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Home My WebLink AboutBLD2010-00237 4110 S 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 #: BLD10-00237 Received Date 7/6/2010 SITE ADDRESS: 60 CEMETARY RD Issue Date 7/6/2010 QUILCENE, 98376 APPLICANT: BEVERLY J GUSTAVSON PHONE: 360-871-1906 PO BOX 1 SOUTHWORTH WA 983860001 TX 67 SUBDIVISION: Block: Lot: PARCEL NUMBER: 702132008 Section: 13 Township: 27N Range: 02W CONTRACTOR: DAVIS MASONRY PHONE: (360)765-3577 PO BOX 357 QUILCENE WA 98376 Contractor's License DAVISML966OL Expires 9/13/2010 OWNER, BEVERLY J GUSTAVSON PHONE: 360-871-1906 if different: PO BOX 1 SOUTHWORTH WA 983860001 PROJECT DESCRIPTION: INSTALL WOODSTOVE & RECONSTRUCT CHIMNEY 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 7/6/2011. REQUIRED INSPECTIONS: Tank/Line/Appliance: 6, L I�, 7//340 FinalApproval: r--\e 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 APPLICI Revviewiew T TyON BL y237 pe: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00237 Received Date: 7/6/2010 SITE ADDRESS: 60 CEMETARY RD QUILCENE, 98376 OWNER: BEVERLY J GUSTAVSON PHONE: 360-871-1906 PO BOX 1 SOUTHWORTH WA 983860001 SUBDIVISION: Block: Lot: TX 67 PARCEL NUMBER: 702132008 Section: 13 Township: 27 N Range: 02 W CONTRACTOR: DAVIS MASONRY PHONE: (360)765-3577 PO BOX 357 QUILCENE WA 98376 Contractor's License DAVISML966OL Expires 9/13/2010 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION INSTALL WOODSTOVE & RECONSTRUCT CHIMNEY TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 10,000.00 ADD'L: HEAT TYPE: CODE EDITION. 2009 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 07/06/10 117946 Permit $181.25 LYK 07/06/10 117946 Plan Check $117.81 LYK 07/06/10 117946 State Building Code $4.50 LYK 07/06/10 117946 Total: $445.56 • • JEFFERSON COUNTY DCD BUILDING PLAN REVIEW AS SUBMITTED APPROVE AS NOTED v REJECTS Reviewer _EZL. , t PenT_ICE_ Plans aree;r►proved exr:epti�!l a; ti rrors orlornlsslcrns. All work mc1 st inspect. n In conformance e°tth I "mot r :pi cabin codes and regulations. \" 1 A (A) j 3 • ; i. . :A \i, rinl A j . 1 v‘ i \: iS FILE COPY r,.w ON C 06 JEFFERSO UNTY 110 ' a DEPARTMENT OF COMMUNITY DEVELOPMENT 1-) ` i4 621 Sheridan Street • Port Townsend •Washington 98368 4\< t. 360/379-4450 • 360/379-4451 Fax www.co.jefferson.wa.us/commdevelopment Cs Master Permit Application MLA: NO 1 ' Vt i N Project Description(include separate sheets a,,s necessary): /I --IA S fce 17 0I60c4S ILO Y N'--- Fe Cc 4 Sete c ` , i/L Ii e Tax Parcel Number: 7i72/3.2.Pt'c' Property Size: (acres/square feet) Site Address and/or Directions to Property: .6e' C /e6- / €77 epCi /zG�,,r1‘..- Gif.V Property Ow er(s)of Record: G l Telephone: (3 ) f 7/ -/gam 6 Fax: email: ' Ufa; 2 Mailing Address: / '. 73 .1 i G®�r1-11�02Y , £ 4 r 6 fri7<- Applicant/Agent(if different from owner): .,T'C Telephone: 6 Fax: email: Mailing Address: Wt kind of Permit?(Check each box that applies 0 Lot or Road Segregation uilding 0 Critical Areas Stewardship Plan Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family ❑ Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]** ❑ Manufactured Home .0 Modular 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* 0 Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment ❑ Address 0 Road Approach 0 Short Plat** ❑ Home Business 0 Cottage Industry 0 Binding Site Plan** ❑ Propane 0 Long Plat** ❑ Sign 0 Planned Rural Residential Development(PRRD)/Amendments** • ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** ❑ Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions** ❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development** ❑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 0 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 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 try to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any required later inspections. S ff s a ss and right of entry will be assumed unless the applicant informs the County in writing at the time of the apple On tha an prior n Signature: a 1., ,ifeC _ 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 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 u are in compliance with the efferson County development code.The Applicant acknowledges that he,she or it holds individual and non-tratrifer tl sgo sibi' eri g to and plying with the ESA. The Applicant has read this disc) ' er nd signs and dates it below. Signature: /// �� l��s j/�E-1 Date: 7 /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 MANUFACTURED HOME INSTALLER: PHONE: FAX: ni/i<� iiii . l2-v _/ L. G (3k/'la. Stel " ‘ ( ) l MAILING ADDRESS: EMAIL: a. 1/74/l1G�5 474r�. 6,,,�/17 CONTRACTOR'S LICENSE / / / WAINS NUMBER: 7, IV/G 5/d6 c 9Lt 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 ❑ 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 • 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: 1 Underground Tank 1 Above Tank Size of Propane Tank: l Heat Stove 1 Cook Stov 1 Wood tove i Fireplace Insert 1 Hot Water Tank i Pellet Stove 1 Other Is this appliance being insta in nufactured/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 w Revision Main Floor Heated EH Bld App Review: ___,, 2nd Floor Heated Consistency Review: Other Heated Base fee: / 2 — Mezzanine ado 57Q ID O Heated Basement Plan Check fee: j/ 7- F"/ Unheated BasementL State Surcharge fee: ,XS Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL , /xr5" `_, Decks 911/Rd Approach fee: t____ _ Other TOTAL: $ /7 if" Receipt Number: I I7R(KO - ' Cash/Check Number: rca l- I s i % ( E !MATED COST(REQUIRED) Date: . air market value of all labor and mat ' s foundation finish �. /0) D v V 1 Initials: c G:\PennitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc