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Home My WebLink AboutBLD2008-00294 • • 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 #: BLD08-00294 Received Date 7/1/2108 SITE ADDRESS: 512 HIGHLAND DR Issue Date 7/1/2108 PORT LUDLOW, 98365 APPLICANT: JOHN A O'BRIEN PHONE: (360)417-5186 FLOY A O'BRIEN 512 HIGHLAND DR PORT LUDLOW WA 98365-9749 33 SUBDIVISION: SOUTH BAY#1 Block: Lot: PARCEL NUMBER: 995500033 Section: 21 Township: 28N Rang : 01 E CONTRACTOR: PERDUE CONSTRUCTION PHONE: (360) 460-4767 220 FLEMING DR SEQUIM WA 98382 Contractor's License PERDUE*946NH Expires 8/8/2008 OWNER, JOHN A O'BRIEN PHONE: (360) 437-5186 if different: FLOY A O'BRIEN 512 HIGHLAND DR PORT LUDLOW WA 98365-9749 PROJECT DESCRIPTION: CHANGE GAS FIREPLACE TO WOODSTOVE 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 7/1/2009. REQUIRED INSPECTIONS: Tank/Line/Appliance: `dart) /4)57 4z4-M /o) Tk A6.efff FinalApproval: !/� j ;141.0 J/L/"),g t* 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 APPLICAN BLD081-00294RevievVType: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD08-00294 Received Date: 7/1/2008 SITE ADDRESS: 512 HIGHLAND DR PORT LUDLOW, 98365 OWNER: JOHN A O'BRIEN PHONE: (360) 437 186 FLOY A O'BRIEN 512 HIGHLAND DR PORT LUDLOW WA 98365-9749 SOUTH BAY#1 SUBDIVISION: Block: Lot: 33 PARCEL NUMBER: 995500033 Section: 21 Township: 28 N Range: 01 E CONTRACTOR: PERDUE CONSTRUCTION PHONE: (360) 460-4767 220 FLEMING DR SEQUIM WA 98382 Contractor's License PERDUE*946NH Expires 8/8/2008 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION CHANGE GAS FIREPLACE TO WOODSTOVE 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 By: Date: Receipt: Approved/Date Propane Tanks/Stoves $105.00 KAS 07/01/08 103400 Total: $105.00 • • RECEIIVED JUL - 12008 JEFFERSON COUNTY DCD `4.\‘' r )‘" flok 1 44,eON C k,, JEFFERSOF*UNTY . rokDEPARTMENT OF COMMUNITY DEVELOPMENT ii ` 1� 621 Sheridan Street• Port Townsend •Washington 98368 RECEIVED 360/379-4450 • 360/379-4451 Fax `! 4 " d� www.co.jefferson.wa.us/commdevelopment s � JUL - 1 2008 Master Permit Application MLA:Project Description (include separate sheets as necessary) ,/ L 1EffERSO N ��Ul1P PCDe m,L.,a (.q5 w0t4A,& im�:/rifie - //, -eD iuR //YG- Tax Parcel Number: QC�g 6 OC-' 0 .] Property Size:� p y (acres/square feet) Site Address and/or Directions to Property:�aR7'h vAG-o`t� `j.�'�'r/f �-n 1),: To cj.Votr71 4L.. j?, c441 T sa4.hi'P. iii62-,c.p eoue54-- 3i: 11/6/i'is,AIV0 _DR/V , Pe,i r k ins A.o\v, vvW 9k34,5 Property Owner(s)of Record: SS At,is .- F.Ai,y 0/3 R/,N! Telephone: 3 G t' '/,3`' _57146 Fax: /y/// email: it!/9 - Mailing Address: 5// /-// *//j- AND jD /i/- leer ,L✓D4.0'it"' //I//4 �/ic>`3 Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: Wht kind of Permit?(Check each box that applies OBuilding 0 Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) ❑Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a),C(d),or C]** ❑ Manufactured Home ❑ Modular 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* 0 Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment ❑ Address 0 Road Approach 0 Short Plat** ❑Home Business 0 Cottage Industry 0 Binding Site Plan** ❑ Propane 0 Long Plat** 1 ❑Sign 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** ❑Stormwater Management ❑ Shoreline Master Program Exemption/Permit Revisions** ❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development** ❑Temporary Use 0 Shoreline Management Variance ❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment *May require a Pre-Application Conference 0 Tree Vegetation Request **Requires a Pre-Application Conference Please identify any other local, state or federal permits required for this proposal, if known: DESIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct tq 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 applicatign 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 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 app' tion that hhee or she nts prior notice. Signature: ( ' ( �, 61 A hrl t.;>iyL Date: ��- / r C A I The action or a ions 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 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 reglarding 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 non-trap erable espponsibility foror adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: C 7l 6, ri!AAA- .-- Date: 7- / - /) G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc • 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: MAILING ADDRESS: `—fz-721 !/N(4- 1,R J V� -{�IIE: C�i� �, /�� vt/ CONTRACTORS LICENSE , WAINS J Y NUMBER: PkRDU ,< /`f,, `/ NUMBER ARCHITECT/ENGINEER: �/ / / PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ 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: i Underground Tank t Above ground Tank ,— -- Size of Propane Tank: Heat Stove i Cook Stove Woodstove' I(ireplace Insert i Hot Water Tank i Pellet Stove i Other Is this appliance being installe 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 i EH Bld App Review: 2n0 Floor Heated Consistency Review: Other Heated Base fee: COO COS oVQ— 1o5.DO Mezzanine Additional Section: Heated Basement ' r Plan Check fee: 111 Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL 105.00 Decks 911/Rd Approach fee: Other TOTAL: $ 1,05.CD Receipt Number: I O 4 W Cash/Check Number: n 4 ESTIMATED COST(REQUIRED) Date: lam-/ 'Fair market value of all labor and materials foundation to finish rill log Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc llle,/f,4A1V1) OR NO LL v W L W 1 O �l W m M z W O x a otl y w O 4 W , z � w f 0 a