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HomeMy WebLinkAboutBLD2014-00110 •ILDING PERMIT APPLICATION BLD14-00110 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00110 Received Date: 3/21/2014 SITE ADDRESS: 133 BALDWIN LN PORT LUDLOW, 98365 OWNER: JAMES W RANDALL PHONE: 360-437-9222 GLORIA L RANDALL 133 BALDWIN LN PORT LUDLOW WA 98365-9615 PORT LUDLOW NO. 2 SUBDIVISION: Block: Lot: 8 PARCEL NUMBER: 990600108 Section: 9 Township: 28 N Range: 01 E CONTRACTOR: AIR FLO HEATING COMPANY INC PHONE: 360-683-3901 221 W CEDAR SEQUIM WA 98382 Contractor's License AIRFLI*206DG Expires 4/25/2014 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION IN KIND HEAT PUMP SYSTEM REPLACEMENT 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 03/21/14 148499 APPROVED Total: $152.00 Jefferson County DCD \\+irlomo Held ofo\fnrme\G RI fl Ann RId rn+ Z/ imniA ."e"(°N c0� • JEFFER�N COUNTY e } DEPARTMENT OF COMMUNITY DEVELOPMENT `d 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax 1 O c5' www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Project Description(induce separate sheets as��s,��): ��s��� Q ��� * � L(KE 114 k►Nb tc€M� M_C . •� Itc. hkE I Tax Parcel Number: qq 0 4 D 6 1 0 S Property Size: (acres/square feet) Site Address and/or Directions to Property: 133 6htz vJttJ 't-R 0 a PORT w DLO v..) Property Ovlrner(s)of Record: J t M. r1,... �t ” �t�l D ail u Telephone: D4"311-0%441c Fax: email: Mailing Address: t3 5 nt L1)W1 .) LRPJEt f o er U) Dt,.ouJ yVR '$3 ,o Applicant/Agent(if different from owner): 6 r F1 o 1lea'}i r _ Telephone:31 .0"'ID i�PIO 1 Fax 1nBB- 3a1`lr email:ei1e.r1t�S1\r•�1O tr,N.GOM Mailing Address: 2-7t W• Cedar SA• t>O. ,W '1 qB3$Zr What kind of Permit?(Check each box that applies OBuilding 0 Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use) ❑Single Family ❑Garage Attached/Detached 0 Conditional Use[C(a),C(d),or CI** ❑ Manufactured Home 0 Modular 0 Discretionary`D'or Unnamed Use Classification ❑ Commercial" ❑Special Use(Essential Public Facilities)** ❑ Change of Use ❑Boundary Line Adjustment ❑ Address 0 Road Approach 0 Short Plat-- ❑ Home Business ❑Cottage Industry ❑Binding Site Plan** O Propane ❑Long Plat** O Sign ❑Planned Rural Residential Development(PRRD)Amendments** ❑Allowed'Yes"Use Consistency Analysis ❑Plat Vacation/Alteration** O Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions** O Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development** O Temporary Use 0 Shoreline Management Variance O Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amepdment O Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment 'May require a Pre—Application Conference 0 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 • I•r 1 V A-tea t t n• to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE ,. �i Date: '- / - ..Z" C- / 7 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 ail 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 requi er inspections. Staff's access and right of entry will be assumed unless the applicant informs the County in writing at the time of the application t he or shg-wan , notice. Signature: ' --,--f.........4-40/.-- .--It Date: -.3 — /,,g.— �. y 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 areijk compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferable sibitity for hexing to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Pr Signature: I Date: .2 -/6- " Ci/ G:\PeanitCenter\###FORMS###\DRD FORMS\Master Permit.Application 5-29-O8.doc • 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: R1Q. Fu' t.Vekt d— eve&3%S- 5'354 ' ,,x)6'3-39'11 MAILING ADDRESS: M. V.111 te,>h' n 0 dl EMAIL: AI CONTRACTOR'S LICENSE A1e.FLI^ �(0D WAINS NUMBER: PV 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 0 Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: 0 Private well 0 Two Party Typ ..Qf�yo� Proposed: 0 Public J��N d 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 Propane Tank and/or Appliance Installation permit,mark all items below that apply: I Underground Tank I Above ground Tank Size of Propane Tank: I Heat Stove I Cook Stove I Woodstove I Fireplace Insert I Hot Water Tank 1 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, includin• the reserve area. S•uare Foots e e Current • •. •sec �, i "� ' Main Floor Heated EH Bld App Review: _. , H wa:; 2na Floor Heated �. a Consistency Review: Other Heated = Base fee: Mezzanine v `: Additional Section: x Heated Basement k � -a" Plan Check fee: Unheated Basement -t�,,, State Surcharge fee: Other Unheated f' Pot Water Review fee: Garage/Carport r r SUBTOTAL • Decks ` - 911/Rd Approach fee: Other Ni✓or e v tkp $ � TOTAL: , Receipt Number a s Cash/Check Number. , ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation/� to finish 2-LJ L Initials: G:\PemritCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc • • 4 I� «o � �g AIR FLO HEATING COMPANY INC Page 1 of 2 • • Washington State Department of Labor & Industries AIR FLO HEATING COMPANY INC Owner or tradesperson 221 W CEDAR SEQUIM, WA98382 BEQUETTE, MARK A 360-683-3901 Principals CLALLAM County BEQUETTE, MARK A BEQUETTE, SANDRA A BERSON,JOEL R FULLAWAY, MICHAEL (End: 04/01/2010) Doing business as AIR FLO HEATING COMPANY INC WA UBI No. Business type 600 347 761 Corporation Governing persons - MARKBEQUETTE License . Verify the contractor's active registration/license/certification (depending on trade)and any past violations. Construction Contractor Active. Meets current requirements. License specialties HeatingNent/Air-Conditioning and Refrig (HVAC/R) License no. AIRFLI*206DG Effective—expiration 03/07/1980—04/25/2016 Bond CBIC $6,000.00 Bond account no. SI5215 Received by L&I Effective date 02/05/2010 02/01/2010 Insurance American Fire&Casualty Co $1,000,000.00 . Policy no. BKA53735233 Received by L8,1 Effective date 03/26/2013 04/25/2012 Expiration date 04/25/2014 https://secure.lni.wa.gov/verify/Detail.aspx?UBI=600347761&LIC=AIRFLI*206DG&SAW= 3/21/2014 AIR FLO HEATING COMPANY INC Page 2 of 2 Savings No savings accounts during the previous 6 year period. Lawsuits against the bond or savings No lawsuits against the bond or savings during the previous 6 year period. Tax debts No tax debts during the previous 6 year period. License Violations No license violations during the previous 6 year period. 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 current. 351,432-00 Doing business as AIR FLO HEATING COMPANY.INC. Estimated workers reported Quarter 4 of Year 2013"21 to 30 Workers" L&I account representative T1 /FEARAED FEROZE (360)902-4797-Email: FERH235©Ini.wa.gov Workplace safety and health Check for any past safety and health violations found on jobsites this business was responsible for. Inspection date 07/24/2012 Violations Inspection no. 315954529 Location 125 Horizon View Dr. Sequim,WA 98382 Washington State Dept.of Labor&Industries. Use of this site is subject to the laws of the state of Washington Acass %`ti,hintor • .¢'{14 Sj,R A t[t..NL Bk�4aln https://secure.lni.wa.gov/verify/Detail.aspx?UBI=600347761&LIC=AIRFLI*206DG&SAW= 3/21/2014 Screen: 01 REAL PROPERTY MASTER Mode : INQUIRY Auto Roll : OFF Parcel # 000990600108 o Cd 282109207231 PORT LUDLOW NO. 2 Nbhd Cd 3331 AREA 1 8 Loc ID * Taxpayer Cd RAND 0920 RANDALL, JAMES W T/P Chg Dt 8/06/2013 * Title Owner T/P Chg Usr JA Tax Code 0231 Status TX TAXABLE Land Use 1100 RES-SINGLE Affidavit 119653 Vol/Page / C/U Code COMPLETE ADDRESS WINDOW Taxpayer RAND0920 JAMES W RANDALL GLORIA L RANDALL 133 BALDWIN LN • PORT LUDLOW WA 98365-9615 Search Key CMD 6: End Window CMD 7: End of Job Screen: 01 REAL PROPERTY MASTER Mode: INQUIRY Auto Roll : OFF Parcel # 000921093005 Cd 292109303210 S9 T29 R1E Nbhd Cd 3220 TAX 62 Loc ID * Taxpayer Cd COFF 2000 COFFEEN, MICHAEL P T/P Chg Dt 4/06/2006 * Title Owner T/P Chg Usr JA Tax Code 0211 Status TX TAXABLE Land Use 1100 RES-SINGLE Affidavit 106296 Vol/Page / C/U Code COMPLETE ADDRESS WINDOW Taxpayer C0FF2000 MICHAEL P COFFEEN PAMELA L COFFEEN 450 ROBBINS RD NORDLAND WA 98358-9671 Search Key CMD 6: End Window CMD 7: End of Job • AIR FLO HEATING COMPANY Check Number: 42103 4 210 3 Jefferson County Building Department Date Description Amount 03/19/2014 Randall Permit 171.00 • 4lOZ/t ;drauedoid-pwied alb I\swJe;\Z 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#: BLD14-00110 Received Date 3/21/2014 SITE ADDRESS: 133 BALDWIN LN Issue Date 3/21/2014 PORT LUDLOW, 98365 APPLICANT: JAMES W RANDALL PHONE: 360-437-9222 GLORIA L RANDALL 133 BALDWIN LN PORT LUDLOW WA 98365-9615 8 SUBDIVISION: PORT LUDLOW NO. 2 Block: Lot: PARCEL NUMBER: 990600108 Section: 9 Township: 28N Range: 01E CONTRACTOR: AIR FLO HEATING COMPANY INC PHONE: 360-683-3901 221 W CEDAR SEQUIM WA 98382 Contractor's License AIRFLI*206DG Expires 4/25/2014 OWNER, JAMES W RANDALL PHONE: 360-437-9222 if different: GLORIA L RANDALL 133 BALDWIN LN PORT LUDLOW WA 98365-9615 PROJECT DESCRIPTION: IN KIND HEAT PUMP SYSTEM REPLACEMENT 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 3/21/2015. REQUIRED INSPECTIONS: Installation per Manufacturer Specifications/CO2: Tank/Line/Appliance: Final Approval: 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 3/21/2014 DSO, C --' _.:- <;s� °? JEFFERSON COUNTY A. 4 � DEPARTMENT OF COMMUNITY DEVELOPMENT it 1SK`NG.° 9 5-9 o( Date: Time Time Received: , ' 0/pm Mon. Tue. Wed. hur Fri. Date: 11'21 BLD: 'LE- - lip Contact Name: Owner: Contact Number: 360 4+j7 ,-106 Address: t33 gp,,,),tis 1.—ti 206 Notes: I--67114— ?U r 1—,A2441,--,_,.._ Foundation Plumbing Framing v Propane Tank Mechanical Setbacks Under-ground Framing Under ground Furance Footing Rough In Air Seal Above ground Gas Sternwall 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 JEFFERSON COUNTY c) U NO. 9i i DATE 24 i)fi.t_ --\)\toAN\(\'''') RECEIVED FROM V DESCRIPTION BARS# AMOUNT CURRENCY I 111.. COIN v 4 t O m 3 33 RECEIVED BY ..=? TOTAL 1,1.,mac' I