HomeMy WebLinkAboutBLD2011-00055 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 #: BLD11-00055 Received Date 3/14/2011
SITE ADDRESS: 60 KEEFE LN Issue Date 3/14/2011
PORT LUDLOW, 98365
APPLICANT: JOSEPH F BAIER PHONE: 360-437-7930
ANN T BAIER
PO BOX 65055
PORT LUDLOW WA 98365-0055 75
SUBDIVISION: PORT LUDLOW NO 2 AREA 3 Block: Lot
PARCEL NUMBER: 990600375 Section: 9 Township: 28N Range: 01 E
CONTRACTOR: ABODE CONTRACTING ONC PHONE: 425-319-8217
12414 HWY 99#6
EVERETT WA 98204
Contractor's License ABODECI931JW Expires 4/16/2011
OWNER, JOSEPH F BAIER PHONE: 360-437-7930
if different: ANN T BAIER
PO BOX 65055
PORT LUDLOW WA 98365-0055
PROJECT DESCRIPTION: WOODSTOVE SWAP OUT
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 3/14/2012.
REQUIRED INSPECTIONS:
Tank °re/Appliance: •
7,-i
FinalApproval: -I ri
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 APPLICAIN BLD11-00055
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD11-00055 Received Date: 3/14/2011
SITE ADDRESS: 60 KEEFE LN
PORT LUDLOW, 98365
OWNER: JOSEPH F BAIER PHONE: 360-437-7930
ANN T BAIER
PO BOX 65055
PORT LUDLOW WA 98365-0055 PORT LUDLOW NO 2 AREA 3
SUBDIVISION: Block: Lot: 75
PARCEL NUMBER: 990600375 Section: 9 Township: 28 N Range: 01 E
CONTRACTOR: ABODE CONTRACTING ONC PHONE 425-319-8217
12414 HWY 99#6
EVERETT WA 98204
Contractor's License ABODECI931JW Expires 4/16/2011
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP WOODSTOVE SWAP OUT
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:
CONST TYPE: OTHER:
GARAGE: SHORELINE:
CONST TYPE: SETBACK:
DECK:
SEWAGE DISPOSAL: BANK HEIGHT:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total:
Routing Date:
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $71.00 LYK 03/14/11 123288
Total: $71.00
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�4��SON CAL JEFFERSON.UNTY •
a ' DEPARTMENT OF COMMUNITY DEVELOPMENT
ekilli
621360/379-4450 Sheridan Street• 360/•379-4Port Tow
451 nsend • Washington 98368
Fax
4* . N0jp'� www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: ry) (Y). n P Fti'b
Project Description(include separate sheets as necessary):
L0 c LVQ Sig 00W-
Tax Parcel Number: 9 `9(7 (0 (7 3 5 Property Size:
7 p y (acres/square feet)
Site Address and/or Directions to Property:
'\
Leh /-c P-7 e- I. -.r.,@
Property Owner(s)of Record: I r ' 4-- Z S-pe ,65,�Ep
'[Telephone:360 - 8 •7` 7`�3O Fax: eail: /3, 5 .//t.' ((g[3)04_ C /;_0 -'
Mailing Address: ,(ir) ' �,r� ,� jr.)/
; �� G.n„U C,(� im/ �� r
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
W[tat kind of Permit?(Check each box that applies ❑Lot or Road Segregation
email:
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 ❑Boundary Line Adjustment
❑ Address 0 Road Approach_ 0 Short Plat**
❑ Home Business ❑Cottage Industry ❑Binding Site Plan**
❑ Propane ❑Long Plat**
❑ Sign 0 Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration**
El 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* ❑Comprehensive Plan/UDC/Land Use District Map Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment
*May require a Pre—Application Conference ❑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 Ciebiyiictie to act as my agent in Matteis relating to this application for periiiit(s).
OWNER SIGNATURE Date: I ' ;'^r' r f
4 UL
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 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 she wants prior notice.
'Signature: '\ r' ,r . \ �' .,. -& Date: ,V7 /�!>i
r
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
� nd non-transferable responsibility for adhering to and complying with the ESA. The Applicant has read this disclaim r and signs and dates it below.
, `Signature: ���_,F. , V-'cN.' ,J Date: `3/7/C5/"/
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• •
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:
k
ENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: Fax.
(-. 07kficr (1 l �Ac i ?77)7yr-X1( )
MAILINGADDRESS: I
,—Vj EMAIL:
,����� �u)� d WAINS
CONTRACTOR'S LICENSE F ER. 7T, w NUMBER LP m �5�7`��'S
NUMBER: ��o GE G i `7�I� w
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Type:Frame T e Bathrooms: Shoreline: Type of Sewage Disposal:
CI Sewer
❑
II New Wood Existing: Bank ❑ CommunitySystem
O ����Sav ❑ Steel Proposed: y
)11f
Addition
Alteration/Remodel W ❑ Concrete Total: _ Height: ❑ Individual System
Je, ❑ Masonry SEP Permit#
❑ Repair Bedrooms: Water Supply:
❑ Demolition ❑ Other: Existing: Setback: ❑ Private well ❑ Two Party
Proposed: CI Public
Type of Heat: Total: Name of System: •
If this is a Commercial Project you must answer the following: Number of ADA Parking Spaces:
Number of Parking Spaces: Current: Proposed: Proposed
Number of occupants(includes owners,tenants,employees,etc) Current p
IBC Occupancy: Type IBC T e 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:
1 Underground Tank 1 Above ground Tank Size of Propane Tank:
1 Heat Stove 1 Cook Stoveoodstove 1 Fireplace Insert I Hot Water Tank 1 Pellet Stove 1 Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes /
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 I Current Proposed Fg r Office Useet�ly A►m'o nt Revision
Main Floor Heated 1-5 s EH Bid App Review:
2T Floor Heated Consistency Review:
tli
Other Heated r Base fee: r�1 �j
Mezzanine I y
N ) Additional Section:
/P
Plan Check fee:
Heated Basement /q
Unheated Basement ! State Surcharge fee:
/`-Y
Other Unheated. p Pot Water Review fee:
f SUBTOTAL
Garage/Carport r -
Ufkihe r,-,
Decks i 911/Rd Approach fee:
Other Jam/ //4 TOTAL: $
Receipt Number: 13)Ng
Cash/Check Number: (3 �
ESTIMATED COST(REQUIRED) \J Date:
•Farr market value of all labor and materials foundation to finish Initials:
L
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Pemut Application 5-29-08.doc