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Home My WebLink AboutBLD2011-00307 0 i 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 #: BLD11-00307 Received Date 11/7/2011 SITE ADDRESS: 304 GIFFORD HILL DR Issue Date 11/7/2011 CHIMACUM, 98325 APPLICANT: SHEILA J GIFFORD PHONE: 360-732-4052 PO BOX 304 CHIMACUM WA 983250304 TX78 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901104024 Section: 10 Township: 29N Range: 01W CONTRACTOR: THURMAN SUPPLY PHONE: 360-457-8591 1807 E FRONT ST PORT ANGELES WA 98362 Contractor's License THURMS*954JA Expires 11/26/2012 OWNER, SHEILA J GIFFORD PHONE: 360-732-4052 if different: PO BOX 304 CHIMACUM WA 983250304 PROJECT DESCRIPTION: NEW FREESTANDING 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 11/7/2012. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: I 2..cf- 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 BLD11-00307 •UILDING PERMIT APPLICAlON Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD11-00307 Received Date: 11/7/2011 SITE ADDRESS: 304 GIFFORD HILL DR CHIMACUM, 98325 OWNER: SHEILA J GIFFORD PHONE: 360-732-4052 PO BOX 304 CHIMACUM WA 983250304 SUBDIVISION: Block: Lot: TX78-1 PARCEL NUMBER: 901104024 Section: 10 Township: 29 N Range: 01 W CONTRACTOR: THURMAN SUPPLY PHONE: 360-457-8591 1807 E FRONT ST PORT ANGELES WA 98362 Contractor's License THURMS*954JA Expires 11/26/2012 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP NEW FREESTANDING WOODSTOVE TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2009 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE SHORELINE: GARAGE: SETBACK: CONST TYPE: DECK: 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 $142.00 LYK 11/07/11 128304 Total: $142.00 41/ +�gN c0� JEFFERSOWCOUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 �� >' ' 360/379-4450 • 360/379-4451 Fax 3�3IN www.co.jefferson.wa.us/commdevelopment 6 I Master Permit Application MLA: NO Ifl LA 0€43 Project Description(include separate sheets a,s necessary): i nS 71Z1 // GU co,t J`-ht."e—' Tax Parcel Number: ?O/ /of o�,1 Property Size: (acres/square feet) Site Address and/or Directions to Property: 30Al 6/FForaL /-rl.i"// Di ire- U.Pli rvta c ccm, ti.,h q e3 26- Property Owner(s)of Record: SA e I Is_ 6F/tiprL Telephone: 732.- '/t5 a- Fax: email: Mailing Address: PC tgo lc 3odi wUnu1c um.., wI• ge5ZS— Applicant/Agent(if different from owner): Telephone: Fax: email: Mailin Address: E g 1L-, \ L - I \J r, i^`1 wtW kind of Permit?(Check each box that applies ---� ilding 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)" i i J 1 O Manufactured Home 0 Modular 0 Discretionary"D"or Unnamed Use Classification J i ❑ Commercial* 0 Special Use(Essential P_ithlir.Facilities)_'' ❑ Change of Use 0 Boundary Line Adjustment J.i 1 L A`:u'N LUUNTY ❑ Address 0 Road Approach 0 Short Plat" PTT O' ''''11"''T'ilrvrl ON/TNT ___, ❑Home Business 0 Cottage Industry 0 Binding Site Plan" ❑Propane 0 Long Rat" ❑Sign 0 Planned Rural Residential Development(PRRD)Amendments"" ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** ❑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: DESIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application for permit(s). 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 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 applicatipo that he or she wants prior notice. Signature: .JA.ea t/L. � /-4 Li- Date: /U/2 ,"/i 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-transferable onsibJity for ad� turd complying with the ESA. The Applicant has read this disclaimer a9d s and dates it below. Signature: C.�` (u (L X Date: (/( i G:\PermitCenter\###FORMS###\DRD FORMS\Master Pewit 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: S It _4fa 6 71r Date: jO/ZJ'71 r GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: 1/ aeitAai1 Sure/ (3"4' 457- 5`6-9/ ( ) MAILING ADDRESS: /f 0 7 j f Frey IL k,&, EMAIL: CONTRACTOR'S LICENSE Per f- Aryl--.at's, /} Q!jyWAINS NUMBER: 7^hHUK44 c key 4J-A NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disp osal: posal: ❑ New ❑ Wood Existing: 1 Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair 0 Masonry SEP Permit# ❑ Demolition C Other: Bedrooms: Water Supply: Existing: Setback: i Private well ❑ Two Party Type of Heat: Proposed: C] 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 t Above ground Tank Size of Propane Tank: I Heat Stove i Cook Stove i /�Uoodstove i Fireplace Insert i Hot Water Tank i Pellet Stove t Other Is this appliance being installed in a Manufactured 1 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 Only Amount >Revision Main Floor Heated EH Bld App Review: 2"0 Floor Heated Consistency Review: Other Heated • Base fee: q Q Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated�_ j�J [� , c� !; Pot Water Review fee: Garage/Carport ��- L_"�—r SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $ \ 14c; • ,c:I INTY Receipt Number. ( 3 Fs 30q- • Cash/Check Number: 61.4,,a7 ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish ti -71—l � � . 0Initials: �� • p------- G:\PermitCcnter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc ---------- --