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Home My WebLink AboutBLD2011-00333 S 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 #: BLD11-00333 Received Date 12/13/2011 SITE ADDRESS: 450 ROBBINS RD Issue Date 12/13/2011 NORDLAND, 98358 APPLICANT: MICHAEL P COFFEEN PHONE: 360-385-3342 PAMELA L COFFEEN 450 ROBBINS RD NORDLAND WA 983589671 TX 62 SUBDIVISION: Block: Lot: PARCEL NUMBER: 921093005 Section: 9 Township: 29N Range: 01 E 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, MICHAEL P COFFEEN PHONE: 360-385-3342 if different: PAMELA L COFFEEN 450 ROBBINS RD NORDLAND WA 983589671 PROJECT DESCRIPTION: A/G 120 GAL PROP TANK, COOK STOVE & LINES 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 12/13/2012. REQUIRED INSPECTIONS: Tank/Line/Appliance: } hn;n L -Z r- I Fin royal: y-)0 '1,0(17/ 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 GILDING Review PERMIT APPLICA•N B T0333 Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD11-00333 Received Date: 12/13/2011 SITE ADDRESS: 450 ROBBINS RD NORDLAND, 98358 OWNER: MICHAEL P COFFEEN PHONE: 360-385-3342 PAMELA L COFFEEN 450 ROBBINS RD NORDLAND WA 983589671 SUBDIVISION: Block: Lot: TX 62 PARCEL NUMBER: 921093005 Section: 9 Township: 29 N Range: 01 E 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 DESCRIPTIOP A/G 120 GAL PROP TANK, COOK STOVE & LINES 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 By: Date: Receipt: Approved/Date Propane Tanks/Stoves $213.00 LYK 12/13/11 128390 Total: $213.00 (.-„;'-ozsi, Cod JEFFERSOt UNTY ' DEPARTMENT OF COMMUNITY DEVELOPMENT II �' ` '� 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax 17 �p� www.co.jefferson.wa.us/commdevelopment ,& Master Permit Application MLA: L)CD V1CA 6E01 Project Description(include separate sheets as necessary): AAA prop-.one A-�v`k w 1<;-�cl,c%,, ►•,a..,,. AA >l�p qd, I'bp Tax Parcel Number: 9 Z 1 0 q Sao S Property Size: (acres/square feet) Site Address and/or Directions to Property: LI S c> ‘Z.., �bN`nS R , QorS`elr.A C%V 3 S Property Owner(s)of Record: NA ICl(1ao b k C1� Telephone: 3to0 - 3 $ S —S3 '-I Z Fax: sc..w.e email: �C.occee av,Sn- c...h 1 Mailing Address: y S b (Z o \:›\ kSe. Nara ,w S ufA ore 3 Z Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies ❑ Lot or Road Segregation ❑Building 0 Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family ❑ Garage Attached/Detached 0 Conditional Use[C(a), C(d),or Cj** ❑ Manufactured Home .0 Modular 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* 0 Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Lin gAdjustment-- ❑ Address 0 Road Approach ❑ Short Plat** I -_ ❑ Home Business 0 Cottage Industry ❑ Binding Site Ptah 4* �� _ �"l I IX Propane 0 Long Plat** , ,I ❑ Sign 0 Planned Rurai Residential Development(PRR dments** . ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** ❑ Stormwater Management 0 Shoreline Master Program Exemption/Permit I i s** ❑Site Plan Approval Advance Determination (SPAAD)* 0 Shoreline Managem nt Substantial Develo m 0 Temporary Use 0 Shoreline Management VariantaN COUNTY ❑Wireless Telecommunication* 0 Comprehensive Plash/t/IX/Iand!;tafsq,Disitpp gpp A endment ❑ Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Ma er rogram men ment *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 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 ent will be assumed unless the applicant informs the County in writing at the time of the application that he or she w nts prior notice. Signature: •.• Date: Dec.., t t , -2..c II 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 responsibility for adhering to ar complying with the A. Th Ap icant has read this disclaimer and signs and dates it below. Signature: Date: —Ia.., • t.I i 26 IA G:\PernutCenter\###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 Genera Contractor for the proposed project. Signature: 4—P d c_ n.. tom-- Date: "Dec . Li / Z o ►I GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: C I1 ( ) ( ) MAILING ADDRESS: 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: G Sewer • Addition E Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel G Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# _ ❑ Demolition li Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: ❑ 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 - bove ground Tanks Size of Propane Tank: (La o,.Q I Heat Stove - Cook Stove I Woodstove i Fireplace Insert i Hot Water T nk i Pellet Stove i Other Is this applian ng 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 Current Proposed For Office Use Only Amount Revision Main Floor Heated EH Bid App Review: 2r4 Floor Heated Consistency Review: Other Heated • .__ ,._...._----- Base fee: Q 13 Mezzanine 1 Additional Section: Heated Basement I Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $(.9�v- Receipt Number: t c� O-3--(I° Cash/Check Number: ^1� ESTIMATED COST(REQUIRED) Date: .Fair•Fair market value of all labor and materials foundation to finish al Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc I F n r N 0 .a 0 0 LA r r to 7, Z + D 'n r a c fr) Vs P 0 v 174 15 G r 6 a r . - 1, . "li-P j N - ''' 1 • O u ,....., ,. ,.!. ,c. q . ,. :4:3 .,-,, . ��, 0 0 l- _--- ,e — ,I 4 e. 4 r. 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