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HomeMy WebLinkAboutBLD2008-00162 • • PROPANE/PELLET/WOOD STOVE & TANK INSTALLATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Pori: Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD08-00162 Received Date 4/24/2008 SITE ADDRESS: 7270 SR 20 Issue Date 4/24/2008 PORT TOWNSEND, 98368 APPLICANT: GARY N STEPHAN PHONE: 360-821-9133 BONNIE L STEPHAN 2023 E SIMS WAY# 345 PORT TOWNSEND WA 983686905 + SUBDIVISION: Block: Lot: PARCEL NUMBER: 001282011 Section: 28 Township: 30N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 p) 3g Contractor's License SUNSHP*0770P Expires 1 1/((33 67/2005 5875 OWNER, GARY N STEPHAN PHONE: 360-821-9133 if different: BONNIE L STEPHAN 2023 E SIMS WAY# 345 PORT TOWNSEND WA 983686905 PROJECT DESCRIPTION: NEW 100 GAL A/G PROP TANK & GAS PIPE-NO MLA REQ'D Directions SEE MAP AND DIRECTIONS IN FILE 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 4/24/2009. REQUIRED INSPECTIONS: elil- Tank/Line/Appliance: I rEQiu, Jfru„s 25/(6 2J4 •�,rr`ve,ee. Lim Ok S/�/ 0 J ) JLX /)l' 5/2/0 111 rr__ p FinalApproval: r. 1✓cL/ 572 ,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 RILDING PERMIT APPLICATON BLD08-00162 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD08-00162 Received Date: 4/24/2008 SITE ADDRESS: 7270 SR 20 PORT TOWNSEND, 98368 OWNER: GARY N STEPHAN PHONE: 360-821-9133 BONNIE L STEPHAN 2023 E SIMS WAY# 345 PORT TOWNSEND WA 983686905 SUBDIVISION: Block: Lot: + PARCEL NUMBER: 001282011 Section: 28 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 NEW 100 GAL A/G PROP TANK & GAS PIPE-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: 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: L I �� ta3- Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $105.00 AMS 04/24/08 97410 Total: $105.00 • SITE VISIT REPORT (PLOT PLAN) JOB �� of DIE STE PN DATE : CONTACT: ADDRESS PHONE #: DIRECTIONS FAX #: Email PLANNER: ,o� Io$or \6 - RcjAm 14 � I IM C 00 I � � I-- —-- , c..-e,i.r P4- `� RECEIVED lv �, JEFFERSON OUNTY 1 '\g DEPARTMENT OF COMMUNITY DEVELOPMENT APR 2 4 2008 '� 621 Sheridan Street • Port Townsend •Washington 98368 Kiillo, §1> 360/379-4450 • 360/379-4451 Fax tJ www.co.jefferson.wa.us/commdevelopment JEFFERSON 1,isLNil 110 Master Perr lit Application MLA: nd m ( req,of Project Descriotiory(include separate sheets as necessary): �/LrSjfJ ��> p`$"� s Tax arceR I Property U O Number: ' 0 // Size: (E ,es/square feet) Site Address and/or Directions to Property: '7c9 7 0 . - . .2_,Q Io Property Owner(s)of Record: C � c' Q.t. e.fir)/ _ ,f1�,p/�a. j Telephone: Raj 1 (3 Fax: email: Mailing Address: .Scz.,____ Applicant/Agent(if different from owner): S U.-MS H I N E P Ro FA N E Telephone: Jae-5--579 7 Fax: 38S 5 75-- email: (NFOSuAlsfri JE ProPA1-7C• Mailing Address: I OS53 RHODy De• Pi-. (1fOI-Ock/ W A- 9 833'1 ,c,,,,, What kind of Permit? (Check each box that applies ❑Building ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Single le Fam Fion amily 0 0 Garage Attached/Detached O D scret ovary"D"'Use or Unn(a), amedUse Classification g Y ❑ Manufactured Home 0 Modular ❑Special Use(Essential Public Facilities)** ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use 0 Short Plat** ❑ Address 0 Road Approach 0 Binding Site Plan** ❑ Home Business 0 Cottagelndustry 0 Long Plat** Propane 0 Planned Rural Residential Development(PRRD)/Akiendments** ❑ 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 0 Tree Vegetaion Request *May require a Pre—Application Conference **Requires a Pre-Application Conference Please identify any other local, state._or_feder..al permits required.for.this._proposal, if known: c` I hereby desi vat t�IS (� l>\}E P� DESIGNATION OF AGENT 9 P e___`to act as my agent in matters relating to this application f.:r permit(s). --- 5—wNER SIGNATURE_� L d� �� Date: S ' By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correc. 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 appli�:.ation 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',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. Si I further agree to provide access and right of entry to Jefferson County and its employees,representatives entatives 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�applic I that he or she ants or' ignaturep �,z u.—A. -� Date: ) Li" I S Oc 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-is the r "Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this t 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 yo are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it hold::individual and non- ansfer responsibility for adhe' o and c plying with the ESA. The Applicant has read this disclaimer i n gsJ,si ns a d�a;es it below. Date: Signature: ti\ t• G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc (0S • 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:_ 1 Date: GENERAL CONT'-,,CTOR OR MANUFACTURED HOME INSTALLER: PHONE: ll S�ISS'H 1 N E P R,v ail F,vc: (' (360) 3�35- 5797 ( 360) 3E35-587S MAILING ADDRESS: )0853 P oo y n l u e. P. I-I. EMAIL: I n ? Par, 6 �plyt � CONTRACTOR'S LICENSE `�sUl'1s{��V�� pro n WAINS NUMBER: u v1St-{ P7� t'�i7 M P NUMBER ARCHITECT/ENGINEER: PHONE' ( ) Fax: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New 0 Wood Existing: 0 Sewer 0 Addition 0 Steel Proposed: Bank 0 Community System ❑ Alteration/Remodel 0 Concrete Total: Height: 0 Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: p y' Type of Heat: Proposed: Cl Private well ❑ Two Party Total: 0 Public Name of System: If this is a Commercial Project you must answer the following: Numb r 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 Alliance Installation permit,mark all items below that apply: I Underground Tank Above ground Tank Size of Propane Tank: / o to 6,9 - I Heat Stove I Cook Stove I Woodstove I Fireplace Insert I Hot W ter Tank I Pellet Stove I Other Is this appliance being installed in a Manufactured/Mobile Home? Ye / 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 FootageI "r ,, ;i , i a, ,w x L , q g Current Proposed ..:P ikf4�tr ,yti w"-II TM f p..s k t .41 ;s,n.- ��'y 1,i'l ti t 1 �' jai a f e ©��r �..P�©'t fy�.� � ��i'i�� .wit ,„ @,► d°d9ftk';�,�}„C} •!t�4,Y�� r *d" ` ^E Main Floor Heated . ?E, u ,•s.fi i EH Bld App Review r 2"°Floor Heated 4 ., : Consistency Review: Other Heated ''",; ,(. �a : ` : Base fee: Mezzanine f , , :.•.�,T•: ,�' Additional Section: , Heated Basement i .' -4i •a Plan Check fee: i t , 5,;� Kh _ Unheated Basement f=) z.ss State Surcharge fee: - Other Unheated >,`. /' `= ` i 1 , ,' Pot Water Review fee: Garage/Carport `kz - R SUBTOTAL Decks rmil rtS 911/Rd Approach fee: Other "'e r ?, TOTAL: $ 05 O • ,,t Receipt Number: A An Cash/Check Number: ESTIMATED COST(REQUIRED) 0.1, ,„_ Date: LA I of •Fair market value of all labor and materials foundation to finish (—II aU )O .G Initials: ` O G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc