HomeMy WebLinkAboutBLD2009-00086 • .
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 #: BLD09-00086 Received Date 3/24/2009 •
SITE ADDRESS: 151 DISNEY RD Issue Date 3/24/2009
NORDLAND, 98358
APPLICANT: ERIC R YOUNG PHONE: (360) 385-4859
KIRSTIE A YOUNG
151 DISNEY RD
NORDLAND WA 98358-9535
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 921094006 Section: 9 Township: 29N Range: 01 E
CONTRACTOR: EVERWARM INC PHONE: (360) 452-3366
257151 HWY 101
PORT ANGELES WA 98362
Contractor's License EVERWI`088NL Expires 8/17/2010
OWNER, ERIC R YOUNG PHONE: (360) 385-4859
if different: KIRSTIE A YOUNG
151 DISNEY RD
NORDLAND WA 98358-9535
yrcolypen.com
PROJECT DESCRIPTION:' ACC_MG_A)c (CAD,n}pve_._ 1\ A)14reACItAireci
Directions cJ1 t 171- 1
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 3/24/2010.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: <,70✓i Cif iu )_Z.-
FinalApproval: 3/3 D/O,
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
UILDING PERMIT APPLICASDN B RDO9 00086
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD09-00086 Received Date: 3/24/2009
SITE ADDRESS: 151 DISNEY RD
NORDLAND, 98358
OWNER: ERIC R YOUNG PHONE: (360) 385-4859
KIRSTIE A YOUNG
151 DISNEY RD
NORDLAND WA 98358-9535
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 921094006 Section: 9 Township: 29 N Range: 01 E
CONTRACTOR: EVERWARM INC PHONE: (360)452-3366
257151 HWY 101
PORT ANGELES WA 98362
Contractor's License EVERWI*088NL Expires 8/17/2010
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOF
EPLPc'C 1-teT a F LOOODStn vQ ) MA tJk / 1,1,2- D
TYPE OF WORK NON SQUARE FOOTAGE: chi min
TYPE OF IMP NEW
VALUATION MAIN:
CODE EDITION: 2006 ADD'L: HEAT TYPE:
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: 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 $71.00 KAS 03/24/09 105608
Total: $71.00
cb JEFFERS•COUNTY •
w
DEPARTMENT OF COMMUNITY D; T
621 Sheridan Street • Port TownsieldiJJ on 98368
360/379-4450 • 360/379-4451 Fax
www.co.jefferson.wa.us/commdevelo t
�SHING� BAR 2 4 2009
Master Permit Application MLA:
Project Description(include separate sheets as necessary): Jf a '
�\ ter,
R
�1 L��CC_fi 1aTU T CU r �.L'C. .:1 S l.[-+�.._
Tax Parcel n Property
Number: "lC. I Oc)y 0 0(0 Size: y. *Li AC R-CS (acres/square feet)
Site Address and/or Directions to Property:
t 5l ��,5tvc'f Roams �3S
Property Owner(s)of Record: .�F �� K to S 1
Telephone: -7>t<.L; Sc)e8 Fax: email: y(",=CC c Iy -'. cC•rn
Mailing Address: I 1 t"). C 'Latin t\-101, lkllA.,L7 , L A "55d">S,
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies
❑Building (t a:a.c�i t' J 'L IC k,,�N c'r QL ,liL) 0 Variance(Minor, Major or Reasonable Economic Use)
❑ Demolition Permit ❑ Conditional Use[C(a),C(d),or Cj**
❑Single Family ❑ Garage Attached/Detached ❑ Discretionary"D"or Unnamed Use Classification
❑ Manufactured Home ❑ Modular ❑ Special Use (Essential Public Facilities)**
❑ Commercial* ❑ Boundary Line Adjustment
❑ Change of Use ❑ Short Plat**
O Address ❑ Road Approach ❑ Binding Site Plan**
❑ Home Business ❑ Cottagelndustry ❑ Long Plat**
❑ Propane ❑ Planned Rural Residential Development(PRRD)/Amendments**
❑Sign ❑ Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions**
❑Stormwater Management 0 Shoreline Management Substantial Development**
❑Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance
❑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: 7Ie 3/c'y
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. Staff's access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the applic n.tliat4ie or he wants prior notice. L 1 I,, I
Signature: t �, �. �'1 G,Cry`UD Date: 7`L�/C
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 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-transferabl ibili for adhering to and complying with t e'ESAA.',Ti�e Ap licant has read this disclaimer an signs and dates it below.
Signature: ' �� @� 1 `Q3 Date: j/Z 3 A�/
C:\Documents and Settings\canal\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.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 assupiRgmesponsibility of the General Contractor for the proposed project.
Signature: (A Date: '3//
Z3/07
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
Eve(•w Ng.rn Flee—w t t4a1,G ( 3 _,) 4SZ-33<.:G. (i))`ls-z--33'`;
MAILING ADDRESS: ZS 1 I S I t'L ( to t E. Lt - f ij'- EMAIL: 02v 42,^w1IvT 4L L.ty().(>_ (�v)
CONTRACTOR'S LICENSE c2¢Ztor54- WAINS
NUMBER: L,ZERW I•+l (.. 8 cb N L.. NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
J New Li Wood Existing: J Sewer
J Addition Li Steel Proposed: Bank J Community System
J Alteration/Remodel Li Concrete Total: Height: LI Individual System
J Repair a Masonry SEP Permit#
l Demolition a Other: Bedrooms: Water Supply:
Existing: Setback: I I Private well I Two Party
Type of Heat: Proposed:
yp Total: Name
Public
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: « /r
❑Underground Tank []Above ground Tank Size of F'ropane Tank: 4, 5t 2
❑Heat Stove 0 Cook Stove L"Woodstove 0 Fireplace Insert 0 Hot Water Tank 0 Pellet Stove 0 Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes /6o L
When applying for a permit to install a propane tank you must also submit a site plan showing rill The buildings,all �erty
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:
1454 Zl IZIS sF
2na Floor Heated Consistency Review:
Z5 J(Z7 = 75(.;SF
Other Heated Base Lhl)06 D v 1 I` OD
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee:
Garage/Carport"_, `—mom' SUBTOTAL r-t` 1 l ' 00
+
Decks S•4 I sF #401v 911/Rd Approach fee:
Other _ TOTAL: $ 1-1 1. UV
Receipt Number: /O 5(0 OS
Cash/Check Number: 3Li 8
trl
ESTIMATED COST(REQUIRED) Date:
.Fair market value iI labor and materials foundation to finish C3 a . q_
0._ Initials: /
C:\Documents and Settings\canal\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.doc
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