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Home My WebLink AboutBLD2008-00316 • 0 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 #: BLD08-00316 Received Date 7/17/2008 SITE ADDRESS: 61 QUARRY RD Issue Date 7/17/2008 PORT LUDLOW, 98365 APPLICANT: FRANK M MINTEER PHONE: 360-437-2240 61 QUARRY RD PORT LUDLOW WA 983659457 3+ SUBDIVISION: BASALT BEACH Block: 2 Lot: PARCEL NUMBER: 931500203 Section: 4 Township: 28N Range: 01 E CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2008 OWNER, FRANK M MINTEER PHONE: 360-437-2240 if different: 61 QUARRY RD PORT LUDLOW WA 983659457 PROJECT DESCRIPTION: INSTALFF ❑p (2) 120 GAL A/G PROP TANKS & HEAT STOVE- NO MLA Directions SEE MAP AND DIKE,L9'I"UNS 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 7/17/2009. REQUIRED INSPECTIONS: 94 Tank/Line/Appliance: k7ER_/ WA-r(pfo J,tc< a yz.h/ FinalApproval: 12- 08 ---1--974-- 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 WILDING PERMIT APPLICATSN BLD08-00316 Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD08-00316 Received Date: 7/17/2008 SITE ADDRESS: 61 QUARRY RD PORT LUDLOW, 98365 OWNER: FRANK M MINTEER PHONE: 360-437-2240 61 QUARRY RD PORT LUDLOW WA 983659457 BASALT BEACH SUBDIVISION: Block: 2 PARCEL NUMBER: 931500203 Section: 4 'ownship: 28 N Range: 01 E t 3+ CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790? Expires 9/7/2008 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOt INSTAL (2) 120 GAL A/G PROP TANKS & HEAT STOVE- 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: CONST TYPE: GARAGE: SHORELINE: DECK: SETBACK: SEWAGE DISPOSAL: BANK HEIGHT: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $157.00 AMS 07/17/08 100538 Total: $157.00 rgUN car, JEFFERSON UNTY RECEIVED DEPARTMENTiffirCOMMUNITY DEVELOPMENT • ti 621 Sheridan Street • Port Townsend • Washington 98368 �.; 360/379-4450 • 360/379-4451 Fax JUL 1708 is, 7NGO www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: no YYl `.C_JEFFERSON CU Y-OC[J e9Project Description (include separate sheets as necessay) /n V/d // Z' - /Z O 9 c.'//c's-7 12/ -(a)'i7>7 r' //'► d - Tax Parcel Number: ?3 j Sa 0 2 4,3 Property Size: ) •3 a.,I. (acres/square feet) Site Address and/or Directions to Property: // (D / ' . per/i r/ L Jiro.., 4. 8 L,•— frj7 Property Owner(s)of Record: Ara el.* /1. . Nolen A• Aye fro fr t e.. Telephone: 3 6 0 • 4/3 7. 12 fie Fax: / Mailing Address: / r email: /it 4 fdMupis to,ape*c a o.. rgat. portt.�lm., 14 . 9-83A,- Applicant/Agent(if different from owner): /V/A Telephone: eV/4Fax: Mailing Address: email: What kind of Permit?(Check each box that applies ❑Building 0 Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family ❑ Garage Attached/Detached 0 Conditional Use[C(a),C(d),or CI** ❑ Manufactured Home 0 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 ❑Cottage Industry 0 Binding Site Plan** ❑ Propane 0 LongPlat** ❑Sign D Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis 0Plat Vacation/Alteration** ❑Stormwater Management 0 Site Plan A 0 Shoreline Master Program Exemption/Permit Revisions** pproval 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 AcURelease of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment *May require a Pre-Application Conference ❑Tree Vegetation Request **Requires Pre-Application Conference Please identify any other local, state or federal permits required for this aproposal, if known: I hereby designate DESIGNATION OF AGENT 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 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 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 appli ' that he or wan r r noti . Signature: 104,,,,G , Date: 74ele die The action 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 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 are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferab ponsibility f�padher. and omplying with the ESA. The Applicant has read this disclaimer and Sins and dates it below. Signature: 0_r��/ • Date: 7//e4 9 G:\PemvtCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc • BUILDER STATEMENT • The signer of this statement does hereby certt they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be ass the res /�:'Ly oft - , r=rat C tractor for the proposed project. Signature: 7l ' ' /0 C �z Date: 7� /emu FAX: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: � /��'71 r x 6Gd) 4/f 7—2 (;V ) MAILING ADDRESS: EMAIL: �/?//Y7O 4. :3..CONTRACTOR'SWAINS LICENSE NUMBER NUMBER: ARCHITECT/ENGINEER: PHONE (33 4 772 j ' ) MAILING ADDRESS: • EMAIL Project Type: Type:T e: Bathrooms: Shoreline: Type of Sewage Disposal:❑ New ❑ Wood Existing: ❑ Sewer ❑ Steel Proposed: Bank ❑ Community System ❑ Addition Total: Height: ❑ Individual System CIAlteration/Remodel =� Concrete❑ Repairs- 0 Masonry SEP Permit# ❑ Other: .Bedrooms: Water Supply:'• ❑ Demolition Existing: Setback: r i Private well ❑ Two Party Type of Heat: Proposed: ❑ Public Total: Name of System: If this is a Commercial Protect you must answer the following: Number of ADA Parking Spaces: Number of Parking Spaces: Current: Proposed: 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 nd/orAnoliance Installation permit,mark all items below that apply: i Un and Tank - Above ground 113 Size of Propane Tank: 2- - /..0� 98 /7 v 0. Heat S ov i Cook Stove i Woodstove i Fireplace Insert i Hot Water Tank i Pellet Stove i Other Cry 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 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 d App Review: Main Floor Heated EH 2nd Floor Heated Consistency Review: Other Heated Base fee: Ni At- 15`1- DC Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL 151 ^ram Decks 911/Rd Approach fee: —_�-1�.! Other TOTAL: $ 151 ICJ Receipt Number: (y 5 315 Cash/Check Number: �0 I , ESTIMATED COST(REQUIRED) Date: —1 I--1 `'`J�� 'Fair market value of all labor and materials foundation to finish Initials: ` l • G:\PcrrnitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc V1 V1 3 tvq IQ h ,r M U 1 0 ro N 'e a m� iL a w ( L p ?� v N m w a LL \ � O`\\ w m � D V z w z 4 S a C e6 �` N •� N W 0 Q � W Q ^L 61 * I J o U O C 1h a z m