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Home My WebLink AboutBLD2008-00022 • • 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 #: BLD08-00022 Received Date 1/22/2008 SITE ADDRESS: 11 CORA ST Issue Date 1/22/2008 PORT HADLOCK, 98339 APPLICANT: KRISTINA A LARSEN PHONE: (360) 531-1150 JEROMY A LARSEN 11 CORA ST PORT HADLOCK WA 98339-9515 25+ SUBDIVISION: CHALMER'S 1ST ADDITION Block: 3 Lot: PARCEL NUMBER: 942600310 Section: 3 Township: 29N Range: 01W CONTRACTOR: OWNER/BUILDER PHONE: OWNER, KRISTINA A LARSEN PHONE: (360) 531-1150 if different: JEROMY A LARSEN 11 CORA ST PORT HADLOCK WA 98339-9515 PROJECT DESCRIPTION: INSTALL NEW WOODSTOVE Directions START SO ON HWY 20,TURN SO ON HWY 19,TRUN LEFT ONTO IRONDALE RD, TURN RIGHT ONTO To Site: PATTISON, FOLLOW TO STOP SIGN,TURN LEFT ONTO SO 7TH,TRUN LEFT ONTO CORA ST, 1ST HOUSE UN LEI 1 (BROWN HOUSE) 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 1/22/2009. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: 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 ilt UILDING PERMIT APPLICAION B RD pe Review y : Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD08-00022 Received Date: 1/22/2008 SITE ADDRESS: 11 CORA ST PORT HADLOCK, 98339 OWNER: KRISTINA A LARSEN PHONE: (360) 531-1150 JEROMY A LARSEN 11 CORA ST PORT HADLOCK WA 98339-9515 CHALMER'S 1ST ADDITION SUBDIVISION: Block: 3 Lot: 25+ PARCEL NUMBER: 942600310 Section: 3 Township: 29 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTION INSTALL NEW WOODSTOVE: 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 $105.00 KAS 01/22/08 E'5808 Total: $105.00 ,iii ON GyO�`Ir JEFFERSOSOUNTY � �l' IL1� � , ,� DEPARTMENT OF COMMUNITY DEVELOPMEIV�' `-4 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax JAN 2 2 2008 r .q5, (0p www.co.jefferson.wa.us/commdevelopment HIN -r'rrn,,. rn,,,,;, nnrc, Master Permit Application MLA: " Project Description (include separate sheets as necessary): C*Jr TALUAk- Iu lEA.4 v.)ewsrov Tax Parcel Property Number: (19)6 00310 Size: (acres/square feet) Site Address and/or Directions to Property: Siv'T �tVy aO-Tom S Tiy ou 1 t-y 19 Tcaw) c t FT our,: zaoNvau 7 I [(�� 1 TJ(LP �%raa( pr.)rb 1-)4Tnsou Fo��O� To Srof•SIcN� TJRIJ �t3Fr o,,ro So,'Ti ry CrYD_A S, I ORr NAcLoCK TO RAJ t GFT on no loPR Sr. 15 Hosksc oo Liscr l Q• I-1e..66- Property Owner(s)of Record: SeRer►r 3 K04s1144 L4 a..5eAl Telephone: -)K7 psi-il3t) Fax: email: L P,SLN SS 17®Gt7AI(,C00/1 Mailing Address: II Cz1:.p 5, N(tT I--l40Louc Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit? (Check each box that applies ❑Building ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use[C(a), C(d), or C]** ❑ Single Family ❑ Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home ❑ Modular 0 Special Use(Essential Public Facilities)** ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use ❑ Short Plat** ❑ Address ❑ Road Approach 0 Binding Site Plan** ❑ Home Business ❑ Cottagelndustry 0 Long Plat** ❑ Propane ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑ Sign ❑ Plat Vacation/Alteration** ❑Allowed "Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management ❑ Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination (SPAAD)* ❑ 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 ❑ 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 application that he or she wants prior notice. Signature: _ Date: 1 —1$-06 The action or a ions 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-transferable responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: .3- 74 C---- Date: 1- -o8 G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc 0 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.t. Signature: .,, yre 1_ Date: )—) C� 0 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: x New ❑ Wood Existing: ii Sewer LI Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ 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: i Underground Tank i Above ground Tank Size of Propane Tank: i Heat Stove I Cook Stove/-.1/Voodstove i Fireplace Insert i Hot Water Tank i 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 Bld App Review: 2na Floor Heated } ,E I \�f j�`i.1 f I Consistency Review: Other Heated Base fee: Mezzanine JAN 2 2 r 008 0 NR 105. cc)Additional Section: Heated BasemenfEEfSUN COU tY DCD Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL I05.op Decks 911/Rd Approach fee: Other TOTAL: $ I 05. DO Receipt Number: q5 og Cash/Check Number: n ESTIMATED COST(REQUIRED) Date: I 'Fair market value of all labor and materials foundation to finish 1 I l o g Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc 73 0 c- m 0 -I z a E m v n �' s;, r ‘C • C-- 7::j. -,,_, ceD i Ce' m \ Z ti Wi rn co v 1 0 \ vl, r v G) q -7 > m c r r m s r O x z U' m Cv v (v , 7 m c cn 90 -9 s zCI m z c g W m 0 o z U O z (v m n 73 z G v . z 0 ;I