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Home My WebLink AboutBLD2011-00211 - RE ROOF flILDING PERMIT APPLICAT BLD11-00211 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD11-00211 Received Date: 8/2/2011 SITE ADDRESS: 1893 S JACOB MILLER RD PORT TOWNSEND, 98368 OWNER: MADELEINE C HOUSTON PHONE: 360-385-1489 PO BOX 751 PORT TOWNSEND WA 98368-0751 IRVING PARK ADDITION SUBDIVISION: Block: 14 Lot: 1-10 PARCEL NUMBER: 963301401 Section: 16 Township: 30 N Range: 01 W CONTRACTOR: INTERLOCK INDUSTRIES INC PHONE: 425-438-8585 1420 80TH ST SW SUITE E EVERETT WA 98203 Contractor's License INTERII020LC Expires 2/6/2013 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION RE-ROOF PALDRONE TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 34,843.00 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 Permit $492.25 LYK 08/02/11 127969 Plan Check $319.96 LYK 08/02/11 127969 APPROVED State Building Code $4.50 LYK 08/02/11 127969 AUG 3 2011 Total: $816.71 Jefferson County Planninc &Building Department BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD11-00211 Received Date: 8/2/2011 SITE ADDRESS: 1893 S JACOB MILLER RD Issue Date 8/3/2011 PORT TOWNSEND, 98368 Expiration Date 8/3/2012 OWNER: MADELEINE C HOUSTON PHONE: 360-385-1489 PO BOX 751 PORT TOWNSEND WA 98368-0751 IRVING PARK ADDITION SUBDIVISION: Block: 14 Lot: 1-10 PARCEL NUMBER: 963301401 Section: 16 Township: 30 N Range: 01 W CONTRACTOR: INTERLOCK INDUSTRIES INC PHONE: 425-438-8585 1420 80TH ST SW SUITE E EVERETT WA 98203 Contractor's License INTERI1020LC Expires 2/6/2013 PROJECT DESCRIPTION: RE-ROOF PALDRONE TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 34,843.00 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: Type Amount Paid By: Date: Receipt: BEDROOMS: BATHROOMS: Permit $492.25 LYK 08/02/11 127969 Exist: Exist: Plan Check $319.96 LYK 08/02/11 127969 Prop: Prop: State Building Code $4.50 LYK 08/02/11 127969 Total: Total: Total: $816.71 Directions to Site: HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED BUILDING INSPECTION HOT-LINE 379-4455. Request must be received by 7 am the day the inspection is needed. Office Hours 9:00 am -4:30 pm MONDAY -THURSDAY HOT LINE AVAILABLE 24 HOURS A DAY Jefferson County Building Dion Permit Num. BLD11-00211 Applicant: HOUSTON BUILDING PERMIT INSPECTION APPROVALS kpplicable Code: 2009 International Building Codes To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection. Requests received after 7:00 AM will not be scheduled for that day's inspections. ELECTRICAL PERMITS are issued by the Washington State Department of Labor&Industries. The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection Inspection Item Date Approval Signature Notes Framing Insulation: Ceiling FINAL INSPECTION 7 S /L (OD FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR i • ' N 6 JEFFERSON COUNTY f "AlDEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend•Washington 98368 360/379-4450. 360/379-4451 Fax www.co.jefferson.wa.us/commdevelopment ,...") t Master Permit Application MLA: ( J- ?&3 J Project Description(include separate sheets as necessary): PALINDROME:Clean existing roofing&Reroof to New Interlock Aluminum Shingles in our Slate design. Flat part of roof(Torch Down)to be torn off&replaced with IB Roofing Membrane Tax Parcel Property Number: I I i Size: (acres/square feet) Site Address and/or Directions to Property: 1893 South Jacob Miller Road, Port Townsend, WA 98368 Property Owner(s)of Record: Madeleine Houston&Daniel Hauptman Telephone:360-385-1489&/or 503-507-3571 Fax: email: Mailing Address: P.O.Box 751,Port Townsend,WA 98368 Applicant/Agent(if different from owner): Interlock Industries,Inc. Telephone:425-438-8585 Fax: 425-438-8577 email: RBLACK@ALROOF.COM Mailing Address: 1420 80th Street SW Suite E,Everett,WA 98203 11at kind of Permit?(Check each box that applies 13uilding ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit ❑Conditional Use[C(a),C(d),or C]** ❑Single Family ❑Garage Attached/Detached ❑Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home ❑ Modular ❑Special Use(Essential Public Facilities)** ❑ Commercial* ❑Boundary Line Adjustment ❑ Change of Use ❑Short Plat**S Site C ❑ Address 0 Road Approach 0 Binding Site P. ❑ Home Business ❑Cottagelndustry ❑Long Plat** ❑ Propane ❑Planned Rural •'--.i.ential Development(PRRD)/ -i.rents** ❑Sign ❑Plat Vacation/At- -tin** ❑Allowed"Yes"Use Consistency Analysis ❑Shoreline Mast,. '�cgra mptiof/F P }it Re . ** ❑Stormwater Management ❑Shoreline Man.,e y ent Substantial Oevelopmen, ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Man-.e".ent Variance ❑Temporary Use ❑Comprehensive Plan It a T• n jl'.' . ..Amendment ❑Wireless Telecommunication* ❑Jefferson Co nty�ibe to mendment ❑Forest Practices Act/Release of Six-Year Moratorium ❑Tree Vegetal Ni NI D_ FLOPMENT *May require a Pre–Application Conference **Requires a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal, if known: DESIGNATION OF AGE T I hereby designate Interlock Industries,Inc. to - • - y a,-nt in matters relating to this application for permit(s). OWNER SIGNATURE ■ h.ii.l. _iA- . al ilk & _. .n_ '/ tlU4— Date: 10/l By signing this application form,the owner/agent attests that the information prov•ed erein,and in any attachments,is true and correct to the best of his,her or it's knowledge. Any material falsehood or any omission of a material fact ade 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 i emplo -es,representatives or agents for the sole purpose of application review and any required later inspections. Staffs access and right of-nt ill be --sumed unless the applicant informs the County in writing at the time of the appl'-•- ion t at e or she .nts prior notice. Signature: L1 i I•_,At _,(14 Wail ��A �r1aV 4,41"--- Date: C The action or actions Applicant will un•ertake as a result of the issuance of this pt it 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 assurance 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 ag;ncy c: file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in compliance with the Jefferson County de - ••me t cod• I he Applicant acknowledges that he,she or it holds individual and non-tran f-rabl- r- popsibilit fpr adh=ring to a r, .mplying wi h th- =S•. •• °pplicant has read this disclaim 9r and signs and dates it below. Signature: AijJ I�1 'W '/ i � � '\�it_... . A Date: /. x..O(t C:\Documents and Settings\carat\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.doc • • BUILDER STATEMENT The signer of this statement does hereby certify that they are the • ner of the parcel referenced herein,that they are not licensed contractors and that they will be assuming th- responsibility of the Gen:-a on- . .r •- •roposed project., /1 I # I . .. �P Date: n�1 7 ' /i)1 X Signature: 1 j_,:-. ' : .ifR 1tJ�� !� , U GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: , PHONE: FAX: Interlock Industries,Inc. ( 425)438-8585 (425 )15b-35"1'7 MAILINGADDRESS: HD) Bem� IN&4ie Et �tf-, w4 98zo3 EMAIL: [1'PL/�C14�A#t,go Or.coM CONTRACTOR'S LICENSE WAINS NUMBER: UBI:601 828 920 NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System 4Z Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well •❑ Two Party Type of Heat: Proposed: ❑ Public Total: Name of System: If this is a Commercial Proiect you must answer the following: Number of Parking Spaces: Current: Proposed: NuniUer of A P rkiny Number of occupants(includes owners,tenants,employees,etc) Current I rte, �_., v Th IBC Occupancy: IBC Type of construction: Will y.0 eve Food Service( Yes / N3 If this is a Propane Tank and/or Appliance Installation permit,mark all items bel. at apply: ❑Underground Tank 0 Above ground Tank Size of Propane Tank: +i 2 r l l ❑Heat Stove ❑Cook Stove ❑Woodstove ❑ Fireplace Insert ❑Hot Water Tank 1 r-llet Stove ❑Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / No i When applying for a permit to install a propane tank you must also submit a site plan showifti,EB9000104bluildings,all property lines,tank location and size,distances from the propane tank to all property lines,bg( irtff[ yqgygftpomponents, including the reserve area. ' ' Square Footage Current Proposed For Office Use nly... ,„ Amount Revision Main Floor Heated EH Bld App Review: 2n°Floor Heated . Consistency Review: Other Heated Base fee: /f f� a5 Mezzanine Additional Section: `��'�j Heated Basement Plan Check fee: Unheated Basement , State Surcharge fee: o Other Unheated "', Pot Water Review fee: Garage/Carport ° ° ' SUBTOTAL Decks = 911/Rd Approach fee: Other TOTAL: $ ?l , .7 Receipt Number: 1 219 Cash/Check Number: lacT1 EVINAlil5 COST(REQUIRE Date: •Fairrierkeall lati"orand materials foundation to finish 3 �5561'S Initials: I r C:\Documents and Settings\caral\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.doc Contractors or Tradespeople Prinirriendly Page Page 1 of 2 General/Specialty Contractor A business registered as a construction contractor with LEI to perform construction work within the scope of its specialty.A General or Specialty construction Contractor must maintain a surety bond or assignment of account and carry general liability insurance. Business and Licensing Information Name INTERLOCK INDUSTRIES INC UBI No. 601828920 Phone 4254388585 Status Active Address 1420 80Th Street Sw,Suite E License No. INTERI1020LC Type License T e Construction Contractor City Everett Effective Date 6/3/1998 State WA Expiration Date 2/6/2013 Zip 98203 Suspend Date County Snohomish Specialty 1 General Business Type Corporation Specialty 2 Unused Parent Company Other Associated Licenses Specialty Specialty Effective Expiration License Name Type Status 1 2 Date Date AMERIER014JKAMERICAN EVERLAST Construction General Unused 4/12/1999 12/31/2000 Archived ROOFING CO Contractor INTERSR110RKINTERNATIONAL Construction General Unused 12/12/1989 12/31/2000 Archived SUPER ROOF LTD Contractor Business Owner Information Name Role Effective Date Expiration Date WENZEL,MARK President 12/20/2004 WENZEL, IVOR Vice President 06/03/1998 01/10/2005 Bond Information Bond Bond Company Name_Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date 2 GENERAL INS CO OF 6119361/VM000300200901/15/2002 Until Cancelled $12,000.0001/17/2002 AMERICA Assignment of Savings Information No records found for the previous 6 year period Insurance Information Insurance Company Name Policy Number Effective Date Expiration Date Cancel Date Impaired Date Amount Received Date NATIONAL 9 UNION FIRE INS GL5836199 02/01/2010 02/01/2012 $2,000,000.0001/13/2011 OF PA NATIONAL 8 UNION FIRE INS gl5836199 02/01/2009 02/01/2010 $2,000,000.00 02/06/2009 OF PA AMERICAN 7 HOME GL5836199 02/01/2008 02/01/2009 $2,000,000.00 02/05/2009 ASSURANCE CO • AMERICAN 6 HOME RMGLA2507311 02/01/2004 02/01/2008 $1,000,000.0002/05/2007 ASSURANCE CO Summons/Complaint Information Cause County Complaint Judgment Status Payment Paid By 06-2-05586-1 KING Date:01/23/2007 Dismissed Date: Date: STEPEN Et MELINDA SCHMEISING Amount: $0.00 https://fortress.wa.gov/lni/bbip/Print.aspx 8/2/2011