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Home My WebLink AboutBLD2011-00241 0 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 #: BLD11-00241 Received Date 8/29/2011 SITE ADDRESS: 611 CEDAR AVE 48 Issue Date 8/29/2011 i!-FPu CA'n 1- APPLICANT: ROBERT E BATES I-ker, G PHONE: ROSELLA M BATES 611 CEDAR AVE#77 PORT HADLOCK WA 98339-9556 SUBDIVISION: B&R MOBILE HOME CT SP#1 Block: Lot: PARCEL NUMBER: 901023016 Section: 2 Township: 29N Range: 01W 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, ROBERT E BATES PHONE: if different: ROSELLA M BATES 611 CEDAR AVE#77 PORT HADLOCK WA 98339-9556 PROJECT DESCRIPTION: SWAP OUT A/G 500 GAL PROP TANK-SAME SIZE & LOCATION 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 8/29/2012. REQUIRED INSPECTIONS: Tank/Line/Appliance: 0---/( L' FinalApproval: j 0 Z (11 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 ItUILDING PERMIT APPLICAN BRDew00p2e41 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD11-00241 Received Date: 8/29/2011 SITE ADDRESS: 611 CEDAR AVE 48 OWNER: ROBERT E BATES PHONE: ROSELLA M BATES 611 CEDAR AVE#77 PORT HADLOCK WA 98339-9556 B&R MOBILE HOME CT SP#1 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901023016 Section: 2 Township: 29 N Range: 01 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 DESCRIPTION SWAP OUT A/G 500 GAL PROP TANK - SAME SIZE & LOCATION 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 08/29/11 128060 Total: $71.00 liNe � JEFFERSOFJUNTY III az; 74 DEPARTMENT OF COMMUNITY DEVELOPMENT 1-1 ` '4 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax �/ .p9 www.co.jefferson.wa.us/commdevelopment hTIN Master Permit Application MLA: 100 ( ry - Q,EO 'J Project Description(include separate sheets as necessary): j 1,l) (' CST t�(`a e-- azn/l= Tax Parcel Number: 901(2:3(�(G, Property Size: , , . (acres/square feet) Site Address and/or Directions to Property: 4// �e ow-e- f Yo-tt /L,j..4'`,/t / t (1,' 8 ntia it - -► g- —spo a q g %roperty Owner(s)of Record: R 1 et L iarT 5"S Telephone: o Fax: email: Mailing Address: (Q( 1 C xf,o ai L -7 7 'V �f(C' L c Q '>9 Applicant/Agent(if different from owner): (k'— r e a r4 IQ T Telephone: '2 — 33 Fax: email: Mailing Address: (?�L / �U �t�'i.�`- , i. )a 8 3 39 at kind of Permit?(Check each box that applies 0 Lot or Road Segregation uilding 0 Critical Areas Stewardshi Plan ❑ Demolition Permit 0 Variance(Minor, Mr Ft r r�p�,�p ❑ Single Family 0 Garage Attached/Detached 0 Conditional Use C ] V ❑ Manufactured Home .0 Modular . 0 Discretionary"D"qii vnmed Use Classification ❑ Commercial* 0 Special Use(Es ICI Public Facilities)** ❑ Change of Use 0 Boundary Line A tis ent • `'`l'1 ❑ Address _0 Road Approach_ 0 Short Plat** Home Business 0 Cottage Industry 0 Binding Site Pla *' i Propane 0 Long Plat** JEFI RSON•CO[l • ❑ Sign 0 Planned Rural R sidefltirAl I so : ,� mend ents** 0 Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alt --- - ❑ 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 ❑ 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: /n� DESIGNATION OF AGENT 4i hereby designate t eO , - J� e T to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE ( ' Date: g t/ 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 app lic ion t the r Van norr notice. — —/Signature: _ �> Date: Y i) -(/ 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 and non-transf ble espons ility for adhering to and complying with the ESA. The Applicant has read this i laimler and signs and dates it below. `,'Signature: 1,77_ Date: '— /�5 �� G:\PermitCenter\###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: ( ) ( ) MAILING ADDRESS: el—H S 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 Li Addition Ti Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: _ Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# _ L 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 Proiect 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 v Bove ground Tank Size of Propane Tank: '5IW i Heat Stove i Cook Stove i Woodstove I Fireplace Insert i Hot Water Tank i Pellet Sto e 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 [ urrent Proposed For Office Use Only Amount Revision Main Floor Heated EH Bld App Review: • 2r4 Floor Heated Consistency Review: Other Heated Base fee: I1 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: $ Q.1 1 Receipt Number: O Cash/Check Number: G53 ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish ( 1' Initials: c G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc 1