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Home My WebLink AboutBLD2009-00327 • • 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 #: BLD09-00327 Received Date 9/30/2009 SITE ADDRESS: 2981 PARADISE BAY RD Issue Date 9/30/2009 PORT LUDLOW, 98365 APPLICANT: DOUGLAS M KVINNESLAND PHONE: 360-437-5183 2981 PARADISE BAY RD PORT LUDLOW WA 98365-8739 15 SUBDIVISION: TALA SHORES#1 Block: Lot: PARCEL NUMBER: 998200114 Section: 22 Township: 28N Range: 01 E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 1/17 2010-5875 Contractor's License SUNSHP*077QP Expires 1 -I / lu OWNER, DOUGLAS M KVINNESLAND PHONE: 360-437-5183 if different: 2981 PARADISE BAY RD PORT LUDLOW WA 98365-8739 PROJECT DESCRIPTION: PROPANE FIREPLACE 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 9/30/2010. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval:A- 12 1 _ i _ 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 IUILDING PERMIIT APPLICA N BLD09-00327 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD09-00327 Received Date: 9/30/2009 SITE ADDRESS: 2981 PARADISE BAY RD PORT LUDLOW, 98365 OWNER: DOUGLAS M KVINNESLAND PHONE: 360-437-5183 2981 PARADISE BAY RD PORT LUDLOW WA 98365-8739 TALA SHORES#1 SUBDIVISION: Block: Lot: 15 PARCEL NUMBER: 998200114 Section: 22 Township: 28 N Range: 01 E 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 DESCRIPTIOP PROPANE FIREPLACE 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: 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 $71.00 LYK 09/30/09 111023 Total: $71.00 4�¢gON co JEFFERSON'UNTY • W ,,o y DEPARTMENT OF COMMUNITY DEVELOPMENT I' �\ "4 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax �qS, N6O� www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Project Description (include separate sheets as necessary): djn e ,e,� -,..._ r / Tax Parcel (� � _� �� v/� �� `' �� Number: q -( Gl C; /7 Prope Sizrtye: (acres/square feet) Site Address and/or Directions to Prooerty. Property Owner(s)of Record: ,b0 i•c -J Av/ _ e, /h r0 c1-/a h 4' Telephone: q-3 7- ,S%�� - ' Fax: email: Mailing Address: -:-'-e---- -__ Applicant/Agent(if different from owner): S(-L-NS H I N E P Ro PANE Telephone: 395-579 7 Fax: 313S- SO7S email: INFr SUN5)-1/NE PrOe4r7C. Mailing Address: I D853 RHoD y Die• / P . Nl�LOCK LJ Fl- ci 833� �m What kind of Permit? (Check each box that applies ❑Building ❑ Variance (Minor, Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use[C(a), C(d),or C]** Single Family 0 Garage Attached i Detached Li Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home 0 Modular ❑ Special Use(Essential Public Facilities)** ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use ❑ Short Plat** ❑ Address ❑ Road Approach 0 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)* 0 Shoreline Management Variance 0 Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* 0 Jefferson County Shoreline Master Program Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium 0 Tree Vegetaion Request *May require a Pre-Application Conference **Requires a Pre-Application Conference Please identify any other local, state or federal permits required for this proposal, if known: �t DESIGNATION OF AGENT \,I hereby designate 5t,(?1S I Ne- P t act as my agent in matters relating to this applicatio for permit(s). - 5-wNER SIGNATURE ( Date 77,2 V b By signingthis 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 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 acc and right of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application UU review and any required lat specti . St access and ri t of entry will be assumed unless the applicant informs the County in writing at the time of the a plication that 7ePotice ,,wio Date: -/(� 0-Al 0 q 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 w• of 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 complianc wi h t e Jefferson Co ty development code.The Applicant acknowledges that he, she or and non-transferable r 9it holds individual � _ ponsibility for i g to and con•Fp n ith the ESA. The Applicant has read this disclaimer a si ar�d d .es it below. Signature: Date: 1 o G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc 110 • BUILDER STATEMENT The signer of this statement does hereby 7ertify 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: SitJOE P2o pane (36O) 335- 5791 ( 36O) 3B5-587. MAILING ADDRESS: 1 0853 4v,00 t/ (�e u e_ ( H. EMAIL: Q n' St,(VISHIV)e_ pro Pane a can CONTRACTOR'S LICENSE [' �7�/ l( +� WAINS NUMBER: 5uhSN P7 U f 7 P NUMBER ARCHITECT/ENGINEER: PHONE'( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: Ci New ❑ Wood Existing: i7 Sewer C! Addition ❑ Steel Proposed: Bank ❑ Community System Cl Alteration/Remodel ❑ Concrete Total: Height: [i Individual System CI Repair ❑ Masonry SEP Permit# 0 Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: i_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 Installatio ermit,mark all items below that apply: i Underground Tank I Above ground Tank C7AS" 6 ize of Propane Tank: i Heat Stove I Cook Stove I Woodstov I Fireplace i Hot Water Tank I Pellet Stove I Other Is this appliance being installed in a Man ctured obile 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. a a v.Square Footage Current Proposed :ForOffice;Use;Only .a . Amo,unt ReviSi0; Main Floor Heated EH Bid App Review: 2fd Floor Heated ;.,`, Consistency Review: Other Heated Base fee: ----1 — Mezzanine Additional Section: Heated Basement ' Plan Check fee: Unheated Basement 7 State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carpoit I SUBTOTAL Decks ` . 911/Rd Approach fee: Other TOTAL: $ • Receipt Number: 1 I I C 2.3 Cash/Check Number: ESTIMATED COST(REQUIRED) Date: n ,�, .Fair market value of all labor and materials foundation to finish Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc