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Home My WebLink AboutBLD2010-00259 • 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 #: BLD10-00259 Received Date 7/26/2010 SITE ADDRESS: 344 LOVE RD Issue Date 7/26/2010 BRINNON, 98320 APPLICANT: JAMES J KOWALCZYK PHONE: (360) 668-9698 MARY K KOWALCZYK PO BOX 826 BRINNON WA 983200826 TX11-1 SUBDIVISION: Block: Lot: PARCEL NUMBER: 502094015 Section: 9 Township: 25N Range: 02W CONTRACTOR: FERRELL GAS PHONE: 360-877-5311 646 3RD AVE SEQUIM, WA 98382 Contractor's License FERRELP055LH Expires 9/6/2010 OWNER, JAMES J KOWALCZYK PHONE: (360) 668-9698 if different: MARY K KOWALCZYK PO BOX 826 BRINNON WA 983200826 PROJECT DESCRIPTION: A/H 120 GAL PROP TANK, LINES & GENERATOR 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 7/26/2011. REQUIRED INSPECTIONS: Tank/Line/Appliance: . — ID 77-_— FinalApproval: y 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 lit UILDING PERMIT APPLICA ON BLD10-00259 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00259 Received Date: 7/26/2010 SITE ADDRESS: 344 LOVE RD BRINNON, 98320 OWNER: JAMES J KOWALCZYK PHONE: (360)668-9698 MARY K KOWALCZYK PO BOX 826 BRINNON WA 983200826 SUBDIVISION: Block: Lot: TX11- PARCEL NUMBER: 502094015 Section: 9 Township: 25 N Range: 02 W CONTRACTOR: FERRELL GAS PHONE: 360-877-5311 646 3RD AVE SEQUIM, WA 98382 Contractor's License FERRELP055LH Expires 9/6/2010 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI` A/H 120 GAL PROP TANK, LINES & GENERATOR TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 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 $213.00 LYK 07/26/10 118027 Total: $213.00 44f,.*,, oNN JEFFERS OUNTY • 1 DEPARTMENT OF COMMUNITY DEVELOPMENT fli• *C 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax 'ISSN((co" . www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: l� (l'r A ?€v I.' Project Description(include separate sheets as necessary): iNSTAk-L... Pao PA,+�. c pot_ (..i.•,,-cmro,Z Tax Parcel Number: ` c),1 p S y Of S Property Size: a/_ ts /K.; 5 (acres/square feet) Site Address and/or Directions to Property: 3yy L.ovc Rom. Rteltvn,oN CuA 320 Property Owne s)of Record: TAM e-S `-- /A AR y oW A-Le z y is Telephone:((o 7 it.- LI4/St Fax emad: .SkAlKowa(ctj/1 cJ h..s✓,at- Mailing Address: P O. lab, k 2 L, 1\12,tA/Af s s, W Pt- 4 3 Z D Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies ❑Building ❑Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use) GI-Single Family ❑Garage Attached/Detached ❑Conditional Use[C(a),C(d),or C]** ❑ Manufactured Home ❑ 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 ❑Short Plat-- ❑Home Business ❑Cottage Industry ❑Binding Site Plan-- lropane 0 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** ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development** ❑Temporary Use ❑Shoreline Management Variance ❑Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendment ❑Forest Practices Act/Release of Six-Year Moratorium ❑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: 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 e9try to Jefferson County and its employees,representatives or agents for the sole purpose of application review and a required later inspections. ffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the p 'cation th ' or prior notice. Signature: / - ,Ore .'1 ei — Date: ' L 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) if you are in compliance with the rson County development code.The Applicant acknowledges that he,she or it holds individual and non n rable res nsi lity for a a• o and plying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: Date: D 7-2.6.—/U (i:\PermitCe ter\###FORMS###\DRD FORMS\Master Permit Application 5-29-O8.doc • • BUILDER STATEMENT The signer of this statement does hereby cert. at they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be uming the responsibif of neral Contractor for the proposed project. Signature' Date: . 2 2 , ._ GENERAL ONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: 0 New i1 Wood Existing: !i Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System O Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other. Bedrooms: Water Supply: Existing: Setback: ;i Private well 0 Two Party Type of Heat: Proposed: 0 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 T " q.e Installation permit,mark all items below that apply: i Underground Tank 1-Above ground Tank} Size of Propane Tank: I) C G:.0 4- I Heat Stove f Cook Stove Woodsfove 1 Fireplace Insert I Hot Water Tank 1 Pellet Stove i Other C., :,_\-ri;` Is this appliance being installed in a Manufactured/Mobile Home? Yes / le 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 tr 3 :41.. Fri 7', >; ,., Main Floor Heated -- , EH Bld App Review: 51 Floor Heated „ . Consistency Review: Other Heated Base fee: 1 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 1. Receipt Number: l I��IN / 44.441 Cash/Check Number: a Ili ESTIMATED COST(REQUIRED) Date: — --r -, .Fair market value of all labor and materials foundation to finish 1 _ Initials: . L_ G:\Pe mitCenter\###FORMS###\DRD FORMS\Master Pewit Application 5-29-08.doc I • i�jl L v I Nimpi ,.\,\ , i 0 mOZs� zr yor z O 'A'1�tiAZ • mOD mom m-,.mnz 2DZOa -� D�a y�> am N • O I \ Q % 8 2 ''' -------\ Dp o O D H / 0. Al 1 V V ti / Z O /2 4 / / O -T.: / Q/ 11.11‘LHIll z s 4`oTIL I P\ . a• // / '.r. A Z @ _` o n . s E c-,.. 11111:111111N g o 82, / / 2 ii b. ai ii, -- 1:44is �qS v lir__, N., :.k, .„) , ,. 9. ...,,,,, o 4....,.,;,,.._ , AAA/I I o II z8 O O u o a o m a n I11m :WI m In o '.(1o� o 4-0 4aa 2 o a) rtg O N R m N n E..,, t'l m. o II F m o n D F n a ..o ��Rm N i'a oAa o G N l N O a O§3nF 2 S4 / m "RECORD DRAWING" = g ie y TAX PARCEL # 502-094-015 SOILS APPLICATION, INC. 51 M 6 '' R o 0 863 CARLSBORG ROAD, SUITE A, A g m OPEN BOTTOM SAND FILTER SYSTEM FOR SEQUIM, WA 98382 KOWALCZYK PH(360)683-6300 FAX(360)683-5652 ,r414.: 1 Z• , 0 al ,. JUL 2 6 2010 t , -...„._---- 1 i i • li Ci:1 .4.1 irmic: F 18.••••••• I .. I - I i , , . 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