HomeMy WebLinkAboutBLD2014-00146 BUILDING PERMIT APPLIC*ION BLD14-00146
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD14-00146 Received Date: 4/28/2014
SITE ADDRESS: 61 SIMCOE RD
PORT TOWNSEND, 98368
OWNER: R RONALD DIONNE PHONE: 360-385-3363
PAMELA MOORE DIONNE
PO BOX 1820
PORT TOWNSEND WA 98368-0219
SUBDIVISION: Block: Lot: T 27+
PARCEL NUMBER: 001324010 Section: 32 Township: 30 N Range: 01 W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2014
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI INSTALL 500 GAL PROPANE TANK UNDERGROUND.
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 2012 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 $228.00 MEB 04/28/14 148585
Total: $228.00
APPROVED
Jefferson County JCS
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�q�"" °G� JEFFERSON COUNTY % ',t�� (� ..- )j1 f
~ ARTMENT OF COMM TY DEVELOPMENT
k �: ►'� 611�Sheridan Street 1 Port Townsend,WA 98368 I Web: , .co.iefierson.wa.usJcommunitvdeveiopment
�d' rx°t° Tel:360.379.4450 I Fax:360.379.44511 Email:dcd(c co,jefferson.wa.us
Building Permits&Inspections j Development Consistency Review!Long Range Planning j Watershed Stewardship Resource Center
Master Permit Application MLA:
Project Description(include separate sheets as necessary):
500-92.1. 1 n-11-o u.v.,A preioain e 4a.v.V .trtsfe.tU n f (of Si ITIcOP'R A i Fort Toc�nser►r1 LJA 98348
Tax Parcel Number. 00 1 32 4 0 1 O Property Size: (acres/square feet)
Site Address and/or Directions to Property:
to l S t •v Co a Po r+ Tt�1,DY%ISEY4 Lip A R S'3(o8'
Property Owner(s)of Record: iv Mono (A 4 R e I - Yll ocr e_ T)t on r e
Telephone: 40-,�3 85-3'3k:,5 Fax: email: �rn 4i ytyt � ri.ctsn
Mailing Address: VO ?o)( 8Q,6 Port Tbt.NVtSPY1d) (,JA '? 36 g
J
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address: (� �, a r'
What kind of Permit?(Check each box that applies ❑Lot or Road Segregation [ (L [ I V�/y !E
wilding ❑Critical Areas Stewardship Plan
❑ Demolition Permit ❑Variance(Minor, Major or Reasqr-• conomic Use)
❑Single Family ❑Garage Attached/Detached ❑Conditional Use[CO),C(d),or C] APR 2 8 2014
❑ Manufactured Home ❑ Modular ❑Discretionary"D"or Unnamed Us. •I:.sification �y
❑ Commercial* ❑Special Use(Essential Public Fa ; -1 ** —/
❑ Change of Use I ❑Boundary Line Adjustment
❑ Address ❑Road Approach ❑Short Plat** JEFFERSON COMMUNITY COUNTY
DEVEL
❑Home Business ❑Cottage Industry ❑Binding Site Plan** DEPT.OF COMMUNITY OEVEIOPMEN!
%Propane ❑Long Plat**
❑Sign ❑Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration**
❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions**
❑Site Plan Approval Advance Determination(SPAAD)* . ❑Shoreline Management Substantial Development**
Temporary Use ❑Shoreline Management Variance
Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendment
❑Forest Practices Act/Release of Six-Year Moratorium ❑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. Staff's access and right of entry will be assumed unless the applicant informs t County in writing at the
time of Signatu e: O �Q- he/ wa'pror Date: t 2 /q
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 S.- Ad"or"ESA"Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this
permit has been will not violate the ESA Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
actions even'r • are in compliance with > - County development code.The Applicant acknowledges that he,she or it holds individual
and not : -- _. v. `' ' for.. - ."and .ying with the ESA The Applicant has read this.'.> '_ - and and d: - it below.
Signature: ice,/t/fe / f.i°i / / ` �i %/ Date: 7 i e
07/24/2013
BUILDER STATEMENT
The signer of this statement does hereby they are the Owners of the parcel referenced herein they are not licensed contractors and that
they will be ing the responsibility of the ral Contractor for the proposed proj-w
Signature: Vi i; `�7f'e`�7 I�Zd1�itE. Date: Al.i /
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX
( ) (
MAILING 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:
❑ New ❑ Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank ❑ Community System
El 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 Comlpercla)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 / No
,,, If a Pro ne Tank and/or Appliance Installation permit,mark all items below that apply:
round Tank Above ground tank Size of Propane Tank: „bo a.i lens
Heat Stove hook Stove Woodstove Fireplace.nsert re tO I evotSt lleP I knaT retaWtoH I
Is this appliance being installed ufactured/Mobile Horne? 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 properly
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:
2"°Floor Heated Consistency Review:
Other Heated Base fee:
Mezzanine son: / 1- O p
Heated Basement Plan Check fee: Z2-S)/ CP
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL n r f � 00
Decks 911/Rd Approach fee: p( 7 ,
Other TOTAL: $c.._2.(17, 'Ja
Receipt Number: IL/ • eS
Cash/Check Number: /1 q� ti.
ESTIMATED COST(REQUIRED) Date: ye_�•Fair ?0 do ITOY and materials
i_ein k 4 ininp n l i�1,f 13..j 1 Initials:
!Y7/OA P1,111
03/05/14 1 1
�• . SUNSHINE PROPANE PROPOSAL & CO'NTRACT,
EwaQuality Heating Services since 1980
Pa 10853 Rhody Dr. Port Hadlock, WA. 98339
(360) 385-5797 Lic # SUNSHP*077QP
CUSTOMER I RON & PAM DIONNE PROJECT NAME TANK & PIPING
ADDRESS P.O. BOX 1820 LOCATION 61 SIMCOE RD.
CITY, ZIP i PORT TOWNSEND, WA. 98368 CITY SAME
PHONE 385-3363 Contract Prepared by DAVE LEMLEY
CONTACT PERSON RON & PAM
SCOPE OF WORK:
1. Supply and install a 500 gallon underground propane tank in the specified location
with mastic coating, ENKA-DRAIN tank wrap, 17 pound magnesium anode, gas
regulator, tank connector and concrete blocks for placement. The tank will be
delivered and placed in a supplied 5'x5'x12' excavated hole. Initial cathodic tank
protection readings will be taken and again after one year form the installation date.
Installed Price $ 2510.00
2. Install a gas distribution line from the new tank location to the existing gas line next
to the house using 3/4" polyethylene and ditch tape in a supplied minimum 12" deep
trench. Put the line on test for an inspection then return and connect the new line
to the existing one. Complete a gas system safety check.
Installed Price $ 290.00
Note: The existing fuel in the 120 tanks will be transferred into the new tank.
ITEMS NOT INCLUDED: Unless soeciflcaliy included in the contract above.
1. Removal or repair of items obstructing the installation(Including but not limited to: Furniture,appliances,wood stoves or chimney
cleaning).
2. Clearing brush,plants,and limbs or excavating for piping,tank locations,or burial.
3. All 110Volt electrical wiring.
4. Testing,removal,and disposal of materials containing asbestos or any other hazardous materials,as defined by the EPA.
5. Repair of concealed underground utilities not located on prints or physically staked out or exposed,that are damaged by
installation. We can coordinate a line locate service before our trench work,and the customer agrees to pay any charges for the
line locate service,if any.
RETURNS:
1. Special order items refused by customer after they have been shipped from our supplier are subject to a fee of 10%of
installation price.
2. Products are subject to slight variations in appearance from product literature or display models(color,flames,finish,controls)
3. Sunshine Propane is not responsible for manufacturer's specification changes made without notification.
03/05/14 2
SUNSHINE PROPANE PROPOSAL & CONTRACT
Quality Heating Services since 1980
10853 Rhody Dr. Port Hadlock, WA. 98339
(360) 385-5797 Lic # SUNSHP*077QP
CUSTOMER: RON & PAM DIONNE Contract Prepared By:DAVE L.
ITEMS ACCEPTED FROM PG 1: #]. #2 #3 #4 #5 A B C D E
CONTRACT SUBTOTAL OF ITEMS ACCEPTED FROM PAGE 1: $ 290.00
PROPANE TANK: 500 U.G. gal. PURCHASED A.S.M.E. TANK $ 2510.00
A Permit is required for this work. jurisdiction: JEFFCO BY OWNER
•
TOTAL PROJECT PRICE (Does not include sales tax) $ 2800.00
1ST FUEL DELIVERY: 250 Gals @ $2.90 /Gal for FIRST FILL (PriceSubject to change) •
ALL PROPANE DELIVERIES WILL BE ON A KEEP FULL BASIS.
TERMS & CONDITIONS:
Alt work is to be completed in a professional manner according to industry standards or better. All our work is
unconditionally guaranteed for one year from install. We do not assume liability for any failure of any product not
manufactured by us. This proposal is based on documents and information provided by the customer;any changes to
or omissions within these documents which require alteration of these specifications may significantly change the
project total from this-proposal. All agreements are contingent upon conditional factors (strikes, accidents,site
conditions,delays,etc.) which are beyond our control; additional charges may be necessary in such an event. Any
alterations or deviations from specifications involving extra costs will be executed only upon written orders,and will be
an extra cost over and above this proposal.Customer will carry fire and other necessary insurance. Our workers are
fully covered by Workman's Compensation Insurance.
Customer shall defend,indemnify,and hold harmless the Contractor, and its subcontractors,from and against any and
all claims, demands, causes of action,damages, liabilities, losses, and expenses arising from the project and/or the
contract to the extent caused by the fault of Owner or its consultants,design professionals, or agents.
DAVE LEMLEY 03/05/2014
Authorized Sunshine Propane Signature: Date of Offer
Proposal may be withdrawn if not accepted within 60 Days of Offer
ACCEPTANCE OF PROPOSAL.:
The above prices, specifications, and conditions are satisfactory and are hereby accepted. You
are authorized to order, deliver and install materials as specified.
Deposit: 20% at time of contract acceptance $ WAIVED,
Balanc:: Due and payable within 10 days of billing date
:ill' •• I voi in ph - based upon percent completion method
ustomer's Signature Da a of cceptance •
NOTICE TO CUSTOMER: The enclosed "Disclosure Statement- Notice to Customer" is part of this
contract. It must be signed and returned to Sunshine Propane with the contract acceptance.
Return One Copy of pages 3. & 2 with initials, signature & deposit. and return the
Notice to Customer. Call to schedule.
Department of Labor and Indu
DIS OSURE STATEMENT
Construction Compliance . CE TO CUSTOMER
This contractor is registered with the state of Washington, registration no.SUNSHP*077QP , and
has posted with the state a bond or deposit of $12,000.® for the purpose of satisfying
claims against the contractor for breach of contract including negligent or improper work in the conduct
of the contractor's business. The expiration date of this contractor's registration is
November 17,2014
THIS BOND OR DEPOSIT MIGHT NOT BE SUFFICIENT TO COVER A CLAIM THAT MIGHT
ARISE FROM THE WORK DONE UNDER YOUR CONTRACT.
This bond or deposit is not for your exclusive use because it covers all work__performed by this contractor.
The bond or deposit is intended to pay valid claims up to $12,0000 that you and
other customers,suppliers, subcontractors,or taxing authorities may have.
FOR GREATER PROTECTION YOU MAY WITHHOLD A PERCENTAGE OF YOUR,
CONTRACT
You may withhold a contractually defined percentage of your construction contract as retainage for a
stated period of time to provide protection to you and help insure that your project will be completed as
required by your contract.
YOUR PROPERTY MAY BE LIENED,
If a supplier of materials used in your construction project or an employee or subcontractor of your
contractor or subcontractors is not paid,your property may be liened to force payment and you could pay
twice for the same work.
FOR ADDITIONAL PROTECTION YOU MAY REOUEST THE CONTRACTOR TO PROVIDE
YOU WITH ORIGINAL "LIEN RELEASE" DOCUMENTS FROM EACH SUPPLIER OR
SUBCONTRACTOR AT YOUR PROJECT.
The contractor is required to provide you with further information about lien release document if you
request it. General information is also available from the state Department-of Labor and Industries.
I have received a copy of this disclosure statement.
t as
Dated day of ; of the year , I .
*41( 4' " eZ2
Signature of Customer
The contractor must retain a signed copy of the disclosure statement in his or her files for a minimum of
three years, and produce a signed or electronic signature copy of the disclosure statement to the
department upon request.
F625-030-000 model disclosure statement notice to customer 09-2007
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MECHANICAL AND DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT#: BLD14-00146 Received Date 4/28/2014
SITE ADDRESS: 61 SIMCOE RD Issue Date 4/28/2014
PORT TOWNSEND, 98368
APPLICANT: R RONALD DIONNE PHONE: 360-385-3363
PAMELA MOORE DIONNE
PO BOX 1820
PORT TOWNSEND WA 98368-0219 T 27+
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 001324010 Section: 32 Township: 30N Range: 01W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339 (360 385-5875
Contractor's License SUNSHP*077QP Expires 1T/1 92014
OWNER, R RONALD DIONNE PHONE: 360-385-3363
if different: PAMELA MOORE DIONNE
PO BOX 1820
PORT TOWNSEND WA 98368-0219
PROJECT DESCRIPTION: INSTALL 500 GAL PROPANE TANK UNDERGROUND. 1
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 4/28/2015.
REQUIRED INSPECTIONS:
Installation per Manufacturer Specifications/CO2: i
Tank/Line/Appliance: T4cs)Z. °1?ki L-MJ4 .411.11/
Final Approval: C/2-ii4/
BUILDING INSPECTION HOT-LINE 379-4455.
REQUESTS MUST BE RECEIVED BY 3 PM THE DAY BEFORE THE INSPECTION IS NEEDED.
Office Hours 9:00 a.m. -4:30 p.m. Monday-Thursday
HOT LINE AVAILABLE 24 HOURS A DAY
\\tidemark\data\forms\F_BLD_Permit_Propane.rpt 4/28/2014