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Home My WebLink AboutBLD2009-00214 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 #: BLD09-00214 Received Date 7/9/2009 SITE ADDRESS: 1971 OLD GARDINER RD Issue Date 7/9/2009 SEQUIM, 98382 APPLICANT: WENDELL PAULSON TRSTE PHONE: 360-797-0055 CYNTHIA PAULSON TRUSTEE 1971 OLD GARDINER RD GARDINER WA 98382-8749 SUBDIVISION: TAX 51(LESS TAX 97) Block: Lot: PARCEL NUMBER: 002341033 Section: 34 Township: 30N Range: 02W CONTRACTOR: EVERWARM INC PHONE: (360) 452-3366 257151 HVVY 101 PORT ANGELES WA 98362 Contractor's License EVERWI*088NL Expires 8/17/2010 OWNER, WENDELL PAULSON TRSTE PHONE: 360-797-0055 if different: CYNTHIA PAULSON TRUSTEE 1971 OLD GARDINER RD GARDINER WA 98382-8749 PROJECT DESCRIPTION: NEW WOODSTOVE 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 7/9/2010. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApprovaI yi.. ID- f -D 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 10/29/19 214 BUILDING PERMIT APPLICA.N B Review 0 Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD09-00214 Received Date: 7/9/2009 SITE ADDRESS: 1971 OLD GARDINER RD SEQUIM, 98382 OWNER: WENDELL PAULSON TRSTE PHONE: 360-797-0055 CYNTHIA PAULSON TRUSTEE 1971 OLD GARDINER RD GARDINER WA 98382-8749 TAX 51(LESS TAX 97) SUBDIVISION: Block: Lot: PARCEL NUMBER: 002341033 Section: 34 Township: 30 N Range: 02 W 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 DESCRIPTIOt NEW WOODSTOVE 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 STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $142.00 LYK 07/09/09 108739 Total: $142.00 • • -9 Ste, n E - --, 1 i - . 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A ' M-1:-•, -I, .C i 4. s rr 1 CO L , i ��,SON cO JEFFERSON• • COUNTY r4, ' 3 DEPARTMENT OF COMMUNITY DEVELOPMENT `4 621 Sheridan Street • Port Townsend •Washington 98368 rN 360/379-4450 • 360/379-4451 Fax vqS, NGer, www.co.jefferson.wa.us/commdevelopment JP! -- 9 2009 Master Permit Application MLA: N.16 ri-1A ee6)I h Project Description(include separate sheets as necessary): 7-- k e t4 cc c e 6-xi�1`r_iZ e j, Pc "l t't si rove. ,A, i 1- LL) ct t'1 6' -�t ci .L-c e nS erfi Tax Parcel Number: 00 2 3`{ ( 0,.3 rg Property Size: / /-c R E (acres/square feet) Site Address and/or Directions to Property: (`17 ( Old barcir1ec- Vc Se"' LL i \ r LA)15\n 9Es-'3d a Property Owner(s)of Record: u1 r t,��PI I � Q ,n Telephone: : L,O— 717-c.)O5,c, Fax: // email: eauiso,,uJ m 0.A4c:co Mailing Address: ((- 71 9Ict GA.rc i rlc"f (Court ) Se. cL�'M_ 1 WA �1 3�Z Applicant/Agent(if different from owner): NML� Telephone: Fax: email: Mailing Address: What kind of Permit? (Check each box that applies ❑ Lot or Road Segregation Building 0 Critical Areas Stewardship Plan 0 Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) 0 Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]** 0 Manufactured Home 0 Modular ❑ Discretionary"D"or Unnamed Use Classification 0 Commercial* 0 Special Use(Essential Public Facilities)** 0 Change of Use 0 Boundary Line Adjustment ❑ Address 0 Road Approach ❑Short Plat** ❑ Home Business 0 Cottage Industry ❑Binding Site Plan** 0 Propane 0 Long Plat** 0 Sign 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis ❑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 0 Shoreline Management Variance 0 Wireless Telecommunication* 0 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: 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 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 tequi later inspections affs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the ap`' : hat nSignature: r� eir:i,or >/ ;/ �j Date: I The action or actions Applicant w II ertake as a result of the issuance of this perm t may negatively impact upon one or more threatened or endangered species and could I 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 E A. 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 it the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-trap er bte resp nsib.'t fo ering t d complying with the ESA. The Applicant has read this discla' er and signs and dates it below. _ Signature. Date: D G:\Pen •tCenter\###FORMS###\ FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc III • 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: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: Cvaz W4IRN) ( ) ( ) 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 Typeof 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: i Underground Tank i Above ground Tank Size of Propane Tank: I Heat Stove i Cook Stove i Woodstove `' Fireplace Insert} i Hot Water Tank 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 For Office Use Only Amount Revision Main Floor Heated EH BId App Review: 2nd Floor Heated Consistency Review: Other Heated Base fee: I i 3 Mezzanine Additional Section: ' Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL L 1 ') ,- Decks 911/Rd Approach fee: Other TOTAL: $ I U a — Receipt Number: (0 C1 Cash/Check Number: ESTIMATED COST(REQUIRED) Date: -7 �� ,Q .Fair market value of all labor and materials foundation to finish Initials: ------- —D G:\PemutCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc