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HomeMy WebLinkAboutBLD2008-00115 • • 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 #: BLD08-00115 Received Date 3/26/2008 SITE ADDRESS: 185 BURNT TREE LN Issue Date 3/26/2008 QUILCENE, 98376 APPLICANT: KENNETH M JAFFE PHONE: 206-523-6369 ADA SHEN-JAFFE 5115 NE LATIMER PL SEATTLE WA 981054953 SUBDIVISION: Block: Lot: PARCEL NUMBER: 501032021 Section: 3 Township: 25N Range: 01W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2008 OWNER, KENNETH M JAFFE PHONE: 206-523-6369 if different: ADA SHEN-JAFFE 5115 NE LATIMER PL SEATTLE WA 981054953 PROJECT DESCRIPTION: INSTAL� NEW A/G 500 GAL PROP TANK AND GENERATOR- NO Directions SEE MAP AND DII L1IMR1 FILE To Site: C icv\--e * I COO\k)0 '. y Ooa 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 3/26/2009. REQUIRED INSPECTIONS: Tank/Line/Appliance./,7J IL 1- t 11U. i.,,,,,,i TD 6.r�cckre,,-$ . 1 7/by FinalApproval: L% -cor -Cola.. I ��3/e, 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 APPLICA BLD08-00115 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD08-00115 Received Date: 3/26/2008 SITE ADDRESS: 185 BURNT TREE LN QUILCENE, 98376 OWNER: KENNETH M JAFFE PHONE: 206-523-6369 ADA SHEN-JAFFE 5115 NE LATIMER PL SEATTLE WA 981054953 SUBDIVISION: Block: Lot: PARCEL NUMBER: 501032021 Section: 3 Township: 25 N Range: 01 W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2008 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION INSTAL NEW A/G 500 GAL PROP TANK AND GENERATOR - 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: CV) aCCIOS Type Amount Paid Bv: Date: Receipt: Approved/Date Propane Tanks/Stoves $157.00 AMS 03/26/08 97185 Total: $157.00 Mar . 21 2008 2: 56PM HMC Rebab Medicine 20G -744-6554 p. 1 tt V1t ri�7iIIIIIIIC19A1N4111Zi 03/21/2008 11:2B 360-732-4892 OlE; INC Ras; 1/04 iii,D :occ;...r.i.,,, , 7..) JEFFERSON COUNTY MAR 2 6 2008 DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend•Washington 98368 • 360/37s 4450' 360r3744451 Fax JEf f ERSON i'r z i ru D CD vruiauv,co.Jeeffetson.wa,uslcommdevelopment 4 Master PemnItApplication MLA; ill.) D1 I CL r--Q " 14 Pop rst Deediptlon(include separate sheets se necessary): � Tax Paner:e: � / /J7O 1 © u Property Size: lrnunb v J Site: (sctes/squsro feet) Site Address randier Directions to Property! Property Owter(sl of Record: A=tnh+L AL Pf. f' & + Telephone: "2-o , 5-2 3— b 3 6 9 Fax: email: /I;.. -.. /1014,f y h QJ' Malting Address: S//S � 4 brk t N ,r AppNnant/Agent(if dUlersnttorn own+ ,,�i--a0+ -n.a h, — �e Y/9'l Telephone' O ——73 2,-- Fax: 0_ 32 — , II: Mailing Address: .c *Ns Z- 19 3/s- �ra 4 i` CA 1 n.0,6-07.-J '` whet kind of Permit?(Check each box that applies OBuildilg 0 VMiance(Minor,Major or Reasonable Economic Use) O Demolition Permit 0 Conditional use IC(e),C(d),or C]N' 0 Sfngle Family 0 Garage Attached f Detached 0 Discretionary"D"or Unnerved Use Cbssification O Manufactured Home 0 Modular 0 Special Usti(Eaaenelel Ptblo Feoilities)'"' El Cotnrnercial' 0 Boundary Line Adjustment O Change of Uso 0 Snot/Plat se O Address 0 Road Approach 0 B'nding Site Plan" o Horne Business Ci Cottegelnduslty 0 L.eng Plat" —propene 0 Planned Rural Residential Development(PRRDyArnendmeMs" CI Sign 0 Piet Vacation/Alteration" 0 Allowed'Yes'Use Consistency Anelyele 0 Shoreline Master Program Exemption/Permit Revisions" 0 Stomtweter Management Ci Shoreline Management Substantial Development" CI Site Plan Approval Advance Determination(SPMO)" CI Shoreline Management Variance O Temporary Use 0 Cornprohensive PlanlUDC/Land Use District Map Amendment 0%Uretttse Telecommunication' 0 Jefferson County Shoreline Master Program Amendment 0 Forest Practices Act/Release of Sia-Veer Moratorium 0 Tree Veg•bion Request 'Meer'flr.*s a Pte-ralpprlestbn Cenfaenoe "Raqulraa a Pre,Appllesaloq Coafbneree Please Identify any other local,state or federal$permits required for this proposal,if known: t hereby designate C1i /C *w �¢"l^J y)ct� �y�- � Ct as my agent In matters relating to this application Or partttit(s). OWNER SIGNATURE z / r^t ne �- Date: 3(2/4 I By aigninp this eppeeation torn,the ownedagent tweets a iMmn otlen provided herein,and in any attsohnanta Is true end sonic/is the best of bk,her or its ldwvriedg•. Any Morel Mechoad or any oaten of a metonel'tact adds by this ewseerfaaont with respaa to this'vocation packet nary insult in this parntkbeing null and void. (further agree to cave,IndemM&and hold harmless Jelllsrsoa County against all Iiabdlies,judgments,court costa,reesanablo attorney's ham rind expanses which may h any way accrue against Jefferson County se■result of or n cerrseque nos or the granting of this permute i further agree to provide access and right or entry to Jo/oreon County and Rs employees,reproeonbewts or agents for the sole purpose of appecetbn review and any required late wapndions. start wean and re or entry wen ua assumed unless the spOcant Informs the corny In waiting st tire err a of the appecslon Ones she wan r Signature; Dote: . 2./ Q The action or actions Applicant wig undertake as a remelt issuance of this permit may nogativoy knpact upon ono or more thivatoned or endangered species ens cooks load to a potonMd"Wheaten endangered spades us those tense aro defined in the federal law known es the "Endsngnred Spades Act'or'EBA."Jefferson County moires no essurenoaa to the applicant that the actions that we be undertaken because Mk: permit hes Seen issued wilt net violate Me SSA. My Individual.group or agency can Its a lawsuit en behalf of en endangered species regnd/ng your notions)ew:n If you am In avmpsrrwa with Nee Jefferson County de meet ode,The Applicant ooknow sigos that he.alto or It holds Individual and non•Irar>sbreble respond for adhering comgyine • . The Applicant has mad this desafslrrua ridds,,'s and slow. gspiaturn: s' L - Onto: i3</ . u C\Dxrxnrnv sari Ceram\cue\lead d.utngATanpanrymount Pier\OLK861Moswr r cat/ie./WO arbour t2-+94004 der ..T .......,. _iv_ BUILDER STATEMENT r• 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: rk t_L> \V\ a _ ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE O WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New 0 Wood Existing: ❑ Sewer El Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel [1 Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition El Other:Other: 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:\Above ground Tank Size of Propane Tank: .: _) I Heat Stove i Cook Stove 1 Woodstove i Fireplace Insert I Hot Water Tank I Pellet Stove I Other �-07.6 2 /ex..._ 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: 2"0 Floor Heated Consistency Review: Other Heated Base fee: j 1 . .l .)r, Mezzanine Additional Section: I 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 J1 Receipt Number: q 1 1 8 Cash/Check Number: CC4A ESTIMATED COST(REQUIRED) Date: 3/ � '� •Fair market value of all labor and materials foundation to finish Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc L Pc Co t,n¢,z, - Z- 4FF • a Krzli p Gar '2 Y \ALK. \on c t?AaCEL-F So 1 -032-02( 1 a5 � taC' �� �N 'C� - �iJ� t N �}tN VI-ev�^ Cv-fL-� L SE 'S �`` i NtMt°'t _____, i@ 7.74:4_ (4eGItAkilEME NTS 0ea . .� cam Og of . t')\4-i' 1 s' -�-740 , SET A I D U NE FROM 9P.;A fov e "1 ' AT) L1' N2. 10 • T‘^tzE-- di 2 J 1 0 tz 1 w ; 2 I PO G ATC 1