HomeMy WebLinkAboutBLD2008-00472 • • .
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 #: BLD08-00472 Received Date 11/5/2008
SITE ADDRESS: 400 SEAMOUNT DR Issue Date 11/5/2008
BRINNON, 98320
APPLICANT: ERNEST N STEWART PHONE: 360-796-3525
LINDA M STEWART
PO BOX 36
BRINNON WA 983200036
SUBDIVISION: SEAMOUNT ESTATES DIV 1 Block: Lot:
PARCEL NUMBER: 993000030 Section: 29 Township: 25N Range: 02W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI983O6 Expires 9/26/2010
OWNER, ERNEST N STEWART PHONE: 360-796-3525
if different: LINDA M STEWART
PO BOX 36
BRINNON WA 983200036
PROJECT DESCRIPTION: NEW PROPANE HEAT STOVE -NO MLA REQ'D
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 11/5/2009.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: OP A) 61 'v ?T /P514LL47W/) c7A( 1%ZJ t
f`FinalApproval: �/K\ -��C/-• -21iail /l/Z3/0i) 4 /
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
I
UILDING PERMIT APPLICAJN BLviewTy 472
Review Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD08-00472 Received Date: 11/5/2008
SITE ADDRESS: 400 SEAMOUNT DR
BRINNON, 98320
OWNER: ERNEST N STEWART PHONE: 360-796-3525
LINDA M STEWART
PO BOX 36
BRINNON WA 983200036 SEAMOUNT ESTATES DIV 1
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 993000030 Section: 29 Township: 25 N Range: 02 W
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTP198306 Expires 9/26/2010
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION NEW PROPANE 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: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total:
Routing Date: al.)
' I�
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $157.00 AMS 11/05/08 102963
Total: $157.00
.¢,SON co RlEIVFD
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4� , , �� JEFFERSOP*UNTY •
r3 DEPARTMENT OF COMMUNITY DEVELOPMENT NOV 5
1 ' `4 621 Sheridan Street • Port Townsend •Washington 98368 2QQ8
360/379-4450 • 360/379-4451 Fax
�`S�tIN �.' www.co.jefferson.wa.us/commdevelopment CffbIf tr Ji oN CuUNiYDCD pp
Master Permit Application MLA: Y\c) YY1 ( *irca' �ci(
Project Description(include separate sheet necessary): nn
�/V 7i4 L L G"?CC), 9 A/� 6 J7` 2 I/L
Tax Parcel p�w Property
Number: G ! ' &c9 c7 D 3 o Size: /(' ODO
/ (assisiequare feet)
Site Address and/or Directions to Property:
100 .- ----H-iofirr✓`T 2/2/V -----1 /J2//v/✓p
Property Owner(s)of Record: .en/e--5 T /V , ,C i„//),q - •9Y- ,e2,e?-
Telephone: 3 ,,Q Q, —3,5—ZS Fax: email: �2ti.5"7-rvti,9i2r—ea, /4UL• Ce7.-►-N
Mailing Address: IV CSOx
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies
❑Building 0 Variance(Minor, Major or Reasonable Economic Use)
❑ Demolition Permit 0 Conditional Use[C(a),C(d),or C]**
❑ Single Family 0 Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification
❑ Manufactured Home 0 Modular 0 Special Use(Essential Public Facilities)**
❑ Commercial* ❑ Boundary Line Adjustment
❑ Change of Use ❑ Short Plat**
❑ Address 0 Road Approach 0 Binding Site Plan**
❑ Home Business 0 Cottagelndustry ❑ Long Plat**
Propane 0 Planned Rural Residential Development(PRRD)/Amendments**
❑ Sign 0 Plat Vacation/Alteration**
❑Allowed"Yes" Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions**
❑ Stormwater Management ❑ Shoreline Management Substantial Development**
❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Variance
❑ Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* 0 Jefferson County Shoreline Master Program Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium ❑ Tree Vegetaion Request
*May require a Pre—Application Conference **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 it's 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 -•- '.ht of entry to Jeffe on County and its employees, representatives or agents for the sole purpose of application
review and any required I..-+afiT.-ctio s. •ff' acre• and right entry will be assumed unless the applicant informs the County in writing at the
time of the applicati. h. or he w,• s .;
Signature: /41; / Date: //— e7 —C2 ,
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 t vielate the ESA. Any indivi 1,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)even if you onipliance\with the J rson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transferb1 nsibility for dd e6 v�lying ith t Tha_Applicant has read this disclaimer and signs and
��B � 9 dates it below.
Signature: �/tiliG�� i Date: //" `62 c'9
-,
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc
• BUILDER STATEMENT •
The signer of this stat .
oes hereby c • they are the Hers of the parcel referenced herein,that they are not licensed contractors and that
they will be assy spohsjbili he pal Coptractor f e proposed project.
Signature:._ _ Date: _
GENERAL CONTRACTOR OR MANUFACTURED ME INSTALLER: PHONE: FAX:
ml l vr/gi�MANUFACTURED ME
(30) 3 ,6 -Coev3 (36c)56 --ro9/'f
MAILING ADDRESS: Z 6 5-- (el/en/4CN 2i) EMAIL: ,j,,ti//ifitdti f/") "er.2, n/6= s C.Q).VYi
CONTRACTOR'S LICENSE / 'r ,l./Y4-0L-CsG/k- WAINS
NUMBER: mor LCNTPii i 5 3 op NUMBER
ARCHITECT/ENGINEER: A) PHONE ( ) FAX: ( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
ii 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 Und and Tank i Above ground Tank Size of Propane Tank: __
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 ' 1.
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:
2ntl Floor Heated Consistency Review:
Other Heated Base fee: --7
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL
Decks 911/Rd Approach fee:
Other TOTAL: $
1 _--1 ,, "
Receipt Number: 1 Vag G 3
Cash/Check Number: Q s x-5
ESTIMATED COST(REQUIRED) Date: V (J�_J
•Fair market value of all labor and materials foundation to finish I ) 1 C
5 kc
Initials:
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc
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