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Home My WebLink AboutBLD2010-00023 • 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 #: BLD10-00023 Received Date 1/21/2010 SITE ADDRESS: 12 BENTLEY PL Issue Date 1/21/2010 PORT TOWNSEND, 98368 APPLICANT: JEFFERSON CO FIRE DISTRICT#5 PHONE: 360-774-1919 2000 OLD GARDINER RD SEQUIM WA 98382-8750 SUBDIVISION: Block: Lot: PARCEL NUMBER: 902252012 Section: 25 Township: 29N Range: 02W CONTRACTOR: DOUBLED ELECTRICAL INC PHONE: 360-385-1130 PO BOX 957 PORT HADLOCK WA 98339 6pp)) Contractor's License DOUBLDE982PD Expires 1D((3/4/2010385-5761 OWNER, JEFFERSON CO FIRE DISTRICT#5 PHONE: 360-774-1919 if different: 2000 OLD GARDINER RD SEQUIM WA 98382-8750 PROJECT DESCRIPTION: !I IG 1000 GAL PROP TANK& GENERATOR 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 1/21/2011. REQUIRED INSPECTIONS: Tank/Line/Appliance: R ' _--› FinalApproval: S/J-0-A A a �r ,< 'IL— C) S 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 BLD10-00023 UILDING PERMIT APPLICA N Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00023 Received Date: 1/21/2010 SITE ADDRESS: 12 BENTLEY PL PORT TOWNSEND, 98368 OWNER: JEFFERSON CO FIRE DISTRICT#5 PHONE: 360-774-1919 2000 OLD GARDINER RD SEQUIM WA 98382-8750 SUBDIVISION: Block: Lot: PARCEL NUMBER: 902252012 Section: 25 Township: 29 N Range: 02 W CONTRACTOR: DOUBLED ELECTRICAL INC PHONE: 360-385-1130 PO BOX 957 PORT HADLOCK WA 98339 Contractor's License DOUBLDE982PD Expires 10/4/2010 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION #14 1000 GAL PROP TANK & GENERATOR TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 38,095.00 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 Permit Plan Check State Building Code Total: si r i,4`$QN 00 JEFFERS•COUNTY ' `.\ 3 DEPARTMENT OF COMMUNITY DEVELOPMENT ") `(` '� : 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax c5 www.co.jefferson.wa.us/commdevelopment ' rN Master Permit Application MLA: ICI rn I2efi ' � Project gtpj;T(Lj1k scription(include separate sheets as necessary): j Lif% vat 4 ��14�1' i_ Tax Parcel c 1 ` l Property Number: 1 Goa Jd-O I Size: (acres/square feet) Sit Ad ress an or Directions to Property: ' • � 1 L• ��r •TC�t�n$ 1 (c 4- e Ln Co-5 t `c-'a-Q Property Owner(s)of Record: Tr, '1 I(J. D i.-A ! " "5 Telephone: .(t")0--if-)U— le/ 'i Fax: - . email: Mailing Address: . I• ap, A r - I ill UNI ‘4 gr'.A4 Applicant/Agent(if different from owner): a U)1V rai ?; �1 Ci'�L Telephone: -_ ‘1._ *i ~ i I At ' Fax: -,i'�:�f/4•• —��j / email: Mailing Address: s r r , CI /- f ' ✓'- •r WWII - Cj, `3 G' What kind of Permit?(Check each box that applies) ❑Building 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit 0 Conditional Use[C(a),C(d),or C]** 0 Single Family 0 Discretionary"D"or Unnamed Use Classification ❑Garage Attached/Detached 0 Special Use(Essential Public Facilities)** O Manufactured Home 0 Boundary Line Adjustment ❑ Modular 0 Short Plat** ❑ Commercial* 0 Binding Site Plan** O Change of Use 0 Long Plat** Address 0 Road Approach 0 Planned Rural Residential Development(PRRD)/Amendments** Propane 0 Plat Vacation/Alteration** 0 Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** ❑Stormwater Management 0 Shoreline Management Substantial Development** ❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Variance ❑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: DESIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: 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 review and any required later inspections. Staffs access and right of entry will be assumed unless the applicant in orms the County in writing at the time of the applica ion that he.o she wa is pri n ce. Itl , `) /•1 Signature: Date: �J I(,' The action or actions Applicant will unde ake 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 non-transferable responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: Date: C:\Documents and Settings\carat\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.doc I . . I MP 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 R MANUFACTURED HOME INSTALLER: PHONE: FAX: ‘49 1 r,-Ii'i c.+ .J Line_ ).35- 11 M% >t)3S -5r�I MAILING ADDRESS: '� 0 . j�0X q fjvJ ,/-l„ 1 Io.�t loe n((EMAIL: • c` „ €, CONTRACTOR'S LICENSE / rJ (,(Jt- Cib WAIN NUMBER: OCf t!j-' r O� C, '�p 0 NUMBER ARCHITECT/ENGINEER: �_J PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: '--I, New ❑ Wood Existing: ❑ Sewer Addition ❑ Steel Proposed: Bank ❑ Community System Alteration/Remodel ❑ Concrete Total: Height: Individual System Repair ❑ Masonry SEP Permit# o Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: I Private well I Two Party Type of Heat: Proposed: 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 a�f lyG' ^ gUnderground Tank ❑Above ground Tank Size of Propane Tank: 1,O �I ��t� �- ❑Heat Stove ❑Cook Stove ❑Woodstove 0 Fireplace Insert ❑Hot Water Tank ❑Pellet Stove 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. Square Footage Current Proposed For Office Use Only Amount Revision Main Floor Heated EH Bld App Review: 2na Floor Heated Consistency Review: Other Heated Base fee: 1 1 \ - .95 Mezzanine Additional Section: Heated Basement Plan Check fee: -j • 3' Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee:Other TOTAL: $ 1 %' .?lb Receipt Number: I (5e1432 Cash/Check Number: I/,lJo ESTIMATED COST(REQUIRED) Date: •Fair malret value of f all labor and materials foundation to finish I 2(— 0 Initials: f ( _ .-7 -D C:\Documents and Settings\caral\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.doc ArcIMS Viewer 111/ 41( Page 1 of 1 ',\ 32 g6t4613050.1 — '",i6t3t4,..-36,YJ'3 •". 1 , = •i i '3 S, .4(12262° Renfley ‘ %=,\ . 90225201A 6." ,-„, v") i 3 3 = 3 1 ','''. 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