HomeMy WebLinkAboutBLD2010-00282 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 #: BLD10-00282 Received Date 8/5/2010
SITE ADDRESS: 2450 E MARROWSTONE RD Issue Date 8/5/2010
NORDLAND, 98358
APPLICANT: LARRY T HOWLAND TRSTEE PHONE: 360-385-3578
CONSTANCE R HOWLAND TRSTE
PO BOX 831
PORT HADLOCK WA 983390831 4
SUBDIVISION: GEORGE NORDBY SHORT Block: Lot:
PARCEL NUMBER: 976200609 Section: 33 Township: 30N Range: 01 E
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTP198306 Expires 9/26/2010
OWNER, LARRY T HOWLAND TRSTEE PHONE: 360-385-3578
if different: CONSTANCE R HOWLAND TRSTE
PO BOX 831
PORT HADLOCK WA 983390831
PROJECT DESCRIPTION: NEW GAS GENERATOR & LINES
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 8/5/2011.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: i A-MX- b t-►rJiZS a - 13 -/13
FinalApproval: Li 4
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
4UILDING PERMIT APPLICASDN BR vie 00282
w Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD10-00282 Received Date: 8/5/2010
SITE ADDRESS: 2450 E MARROWSTONE RD
NORDLAND, 98358
OWNER: LARRY T HOWLAND TRSTEE PHONE: 360-385-3578
CONSTANCE R HOWLAND TRSTE
PO BOX 831
PORT HADLOCK WA 983390831 GEORGE NORDBY SHORT
SUBDIVISION: Block: Lot: 4
PARCEL NUMBER: 976200609 Section: 33 Township: 30 N Range: 01 E
CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883
265 CHIMACUM RD
PORT HADLOCK WA 98339
Contractor's License MOUNTP198306 Expires 9/26/2010
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION NEW GAS GENERATOR & LINES
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW
VALUATION MAIN:
CODE EDITION: 2009 ADD'L: HEAT TYPE:
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
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
Permit $142.00 LYK 08/05/10 119899
Total: $142.00
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JEFFERSON COUNTY
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' 13 DEPARTMENT OF COMMUNITY DEVELOPMENT
''I ` `4 621 Sheridan Street• Port Townsend • Washington 98368
360/379-4450 • 360/379-4451 Fax
q`SBING $ www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA:
Project Description(include separate sheetsas necessary):
ICIQ (.U -ftAlLfr t 1_ ( L CS
Tax Parcel Number: C01rz _Z.` 0 -(c(CI\ Property Size: (acres/square feet)
Site Address and/or Directions too Property:
2 T.A) `c t ` `N_ 110 do ' ,\
Property Owner(s)of Record:
Telephone: TC - �h-1l l`6 Fax: email: _ v ,C\ik'
Mailing Address: Q�1 U r6 )` 40tk \\.A k
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
:uilding 0 Critical Areas Stewardship Plan
' N Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
❑ Single Family 0 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**
`•iyn 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 SIGNATUR < < ‘ Date: 11\
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 entry to Jefferson County and its employees, representatives or agents for the sole purpose of application
review and any required later i spections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the a li i n that h"or he wants prior notice.
Signature: �*'•-� Date: t\\I\ Cc)\Q)
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
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-tra` fec� e espo sibili for r adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature:< �1\ ��1 i Date: �\'0C .20�tt
• •
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: 1 Date:
GENERAL ONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
11 ll�`]�(1 i k —0 ( ) ( )
MAILING A DRESS: EMAIL:
CONTRACTOR'S 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 0--Steel._ __ Proposed: Bank ❑ Community System
1---- Total: Height: El Individual System
❑ Alteration/Remodel 0 Concrete --0 Masonry ��� SEP Permit#
❑ Repair ❑ Other: Bedrooms: Water Supply:
❑ Demolition Existing: Setback: well 0 Two Party
Typeof 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(indudes 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 i Above ground Tank Size of Propane Tank:
Heat Stove I Cook Stove I Woodstove i Fireplace Insert i Hot Water Tank I Pellet Stove i Other
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' =- Amount Revision
Main Floor Heated EH Bld App Review:
2`d Floor Heated Consistency Review:
-Other Heated Base fee: 1 (--'
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: $ I ( . ; —
Receipt Number: I (1 CQQ
Cash/Check Number: 1 l 0
ESTIMATED COST(REQUIRED) Date:
1
.Fair market value of all labor and materials foundation to finish '�
Initials: — ,