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Home My WebLink AboutBLD2008-00497 • 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 #: BLD08-00497 Received Date 12/3/2008 SITE ADDRESS: 861 OLELE POINT RD Issue Date 12/3/2008 PORT LUDLOW, 98365 APPLICANT: STEPHEN J CUMLIFFE PHONE: 360-437-0292 SUZANNE W CUMLIFFE 861 OLELE POINT RD PORT LUDLOW WA 98365-9413 21+ SUBDIVISION: OLELE POINT Block: Lot: PARCEL NUMBER: 977400015 Section: 28 Township: 29N Range: 01 E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 1 /2010-5875 OWNER, STEPHEN J CUMLIFFE PHONE: 360-437-0292 if different: SUZANNE W CUMLIFFE 861 OLELE POINT RD PORT LUDLOW WA 98365-9413 PROJECT DESCRIPTION: (2) GAS FIREPLACES - 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 12/3/2009. REQUIRED INSPECTIONS: Tank/Lin / liance: )Z (22_- O( � FinalApproval: Lam` `pz, 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 03UILDING PERMIT APPLIC BLD08-00497 N Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD08-00497 Received Date: 12/3/2008 SITE ADDRESS: 861 OLELE POINT RD PORT LUDLOW, 98365 OWNER: STEPHEN J CUMLIFFE PHONE: 360-437-0292 SUZANNE W CUMLIFFE 861 OLELE POINT RD PORT LUDLOW WA 98365-9413 OLELE POINT SUBDIVISION: Block: Lot: 21+ PARCEL NUMBER: 977400015 Section: 28 Township: 29 N Range: 01 E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2010 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI' (2) GAS FIREPLACES - NO MLA REQ'D TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2006 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 0 Prop: 0 Total: 0 iota+---0- Routing DateLr' --�- Type Amount Paid Bv: Date: Receipt: Approved/Date Propane Tanks/Stoves $52.00 LYK 12/03/08 102998 Total: $52.00 • 411P - SITE VISIT REPORT (PLOT PLAN) JOB STE t'14E.�-- s-z-tat oe CiOL l FF� DATE : I l !�( (6Y CONTACT: ADDRESS PHONE #: DIRECTIONS FAX #: Email PLANNER: \° ----- ..._ _ tld.HNST�1t7 \\N\\) \tC. 6(0 1pJ I P DEC - 32008 P11111‘1(°N cifIN,,, � JEFFERSOiv COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT' , 621 Sheridan Street • Port Townsend • Washington 98368 411 360/379-4450 • 360/379-4451 Fax O. www.co.jefferson.wa.us/commdevelopment NOZ Master Permit Application MLA: i( A eO1 Project Description (include separate sheets as necessary): 02 c r 7z-1-- Tax Parcel qr yoo � � roperty Number: 11 ( Size: (acres/square feet) Site Address and/or Directions to Property: 8 (.( o / e [Q, P , QF Property Owner(s)of Record: %� r Telephone: hi- 7— ol_ '—s a email: Mailing Address: IS— (- - Applicant/Agent(if different from owner):_ S u-NS H I N E P Ro PA NE_ Telephone: 3S5-579 7 Fax: 3 SS- .5S'7S email: INFOeSun151-H/r\jEProPFA1-7e. Mailing Address: 10853 RHovy A 2- ,, Fri. NFID Lock Lc)R- 9 833.7 corn What kind of Permit? (Check each box that applies ❑Building 0 Variance(Minor, Major or Reasonable Economic Use) 0 Demolition Permit ❑ Conditional Use[C(a), C(d),or C]** ❑ Singie Family 0 Garage Attached/Detached LJ Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home 0 Modular ❑ Special Use(Essential Public Facilities)** 0 Commercial* 0 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 ❑ Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis ❑ 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* ❑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 K I hereby designate SU.t• [9.3) E P P{ e____to act as my agent in matters relating to this application for permit(s). WNER SIGNATURE `.• (Date: I I ' ( C.A By signing this application form,the owner/agent attests hat 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. 3.. 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 Gig' review and any required r inspectidns. taffs'access and right of entry will be assumed unless the applicant informs the County in writing at the time of the application- at she wants kri r tice. ignature: Zy �. Date: CZ 1 1 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 e` 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 . "compliance.with the e erson County development code.The Applicant acknowledges that he,she or it holds individual and non:traansferablkgesp nsibility forp'dhcing o nd complying with the ESA. The Applicant has read this disclaimer and si ns a dates it below. Signature: '\ Date: G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc a The�;�,o BUILDER STATEMENT -lel r of this statement does hereby^ert!fy that they are the Owners of the parcel enced herein,that they they will be assuming the responsibility of the General Contractor for the proposed project. are not licensed contractors and that Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: SO fps'N I L" P(2 0 pin PHONE: FAX: MAILING ADDRESS: 085 c3 3235- 5-7 7 ( 36a) om CONTRACTORS LICENSE 0 e U e P. F1. EMAIL:IL: I(ISUnS�Ivlc prop 38 5-��7� NUMBER: c�L � WAINS 6 C ARCHITECT/ENGINEER: ` S14 P 07 p NUMBER MAILING ADDRESS: PHONE( ) Project Type: FAX: ( ) Frame Type: EMAIL ❑ New Yp Bathrooms: ❑ Addition ❑ Wood Existing: Shoreline: Type of Sewage Disposal: ❑ Alteration/Remodel ❑ Steel Proposed: ❑ Sewer 0 Repair ❑ Concrete Total: Bank ❑ Community System Li Demolition ❑ Masonry — Height: ❑ Individual System ❑ Other:_ Bedrooms: SEP Permit# Type of Heat: Existing: Setback: Water Supply: �— Proposed: — ❑ Private well G Two Party Total: ❑ Public Name of System:__ If this is a Commercial Project ou must answer the followin : Number of Parking Spaces: Current: '--- Number of occupants (includes owners, tenants, employeesPr etc)eCurrent IBC Occupancy: — Number of ADA Parking Spaces: If this is a Pro ane Tank aand/or A IBC Type of Installation. ermit mark Proposed Will you have Food Service? Yes I Underground Tank I Above ground Tank all items below that a I :I eat Underground Cook Stove 1 Size of Propane Tank: Is is a fiance bein installed nodstove I fireplace Inser• I -f// w 7 n_ Hot Water Tank I Pellet Stove i When applying for a Manufacture. obile Home? Yes / No Othe permit to install a propane tank you must also submit a site plan showing al/of the buildings, all ilines, tank location and size, distances from the propane tank to all properly includin• the reserve area. P p rty lines, buildings and septic system components, property S•uare Foota•e Current osed Main Floor Heated Pro E,o�'Q fire Use Onl �' ` ' � z 4' 2"' Floor Heated111111111.1. MU EH Bid App Review. x Consistency Review: 1.111111111.1111111111 Other Heated '.i, .:_. .=,�, _." r Additional Section:liall11111M1111 IIIIIIIIIIIIIIIIIIIIII Heated Basement 111111111111.:::,,Ii r , -'. Unheated Basement Plan Check fee: MIMI State Surcharge fee: MOM Other Unheated Pot Water Review fee: Garage/Carpor t Decks SUBTOTAL _ 911/Rd Approach fee: Other 11111..... MO TOTAL: Mt.,'' '''''. , Receipt Number: 10 i,!int Cash/Check Number: ESTIMATED COST(REQUIRED) . , ��S Date: • •Fair market value of all labor and materials foundation to finish Initials: — --OS G:\PernitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc