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Home My WebLink AboutBLD2007-00615 • 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 #: BLD07-00615 Received Date 12/26/2007 SITE ADDRESS: 362 BACHELOR RD Issue Date 12/26/2007 SEQUIM, 98382 APPLICANT: WILLIAM E CAMPBELL PHONE: 360-797-7742 COLETTE L CAMPBELL 362 BACHELOR RD SEQUIM WA 983828708 SUBDIVISION: Block: Lot: PARCEL NUMBER: 002341052 Section: 34 Township: 30N Range: 02W CONTRACTOR: OWNER/BUILDER PHONE: OWNER, WILLIAM E CAMPBELL PHONE: 360-797-7742 if different: COLETTE L CAMPBELL 362 BACHELOR RD SEQUIM WA 983828708 PROJECT DESCRIPTION: NEW WOODSTOVE -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 12/26/2008. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: J 111 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 APPLICAAN BLD07-00615 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00615 Received Date: 12/26/2007 SITE ADDRESS: 362 BACHELOR RD SEQUIM, 98382 OWNER: WILLIAM E CAMPBELL PHONE: 360-797-7742 COLETTE L CAMPBELL 362 BACHELOR RD SEQUIM WA 983828708 SUBDIVISION: Block: Lot: PARCEL NUMBER: 002341052 Section: 34 Township: 30 N Range: 02 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP NEW WOODSTOVE - 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: 0.,3 al 'e:Kc I Cr7 Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $102.00 AMS 12/26/07 95710 Total: $102.00 43 • \rr_24____3 r • J .1 u A V .. 0 1 i V M gI 2 i A C4 __ _ , ..._, JffffliSa tiliii 1 �V/YC1t,;,, I1T v II-< ��sO cod JEFFERSON�UNTY • e(_ li it 1t!.fl . rti '� ,k, DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend •Washington 98368 DEC 2 6 2007 360/379 4450 • 360/379-4451 Fax Is, www.co.jefferson.wa.us/commdevelopment N JEFFEBSON Ciliillryp Master Permit Application MLA: ,{\j )C irCl Project Description (include separate sheets as necessary): L.V\S}-C-1'&. l,ti%oc ct S-E-c -z-- Tax Parcel Property Number: 00 c 3 LI I eS Size: (acres/square feet) Site Address and/or Directions to Property: t-('\n3 I I ct Iv Nw Y le i 1-3 •- `.i crv- Gcu-z•-.-.-v- eezp.(--t,, 12-� 3L, Ba C /\e I'r 0-- , v i.v� 9 ES-.3 S du ac�1,,4 Property Owner(s)of Record: 3:. - c, + a)e tt.e. Cik,,.,,_.i b<L_k Telephone: 3isC .7-c-7 /3 '-t om Fax: email: ------ Mailing Address: 3 GO, Bc t-k lgr h* rac..ciu -...�- w'14 gii-3S 2_ Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies ❑Building El Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use[C(a), C(d),or C]** ❑ Single Family 0 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 0 Change of Use 0 Short Plat** ❑ Address ❑ Road Approach ❑ Binding Site Plan** ❑ Home Business ❑ Cottagelndustry ❑ 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)* ❑ Shoreline Management Variance ❑ Temporary Use ❑ 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 ❑ 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 ap a�tiion�t�hat hee she wants prior notice. Signature: D lJ�v^— Date: 1 L_ 2-6e 0 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-tran rable�respon ' ility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: o G bl�tA-tom Date: / 2-- Zie f5-A- G:\PermitCenter\###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: a ,¢vim-•--t Date: l Z-2-L2 MTh- GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: 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 LI Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System Li Repair ❑ Masonry SEP Permit# I 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: 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 i Above ground Tank Size of Propane Tank: i Heat Stove i Cook Stove 1 Woodstove i Fireplace Insert i Hot Water Tank 1 Pellet Stove i Other 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. Square Footage Current Proposed For Office Use Only Amount Revision Main Floor Heated EH BId App Review: 2° Floor Heated Consistency Review: Other Heated Base fee: } 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 o ao3 Receipt Number: 61 57 `Q Cash/Check Number: G -5a ESTIMATED COST(REQUIRED) Date: I a�t'� /�� •Fair market value of all labor and materials foundation to finish l Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc G o s m � c c� a END c y r o � o , r.