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Home My WebLink AboutBLD2012-00324 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 #: BLD12-00324 Received Date 10/11/2012 SITE ADDRESS: 1125 TOANDOS RD Issue Date 10/11/2012 QUILCENE, 98376 APPLICANT: THOMAS J HOUGH PHONE: 847-322-2583 1125 TOANDOS RD QUILCENE WA 98376-9634 TX 2 SUBDIVISION: Block: Lot PARCEL NUMBER: 701153003 Section: 15 Township: 27N Range: 01W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2014 OWNER, THOMAS J HOUGH PHONE: 847-322-2583 if different: 1125 TOANDOS RD QUILCENE WA 98376-9634 PROJECT DESCRIPTION: NG 250 GAL PROP TANK& 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 10/11/2013. 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 \\tidemark\data\forms\F_BLD_Permit_Propane.rpt 10/11/2012 IPU ILDING PERMIT APPLICA1N BLD12-00324 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD12-00324 Received Date: 10/11/2012 SITE ADDRESS: 1125 TOANDOS RD QUILCENE, 98376 OWNER: THOMAS J HOUGH PHONE: 847-322-2583 1125 TOANDOS RD QUILCENE WA 98376-9634 SUBDIVISION: Block: Lot: TX 2 PARCEL NUMBER: 701153003 Section: 15 Township: 27 N Range: 01 W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2014 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION A/G 250 GAL PROP TANK & 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 Bv: Date: Receipt: Approved/Date Propane Tanks/Stoves $148.00 LYK 10/11/12 135294 ��R®` , Total: $148.00 V oc Jefferson County Plannini & Building Department \\firlcmorWrlofo\forme\f= RI n n„„ Rid r„+ 1ni11ro11i) • �,�•sox cOtr JEFFERSON C UNTY w� • ' 'N� rA DEPARTMENT OF COMMUNITY DEVELOPMENT h ` `� 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax .' # www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: 11Q0 t - .(A / Proj ct Description (include separat�sh' is as necessary): . c. i 1 (bD . Parcel N Tax Number: II p 1 (55O p1�j Property Size: S-.,L { E...)-es quare feet) ) Site Address and/or Directions to Property: //2.5- 7 4AM0 �� q�37Sv Property Ow C,Cn�er(s)of Record: l O(�Q s (' Telephone: 47i7 3 5 Fax: email: Mailing Address: /i'2`J 4hw0c &•J, (jizc (=/V!= ga37, Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit? (Check each box that applies 0 Lot or Road Segregation wilding 0 Critical Areas Stewardship Plan Demolition Permit 0 Variance(Minor, Ma'or or Reasonable Economic Use) ❑ Single Family 0 Garage Attached/Detached 0 Conditional Use - ) � 0 Manufactured Home .0 Modular 0 Discretionary"D"d s s ,Hi ❑ Commercial* 0 Special Use(Es aritipublic acl I les EI Change of Use 0 Boundary Line A j nt ❑ Address 0 Road Approach_ 0 Short Plat** OCT 1 1 2012 o Home Business 0 Cottage Industry 0 Binding Site Plar) \I�Propane 0 Long Plat** 1 .� �❑ ;3iyn 0 Planned Rural siderlLra1 d OltdN 'dblri RD)/Amen ents** ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/AI eratic T ❑ Stormwater Management 0 Shoreline MasterProgr • ** 0 Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development** ❑Temporary Use 0 Shoreline Management Variance D 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 harrnless 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 appli tha he or,�li -is prior notice. �� - ignature:�-,/ � ., Date: /0 / --- The action or actions Applicant wi undertake a esult of the issuance of this permit may negatively impact upon on or more threatened or endangered species and could I ad 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 .nd non-tran -rab-j•:-sitjility her' g to and c• plying with the ESA. The Applicant has read this disclaimer nd s•gns and dates it below. .ignature: _ .:, ,..� d Ar..... ,,. Date: v • • 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: GEN ERAL CONTRAC.TOR OR MANUFACTURED HOME INSTALLER: PHONE: / \� ( _) ( ) MAILING ADDRESS: EMAIL: CONTRACTORS LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New L. Wood Existing: I Sewer i. Addition : Steel Proposed: Bank I Community System Alteration/Remodel J Concrete Total: Height: LI Individual System Repair C Masonry — SEP Permit# _ Demolition Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well 7 Two Party Proposed: Public Type of Heat: 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 T k and/or Appliance Installation permit,mark all items below that apply: i Underground Tank NOve ground Tank Size of Propane Tank: f'-4-.-Nf._) 1 Heat Stove 1 Cook Stove i Woodstove 1 Fireplace Insert i Hot Water Tank i Pellet Sto _ 1 Other 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 For Office Use Only Amount Revision Main Floor Heated EH Bld App Review: 2nd Floor Heated Consistency Review: Other Heated Base fee: 1 14S — 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: $ 1`i O .- Receipt Number: 1: 4 Cash/Check Number: I a5Zn' I1 ESTIMATED COST(REQUIRED) Date: "1`C •Fair market value of all labor and materials foundation to finish —1,1—l2.. .__ Initials: _� ..,._ . .,. ,uaau��n“4,1111111 nnn nnnA l01 r..____.nnn n,,__\r! n..W:. .1...-1:..,..:....c 1n no A..,