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Home My WebLink AboutBLD2010-00402 • 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#: BLD10-00402 Received Date 12/8/2010 SITE ADDRESS: 531 JUANITA DR Issue Date 12/8/2010 BRINNON, 98320 APPLICANT: KRIS E UDD PHONE: PO BOX 253 BRINNON WA 983200253 SUBDIVISION: Block: Lot: PARCEL NUMBER: 502101012 Section: 10 Township: 25N Range: 02W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2012 OWNER, KRIS E UDD PHONE: if different: PO BOX 253 BRINNON WA 983200253 PROJECT DESCRIPTION: New Propane Tank InstallatiotiAG 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 12/8/2011. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: ,AIL- (_Inflr- 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 BUILDING PERMIT APPLICA!ON B RDIO-00w p402 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00402 Received Date: 12/8/2010 SITE ADDRESS: 531 JUANITA DR BRINNON, 98320 OWNER: KRIS E UDD PHONE: PO BOX 253 BRINNON WA 983200253 SUBDIVISION: Block: Lot: PARCEL NUMBER: 502101012 Section: 10 Township: 25 N Range: 02 W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2012 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIO1` New Propane Tank Installation 5 AG TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: CODE EDITION: 2009 ADD'L: HEAT TYPE: EEE OCCUPANCY: HEAT BASE: HEAT TYPE: PRO 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 Bv: Date: Receipt: Approved/Date Permit $142.00 RAC 12/08/10 120325 APPROVED Total: $142.00 DEC 9) 2010 Jefferson County Planning & Building Department 1 oN cols JEFFERSON COUNTY w \ j DEPARTMENT OF COMMUNITY DEVELOPMENT DEC - 8 t`''� 1, '� . 'C 621 Sheridan Street• Port Townsend •Washington 98368 �' 360/379-4450 • 360/379-4451 Fax S�4IN www.co.jefferson.wa.us/commdevelopment Cs Master Permit Application MLA: Project Description(include separate sheets as necessary): Zik. 63II fr ,2Qi� (- n Tax Parcel Number: ,, 6 -) _ r C, I_G , Property Size: 7:ie i f-s (acres/square feet) Site Address and/or Directions to Property: ,/ 63/ a-t_avt_/ t b' r ve, e i'v.vie6, LZip o✓ 333e 6 ,'tic /0 )i (. ,,. n )1 nti- . Property Owner(s)of Record: 71rr s E, Telephone: �6 79G--dS 3 Fax: email: Mailing Address: PCAc;t' 253 b✓ i`v.vtdyl k(,)A. 9 -32c 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 ABuilding 0 Critical Areas Stewardship Plan ❑ 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** Za 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 0 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: �/ ,,Q DESIGNATION OF AGENT I hereby designate et-f A v'' n `► to act as my agent in matters relating to this application for permit(s). y i /' OWNER SIGNATUR Zfri Date: /2—7/0 By signing this application form,the owner/age ttests 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 inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the ap licatio that he or she wa ri r tics. /1 j1,Q -7 Signature: 9 eVZ G f"Q� 4 ? �t,4Ai Date: /2 — / ^/ O The action or actions Applicant will undertake as a ault 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-tran er b res nsibility for a rin and coAñ7A mg withESA. T e Applicant has read this disclaimer and signs and dates it below. Signature: r ( r4.c `� li/ ,) tad' Date: /2_ -7-lb G:\PemutCenter\###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: CY_ h ( ) ( ) 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: ❑ New ❑ Wood Existing: ❑ Sewer O Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel Li 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 Tan artd/orAnalianncce Installation permit,mark all items below that apply: i Underground Tank 1 Above ground Tank' Size of Propane Tank: 2-c�Lr A-a i Heat Stove i Cook Stove 1 Woodstove i Fireplace Insert i Hot Water Tank i Pellet Stdde 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 Only Amount Revision Main Floor Heated EH Bld App Review: 2n4 Floor Heated Consistency Review: Other Heated Base fee: � Mezzanine Additional Section: l 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: $ 1142 Receipt Number: /l,<0 3 2 5 - Cash/Check Number: ESTIMATED COST(REQUIRED) Date: 2 ^ _ 'Fair market value of all labor and materials foundation to finish / Initials: --k n C__J G:\PermitCcnter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc • 1 /°41'-er"tieljle = i S 2,(4,, ' ...... ... ... _ *- f , 1 ,r 1 2- a D e gg i ...... ..... - 2 z , j a • • CS Lail C. i 0: O. re a 33 " "*" ./ . .- - . w LU M _ . +: Z ‘ , \ Z 1 1 Q, 06 03 I ai 1 . z J , . . . ..... 4 . 561 1 - . ---. ,-.6.,,..--:-.- .1. ft L ,i . , 03 I , .. _ CI. _ • • • , r r- . CI , r Lu 3 3r F- -I i T .. .. a . : I • Z V 0