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HomeMy WebLinkAboutBLD2009-00372 • • 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 #: BLD09-00372 Received Date 11/3/2009 SITE ADDRESS: 73 GOLDFINCH LN Issue Date 11/3/2009 PORT LUDLOW, 98365 APPLICANT: NELSON D LUDLOW PHONE: 360-344-3233 BONNIE L LUDLOW 2023 E SIMS WAY# 194 PORT TOWNSEND WA 98368-6905 32 SUBDIVISION: PORT LUDLOW NO. 4 Block: Lot: PARCEL NUMBER: 990500032 Section: 17 Township: 28N Range: 01 E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 ((33 p) 3g5 Contractor's License SUNSHP*077QP Expires 11/67/2010-5875 OWNER, NELSON D LUDLOW PHONE: 360-344-3233 if different: BONNIE L LUDLOW 2023 E SIMS WAY# 194 PORT TOWNSEND WA 98368-6905 PROJECT DESCRIPTION: A/G 120 GAL PROP TANK PIPE & FIREPLACE 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 11/3/2010. REQUIRED INSPECTIONS: Tank/Line/Appliance:_ FinalApproval:' L- ) 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 •UILDING PERMIT APPLICA N B RD09 00eview ppe72 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD09-00372 Received Date: 11/3/2009 SITE ADDRESS: 73 GOLDFINCH LN PORT LUDLOW, 98365 OWNER: NELSON D LUDLOW PHONE: 360-344-3233 BONNIE L LUDLOW 2023 E SIMS WAY# 194 PORT TOWNSEND WA 98368-6905 PORT LUDLOW NO. 4 SUBDIVISION: Block: Lot: 32 PARCEL NUMBER: 990500032 Section: 17 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 DESCRIPTIOI A/G 120 GAL PROP TANK PIPE & FIREPLACE 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: 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 $213.00 LYK 11/03/09 111178 Total: $213.00 • SITE VISIT REPORT (PLOT PLAN) JOB (30,`3D-31 E LJ L1O) DATE : / l/OZ /0, CONTACT: ADDRESS 7,3 C 0LD pi k c 4 L.A►J& PHONE #: DIRECTIONS 2'T' LOOLCLAD FAX #: Email PLANNER: ID0 II- 1-Jo V J �4�¢goN C�&� JEFFERSOUNTY 1 W \ ya DEPARTMENT OF COMMUNITY DEVELOPMENT <� v4 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax 40.1,, N�K.0� www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: l\ O A- e_e6,.I Project Description (include separate sheets as necessary): — Tax Parcel 61 g D _ 5 D D _ 0,2 Property Number: Size: (acres/square feet) Site Address and/or Directions to Property: 7 3 a L el-F'I n cL-t t-t e_ P a 12._-+ 4. j / Lt.- c L-o IA Property Owner(s)of Record: r h iJ/ Telephone: 3(00 3 4/(I 3 Z Fax: email: Mailing Address: Applicant/Agent(if different from owner): S(-L MS H /N E P R.0 PA N E Telephone: 395-579 7 Fax: 3BS SO7S email: trJF oe Sun1SN/NE ProP,4r7F, Mailing Address: I OS53 RHovy D e• / �P i . NF}D Lock [.,L A- 9(8 COM 33'7 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]** • Singie Family ❑ Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home ❑ Modular ❑ Special Use(Essential Public Facilities) ** ❑ Commercial* ❑ Boundary Line Adjustment NOV — ,j 2009 ❑ Change of Use ❑ Short Plat** ❑ Address ❑ Road Approach ❑ 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 0 Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination (SPAAD)* ❑ Shoreline Management Variance ❑ Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* ❑ Jefferson County Shoreline Master Program Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium ❑ 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: �u�S DESIGNATION OF AGENT �� I hereby designate H I Nt✓ Pry(� � to act as my agent in matters relating to this application for permit(s). �VNER SIGNATURE %�� ��jyl 4 �� — (Date: OZ Y(.1.0 ' 20Q ' 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 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 UU 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 th t he or she wa is fSLJ ��J �y 1 ignature� Date�� D 2 /(fi}7f 2� l 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 nonransferable responsibility for adhe 'ng to n omplying with the ESA. The Applicant has read this disclaimer and�/ signs and�dyattees i below. '� Signature: Date: ©Z 7'u i--0 00 G:APennitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc • BUILDER STATEMENT • The signer of this statement does hereby^ertify 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: r`S.IH P2opanQ, (360) 335- 57c 7 ( 360) 385-5875 MAILING ADDRESS: 1 08S3 41.-00 Y l ej v P. 1.1. EMAIL: 0 n q} foLSUy\s4liv►e Pao Phi e 6 cor►1 CONTRACTOR'S LICENSE WAINS NUMBER: u0s•c1 P+ Di7r7/1 P NUMBER ARCHITECT/ENGINEER: rT 1 t "( PHONE( ) FAX: ( MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: LI New ❑ Wood Existing: [] Sewer L! Addition ❑ Steel Proposed: Bank ❑ Community System Li Alteration/Remodel 0 Concrete Total: Height: i I Individual System L! Repair 0 Masonry SEP Permit# Demolition ❑ Other: — Bedrooms: Water Supply: Existing: Setback: i7 Private well ❑ Two Party Type of Heat: Proposed: H 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 Installation permit mark all items below that apply: Underground Tank Above ground Tank ) _ Size of Propane Tank: l02 c� mac` Heat Stove i Cook Stove I Woodstove Fireplace I Hot Water Tank t Pellet Stove I Others �72e Is this appliance being installed in a Manufac •• obile Home? Yes / No (J 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 , Foi';O ce,tUse,'Only . ,_; Amount, Revisjoftt_' :- . Main Floor Heated EH Bld App Review: 2"0 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: Carage/Cerpoit SUBTOTAL Decks - 911/Rd Approach fee: Other TOTAL: $ Receipt Number: - Cash/Check Number: ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish Initials: G:\PermitCenter\####FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc