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Home My WebLink AboutBLD2012-00073 Q 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 #: BLD12-00073 Received Date 3/7/2012 SITE ADDRESS: 332 RUSSERT DR Issue Date 3/7/2012 QUILCENE, 98376 APPLICANT: RONALD M DIIMMEL PHONE: 360-460-3646 LESLIE P DIIMMEL 128 DIAMOND VIEW DR PORT ANGELES WA 98363-9437 T 20 SUBDIVISION: Block: Lot: PARCEL NUMBER: 501044005 Section: 4 Township: 25N Range: 01W CONTRACTOR: SEKIU CHIMNEY SWEEPS PHONE: (360) 963-2864 PO BOX 573 CLALLAM BAY WA 98326 3 Contractor's License SEKIUCS088CD Expires 1/ 76/ 19363-2975 OWNER, RONALD M DIIMMEL PHONE: 360-460-3646 if different: LESLIE P DIIMMEL 128 DIAMOND VIEW DR PORT ANGELES WA 98363-9437 PROJECT DESCRIPTION: NEW WOOD FIREPLACE INSERT 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 3/7/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: 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 BLD12-00073 OUILDING PERMIT APPLICAN Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD12-00073 Received Date: 3/7/2012 SITE ADDRESS: 332 RUSSERT DR QUILCENE, 98376 OWNER: RONALD M DIIMMEL PHONE: 360-460-3646 LESLIE P DIIMMEL 128 DIAMOND VIEW DR PORT ANGELES WA 98363-9437 SUBDIVISION: Block: Lot: T 20 PARCEL NUMBER: 501044005 Section: 4 Township: 25 N Range: 01 W CONTRACTOR: SEKIU CHIMNEY SWEEPS PHONE: (360) 963-2864 PO BOX 573 CLALLAM BAY WA 98326 Contractor's License SEKIUCS088CD Expires 1/27/2013 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr NEW WOOD FIREPLACE INSERT 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 $148.00 LYK 03/07/12 131530 Total: $148.00 N • IP e 0%,, JEFFERSON COUNTY iDEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend Washington 98368 360/379-4450 • 360/379-4451 Fax '�'$s�N�,0p'$ www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: t) MLA 1L P 'Ff) I l Project Description(include separate sheets as necessary): �.>-t. i I (. I,t t t t\-e— "Lib()I- Ulf,-wl J--A Se r t &)/ r J l.rx. Tax Parcel Number: S C'1 C `H )0 5 Property Size: (acres/square feet) Site Address and/or Directions to Property: I� r 1a.1 b01 l A ii 4 f N t�1 I eft, CM # :3 �- L '►v-e t.cLe cc,LC (-A Property Owners)of Record: ' it&c d Ct -4 Le s I re_.- / Telephone: ')OD-4-1 120- 30Lt Sp Fax: email: [' i /i1'1 < S?N[Sh• L. Mailing Address: 17-is ,f ta1wr-rvle-( V 44-3 OF) t' ) r1"11N�J Lc)4 Applicant/Agent(if different from owner): Telephone: Fax: email: . Mailing Address: What kind of Permit?(Check each box that applies ❑Building ❑Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use) ❑Single Family ❑Garage Attached/Detached ❑Conditional Use[C(a),C(d),or C]** ❑ Manufactured Home 0 Modular ❑Discretionary"D"or Unnamed Use Classification ❑ Commercial* ❑Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment ❑ Address 0 Road Approach 0 Short Plat** ❑Home Business ❑Cottage Industry ❑Binding Site Plan ❑Propane 0 Long Plat** ❑Sign ❑Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes'Use Consistency Analysis ❑Plat Vacation/Alteration** ❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions** ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development** _ ❑Temporary Use 0 Shoreline Management V a fl ❑Wireless Telecommunication* ❑Comprehensive Plan/UDC I it Ua 4pn ' ❑Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment, *May require a Pre—Application Conference ❑Tree Vegetation Request *'Requires a Pre-Application Conference 7 2r�-.` Please identify any other local,state or federal permits required for this proposal,if known: / Ili 1 I DESIGNATION OF AGENT JEFFERSON COUNTY I hereby designate ' ' to act as my agent in matters relating,tlo thislipplicatiopifor pe it(s)_ OWNER SIGNATURE I , - �//i --'/ ?�: Date: •_) _ I L 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 attomey'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 application that ha or she wants prior notice. -2 I Signature: }tiJLLl. ,' - - - ( Date: ' S I( 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-transferable responsibility for adhering to and complying with the ESA. The Applicant has read this disclai r a signs and dates it below. Signature: i • Date: '/ Il < \PermitCenter\###FORMS###\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 Ge eral Contractor for the proposed project. Signature: `` � ` L Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: MAILING ADDRESS: �I,.j ;r-j I lyi7 ;Ii Ar4_ EMAIL: r UJu-Q 7 t'M I l Ce CONTRACTOR'S LICENSE '\ f WAINS NUMBER: `_,ELK I U SDI? L SC NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New 0 Wood Existing: i I Sewer ❑ Addition ❑ Steel Proposed: Bank 0 Community System LI Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: 0 Private well 0 Two Party Type of Heat: Proposed: 0 Public Total: Name of System: If this is a Commercial Protect 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: 1 Underground Tank 1 Above ground Tank ize of Propane Tank: 1 Heat Stove 1 Cook Stove 1 Woodstove Fireplace Insert 1 Hot Water Tank 1 Pellet Stove 1 Other Is this appliance being installed in a ManufactureditMOb l] ome? 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 U ly Amount �wision Main Floor Heated EH Bld App Review: 2nC1 Floor Heated Consistency Review: Other Heated Base fee: 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 lb 7 V Receipt Number. (2)I Cash/Check glum n 8 g ESTIMATED COST(REQUIRED) Date: (� .Fair market value of all labor and materials foundation tannish L.--- CDUNTY �D U Q ,6 b Ettifi DCPT.OF i CO � HEW --5� G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc e ,0,,,h,y, ________ _ i , ( _ , t 4_, .„--__. ., ,) __--*, - ----,..-- vI 4,,o , a Sa, ,S < 1 -_-_, ..„. ..g vcw meow � w i� _ L. U o N. w CC -' c Lu U 4 O t__ L. ____J t.... 41 ti1 ..f..--- t I i al 0.