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Home My WebLink AboutBLD2008-00024 • • 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 #: BLD08-00024 Received Date 1/22/2008 SITE ADDRESS: 2327 HASTINGS AVE W Issue Date 1/22/2008 PORT TOWNSEND, 98368 APPLICANT: SUSAN M OHLSON PHONE: PO BOX 1162 PORT TOWNSEND WA 983680962 SUBDIVISION: SYNDICATE Block: Lot: PARCEL NUMBER: 997600013 Section: 5 Township: 30N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 p) 3g5 Contractor's License SUNSHP*077QP Expires 1 1/((33 67/2008 5875 OWNER, SUSAN M OHLSON PHONE: if different: PO BOX 1162 PORT TOWNSEND WA 983680962 PROJECT DESCRIPTION: RNNE((PLAALLCIINL2GE2 GAS HEATERS, EXISTING 500 GAL A/G PROP TANK Directions SEE MAP& DIREC"i'I'C7I�5 r F1L9 D 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 1/22/2009. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval:r�j�I 1J'U`1 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 Ii ILDING PERMIT APPLICATN BLD08-00024 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD08-00024 Received Date: 1/22/2008 SITE ADDRESS: 2327 HASTINGS AVE W PORT TOWNSEND, 98368 OWNER: SUSAN M OHLSON PHONE: PO BOX 1162 PORT TOWNSEND WA 983680962 SYNDICATE SUBDIVISION: Block: Lot: PARCEL NUMBER: 997600013 Section: 5 Township: 30 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 DESCRIPTION REPLACING 2 GAS HEATERS, EXISTING 500 GAL A/G PROP TANK - NO MLA REQ'D 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: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $104.00 AMS 01/22/08 95872 Total: $104.00 • • • SITE VISIT REPORT (PLOT PLAN) JOB S u L O H L SdO DATE : CONTACT: ADDRESS PHONE #: DIRECTIONS FAX #: Email PLANNER: CA A 3D 'E IVF v SON RECEIVFD � • 9� �O JEFFERSON JNTY W , ' .• 'el,� DEPARTMENT OF COMMUNITY DEVELOPMENT — JAN 2 2 2008 `' ` `4 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax r��L- i r q�,4trN ,O www.co.jefferson.wa.us/commdevelopment Ji.1 IfRSON GOUNTY DCU Master Permit Application MLA: t--o r,.,(I-- -e-A Project Description(include separate sheets as necessary): 4,'" - "t /a_«.fr Q,> �� Tax Parcel q Property /� Number: -( ` 6 0 ® 0/3 Size: (acres/square feet) Site Address and/or Directions to Property: a- 3027 J C-/Du ) 3 aS A4,1-(1---, 6)( Property Owner(s)of Record: O II SOA 1 �u L Telephone: r - Fax: email: Mailing Address: Applicant/Agent(if different from owner): S U-MS HI NE P Ro PA N E Telephone: 385-5797 Fax: 3BS- S8rS email: INFO SUn13N/NEPr'oP e. Mailing Address: I D853 cj or,.., D( . 1 �P i NR t�-fl Ock, (,�,q_ q 833 I 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]** ❑ Singie 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 ❑ Change of Use 0 Short Plat** ❑ Address 0 Road Approach ❑ Binding Site Plan** ome Business 0 Cottagelndustry 0 Long Plat** opane 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 ❑ Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination (SPAAD)* 0 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 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: 3 DESIGNATION OF AGENT I hereby designatet1S NI t\E P 39-0 Pik-4-1t to act as my agent in matters relating to this application for permit(s). WNR S EIGN ATURE t• X-�L (Date: G(-1 . ( u Y 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. .t.,� 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 requir 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 plicatio hat he or she s i ti . )) ignature: ( f' (C Date: d l— ' `J (6 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 issu 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 re in complia a it the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-ransferab responsibility rin fd\a c lying with the ESA. The Applicant has read this disclaimer and signs anMates it below. '4 Signature: f I /1 �" /1 1 ((Oate� l j — G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc 0 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: St4tS214 NE P20 pall. (360) 385- 5797 ( 36o) 385-5875 MAILING ADDRESS: r'u � )o8s3 �.�+�Oo Y Aa1-1. EMAIL: t n- c>)StAlAs{lwwwe pro pale 6 Ce Y\ � CONTRACTOR'S LICENSE WAINS NUMBER: uv15 4 P+ ar7rl4 P 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 ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ 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 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: �1 _ 1 erground Tank I Above ground Tank Size of Propane Tank: i'J-?-//7 f o '/7� I Heat t ve Cook Stove i Woodstove i Fireplace Insert 1 Hot Water Tank i Pellet Stove I Other s nce 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 M1T' f b. ,1.0tobickg,,i 0. T" ��'' nfe:I.A�`nount, 'r_,Re(r>Isti'tw Main Floor Heated , ' ' _ EH Bld App Review: 2n0 Floor Heated lg' v' Consistency Review: Other Heated r-� i , Base fee: Mezzanine ,_,, ' _, 4i .11:4 Additional Section: ._{ fit= :: Heated Basement Plan Check fee: Unheated Basement r State Surcharge fee: Other Unheated ` t, Pot Water Review fee: Garage/Carport SUBTOTAL Decks s 911/Rd Approach fee: Other TOTAL: $ l at..] ()'-.. .tom Receipt Number: Jrl t:,:i,,„,,,:::,,,,!:-., , Cash/Check Number: 1-105 I ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish 1 2 (iD Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc