The URL can be used to link to this page

Home My WebLink AboutBLD2010-00144 • 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 #: BLD10-00144 Received Date 5/6/2010 SITE ADDRESS: 181 HAYDEN ST Issue Date 5/6/2010 PORT HADLOCK, 98339 APPLICANT: FREELAND E MC MULLEN PHONE: 360-385-1544 181 HAYDEN ST PORT HADLOCK WA 98339-9521 SUBDIVISION: PHILLIPS ADDN TO IRONDALE Block: Lot: PARCEL NUMBER: 986400102 Section: 2 Township: 29N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 2010 5875 Contractor's License SUNSHP*077QP Expires 1 / OWNER, FREELAND E MC MULLEN PHONE: 360-385-1544 if different: 181 HAYDEN ST PORT HADLOCK WA 98339-9521 PROJECT DESCRIPTION: A/G 100 GAL PROP TANK, LINES & HEAT STOVE 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 5/6/2011. REQUIRED INSPECTIONS: Tank/Line/Appliance: 5II)Jio FinalApproval: C.13110 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 APPLICA1113N BLD10 001144 view Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00144 Received Date: 5/6/2010 SITE ADDRESS: 181 HAYDEN ST PORT HADLOCK, 98339 OWNER: FREELAND E MC MULLEN PHONE: 360-385-1544 181 HAYDEN ST PORT HADLOCK WA 98339-9521 PHILLIPS ADDN TO IRONDALE SUBDIVISION: Block: Lot: PARCEL NUMBER: 986400102 Section: 2 Township: 29 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 100 GAL PROP TANK, LINES & HEAT STOVE 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 Bv: Date: Receipt: Approved/Date Propane Tanks/Stoves $213.00 LYK 05/06/10 117656 Total: $213.00 • • SITE VISIT REPORT (PLOT PLAN) JOB RL d 14R 772 r in c /l DATE : !/2/'/ 4 , l CONTACT: ADDRESS /C•I M4'�� PHONE #: DIRECTIONS FAX #: Email PLANNER: a g5,0 1CA0OT 1 / )SON C06, JEFFERSO)UNTY • =7 `� DEPARTMENT OF COMMUNITY DEVELOPMENT ~' <� ''' 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax qs N�,0p www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Gl li2 -b Project Description (include separate sheets as necessary): - -c2X-4//frz) ,Ak1 WO C.(1)9- V)-- id Tax Parcel / Property r I Number: 91c6 10d -/02_ Size: (acres/square feet) Site Address and/or Directions to Probe /f7 .� ((I-, rOPuJ I Property Owners)of R cord: / e e Lr, ,Q i-k7 Gc= Telephone: .�Owner ) -/J"f� - Fax: email: Mailing Address: --5-t7 c Applicant/Agent(if different from owner): S(A-MS 1-0 K E P R_o PA N E Telephone: 395-5797 Fax: 3BS SO7S email: INF0@$uAisH/NEProp/ic• Mailing Address: I (Ds 53 HODy D 2• ` �• F{l�LDC/C� Lc)A_ g 83.E 9 �m 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]** ❑ Single Family 0 Garage Attached i Detached 0 Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home 0 Modular ❑ Special Use(Essential Public Facilities)** ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use 0 Short Plat** ❑ Address El Road Approach 0 Binding Site Plan** ❑ Home Business ❑ Cottagelndustry 0 Long Plat** Propane 0 Planned Rural Residential Development(PRRD)/Amendments** ❑ Sign 0 Plat Vacation/Alteration** ❑Allowed"Yes" Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management ❑ 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* ❑Jefferson County Shoreline Master Program Amendment O 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: ?t c DESIGNATION OF AGENT I hereby designate �Jld 1,1S N I NE pp.()P t4"e. to act as my agent in matters relating to this application for permit(s). ��WNER SIGNATURE �� (Date: �°5 �°� /O 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. (\C ' 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 applicafon t rphe a is priorotice. _ ignature /'L'� Date: aj —U`��/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 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 S\ 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 nontransferable r spons. ility for adhering to and complying with the ESA. The Applicant has read this disclairiler and signs and dates it below. Signature~ ) Date: —'°`(— G:\PermitCcnter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc ( , / 0 • BUILDER STATEMENT • I _ti The signer of this statement does hereby^ertify 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 MANUFACTURED HOME INSTALLER: PHONE: FAX: Sof\SEH NE P2opan.� (360) 3�35- 5797 ( 36o) 35-5875 MAILING ADDRESS: EMAIL: nfo(�3LoAs�I1ve pro P�e 6 C 0� 1o�s3 ��-OoY ��iu � P. N. I CONTRACTORS LICENSE WAINS NUMBER: 5uhs14 P+ '-(0r7r7/1 P NUMBER ARCHITECT/ENGINEER: l PHONE( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: LI New 0 Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System El Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ 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 _ f IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes I No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: j tnripr round Tank 1 Above ground Tank Size of Propane Tank: Heat Stov 1 Cook Stove 1 Woodstove 1 Fireplace Insert 1 Hot Water Tank 1 Pellet Stove (1 Othe /J-yar4-, 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: 2n0 Floor Heated Consistency Review: Other Heated Base fee: r' [3 ,-- 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: $(9 l Receipt Number: l n(6` Cash/Check Number: 7 - ESTIMATED COST(REQUIRED) Date: —I �T •Fair market value of all labor and materials foundation to finish __-3- Initials: G:\PennitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc