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Home My WebLink AboutBLD2009-00263 • • 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 #: BLD09-00263 Received Date 8/6/2009 SITE ADDRESS. 290 N PALMER DR Issue Date 8/6/2009 PORT TOWNSEND, 98368 APPLICANT: TIMOTHY A LITTLEJOHN PHONE: 360-385-3900 DEBORAH M LITTLEJOHN 16280 CANDY LOOP NE POULSBO WA 983707810 3 SUBDIVISION: CAPE GEORGE COLONY DIV 3 Block: 7 Lot: PARCEL NUMBER: 938400703 Section: 12 Township: 30N Range: 02W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 (3 Contractor's License SUNSHP*077QP Expires 11/62/1 $5 5875 OWNER, TIMOTHY A LITTLEJOHN PHONE: 360-385-3900 if different: DEBORAH M LITTLEJOHN 16280 CANDY LOOP NE POULSBO WA 983707810 PROJECT DESCRIPTION: A/G 120 GAL PROP TANK, LINES & HEAT STOVE 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 8/6/2010. REQUIRED INSPECTIONS: Tank/Line/Appliance q-3-07 FinalApproval: '3--199 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 • BLD09-00263 BUILDING PERMIT APPLICATON Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD09-00263 Received Date: 8/6/2009 SITE ADDRESS: 290 N PALMER DR PORT TOWNSEND, 98368 OWNER: TIMOTHY A LITTLEJOHN PHONE: 360-385-3900 DEBORAH M LITTLEJOHN 16280 CANDY LOOP NE POULSBO WA 983707810 CAPE GEORGE COLONY DIV 3 SUBDIVISION: Block: 7 Lot: 3 PARCEL NUMBER: 938400703 Section: 12 Township: 30 N Range: 02 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 DESCRIPTION A/G 120 GAL PROP TANK, LINES & HEAT STOVE 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 By: Date: Receipt: Approved/Date Propane Tanks/Stoves $213.00 LYK 08/06/09 110700 Total: $213.00 .._.. 11, 4111 .. SITE VISIT REPORT (PLOT PLAN) JOB ) lYn 4-r-a.--s3 .31E t—r1tie -3-oPtO DATE : CONTACT: ADDRESS .270 /kJ- PA Lyn el__ F..i: PHONE #: . DIRECTIONS C..//Pe 6 ettR‘e: FAX #: . Email PLANNER: C 2 A ‘ \O (r,g0 [ 1 ---------- 1 .:.c))kf 1 6 ---- 1 e .... , ---- ,--------/EA-V E ..1.0 0") ..._1_, ,•<\' \,/ 13 AUG - 6 2009 4 4$ON 00 • • 44' 6, JEFFERSON COUNTY W \ ` -4 DEPARTMENT OF COMMUNITY DEVELOPMENT �' '14 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax q p www.co.jefferson.wa.us/cornmdevelopment SINGT Master Permit Application MLA: NO vytuk �Q Project Description (include separa heets as necessary): U A/ (20 GIA( . ry I �� --�'of S SiMjow Ta)t Parcel Property Number: 0 3 4007 t) 3 _ Size: (acres/square feet) Site Address and/or Directions to Property: MD /V . 7 I-/1t ._ Property Owner(s)of Record: /—f 7 2_ Telephone. 3(4 t Stet --C/ 7' Fax: email: Mailing Address: ((O? 'D I_e �'fu N • 6 Applicant/Agent(if different from owner): S LL S fJ I N� P Ro PA N E Telephone: 3135—57 9 7 Fax: 381" email: IN FOe SUNSN/NE(roP341-7 , Mailing Address: i bg53 RHOD D2 / P. I-1AO Lock (.,�fa. 9 833 What kind of Permit? (Check each box Viet applies ❑Building ❑Variance (Minor, Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use [C(a), C(d),or C]** El Single Family ❑ Garage Attached/Detached U Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home ❑ Modular ❑ Special Use(Essential Public Facilities)** ❑ Commercial* ❑ Boundary Line Adjustment ❑ Change of Use ❑ Short Plat** ❑ 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 ❑ 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 **Re•uires a Pre-A..lication Conference Please identify any other local, state or federal permits required for this proposal, if known: • 2) DESIGNATION OF AGENT � (I hereby designate 6t.o s N I tJ E ,� (D A�C' to act as my agent in matters relating to this appli ation for permit(s). WNER SIGNATURE (�� 1-Date: 7231 v By signing this application form,the owner/agent atte 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 ri• t of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application review and any required later inspec o s. Staffs access and right of entry will be assumed unless the applicant inform the County in writing at the time of the application that+e or s s ice. �l 0? ignature: !t ► ;it Date: - ir 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 L\ \ 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 compli with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-.transferable re ponsibili or " r ng to and complying with the ESA. The Applicant has read this disclaimer nd si s and dates it below. Signatures Date: u ',Permit{;enter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc • • BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the narcel 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: SIMA2H IIL P2o pail. (360) 335- 577 ( 360) 385-5875 MAILING ADDRESS: )0 853 .4T o 0 y -/u e P• I.I. EMAIL: ((l 3LA✓\si-mt Pro P e 6 C CA'\ CONTRACTOR'S LICENSE WAINS NUMBER: ✓1SFI P+ 0 7 r7 P NUMBER ARCHITECT/ENGINEER: PHONE( ) FAX: ( MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New i i Wood Existing: 11 Sewer Addition !1 Steel Proposed: Bank ❑ Community System Alteration/Remodel Li Concrete Total: Height: I_I Individual System Repair IL Masonry SEP Permit# Demolition CI Other: Bedrooms: Water Supply: Existing: Setback: LI Private well C Two Party Type of Heat: Proposed: I, 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: Underground Tank i Above ground Size of Propane Tank: lo'%O CI Heat Stoves I Cook Stove i Woodstove i Fireplace Insert i Hot Water Tank i Pellet Stove i Other Is this appliance being installed in a Manufactured!Mobile Home? Yes o 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. tis Square Footage Current Proposed . For.Office Use<Only Annount Rpvi§jb #. . Main Floor Heated EH Bid App Review: 2"a Floor Heated Consistency Review: Other Heated Base fee: ^ Mezzanine Additional Section: al -5 Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carpo t — - SUBTOTAL i 3 Decks 911/Rd Approach fee: Other TOTAL: $(:94 J Receipt Number: I t CO Cash/Check Number: -IZ12 ESTIMATED COST(REQUIRED) Date: �(� .Fair market value of all labor and materials foundation to finish - (CJ ']_ Initials: G:APennitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc