment �`SIYING- Master Permit Application MLA: Project Description(include separate sheets as necessary): Pl2cPill-J E -, l -)--- _l_- t-otz_ 'Ia.00/ \ P T __. Tax Parcel q C� 47[/ U//„C� 2 ! Property i Oo�I GC, . 1-- Number: 7 Size: (acres/square feet) 1-1 t7 1 L�.IZ -14o0C.GA{ PjfL1''Ls/fa-rt21.5 LN=2,1Z-5Nth-+G rz_o/Ri-ajCtea`' Site Address artd/or Directions to Property: I 7--CA �-�T. PO P-1 ' 0 vo IN A ( fz,-, -f-u is) Property Owner(s)of Record: P-1 t_ P / ('/ / 4 fie- E`-- 1i�E. J O I-2 t`I Telephone: -31:0 I-V 7 7( ( Fax: email:fJVl�l 1Ci b"e1''t S E 114 LC VV\ Mailing Address: 0 ( 3t"Pt,-I �7T' Pc)1=r w 1)1- ‘j t,/V A 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)** ❑ Commercial* ❑Boundary Line Adjustment ❑ Change of Use ❑Short Plat** ❑ Address ❑Road Approach ❑Binding Site Plan** ❑Home Business ❑Cottagelndustry ❑Long Plat** )0—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 Vegetation Request *May require a Pre-iftp4ill¢alio/r copfe arrnt **Requires a Pm-Application Conference Please identify any ott9t.local state'br federal permits required for this proposal, if known: 0 (1 DESIGNATION OF AGENT I hereby designate NOV 2 2007 to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE cirri, , Date: By signing this application form,;h��t r j t tAinratl`t1`tlnformation provided herein,and in any attachments,is true and correct to the best of his,her or it's knowledge. Any material'alse ood 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 appli • r she w p• r notice. Signature: / C Date: ///'2"12-e"O 7 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 e in co pliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transfera b or ing to and complying with the ESA. The Applicant has read this disclaim r and igns and dates it below. Signature: �/ L ,, Date: //-7 /7 Uc 7 G:APcrmitCentcr\###FORMS###\DRD FORMS\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: N 1,v L'2-� 7 ))_ 1 - (6o) GL/ Z2 6 (' ) 3c]9 2_2/3 Z MAILING ADDRESS: 17. ) /<_(' 1'2 4 i `))J f INN— EMAIL: NIA,&p.c5e EA1 l�ra MA'i L,C1,'M CONTRACTOR'S LICENSE / WAINS NUMBER: P.L1jL.` S 1-g c 7 f 1 NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Pro' Fram Bathrooms: Shoreline: Type of Sewage Disposal: -ANe oer w (_Wo Existing: `� Sewer ddition Steel Proposed: 49 Bank Com nunit;system Alteration/Remodel Concrete Total: Height: ndivi ual System Repair Masonry SEP Permit# Demolition Other: Bedrooms: 2 Water Supply: Existing: J Setback: Private well Two Party Type of Heat: Proposed: G°> Public t7"11Zti Total: Nqjne of System: 2t?Ili-P p/?� 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 Ap lime Installation permit,mark all items below that apply: I Under round Tank I Above ground Tank Size of Propane Tank: Z - 7E7+N-1-- Heat Stove I Cook Stov - Wuudgtove I Fireplace Insert I Hot Water Tank I Pellet Stove I Other Is ' ap I nce being installed in a Manufactured/Mobile Home? Yes N 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"0 Floor Heated Consistency Review: Other Heated Base fee: 153 ^ Mezzanine C J J�<\' �� Additional Section: ��lJ Heated Basement 1a`L Plan Check fee: Unheated Basement NOV 0 2 n07 State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport JEFI EFSON CEJIJN1Y DCD SUBTOTAL 155.00 h Decks 911/Rd Approach fee: Other TOTAL: $ `5 3 co Receipt Number: l 3i-1 ot Cash/Check Number: ..3-1 Li i ESTIMATED COST(REQUIRED) Date: U� i7market value of all labor and materials foundation to finish / l / � 7 Initials: 1 G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc 0 erZitaS® ... Made in Canada ^ Innovation in tools® 10 7 . = —:-E . from the workberich 4 °Me:6 i P 17°1L1) - 9 4 • -..- IP -:-2 oolz 4 i,i p f!-Jy--Qp , 4. 7 621_,_-3(30-ryt__A IS- •%. 4 3,---f-- 1 it. ;22_ -: - = '''• , ....... .. 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