HomeMy WebLinkAboutBLD2009-00012 BLD09-00012
UILDING PERMIT APPLIC ON Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD09-00012 Received Date: 1/22/2009
SITE ADDRESS: 374 CAMBER DR
PORT LUDLOW, 98365
OWNER: ROY E CRAIG TRUSTEE PHONE: 360-437-9315
LOIS J CRAIG TRUSTEE
374 CAMBER LN
PORT LUDLOW WA 98365-9579 LUDLOW POINT VILLAGE DIV 3
SUBDIVISION: Block: Lot: 12
PARCEL NUMBER: 969700012 Section: 17 Township: 28 N Range: 01 E
CONTRACTOR: ASSOCIATED PETROLEUM PROD INC PHONE: 253-627-6179
PO BOX 1397
TACOMA WA 98401
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr A/G 120 GAL PROP SWAP OUT - 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:
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $55.00 LYK 01/22/09 105305
Total: $55.00
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 #: BLD09-00012 Received Date 1/22/2009
SITE ADDRESS: 374 CAMBER DR Issue Date 1/22/2009
PORT LUDLOW, 98365
APPLICANT: ROY E CRAIG TRUSTEE PHONE: 360-437-9315
LOIS J CRAIG TRUSTEE
374 CAMBER LN
PORT LUDLOW WA 98365-9579 12
SUBDIVISION: LUDLOW POINT VILLAGE DIV 3 Block: Lot:
PARCEL NUMBER: 969700012 Section: 17 Township: 28N Range: 01 E
CONTRACTOR: ASSOCIATED PETROLEUM PROD INC PHONE: 253-627-6179
PO BOX 1397
TACOMA WA 98401
OWNER, ROY E CRAIG TRUSTEE PHONE: 360-437-9315
if different: LOIS J CRAIG TRUSTEE
374 CAMBER LN
PORT LUDLOW WA 98365-9579
PROJECT DESCRIPTION: A/G 120 GAL PROP SWAP OUT- 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 1/22/2010.
REQUIRED INSPECTIONS:
Tank/Line/Appliance:
FinalApproval: 5 --ID
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
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4 � JEFFERSO�OUNTY
W � `\ir3 DEPARTMENT OF COMMUNITY DEVELOPMENT
" ' I 621 Sheridan Street• Port Townsend •Washington 98368
4i � 360/379-4450 • 360/379-4451 Fax
`SKIN www.co.jefferson.wa.us/commdevelopment
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Master Permit Application MLA: C0 MA e o r is
Project Description(include separate sheets as necessary):
R ,0 4„"i f 'i-(.. j/LA P/1.-,..L-- 1 7),1V sc.,,4P-O u ) /ry2 o M C.o r►-,.o z-�7 70 r•-'
Tax Parcel Number. q (pq loco 1 7_ Property Size: (acres/square feet)
Site Address and/or Directions to Property:
37 C4ci i/3r-''"- L,- 1 A';-- _
1_0.0 o4, s
9S'36,.
Property Owners)of Record: yeo 1 v LO t S C 2-/4-I G
Telephone: ( 3 6 o) L(37-%3 / 5" Fax: email:
Mailing Address: ( S4 ni,="--)
Applican(Agent if different from owner): /4Pn 1 P` - "`_•
Telephone: ( -L s3) C. 2:7- & I'7`j Fax: (, Z,s-3) 6, L-7- 3 G 3-7 email: /</o z-c,-n 4.,p3`-,...4 t3'h-
Mailing Address: CP/i sta../A-;'�`0At's-/�-o 1.-i=�m.c.o.-r-7
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 F-cilities)**
❑ Change of Use 0 Boundary Line Adjustment
❑ Address 0 Road Approach 0 Short Plat**
❑Home Business 0 Cottage Industry ❑ Binding Site Plan**
0 Propane — k o,�,n„L m a.j u ,5,.0-P c u 7- ❑Long Plat**
❑Sign ❑ Planned Rural Residential Development(PRRD)/Amendments'"'
❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration**
❑Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions**
❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development**
❑Temporary Use ❑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:
14/ o A.0/fi4 ,..)L
DESIGNATION OF AGENT
/;" //��n^i�_• to act as myagent in matters relatingto this application for permit(s).
I hereby designate r (IL
g pp p ( )'
OWNER SIGNAnJRE r ' _� Date: Z /S 4.,
5
By signing si nin this application form,the owner/agent attests that the infounton 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 attomey'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 wa is prinotice.
Signature: J� i-z L: sc._s Date: /Z l
The action or actions Applicant will undertake as a result o ie 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 respons ility for helillg to and complying with the ESA. The Applicant has read this disclaimer a signs nd dates it below.
Signature: v4--5 _,, Date: /2. G
G;\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
rIII BUILDER STATEMENT 4110
•' 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 assum'ng the ponsi, " oft General contractor for the proposed project.
/ / '
k. Signature: - 6`1� -../L.�-- Date: / �'
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
/9 PP "Rnt .•.. ':: P.13) ‘, Z7- 4. i 9 (-z.3-)) (a 2.7-3637
MAILING ADDRESS: ? (7 ,Vfo X / 3 Si 7 EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: /95-SoC_P f cF-`j L .?"—" NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
D New 0 Wood Existing: 0 Sewer
O Addition 0 Steel Proposed: Bank 0 Community System
❑ Alteration/Remodel 0 Concrete Total: Height: ❑ Individual System
❑ Repair 0 Masonry SEP Permit#
❑ Demolition 0 Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well 0 Two Party
Type of Heat: Proposed: 0 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 I No
If this is a Propane Tank and/or Appliance Installation rmi mark all items below that a I :
I Underground Tank (t Above ground Tan _ Size of P%pane Tank:(/7-O G a t- • X Z
I Heat Stove Cook Stove)I Woodstove ,I. Fireplace Inse') '! Hot Water Tan 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 VorOfficd.UsiiOnly Amount Revision
Main Floor Heated EH BId App Review:
2nd Floor Heated Consistency Review:
Other Heated • Base fee: 55
'Pfrspa►,ru_5wap
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL
55 . 00
Decks 911/Rd Approach fee:
Other TOTAL: $ 55 • OD
Receipt Number: 1 t)CA
Cash/Check Number: Lo'(Up p '7
ESTIMATED COST(REQUIRED) Date:
.Fair market value of all labor and materials foundation to finish _ j
Initials:
G:\PerxnitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc