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Home My WebLink AboutBLD2009-00215 • 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 #: BLD09-00215 Received Date 7/9/2009 SITE ADDRESS: 95 MARTINGALE PL Issue Date 7/9/2009 PORT LUDLOW, 98365 APPLICANT: ALEXANDER B MYERS PHONE: (360) 437-9363 JEANETTE L MYERS 95 MARTINGALE PL PORT LUDLOW WA 98365-9559 47 SUBDIVISION: BAYVIEW VILLAGE DIV 3 Block: Lot: PARCEL NUMBER: 931900047 Section: 16 Township: 28N Range: 01 E CONTRACTOR: MOUNTAIN PANE C 45 PHONE: (360)385-6883 265 C UM RD HADLOCK WA 98339 Contractor's License MOUNTP198306 Expires 9/26/2010 OWNER, ALEXANDER B MYERS PHONE: (360) 437-9363 if different: JEANETTE L MYERS 95 MARTINGALE PL PORT LUDLOW WA 98365-9559 PROJECT DESCRIPTION: INSTALL 120 GAL A/G PROPANE TANK, GAS PIPING AND Directions FIREPLACE INSERT 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: ff V-te`v C FinalApproval:&`(, 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 BLD09-00215 UILDING PERMIT APPLICA i N Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD09-00215 Received Date: 7/9/2009 SITE ADDRESS: 95 MARTINGALE PL PORT LUDLOW, 98365 OWNER: ALEXANDER B MYERS PHONE: (360)437-9363 JEANETTE L MYERS 95 MARTINGALE PL PORT LUDLOW WA 98365-9559 BAYVIEW VILLAGE DIV 3 SUBDIVISION: Block: Lot: 47 PARCEL NUMBER: 931900047 Section: 16 Township: 28 N Range: 01 E CONTRACTOR: MOUNTAIN PROPANE' C)-) 5 PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTP198306 Expires 9/26/2010 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP INSTALL 120 GAL A/G PROPANE TANK, GAS PIPING AND FIREPLACE INSERT 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: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid Bv: Date: Receipt: Approved/Date Propane Tanks/Stoves $213.00 KAS 07/09/09 108755 Total: $213.00 ON fo cO JEFFERSON COUNTY ,, i.�.a 4111 �` ��,_'l' DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 ' ( $3' . 360/379-4450co.je • 360/379-4451 Fax www. fferson.wa.us/commdevelopment tiff[f RSON Rimy no Master Permit Application MLA: Project Description(include separate sheets as necessa ): L A/(-5- Propcuie_TA rdc ii. ja,S rptp 1 '19 Tax Parcel Number: 3I M O 7 Property Size: die j?X (acre quare feet Site Address and/or Directions to Property: �5 * /I/t6 2/1(g 1 Property Owner(s)of Record: /elrm./p y' NI-,- �f/� 4: l //�� ff y Telephone: �Lp v %, - e/,3(o•"Fax: err ail: Mailing Address: Jr 74�� 7�� i' 6�'��-) >7f��S' Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies 0 Lot or Road Segregation ❑Building 0 Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]** ❑ Manufactured Home 0 Modular 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* 0 Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment ❑ Address 0 Road Approach 0 Short Plat** ❑ Home Business 0 Cottage Industry 0 Binding Site Plan** Propane ❑ Long Plat** Sign - 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** ❑ Stormwater Management 0 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 ❑ 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 **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 required later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the a licat on that he or he wants p'qr of Signature: . > A Date: 7—��-"£/ The action ctions Applicant will undertake as a result he issuance of this permit may negatively impact upon one or more threatened or endanger 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-tr ble responsibility for a erin to and corn yin with the ESA. The Applicant has read this disclaimer annddSigns anct dates it below. Signatur 1 �Q�y Date: / ��GI `•\D.....:.!',,,,,..\ffffff F(1RMCutfia\1wn F(IR ('MC\ I,..,nt TIT?TI Fn,..-tc\\Tr('lcr...P...,.:r A.,..1:�,t:,,.,S/O(142,i,,,. • • 1 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: EIF/M Loa ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: +CVkr�G -.. �IU�. jr %/Y life/i--' ./,_-- NUMBER ARcuaan ' `/ PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: O New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel 0 Concrete Total: _ Height: 0 Individual System O Repair ❑ Masonry SEP Permit# Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: n 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 A liance Installation permit,mark all items below that apply: i Underground Tank - Above ground Tank ize of Propane Tank: /? I Heat Stove i Cook `cove I Woods ove i Fireplace Insert j1 Hot Water Tank i Pellet Stove i Other Is this appliance being installed in a Menu-ac ire—Home? Ye' 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: 2 Floor Heated Consistency Review: Other Heated Base ( yl Q-- a O. DO Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL a13- oD Decks 911/Rd Approach fee: Other TOTAL: $ al 3,. 00 Receipt Number: 1 O$-7 55 Cash/Check Number: 1130(0 ESTIMATED COST(REQUIRED) Date: /� •Fair market value of all labor and materials foundation to finish [ Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc rm ZYS Do' q,5 mPd41 rocj2' L Pdv+ Lu DL-,tcji tkm gw-50 v, T,OJ.tj FrD pplt - Tn r