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HomeMy WebLinkAboutBLD2009-00300 0 • 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 #: BLD09-00300 Received Date 9/10/2009 SITE ADDRESS: 140 W FITCHBURG AVE Issue Date 9/10/2009 PORT HADLOCK, 98339 APPLICANT: VICKI D SHAVER PHONE: 360-301-9727 JAMES L SHAVER PO BOX 332 PORT HADLOCK WA 98339-0332 4 SUBDIVISION: WOODLAND ACRES#1 Block: Lot: PARCEL NUMBER: 999501004 Section: 2 Township: 29N Range: 01W CONTRACTOR: OWNER/BUILDER PHONE: OWNER, VICKI D SHAVER PHONE: 360-301-9727 if different: JAMES L SHAVER PO BOX 332 PORT HADLOCK WA 98339-0332 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 9/10/2010. REQUIRED INSPECTIONS: Tank/Line/Appliance: _ FinalApproval: 1�—/7 "C"1 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 BLD09-00300 91ILDING PERMIT APPLICATION Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD09-00300 Received Date: 9/10/2009 SITE ADDRESS: 140 W FITCHBURG AVE PORT HADLOCK, 98339 OWNER: VICKI D SHAVER PHONE: 360-301-9727 JAMES L SHAVER PO BOX 332 PORT HADLOCK WA 98339-0332 WOODLAND ACRES#1 SUBDIVISION: Block: Lot: 4 PARCEL NUMBER: 999501004 Section: 2 Township: 29 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP NEW WOODSTOVE 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: CONST TYPE: OTHER: SHORELINE: CONST TYPE GARAGE: SETBACK: 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 $142.00 LYK 09/10/09 110891 Total: $142.00 S • 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 assuring the responsibility of the General Contractor for the proposed project. C Signature�y'.�II Date: 1 /Cc/c' GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) 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 )g Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System W. Alteration/Remodel 0 Concrete Total: Height: ❑ Individual Syste J ❑ Repair ❑ Masonry h`/ SEP Permit# /� _A/ .I O Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: 0 Private well ❑ Two Party Type of Heat: Proposed: G] Public I1eL Uoce,1 1rr 1,: c Total: Z �'1/� 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 Tank \--i1r Size of Propane Tank: Heat Stove i Cook Stove I Woodstove i Fireplace Insert Hot Water T nk Pellet Stove Other Is this appliance being installed in a Manufacture ome? 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 properly lines,buildings and septic system components, including the reserve area. Square Footage Current Proposed For Office Use Only AmountRevision Main Floor Heated `44,1, EH Bld App Review: 2n0 Floor Heated /. Consistency Review: Other Heated Base fee: Mezzanine / Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: • • Other Unheated• Pot Water Review fee: Garage/Carport S Y`� SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $/•y2 d° Receipt Number: l t©gq 1 CashiCheck Number: ; t3 ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish i; Initials: • • 4� ON ca JEFFERSON COUNTY w ormituk.„"S- kat �j DEPARTMENT OF COMMUNITY DEVELOPMENT "n `4 621 Sheridan Street• Port Townsend •Washington 98368 �� 360/379-4450 • 360/379-4451 Fax www.co.jefferson.wa.us/commdevelopment G Master Permit Application MLA: Project Description(include separate sheets as necessary): i UJ COLIACtCh Tax Parcel Number: clq� co 60'-1 Property Size: I 1 �� �' S�f� (acres/square feet) Site Address and/or Directions to Property: (: ' c t_. _1- , ictO3 r) Ilvc o `9 \-ViAoc\L L✓ Cl$,33`? Property Owner(s)of Record: caw.es- c,„,` ,\fit lt: St,,c-,VFr Telephone: ?c 0 -30 i 1 7-Z 7 Fax: email: b-,ke ma:,kc/ 62,5 F?i•,,„, ,I r, Mailing Address: 9 �i. ,N- 332 S , \,,,llc 1L 1 ✓R `I r1,331 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 ❑Garage Attached/Detached ❑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 B undfe?Adjustment ❑ Address 0 Road Approach 0 Short Plat** „` ❑ Home Business ElCottage Industry ❑ Bidding Site Plan** ❑ Propane El Long Plat** ❑ 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)* ❑Shoreline Management Substantial Development** ❑Temporary Use 0 Shoreline Management Variance El Wireless Telecommunication* ❑ 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 El 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 iospectiobs, .,,Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the application that he or she wants prior notice. �J Signature:t_I -- .---"- wt • t— 1 l,, ",'` Date: l/06 /C'( 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 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-transferable responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: Date: 0 m C -1 z Is. m _w a 00 m r N • I m - a r v -r . v N c-- K 130 ' r-c 7r — - t J 7 . v L * x! , --A-(- , � \h a m I Y A 1 - . r I; m i v is IC") s J6 s l r L� lac I ,y WUOJ Dr("L Hai •' T.' , 2i z I i 0m T. ° co 1 �� 1 � 1 J _ ` _ i� czo 1 c\ \ r- . v — � ' \\ ^ \ice p M _ `U. — -- — - 'Gt� \ J lin N ^ C 1 \ �� N • N. M77 I ( I N ` WGIer O I 1 (cou ci I N N. -� V—— r i I �. \ QOCcr' -S1 0 O .o 1d w ,i 0,\ vrj Ave. i e- v v z O s Q