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HomeMy WebLinkAboutBLD2014-00124 likUILDING PERMIT APPLICAN BLD14-00124 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00124 Received Date: 4/9/2014 SITE ADDRESS: 190 CHERRY AVE CHIMACUM, 98325 OWNER: KAREN C STARLING PHONE: 190 CHERRY AVE CHIMACUM WA 98325-9755 IRONDALE ORCHARD TRACTS SUBDIVISION: Block: Lot: PARCEL NUMBER: 963000203 Section: 10 Township: 29 N Range: 01 W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2014 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION REPLACING 120 GAL PROPANE TANK TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC 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 $152.00 JLA 04/09/14 148564 APPROVED OVED Total: $152.00 G Jefferson County DCD \\tidemark\data\forms\F_BLD_App_Bld.rpt 4/9/2014 &-D 1 a - ( (isoN el 6. JEFFERSOtOUNTY � DEPARTMENT OF COMMUM T Y DEVELOPMENT 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 . 360/379-4451 Fax �yyS, N��Q www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Project Description(include separate sheets as necessary): ' ■GR-fr s 2 l a yu ,.n..e._.. ---c-t.A...(1_ . Tax Parcel Number: i G'J a b(' A,0� Property Size: (acres/square feet) Site Address and/or Directions to Property: 1 qo CI F rt 2 y AVE ivC/F C11m/fAcC/4t, G//9 18-3 c Property Owner(s)of Record:_ j9 i2 F.,0 S /g.iZL(,?V Telephone: Fax: email: "-0-CA-e-?o('cila Mailing Address: Applicant/Agent(if different from owner): t, Telephone: Fax: email: Mailing Address: — What kind of Permit?(Check each box that applies ❑ Lot or Road Segregation J Building ❑ Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family ❑Garage Attached/Detached ❑ Conditional Use[C(a),C(d),or C]** ❑ Manufactured Home .❑ Modular ❑ Discretionary"D"or Unnamed Use Classification 0 Commercial* ❑ Special Use(Essential Public Facilities)** ID Change of Use ❑ Boundary Line Adjustment ❑ Address ❑ Road Approach ❑Short Plat** ❑ Home Business ❑Cottage Industry ❑ Binding Site Plan** %Propane ❑Long Plat** viyn ❑ Plannea Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis ❑ Plat Vacation/Alteration** ❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions** ❑Site Plan Approval Aavance 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. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applic- on that he or s e wants,prior notice. Signature: )1:____ __...;,'r Vq° �'//, Date: / `� The action or actions Applicant will undertake 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-transf r le responsi•ill • -••- • to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: 5 ke /V / Date: G:\PermitCenter\###FORb1S###\DRD FORMS\Current DRD Fnrmc\Mach,~n,.,,,:h a.,,,r.,-„.;,,.,S_oo_11Q a,.- 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: !. - C. /IF , _ _ Date: / - ? f' GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: P,ICNE: Fax: c• ( ) ( ) 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: E New ❑ Wood Existing: I C Sewer Li Addition ❑ Steel Proposed: Bank ❑ Community System C Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry — SEP Permit# _ C 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 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:A IBC Type of construction: Will you have Food Service? Yes / No If this is a Propane Tank andlgr Appliance Installation permit,mark all items below that apply: i ••- • • d Tank i @lwveground Tan Size of Propane Tank: f d.o 44 C.Ca,v i Heat Stove i Cook Stove i Woodstove i Fireplace Insert i Hot Water Tank I Pellet Stove ! 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: 2`°Floor Heated Consistency Review: Other Heated Base fee: l ^ " Mezzanine Additional Section: J'.6 "' Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL l f OD Decks 911/Rd Approach fee: Other TOTAL: $ Receipt Number: /L/g5(0L/ Cash/Check Number: r1 5c1 ESTIMATED COST(REQUIRED) Date: /i 'Fair market value of all labor and materials foundation to finish Initials: G:\FermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc S • Cm 7 cc S"` Screen : 01 REAL PROPERTY MASTER Mode : INQUIRY Parcel # 000963000203 It Cd 290110404211 • Auto Roll : OFF IRONDALE ORCHARD TRACTS Nbhd Cd 4238 BLK 2 LOT 10 Loc ID * Taxpayer Cd STAR 2875 STARLING, KAREN C T/P Chg Dt 4/10/2009 * Title Owner T/P Chg Usr JA Tax Code 0211 Status TX TAXABLE Land Use 1101 MANU HM W/LN Affidavit 112675 Vol/Page / C/U Code COMPLETE ADDRESS WINDOW Taxpayer STAR2875 KAREN C STARLING 190 CHERRY AVE CHIMACUM WA 98325-9755 Search Key CMD 6 : End Window CMD 7: End of Job CHSINC Page l of l • • C) Washington State Department of Labor & Industries CHSINC Doing business as RT 1 BOX 60 CHSINC CONCRETE, WA 98237 WA UBI No. A37 085 200 Workers' comp Do you know if the business has employees? If so, verify the business is up-to-date on workers'comp premiums. L&I Account ID Account is closed. 370,852-00 Doing business as CHSINC Estimated workers reported N/A L&I account representative T2/SUSAN BETTS (360)902-4828-Email: BETT235 @lni.wa.gov Workplace safety and health No inspections during the previous 6 year period. ©Washington State Dept,of Labor&Industries.use of this site is subject to the laws of the state of Washington. AllikWashingtoe ' °,:=,a blYr°E Layx,.fs,r3esttE'si4f*.w;1.., https://secure.lni.wa.gov/verify/Detail.aspx?UBI=A37085200&SAW= 4/9/2014 S 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#: BLD14-00124 Received Date 4/9/2014 SITE ADDRESS: 190 CHERRY AVE Issue Date 4/10/2014 CHIMACUM, 98325 APPLICANT: KAREN C STARLING PHONE: 190 CHERRYAVE CHIMACUM WA 98325-9755 SUBDIVISION: IRONDALE ORCHARD TRACTS Block: Lot: PARCEL NUMBER: 963000203 Section: 10 Township: 29N Range: 01W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2014 OWNER, KAREN C STARLING PHONE: if different: 190 CHERRYAVE CHIMACUM WA 98325-9755 PROJECT DESCRIPTION: REPLACING 120 GAL PROPANE TANK 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 4/10/2015. REQUIRED INSPECTIONS: Installation per Manufacturer Specifications/CO2: Tank/Line/Appliance: Final Approval: 4-) /(f 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 4/10/2014 • 0 MANUFACTURED/MOBILE • u ∎STALLATION PERMIT Jeff`,;.:--_:--fi- •. - • -: - .. •. Development - _ - --_- .. A A • •-68 (360)379-4450 'i. - .; •=__1 PERMIT#: BLD14-00124 Received Date: 4/9/2014 SITE ADDRESS: 190 CHERRY AVE Issue Date: 4/9/2014 CHIMACUM, 98325 APPLICANT: KAREN C STARLING 190 CHERRY AVE CHIMACUM WA 98325-9755 SUBDIVISION: IRONDALE ORCHARD TRACTS _,_._.------~-------Bieck, Lot: PARCEL#: 963000203 S tidn:-- 10 Township: 29 N Ran : 01 W CONTRACTOR/ C H S INC PHON (360)732-4585 DEALER PO BOX 51 AUBUR f A 98071-0518 Con actor's Lice., - CHSIN**97 OZ E ires 9/7/2014 PROJECT DESCRIPTIO R • . A• 1 AL PRPANE NK i` MAKE: YEAR. SIZE: D --e irections To Site: To schedule ins)ections, call (360)379-445 later than 3:00 PM e day befo - the inspection is needed. Requests recei ed after 3:00 PM will not be duled for the next days insp tions. Office Hours 9: 0-4:30 MONDAY-THURSDA ELECTRICAL P RMITS are issued by the Washington State Departme of Labor& Industries. The electrical pe it must be signed off by the/State Inspector prior t• e County's Framing Inspection Inspection Item Date Ap val Signature No -s A final inspection will not be scheduled until all of the following are completed and signed off by the applicable Department: • Building Permit Conditions are met • Septic Permit Final/Complete for any building containing plumbing • Land Use Conditions met and signed off • Public Works Permit Final(where applicable) FINAL INSPECTION FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR .., A :1--:.1q.-,"-:z--i r ..,.-:a-,- • itXV;.__ ,.:. .... . _ Date 5.***C 'time received 407 am /6) Mon. Tues. 4;:g/' Thur. -Pri. • OLD: ) 4- 121 Date: OWNER: . Contact Name: ADDRESS: 91) 6-kW ry Contact Number:360 2.32, ("/".51 • t:. "7 2 I ' 'i . 0 , Notes: • tr ' • . ' . Foundation Plumbing - Framing Propane Tank Mechanical - • Setbacks Under-ground Framing• Undeground . 6 Furnace Footing Rough in _ Air seal Above ground Gas ___ Stemwall _ Hydronic ____ Exterior shear Exterior lines Oil Straps Interior shear Interior lines . Ducts #—_____. • --7--- Post Hole _ • Ventilation Appliance Man4lomes Underfloor . Gas/wood stove . Setbacks - Insulation . Final inspection ___ __ Foundation ,-..... tv Block&Tie floor ' _wall ceiling Address Posted i