HomeMy WebLinkAboutBLD2008-00125 • •
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 #: BLD08-00125 Received Date 11/3/2008
SITE ADDRESS: 1155 ELKHORN LN Issue Date 11/3/2008
QUILCENE, 98376
APPLICANT: MICHAEL D JOACHIMS PHONE:
SUSAN K JOACHIMS
50 MOCKINGBIRD LN
PORT LUDLOW WA 983659759 T 17+
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 802274006 Section: 27 Township: 28N Range: 02W
CONTRACTOR: THURMAN SUPPLY PHONE: 360-457-8591
1807 E FRONT ST
PORT ANGELES WA 98362
Contractor's License THURMS*954JA Expires 11/26/2008
OWNER, MICHAEL D JOACHIMS PHONE:
if different: SUSAN K JOACHIMS
50 MOCKINGBIRD LN
PORT LUDLOW WA 983659759
PROJECT DESCRIPTION: NEW WOODSTOVE - NO MLA REQ'D
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 11/3/2009.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: '.t]Ooh J'i r,JF L5K I I/Lo/C>�,
FinalApproval: ("V
OK -cc�r 43,0td rl /O
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
OUILDING PERMIT APPLICA•N Review Type:
i
Review Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD08-00125 Received Date: 11/3/2008
SITE ADDRESS: 1155 ELKHORN LN
QUILCENE, 98376
OWNER: MICHAEL D JOACHIMS PHONE:
SUSAN K JOACHIMS
50 MOCKINGBIRD LN
PORT LUDLOW WA 983659759
SUBDIVISION: Block: Lot: T 17+
PARCEL NUMBER: 802274006 Section: 27 Township: 28 N Range: 02 W
CONTRACTOR: THURMAN SUPPLY PHONE: 360-457-8591
1807 E FRONT ST
PORT ANGELES WA 98362
Contractor's License THURMS*954JA Expires 11/26/2008
REPRESENTATIVE: THURMAN SUPPLY PHONE: 3360-457-8591
1807 E FRONT STREET
PORT ANGELES WA 98362
PROJECT DESCRIPTIOP NEW WOODSTOVE - NO MLA REQ'D
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION ADDT: HEAT TYPE:
CODE EDITION: 2006 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY:
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:
1113t0b OLIO
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $105.00 AMS 11/03/08 102961
Total: $105.00
1;:30N c ,CEIVEI)
� JEFFERSON•OMMUNITY
UNTY
z ' '+a DEPARTMENT DEVELOPMENT
`' ` ' 621 Sheridan Street • Port Townsend •Washington 98368 h O V 0 3 2008
\\... ,
360/379-4450 • 360/379-4451 Fax
49 �p� www.co.jefferson.wa.us/commdevelopment
�xN� JEffERSI''
Master Permit Application r u l�r �i✓
pp MLA: C1�7 � 1 � C�t��
Project Description (include separ to h ets as necessary):
a)00 o Lt-�
Tax Parcel Property
Number: 802 22/00 6 Size: (acres/square feet)
Site Address and/or Directions to Property:
Property Owner(s)of Record: . )(,�j. ,To Of( ;41,c
Telephone: J 'CJ - ' j-/Q U Fax: email:
Mailing Address: /t 5-C , -r r- Qr'1 ✓t
Applicant/Agent(if different from owner): 74"0,y,vrr t/t S
Telephone: 4/45; 7-- .�`Z/ Fax: email: •
Mailing Address: c t ,., / E c �---
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**
❑ Address ❑ Road Approach ❑ Binding Site Plan**
❑ Home Business 0 Cottagelndustry ❑ Long Plat**
❑ Propane 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 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* 0 Jefferson County Shoreline Master Program Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium ❑Tree Vegetation 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:
/Y1L� g
f� DESIGNATION OF AGENT
I hereby designate to act as my agent in matters relating to this application for permit(s).
. �,
OWNER SIGN4fHR —� 1�ytic�—> Date: i 7�Qe
i
By signing this application form,the owner/ag attests that the information provided herein,and in any attachments,is true and correct to the best of
his, her or its 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 req ' d later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
Y time of the applic n that he or she wants p ' r notice.
"\ Sign tur ' 3 - Date: //74 fv
i
The action or actions Applicant will and ake 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 ar in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transferab esponsibililyfor adheriri to and co plying with the ESA. The Applicant has read this disclaim r and igns and dates it below.
Signa fk-c' Date: /0���
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc
0 BUILDER STATEMENT IP
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 ONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
�vjL`w,�, ,��� (• ���) us y �� p ( >
MAILING ADDRESS: /,7 �c, 1L ✓ LL 11 EMAIL:
•
S/ Sl
CONTRACTOR'S LICENSE/� _ WAINS
NUMBER: /-etHi,./t S k J/1 9 1f_ NUMBER
ARCHITECT/ENGINEER: /VA PHONE ( ) FAX:( )
MAILING ADDRESS: /� EMAIL
Project Type: �T Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New Wood Existing: 0 Sewer
❑ Addition ❑ Steel Proposed: Bank ❑ Community System
❑ Alteration/Remodel 0 Concrete Total: Height: ❑ Individual System
O 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:
Underground Tank i Above ground Tank Size of Propane Tank: 4j-e
Heat Stove i Cook Stove i oodstove i Fireplace Insert i Hot Water Tank i Pellet Stove T Other
Is this appliance being installe nufactured/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"1 Floor Heated Consistency Review:
Other Heated Base fee: .'u
Mezzanine Additional Section:
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: $ ' ��
Receipt Number: I(tir1C1C-e 1
Cash/Check Number: C�
ESTIMATED COST(REQUIRED) Date: �
•Fair market value of all labor and materials foundation to finish ' \ 13
Y
Initials: Q >
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc
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F t M ON—SITE WASTEWATER PLANS SOILS APPLICATION,la ' �' — 74-00sI INC. .
tO V TAX PARCEL # 802 2
�,1. :z c N �� 863.. I;ARLSORG RbAD, SUITE A, .
CI N SANDF 7E PRESSURIZED SISTEM 'FOR` • QUIM, •WA 8838�
C3) JOACI-I#AS
pH� FAX (38Q) 83-580
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