HomeMy WebLinkAboutBLD2009-00030 BLD09-00030
UILDING PERMIT APPLICAPON Review Type:
Jefferson County Department of Community Developm nt
621 Sheridan Street Port Townsend, WA 9836
PERMIT #: BLD09-00030 Received Da e: 2/5/2009
SITE ADDRESS: 694 E MARROWSTONE RD
NORDLAND, 98358
OWNER: GREGG F LARSON PHONE: (206) 719-3052
694 E MARROWSTONE RD
NORDLAND WA 98358-9633
OLSON & HAMBLETON'S
SUBDIVISION: Block: Lot: 1+
PARCEL NUMBER: 977700082 Section: 9 Township: 29 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOF INSTALL A/G 500 GAL PROPANE TANK AND GAS P PING TO
CONNECT TO HOT WATER TANK TO BE PLACED I EXISTING
HOUSE
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 STORI: S:
OCCUPANCY:
OTHER:
CONST TYPE: GARAGE: SHORELINE
CONST TYPE: DECK: SETBACK:
BANK HEIG T:
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 $165.00 KAS 02/05/09 105406
Total: $165.00
4gON co •
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p JEFFERSON COUNTY
\� 2� DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street• Port Townsend • Washington 98368
�`� 360/379-4450 •
p$ www.co.jefferson.wa.us/commdev360/379-4451Fax
N. elopment
'Q i�I I N GEC
Master Permit Application MLA:
Project Description(include separate sheets as necessary):
4NE -r-At 1NSrAL1-4-rt
Tax Parcel g 7 7 7 '" o 8 y Property , Z
Number: ( Size: (acres/square-fect)
Site Address,and/or Directions to Property:
`Z
"1
6 E , MAgReu)3- UNE RI, .A-KJ N0/ZDit WA GI K3
Property Owner(s)of Record: "RrL 1 F. LliR S>t'J
Telephone: ZC E 71 k - 305 2- Fax: email:C 4 P 4/EE a) c✓`C L0-(R($
Mailing Address: A-a"u ti�T
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies
❑Building El Variance(Minor,Major or R asonable Economic Use)
❑ Demolition Permit ❑Conditional Use[C(a), C(d), r C]**
❑ Single Family ❑Garage Attached/Detached 0 Discretionary"D"or Unnam Use Classification
❑ Manufactured Home ❑ Modular ❑ Special Use(Essential Publi Facilities)**
❑ Commercial* ❑ Boundary Line Adjustment
❑ Change of Use ❑ Short Plat**
❑ Address ❑ Road Approach ❑ Binding Site Plan**
❑ Home Business ❑ Cottagelndustry ❑ Long Plat**
Propane 0 Planned Rural Residential D velopment(PRRD)/Amendments**
❑ Sign ❑ Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program E emption/Permit Revisions**
❑ Stormwater Management ❑ Shoreline Management Sub tantial Development**
❑ Site Plan Approval Advance Determination (SPAAD)* ❑ Shoreline Management Van nce
❑Temporary Use ❑ 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
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 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. taff s access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the application at he oriste w s prior notice.Signature: ✓,% ,-*1V1------ Date: ,,2--5_- Of
The action or actions Applican 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 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 w'h the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transferable
resspponsibili for dhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: ..'s' i Date: 5 - e/f
• •
BUILDER STATEMENT
The signer of this statement does hereb certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be assuming the respo ibil- of the General Contractor for the proposed project.
Signature: Date: S.- ' 0
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:
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:
❑Underground Tank\bove ground Tank Size of Propane Tank: -Ue'61 4 L
❑Heat Stove 0 Cook Stove 0 Woodstove ❑ Fireplace Insert %Hot Water T k 0 Pellet Stove 0 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 subm ite 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 Consistency Review:
Other Heated Base fee: I(05.00
't.Ot�R OE, _
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL 5
Decks 911/Rd Approach fee:
Other TOTAL: $ I(O 5.
Receipt Number: I *
�3 4
Cash/Check Number: q a3
ESTIMATED COST(REQUIRED) /Z5 . Date:
•Fair market value of all labor and materials foundation to finish
Initials:
I
• •.
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 #: BLD09-00030 Received Date 2/5/2009
SITE ADDRESS: 694 E MARROWSTONE RD Issue Date 2/5/2009
NORDLAND, 98358
APPLICANT: GREGG F LARSON PHONE: (206) 719-3052
694 E MARROWSTONE RD
NORDLAND WA 98358-9633
1+
SUBDIVISION: OLSON & HAMBLETON'S Block: Lot:
PARCEL NUMBER: 977700082 Section: 9 Township: 29N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
OWNER, GREGG F LARSON PHONE: (206) 719-3052
if different: 694 E MARROWSTONE RD
NORDLAND WA 98358-9633
PROJECT DESCRIPTION: INSTALL A/G 500 GAL PROPANE TANK AND GAS PIPING TO
Directions CONNECT TO HOT WATER TANK TO BE PLACED IN EXISTING
To Site: HOUSE
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 2/5/2010.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: '..fit 4 ittit // l'tG, - Off.. e2-It -`- `7 ;
FinalApproval: 3/c t9(
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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