HomeMy WebLinkAboutBLD2007-00585 • •
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 #: BLD07-00585 Received Date 11/19/2007
SITE ADDRESS: 121 W EUGENE ST Issue Date 11/19/2007
PORT HADLOCK, 98339
APPLICANT: CHRISTOPHE L EDLER PHONE: (360) 379-2469
PAMELA H EDLER
PO BOX 1878
PORT TOWNSEND WA 98368-0059 1+
SUBDIVISION: IRONDALE Block: 85 Lot:
PARCEL NUMBER: 961808501 Section: 34 Township: 30N Range: 01W
CONTRACTOR: C H S INC PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CHSIN**9790Z Expires 9/7/2008
OWNER, CHRISTOPHE L EDLER PHONE: (360) 379-2469
if different: PAMELA H EDLER
PO BOX 1878
PORT TOWNSEND WA 98368-0059
PROJECT DESCRIPTION: INSTALL 120 GAL A/G PROPANE TANK AND GAS PIPING
Directions LOOK FOR 175 10TH AVE TO LOCATE HOUSE
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 11/19/2008.
REQUIRED INSPECTIONS:
Tank/Line/Appliance:p,v,_ .CacsoT/ev Ole 9/6/eg
Me6r, Li95 [�NE.e e AS Y.5-7V w, /5 i CPErr ser c,x)
FinalApproval: „ iQ 7I
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
'FUY' lrz C k ►-v. S h1 a. ,r erm cCe fon
I.\F_BLD_Permit_Propane.rpt 10/29/19
•ILDING PERMIT APPLICAT1 B Review
00585
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD07-00585 Received Date: 11/19/2007
SITE ADDRESS: 121 W EUGENE ST
PORT HADLOCK, 98339
OWNER: CHRISTOPHE L EDLER PHONE: (360) 379-2469
PAMELA H EDLER
PO BOX 1878
PORT TOWNSEND WA 98368-0059 IRONDALE
SUBDIVISION: Block: 85 Lot: 1+
PARCEL NUMBER: 961808501 Section: 34 Township: 30 N Range: 01 W
CONTRACTOR: C H S INC PHONE: (360)732-4585
PO BOX 518
AUBURN WA 98071-0518
Contractor's License CHSIN**9790Z Expires 9/7/2008
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI, INSTALL 120 GAL A/G PROPANE TANK AND GAS PIPING
LOOK FOR 175 10TH AVE TO LOCATE HOUSE
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:
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $102.00 KAS 11/19/07 95473
Total: $102.00
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DEPARTMENT OF COMMUNITY DEVELOPMENT
~' 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
gS, N��p www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA:
Project Description (include separate sheets as necessary):
-UI1a��.avt of I ZO v1/dam vet /c c Irvpavte -to ki k am( d- s
Tax Parcel a�! Prop'erty
Number: SQ 85 0 !/9( P 0r3.4-0/ Size: 0.8 QC rc (acres/square feet)
Site A dr s d/or Diregc�li ns tp Property: �'b IAN =1'v h i e e( c�o Nov-4, o v, 10-4-1 1A ye, p yt -Q-
I �o-�A• v (PKyscc4 atQ ls) bI0c_ JC/
r 2l Li. E-t4 f` ceS { -bt 2v `� I— �ct(L2 t.��IJewcty
ae k f _S l I'c I7 i-t -1--c; l e -t- l /0 -pi- 1-e d "i 75�'s(5 v1 on `6-t e)
Property Owner(s) Record: e L. C le 14 � � (n N. Enl Iet--
Telephone: ( 36.6 37 Fax: C36037g- 2.4L°1 email: pawl CllhjsleEt./hI-M7k,hC'f-
Mailing Address: -(; ' nk• I i '72 ?c>r4 TNIJ LA -Se in ck Wit 9R36 S
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit? (Check each box that applies
❑Building 0 Variance(Minor, Major or Reasonable Economic Use)
❑ Demolition Permit ❑ Conditional Use[C(a), C(d),or C]**
❑ Single Family 0 Garage Attached/Detached ❑ 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**
❑ yome Business 0 Cottagelndustry 0 Long Plat**
[Propane 0 Planned Rural Residential Development(PRRD)/Amendments**
❑ Sign 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)* 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:
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 a9p]ic tion th 1 he r she wa is i tice.
Signature: I Tll %L-- Date: I I t' t 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 are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-tra fe able res onsi ility for ad rin t d complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: —L YL� Date: / I - I ct — Q 7
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc
• BUILDER STATEMENT 0
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:
GENERAFF,QNTRA TOR OR MANUFACTURED HO E INSTALLER: PHONE: FAX:
C.i � ( C{O� -tom k. (w.. �I) ( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: UJe,1 NUMBER
S ery;cc_Eric get reD(AX (-coy-(9,:15 (►ues) PHONE ( ) FAX: ( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
New ❑ Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank ❑ Community System
Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System
Li Repair ❑ Masonry SEP Permit#
Li Demolition CI Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type of Heat: Proposed: ❑ 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:
i Underground Tank Above ground Tank) Size of Propane Tank: 'i 2- L) 6t I In R S
i Heat Stove I Cook Stove i Woodstove i Fireplace Insert i Hot Water Tank i Pellet Stove i Other
Is this appliance being installed in a Manufactured/Mobile Home? es / 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:
2nd Floor Heated Consistency Review:
Other Heated Base fee:(WOW
oa_o
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL
{O a,C)O
Decks 911/Rd Approach fee:
Other TOTAL: $ [ 0 a
.,:f.,
Receipt Number: ,5`A 1 3
Cash/Check Number: a
ESTIMATED COST(REQUIRED) Date:
•Fair market value of all labor and materials foundation to finish t< <q L 07
Initials:
G\PermitCent r\###FORMS###\DRD FORMS Master Permit Application 12-19-2006.doc