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HomeMy WebLinkAboutBLD2010-00130 • 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 #: BLD10-00130 Received Date 4/26/2010 SITE ADDRESS: 521 BACHELOR RD Issue Date 4/26/2010 SEQUIM, 98382 APPLICANT: LYNNE A TJOMSLAND PHONE: 818-242-4740 INA B JAFFE JTWROS 1833 NIODRARA DR GLENDALE CA 912082644 T 6+ SUBDIVISION: Block: Lot: PARCEL NUMBER: 002352006 Section: 35 Township: 30N Range: 02W CONTRACTOR: OWNER/BUILDER PHONE: OWNER, LYNNE A TJOMSLAND PHONE: 818-242-4740 if different: INA B JAFFE JTWROS 1833 NIODRARA DR GLENDALE CA 912082644 PROJECT DESCRIPTION: REPLACE 2 HEATING STOVES 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 4/26/2011. REQUIRED INSPECTIONS: Te ne/Appliance: (- % Jt;uC < ov FinalApproval:__ `' _\`"-I 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 03UILDING PERMIT APPLICi3 Revviewiew T TyN BL y130 pe: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD10-00130 Received Date: 4/26/2010 SITE ADDRESS: 521 BACHELOR RD SEQUIM, 98382 OWNER: LYNNE A TJOMSLAND PHONE: 818-242-4740 INA B JAFFE JTWROS 1833 NIODRARA DR GLENDALE CA 912082644 SUBDIVISION: Block: Lot: T 6+ PARCEL NUMBER: 002352006 Section: 35 Township: -30 N Range: 02 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTION REPLACE 2 HEATING STOVES 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 $142.00 LYK 04/26/10 117598 Total: $142.00 kfhweArn I iasON oe, JEFFERSON COUNTY 4 DEPARTMENT OF COMMUNITY DEVELOPMENT 11-3 o r s 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax IIIIG�O www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: NC mt 1 EG Project Description(include separate sheets as necessary): • 'P..•plpwt 2 old ,eAt 5kpve s '"/N / 3tn eq(c4tivtel wood /44041 1 Itotie • Tax Parcel Property l 6 IEG2 (acres/square feet) 0d2 O ' 352'D ` Size: ( q Site Address and/or Directions to Property: s;/ BAch E./OR R04 d Goveci/N-E2 Property Owner(s)of Record: Lyiv1v f —TreprnS l a# d TN* -74 Telephone:P51 ,/ 24 2 — 4/74/0 Fax: --- email:"1—gL___m_*(41vd Cha- ` t�e l , wt+ Mailing Address: 19, 33 /J,odacvrco ZsJ¢Ivx / GIeMelAlt CA q/2O8 Applicant/Agent(if different from owner): —9— Telephone: -er Fax: -f3- email: -& Mailing Address: $ 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]** ❑Single Family ❑Garage Attached/Detached ❑ Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home ❑ Modular ❑Special Use(Essential Public Facilities)** ❑ Commercial* ❑ Boundary Line Adjustment ❑ Change of Use ❑Short Plat** ❑ Address ❑ Road Approach ❑ Binding Site Plan** ❑ Home Business ❑Cottagelndustry ❑ Long Plat** ❑ Propane Cl Planned Rural Residential Development(PRRD)/Amendments** ❑Sign ❑ Plat Vacation/Alteration** ❑Allowed"Yes" Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisions"* ❑Stormwater Management ❑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: 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 requi ed later i spections. Staff' access and right of entry will be assumed unless the applicant informs the County in writing at the time of the appli a t e o she Its pri otice. et i-Date: " 2. - /d The action r 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 in ce with th effers ounty development code.The Applicant acknowledges that he,she or it holds individual and non-transferabl esponsibility or adheri o an col plying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: I Date: ti ::ADocuments and Settings\carat\Local Settings\Temporary Internet Files\()1.h86\Master Permit Application 12-19-201)6.dnc • • 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 assum g thelksp sibility of le General Contractor for the proposed project. Signature:: i t// Date: -Z©-/ GENERAL ONTRACTOR OR MANUFACTURED ME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: h PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New L.--Wood Existing: N`— Sewer Addition Steel Proposed: Bank Community System Alteration/Remodel Concrete Total: Height: Individual System ARepair Masonry SEP Permit# 1 Demolition Other: Bedrooms: Water Supply: Existing: N1L Setback: Private well Two Party Type of Heat: — Proposed: 4Fublic e � p� ill', /1000� Total: O Name of System: /�J (� 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: ❑Heat Stove 0 Cook Stove 0 Woodstove 0 Fireplace Insert ❑Hot Water Tank 0 Pellet Stove 0 Other Is this appliance being installed in a Manufactured/Mobile Home? Yes /aIQ 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 Iv Consistency Review: Other Heated Ile fee: ppltcfrk1ON Ili2 Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $ /y' Receipt Number: 1115c C.Cash/Check Number: i L,`I'�, j r ESTIMATED COST(REQUIRED) Date: 1, 'Fair market value of all labor and materials foundation to finish 6 3 S ao Initials: ____D is\1 neurncnts and Scnings\carat\1,ocal Set tit s\fcmpurarc lntcrnct Files\(11,Kl6\iNlastcr Permit Application 12-19-20(16. t,c 52-1 lik-c_Itt Ic.3r< P°1-(31 . • 41:78-42Yn t t ki)k--)1i U-41'1 0 Kj , CTAaoki oin lAJA-sk vv3•'‘-'01\J ..... /11 iviv e 1,,c)eryv,s iii41 .3- Ti :,-- ...... 4 2,i 2.Lt "•< i ,• 0 * 1 11 f 2 14 i, 2 , 1 I ,- of *1 \ I i 1 c.e_ Sif‘tS4 .1k, e1/41nue-A ye , . 1,10 4' . 1 c ., sivve ,07 -q pcytA-e-e- 1 Ni,eArit- .1 14 r* th.) ....SlctlAi .c;f?44ptiv cf._ A.4 -•-* * ,,.. ,,,...ix A ' ' kNt. 11 r" :)0CSITVN ltv‘eiti. 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