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Home My WebLink AboutBLD2009-00387 • . 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 #: BLD09-00387 Received Date 11/23/2009 SITE ADDRESS: 267 FOXFIELD DR Issue Date 11/23/2009 PORT TOWNSEND, 98368 APPLICANT: JAMES A HODGES PHONE: 360-379-9020 ANDREA G HODGES 267 FOXFIELD DR PORT TOWNSEND WA 98368-9549 113 SUBDIVISION: KALA POINT#4 Block: Lot: PARCEL NUMBER: 965000107 Section: 27 Township: 30N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 ((33ggpp)) 338g5 Contractor's License SUNSHP`077QP Expires 11/17/2010-5875 OWNER, JAMES A HODGES PHONE: 360-379-9020 if different: ANDREA G HODGES 267 FOXFIELD DR PORT TOWNSEND WA 98368-9549 PROJECT DESCRIPTION: A/G 120 GAL PROP TANK REPLACEMENT-SAME SIZE & Directions LOCATION 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 11/23/2010. REQUIRED INSPECTIONS: Tank/Line/Appliance: + 'O FinalApproval: - j 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 APPLICION BLD09-00387 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD09-00387 Received Date: 11/23/2009 SITE ADDRESS: 267 FOXFIELD DR PORT TOWNSEND, 98368 OWNER: JAMES A HODGES PHONE: 360-379-9020 ANDREA G HODGES 267 FOXFIELD DR PORT TOWNSEND WA 98368-9549 KALA POINT#4 SUBDIVISION: Block: Lot: 113 PARCEL NUMBER: 965000107 Section: 27 Township: 30 N Range: 01 W 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 DESCRIPTIOF A/G 120 GAL PROP TANK REPLACEMENT - SAME SIZE & LOCATION 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 $71.00 LYK 11/23/09 113470 Total: $71.00 !SIT VJSIT 'R PO JOB DATE ADDRESS aCo 7 00C I=' t 21 BY A 4 ' 'O PH E Draw a simple plot plan: include prop-rty lines and •roxi it t lines, tanks, wells, driveways. shrubs & trees, exhaust vents,I air rota_ e, combustibl sources, relevant . in Clallam County, include septic., Hous. Mobile H•meCOmmer windows and door$, in s rzeep (i ` 7 (cmore7e Dr?'ve (it , C i ,i Ltd io 70' I - 41 °1, 1\ �.� ~I 1 lJ l 0 crew/ "; I. ,dices S I! V u { " Description 1 I r I • oN co JEFFERSO•OUNTY • h; . • \� •f DEPARTMENT OF COMMUNITY DEVELOPMENT o_ 621 Sheridan Street • Port Townsend •Washington 98368 `�'1 360/379-4450 • 360/379-4451 Fax www.co.jefferson.wa.us/commdevelopment BIND Master Permit Application MLA: KO A f Project Description(include separate sheets as necessary): l T Tax Parcel Number: 9 6 ,S C C-0 / L'7 Property Size: (acres/square feet) Site Address and/or Directions to Property: Property Owner(s)of Record: J rJ ' -- £ '„""'—r e_.__ -0.- Telephone: 3 7 r1 - I v 2— c Fax: email: Mailing Address: C 7 ,c &' /:- L 19 / / / OCJ/1f -7i Applicant/Agent(if different from owner): \ AL,z)-y".„..z._-- Telephone: ,?el5 - S 7 7 Fax: 3 S 5 - 975 email: . )-2-¢c'`_.<"4-4 `O4-tr,a---4- .c_z-,,___ Mailing Address: /0853 ,e/-by 6Q• Pi f/1919 c v c/c 1„)A What kind of Permit?(Check each box that applies ❑ 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 Cl** ❑ Manufactured Home .0 Modular - 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* 0 Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment ❑ Address 0 Road Approach 0 Short Plat** ❑ Home Business 0 Cottage Industry 0 Binding Site Plan** ropane ❑ Long Plat** 0 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** ❑ 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: DESIGNATION OF AGENT I ereby designate to act as my agent in matters relating to this application for permit(s). 510(.2 � WNER SIGNATURE S ��,�� Date: h w owner/agent attests that the information rovided herein,and in anyattachments,is true and correct to the best of By signing this cation form,t e o ne g p his,her or its owledge. 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 I r inspections. Staffs a and of entry will be assumed unless the applicant informs the County in writing at the r time of the applicatio at he or she w is /t§nature: '� Date: 1 1 The a • or actions Applicant will undertake as a r suit of the issuance of this permit may negatively impact upon one or more threatened or enda gered 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 d complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. ` Signature: Date: -4/0 / /9-—c / (:• rr•rrnrCanr'r\###FnRMS###\r)Rr)F(lR tifc\('nrrPr,r flRil F,,....e\M.,oro.n.....,:, 4....1:,.4-:,...c'In no a— • • BUILDER STATEMENT f t' 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 ER: PHONE: FAX: .r.-r Satre rP(2_-, P ()6u ) 3 es- S7Y7 ( 364 3 es-sa' 7S MAILING ADDRESS: /0 5 3 pr /) hi EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: S tit i l s' >k ,e 7 z7 Q 1 NUMBER ARCHITECT/ENGINEER: / PHONE ( ) FAx:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: ❑ Sewer D Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: _ Height: ❑ Individual System 0 Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well LI Two Party Type of Heat: Proposed: ❑ Public Total: Name of System: If this is a Commercial Proiectyou 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: ` i Underground Tank I Above ground Tank Size of Propane Tank: / 20 �' - i Heat Stove I Cook Stove I Woodstove 1 Fireplace Insert I Hot Water Tank I Pellet Stove i Other Is 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. i Tis � { r l F c '4. ' ae F; F v ' �Square Footage Current Proposed T ice W � x, 0 . K , 0 v on .Main Floor Heated = EH Bld App Review: 2`°Floor Heated Consistency Review: - - Other Heated ;, " - fee: Base Mezzanine Additional Section: Heated Basement Plan Check fee: - j F Unheated Basement '' i. State Surcharge fee: Other Unheated , Pot Water Review fee: Garage/Carporty ' r SUBTOTAL , " `'Decks - 911/Rd Approach fee: Other 0 TOTAL: $ ''] I t, Receipt Number: I t B1 fF7'3 Cash/Check Number: � (� - 3ybgQ ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish Initials: - G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc