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Home My WebLink AboutBLD2012-00055 • • 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 #: BLD12-00055 Received Date 2/22/2012 SITE ADDRESS: 1371 GRIFFITHS POINT RD Issue Date 2/22/2012 NORDLAND, 98358 APPLICANT: JOHN G MURPHY TRUSTEE PHONE: 360-385-1228 J G MURPHY HERITAGE TRUST PO BOX 306 NORDLAND WA 98358-0306 T 63+ SUBDIVISION: Block: Lot: PARCEL NUMBER: 021321039 Section: 32 Township: 30N Range: 01 E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17 20152 5875 OWNER, JOHN G MURPHY TRUSTEE PHONE: 360-385-1228 if different: J G MURPHY HERITAGE TRUST PO BOX 306 NORDLAND WA 98358-0306 PROJECT DESCRIPTION: PROP TANK& LINES TO EXISTING COOK STOVE Directions i4f t_ i Z"(4 `'- 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 2/22/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: n I FinalApproval' _ 3 i I)Z J 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_Perm it_Propane.rpt 10/29/19 SJILDING PERMIT APPLICASN BRLD12 00055 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD12-00055 Received Date: 2/22/2012 SITE ADDRESS: 1371 GRIFFITHS POINT RD NORDLAND, 98358 OWNER: JOHN G MURPHY TRUSTEE PHONE: 360-385-1228 J G MURPHY HERITAGE TRUST PO BOX 306 NORDLAND WA 98358-0306 SUBDIVISION: Block: Lot: T 63+ PARCEL NUMBER: 021321039 Section: 32 Township: 30 N Range: 01 E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2012 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION A/G 120 GAL PROP TANK & LINES TO EXISTING COOK STOVE 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: 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 $148.00 LYK 02/22/12 131483 Total: $148.00 K.C.4:5°11 co. JEFFERSOCOUNTY i ' \,v DEPARTMENT OF COMMUNITY DEVELOPMENT 'N a 621 Sheridan Street• Port Townsend•Washington 98368 360/379-4450 360/379-4451 Falx www.co,jefferson.wa.us/commdevelopment Master Permit Application MLA: 7 ' Project Description(include separ to sheets as necessary): , /moo 6',9 L. f�2v/',grJ e 7Y/c z 6 /iL,r- L/4/e. 77) ---1(7f 77"V 6 41Ge Tax Parcel Number: 602_ /— 3 c -/ 6 3 ? Property.Size: (acres/square feet) Site Address.and/or Directions to Property: • /3 7/ CZC o/4 7` iae0 Property Owner(s)of Record: `7pW,t/ . `,1 Pam/�cQ Telephone: JgS- /o)a� Fax: email: Mailing Address: /9O _90 so f ' - C/ /et, �,, :isc,Applicant/Agent(if different from owner): /ice -L-r .a - ->d.41-'e'- Telephone: Yel5 - b7, 7 Fax: .3g 5 - 87S; email: G?. S dk""'4-,/W`c-.-e ,c.o,, Mailing Address:/a(1'.. ..3 k.H v,6/. ,OR. PT. //41-04-v c% u), What kind of Permit?(Check each box that applies 0 Lot or Road Segregation ❑Building 0 Critical Areas Stewardship Plan O Demolition Permit 0 Variance(Minor, Major ❑ Single Family 0 Garage Attached./Detached Elr-ConditiOnal Use[C(a), ] ❑ Manufactured Home . .0 Modular 0 Discretionary'ID"or U a 0 Commercial* 0 Special Use(Essential pu blic Facilities)** 0 Change of Use 0 Boundary Line Adjust e ti Address O'Road Approach 0 Short Plat** 1 I i , ❑ Home Business 0 Cottage Industry 0 Binding Site Plan** 1, �' ropane 0 Long Plat** ❑ Sign 0 Planned Rural Reside tial;Develo ** ❑Allowed"Yes"Use ConsistencyAnalysis B MIINUY ) rnendments Y _ 0Plat Vacation/Alteratio ** , ❑ Storrnwater Management PEPT Or OMMI I vIIY Milvl lbtENT 0 Shorelihe Master Program amp o ❑Site Plan Approval Advance Determination(SPAAD)* 0 Temporary Use 0 Shorelihe Management Substantial Development** •0 Shorelihe Management Variance 0 Wireless Telecommunication* 0 Compi hensive Plan/UDC/Land Use District Map Amendment 0 Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment *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 ereby designate r ' to act as my agent in matters relatingto this application for permit(s). { I 4 0wNER SIGNATURE f ::` fib Date: v�.Z t I. i By signing this application form,the owner/agent atte is 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 ny omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being nyill 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 provitp access and right of entry to Jefferson County and its employees,representatives or a9Ents for the sole purpose of application review and any required tater Ipspectioongi.4$0affs access and right of entry will be assumed unless the applicant Informs.the County in writing at.the. time of the application that� Sfi epr e}w r notice, . �, ..nature: t SI / ,r 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 in complianlse wit the Jefferson County development code:The Applicant acknowledges that he,she or it holds individual and non-transferable re4poniibijitx fort dh ri to and complying with the ESA. The Applicant has read this disclairrmr an ins and dates it below. Signature: �Date; -� . r.4.-V /, — . �( 1 n\P,.,,,,,,-c,,re,-\###FnRMS###\r)Rn FfRM.C1r,,r"P rTIRn P,,...,,•\1.f.0ro,na...,;,a.,.,i:...,.;,,,,G nil noa • • 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 ER: PHONE: FAX: Su_I„ a in e pc) N°,+-v 06d ) 3 es'- -r 7 17 ( 3 6e4 3 eS-S P 75 MAILING ADDRESS: d I C7 g JC 3 (�. pt P. (-' ENIAlL: CONTRACTORS LICENSE _ WAINS NUMBER: 5 LA V1 S > (2)47 7 Q r NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: O New 0 Wood Existing: ❑ Sewer O Addition 0 Steel Proposed: Bank Ci Community System O Alteration/Remodel 0 Concrete Total: Height: 0 Individual System ❑ Repair 0 Masonry SEP Permit# ❑ Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: 0 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 ' 41f this is a Propane Tank and/or A liance Installation permit,mark all items below that apply: I Underground Tank Above ground Tank] Size of Propane Tank: I Q ---- _� I Heat Stove I Cook S ove Woodstove 1 Fireplace Insert I Hot Water Tank I.Pellet Stove Other L_' (-4--Q 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 4�°�dvi.t s,d&.t" ? "�^ ,, ' .; �f, ,, , Main Floor Heated •cw if', , ty,NE', • EH Bid App Review: L:P2�Floor Heated x �� y�z Consistency Review: + y'4R,i, s Other Heated , if 4yfi Base fee: • • Mezzanine l: ,' Additional:Section: Heated Basement Mai ''', t" Plan Check fee: Ikv Unheated Basement , ` State Surcharge fee: Other'Unheate'd " r�' 7' r•r:4i, Pot Water Review fee: Garage/Carport t$ "� 2.:! SUBTOTAL Decks `t�syA;v� � 911/Rd Approach fee: Other , TOTAL: $ l Ll I * r tl ti1 Receipt Number: 3t R y SI`' Ciash/Check Number I t ESTIMATED COST(REQUIRED) Date: 1 •Fair market value of all labor and materials foundation to finish: C -= a-"t• Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Applicition 5-29-08.doc