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HomeMy WebLinkAboutBLD2009-00313 S • 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 #: BLD09-00313 Received Date 9/17/2009 SITE ADDRESS: 1560 E MARROWSTONE RD Issue Date 9/17/2009 NORDLAND, 98358 APPLICANT: DARLENE G SANDERS PHONE: 360-301-9592 PO BOX 244 NORDLAND WA 98358-0244 TX 24 SUBDIVISION: Block: Lot: PARCEL NUMBER• 921042016 Section: 4 Township: 29N Range: 01 E CONTRACTOR: QCO MAINTENANCE INC PHONE: (360) 876-4876 PO BOX 370 PORT ORCHARD WA 98366-0370 Contractor's License QCOMAI*993NS Expires 8/10/2011 OWNER, DARLENE G SANDERS PHONE: 360-301-9592 if different: PO BOX 244 NORDLAND WA 98358-0244 PROJECT DESCRIPTION: WOODSTOVE CHIMNEY REPLACEMENT 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 9/17/2010. REQUIRED INSPECTIONS: Tank/Line/Appliance: atn FinalApproval: 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 GILDING PERMIT APPLICATS B Review 0313 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD09-00313 Received Date: 9/17/2009 SITE ADDRESS: 1560 E MARROWSTONE RD NORDLAND, 98358 OWNER: DARLENE G SANDERS PHONE: 360-301-9592 PO BOX 244 NORDLAND WA 98358-0244 SUBDIVISION: Block: Lot: TX 24 PARCEL NUMBER: 921042016 Section: 4 Township: 29 N Range: 01 E CONTRACTOR: QCO MAINTENANCE INC PHONE (360) 876-4876 PO BOX 370 PORT ORCHARD WA 98366-0370 Contractor's License QCOMAI*993NS Expires 8/10/2011 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI WOODSTOVE CHIMNEY REPLACEMENT 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: 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 $71.00 LYK 09/17/09 110930 Total: $71.00 ,io- s0rr c wow ° JEFFERSON COUNTY ' DEPARTMENT OF COMMUNITY DEVELOPMENT • 1' ` 1 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax �.g -. :ep') www.co.jefferson.wa.us/commdevelopment Master Permit Application ^D m pp MLA: N,,, 1 I K.k A=c-a Pr ' ct Description(include separat- sheets as necessary): —�, ' A PAJ c_ t •� &+O\l .Q om\ I r1 `�of E.X 1S\ ,Ytc .l.J e'nigh-6 ye_ ,k Tax Parcel Number: 9I C;-- I Pro ert Siz P Y (a s/square feet) Site Address and/or Directio s to Properly.; — I S I/e_ MAP VlA/ If ) v✓ /5�0 �-/tS i A44/�t57T C- R©, A).0,< aC_ifijO i�h. 9r35F Pei2 -r2c Property Owner(s)of Record: ')Ai _,t.--i1✓ G #C'(J Al.Ice Telephone: 3 to b 30 I g S%2 Fax: email: Mailing Address:J SZPO (FACT /'7)/)—1,2r)Gv 5' ID ot•-lv &-i7, A✓t?•2-t'C s,4.t,4,' 9 F 3S-5 Applicant/Agent(if different from owner):QCO 414'!A)j6 r4105 J r0C- Telephone:360— /6 —''g 710 Fax: 3(ao .-g 7S--/8 r 7 email:t COQ WA.tie-CAR-6 ,(et Mailing Address: fO &c 370 Po,Qr o ce-mko lt$ en 3 w t kind of Permit?(Check each box that applies Building ❑Lot or Road Segregation J 0 Critical Areas Stewardship Plan Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family El Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]** ❑ Manufactured Home 0 Modular 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* ❑Special Use(Essential Public Facilities)** ❑ Change of Use ❑ Boundary Line Adjustment ❑ Address 0 Road Approach ❑Short Plat** ❑ Home Business 0 Cottage Industry ❑Binding Site Plan** X7 Pfepaae(0000 TDtC Ci+t01 6y AoLACC-- ❑Long Plat** ❑ Sign - 0 Planned Rural Residential Development PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** S E p 1 7 2009 ❑ Stomiwater Management ❑Shoreline Master Program Exemption/Permit Revisions*"` ❑Site Plan Approval Advance Determination (SPAAD)* 0 Shoreline Management Substantial Development** ❑Temporary Use ❑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 El Tree Vegetation Request **Requires a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal, if known: � v� DESIGNATION OF AGENT �[ I hereby designate"i)ce sl/4/N7Z .J/)ckee1 .)„�}G_., to act as my agent in matters relating to this application for permit(s). /( OWNER SIGNATURE/ &at'^s' 122:t.4'4-e Date: /G„ I. /. -- °. 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 application ith,at he or she wants prior notice.* Signature:/ ia,„- c- / fi" r - Date: l(v /(.;' -i--- L'y 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 tederal 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 retsponsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. X Signature:/ kith-r G�III't-w _ ll- ;Date: / ;� ,,,et-_ - iY j , G:\PerrnitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc • • 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: Co VYI 14 IN Tau Uce Nc: (310 37(0 c'276 ( 0) g7V /917 MAILING ADDRESS: Po & - 37cf 2 (C(. EMAIL: CO W V6 &LE.c CONTRACTOR'S LICENSE UJ g3h WAINS NUMBER: c jClo, Aii4 9-93AJ5 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 O Repair ❑ MasonrySEP Permit# El Demolition ❑ Other: Bedrooms: Water Suppiy: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: ❑ Public Total: Name of System: � \�' If this is a Commercial Project you must answer the following: ,1 Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: NC IBC • of occupants(includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No v f this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: Underground Tank 1 Above ground Tank Size of Propane Tank: N. 'is Heat,Stove 1 Cook Stove VV odstove)1 Fireplace Insert 1 Hot Water Tank 1 Pellet Stove 1 Other 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 Bld App Review: 2nd 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 SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $ 7/ . ° 0 Receipt Number: l 1a(13 Cash/Check Number: 1163 _ — ESTIMATED COST(REQUIRED) Date: (�1 ,-7-na •Fair market value of all labor and materials foundation to finish TL_1 Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc 7O Cm c4 -12 n , m • r ._ , Q t-� r;, Go v mm IvQ M �(1) if, ,, • -2 -t.., / . 1 • 5. . , v X A --I q m i li 03 PIC Z 0 z a gl.c m I SZ p \ \ R 4, v _, m co co Ac+ _ i a, A {i. IA Q , 5 m \, • y -ra 'cam m z --s.-IT, ., ,, , i93 ' v i' , X