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HomeMy WebLinkAboutBLD2011-00117 • • • 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 #: BLD11-00117 Received Date 5/9/2011 SITE ADDRESS: 8460 COYLE RD Issue Date 5/9/2011 QUILCENE, 98376 APPLICANT: MARY G FALK PHONE: 360-765-0055 8460 COYLE RD QUILCENE WA 98376 TX 1+ SUBDIVISION: Block: Lot: PARCEL NUMBER: 601023012 Section: 2 Township: 26N Range: 01W CONTRACTOR: EVERWARM INC PHONE: (360) 452-3366 257151 HWY 101 PORT ANGELES WA 98362 Contractor's License EVERWI*088NL Expires 9/17/2012 OWNER, MARY G FALK PHONE: 360-765-0055 if different: 8460 COYLE RD QUILCENE WA 98376 PROJECT DESCRIPTION: REPLACE EXISTING WOODSTOVE 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 5/9/2012. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: ( 2_1-\l 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 tILDING PERMIT APPLICA1IN B RD1e 001w pe1:7 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD11-00117 Received Date: 5/9/2011 SITE ADDRESS: 8460 COYLE RD QUILCENE, 98376 OWNER: MARY G FALK PHONE: 360-765-0055 8460 COYLE RD QUILCENE WA 98376 SUBDIVISION: Block: Lot: TX 1+ PARCEL NUMBER: 601023012 Section: 2 Township: 26 N Range: 01 W CONTRACTOR: EVERWARM INC PHONE: (360) 452-3366 257151 HWY 101 PORT ANGELES WA 98362 Contractor's License EVERWI*088NL Expires 9/17/2012 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP REPLACE EXISTING WOODSTOVE 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 $71.00 LYK 05/09/11 123484 Total: $71.00 I SON c Ill��i oe, JEFFERSON UNTY ` DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax k -,„,„, '�.� 0S0�' www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: K.0 n A 2 kPypject Description(include separate sheets as necessary): /�1 L/.4CI EX1sTtAl, WOOD (S7 f6 t ! P8_ W1i/-1 A/Evv WWWW©o S v✓e t- ii .. Tax Parcel Number: 6 d/0„_3O/,2._ Property Size: (acres/square feet) Site Address_ ea Directions to Property: 0 7 6 lJ 0 vi--C ie0 4 4 It 1 LC. /✓� — -- — Property Owner(s)of Record:�,9R Y -A[-A Telephone: 36'0-7425-003 6' Fax: email: Mailing Address: 8'/6,0 (4y ce. 1e a1�c�NA /6376- y/v 7 Applicant/Agent(if different from owner): Lv v 2,'4 --/41C . _ _ Telephone:c.3(7O-�Y50-.3 3 (o Fax: 9Sol-3 307 r1 a email: �DeVe✓iva✓�Pt. CO✓l- Mailing Address: 71S/ /i(,1 /O/ �/LT /`i/Y.'�L�S, �j4L 783( _ What kind of Permit?(Check each box that applies )16Building 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" O Home Business ❑Cottage Industry ❑Binding Site Plan** O Propane 0 Long Plat** ❑Sign 0 Planned p k� a •°'Amendments** ❑Allowed'Yes"Use Consistency Analysis 0 Plat Vac ib ❑Stormwater Management 0 Shoreline* prlw'rogram Exemption/Pe isions** O Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Man>4dement Substantial Devel•• = ** O Temporary Use ❑Shoreline iManagem�gt arianb* 2011 o Wireless Telecommunication* 0 Compreh naive PIan?Ul /Land Use Distn Amendment ❑Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson ountt Shoreline Master Prog - . -:ndment *May require a Pre-Application Conference 0 Tree Vegetation **R res a Pre- (i C N Y • Please identify any other local,state or federal permits required for-this- ! 0" , rat wT — DESIGNATION OF AGENT I hereby designate �V R 4�1��'f't �. to act my agent in matters relating to this application for permit(s). OWNER SIGNATURE l'VL (/. L'- Date: > :57) •-2 v// 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 applicatio t he or she wan prior notice- Signature: % ." �% `- (' Date: �`` -� c' ( / The action or actions Applican ill undertake as a result of the issuance of this permit may negatively impact upon onri 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 wi the Jefferson County dev lopment code.The Applicant acknowledges that he,she or it holds individual and non-trans blq ponsibility for ring to and ing /the ESA. The Applicant has read this disclaimer and signssand dates it below. Signature: ,�/% Date: /Z/ > j `> / / G:\PetmitCenter\f###FORMS###\DPJD FORMS\Master Pcnmt Application`ram-08.doc , I , • • 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: GE RAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: VEQ way n1 � .�� (3e)lisz-33 cam 9 2 -33 7 MAILING ADDRESS: 02/:7/3/ /])y /U J! /3 a� 5 EMAIL: ry ` � WAINSt�eV�t✓s'hi1�1. Coil._ CONTRACTOR'S LICENSE r:vc(e w.z* 05,/L NUMBER: ��'Y D S rY NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: ' EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: u New ❑ Wood Existing: i Sewer ❑ Addition ❑ Steel Proposed: Bank 7 Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: El Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: I Private well J Two Party Type of Heat: Proposed: _i 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: I Heat Stove i Cook Stove oodstove 1 Fireplace Insert i Hot Water Tank 1 Pellet Stove 1 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 a Only _ Amount ,R vision Main Floor Heated EH Bld App Review: 21 Floor Heated Consistency Review: Other Heated Base fee: q j 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:�$ II vim " ` fr umber: ESTIMATED COST(REQUIRED) te: _ 9 2011 .Fair market value of all labor and materials foundation to finish i i AY 1�>ILftiale: ' --9) J ` JEFFERSON COUNTY DFPT.OF COMMUNITY DEVELOPMENT G:\Pemutcenter\###FORMS###\DRD FORMS\Master Permit Application -29 OS.doc • ' . . ku ir 1 3 p 51 o 01 c I a W rl (l n(i c' o rr I ..i) � Fr\llo / .... ..... ...4.(\t')c 1..cz______\___ f/J 4 >`j7), � 4 N