The URL can be used to link to this page

Home My WebLink AboutBLD2011-00028 • 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 #: BLD11-00028 Received Date 2/7/2011 SITE ADDRESS: 2339 W VALLEY RD Issue Date 2/7/2011 CHIMACUM, 98325 APPLICANT: CHRISTOPHE D EJDE PHONE: 360-316-9764 MARGARET 0 EJDE PO BOX 701 CHIMACUM WA 98325-0701 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901271007 Section: 27 Township: 29N Range: 01W CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTPI983O6 Expires 9/26/2011 OWNER, CHRISTOPHE D EJDE PHONE: 360-316-9764 if different: MARGARET 0 EJDE PO BOX 701 CHIMACUM WA 98325-0701 PROJECT DESCRIPTION: A/G 120 GAL PROP TANK, LINE &COOKSTOVE 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 2/7/2012. REQUIRED INSPECTIONS: Tank/Line/Appliance).<! 1 nJsr ._ t2 .rLA.- ,,.. �P/ I I 4 FinalApprovai: 2It /i i (tt 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 •UILDING PERMIT APPLICAltN BLRD11-000eview e28 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD11-00028 Received Date: 2/7/2011 SITE ADDRESS: 2339 W VALLEY RD CHIMACUM, 98325 OWNER: CHRISTOPHE D EJDE PHONE: 360-316-9764 MARGARET 0 EJDE PO BOX 701 CHIMACUM WA 98325-0701 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901271007 Section: 27 Township: 29 N Range: 01 W CONTRACTOR: MOUNTAIN PROPANE PHONE: (360)385-6883 265 CHIMACUM RD PORT HADLOCK WA 98339 Contractor's License MOUNTPI983O6 Expires 9/26/2011 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr A/G 120 GAL PROP TANK, LINE & COOKSTOVE 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 $213.00 LYK 02/07/11 120438 Total: $213.00 (c,„SONob JEFFERStOUNTY' �q DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax 4. o www.co.jefferson.wa.us/commdevelopment`S$ING Master Permit Application MLA: Project Description(include separate sheets as necessary): Tax Parcel Property ,l Number: 1 0/ 2 -7 I 0 0-7 Size: / C) a C-Ye„. (acres/square feet) Site Address and/or Directions to Property: 2,3 we- s f Vcc !C I 1 ctt ;vim au,(fri,„ /"A 54 3 2S Property Owner(s)of Record: rnctrc c, L 4 G l,, 5 etc_ Telephone: e) 73 2- vo 2 I 1 c3i3O 3i6'`1az:J 3Lo -732. - '-/ 33 o email: e)do c*i) q2"-to;/. Cale, Mailing Address: . -7 01 at 'kW(cur , 32 5 `J Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies ❑Building ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit ❑Conditional Use[C(a), C(d), or C]** ❑Single Family ❑Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification El Manufactured Home ❑ Modular 0 Special Use(Essential Public Facilities)** ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use 0 Short Plat** ❑ Address ❑ Road Approach 0 Binding Site Plan** ❑ Home Business ❑Cottagelndustry 0 Long Plat** 0 Propane ❑ Planned Rural Residential Development(PRRD)/Amendments** El Sign ❑ Plat Vacation/Alteration** ❑Allowed"Yes" Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisions** ❑Stormwater Management 0 Shoreline Management Substantial Development** ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Variance ❑Temporary Use ❑Comprehensive Plan/UDC/Larytysie fli tript,All4p mendment CI Wireless Telecommunication* El Jefferson County Shoreline M r r'pdramiArrie v fiq{ , ❑ Forest Practices Act/Release of Six-Year Moratorium ❑Tree Vegetaion Request -) *May require a Pre—Application Conference **Requires a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal, if known4 0 � 2011 DESIGNATION OF AGENT I hereby designate to act as my agent in matters relating,j4itli Oplipatfpr);figrrper, i>:(s). �rl • , 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 it's 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 e red later inspe ns. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the i i n t h r nts notice. / / I Signature: Date: 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 qou, e in, ompliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-tr ns a Ile e sibili o adhering to and co " the ESA. The Applicant has read this disclaimer d signs and dates it below. Signature: f Date: ` / ( C:ADocuments and Settings\canal\Local Settings\Temporary Internet Files\OI,K86\Master Permit Application 12-19-2006.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 MANUj Il. OME INSTALLER: PHONE: FAX: MAILI G 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 Addition Steel Proposed: Bank Community System Alteration/Remodel 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 Tank and/or Appliance Installation permit,mark all items below that apply: ❑Underground Tank 0 Above ground Tank Size of Propane Tank: 120 gal ❑Heat Stove m Cook Stove 0 Woodstove ❑ Fireplace Insert 0 Hot Water Tank 0 Pellet Stove 0 Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / N,6 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: 2na Floor Heated Consistency Review: Other Heated Base fee: 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: $ j 5-- Receipt Number: Cash/Check Number: ESTIMATED COST(REQUIRED) Date: 'Fair market value of all labor and materials foundation to finish Initials: C:\Documents and Settings\caral\Local Settings\Temporary Internet Files\OI.K86\Master Permit Application 12-19-2006.doc ii41.4)- - • '-----111- I 1 . 0 °° (.0 (-6 1 17- „.,ttA•15t. -L, --.__ ,61/4 99e 0 ° ° 0 iD)11"-/ ,..vet.i.-- 10 r.e..,..... . _ ) i RECEIVED r"- 1 FEB 0 7 2011 JEUi . ialiCiNT ! DEB .• ! . \'/