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Home My WebLink AboutBLD2008-00429 • •. 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 #: BLD08-00429 Received Date 9/29/2008 SITE ADDRESS: 2481 ANDERSON LAKE RD#533 Issue Date 9/29/2008 PORT HADLOCK, 98339 APPLICANT: NANCY L PATNODE PHONE: (253) 229-8156 ALVA 0 & M JOSE BROWER 2481 ANDERSON LAKE RD#533 CHIMACUM WA 98325 SUBDIVISION: JENNINGS SHORT PLAT Block: Lot: PARCEL NUMBER: 901101030 Section: 10 Township: 29N Range: 01W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2010 OWNER, EVERGREEN COHO ESCAP RETREAT PHONE: f different: CHIMACUM WA 98325 PROJECT DESCRIPTION: INSTALL A/G 120 GAL PROPANE TANK AND LINES 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 9/29/2009. REQUIRED INSPECTIONS: ine/Appliance4, — FinalApproval: //9-711/< Q --Q 5-09 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 F_BLD_Permit_Propane.rpt 10/29/19 JILDING PERMIT APPLICA §N BLD08-00429 Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD08-00429 Received Date: 9/29/2008 SITE ADDRESS: 2481 ANDERSON LAKE RD#533 PORT HADLOCK, 98339 OWNER: NANCY L PATNODE PHONE: (253) 229-8156 ALVA 0 & M JOSE BROWER 2481 ANDERSON LAKE RD#533 CHIMACUM WA 98325 JENNINGS SHORT PLAT SUBDIVISION: Block: Lot: PARCEL NUMBER: 901101030 Section: 10 Township: 29 N Range: 01 W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2010 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION INSTALL A/G 120 GAL PROPANE TANK AND LINES TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION CODE EDITION: 2006 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: 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 09/29/08 102723 Total: $105.00 ��g ON cam JEFFERSONOUNTY • C , , a D \� DEPARTMENT OF COMMUNITY DEVELOPMENT t-3 lit 621 Sheridan Street • Port Townsend •Washington 98368 tc; 360/379-4450 • 360/379-4451 Fax S pe ?`' ' 4.. - G O� www.co.jefferson.wa.us/commdevelopment pp ML,�EffERSON COWDC0 Master Permit Application Project Description (includAfrl-A rate sheets as_necessary): �.t � 014/tri/&/' , ,11 Tax Parcel Number: . l N/0l0 y9 Property Size: (acres/square feet) Site Address and/or Directions to Property: , " PLG �. �I Property Owner(s)of Record: Z:z,.ej,y>`, .yt r�z .'n p Telephone: J _ Fax: / email: Mailing Address: 1� r Applicant/Agent(if different from owner):1114 tq e y� L ,-,p41 y -th_c L+rI e_AL'1A"1 5LL 'r-, ,uKrL Telephone: - Fa • email: Mailing Address:' • ( f ,n� — What kind of Permit?(Check each box that applies Building 0 Critical Areas Stewardship Plan ❑ Demolition Permit ❑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 ❑ Discretionary"D"or Unnamed Use Classification ❑ Commercial* ❑ Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment 0 Address 0 Road Approach 0 Short Plat** ❑ Home Business ❑ Cottage Industry ❑ Binding Site Plan** 'ropane 0 Long Plat** ❑Sign ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis ❑ Plat Vacation/Alteration** 0 Stormwater Management ❑ Shoreline Master Program Exemption/Permit Revisions** ❑Site Plan Approval Advance Determination(SPAAD)* ❑ 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 ❑Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference ❑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 a' p - ir—' -,' '- Date: P ;2.Q /V.& By signing this application form,the owner/ gent 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 application that he or she wants prior notice. Signature: : GLI'N[-, Iz,{ — ��L " � Date: 9/ /t26 The action or actions pplicant ill 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-transferable responsibility ad ring to nd:Eomplying with the ESA. The Applicant has read this disclaim and si7oj and dates it below. Signature: CL/Y�c,� �. C ( Date: �02 . G:\PemutCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc 0 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: e1L15 ill c ( ) ( ) MAILING ADDRESS: . (-ft., EMAIL: CONTRACTOR'S LICENSE �� ` WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: 1 New ❑ Wood Existing: U Sewer Addition LI Steel Proposed: Bank ❑ Community System U Alteration/Remodel C1 Concrete Total: Height: u Individual System L I Repair r I Masonry SEP Permit# 11 Demolition U Other: Bedrooms: Water Supply: Existing: Setback: U Private well ❑ Two Party Type of Heat: Proposed: U 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 C If this is a Propane Tank and/or A..Iiance Installation permit, mark all items below that apply:" �.f I Underground Tank Above 'round Tank Size of Propane Tank: j, O I Heat Stove I Cook Stove I Woodstove I Fireplace Insert I Hot Water Tank I 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: 2nd Floor Heated `.1i_ 'l Consistency Review: Other Heated Base fe ro e_ 105_DO Mezzanine Additional Becton: Heated Basement i.,n Plan Check fee: Unheated Basement t.fld� State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL 1 tD5 . 00) Decks 911/Rd Approach fee: Other TOTAL: $ l()5 Receipt Number: I Dal a3 Cash/Check Number: 35 0 Q ESTIMATED COST(REQUIRED) Date: r arAUIU� .Fair market value of all labor and materials foundation to finish _L I. Initials: G:\PemntCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc