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HomeMy WebLinkAboutBLD2008-00320 • 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 #: BLD08-00320 Received Date 7/21/2008 SITE ADDRESS: 657 CRUTCHER RD Issue Date 7/21/2008 PORT TOWNSEND, 98368 APPLICANT: BETH R LORBER BONYUN PHONE: (360) 385-7800 657 CRUTCHER RD PORT TOWNSEND WA 98368-9046 TX13- SUBDIVISION: Block: Lot: PARCEL NUMBER: 001184014 Section: 18 Township: 30N Range: 01W CONTRACTOR: EVERWARM INC PHONE: (360)452-3366 257151 HWY 101 PORT ANGELES WA 98362 Contractor's License EVERWI*088NL Expires 8/17/2010 OWNER, BETH R LORBER BONYUN PHONE: (360) 385-7800 if different: 657 CRUTCHER RD PORT TOWNSEND WA 98368-9046 PROJECT DESCRIPTION: INSTALL WOODSTOVE IN EXISTING RESIDENCE Directions SEE GOOGLE 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 7/21/2009. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApprova ( `/'8 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 BLD08-00320 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD08-00320 Received Date: 7/21/2008 SITE ADDRESS: 657 CRUTCH ER RD PORT TOWNSEND, 98368 OWNER: BETH R LORBER BONYUN PHONE: (360) 385-7800 657 CRUTCHER RD PORT TOWNSEND WA 98368-9046 SUBDIVISION: Block: Lot: TX131 PARCEL NUMBER: 001184014 Section: 18 Township: 30 N Range: 01 W CONTRACTOR: EVERWARM INC PHONE: (360) 452-3366 257151 HWY 101 PORT ANGELES WA 98362 Contractor's License EVERWI*088NL Expires 8/17/2010 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION INSTALL WOODSTOVE IN EXISTING RESIDENCE TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: CODE EDITION: 2006 ADD'L: HEAT TYPE: WOD 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 07/21/08 100576 Total: $105.00 4�45QN G©�, JEFFERSOWUNTY o— DEPARTMENT RF COMMUNITY DEVELOPMENT • j�4y' �� i' ` ''� 621 Sheridan Street• Port Townsend •Washington 98368 R"�`'�'��'J \V,E D 360/379-4450 • 360/379-4451 Fax -'gS, N��O� www.co.jefferson.wa.us/commdevelopment JUL 21 2008 Master Permit Application MLA: Project Description (include separate sheets as necessary): JE( I,t t LJt fl uco i kSZ I k. u c. v E I 1 >([G-- T tY-- (lEkra Tax Parcel Number: CO 1 1 a 4-0 IA-- Property Size: 5 A o_ (acres/square feet) Site Address and/or Directions to Property: C'57 CQUZa-1 ,?_.- R Property Owner(s)of Record: f C)f /`P SC3r..WON Telephone(3LC5) 5-78 Fax: email: Mailing Address: 4.S7 CT?O7C 4 _ C2.--C Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies ❑Building ❑ Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) ❑Single Family ❑Garage Attached/Detached 0 Conditional Use[C(a),C(d),or C]** ❑ Manufactured Home 0 Modular 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* ❑Special Use(Essential Public Facilities)** ❑ Change of Use ❑ Boundary Line Adjustment ❑ Address 0 Road Approach 0 Short Plat** ❑ Home Business ❑ Cottage Industry ❑ Binding Site Plan** ❑ Propane 0 Long Plat** 0 Sign 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes" Use Consistency Analysis ❑ Plat Vacation/Alteration** 0 Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions** ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development** ❑Temporary Use ❑ 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 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 a ess and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and arty required I er inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applicatio t he r o�l is prior notice. Signature: Date: , ( 06 The action or action 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 potentjdl"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 art in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transfer bl a ponsibilit fo a rin to and complying with the ESA. The Applicant has read this disci 'mer a (i si ns and dates it below. Signature: Date: Z G:\PermitCenter\###FORMS###\DRD FORMS\Master ermit 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: aQ ' 42- (NC. ( +� ) MAILING ADDRESS: 5-1t 1 ( 1.Wy to (24.. EMAIL S�G CONTRACTOR'S LICENSE C WAINS NUMBER: I O Wl i NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: 1=1 New ❑ Wood Existing: ❑ Sewer Li Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel Li Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well 1_1 Two Party Type of Heat: Proposed: ❑ Public Total: Name of System: If this is a Commercial Protect 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: Underground Tank Above ground Tank Size of Propane Tank: Heat Stove t Cook Stove i Woodstove i Fireplace Insert i Hot Water Tank 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 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 EH Bld App Review: 2' Floor Heated Consistency Review: Other Heated Base fee: woae. 1 D5-CC Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL 1,d5.o0 Decks 911/Rd Approach fee: Other TOTAL: $ 105. cO Receipt Number: 1 I oD`5-1 Cash/Check Number: l0 b(0 5 ESTIMATED COST(REQUIRED) Date: JDg •Fair market value of all labor and materials foundation to finish I I Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc v 0 C- m C) -13 • m C) m r rn c co • rn O 7 Z \ rn 7 m � N O 73 c � W v Q rn i y 'C -17 c= 0