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HomeMy WebLinkAboutBLD2009-00356 • • 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#: BLD09-00356 Received Date 10/15/2009 SITE ADDRESS: 71 FOSTER ST Issue Date 10/15/2009 PORT HADLOCK, 98339 APPLICANT: PHILIP C PEET PHONE: 360-379-0419 ELIZABETH E PEET 50 FOSTER ST PORT HADLOCK WA 98339-9519 39-42 SUBDIVISION: CHALMER'S 1ST ADDITION Block: 5 Lot: PARCEL NUMBER: 942600507 Section: 3 Township: 29N Range: 01W CONTRACTOR: OWNER/BUILDER PHONE: OWNER, PHILIP C PEET PHONE: 360-379-0419 if different: ELIZABETH E PEET 50 FOSTER ST PORT HADLOCK WA 98339-9519 PROJECT DESCRIPTION: RE-TILE AROUND 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 10/15/2010. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: - -- `--�" 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 411CUILDING PERMIT APPLIC bN B Review Type: y pe: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD09-00356 Received Date: 10/15/2009 SITE ADDRESS: 71 FOSTER ST PORT HADLOCK, 98339 OWNER: PHILIP C PEET PHONE: 360-379-0419 ELIZABETH E PEET 50 FOSTER ST PORT HADLOCK WA 98339-9519 CHALMER'S 1ST ADDITION SUBDIVISION: Block: 5 Lot: 39-42 PARCEL NUMBER: 942600507 Section: 3 Township: 29 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP RE-TILE AROUND WOODSTOVE TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 4,000.00 ADD'L: HEAT TYPE: CODE EDITION: 2006 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: 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 $142.00 LYK 10/15/09 110966 Total: $142.00 • • Ic;.i., • 7, �f`.� "Z/ "W iss‹ o>,.)_ ______,, - 6/ ,,, -z_, s T \ 1 4/ 0 < ____ ___ _,____9__../* ____.------ >7' \<[J"\ Cr II,10,4, y S 1 �i aC Gl v 6 .5 -� x of Z „off 3 f t 1 0 • • • -3 z * • �M Itsc4 z 7 Te • ' ON �, fvZ or, JEFFERSOOUNTY 0 '�al ' TADEPARTMENT OF COMMUNITY DEVELOPMENT ` 04 621 Sheridan Street• Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax &„g9.81-N��p/ www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: NO 0 lt Project Description(include separate sheets as necessary): /I- A Rou N 9 1�� ItirDaO,-ro v -- • Tax Parcel Number: 94 a Goo 5 C3 `7 Property Size: r I2 yi ) / 0c) (acres/square feet) Site Address and/or Directions to Property: 7/ v STZ I PT- /MD cO C 1/✓k 9 y 33 9 Property Owner(s)of Record: PH IL if c . PCET- / EL I Z , C. P CC-I- Telephone: 360 - 37?- 04- r 9 Fax: email: Mailing Address: 50 F2 I)T JS r P i hA.0L pc g Pvti- 7$ 3 Applicant/Agent(if different from owner): 4l/ Telephone: ax: email: Mailing Address: What kind of Permit?(Check each box that applies 0 Lot or Road Segregation lg.-Building 0 Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) "Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]** O Manufactured Home .0 Modular - 0 Discretionary"D"or Unnamed Use Classification O Commercial* 0 Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment ❑ Address 0 Road Approach 0 Short Plat** Home'?usiness ❑ Cottage Industry 0 Binding Site Plan** ❑ Propane 0 Long Plat** ❑ Sign 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** ❑ Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions** 0 Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development** ❑Temporary Use 0 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 0 Tree Vegetation Request **Requires a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal, if known: nA DESIGNATION OF AGENT I hereby designate Phi it- P E-C-T to act as my agent in matters relating to this application for permit(s). OWNER SIGNATUR '"-----"---L-- ��--- Date: c9 /1' -(/ 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 that he or she wants prior noti Signature:. - C Date: 70 - / 0 7 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 lake"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 respo ' .'ty for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: . ....._...,..... Date: Date: i ro . / S / G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Pemut Application 5-29-08.doc , i • 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: G.--- Date: /0 —/fo? GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAx: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTORS LICENSE WAINS NUMBER: 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 ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: ❑ Public EL EC- 7 I c./WUv0 Total: Name of System: • If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current: 3 Proposed: 2 Number of ADA Parking Spaces: /1"-/rii Number of occupants(includes owners,tenants,employees,etc) Current 4 Proposed 1 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: 1 Underground Tank i Above ground Tank Size of Propane Tank: I Heat Stove 1 Cook Stove 1 Woodstove i Fireplace Insert i Hot Water Tank 1 Pellet Stove i Other_ is 1 i,apt iaii�e- bc`iniq installed in a Manufactures i Mobile Home? Yes / ) 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. 40 f30o 13.,,,r9 ,3 + v Square Footage Current Proposed For Office Use Only - Amount Revision Main Floor Heated EH Bld App Review: e Floor Heated Consistency Review: Other Heated Base fee: / j.. £G Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport s � SUBTOTAL /gg?Do - Decks 911/Rd Approach fee: Other /' / .�. 1�� CUB61 w TOTAL: $/'�/� O C) �C-71 LC-D ARouN A Receipt Number: ///O 9 6 tNUo __ p�_ TILE _ Cash/Check Number: ESTIMATED COST(REQUIRED) Date: �} •Fair market value of all labor and materials foundation to finish /a- -° I -1 ©®,C-s'_ Initials: 24e_, G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc