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Home My WebLink AboutBLD2007-00567 • • 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 #: BLD07-00567 Received Date 11/2/2007 SITE ADDRESS: 861 OLELE POINT RD Issue Date 11/2/2007 PORT LUDLOW, 98365 APPLICANT: STEPHEN J CUNLIFFE PHONE: 360-437-0292 SUZANNE W CUMLIFFE 861 OLELE POINT RD PORT LUDLOW WA 98365 21 SUBDIVISION: OLELE POINT Block: Lot: PARCEL NUMBER: 977400015 Section: 28 Township: 29N Range: 01 E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2008 OWNER, STEPHEN J CUNLIFFE PHONE: 360-437-0292 if different: SUZANNE W CUMLIFFE 861 OLELE POINT RD PORT LUDLOW WA 98365 PROJECT DESCRIPTION: 120 GAL A/G PROP TANK W/APPLIANCES- NO MLA REQ'D Directions SEE MAP& DIRECTIONS IN FILE 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: x re ew e rk-..0 A Lr iva Z7 iL ►!/fS/6'7 / acp&-E rraR_ ,* to/i414s FinalApproval: cf� --PCi - 1,1 Ns..'I 0/24/4 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 EILDING PERMIT APPLICATIN BLD07-00567 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00567 Received Date: 11/2/2007 SITE ADDRESS: 861 OLELE POINT RD PORT LUDLOW, 98365 OWNER: STEPHEN J CUNLIFFE PHONE: 360-437-0292 SUZANNE W CUMLIFFE 861 OLELE POINT RD PORT LUDLOW WA 98365 OLELE POINT SUBDIVISION: Block: Lot: 21 PARCEL NUMBER: 977400015 Section: 28 Township: 29 N Range: 01 E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2008 REPRESENTATIVE: SUNSHINE PROPANE PHONE: (360) 385-5797 10853 RHODY DR (360)875 PORT HADLOCK WA 98339 PROJECT DESCRIPTIOI` 120 GAL A/G PROP TANK W/APPLIANCES- NO MLA REQ'D TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 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: \ ' \: 1 C� Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $153.00 AMS 11/02/07 95404 Total: $153.00 ! . SITE VISIT REPORT (PLOT PLAN) JOB STEPI 3 <f- C>uzv1t•3Nt C0h3(_.I FFE DATE : 10 130 Io-4 CONTACT: ADDRESS PHONE #: DIRECTIONS FAX #: Email PLANNER: �O J`,1V� 1 - \ 14, O I ! f1Ci 0 1\TIE LP7b EX will b o RECEJTVE c JEFFERSONtOUNTY • rr7k iiirilliko, `� DEPARTMENT OF COMMUNITY DEVELOPMENT NOV O 2007 ti i� 621 Sheridan Street • Port Townsend •Washington 98368 - • 1 Fax /� p w6ww.co.jeffe son.wa/us//ommdevelopment �t� f�}�� t COUNTY BCD �:IN t, Master Permit Application MLA: l la_ �'� /''J Project Description (include separate sheets as necessary): T ,__ , /'i a-e-/I c_fr2- �41 Tax Parcel G Property Number: I ` y66 of s Size: (acres/square feet) Site Address and/or Directions to Property: g6 ( d/elm %7 • /< Property Owner(s)of Record: -) de_,....„..iii,_, Telephone: -3 7- 63-SL- Fax: email: Mailing Address: Applicant/Agent(if different from owner): S LL NS H IN E P R_o PA N E Telephone: 3a5-5717 Fax: 3BS-587S email: INFOg Sun12H/NEProf/WC. Mailing Address: I d4353 HODy De >�• N►`r0��/� (� _ q 533 9 cool 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 CI** ❑ Single Family 0 Garage Attached i Detached 0 Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home 0 Modular 0 Special Use(Essential Public Facilities)** ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use 0 Short Plat** ❑ Address 0 Road Approach 0 Binding Site Plan** ❑ Home Business 0 Cottagelndustry ❑ Long Plat** 'gI Propane ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑ Sign ❑ 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)* 0 Shoreline Management Variance ❑Temporary Use 0 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 0 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: 2Dt-0 JG CIS I NE P(Zfl DESIGNATION OF AGENT \,I hereby designate N P e to act as my agent in matters relating to this application for permit(s). `�WNER SIGNATURE C.Date: /4/A9p By signing this application form, 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 J UUU review and any requ ed later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the a.plic• ''�n that he or she -nts prior ln.ti e. l'° ignature: it ��: _ ��..�,-. Date: iO/D 3— ) The action or actions At ant will undertake as • sult of the issuance of this permit may negatively impact upon one or more threatened or endangered species an• 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 iss ed will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your d action(s)even if yo are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and nonr_tansfe a responsibility fof adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: 1mot Date: ., i G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc 15 V • 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: SE.iN2H NE P2o pan.e (360) 3S5- 5797 ( 36o) 3BS-5875 MAILING ADDRESS: )0853 }}-OO y p�I V P. N. EMAIL: n Fo��sUv�s 1Iv\t pro purl e 6 ceoi CONTRACTORS LICENSE l WAINS NUMBER: Uv\S'N P+ 0'774 P NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: O New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# CI Demolition CI Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: 0 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 A. •liance Installation permit,mark all items below that apply: I Underground Tank bove ground Tank Size of Propane Tank: /2_0 feat Stove �`�ook Stove i woodstov- I Fireplace Insert I Hot Water Tank i Pellet Stove I Other Is this appliance being installed in a Manufactured/Mobile Home? Yes I 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 �., Rest iop Main Floor Heated , ' EH Bld App Review: 2na Floor Heated Consistency Review: Other Heated Base fee: • • ' 'f> 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: $ i G) 3 e)v 4 Receipt Number: Cfcj(-1QL I Cash/Check Number: ESTIMATED COST(REQUIRED) Date: I ' I al 0---1 •Fair market value of all labor and materials foundation to finish Initials: Ot.,3 G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc