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Home My WebLink AboutBLD2012-00372 r ! 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 #: BLD12-00372 Received Date 11/16/2012 SITE ADDRESS: 152 FLORENCE ST Issue Date 11/16/2012 PORT TOWNSEND, 98368 APPLICANT: CHARLES L SHAW PHONE: 360-385-9488 VERONICA K SHAW 152 FLORENCE ST PORT TOWNSEND WA 98368-9803 3+ SUBDIVISION: IRVING PARK ADDITION Block: 21 Lot: PARCEL NUMBER: 963302104 Section: 16 Township: 30N Range: 01W CONTRACTOR: OWNER/BUILDER PHONE: OWNER, CHARLES L SHAW PHONE: 360-385-9488 if different: VERONICA K SHAW 152 FLORENCE ST PORT TOWNSEND WA 98368-9803 PROJECT DESCRIPTION: PELLET STOVE 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 11/16/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: 11-21-1 Z 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 11/16/2012 11.1ILDING PERMIT APPLICATS BLD12-00372 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD12-00372 Received Date: 11/16/2012 SITE ADDRESS: 152 FLORENCE ST PORT TOWNSEND, 98368 OWNER: CHARLES L SHAW PHONE: 360-385-9488 VERONICA K SHAW 152 FLORENCE ST PORT TOWNSEND WA 98368-9803 IRVING PARK ADDITION SUBDIVISION: Block: 21 Lot: 3+ PARCEL NUMBER: 963302104 Section: 16 Township: 30 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI PELLET STOVE 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: pproved/Date Propane Tanks/Stoves $148.00 LYK 11/15/12 139752 I ` ' I F Total: $148.00 NOV 16 Jefferson County Plannin! &Buildinn DQ artment \ \fnrmc\C RI fl Ann PIA rn4 11/1A/9f119 i/ izig 40,1°11bJEFFERSON UNTY CC 5 i 'LICile,c4%rt _',DEPARTMENT OF COMMUNITY DEVELOPMENT'4 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax p www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: NUia Project Description(include separate sheets as necessary): Pe ( leaf Uf-orl cislet_a_c --bc,i Tax Parcel Number: Ci&g 0=a-g'9 Property Size: (acres/square feet) Site Address and/or Directions to Property: /15 0 F(0 re_r?c -e_ c±/ Po r 4 0c,v f 11 erld GU>9 q F i 6, r Property Owner(s)of Record: aka.r(,es ' CP ron rc• c� ,C�a lAj Telephone: 31i' '• 3 5-- qta Fax: email:___S itaw 6e o O(j en"orb Mailing Address: SCt.-/!'l'e 41 a -) c?J c' JJ 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 ❑Building 0 Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) _. ❑ Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a), C(cOr �`* ❑ Manufactured Home ❑ Modular - ❑ Discretionary"D"or Unna Classification__._4_ ❑ Commercial* 0 Special Use(Essential Public Facilities)** Change of Use 0 Boundary Line Adjustment ❑ Address 0 Road Approach_ 0 Short Plat** ❑ Home Business 0 Cottage Industry ❑ Binding Site Plan*' ❑ Propane ❑ Long Plat** 0 3ign 0 Planned Rural Residential DevOq ent(PRRD)/Amendm nts** ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** OF COMMIT' ❑ Stormwater Management 0 Shoreline Master Program Exempflon1Permit Revisions**' ❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development** 0 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 , ich may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further.gr;.- to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review an• • y require. ra spections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the me of the -.• •-tion_ �s r she want r notice. t'Al r ignature: 7 / Date: I I • ` The action o -ctions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endange d species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the "Endan er Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has een 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)e e Iyou are in pliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual 3,and non-tr sf rable res ability for adhering to and complying with the ESA. The Applicant has read this disci imer ignstaud-cletesJt below. ignature: Date: 'G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-O8.doc • • BUILDER STATEMENT The signe of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that ey will b s ing esponsibility of the General Contractor for the proposed project. Signature: Date: __ ` I • I GENERAL RACTOR OR MANUFACTURED HOME INSTALLER: PHCNE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL.: CONTRACTORS LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Fra ne Type: Bathrooms: Z Shoreline: Type of Sewage Disposal: � New Wood Existing: Sewer C Addition El Steel Proposed: Bank / C Community System C Alteration/Remodel ❑ Concrete Total: Height: / ❑ Insiivielual-System ❑ Repair _ ❑ Masonry — SE`P Permit# - _ —61 S�GC LI' �� c 4 Bedrooms: pPIY: C Demolition �, ❑ Other: 5 Setb k: ❑ (.�,((�{ Existing: Private well ❑ Two Party Type of Heat: ch\/2.--- Proposed: blic Total: me 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 o 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: Heat Stove i Cook Stove i Woodstove i Fireplace Insert I Hot Water T.• ' 'ellet Stove I Other Is this appliance being installed in a Manufactured I Mobile Home? Yes I. 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: I , o 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 cis Receipt Number: l 3c) 152 Cash/Check Number: t` ESTIMATED COST(REQUIRED) Date: ' tc I=ems 2 •Fair market value of all labor and materials foundation to finish Initials: C;\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc