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Home My WebLink AboutBLD2012-00075 HAMILTON BLD12-75 393 SENTINAL FIRS RD NO MLA REQ'D Approvals Req'd Prior to Final Inspection SEP RAP ZON S1Pz ®PVV i'Llute-tacct_ pe12-fAui- gat'sit �� , Yot c.)10 ) 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 #: BLD12-00075 Received Date 3/8/2012 SITE ADDRESS: 393 SENTINAL FIRS RD Issue Date 3/8/2012 PORT HADLOCK, 98339 APPLICANT: JOHN W HAMILTON PHONE: 360-437-4046 JILL A HAMILTON PO BOX 686 PORT HADLOCK WA 98339-0686 T73+ SUBDIVISION: Block: Lot: PARCEL NUMBER: 921193043 Section: 19 Township: 29N Range: 01 E CONTRACTOR: SHAUN WINSLOW CONSTRUCTION INC PHONE: 360-620-8386 3619 NOKOMIS RD SOUTHWORTH WA 98386 Contractor's License SHAUNWC904JT Expires 4/30/2012 OWNER, JOHN W HAMILTON PHONE: 360-437-4046 if different: JILL A HAMILTON PO BOX 686 PORT HADLOCK WA 98339-0686 PROJECT DESCRIPTION: NEW 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 3/8/2013. REQUIRED INSPECTIONS: f „ V� Tank/Line/Appliance: ��? FinalApproval: v9Rxs311/4 \ -\\(\ R0 V \ 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 •UILDING PERMIT APPLICASN BRev e2N00075 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD12-00075 Received Date: 3/8/2012 SITE ADDRESS: 393 SENTINAL FIRS RD PORT HADLOCK, 98339 OWNER: JOHN W HAMILTON PHONE: 360-437-4046 JILL A HAMILTON PO BOX 686 PORT HADLOCK WA 98339-0686 SUBDIVISION: Block: Lot: T73+ PARCEL NUMBER: 921193043 Section: 19 Township: 29 N Range: 01 E CONTRACTOR: SHAUN WINSLOW CONSTRUCTION INC PHONE: 360-620-8386 3619 NOKOMIS RD SOUTHWORTH WA 98386 Contractor's License SHAUNWC904JT Expires 4/30/2012 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP NEW 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: 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 03/08/12 131532 Total: $148.00 CkA, on JEFFERSOI.'OUNTY Ye; DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax www.co.jefferson.wa.us/commdevelopment iNp)- Master Permit Application MLA: MCA- Ca) /6 Project Description(include separate sheets as necessary): , 1�/15yrC �Q wood /-//J( • Tax Parcel Number: C ',Z// g3ogf3 Property Size: (acres/square feet) Site Address and/or Directions to Property: 5cj 3 Se yt i`i / �-i/s ,��/ /mod��' /1I4C)*'c X, Ce-}A g3 Property Owner(s)of Record: ;Joh nl LL) d j;14-4— /69 M/Cie-Al Telephone: .361,'D (/ 7 (-/ Fax: email: J ft.'NAM/z-63,g'C /`"t Mailing Address: C`- i8C X CP Co / Pc' I,* , c. a 1L),4 Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: Vyqat kind of Permit?(Check each box that applies 0 Lot or Road Segregation wilding 0 Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]** ❑ Manufactured Home .0 Modular - 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* 0 Special Use(Essential Public Facilities)** Change of Use 0 Boundary Line Adjustment O Address _ 0 Road Approach_ 0 Short Plat** ❑ Home Business 0 Cottage Industry 0 Binding Site Plan** J Propane 0 Long Plat** ❑ Sign 0 Planned Rural Residential Development(PRRD)/Amendments** 0 Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** ❑ Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions** O 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 ❑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 rime of the application th t he oorr he want pf for notice. n ignature: ( '(y Ixt 7L 7 L- Date: 3 - r .. ;;2C72 The action or a_ ons 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 disclaimer and signs and dates it below. signature: /4-ki AL)7ZP-7t— Date: .3 ;S 2c'J Z_ G:\PermitCenter\###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 General Contractor for the proposed project. Signature: Date: GENE L CONTRACTOR OR MANUFACTURED HOME INSTALLER: PI-Ic NE: FAX: (L---a-g. ( _) ( ) MAILI VG 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: 0 New ❑ Wood Existing: 1 Sewer L Addition I Steel Proposed: Bank E Community System 0 Alteration/Remodel 0 Concrete Total: _ Height: 0 Individual System O Repair 1 Masonry — SEP Permit# _ Bedrooms: Water Supply: �� Demolition � Other: pp y: Existing: _ Setback: i Private well 12. Two Party Type of Heat: Proposed: 0 Public Total: Name of System:__ • . ' 3 = J� If this is a Commercial Project you must answer the/ of v ' U Y r , Number of Parking Spaces: Current: _'Proposed: I Nu ter of ADA Parking Spaces: Number of occupants(includes owners,tenants, employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Wil Iyo have Food Service? Yes / No If this is a Propane Tank and/or Appliance Instaklaticb permit,mark all items bei that apply: 1 Underground Tank 1 Abo a ground Tank .0 4 V I anK: 1 Heat Stove 1 Cook Stove�l 4Noodstove 1 Fireplace11rtsertcnylmb oMa,t pTtoQkT 1 Pallet Stove 1 Other _ Is this appliance being insta led 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 [urrent Proposed For Office Use Only Amount Revision Main Floor Heated EH Bld App Review: 2f41 Floor Heated Consistency Review: Other Heated Base fee: 4S 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 TOTAL: $ t.4 Receipt Number: ' 31532 Cash/Check Number: 2 ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish Initials: G:\PermitCenter\###F tS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc