The URL can be used to link to this page

Home My WebLink AboutBLD2009-00107 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 #: BLD09-00107 Received Date 4/8/2009 SITE ADDRESS: 490 SONG DOG HOLLOW RD Issue Date 4/9/2009 QUILCENE, 98376 APPLICANT: BRIAN D BESSEY PHONE: 360-765-3432 PO BOX 1 QUILCENE WA 98376-0001 T 11 SUBDIVISION: Block: Lot: PARCEL NUMBER: 701292025 Section: 29 Township: 27N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 (��Q 5875 Contractor's License SUNSHP`077QP Expires 1 //2010 OWNER, BRIAN D BESSEY PHONE: 360-765-3432 if different: PO BOX 1 QUILCENE WA 98376-0001 PROJECT DESCRIPTION: NEW GAS RANGE & PIPING Directions SEE MAP IN FILE 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 4/9/2010. REQUIRED INSPECTIONS: Tank/Line/Appliance: 1, --rq-d FinalApprovaI: 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 ItUILDING PERMIT APPLICA SN" BLD09-00107Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD09-00107 Received Date: 4/8/2009 SITE ADDRESS: 490 SONG DOG HOLLOW RD QUILCENE, 98376 OWNER: BRIAN D BESSEY PHONE: 360-765-3432 PO BOX 1 QUILCENE WA 98376-0001 SUBDIVISION: Block: Lot: T 11 PARCEL NUMBER: 701292025 Section: 29 Township: 27 N Range: 01 W 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 DESCRIPTIOP NEW GAS RANGE & PIPING 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: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 0 Prop: 0 Total: 0_ ..-- Total: Routirq Date: _ Type Amount Paid By: Date: Receipt: AP151:40VED ved/Date Propane Tanks/Stoves $142.00 LYK 04/08/09 105699 Total: $142.00 APR 9 2009 Jefferson County Planning &Building Department - cot, JEFFERSON OUNTY • 4,4 � ' '\ pa DEPARTMENT OF COMMUNITY DEVELOPMENT al 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax ,0 www.co.jefferson.wa.us/commdevelopment �`SBING' Master Permit Application MLA: 09 2--16211 Project Description (include separate sheets as necessary): • Tax Parcel Number: 70 5 Property Size: (acres/square feet) Site Address and/or Directions to Property: �o/-) e o NO o cE NL', Vt/f4 • Property Owner(s)of Record: ICJ /Lc cam. "ti e4--a.s� Telephone:• f 7 J"J Z- Fax: O email: Mailing Address: Q v e X / / Q r c, c e P cJ A Applicant/Agent(if different from owner): /0/t--11-yl,� Telephone: 3 87 -5 7 S 7 Fax: email: Mailing Address: /0 6" ��_S� —"`"— ` �( c, - e-9--C-•, Jc (-,.)A What kind of Permit?(Check each box that applies 0 Lot or Road Segregation ❑Building 0 Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family ❑Garage Attached/Detached ❑Conditional Use[C(a), C(d),or C)** ❑ Manufactured Home 0 Modular 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* ❑Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment ❑ Address 0 Road Approach ❑ Short Plat** ❑ Home Business 0 Cottage Industry 0 Binding Site Plan** (Propane ❑ Long Plat** ❑ Sign - ❑ Planned Rural Residential Development(PRRD)/Amendments** 0 Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** ❑ Stormwater Management ❑ Shoreline Master Program Exemption/Permit Revisions** ❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Substantial Development** ❑Temporary Use 0 Shoreline Management Variance ❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment El Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference 0 Tree Vegetation Request **Re•uires a Pre-A••lication Conference o t e i(iE.!lify any ._.thar iv•• i ':te of fcriinr ! "r•.t:�. req•.•rs r�L�i ..a. a.. .. _�-_' !1 .!Z _-.-c nrnr.nc'1 pF 4..ni..+n_ DESIGNATION OF AGENT I hereby designate 8 "`—� iaet'as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: / 3 -0 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 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 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 require* er inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applicatio• e or she w``�'s prior notice. Signature: /iA,�. Cam%�- - Date: 9 The action or actions Applicant will undertake as a ult 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 ar- in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferab ponsibility adhering to and complying with the ESA. The Applicant has read this dis5aimer and signs and dates it below. Signature: / Date: 7—.3—0 7 G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc )‘//-2`" • • 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 assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENE L CONTRACTOR OR M FACTURED HOME INSTALLER: PHONE: 7 FAX: /`��' `'""Q ( ) 33.�s7 ( ) MAILING ADDRESS: /a d"�') 4P— �Q _ 0✓ Fes, EMAIL: CONTRACTOR'S LICENSE `� WAINS NUMBER: d'` --J f—e K a 77Q P NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: 0 Sewer O Addition 0 Steel Proposed: Bank i 1 Community System ❑ Aitelaiioit/Rerruodei ❑ Concrete Total: — — I:eight: LJ individualSysiem O Repair 0 Masonry SEP Permit# ❑ Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: ri Private well U Two Party Type of Heat: Proposed: 17 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: i Underground Tank i Above ground Tank Size of Propane Tank: ,=Qs5 0 C7/ L- X/i i Heat Stove Cook Stove i Woodstove i Fireplace Insert i Hot Water Tank i Pellet Stove i Other 'e-i-►:_�J Is this appliance being installed in a Manufactured/Mobile Home? Yes / to2' 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 _For Office Use Only Amount Revision Main Floor Heated EH Bld App Review: 2nd Floor Heated Consistency Review: Other Heated Base fee: I �2/ r-Mezzanine Additional Section: �-�" Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: • Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL V1Z. Decks 911/Rd Approach fee: Other TOTAL: $ l Li-2Receipt Number: b Cash/Check Number: 'Th ESTIMATED COST(REQUIRED) Date: .2- ,-g' 'Fair market value of all labor and materials foundation to finish5) Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc