HomeMy WebLinkAboutBLD2008-00237 •
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 #: BLD08-00237 Received Date 6/3/2008
SITE ADDRESS: 20 FORESTER LN Issue Date 6/3/2008
PORT LUDLOW, 98365
APPLICANT: SUNSHINE PROPANE PHONE: (3601 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
140+
SUBDIVISION: PORT LUDLOW NO. 2 AREA 3 Block: Lot:
PARCEL NUMBER: 990603140 Section: 9 Township: 28N Range: 01 E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339 pl 3g5
Contractor's License SUNSHP*077QP Expires 1 1/((33 67/2008 5875
OWNER, DOUGLAS A HUBER PHONE:
if different: 20 FORESTER LN
PORT LUDLOW WA 98365-9628
PROJECT DESCRIPTION: INSTALL A/G 120 GAL PROPANE TANK AND GAS PIPING
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 6/3/2009.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: ,cle An F�i[r� L'o6 60jB 14/7
FinalApproval: 3) � it (*29/
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
•UILDING PERMIT APPLICAAN B RD p Review
y�:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD08-00237 Received Date: 6/3/2008
SITE ADDRESS: 20 FORESTER LN
PORT LUDLOW, 98365
OWNER: DOUGLAS A HUBER PHONE:
20 FORESTER LN
PORT LUDLOW WA 98365-9628
PORT LUDLOW NO. 2 AREA 3
SUBDIVISION: Block: Lot: 140+
PARCEL NUMBER: 990603140 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: SUNSHINE PROPANE PHONE: (360) 385-5797
10853 RHODY DR (360) 385-5875
PORT HADLOCK WA 98339
PROJECT DESCRIPTIOr INSTALL A/G 120 GAL PROPANE TANK AND GAS PIPING
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:
Type Amount Paid Bv: Date: Receipt: API {�vd."JEEDDate
Propane Tanks/Stoves $157.00 KAS 06/03/08 100235 R
Total: $157.00 JUN -3 200$
Jefferson County Planning
& Building Department
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SITE VISIT REPORT
(PLOT PLAN)
JOB IJovc, 4 k_A 1E 1-03E DATE : S/0 10 i(' .
`` CONTACT: .
ADDRESS oID Fb R STh2, ?k I Lu ctbJi PHONE #: .
DIRECTIONS FAX #: .
Email .
PLANNER: .
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SoN oJEFFERSOOOUNTY 6 -a CE!Vti DEPARTMENT OF COMMUNITY DEVELOPMENT �l` �
'cl( 621 Sheridan Street • Port Townsend •Washington 98368
, p 360/379-4450 • 360/379-4451 Fax JUN - 3 2008
www.co.jefferson.wa.us/commdevelopment
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Ci I. f 1::,..,
Master Permit Application MLA: .. . �' n n
� :11 U;J(J
Project Descriptio (include separate s4.ets as necessary): 6y O J-j51&�'2 S
dg__.)
Tax Parcel frj-j Pro‘rty
Number: 99d D� /�Q _ Size: (a xes/square feet)
Site Address and/or Directions to Pr nertv: Q _
Property Owner(s)of Record: r ti ?e '
Telephone: - `Fax: email:
Mailing Address:
Applicant/Agent(if different from owner): S u-NS H I N E P Ro FA N E
Telephone: 395-5717 Fax: 3BS SO7S email: (NFQSun1S14/^IEproP e.
Mailing Address: I CDS53 RHOpy D 2. / p(. �(Ig0 Lock t Lc)A- 9 833� �m
What kind of Pen""it?(Check each box that applies
❑Building ❑Variance(Minor, Major or Reasonable Economic se)
❑ Demolition Permit ❑ Conditional Use[C(a),C(d),or C]**
❑ Single Family 0 Garage Attached i Detached U Discretionary"D"or Unnamed Use Classification
❑ Manufactured Home 0 Modular 0 Special Use(Essential Public Facilities)**
❑ Commercial* 0 Boundary Line Adjustment
❑ Change of Use ❑ Short Plat**
❑ Address 0 Road Approach 0 Binding Site Plan**
0 Home Business 0 Cottagelndustry 0 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 ❑ 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:
)t n DESIGNATION OF AGENT
\ \I hereby designate NN �I- p to act as my agent in matters relating to this application fo,permit(s).
�WNER SIGNATURE \ cu�S I�E �(t c�,��J �--L • x ( Date: —a T— 6
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.
(`( 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
UU 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 a plication th he or she wants prior�oticef
ignature: c—eJ a ���`�� ...) Date: _ c 7—n
The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatencu 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 Aci"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this
5\ 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 nontrrpnsferable r ponsibility for adherin to pnd complying with the ESA. The Applicant has read this disclaimer and sins and dates it below.
Signature: ,e) (_e- Date: J d
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc
0 BUILDER STATEMENT •
The signer of this statement dens � '
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:
Date: I
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER:
`��rSE 1-1i N L P�.o an PHONE: FAX:
MAILING ADDRESS: P e (360) 3�35- 57T1 ( 36o) ,3g5-5875
0853 .k�+o o y r'v 2 P. H. EMAIL: n PSUhsAtile Pao Pane 6 c 001
CONTRACTOR'S LICENSE
NUMBER: WAINS
i s74 P+ DTI�/�( P NUMBER
ARCHITECT/ENGINEER:
MAILING ADDRESS: PHONE( ) FAX: ( )
EMAIL
Project Type:
Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New ❑ Wood Existing:
❑ Addition ❑ Steel Proposed: ❑ Sewer
0 Alteration/Remodel Bank ❑ Community System
❑ Concrete Total: Height:
❑ Repair ❑ Masonry 0 Individual System
❑ Demolition ❑ Other Bedrooms: SEP Permit#
Water Supply:
Existing:
Type of Heat: Setback: ❑ Private well ❑ Two Party
Proposed:
--ooTotal: ❑ Public
0 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
IBC Occupancy: IBC Type of construction: Proposed
If this is a Propane Tank and/or A liance Installation ermit mark all itembeu e aFood Service? Yes / No
I Underground Tank Above ground Tank
low that
Size of Propane Tank: /-2-O
Heat Stove ook Stove oo s ove I Fireplace Insert I Hot Water Tank I Pellet Stove I Other a p-,1^
Is appliance einq installed in a Manufactured/Mobile Home? Yes / No l/
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 w
Current Proposed F' t' e , y : A ' n� , .isi{
Main Floor Heated p x Tice Use,Only, 3� Review:
Y Atfi"punk. ,t ,< .`ReV`i to i ir,
t
., EH Bld App Review:
2 °Floor Heated
Consistency Review:
Other Heated PII,`X
{ '
Mezzanine .I . lCJ
�� Additional Sectl�n:
K
Heated Basementg,k x ?
a Plan Check fee:
Unheated Basement
State Surcharge fee:
Other Unheated
Pot Water Review fee:
Garage/Carport
SUBTOTAL
Decks �5�,
911/Rd Approach fee:
Other
TOTAL: $ v5-1 u
: Receipt Number: ID o5 3
Cash/Check Number: �J
ESTIMATED COST(REQUIRED)
.Fair market value of all labor and materials foundation to finish Date:
3d8
Initials:
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc