HomeMy WebLinkAboutBLD2013-00155 • BLD13-00155
BUILDING PERMIT APPLICIPION
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD13-00155 Received Date: 5/20/2013
SITE ADDRESS: 4397 DISCOVERY RD
PORT TOWNSEND, 98368
OWNER: PENNIE P LE FEBVRE PHONE: 503-550-2637
8292 SW 67TH PL
PORTLAND OR 97223-1340
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 001321021 Section: 32 Township: 30 N Range: 01 W
CONTRACTOR: STEWART EXCAVATING PHONE: 360-385-2220
100 2ND ST
PORT HADLOCK WA 98339
Contractor's License STEWAE*9340M Expires 9/14/2013
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION DEMO M/H
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP DEM 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 By: Date: Receipt: Approved/Date
Permit $76.00 JLA 05/20/13 142100
State Building Code $4.50 JLA 05/20/13 142100
Total: $80.50
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Contractors or Tradespeopleeter Friendly Page • Page 1 of 1
General/Specialty Contractor
A business registered as a construction contractor with LE/I 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 STEWART EXCAVATING UBI No. 602761417
Phone 3603852220 Status Active
Address 100 2Nd St License No. STEWAE'9340M
Suite/Apt. License Type Construction Contractor
City Port Hadlock Effective Date 9/14/2007
State WA Expiration Date 9/14/2013
Zip 98339 Suspend Date
County Jefferson Specialty 1 Excavation, Grading And Land Clearing
Business Type Individual Specialty 2 Unused
Parent Company
Business Owner Information
Name Role Effective Date Expiration Date
STEWART,MARK E Owner 09/14/2007
STEWART,AMY SUE Spouse 09/08/2011
Bond Information
Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date
1 CBIC SH5203 09/12/2007 Until Cancelled $6,000.00 09/14/2007
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
6 Underwriters at PFK0422673 09/12/2012 09/12/2013 $1,000,000.00 09/11/2012
Lloyds
5 Underwriters at PFK0422672 09/12/2011 09/12/2012 $1,000,000.00 09/06/2011
Lloyds
4 UNDERWRITERS PFK0422671 09/12/2010 09/12/2011 $1,000,000.00 09/08/2010
AT LLOYDS
3 UNDERWRITERS PFK042267 09/12/2009 09/12/2010 $1,000,000.00 08/20/2009
AT LLOYDS
2 UNDERWRITERS PFK040051 09/12/2008 09/12/2009 $500,000.00 09/02/2008
AT LLOYDS
1 UNDERWRITERS PFK037540 09/12/2007 09/12/2008 $500,000.00 09/14/2007
AT LLOYDS
Summons/Complaint Information No unsatisfied complaints on file within prior 6 year period
Warrant Information No unsatisfied warrants on file within prior 6 year period
Infractions/Citations Information No records found for the previous 6 year period
https://fortress.wa.gov/lni/bbip/Print.aspx 5/20/2013
°N co . %L9 ( ;'�l`js
w t, JEFFERSO COUNTY
Wr.' DEPARTMENT OF COMMUNITY DEVELOPMENT
"' 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
. c www.co.jefferson.wa.us/commdevelopment
SIN
Master Permit Application MLA:
Project Description(include eparate sheets fp necessa
OtAA"O c N: 0 todk LI 1.... WI 40:;‘k .E... k 0m e a a " fr_po,......±/,it ,.
Tax Parcel Number: n / / 0 ___Property Size: 0 r,s-3 I (acres/square feet)
Site Address and/or Directions to Property:
7 c.v t ( d �wvt�-C �
c1 [ll f�-
Property Owner(s)of Record: `C N t°. e b v r-e--
Telephone: • _' 0-- _ - Fax: email: r e 'e f v r
Mailing Address: ia c7 a c-vi 6 7 J�/ Ur� �t C, 2'7)13 c,(jwtc 15 , A et
Applicant/Agent(if different from owner): �"�'v i c_t. . L-t F----c- `l rt l l
Telephone: 1b3 /� 696.3 Fax: 140 i/� k-- email: IDa+. ("� ^1 er�b vr-e.
Mailing Address: 5.4.t. t ' c C1 Wl.. C 01
What kind of Permit?(Check each box that applies ❑Lot or Road Segregation
❑Building ❑Critical Areas Stewardship Plan
Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use)
'o Single Family El Garage Attached/Detached ❑ Conditional Use[C(a),C(d),or Cj**
❑ Manufactured Home .❑ Modular - ❑ Discretionary"D"or Unnamed Use Classification
❑ Commercial* ❑Special Use(Essential Pub I c
• Change of Use ❑ Boundary Line Adjustment 1 E
❑ Address ❑ Road Approach_ ❑Short Plat** J
❑ Home Business El Cottage Industry ❑ Binding Site Plan** i
❑ Propane pane ❑ Long Plat** it I p r A�(y ,
❑ Sign ❑ Planned Rural Residential; vielp m RR-n Arl ime
❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration**I 0
❑ Stormwater Management ❑Shoreline Master Program Exe • --•-•' r- . 'ins**
❑ Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substa� DK/ It1NTY
❑Temporary Use ❑Shoreline Management Varian uF COMMUNITY DEVELOPMENT
❑Wireless Telecommunication* ❑ Comprehensive Plan/UDC/Land Use District Map Amen me
❑ 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:
it r-" GNATION OF AGENT
I hereby designate ; K. ■r` c- L/. J��� ►✓tact as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE / r �%�'� 1i�V ' -- Date: 4° 2-1 -13
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 applicaf n that he or stie lief nt prior notice.
Signature: tIA,yaP �/ Date: Z i
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-transferal responsibility �r eri t and complying with the ESA. The Applicant has read this disclai and d sins and dates it below.
��
Signature: � t.( Date: t-��
r.,n_.__:.!`__.__\444444Vrlo X XC444414.\non ClnD 11 IC\r..--.To TN D_..Y-\T/ n..__:.n__l:__.___c no nO J__
III •
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 OR MANUFACTURED HOME INSTALLER: PHONE: Fax:
j . Gh ( ) ( )
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
❑ Alteration/Remodel ❑ Concrete Total: _ Height: ❑ Individual System
❑ Repair ❑ Masonry SEP Permit#
jmolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type of Heat: Proposed: ❑ Public
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 Pro•ane Tank and/or A A.•liance Installation •ermit mark all items below that a••I :
I Underground Tank i Above ground Tank Size of Propane Tank:
1 Heat Stove i Cook Stove i Woodstove 1 Fireplace Insert 1 Hot Water Tank i 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 Bld App Review: 1 ii, 00
Floor Heated Consistency Review:
Other Heated Base fee: 1 -,
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee: ,J•
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL
15$«5o
Decks 911/Rd Approach fee:
Other TOTAL: $ \51s,
SO
Receipt Number: 1 L4 'u Cr<5
Cash/Check Number: 1
ESTIMATED COST(REQUIRED) Date: s" �
1 _1
.Fair market value of all labor and materials foundation to finish � _
Initials:
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III • D� r_
gEGION CLE;q Olympic Region Clean Air Agency
;4•c " D MAY 2 0 2013
•�y 2940-B Limited Lane NW 1
• Olympia,WA 98502 i.i
K; (360)539-7610•FAX(360)491-6308 •
Port Angeles office(360)417-1466 orr
De ol�.ti t
�'..c, ORCA.A ,�J`~'' Raymond Office(360)942-2137 i_ DEPT F COMMUNITY DEVELOPMENT
y
,is 6::f, •iiifibS0i1•!R15��'••F:�: WWW.ORCAA.org
•
[ I Commercial Structure—Permit fee: $60.00—10 working day wait period
X Owner occupied residential dwelling—Permit fee: $35.00—Prior Notice
LEI e-•(-04 -a.V14
PROPERTY OWNER r
Name: ( ,� ( Phone:iii , ,5/O Email• F v
r C V\.V i Q. L----6. ! �' b VI 1r.e. FAX: ( )r'l V Vim'- Mobiledb 3 Th g_ 137
Mailing Address: City: , State: Z47;Q3
: 1
81.q .5vf 4 pi `�Ja�--V1 a4
Site Address: City-, State: Zip:
y, 9 7 ° .s bc) ti-e..17 72t.P 2 4 c�- l ow es: C
DEMOLITION CONTRACTOR[ 1 Check if same as property owner information l,
Busines Name: _ Phones L� gjr a, ,i^: Email: 51W v -eic i1&1`!�'
51 t 41/-
V V / K CA 1)&2421 LL FAX: ( ) ed �• Le,
On ' Con ct: Phone‘.O Sc olga0 Mobile ( ) ]
/ `'fi� =� S IAT a r+ FAX: ( ) 360 36
Mailing Address: State: Zi :
/0 0 a'.G( 5-1-- &'f]-1-�'J I. u c , ` o 4- ii 33
DEMOLITION INFORMATION
#of Structures being demolished: Start Date: aL 0j Completion Date:
p e Survey �� � ? _ ,3a — /3 •
Asbestos resent Yes _No Sury attach Yes _No Has all identified asbe tos been
removed Yes 2Nq
1-604 D u e- 45.l 5 S v k co �-,a r-a b‘`f. �o . �u t-" —13 "13
D MOLITION PROJECT CATEGORY C we t F94. W. el -e.r.-e S 'e.x. �i°- t - 13
Complete Demolition l4- ) - f ,. q- j �-2
]Training Fire-Fire Agency: I
[ ]Renovation,Alteration,Remodeling,Maintenance,or other Construction (4 Y' /OAS t3 S V4--44A-0 V e 4
[ ]Emergency-Additional Fee of$50.00(must be accompanied by Govenen'�Ordered Declaration-Commercial only)
cy nm
I have read and will abide by the conditions set forth in this permit and any addendum thereto. I do hereby certify that
all identified asbestos has been removed and the information in this application and supplemental data described herein
is, to the best of my knowledge, accurate and complete.
t)ej VI nte. Le, e.,16V-re, PeiMike-' '43 tharie--- Li-21 --13
Applicant Name Signature Date ct� «c;a
3
e o' ed Payment Info. [4 Approved Asbestos Permit
� [ ] Cash [ ] Disapproved Permit# 13 ASB00 3tle1
[ heck # (( Demolition Permit
APR 2 3 2013 [1C Credit Card 43- Review date: S / IS/0 Permit#13 DEM0034(c)
Receive date: L/?i`? Reviewed by: r /g
(W y LJ ly Agency Use Ony Agency Use Only Agency Use Only
10/21/68 — OVER
0 •
DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT#: BLD13-00155 Received Date 5/20/2013
SITE ADDRESS: 4397 DISCOVERY RD Issue Date 5/21/2013
PORT TOWNSEND, 98368
APPLICANT: PENNIE P LE FEBVRE PHONE: 503-550-2637
8292 SW 67TH PL
PORTLAND OR 97223-1340
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 001321021 Section: 32 Township: 30N Range: 01W
CONTRACTOR: STEWART EXCAVATING PHONE: 360-385-2220
100 2ND ST
PORT HADLOCK WA 98339
Contractor's License STEWAE*9340M Expires 9/14/2013
OWNER, PENNIE P LE FEBVRE PHONE: 503-550-2637
if different: 8292 SW 67TH PL
PORTLAND OR 97223-1340
PROJECT DESCRIPTION: DEMO M/H
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 5/21/2014.
REQUIRED INSPECTION:
FinalApproval: 5 f 741tt
BUILDING INSPECTION HOT-LINE 379-4455.
REQUESTS MUST BE RECEIVED BY 3 PM THE DAY BEFORE THE INSPECTION IS NEEDED. 1
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 5/21/2013
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JEFFERSON
DEPT.OF COMMUNITY DEVELOPMENT
GRAPHIC SCALE
3 15 30 60
( IN FE r )
S' l l �- 1 inch = 30 ft.
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SON c,, JEFFERSON COUNTY
. .a ; J DEPARTMENT OF COMMUNITY DEVELOPMENT
Date: S-(=/6o Time Received: 12 A( ame0 Mon. Tue. Wed. Thur. Fri.
Date: 51 2..../ 0 e 22- v r2'
BLD: f' 5'3 Contact Name:
Owner: Contact Number: 360 Lt-7" 30$2.q 7 '
Address: 7140 I , (J _c 206
Notes: _- 40010
Foundation Plumbing Framing Propane Tank Mechanical
Setbacks Under-ground Framing Under ground Furance
Footing Rough In Air Seal Above ground Gas
Stemwall Hydronic Exterior shear Exterior lines Oil
Straps Hot Water Htr Interior shear Interior lines Ducts
Post Hole Ventilation Appliance
Underfloor Gas/Wood stove
Man-Homes Insulation
Final Inspection
Setbacks Floor
Foundation Wall Address Posted
Block&Tile Ceiling
1
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