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Home My WebLink AboutBLD2008-00373 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 #: BLD08-00373 Received Date 8/18/2008 SITE ADDRESS: 70-1 BLUFFS DR Issue Date 8/18/2008 PORT TOWNSEND, 98368 APPLICANT: WILLIAM J GORSE PHONE: (360) 302-5102 JANICE P GORSE 70-1 BLUFFS DR PORT TOWNSEND WA 98368-2571 U300i SUBDIVISION: THE BLUFFS BLDG 4 Block: Lot: PARCEL NUMBER: 965300007 Section: 26 Township: 30N Range: 01W CONTRACTOR: OWNER/BUILDER PHONE: OWNER, WILLIAM J GORSE PHONE: (360) 302-5102 if different: JANICE P GORSE 70-1 BLUFFS DR PORT TOWNSEND WA 98368-2571 PROJECT DESCRIPTION: SWAP OUT WOODSTOVE FOR PELLET STOVE -SAME LOCATION 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 8/18/2009. REQUIRED INSPECTIONS: Tank/Line/Appliance: 5' d. =c_L kb-CJb FinalApproval: 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 9ILDING PERMIT APPLICA1N BLD08-00373 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD08-00373 Received Date: 8/18/2008 SITE ADDRESS: 70-1 BLUFFS DR PORT TOWNSEND, 98368 OWNER: WILLIAM J GORSE PHONE: (360) 302-5102 JANICE P GORSE 70-1 BLUFFS DR PORT TOWNSEND WA 98368-2571 THE BLUFFS BLDG 4 SUBDIVISION: Block: Lot: U300i PARCEL NUMBER: 965300007 Section: 26 Township: 30 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP SWAP OUT WOODSTOVE FOR PELLET STOVE - SAME LOCATION TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION CODE EDITION: 2006 ADD1: 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: Type Amount Paid Bv: Date: Receipt: Approved/Date Propane Tanks/Stoves $52.00 KAS 08/18/08 102473 Total: $52.00 (.4:;ON—ear,. JEFFERSONSUNTY • I i, ` ; \ r' `is A DEPARTMENT OF COMMUNITY DEVELOPMENT `" � C.. '4 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax AUG 1 8 2006 vi', p www.co.jefferson.wa.us/commdevelopment !r IF f f pony pr,!if, Master Permit Application MLA: PCO Project Description (include separate sheets as necessary): P LC-c-(--?— .5�1 U IA-.1. , - ec)�-,1 t l r(1?- OW (-000')/76 /J, [a15 ?-- Tax Parcel Number: Ct 5 300 OC 7 Property Size: (acres/square feet) Site Address and/or Directions to Property: 76 — I i LUrr=s ,D . ?c c Tow ix,56.00 , w tt cta.36 Property Owner(s)of Record: i-J i(-Li it Ili C 0)2567. 7ii iC4 P G01Q 56 Telephone: 340 Z 0 e, to a Fax: email: 6-)-7-66€5C61-)Mt; •t:.d 14( Mailing Address: 70 ` ( 5L-...)FtS Ii ' PdAT Vic)Li)iJ5t11JD W4 se,3G8 -Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: 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 0 Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]** ❑ Manufactured Home 0 Modular ❑ Discretionary"D"or Unnamed Use Classification ❑ Commercial* 0 Special Use(Essential Public Facilities)** ❑ Change of Use ❑ Boundary Line Adjustment 0 Address 0 Road Approach 0 Short Plat** ❑ Home Business 0 Cottage Industry ❑ Binding Site Plan** ❑ Propane 0 Long Plat** ❑ Sign 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** 0 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* ❑ 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 access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any required la r insp tions. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the ap icati at or swan prior notice. Signature: i— 8 Date: . lcUUfS' 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 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 of vi ok to the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)eve if you are in pH.r ce with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-tran-fera.ik espo si ilit fir adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and da it below. Signature: _ jIdllk:. _ �-r Date: Gl/ (7 Zce G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc • BUILDER STATEMENT III The signer of this statemen does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assumin� the r ponsi offtth,,e General Contractor for the proposed projectct.t. Signature: CK1,�`� U "' Date: /`Uee 16. ZC GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: I i New ❑ Wood Existing: ❑ Sewer :7 Addition ❑ Steel Proposed: Bank [i Community System ❑ Alteration/Remodel i7 Concrete Total: Height: ❑ Individual System 0 Repair i i 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 Proiect 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 i Above ground Tank Size of Propane Tank: i Heat Stove i Cook Stove i Woodstove i Fireplace Insert i Hot Water T-1, i.Pellet Stove i Other Is this appliance being installed in a Manufactured/Mobile Home? Yes /m When applying for a permit to install a propane tank you must also submit - 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 Bid App Review: 2na Floor Heated Consistency Review: Other Heated Base fee: 5 .cxo Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement 1i .,Ti State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport "4 SUBTOTAL rJa. oC7 Decks , ... i , ,, 911/Rd Approach fee: Other TOTAL: $ 5 a. 0 d • Receipt Number: 10 a L-13 Cash/Check Number: �� ESTIMATED COST(REQUIRED) Date: q °'�og •Fair market value of all labor and materials foundation to finish D Initials: • G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc k- Lb I= M � 2 3, ly n � A P N N � ,j � o° � � 3 J o J, 3 3r�z a z W J F U W O x a