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Home My WebLink AboutBLD2009-00089 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 #: BLD09-00089 Received Date 3/25/2009 SITE ADDRESS: 103 AMES LN Issue Date 3/25/2009 PORT LUDLOW, 98365 APPLICANT: JAMES L WARD PHONE: (360)437-7847 103 AMES LN PORT LUDLOW WA 98365-9646 SUBDIVISION: PORT LUDLOW NO 1 AREA 3 Block: Lot: PARCEL NUMBER: 990400307 Section: 8 Township: 28N Range: 01 E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 ((3 pp 385 Contractor's License SUNSHP*077QP Expires 11/17/2010-5875 OWNER, JAMES L WARD PHONE: (360) 437-7847 if different: 103 AMES LN PORT LUDLOW WA 98365-9646 PROJECT DESCRIPTION: INSTALL A/G 120 GAL PROPANE TANK, GAS PIPING AND HEATER Directions NO MLA REQ'D 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 3/25/2010. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApprov (- 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 •UILDING PERMIT APPLICAI Revviewiew T TyN BL y089 pe: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD09-00089 Received Date: 3/25/2009 SITE ADDRESS: 103 AMES LN PORT LUDLOW, 98365 OWNER: JAMES L WARD PHONE: (360) 437-7847 103 AMES LN PORT LUDLOW WA 98365-9646 PORT LUDLOW NO 1 AREA 3 SUBDIVISION: Block: Lot: PARCEL NUMBER: 990400307 Section: 8 Township: 28 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: SUNSHINE PROPANE PHONE: (360) 385-5797 10853 RHODY DR (360) 385-5875 PORT HADLOCK WA 98339 PROJECT DESCRIPTIOI' INSTALL A/G 120 GAL PROPANE TANK, GAS PIPING AND HEATER NO MLA REQ'D TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: CODE EDITION: 2006 ADD'L: HEAT TYPE: PRO OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: CONST TYPE: OTHER: GARAGE: SHORELINE: CONST TYPE: SETBACK: DECK: BANK HEIGHT: 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 03/25/09 105613 Propane Tanks/Stoves $48.00 KAS 03/25/09 105614 Total: $213.00 • SITE VISIT REPORT• (PLOT PLAN) JOB (m 4- Ls-LIE: L A(U DATE : . /-z l o ri •, CONTACT: ADDRESS I CD,;?‘) 4101 - Lv�� I Ou.) PHONE #: DIRECTIONS FAX #: Email PLANNER: I 'J aN i o °1P(1� 1e' EC EIVED MAR 2 5 2009 00)c- Ef, lI OCR , aN1 OCO 7 • °NE 144 6,reel ��, JEFFERSO COUNTY y DEPARTMENT OF C:u7liVls)/90:4rUNITY DEVELOPMENT r M 621 Sheridan Street Townsend •Washington98368iIDi..a�CEIV a''D360/379-4450 • 360/ 451FaxJ1O.leE)t y =0... 0www.co.jefferson.wa. ommdevelopment Master Perr slit Application MLA: MAR25 •l ; Project Description (include separate sheets as necessary): -?ro i aas p1 Pt no _� �,t�� JEFFERSON COt1N1Y DO Tax Parcel //�� Property Number: V D 0 3 O� _ Size: (E• ?es/square feet) Site Address and/or Directions to Property: /a te /-AMC-�_ nee, Pci —r t1 L LOk) Property Owner(s)of Record: Tt ,W P ID Telephone: 13-7— 757it - Fax: email: Mailing Address: /D 3 / t-(CS 4-A AJ P0/Z7- LLf0 2-- -yot w1t 9' 0 c Applicant/Agent(if different from owner): S((NS H NE E P RiD PA NE Telephone: 395-5.717 Fax: .38S 5 75— email: INFOgSUnjSN/;4E-pr'opA-r . Mailing Address: l 04353 RHopy DR. / ;. 14 01-0Ck W A, g 63cf �m What kind of Permit?(Check each box that applies ❑Building ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Single Demolition Fami Family 0 Garage -Attached/Detached LTDiscretionary a nl Use[or Unnamed C(a), C(d), rUse Classification ❑ Manufactured Home 0 Modular ❑ Special Use(Essential Public Facilities)** ❑ Commercial* 0 Boundary Line Adjustment • 0 Change of Use 0 Short Plat** ❑ Address 0 Road Approach 0 Binding Site Plan** ❑ Home Business 0 Cottagelndustry 0 Long Plat** . \IQ Propane 0 Planned Rural Residential Development(PRRD)/Aiendments** ❑ Sign 0 Plat Vacation/Alteration** I ❑Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management 0 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 0 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.praposal, if known:. ,toe , c DESIGNATION OF AGENT \ I hereby designate JL t S H I I iIt to act as my agent in matters relating to this application f.sr permit(s). --� U ',NER$IGNATURe , �-�f(�- Date: � Z.3 0 By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and corrici 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 applic$ion 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`GIU� 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 inspect'•.s. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the a plication th-at h or she4:1 is prior notice. 1 1 al ignature: ,e-A -W �2� a..4-4ac��up Date: 2, /07 The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatered or endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known-!s the "Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this I\ 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 hoic individual and non- ansferable respoility f•'=dhering to and complying with thg E A. T e A licant has read this disclaimer nd sig s and dales it below. —4 Signature: / �Q G.T Z ,� Date: 3� 370q G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc • BUILDER STATEMENT • s • The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,.that they are not licensL . :ontractors and that r they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: St4tA 1- ',\1tJ P2o pah. (360) 385- 5797 ( 36c) 385-587.5 MAILING ADDRF.S: 1 0853 M-Oto y I\e i e_ P. '.1� EMAIL: n q)1 t 1 ( foSUAs�I(�e pro Pin e 6 c one CONTRACTOR': . ICENSE n/7 WAINS NUMBER: SUv1Sµ P+ U I ( Q P NUMBER ARCHITECT/EN NEER: PHONE,( ) FAX: ( ) MAILING ADDR,;S: EMAIL • Project Type Frame Type: Bathrooms: Shoreline: Type of Sep• ge Disposal: ❑ New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Commun , System 0 Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual stem ❑ Repair ❑ Masonry SEP Permit 1 ❑ Demolition 0 Other: Bedrooms: Water Supp' . Existing: Setback: ❑ Private w 0 Two Party Type of Heat: Proposed: 0 Public Total: Name of Sys :m: If this is a Con'mr.iercial Project you must answer the following: Number of Park:. g Spaces: Current: Proposed: Number of ADA Parking Spaces: Number of occi.,ants(includes owners,tenants,employees.etc) Current Proposed IBC Occupanc e:- IBC Type of construction: Will you have Food Service? Yes / :lo If this is a Pro; .-ne Tank and/or Appliance Installation permit,mark all items below that apply: I Underground', nk 1(Above ground Tangy Size of Propane Tank: I o2 0 Eta_ Cr-Heat Stov.. • ..;ook Stove 1 Woodstove I Fireplace Insert I Hot Water Tank I Pellet Stove 1 Oth r tom' vv�G� Is this applianc y 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 systeLi components, including the reserve area.Current Square Footage r . � a',` } osed =�u �fQ1e jy rf� 0 ,ei�Ou„ ` I0 R,k Age Main Floor Heated u� t` EH Bid App Review: 2"a Floor Heated t-s t��v ..r. t�:rs�{,�� •; Consistency Review: A'AilKOther Heated ik,Liv-S*+ , i fO n� l (05. nD Lig. DO Mezzanine A. 4$:Y , `�� Additional Section: Heated Basement I E C t_I � saw Plan Check fee: Unheated Basement T ,` } } State Surcharge fee: Other Unheated p,;,74 Pot Water Review fee: s Garage/Carport C[ _p {�Af t01,10 `n,• -- �r V-t', . SUBTOTAL Ir 'l Decks AFfERSON t01, 1J at 'i � ;r RD 5.00 y 6 •06 y AAA 911/Rd Approach fee: Other s,, .. �ir II^ /}7`�`1. .' TOTAL: $ 4/ "� ' - ' €: 's Receipt Number: I D 5(0 )3 I O5o i4 Cash/Check Number: r- D ESTIMATED COST all Date: 31 / I •Fair market value of a!!labor and materials foundation to finish � Initials: �-�- -� (;:\PermitCenter\###FC RMS###\DRD FORMS\Master Permit Application 12-19-2006.doc