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Home My WebLink AboutBLD2009-00286 • • 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 #: BLD09-00286 Received Date 8/25/2009 SITE ADDRESS: 20 GOLDFINCH LN Issue Date 8/25/2009 PORT LUDLOW, 98365 APPLICANT: JOHN P BURGER TRUSTEE PHONE: 360-437-5797 BURGER JOINT LIVING TRUST 20 GOLDFINCH LN PORT LUDLOW WA 98365-9764 25 SUBDIVISION: PORT LUDLOW NO. 4 Block: Lot: PARCEL NUMBER: 990500025 Section: 17 Township: 28N Range: 01 E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 1 i��/gi8-5875 OWNER, JOHN P BURGER TRUSTEE PHONE: 360-437-5797 if different: BURGER JOINT LIVING TRUST 20 GOLDFINCH LN PORT LUDLOW WA 98365-9764 PROJECT DESCRIPTION: A/G 120 GAL PROP TANK & 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 8/25/2010. REQUIRED INSPECTIONS: Tank/Line/Appliance: ()— ) (_a T 4—, —10 - C vA--e_ C1Lo O( 6/( FinalApproval: g— c `6 7 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_Perm it_Propane.rpt 10/29/19 BLD09-00286 •UILDING PERMIT APPLICA•N Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD09-00286 Received Date: 8/25/2009 SITE ADDRESS: 20 GOLDFINCH LN PORT LUDLOW, 98365 OWNER: JOHN P BURGER TRUSTEE PHONE: 360-437-5797 BURGER JOINT LIVING TRUST 20 GOLDFINCH LN PORT LUDLOW WA 98365-9764 PORT LUDLOW NO. 4 SUBDIVISION: Block: Lot: 25 PARCEL NUMBER: 990500025 Section: 17 Township: 28 N Range: 01 CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2010 PHONE REPRESENTATIVE. PROJECT DESCRIPTIOI A/G 120 GAL PROP TANK & HEAT STOVE 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: SHORELINE: CONST TYPE: GARAGE: SETBACK: CONST TYPE: DECK: 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 08/25/09 110820 Total: $213.00 . • IV SITE VISIT REPORT (PLOT PLAN) JOB \,04 t.') E-P_-Ge`C- DATE : F.'! r ?'% ° CONTACT: 11 ADIESS O ('moo',n'' .i1Jc.N L.o,N c PHONE #: I)IRITIONS Q-` 1 ) (L.\ou) FAX #: Email PLANNER: r I I c� ?=�rx4 (-13 AUG 2 5 2009 1 f, -]- , I i I p,IP ,6 I -._. .... ._ ... ..J s f o cJ I U.. ‘ Q. CO i 1 \y fN c0� JEFFERSON•UNTY • DEPARTMENT OF COMMUNITY DEVELOPMENT_ '•`\ ' '� 621 Sheridan Street • Port Townsend • Washington 98368 j 360/379-4450 • 360/379-4451 Fax ,�S, N0�0 www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: (Q I ' A £ l 1t Prct Description (include separate sheets as necessary): `� IQn�� i�c�� QCLf jt' • Tax Parcel Qn Property Number: _f 0 J 0 00 a5- _ Size: (acres/square feet) Site Address and/or Directions to Property: Property Owners)of Record: 1 L,( rc Telephone: 3 ( L L c �r Fax: email: Mailing Address: D..0 L-)1 .1 •l.ti` .0 t') &ft_.. - ' . 1.01: 1.0 0 4 31 ,; Applicant/Agent(if different from owner): S LC.NS N /N E p(�D A Na Telephone: 385-579 7 Fax: 3BS' 5-87S email: fNFoeSt/N5H/NE ProPAr7 . Mailing Address: I OB53 RHOp p 2. PT-. 1- LOC/C L.7 A, 9 e 3 corm 3 7 What kind of Permit? (Check each box that applies ❑Building 0 Variance (Minor, Major or Reasonable Economic Use) 0 Demolition Permit 0 Conditional Use [C(a), C(d),or C]** 0 Single Family ❑ Garage Attached/Detached L7 Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home 0 Modular 0 Special Use (Essential Public Facilities) ** ❑ Commercial* 0 Boundary Line Adjustment 0 Change of Use 0 Short Plat** ❑ Address 0 Road Approach ❑ Binding Site Plan** ❑ Home Business 0 Cottagelndustry 0 Long Plat** Propane 0 Planned Rural Residential Development(PRRD)/Amendments** ❑ Sign 0 Plat Vacation/Alteration** ❑Allowed"Yes" Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions ** 0 Stormwater Management 0 Shoreline Management Substantial Development** 0 Site Plan Approval Advance Determination (SPAAD)* 0 Shoreline Management Variance 0 Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication * 0 Jefferson County Shoreline Master Program Amendment 0 Forest Practices Act/Release of Six-Year Moratorium ❑ Tree Vegetaion Request *May require a Pre—Application Conference Pre-Application Conference Please identify any other local, state or federal permits required for this aproposal, if known: • 121 U •I hereby designateS,N 1JJ DESIGNATION OF AGENT \ t�1 �j .!� f to act as my agent in matters relating to this application for permit(s). WNER SIGNAT R // • uate: e / U By signing this applicat'on form,the owner/agent attests that the information provided herein, and in any attachmefits, is tr a 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 right of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application review and any required later inspects. Sffs access and right of entry will be assumed unless the applicant informs•the County in writing at the time of the a plication�hat or she nts or notice. i gnature: '\./: Date: / 6 C The action or q¢tions Applicant will undertake as a result of he 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 j 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 fferson County development code.The Applicant acknowledges that h ,she or it holds individual and non�ransferable,respoosibility for erin o and complying with the ESA. The Applicant has read this disclaimer nd s' n and dates it below. � Signature: l( /r �� Date: 4-5 �' G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doe • 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: SO( 21- II\I6 Prep pan. (360) 3?5- 5797 ( 360) 385-587.5 MAILING ADDRESS: )0853 uO(/ !1 of l i e P. H. EMAIL: j n b 3UV\sH(VIe Pbo P e 6 cOn CONTRACTOR'S LICENSE r WAINS NUMBER: 5uy 74 P+ D1717 P NUMBER ARCHITECT/ENGINEER: 1 PHONE'( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: L1 Sewer Li Addition ❑ Steel Proposed: Bank n Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: L I Individual System I Repair 0 Masonry SEP Permit# Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: 0 Private well 0 Two Party Type of Heat: Proposed: U Public YP Total: Name of System: If this is a Commercial Protect 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 )(Above ground Tank Size of Propane Tank: /c9 D kjeat Stove 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 / 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 .; r�� . . Amounts.' Revlslon.' Main Floor Heated i i ' ' EH Bld App Review: 2n°Floor Heated ;� , Consistency Review: i1 Other Heated Base fee: (-3 13 Mezzanine Additional Section: Heated Basement Plan Check fee. Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks :. 911/Rd Approach fee: Other TOTAL: $a Receipt Number: 1 \ag'2� Cash/Check Number: 1, r , (. I.--I ESTIMATED COST(REQUIRED) Date: j1`,—tj`' .Fair market value of all labor and materials foundation to finish Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc