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HomeMy WebLinkAboutBLD2007-00594 . 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 #: BLD07-00594 Received Date 12/4/2007 SITE ADDRESS: 61 GUN CLUB RD Issue Date 12/4/2007 PORT TOWNSEND, 98368 APPLICANT: JEFFREY S HUBBARD PHONE: 360-379-0164 61 GUN CLUB RD PORT TOWNSEND WA 983688837 8+ SUBDIVISION: IRVING PARK ADDITION Block: 23 Lot: PARCEL NUMBER: 963302304 Section: 16 Township: 30N Range: 01W CONTRACTOR: THURMAN SUPPLY PHONE: 360-457-8591 1807 E FRONT ST PORT ANGELES WA 98362 Contractor's License THURMS*954JA Expires 11/26/2008 OWNER, JEFFREY S HUBBARD PHONE: 360-379-0164 if different: 61 GUN CLUB RD PORT TOWNSEND WA 983688837 PROJECT DESCRIPTION: NEW WOODSTOVE Directions SEE DIRECTIONS& MAP 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 12/4/2008. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: IZ—gym—07 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 BLRDOe 00594 Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00594 Received Date: 12/4/2007 SITE ADDRESS: 61 GUN CLUB RD PORT TOWNSEND, 98368 OWNER: JEFFREY S HUBBARD PHONE: 360-379-0164 61 GUN CLUB RD PORT TOWNSEND WA 983688837 IRVING PARK ADDITION SUBDIVISION: Block: 23 Lot: 8+ PARCEL NUMBER: 963302304 Section: 16 Township: 30 N Range: 01 W CONTRACTOR: THURMAN SUPPLY PHONE: 360-457-8591 1807 E FRONT ST PORT ANGELES WA 98362 Contractor's License THURMS*954JA Expires 11/26/2008 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr NEW WOODSTOVE 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: 0 Exist: 0 Prop: 0 Prop: 0 Total: 0 ----- Rout. 6'------�� q Date: _ (2--1-0—) Type Amount Paid Bv: Date: Receipt: Approved/Date Permit $51.00 LYK 12/04/07 95399 Total: $51.00 grr • • N g -� ° to P a_ ,A, ---'----- , 3 (_ (,,, }. _. \N \__ , . ": (---.... T k m o c-� tt C ..../ o -__ k...7....\,r"-- 4.. TCN o L S N u 1 0 i Avi tv i<7) -c c) *:,' � ( .<3 � sue N' 4�4g02v c©6. JEFFERSOI UNTY • W l �,� ,.� DEPARTMENT OF COMMUNITK yl�LO?I1IaN ¢ 1.' `\ mi 621 Sheridan Street • Port Tow&$ yl /a r gt n I1;.•08 -" p� w6w0w/3.c7o.-4e4ffes o• n3.w60a/.3u7s9/c-o4m51 qs m dFeavxe l ng R b 4 2007 Master Permit Application i N �+n MLA: ?T) NIL& e�Q� I Project Descripti n (include separate sheets necessa ): a,���it ��i.� cO�NI I Ohlfi GUO O e.St6 / 5 7/(q� u k i / U� (7)14- if 1 ) Tax Parcel Property Number: 7 io 3,, 0 z 3 0 il Size: (acres/square feet) Site Address and/or Directions to Property: hey -'<G Sdc% fa fijI4101 Cc‘ c GVe /ei tun1 4T 65 GuiiC &4 Property Owner(s)of Record: ;�t1 ex. 6 r Telephone: 3 7 5j- 0/ (o 4 Fax: email: (�Mailing Address: / -C-t vt C/t ./ ,e4 Applicant/Agent(if different from owner): GI.i/'l??„..0 S' Telephone(f6 6 J 4/5-7- gs t/ Fax: email: Mailing Address: / R'o? L G.S t Fi^ovt S,rr-- „f"a,,,f.t 7e,S 600k-in,,C, What kind of Permit?(Check each box that applies ❑Building 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit 0 Conditional Use[C(a), C(d),or C]** ❑ Single Family ❑ Garage Attached/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 p Cottagelndustry 0 Long Plat** ),P e' ex,de el S77 0-6- 0 Planned Rural Residential Development(PRRD)/Amendments** ❑ Sign 0 Plat Vacation/Alteration** 0 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 0 Forest Practices Act/Release of Six-Year Moratorium 0 Tree Vegetaion Request *May require a Pre—Application Conference **Requires a Pre-Application Conference Please identif any other local, state or federal permits required for this proposal, if known: / %1ti✓'/milCGl4S DESIGNATION OF AGENT I hereby designate to act as m agent in matters relating to this application for permit(s). OWNER SIGNATUR ' Date: h— 1— 2 By signing this a licat o e 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 applicaf that r she wants rior n ti Signature: Date: / (/ The action or acti i ant 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-transfer a res Asibility for adh ring om lyin with the E A. The Applicant has read this disclaimer signs and it below. Signature: Date: 11C_ T/ 6? G:\PennitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc 0 BUILDER STATEMENT 411 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 ONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: / Gt.Y'k0Q,1/, c � (360) ? 'L / (5G6) Vs2/92 MAILING ADDRESS: /g07 .of,S�&O S f- / ( aK Ce(S. EMAIL: CONTRACTOR'S LICENSE y I WAINS � NUMBER: /�IA ir,l�S A— 7 !" NUMBER ARCHITECT/ENGINEER: ! PHONE ( ) FAX: ( ) MAILING ADDRESS: 7 EMAIL Project Type: game Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System 'q' Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System 0 Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ 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: A/4 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 i Above ground Tank Size of Propane Tank: I Heat Stove i Cook Stove : oodstove I Fireplace Insert i Hot Water Tank i Pellet Stove I Other Is this appliance being installe in a anufactured/Mobile Home? Yes / 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: 51 4'D Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL • 60 I . Decks 911/Rd Approach fee: Other TOTAL: $ I CO Receipt Number: -I t Cash/Check Number: ESTIMATED COST(REQUIRED) Date: I -0-1 .Fair market value of all labor and materials foundation to finish 3,5 0 O 0 0 Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc