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Home My WebLink AboutBLD2008-00041 0 • 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 #: BLD08-00041 Received Date 2/4/2008 SITE ADDRESS: 96 CASCADE LN Issue Date 2/4/2008 PORT LUDLOW, 98365 APPLICANT: BRUCE C VAN BUREN PHONE: 360-437-7932 EVA J VAN BUREN 96 CASCADE LN PORT LUDLOW WA 983659535 13 SUBDIVISION: PORT LUDLOW NO. 1 Block: Lot: PARCEL NUMBER: 990400413 Section: 9 Township: 28N Range: 01 E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 33 pl 3g5 7/2008 Contractor's License SUNSHP`077QP Expires 1�/1 5875 OWNER, BRUCE C VAN BUREN PHONE: 360-437-7932 if different: EVA J VAN BUREN 96 CASCADE LN PORT LUDLOW WA 983659535 PROJECT DESCRIPTION: 2 x 120 GAL A/G PROP TANKS W/ FIREPLACE - NO MLA REQ'D Directions SEE MAP& DIRECTIONS IN FILE GAS ,t?Auc6 To Site: 8A2se-4A6 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 2/4/2009. REQUIRED INSPECTIONS: Tank/Line/Appliance�,(JK 1.4eA?16,t) Qg Op/of /,tfmr,D, _eeopAA,0-1macs Q,r �zo/OS' fieeri rce /A�STAu,lrMA DK 2/z%B ii,eena 4, Dk 0 6, 1/ , FinalApproval: [/K --C:d- .f-itv, 7 5 P I t��}' BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:00 a.rn. - 4:30 p.m. HOT LINE AVAILABLE: 24 HOURS A DAY I:\F_BLD_Permit_Propane.rpt 10/29/19 I ItILDING PERMIT APPLICA1*N BLD08-00041 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD08-00041 Received Date: 2/4/2008 SITE ADDRESS: 96 CASCADE LN PORT LUDLOW, 98365 OWNER: BRUCE C VAN BUREN PHONE: 360-437-7932 EVA J VAN BUREN 96 CASCADE LN PORT LUDLOW WA 983659535 PORT LUDLOW NO. 1 SUBDIVISION: Block: Lot: 13 PARCEL NUMBER: 990400413 Section: 9 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: PHONE: PROJECT DESCRIPTION 2 x 120 GAL A/G PROP TANKS W/ FIREPLACE - 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: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: I1,0 Chi' Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $157.00 AMS 02/04/08 95883 Total: $157.00 • • SITE VISIT REPORT . 11 (PLOT PLAN) JOB Eoxe- Vp,i0 g J -E! DATE : /oZ!/q!C37 . / �� I�) CONTACT: ADDRESS QCo Sf A0E L.�Nt �� PHONE #: . DIRECTIONS FAX #: . Email (C/ PLANNER: rL,t' . ig Epp ! ,L) ,°1' 1 4 �� 0\ 6 pO i i i i clit- J1/4- el- i V) '' � ' If ".vi rY `3 RI' 1 If,,� ,i l ;;�/ �,�4�4 SON C06 JEFFERSOIWOUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT FEB 0 4 2008 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax ��i ER��N COUNTY D��n *°. >IYNwwww.co.jefferson.wa.us/commdevelopment f L!] hUUIY I I t1 Master Permit Application MLA: ll> r l\ e_ ' -eq. i c\ Projec Descri tion (include separate sheets as necessary): Tax Parcel 1 0 1/UO `, / /3 - Property Number: 7"/ Size: (acres/square feet) Site Address and/or Directions to Property: Property Owner(s)of Record: ce cf'i/c7L. Vag.,- r.a ) Telephone:_ `'$7—7 f'i Z Fax: email: Mailing Address: , f c 7e Applicant/Agent(if different from owner): S u-NS H I N E P R.o PA N E Telephone: 385-579 7 Fax: 38S-S8r1S email: (NFQ@SUALSH/NE prow? . Mailing Address: I OS53 RHOiy De- / f i. NFtC Lock, L,2 R- 9 83347 `.o'"t 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/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** 0 Address 0 Road Approach 0 Binding Site Plan** ❑ Home Business 0 Cottagelndustry 0 Long Plat** A:CI;ropane 0 Planned Rural Residential Development(PRRD)/Amendments** ign 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 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: C �� F�� , DESIGNATION OF AGENT I hereby designate H I f P f n to act as my agent in matters relating to is application for permit(s). �WNER SIGNATURE i/(' {fit Qom_ ( D� 0-vt 3// ale 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. /f 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 V review and any req ' d later inspections. Staffs access and right of entry will be assumed unless the applicant info the County in writing at the time of the a pl hat a iir she want for notice. �1 ignature: ll Date: Z I J /c�Ca The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impa pon 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 Li,,. 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-ransferab r pon ibjlit for adher' to and complyingwith the ESA. The Applicant has read this disclai r and signs and date it below. ,J �' pp' Signature: LLnit z Date: /�/�i�-vi , j ��%1 G:\PermitCenter\###FORMS###\DAD 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: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: 3i i- i�� P2opa?.� 1 (360) 3S5- S797 ( 36c) 385-5875 MAILING ADDRESS: )0 85J ! co o y ,1��U f• 1.1. EMAIL: 1(�' Q)56(V\c 4 IA pro pan e C o(►1 CONTRACTORS LICENSE r WAINS NUMBER: �((V1SIT P` U r17�(7 I Q 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: Cl Individual System ❑ Repair ❑ Masonry SEP Permit# O 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: Above ground Tar—ikl Size of Propane Tank:_ Heat Stove i Cook Stove i Woodstove it Fireplace 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: w" 'ell „ .1 Main Floor Heated EH BId App Review: 2nd Floor Heated Consistency Review: Other Heated Base fee: I J Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carpol SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $ I� ' <� Receipt Number: ei 5 S:75 Cash/Check Number: y00-7 ESTIMATED COST(REQUIRED) Date: i '� •Fair market value of all labor and materials foundation to finish Initials: C t_.3 G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc