The URL can be used to link to this page

Home My WebLink AboutBLD2011-00293 • 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 #: BLD11-00293 Received Date 10/25/2011 SITE ADDRESS: 190 LINDSEY LN Issue Date 10/25/2011 PORT TOWNSEND, 98368 APPLICANT: CHRISTIAN ANDREWS PHONE: 360-643-3705 190 LINDSEY RD W PORT TOWNSEND WA 98368-9634 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001074024 Section: 7 Township: 30N Range: 01W CONTRACTOR: JD INSTALLATION PHONE: 360-649-4998 19164 KARL PL POULSBO WA 98370 Contractor's License JDINSI*898N2 Expires 8/22/2013 OWNER, CHRISTIAN ANDREWS PHONE: 360-643-3705 if different: 190 LINDSEY RD W PORT TOWNSEND WA 98368-9634 PROJECT DESCRIPTION: NEW WOODSTOVE INSTALLATION 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 10/25/2012. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: I %fir 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 IU ILDING PERMIT APPLICAAN B 0293 Ree view view Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD11-00293 Received Date: 10/25/2011 SITE ADDRESS: 190 LINDSEY LN PORT TOWNSEND, 98368 OWNER: CHRISTIAN ANDREWS PHONE: 360-643-3705 190 LINDSEY RD W PORT TOWNSEND WA 98368-9634 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001074024 Section: 7 Township: 30 N Range: 01 W CONTRACTOR: JD INSTALLATION PHONE: 360-649-4998 19164 KARL PL POULSBO WA 98370 Contractor's License JDINSI*898N2 Expires 8/22/2013 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI' NEW WOODSTOVE INSTALLATION 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: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid Bv: Date: Receipt: Approved/Date Propane Tanks/Stoves $142.00 LYK 10/25/11 128280 Total: $142.00 F elk III III N �J\ JEFFERSON COUNTY e TY DEVELOPMENT EPAR ENT OF COMMUNITY i D TM 621 Sheridan Street Port Townsend •Washington 98368 �$ 4 360/379-4450 • 360/379-4451 Fax ry �p www.co.jefferson.wa.us/commdeveiopment Master Permit Application MLA: O me A PF0 rD Project Description(include parate sheets as necessary): Tax Parcel Number: 00/ o 7 L/ d .-L/ Property Size: , 5 (acre lsquare feet) Site Address and/or Directions to P fty: 190 Lnasw Property Owners)of Record-' Telephone( .' ^ • Fax emaN:• ('.halt)a•VI.Cf,BIR 1^fIn(S 'r Ai I.c5YLt Mailing Address: /9/` L•JL .S,1, r� In/GS'1 Applicant/Agent(If different from owner): Telephone: Fax email: Mailing Address: Xt kind of Permit?(Check each box that applies uilding ❑Critical Areas Ste I Plan Demolition Permit 0 Variance(Minor,Majo a Is Use)_ _ ❑Single Family ID Garage Attached/Detached 0 Conditional Use[C(a),C( ❑ Manufactured Home 0 Modular 0 Discretionary"D"or Unnamed-Use- E ❑ Commercial* 0 Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment O Address 0 Road Approach ❑Short Plat""' T „�,i 4 ❑Home Business 0 Cottage Industry 0 Binding Site Plan"" I I 1 L ❑Propane ❑Long Plat" i u ❑Sign 0 Planned Rural Residential a: ':'• - •- 0 Allowed'Yes"Use Consistency Analysis 0 Plat Vacation/Alteration"' f' -'- ❑Stormwater Management 0 Shoreline Master Program ❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Developmen ❑Temporary Use 0 Shoreline Management Variance O 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 Pm—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: DESIGNATION OF AGENT ----i I hereby designate to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: i 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 attorneys 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 requi d let inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applicant th he-prahe fits prior noti . / )0ignature: Date• /°/ -5 f L/ 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 r ponsibilily for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates It below. >Signature : _ Date: /0/26/1 / (;:\I'crmitC:cntcA###I UIl.Ms ##\Dfl)FORMS\Mu,tcr Pcnim.'4 piicetiun 5-29-OS.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: ��‘.\A -17I tra✓Ir) (34U)&HR `1115 ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: in(�r 5 i t 8 g S�«2 NUMBER ARCHITECT/ENGINEER: f� G/ PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: I Frame Type: - Bathrooms: I Shoreline: Type of Sewage Disposal: New i Wood Existing: a Sewer Addition ri Steel Proposed: Bank 7 Community System Alteration/Remodel Li Concrete Total: Height: 0 Individual System Repair l 1 Masonry SEP Permit# Demolition IT Other: Bedrooms: Water Supply: Existing: Setback: 1 Private well n Two Party Type of Heat: Proposed: D Public Total: -- — Name of System: If this is a Commercial Proiect you must answer the following; a �_ v 1 Number of Parking Spaces. Current: Proposed: Number cif 9 • j', Number of occupants(includes owners,tenants,employees,etc) Current I ,proposed I �', IBC Occupancy: IBC Type of construction: Will you have Fogd Service?_Yet) No, If this Is a Propane Tank and/or Appliance installation permit mark all Items below that uplvr II,j i Underground Tank I Above ground Tank Size of Propane Tank: Heat Stove 1 Cook Stove Woodstove Fireplace Insert 1 Hot Water Tank 1 Pepe Stove V-Atheti Is this appliance being install°• : ' ,nufacturod/Mobile Home? Yes No lErfEf SON CO l}PI�Y T When applying for a permit to install a propane tank you must also submit a site plan showfr r%rr�,!:\TY DI i s,V i11ElO,MEN propertyp 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 ..Ftx� rri Arh it . .- ion.. && -.. Main Floor Heated -- x � El i Bld App Review 2""Floor Heated , .a>,i14 Consistency Review: Other Heated - tE Base fee: 1 LiA ems- -��.� . Mezzanine - -`°. Additional Section• Heated Basement :- Plan Check fee: Unheated Basement - . . State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport `.;";,.;' SUBTOTAL Decks 911lRd Approach roach tee: rl-t :Ire:, owrr, Other $ t ga ...._ ,.:.,,.,..„,,,:„,.....,, �' TOTAL �`•'� * Receipt Number: a7a 80 4 W Cash/Check Number: ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and matonals foundation to finish 25' Initials: G\I'cmvK:cntcr\###FORMS###\MIT)FORMS\MA"cr Prrmit Appliciti,m 5-29-(8 dnc ". 1 2- c'""1- II°' U .` p '—t i b 4, , , -- --L - ) .42 I . _s. w . __A co ,.‘ ,...... . ---- . . . cct r.. to -i ram, h_' _ 1 I 0 M --) , IN 7: j ; i�� 25 . 'J I� JEEIERSON COUNTY f Tr T nE Cf''yaNtTY OiVFI OPMENT__.