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HomeMy WebLinkAboutBLD2010-00056 • 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 #: BLD10-00056 Received Date 3/2/2010 SITE ADDRESS: 1917 DABOB RD Issue Date 3/2/2010 QUILCENE, 98376 APPLICANT: LOUIS T ALLEN PHONE: 360-732-6832 AMELIA L LEE PO BOX 563 CHIMACUM WA 98325-0563 SUBDIVISION: Block: Lot: PARCEL NUMBER: 801282007 Section: 28 Township: 28N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 (3 pl 3g Contractor's License SUNSHP*077QP Expires 1 (367/2015-5875 OWNER, LOUIS T ALLEN PHONE: 360-732-6832 if different: AMELIA L LEE PO BOX 563 CHIMACUM WA 98325-0563 PROJECT DESCRIPTION: A/G 120 GAL PROP TANK 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 3/2/2011. REQUIRED INSPECTIONS: Tank/Line/Appliance:_ FinalApproval:_ /.7 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 DING PERMIT APPLICATI BLD10 00view 05 6 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00056 Received Date: 3/2/2010 SITE ADDRESS: 1917 DABOB RD QUILCENE, 98376 OWNER: LOUTS T ALLEN PHONE: 360-732-6832 AMELIA L LEE PO BOX 563 CHIMACUM WA 98325-0563 SUBDIVISION: Block: Lot: PARCEL NUMBER: 801282007 Section: 28 Township: 28 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 DESCRIPTION A/G 120 GAL PROP TANK 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 03/02/10 113943 Total: $213.00 e .. • ............._.,.....„...................... , / r• I A ‘r, 0 ! i-- , -3---- \_. c-N.I ) ..r Q CN.1 I -Th 0 V CJ ‘..) `. -- 1')a , ... ,.....- ,- / / „....„... ----, ..s f (--- c--- ....s- & d' \---------------°) .,...-.', ...-- 1 , , , 1 e:713 _..s, .....c.\, C>,-- .____.................. ) •---._....._ .._ .....---- -------- „.....-----• Eiril4- oN co JEFFERSON COIUNNTY • DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend • Washington 98368 1% 360/379-4450 • 360/379-4451 Fax www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: _ I I / , Project Description(include separate sheets as necessary); />U5 7 7z /140/T70/V4-4- iagol.if-Aieg- ri'fr�it (tig/e/6/(i" /2rr7 /) Tax Parcel Number: Fe, 1 , Z. Q 07 Property Size: /2, ' (acres/square feet) Site Address and/or Directions to Property: /9/7 z 413o1' /Z.4 , AQiv way �,v; ilit 7JIa ,D4&'6/o9'OLSr, 2Q Property Owner(s)of Record: GL Telephone:99D- Z3Z-Z-45"32- Fax: email: Mailing Address; P© 6,02( Slv3 GmRl rfe-Gikt WA . 9 3 Applicant/Agent(if different from owner): �� `'`' a r jt----l'>o04,,-._e.__._._-- Telephone: 3e5 - 577 7 Fax: J8 5 -..1-875; email: Gy i S`44'`dA- `D ?A-,-e .c.,. .,___ Mailing Address: /d 8.$3 ./-/ ,y CR Pi . //R-0 c o c% , A What kind of Permit?(Check each box that applies ❑ Lot or Road Segregation ❑Building ❑Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variange (Minor, Major or Reasonable Economic Use) ❑ Single Family ❑ Garage Attached/Detached ❑ Conditional Use[C(a), C(d), or C]** ❑ Manufactured Home ❑ Modular 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* ❑ Special Use (Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment 0 Address 0 Road Approach 0 Short plat** ❑ Home Business Cl Cottage Industry ❑ Binding Site Plan** *propane ❑ Long Plat** ❑ Sign ❑ Planned Rural Residential Development(PRRD)/Amendments** . ❑Allowed"Yes"Use Consistency Analysis ❑ Plat Vacation/Alteration** ❑ Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions** • O Site Plan Approval Advance Determination (SPAAD)* CO Shoreline Management Substantial Development** 0 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 ❑Tree Vegetation Request **Requires a Pre-Application Conference Please identify any other local, state or federal permits required for this proposal, if known: /vG/t/g- �v�L �f�NG f�r�pP�gv c� DESIGNATION OF AGENT I ereby designate to act as my agent in matters relating to this applicationli/ for permit(s). Sly OWNER SIGNATURE e X • Date: 1✓2`//C— 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 rts 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'sfees 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 applltel hatbe oLshe w tire, • 5 ,01 .•nature; tie--t— 2/2-7 Date:Date: 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 non-transferab res Rsibilityjso ad ring to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: :'l/�.— --C, Date: el ./27i`/L VI (:\Prr ,,rC, r \###F(IRM.S###\T)Rr) PrIR MC\(' ,-,, -nun F,,.,,-\l\, ,-.r u_..,,;,A.,.,r,..,.:,,.,c 'n 110 a,... • • The signer of this statement does herebyBUILDER STATEMENT the G thate l Contractor the Owners rothe parcel referenced herein, that they are not licensed contractors and that they wil be this g the responsibility of the General they are the for the pof roposed project. Signature: GENERAL CONTRACTOR QR MANU Date: Q NST ttER. PHONE: s�l� l h rP(2� � ( FAX: MAILING ADDRESS: O ' (;(5d ) 3 F.S- ,-S.- 7 /7 (3 G4 ? , 5 -S P 75 CONTRACTOR'S LICENSE ^/ P. (( EMAIL: J NunnaER: � 177 NWAINS UMBS ARCHITECT/ENGINEER: V` y;� ' � NUM6ER MAILING ADDRESS: PHONE ( ) FAx (-)�.___ _ Project Type: Frame Type: EMAIL " �""'— ❑ New ❑ Wood Bathrooms: Shoreline: ❑ Addition Existing: Type of Sewage Disposal: ❑ Alteration/Remodeldditi 0 Steel Proposed: U Sewer 0 Concrete Bank 0 Community System ❑ Repair 0 Masonry Total: Height: ❑ Demolition0 Individual System 0 Other: Bedrooms: SEP Permit# Type of'Heat: Existing: Setback: Water Supply`"" — Proposed: 0 Private well L., Two Party Total: Public Name of System:• �___ If this:is a Commercial Project ou must answer the foilowin : Number of Parking Spaces: Current: Number of occupants (includes owners, tenants, employes, etc)e Current Number of A op Parking Spaces: IBC Occupancy: IBC Type of construction: Proposed Will you have Food'Service? f this is a Pro•ane Ta , a d/or A.'fiance Installation •ermit mark all items below that a••I Yes / o I Underground Tank Above .round Tank i Heat Stove I Cook Stove I Size of Propane Tank: /a 0 �� , woodstove i Fireplace Insert 1 t Is this a fiance.bein installed in a Manufactured/Mobile Home? 1Yese/ Nok I Pellet Stove I Other Ines,When applying fora permit to install a propane tank you must also submit a site plan showingall lines, tank location and size, distances from the propane tank to all property fines, buildings and septic system to• the.reserve area. of the ystemgs,ap nents, f Y tem components, S•uare Foots•e r Current Pro.osed � , W i,rih i x 5 �,,, 9:a. �'�t rOk4 .fl�ir'� f' yr r ,,, Main Floor Heated •rs"�� r y r i�.)'.i):/ QYi '', .i ,'i .�+T,4.A:a a �� � r Yam:, " w rat , f }, EH BId App Review. � I ,._t!.i?.�;Y G, >c� .� ,�Y 2`Floor Heated '"%,' ' i11111111111111111111111 , � ` ` Consistency Review: Other Heatedisra°} ,,. ,, 111111111241;,+, ' 'Base fee: V ;;'3 ' ;� Additional Section: Heated Basement , `vA.�.nyk i " Plan Check fee: Unheated Basement {,�'{r+J�4df y ���k�'� 1.11.1.; �Z, .., State Surcharge fee: OtherUnheated �, r h ' Garage/Carport 111111.g ' Pot Water Review'fee: �t'"�C SUBTOTAL Decks i a ,; t a a: ��Y r e 911/Rd Approach fee; Other � •tt{u q t ,: TOTAL: 1111.11.111111111111111111111111.111 F'f't9k f 4 Cyr ' r Receipt Number: 1111111111111111111111.11111111111.1111111 ESTIMATED COST(REQUIRED) • i i, Cash/Check Number: •Fair market value of all labor and materials foundation to finish Date: Initials: IIIIIIIIIIIIIIIIIIIIIIIIII G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms.\Master Pemvt Applicztion 5-29-08.doc