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Home My WebLink AboutBLD2007-00598 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 #: BLD07-00598 Received Date 12/10/2007 SITE ADDRESS: 201 S BAY LN Issue Date 12/10/2007 PORT LUDLOW, 98365 APPLICANT: RANDOLPH K LIM TRUSTEE PHONE: 360-437-9839 RANDOLPH LIM TRUST 201 S BAY LN PORT LUDLOW WA 983659562 33 SUBDIVISION: LUDLOW POINT VILLAGE DIV 1 Block: Lot: PARCEL NUMBER: 969400033 Section: 17 Township: 28N Range: 01E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2008 OWNER, RANDOLPH K LIM TRUSTEE PHONE: 360-437-9839 if different: RANDOLPH LIM TRUST 201 S BAY LN PORT LUDLOW WA 983659562 PROJECT DESCRIPTION: 250 GAL A/G PROP TANK& GENERATOR-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 12/10/2008. REQUIRED INSPECTIONS: Tank/Line/Appliance: gbp4t)E 1.t 'L /007, Zjc7,,e/ek AuE /010/7, FinalApproval:CIeG?EI[AL �,eN? etWitI,QEp T MN.f7 BE ifprov c. ,By A I f f7eI e i. ' e4u 4-60AL peRma vie,/ A 6r IrC_! il/f/agfr 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 IJ ILDING PERMIT APPLICA•N BLD07-00598 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00598 Received Date: 12/10/2007 SITE ADDRESS: 201 S BAY LN PORT LUDLOW, 98365 OWNER: RANDOLPH K LIM TRUSTEE PHONE: 360-437-9839 RANDOLPH LIM TRUST 201 S BAY LN PORT LUDLOW WA 983659562 LUDLOW POINT VILLAGE DIV 1 SUBDIVISION: Block: Lot: 33 PARCEL NUMBER: 969400033 Section: 17 Township: 28 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` 250 GAL A/G PROP TANK & 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: tO in. Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $153.00 AMS 12/10/07 95575 Total: $153.00 • I SITE VISIT REPORT (PLOT PLAN) JOB 1,-1 DATE : /a/`lf P CONTACT: ADDRESS PHONE #: DIRECTIONS FAX #: Email ANNER: v a ` w A� / 13� Io 4.1 a •s Jv �4- ��ji `�;.. V S00rt+ rJ.A1 1-41`3t. I It:\'1 0;DSON • i_, i 's' ; k4.4 CO JEFFERSON NTY DEPARTMENT OF COMMUNITY DEVELOPMENT r R -621 Sheridan Street • Port Townsend • Washington 98368 "�-• i 2007 4, 360/379-4450 • 360/379-4451 Fax www.co.jefferson.wa.us/commdevelopment JLFFEfSDp ,�U N� coD Master Permit Application MLA: no m l a rc q ICI Project Description(include separate sheets as necessary): Tax Parcel — Property Number: y D a 0 3 3 Size: (acres/square feet) Site Address and/or Directions to Prooertv: Property Owner(s)of Record: /52 d 2_ Telephone: 443 7- dam_ 5- Fax: email: Mailing Address: �,D' 662-7 Applicant/Agent(if different from owner): 3(-1-MS H I N E P Ro ?A N E Telephone: 395-5717 Fax: 3BS' SO'7S email: INFoesuN5HINEProf/ne• Mailing Address: I OS53 RHODy D 2- / tr. NRfl I-Ock 1 [,,'A- 9 833" `A n'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 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** 0 Home Business 0 Cottagelndustry 1'0 Long Plat** Propane 0 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: 6eDESIGNATION OF AGENT \�I hereby designate Su&Is 14 I J�IE Pry P Ito act as my agent in matters relating to this application for permit(s). WNER SIGNATURE - (Date: I OA d� 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. C. 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 a plic ' e wants prior notice. ignature: Date: 7/0 6 , The action or a pplicant 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-ransferable dhering to and complying with the ESA. The Applicant has read this disclaimer and signs nd dates it below. Signature: Date: j 2-/7 G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc _3° BUILDER STATEMENT • The signer of this statement does hereby^ertify 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: 3oQi4NE: Pilo pane (360) 385- 5797 ( 360) 385-5875 MAILING ADDRESS: )08S3 OO y n ej u P. !I. EMAIL: +n foPSUV1Sthmt Pro Pane 6 COM CONTRACTOR'S LICENSE �/�7 WAINS NUMBER: �UV\SI� P7` 0( l F 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 O Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well 0 Two Party Type of Heat: Proposed: ❑ Public Total: _ Name of System: If this is a Commercial Protect 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: j Underground Tank Above ground Tank Size of Propane Tank: �56 T Heat Stove I Cook Stove Woodstove I Fireplace Insert I Hot Water Tank I Pellet Stove i Other (.1-11,--r 4- Is this appliance being installed in a Manufactured/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. �v "f Square Footage Current Proposed r etise Ony. �L wil ; Amoui i ik7.aGY we* Main Floor Heated • 1` EH Bid App Review: • 2na Floor Heated '1-1;. t` Consistency Review: Other Heated � • �� Base fee: �,1)3 Mezzanine • ~d x' Additional Section: Heated Basement r Plan Check fee: Unheated Basement s• State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks = 911/Rd Approach fee: Other CL I TOTAL: $ 1 5'3 , Receipt Number: 61 5 5`7� Cash/Check Number: ESTIMATED COST(REQUIRED) Date: r� ) •Fair market value of all labor and materials foundation to finish t d-l 16 6�[ Initials: OV3 G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc