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HomeMy WebLinkAboutBLD2008-00003 S 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 #: BLD08-00003 Received Date 1/7/2008 SITE ADDRESS: 3900 LINDSAY HILL RD Issue Date 1/7/2008 QUILCENE, 98376 APPLICANT: SUNSHINE PROPANE PHONE: (360) 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 T 16+ SUBDIVISION: Block: Lot: PARCEL NUMBER: 701321019 Section: 32 Township: 27N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 ��R/2008-5875 Contractor's License SUNSHP*077QP Expires 1 / OWNER, DANIEL J GATCHET PHONE: (360) 765-4566 if different: SALLY FERGUSON 1401 5TH AVE W APT 106 SEATTLE WA 98119-3265 PROJECT DESCRIPTION: SWAP OUT EXISTING GAS STOVE WITH NEW GAS STOVE Directions 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 1/7/2009. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval:/ I-- 17 Elg 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 UILDING PERPERMITAPPLICAJN BLD08-00003Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD08-00003 Received Date: 1/7/2008 SITE ADDRESS: 3900 LINDSAY HILL RD QUILCENE, 98376 OWNER: DANIEL J GATCHET PHONE: (360) 765-4566 SALLY FERGUSON 1401 5TH AVE W APT 106 SEATTLE WA 98119-3265 SUBDIVISION: Block: Lot: T 16+ PARCEL NUMBER: 701321019 Section: 32 Township: 27 N Range: 01 W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2008 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOt SWAP OUT EXISTING GAS STOVE WITH NEW GAS STOVE 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 Bv: Date: Receipt: Approved/Date Propane Tanks/Stoves $52.00 KAS 01/07/08 95689 Total: $52.00 n 4 ?t3�\ JEFFERSO*OUNTY fRECEIVEDk \ DEPARTMENT OF COMMUNITY DEVELOPMENT _ "N ` 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax www.co.jefferson.wa.us/commdevelopment JAN - 2� 8 Master Permit Application ML,EFFEASON COUNTY BCD Project Description(include separatec sheets as necessary): Sc.v o v% /- i r! r•, o--/-- � C}),. c) Tax Parcel' /'��/ ✓ c Property Number: / 3 _2/ o / 1 Size: (acres/square feet) Site Address and/or Directions to Property: c c9e)0 0 411/ ct L Q ' r s�.),.._J Property Owner(s)of Record: / t 7G t.d. rr Telephone: '7e.,.S-- 5- C.-, - Fax: email: Mailing Address: Applicant/Agent(if different from owner): S tot-A S H I N E 'D R_O PA /N E Telephone: 385-579 7 Fax: 3BS 5 7S email: INFOeSUnjsniNE pr-oe/w2e. Mailing Address: I OS53 RH01)y D 2• / fP i. NRfJ W ck R- q 8,33.7 `OV 1 What kind of Permit? (Check each box t at 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 I Detached _. ❑Discretionary"D"`or Unnamed Use Classification ❑ Manufactured Home 0 Modular ❑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 0 Long Plat** Propane 0 Planned Rural Residential Development,(PRRD)/Amendments** ❑ Sign 0 Plat Vacation/Alteration*" ❑Allowed"Yes"Use Consistency Analysis ❑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* ❑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:ce . DESIGNATION OF AGENT ,.....11 hereby designate Su iJS H I N\E PR0 P A ne to act as my agent in matters relating to this application for permit(s). WNER SIGNATURE !s , Date: 62/s//o r- 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 a plication t he or w n prior notice. ignature: Date: /Z/1//1 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- ansferable res o sibilit f a e'ng and complying with the ESA. The Applicant has read this disclaimer nd si ns and dates it below. '� Signature: 6. Date: /2- i/072 G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc 41 • BUILDER STATEMENT The signer of this statement does hereby°edify 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: S'��� ►nI E P 20 a� C FAX: p (36O) 3�35- S7 1q 7 ( 36O) 3B5-5875 MAILING ADDRESS: l 0 853 '44-0 o y fl i v & P. i i. EMAIL: ►n-41)_31.,(1AStlIVIC Pro Pane 6 C eA CONTRACTOR'S LICENSE WAINS NUMBER: Su 0514 C P� r fl Q P NUMBER ARCHITECT/ENGINEER: 1 PHONE ( ) Fes: MAILING ADDRESS: EMAIL ( ) Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: 0 New ❑ Wood Existing: 0 Sewer ❑ Addition ❑ Steel Proposed: Bank 0 Community System 0 Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair 0 Masonry SEP Permit# 0 Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: PP Y: Type of Heat: Proposed: 0 Private well ❑ Two Party Total: 0 Public 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 IBC Occupancy: Proposed P Y 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 Under round Tank I Above ground Tank Size of Propane Tank: '_I Heat Stove i ook Stove I Woodstove I Fireplace Insert I Hot Water Tank I Pellet Stove I Other is appliance being installed in a Manufactured/Mobile Home? Yes / No ying for a it o install a ne tank you must also submit a site s, all property lines, tankhen llocation and size,distancesfromathe propane tank to all property lines, an showing all of buildings buildings and septic systee mcomponents including the reserve area. components, IL.x � kf;r ,�{, P �: rye, x Square Footage Current Proposed I ,© �{ ` �� � � I Main Floor Heated I. ykµ fi,, � '� EH Bid App Review: 2na Floor Heated b ` �^ 1 .. �r- ,,;� Consistency Review: Other Heated iti ; j�yy ¶fir a, �L� l�� 'll \Y �1,� � .}� COUIL 5Z. Mezzanine r `- A�d����nal Section: cc Heated Basement A. �' — 7 2n,: `iiit, -,� Plan Check fee: Unheated Basement , f ' ' KW? State Surcharge fee: °•• Other Unheate. ;, 1 I r ,t r I„ ' r , Pot Water Review fee: 1 n tf ,, I __ Garage/Carport ,� SUBTOTAL Decks Z 1.0,.V,V,, IN ITM ' 911/Rd Approach fee: Other M R , ,$s„�• f' ' ' TOTAL: $ , �� f Receipt Number: q 5lD -0t' y 1",,° Cash/Check Number: ESTIMATED COST(REQUIRED) Mv �' b�(P Date: I I1 Vl8 •Fair market value of all labor and materials foundation to finish Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc