HomeMy WebLinkAboutBLD2008-00163 •
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 #: BLD08-00163 Received Date 4/24/2008
SITE ADDRESS: 41 QUARRY RD Issue Date 4/24/2008
PORT LUDLOW, 98365
APPLICANT: JOHN P RUIDL PHONE: 360-437-5059
BONNIE HUPF RUSH
41 QUARRY RD
PORT LUDLOW WA 983659457 1+
SUBDIVISION: BASALT BEACH Block: 2 Lot:
PARCEL NUMBER: 931500201 Section: 4 Township: 28N Range: 01 E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
1385-5875
Contractor's License SUNSHP*077QP Expires 1 /
OWNER, JOHN P RUIDL PHONE: 360-437-5059
if different: BONNIE HUPF RUSH
41 QUARRY RD
PORT LUDLOW WA 983659457
PROJECT DESCRIPTION: TR3FW��Onn7 GAL PROP TANKS TO COOK STOVE &GAS PIPE-NO MLA
Directions SEE MAP& DIRECIT9 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:
Tank/Line/Appliance: JArIE216Z_ LASES Dg 5/,/ 3 #z — iANK 1..oe,7rldN efik 50/46
OK 7 z4/og
FinalApproval: �//`�\ -0,r 410 01 7A
Agfr
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
eview
BUILDING PERMIT APPLICAT•N R00163
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD08-00163 Received Date: 4/24/2008
SITE ADDRESS: 41 QUARRY RD
PORT LUDLOW, 98365
OWNER: JOHN P RUIDL PHONE: 360-437-5059
BONNIE HUPF RUSH
41 QUARRY RD
PORT LUDLOW WA 983659457 BASALT BEACH
SUBDIVISION: Block: 2 Lot: 1+
PARCEL NUMBER: 931500201 Section: 4 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 DESCRIPTIOI` TWO 7 GAL PROP TANKS TO COOK STOVE & 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:
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: Cam, aq
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 - ot-10 � ouu►e. UIDL_ DATE : q1i6-/br
CONTACT:
ADDRESS PHONE #:
DIRECTIONS FAX #:
Email
f PLANNER:
XI
APR 242(1r18
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1, JEFFERSON OUNTY
' _ DEPARTMENT OF COMMUNITY DEVELOPMENT APR 2 4 20
►C 621 Sheridan Street • Port Townsend •Washington 98368 ��
K360/379-4450 • 360/379-4451 Fax C
'O www.co.jefferson.wa.us/commdevelopment �hfIEI1J�1,' [�;,'t 1;/
Master Perroit Application MLA: r\O m l C _ r- c 167{
Project Description (include separate sheets as necessary):
Y
•Tax Parcel ir—e9- --
Number: Property
�,)t 5OO �(J� _ Size: f
(c,s.:.es/square feet)
Site Address and/or D,iirr jctions to Property: n
_-�C L>'x � Y lam. ,,a --
Property Owner(s)of Record: D ecO7112 fQ,fjl / )
Telephone: 3 77.._5a Fax:
email:
Mailing Address: =Sr 7`�
Applicant/Agent(if different from owner): S L MS hi J Ai E D Ro PA N e
Telephone: 385'579 7 Fax: 38S'S87S email: INF
og Mailing Address:_1 OS53 RHop D 2 I . NF)!J Lock Sun1SN/;JE Plop i�,
LJ�l. q 83�9 cool
What kind of Permit?(Check each box t at applies
❑Building ❑Variance(Minor, Major or Reasonable Economic,.;se)
❑ Demolition Permit 0 Conditional Use[C(a), C(d),or C]** 1
❑ Single Family 0 Garage Attached/Detached CI Discretionary"Cr or Unnamed Use Classification
❑ Manufactured Home ❑ 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 ❑ Cottagelndustry 0 Long Plat**
ropane 0 Planned Rural Residential Development(PRRD)/A iendments**
❑ ign 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)* ❑ 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:
-U) , 0
DESIGNATION OF AGENT
I hereby designate S 14S E) I Przo ��
p to act a;my agent in matters relating to this application for permit(s).
1(6-WNER SIGNATURE rr��<.?-/ J ILI.1.1. (,�,�GL�— 4-/ 7 GJ
Date:
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 appfic tion 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.
V 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 required later in tions. Staff's acc s and right of entry will be assume unless the applicant informs the County in writing at the
\1 time of theaplicat' t s w nor not'
ignature: n �1
�` 1�;,.�,+.-t� 41�i.�1, Date: I.
'/b"U.:/
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 °s the
ce "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 are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it hok: individual
and non- ansf= •e .. •ibilit dh to and complying wif, t ESA. .h 'Applicant has read this disclaimer and signs and da(es it below.
'i Signature: di.„,dr:. IJ Date: `r l'6-01
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc i'wu
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:
SOQH INN: P2o pang (360) 385- 5797 ( 36o) 385-5875
MAILING ADDRESS: )0853 •K}}.flQ(/ O�i U e_ a Fi. EMAIL: r n-FWSLoAs1luvlt Pro Pane 6 CCal
CONTRACTOR'S LICENSE j WAINS
NUMBER: 1, V1SI4 P7` DiN0 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
❑ Addition 0 Steel Proposed: Bank 0 Community System
0 Alteration/Rarr:odel 0 Concrete Total: Height: ❑ Individual System
❑ Repair 0 Masonry SEP Permit#
0 Demolition 0 Other: Bedrooms: Water Supply:
Existing: Setback:
Type of Heat: Proposed: 0 Private well 0 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 Appliance Installation permit,mark all items below that apply:
I Underground Tank d• Size of Propane Tank:
I Heat Stove Cook St ve oodstove I Fireplace Insert 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 building:,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.
Y$tFr #-5�`A ,, . 4,t£ s��t` ,I ' av a io���t' �a S h: 0 9.: 0 ,y s
Square Footage Current Proposed h ® ac`i3 -a , ®, i, w .1. : St ,t.r„, s n
Main Floor Heated ".'" v x. l r,:pj p0 rs,
k,1 EH Bid App Review:
2 Floor Heated 7 ;??,,„ Consistency Review:
Ot ,';4_•"
Other Heated ,, 4'`k° Base fee:
Mezzanine ;1 r�,, �d : "' Additional Section:
Heated Basement ,;- ` q.v,' Plan Check fee:
Y.Unheated Basement R�, " y' " ,e State Surcharge fee:
Other Unheated " k��l .. Pot Water Review fee:
Garage/Carport * a`! r "; TSUBTOTAL
G.d zI4S
Decks � r N��, �;�`, 911/Rd Approach fee:
Other z,";,-'a 0 4 TOTAL: $ j o CJ
4" - % Receipt Number:
Cash/Check Number:
'" ,axis 4 l ,
ESTIMATED COST(REQUIRED) Date:
•Fair market value of all labor and materials foundation to finish Li a4 j0. 3
Initials: A3
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc