HomeMy WebLinkAboutBLD2010-00139 0 0 -
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 #: BLD10-00139 Received Date 5/4/2010
SITE ADDRESS: 30A S CHANDLER CT Issue Date 5/4/2010
PORT LUDLOW, 98365
APPLICANT: JOHN A WALKER PHONE: 360-437-5051
MARY ANN WALKER
64 DEER HOLLOW CIR
PORT LUDLOW WA 98365-9240
SUBDIVISION: INNER HARBOR VILLAGE CONDOS Block: Lot:
PARCEL NUMBER: 961600901 Section: 17 Township: 28N Range: 01 E
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTPI983O6 Expires 9/26/2010
OWNER, JOHN A WALKER PHONE: 360-437-5051
if different: MARY ANN WALKER
64 DEER HOLLOW CIR
PORT LUDLOW WA 98365-9240
PROJECT DESCRIPTION: INSTALL A/G 120 GAL PROP TANK& GAS INSERT
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 5/4/2011.
REQUIRED INSPECTIONS:
ank/Line/ ppliance: Y to to A I. ----
�v-o utcL c -C vv'a
FinalApprovaI: 7 (t.>- )- ►C
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
• BUILDING PERMIT APPLIC 'ION BLD10-00139Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #:
BLD10-00139 Received Date: 5/4/2010
SITE ADDRESS: 30A S CHANDLER CT
PORT LUDLOW, 98365
OWNER:
JOHN A WALKER PHONE: 360-437-5051
MARY ANN WALKER
64 DEER HOLLOW CIR
PORT LUDLOW WA 98365-9240 INNER HARBOR VILLAGE CONDOS
Block: Lot:
SUBDIVISION:
PARCEL NUMBER: 961600901 Section: 17 Township: 28 N Range: 01
CONTRACTOR: 265 CHIMACUM RDNTAIN NE
PHONE: (360)385-6883
PORT HADLOCK WA 98339
Contractor's License MOUNTPI983O6 Expires 9/26/2010
PHONE:
REPRESENTATIVE:
PROJECT DESCRIPTIOP INSTALL A/G 120 GAL PROP TANK & GAS INSERT
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
CONST TYPE: DECK: BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDS: BATHROOMS:
Exist Exist:
Prop: Prop:
Total: Total:
Routing Date:
Type Amount Paid By: Date: Receipt:
Approved/Date
Propane Tanks/Stoves S213.00 LYK 05/04/10 117642
Total: $213.00
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JEFFERSOPOUNTY' A DEPARTMENT OF COMMUNITY DEVELOPMENT
b -- `4 621 Sheridan Street • Port Townsend •Washington 98368
360/379 4450 • 360/379-4451 Fai-Kx
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$ www.co.jefferson.wa.us/commdevelopment
TINO
Master Permit Application MLA: .) f-LA
Project Description(inclu a separate sheets as neces ary):
j C -1( -T-7\L../___ c (-`3. L / --) t - L eic-t-L). " 1-._
Tax Parcel Number: 1(n I I Property Size: (acres/square feet)
Site Address and/or Directions to Property: _
�U�1 -) ( &l.Q ( " P �- )ci 1( C� �Lc Un A
Property Owner(s)of Record: _icx-wn n- (1 ,�1-rr L.. 0
Telephone: —
p �- ��" _>� Fa — 1 email:
Mailing Address: (�# (_ � rN l l�c.a)k e (-C 1 ucl(n (Dk Cf S -3(c-E-�
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies 0 Lot or Road Segregation
Building 0 Critical Areas Stewardship Plan
Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
❑ ingle Family ❑ Garage Attached/Detached 0 Conditional Use[C(a),C(d),or CI**
❑ Manufactured Home .0 Modular 0 Discretionary"D"or Unnamed Use Classification
I ❑ Commercial* 0 Special Use(Essential Public Facilities)**
❑ Change of Use 0 Boundary Line Adjustment
❑ Address 0 Road Approach_ 0 Short Plat**
errme Business ❑Cottage Industry 0 Binding Site Plan**
opane ❑ Long Plat**
I'S �Ign 0 Planned Rural Residential Development(PRRD)/Amendments**
0 Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration**
0 Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions**
❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development**
0 Temporary Use ❑Shoreline Management Variance
❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment
0 Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment
*May require a Pre—Application Conference El 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 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 its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this app ication 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 informs the County In writing at the
time of the application that he or she wants prior notice. 1 1
/Signature: k )J_--1 G"_� ��e4_/ Date: °'// tt v/O
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 tederal 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-tranIferable resp nsibility,for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs a, mates it below.
Signature: \_62- Date: " )c /
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
• •
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 OR MANUFA9TURED HOME INSTALLER: PHONE: FAX:
I IL
6 lk I'l 1-CL=-IL ` i-b ( ) ( )
MA IhG ADDRESS: EMAIL:
i
CONTRACTORS LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New ❑ Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: _ Height: ❑ Individual System
o Repair ❑ Masonry SEP Permit#
E Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: 0 Private well Ill 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 Ta k and/or Appliance Installation permit,mark all items below that apply:
1 Underground Tank Bove ground Tank Size of Propane Tank: . _I , l._
i Heat Stove i Cook Stove i Woodstove replace Insert i Hot Water Tank I Pellet Stove I ther
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:
2`d Floor Heated Consistency Review:
Other Heated __ Base fee: MM.
Mezzanine Additional Secti
Heated Basement Ian Check fee:
Unheated Basement PState Surcharge
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL ■
Decks 911/Rd Approach fee:
Other TOTAL: $ f) I3
Receipt Number: I 1 7(C(12
Cash/Check Number:
1 0 I I
ESTIMATED COST(REQUIRED) Date: �, t ' /-�
•Fair market value of all labor and materials foundation to finish _ f!-t7t.
Initials: .-—
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc