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HomeMy WebLinkAboutBLD2010-00366 • 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 #: BLD10-00366 Received Date 10/18/2010 SITE ADDRESS: 1107 E MARROWSTONE RD Issue Date 10/18/2010 NORDLAND, 98358 APPLICANT: WILLIAM CURRY PHONE: HELEN CURRY 1107 E MARROWSTONE RD NORDLAND WA 983589677 SUBDIVISION: Block: Lot: PARCEL NUMBER: 921043006 Section: 4 Township: 29N Range: 01 E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 p 3 5 Contractor's License SUNSHP*077QP Expires 11/((33 67/2080-5875 OWNER, WILLIAM CURRY PHONE: if different: HELEN CURRY 1107 E MARROWSTONE RD NORDLAND WA 983589677 PROJECT DESCRIPTION: NEW GAS HEAT STOVE & PIPING 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 10/18/2011. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: � l� II ) - 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 BLD10-00366 •UILDING PERMIT APPLICA N Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00366 Received Date: 10/18/2010 SITE ADDRESS: 1107 E MARROWSTONE RD NORDLAND, 98358 OWNER: WILLIAM CURRY PHONE: HELEN CURRY 1107 E MARROWSTONE RD NORDLAND WA 983589677 SUBDIVISION: Block: Lot: PARCEL NUMBER: 921043006 Section: 4 Township: 29 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 DESCRIPTIOr NEW GAS HEAT STOVE & PIPING 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 Propane Tanks/Stoves $142.00 LYK 10/18/10 120210 Total: $142.00 ')UNTY�� ° °� FER F JEFFER . ° \ DEPARTM / COMMUNITY DEVELOPMENT 621 Sheridan eet • Port Townsend •Washington 98368 '' 360/379-4450 • 360/379-4451 Fax ,1 www.co.jefferson,wa,us/commdevelopment Master Permit Application MLA: MO �/�(/� ( ) J Project Description (include separate sheets as necessary): � e- hee-( r/ �& C-G. ) Tax Parcel Number:" �,� / ©�f� O O( Property Size: Gad (acres/square feet) Site Address and/or Directions to Property: Property Owner(s)of Record: �ias�r- Telephone: �Cf s- 45d c 5' Fax: email: Mailing Address: Applicant/Agent(if different from owner): ;.4,,."d_, �.E-,.. /3.71 - pQ1.---e- Telephone: 985 - 5 / 7 Fax: -3 g S.. I,8 7 5 email: .44-i SO4-d/,-.,--e f,r4y/a-.--e. ,c_ Mailing Address: /0 d'.,53 k/-/.6y CP, Pi //f1-fJtO c/ A What kind of Permit?(Check each box that applies 0 Lot or Road Segregation ❑Building ❑ Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) Q Single Family ❑ Garage Attached,/Detached ❑ Conditional Use[C(a),, C(d), or CI '" ❑ Manufactured Home : .0 Modular ' ., C.Discretionary"D"or Unnamed Use Classification ❑ Commercial* ❑ Special Use(Essential Public Facilities)** ❑ Change of Use ❑Boundary Line Adjustment ❑ Address 0 Road Approach 0 Short Plat** ❑ Home Business ❑ Cottage Industry 0 Binding Site Plan** Propane ❑ Long Plat** ❑ Sign C Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration*" ❑ Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions** ❑Site Plan Approval Advance Determination (SPAAD) * 0 Shoreline Management Substantial Development"* © Temporary Use ❑ Shoreline Management Variance ❑Wireless Telecommunication* ❑ 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 **Requires a Pre-Application Conference Please identify any other local, state or federal permits required for this proposal, if known: • ESIGNATION OF AGENT — I ereby designate 5U�t r+i � e P 6�i; iii'v 4 to act as my agent in matters relating to this application for permit(s). iy •WNER SIGNATURE (A_ Imo+. i �T Date: old i'0 l � 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 requir •later inspecti Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the r time of the application th t he•or sh want prior notice,A • .nature: Date: ; C r//") The action or actions licant will undertake as a r of of the issuance of this permit may negatively impact upon o e 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 ' ompliance ith t Jefferson County development code,The Applicant acknowledges that he, she or it holds individual and non-transferabt respo ibility for dherin to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: Date: c.,‘ , (?\P,rmir(''r rPr\###FORMS###\I,R n F(lR MS\('n.TP,„r min 1/ 02" °19 • • 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 ER: PHONE: FAX: SDI-, z 14 t n e 2--,-- PA-v`e (94d ) 3 es- s- 7 17 ( 3 Ge)) .3 .6'S-S-P 73 MAILING ADDRESS: !0 R 5 3 + pt Y'. (-( EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: 5 u KA S * 'Z / Q i( NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX: • MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: _ Lt New ❑ Wood Existing: ❑ Sewer G Addition 0 Steel Proposed: Bank ❑ Community System 0 Alteration/Remodel 0 Concrete Total: Height: ❑ Individual System o Repair o Masonry SEP Permit# ` U Demolition 0 Other: Bedrooms: Water Supply:- ___ Existing: Setback: 0 Private well I; 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: I Underground Tank I Above ground Tank Size of Propane Tank: Heat Stove_i Cook Stove I Woodstove T 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, includin• the reserve area. , Y .s'+1 r,}x p 7acti°s`'r.✓ - d ° Bey: �1 -r?� , Square Footage Current Pro.osed 4r l - .,�.:ti �� �cs.. Y�a� :Ara' .„�.;r��� Y.l.E-ta,�' ' .,..�' t.,��t'f 'wx. l *, Main Floor Heated :,* a EH Bid App Review: �l� ry; 2"°Floor Heated a( i",, , r' Consistency Review: Other Heated °$ �t 4:. y1 Base fee: Mezzanine ! ,� a'" Additional Section: y , v1F Heated Basement 'lz, ,s 7a1,,rt, .` Plan Check fee: ; Unheated Basement {3.176 1 V State Surcharge;fee: rEv t °:' Other Unheated - 7.' Y,,,, 4.i ,'.' r Pot Water Review fee: Garage/Carport k,,,,): :f' ` SUBTOTAL Decks t{1,,,; _ 911/Rd Approach fee: Other Vs.',e,.„:„, ,., " G TOTAL: $ 142, :ii:ii ,z Receipt Number: (22_I rt r , y0, ` Cash/Check Number: ESTIMATED COST(REQUIRED) Date: _ram 'Fair market value of all labor and materials foundation to finish. I U l {u Initials: _._ 1-- G:\permitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master permit Application 5-29-08.doc