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Home My WebLink AboutBLD202-00348 • • 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 #: BLD12-00348 Received Date 10/25/2012 SITE ADDRESS: 11-A N CHANDLER CT Issue Date 10/25/2012 PORT LUDLOW, 98365 APPLICANT: MILTON K LUM PHONE: 360-457-5143 DORIS F LUM 11A N CHANDLER CT PORT LUDLOW WA 983659537 7-A SUBDIVISION: INNER HARBOR VILLAGE CONDO Block: Lot: PARCEL NUMBER: 961600702 Section: 17 Township: 28N Range: 01 E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 1 /17/ 012 5875 OWNER, MILTON K LUM PHONE: 360-457-5143 if different: DORIS F LUM 11A N CHANDLER CT PORT LUDLOW WA 983659537 PROJECT DESCRIPTION: COOKSTOVE & PIPING 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 10/25/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: r i (,, - (a. t717-7 FinalApproval: I - C' 1 2 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 10/25/2012 ILDING PERMIT APPLICATI� BLDI2-00348 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD12-00348 Received Date: 10/25/2012 SITE ADDRESS: 11-A N CHANDLER CT PORT LUDLOW, 98365 OWNER: MILTON K LUM PHONE: 360-457-5143 DORIS F LUM 11A N CHANDLER CT PORT LUDLOW WA 983659537 INNER HARBOR VILLAGE CONDO SUBDIVISION: Block: Lot: 7-A PARCEL NUMBER: 961600702 Section: 17 Township: 28 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 DESCRIPTIOP COOKSTOVE & PIPING 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 Bv: Date: Receipt: Approved/Date Propane Tanks/Stoves $148.00 LYK 10/25/12 135349 APpROvEriTotal: $148.00 oC! 252012 Jefferson County Plannii:. & Building Department \\firlcmnr4\rloM\fnrmo\F RI fl Ann Rlrl rnf 1!1/9F/9f119 (V:4;s10,463 • JEFFERSON•UNTY • DEPARTMENT OF COMMUNITYDEVELOPMENT'' `4 621 Sheridan Street • Port Townsend • Washington 98368 lop360/379-4450 • 360/379-4451 Fax p� www.co.jefferson.wa.us/commdevelopment ,/`rI ING(C Master Permit Application MLA: \�--` Vr)L/i Project Description(include se rate sheets as necessary): % i-' 11. r 1-- '`DL,il 9_____ Tax Parcel Number: j(( (L, C("J 7G Property Size: (acres/square feet) Site Address and/or Directions to Property: r- 11 -;�, ru . ( (]anc�toif <� �� a i��tv c � � Property Owner(s)of Record: M r LTo1J l_a t`1 Telephone: .',,.(.0 �13r1 51�13 Fax: 3u�1 y3t Iq.'� email: POLA,>„\Wok(c51�,��mnc�tt-(.t,4� -.Mailing Address: t t / rV C.HrlNi�Lt Cz- — J Applicant/Agent(if different from owner): Telephone: Fax: email: _ Mailing Address: 4 ❑t kind of Permit?(Check each box that applies 0 Lot or Road Segregation Building B Critical Areas Stewardsl ip Ptdn_, - Demolition Permit 0 Variance(Minor, Major c�r IROiona eectoti 1 ❑ Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a), C;(d),gr,-Cj--- .0 Modular❑ Manufactured Home ❑ Discretionary"D"or UnrfameBUse Classification ❑ Commercial* 0 Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment ❑ Address 0 Road Approach_ 0 Short Plat** I li L� It J Home Business 0 Cottage Industry 0 Binding Site Plan** 1 2Copane 0 Long Plat** JEFFERSn CO;iNTY ❑ Cign 0 Planned Rural Residential e1gm_en_ (PRRD)/A t mendments`* ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration*" " ❑ Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions** ❑ 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 0 Tree Vegetation Request _ **Re•uires a Pre-A.•lication 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 time of the application that he or she wants prior notice. , Fti�l tSignature: AINA- 1-4-f/).- --- _ Date: lo` .)4-1 JC Ia 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 disclaimer and signs and dates it below. tSignature: LLA. 4-71/V. W-41/ Date: 1(�p LI-/2 ii3, 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: GENERAL CONTRACTOR PR MAN, CTURED HOME INSTALLER: PHCNE: FAX: l 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: L. New a Wood Existing: Sewer C Addition C Steel Proposed: Bank ❑ Community System Alteration/Remodel ❑ Concrete Total: Height: C Individual System C Repair C Masonry — SEP Permit# _ C Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ci, Private well C Two Party Type of Heat: Proposed: ❑ 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 FoodService? Yes / No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: i Underground Tank i Above ground Tank Size of Propane Tank: )itlziot Stove XCook Stove i Woodstove i Fireplace Insert i Hot Water Tank 1 Pellet Stove I 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 Bid App Review: 2nd Floor Heated Consistency Review: Other Heated Base fee: ll rr 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: $ I q g Receipt Number: [' J53 Cash/Check Number: ao u ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish - _^ Initials: ----~ CA PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc