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HomeMy WebLinkAboutBLD2010-00345 • • 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 #: BLD10-00345 Received Date 9/29/2010 SITE ADDRESS: 73 GOLDFINCH LN Issue Date 9/29/2010 PORT LUDLOW, 98365 APPLICANT: NELSON D LUDLOW PHONE: 360-344-3233 BONNIE L LUDLOW 2023 E SIMS WAY# 194 PORT TOWNSEND WA 983686905 32 SUBDIVISION: PORT LUDLOW NO. 4 Block: Lot: PARCEL NUMBER: 990500032 Section: 17 Township: 28N Range: 01E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/(3 67/) 080-5875 OWNER, NELSON D LUDLOW PHONE: 360-344-3233 if different: BONNIE L LUDLOW 2023 E SIMS WAY# 194 PORT TOWNSEND WA 983686905 PROJECT DESCRIPTION: NEW GAS STOVE & 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 9/29/2011. REQUIRED INSPECTIONS: Tank/Line/Appliance: .QI _ - , � ✓NAIL ?- FinalApproval: k 2_5 t 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 S UILDING PERMIT APPLICA•N BL Revviewiew T Ty345 ype: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00345 Received Date: 9/29/2010 SITE ADDRESS: 73 GOLDFINCH LN PORT LUDLOW, 98365 OWNER: NELSON D LUDLOW PHONE: 360-344-3233 BONNIE L LUDLOW 2023 E SIMS WAY# 194 PORT TOWNSEND WA 983686905 PORT LUDLOW NO. 4 SUBDIVISION: Block: Lot: 32 PARCEL NUMBER: 990500032 Section: 17 Township: 28 N Range: 01 E 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 NEW GAS STOVE & LINES TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2009 HEAT BASE: HEAT TYPE: OCCUPANCY: OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: OTHER: SHORELINE CONST TYPE: GARAGE: SETBACK: DECK: 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 09/29/10 120142 Total: $142.00 : ( :1(� qx co JEFFERSON COUNTY • ` DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend Washington 98368 360/379-4450 • 360/379-4451 Fax www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: I'0O 1\ \ uipt Project Description (include separate sheets as necessa IIaN €411 ) . Tax Parcel Number: 9 0 - •j pO - �p .3 2__ Property Size: (acres/square f Site Address and/or Directions to Property: � � ,, f� 1 ) c i /;�7 .UV, !� �i21 Property Owner(s)of Record: Qongne `r.. e-S—gerio Telephone: Fax: MailingAddress: �o y` / ,d email: Applicant/Agent(if different from owner): --c � y ./.� — Telephone: 185 - S 7 7 Fax: .�8 S.. 875'' 6 email: S dl .-..-e Mailing Address: /b�,,5,3 kfi v 6P. PT . // - o c/ L f'L4 �, What kind of Permit?(Check each box that applies- ❑ Lot or Road Segregation [FJ Building 0 Critical(Areas Stewardship Plan Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use) 0 Single Family 0 Garage Attached./Detached 0 Conditional Use[C(a), C(d), or C] ** O Manufactured Home 0 Modular 0 Discretionary"D"or Unnamed Use Classiflcatiori ❑ Commercial* ❑ Special Use (Essential Public Facilities)** 0 Change of Use ❑ Boundary Line Adjustment ❑ Address ❑ Road Approach 0 Short Plat** 0 Home Business ❑ Cottage Industry 0 Binding Site Plan** { ) Propane ❑ Sign 0 Long Plat** ❑ 0 Allowed"Yes"Use Consistency AnalysisPlanned Rural Residential Development(PRRD)/Amendments** ❑ Stormwater Management 0 Plat Vacation/Alteration 0 Shoreline Master Program Exemption/Permit Revisions** ❑ Site Plan Approval Advance Determination (SPAAD) * 0 Shoreline Management Substantial Development** 0 Temporary Use 0 Shoreline Management Variance 0 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 0 Tree Vegetation Request tion Conference Please identify any other local, state or federal permits required forth saproposal, if known: /' DESIGNATION OF AGE I ereby designate ENT to act as my agent in matters relating to this application for permit(s). ll ji O-WNER SIGNATURE___.‘?222,4!4.dg "iy/�/�i�Z t — '�z�_3+ Date: 2,3 zare) 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 attorneys fees and I 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 applicst' ,-, 1 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 sh wants dor notice. nature: 1� Data: 45 2076 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 lake"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-transferable responsibilit for d ering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.` Signature: G(Z�CS" . i ._---, Date: .'�� 2lJT� ,: .V,•��,,�,r ,,,,.,,tz##FOR MS###V I)H II F()R MCA('„r,.,,r ilR Tl 1�,..,v A ral„,•,..u.......• A.,,,r. �(J �-' Dui,,o a.,.. • • 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: bate: GENERAL CONTRACTOR . ER: PHCNE: FAX: SDI., Z 14 t n e rP 2_A ► A-1" e / (;6y) 3 is- -r 7 17 ( 3 6e 3 es-5 aP 75 / MAILING ADDRESS: I Q E 5 3 P f Y" (-( EM1A'L CONTRACTOR'S LICENSE WAINS NUMBER: S LA K1 S'y}i: 90 7 Q fO NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New 0 Wood Existing: ❑ Sewer O Addition 0 Steel Proposed: Bank ❑ Community System 0 Alteration/Remodel 0 Concrete Total: Height: ❑ Individual System ❑ Repair 0 Masonry - SEP Permit# ❑ Demolition 0Other; Bedrooms: Water Supply: Existing: Setback: ❑ Private well 0 Two Party type'of=kleat: 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 ' 4_.If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: i Underground Tank i Above ground Tank Size of Propane Tank: ' I Heat Stove Cr Cook Stove'i Woodstove I Fireplace Insert I Hot Water Tank I Pellet Stove I Other •L�, 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. t1 'fyt s a xi y°.,r i'Sv�t$"' har��..P�� �,,� ^ f '' .' rrr , ii,'V hal + ay 7,,*� o' .c, 41 gyp., `! " ;':' ifi { Al.,.r � � r s Square Footage Current Proposed "'4P; a�E � �,� Main Floor Heated , k ., .,1 . .4 EH Bld App Re w: 2' Floor Heated ,>i, i Consistency Review: '',,"',:, r .';', , ‘.. Other Heated ` + Base fee. �7 iro,,,' *4x �"y Additional Section:Mezzanine , 41 ,i ;:t; Heated Basement r.' �h�Kt "�' ` � .. ,lF ��'�,;;; PlaneCheckfee: Unheated Basement ., , I�" x State Surcharge fee: f. I + Other Unheated' i r �la�, �hK� _ — i ��t yea Pot Water Review fee: Garage/Carport " htj SUBTOTAL Decks 1 = ,' 911/Rd Approach fee: ei 't e Other =P TOTAL: $ l --2 ,, t ,. Receipt Numbers I 20 i ,.d: , Cash/Check Number: ESTIMATED COST(REQUIRED) Date: � .Fair market value of all labor and materials foundation to finish Initials: G:\PemvtCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc