HomeMy WebLinkAboutBLD2014-00173 • BUILDING PERMIT APPLICION BLD14-00173
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD14-00173 Received Date: 5/20/2014
SITE ADDRESS: 2054 VAN TROJEN RD
OWNER: DAVID GOHN PHONE:
CANDICE GOHN
PO BOX 502
CHIMACUM WA 98325-0502
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901211011 Section: 21 Township: 29 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 DESCRIPTION Propane tank and Gas piping
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 $228.00 JLA 05/19/14 148677
APPROVED
Total: $228.00 lr•
MAY 202014
Jefferson County DCD
11+irlcmo rNrl o+olfnrmc\G PI n Ann Rirl rn+ nn/')niA
BLD14-00173
BUILDING PERMIT APPLICION Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD14-00173 Received Date: 5/20/2014
SITE ADDRESS: 2054 VAN TROJEN RD
OWNER: DAVID GOHN PHONE:
CANDICE GOHN
PO BOX 502
CHIMACUM WA 98325-0502
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901211011 Section: 21 Township: 29 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 DESCRIPTION Propane tank and Gas piping with a heating stove to be installed.
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:
outing Date:
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $228.00 JLA 05/19/14 148677
Propane Tanks/Stoves $76.00 SRE 06/17/14 148750
Total: $304.00
\\tidemark\data\forms\F_BLD_App_Bld.rpt 6/17/2014
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DEPARTMENT • COMMUNITY DEVELOPM
Date:
GAS Time Received: 2:2g. am pm Mon. Tue. Wed. u . Fri.
Date:
BLD: ( 4r Ll9 Contact Name:
� r Contact Number: 360 gex i`7
Owner: ( �i1A.t�l a 206
Address: r r_ _ _ _A. i-,
�
Notes:
Framing Foundation Plumbing g Propane Tank Mechanical
ground Furance
Setbacks Under ground Framing Under g Gas-
Footing Rough In Air Seal Above ground
Stemwall Hydronic Exterior shear
Exterior lines < Oil-
Interior lines Ducts
Straps Hot Water Htr Interior shear Appliance
Post Hole Ventilation SG(--- -
Underfloor Gas/Wood stove
Man-Homes Insulation
Final Inspection
Setbacks Floor
Foundation
Wall Address Posted
Block&Tile Ceiling
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•
JEFFERSON •COUNTY
' DEPARTMENT OF.COMMUNITY DEVELOPMENT ,
621 Sheridan Street• Port Townsend•Washington 98368
360/379-4450 • 360/379-4451 Fax
„* www.co.Jefferson.wa.us/coinmdeveiopmen#
Master Permit Application MLA:
Project Description(inclgde separate sheets as necessary):
Tax Parcel Number. 90 / 2-/ / [1 f" Property Size (acres/square feet)
Site Address and/or Directions to Property:
r
Property of Record: r• r"" i \/ `�
Telephone: n . a-40 �-'4;---'".---lJ L-- ' r
Fax: r
Mailing Address: .O, r •\C b'�--
Applicant/Agent Of different from owner): - AD , I fJ !.. ®lK® • t , II
Telephone: $5 —S-1 q.'1 Fax: •T� `� t
Mailing Address:
I-\'
What kind of Permit?(Check each"box"that applies ---�� tEFFERSO o`
❑Building ❑Critiic"ai`Areas Ste rd hip Pi=°`T•OF COM1U111 DE\IELOP4ENT
❑ Demolition.Permit" ❑Variance(Minor," ajor or -easonable Economic Use)
❑Single Family 0 Garage Attached/Detached 0 Conditional Use[ (a) C(d),or C]]'*
❑ Manufactured Home ❑ Modular ❑Discretionary"D" r Unnamed Use Classification
❑ Commercial ❑Special.Use'(Ess ntial Public Facilities)*"
❑ Change of Use 0 Boundary Line Ad ustment
❑ Address ❑Road Approach .. . 0 Short Plat**
❑Home Business ❑Cottage Industry ❑Binding Site Plan'!*
g' .eropane ❑Long Plat�"
Cti Sign ; ❑Planned Rural Residential Development(PRRD)/Amendments:**
0 Allowed'Yes'Use Consistency Analysis ❑Plat Vacation/Alteration**
❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions**
Q-Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development**
O Temporary Use ' ❑Shoreline Management Variance
0 Wireless Telecommunication* ; 0"Comprehen'sive Pl'art/UDC/Land Use District Map Amendment
O Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson Opunty 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 fedora permits required for this proposal, if k town:
DESIGNATION OF AGENT!
I hereby designate c, ti.A V � to act as.m ,agent matters relating to this application for permit(s).
V I \i
OWNER SIGNATURE .lt..- �'�' � ,-, ;>, i Date: S � � ��
By signing this application form,the w►r/#gent attests that the information provided'remit,,and in any attachments,is true and correct to the best of
his,her or its knowledge. Any material falsehood or any omisek5n of a material fact made by the owner/agent with respect to this appUCa(iOnpacket°
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 anyway accrue against Jefferson County as a result of or in conse4uence of the granting of this permit.
I further agree to provide access and right of entry to Jefferson:County and its employees," presentatives or agents for the sole purpose of application
review and any required later inspections.. Staffs access and.right of entry will be assume unless the applicant informs the County in writing at the
time of the appl .on that he or she wants prior notice.
Signature: ■- Date: .�' t -' \
The action or actions Applicant will undertake as a result of th Issuance of this permit may negatively Impact upon one or more threatened or
endangered species and could lead to a potential"take'of an'ndangeredspecies 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-trans sable responsibility for adhsri, to and complying with the ESA. The Applicant has read this disclaimer and signs and ates it below.
Signature: (./ - .ta r--e L '�.--�." Date: J ° 1 4-- l
G:\PeanitCentet\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
The signer of this statement does hereby BUILDER STATEMENT
they will be assuming Y certify that they are the Owners of the parcel referenced herein,thatthey are not licensed contractors
Signature: �1, !� "/ / / Contractor for the proposed;pnl) and that
res nsi6il' of the certify General thContra
Date: 5 11 irl
GENERAL CONTRACTOR OR
MANUFACTURED HOME INSTALLER:
�A,. PHONE: FAX:
MAILING ADDRESS: (
CONTRACTOR'S LICENSE EMAIL::
NUMBER: WAINS
ARCHITECT/ENGINEER: NUMBER
MAILING ADDRESS: I PHONE ( )
Project Type: FAX:(, )
Frame Type: EMAIL
O New yp Bathrooms:
New 0 Wood Existing: Shoreline: Type of Sewage Disposal:
Alteration/Remodel dditi Steel Proposed: ❑ Sewer
0 .Repair Q Concrete Total: Bank 0 Community System
Q Demolition 0 Masonry Height: o Individual System_0 Other: Bedrooms: SEP Permit#
Type of Heat: Ex Water Supply:
. Proposed: Setback: ❑ Private well 0 Two Party
Total: 0 Public
Name of System:`
If this is a'Cotnme I I Pro
Number of Parking$paces. Current:must answer f II win :
Number of Para n Proposed. Number of
pants(includes owners,tenants,employees,etc) Current Afl Parking Spaces;
IBC Occupancy; IBC Type of construction:
If this — Proposed
_•• '- : •nk and/o A .11.nee Installatio Wie you have Food Service? Y /=No
Underground T-• i •ermi mark =1 items below th.
I Heat
Underground
I Above ground Tank Size of Propane Tank: c.d a• 'I .
Cook Stove 1 Woodstove I Fireplace Insert I
is a..li� ' bein. installed in : Hot Water Tank I Pellet Stove I
When.applying fora ernst ll din -/Man l M•bile H.m:? Yes / +. Other
' P propane tan
lines, tfor and it distances a ropane tank you must also submit tank lines,to• the reserved size, propane tank to al/property lines,plan d showing and all a the ystemgs,all property
P Perly hoes,bulldm septic system components,
buildings tics
S•uareFoota.e `' t
Main Floor Heated Cunt Pro•osed , 1
r
r
I EH Bld App Review:
2 'Floor Heated
Other Heated 4, y cY
� r" Consistency Review:
R
Base fee
,
Additional Section:
Heated Basement
®�r j Plan Check fee:
Unheated Basement � r
Other Unh ®sY, d, - ,_ •,,,i State,SUrChBfge fee:
entp_
—
�4 a Pot Water Review fee:
Garage/Carport .
1111111•11M
Decks . : , SUBTOTAL
s
Other
• 911/Rd Approach fee:
®�y 4 l
� t
s TOTAL:
Receipt Number. r.,
Cash/Check Number. • ,
ESTIMATED COST(REQUIRED) M� ,f nn \v, Ell
•Fairrnatket value of alllabor and materials foundation Date: a 1r
�n to finish ] l� ��,/A' „I
Initials: ;
m-' iriallf, , 1 9 2014
,
COUNTY G:\P ermitCenter\###FORMS###\DRb FORMS\Hoare Permit Application S 29-08.doc JEFFERSON
DEPT.OF COMMUNITY DEVELOPMENT
• 0
SITE VISIT REPORT
(PLOT PLAN)
r _ np�
JOB €1 '1(Cr(2 LQ. 0 I/l ii DATE: CONTACT:
ADDRESS `O S q V a41 I e.o J-e-vl PHONE #: .
DIRECTIONS FAX #: .
Email
PLANNER: .
Include all street names adjacent to property.property lines,tank..appliance&piping locations,distances of tank to property lines and
buildings,septic.wells,wetland areas,distance to water bodies.
IP
No RorEkty LiA/ES wi lliA/ to
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itURI Ex IJ ll U
AROUND gliGia
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TECFEIFV1
MAY 1 9 2014
JEFFERSON COUNTY
DEPT OFCOMMuiviitur VI.i IJNIVILN I
•
•
Screen: 01 REAL PROPERTY MASTER ' Mode: INQUIRY
Parcel # 00090121101/11Geo Cd 290121106210 • Auto Roll : OFF
S21 T29 R1W Nbhd Cd 4270
TAX 2
Loc ID
* Taxpayer Cd GOHN 1000 GOHN, DAVID T/P Chg Dt 7/13/2009
* Title Owner T/P Chg Usr JA
Tax Code 0211 Status TX TAXABLE Land Use 8300 DESIGNATED
Affidavit 53194 Vol/Page / C/U Code
COMPLETE ADDRESS WINDOW
Taxpayer
GOHN1000 DAVID GOHN
CANDICE GOHN
PO BOX 502
CHIMACUM WA 98325-0502
Search Key
CMD 6: End Window CMD 7: End of Job
SUNSHINE PROPANE Page 1 of 3
Washington State Department of
IC) Labor & industries
SUNSHINE PROPANE
Owner or tradesperson 10853 RHODY DR
CHAWES, RICHARD HENRY PORT HADLOCK, WA98339
360-385-5797
Principals JEFFERSON County
CHAWES, RICHARD HENRY, PRESIDENT
LEMLEY, DAVID BARRY, VICE PRESIDENT
SIMPSON, LAURA ANNE, SECRETARY
YOURISH, ROBERT B, TREASURER
FLANDERS, RONALD LEE, MEMBER
EWING, MICHAEL HOYT, MEMBER
ROSS, LEVI K
(End: 01/01/1980)
CHAWES, RICHARD
(End: 01/01/1980)
YOUNT, JO
(End: 01/01/1980)
SPRING, PERRY
(End: 11/05/2010)
PETERSEN,JAMES
(End: 11/05/2010)
Doing business as
SUNSHINE PROPANE
WA UBI No. Business type
600 342 368 Corporation
Parent company
ENVIRONMENTAL HOUSING INC
License
Verify the contractor's active registration/license/certification (depending on trade)and any past violations.
Construction Contractor Active.
Meets current requirements.
License specialties
GENERAL
License no.
SUNSHP*077QP
Effective--expiration
11/17/1993-11/17/2014
https://secure.lni.wa.gov/verify/Detail.aspx?UBI=600342368&LIC=SUNSHP*077QP&SAW= 5/8/2014
0 0
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#: BLD14-00173 Received Date 5/20/2014
SITE ADDRESS: 2054 VAN TROJEN RD Issue Date 6/17/2014
APPLICANT: DAVID GOHN PHONE:
CANDICE GOHN
PO BOX 502
CHIMACUM WA 98325-0502
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901211011 Section: 21 Township: 29N Range: 01W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339 ((33 � 3g5
Contractor's License SUNSHP*077QP Expires 1?/167/�014-5875
OWNER, DAVID GOHN PHONE:
if different: CANDICE GOHN
PO BOX 502
CHIMACUM WA 98325-0502
PROJECT DESCRIPTION: Propane tank and Gas piping with a heating stove to be installed.
Directions U./(7-M-4314-
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 6/17/2015.
REQUIRED INSPECTIONS:
Installation per Manufacturer Specifications/CO2:f RIr6S`y'/1a1,fur TerPA►,st tie.A'De2 0 K eilL1 i7
Tank/Line/Appliance: r A ∎J I(Z Lir'ri
,t,
‘--C$-t`
Final Approval: 0 V. co* c►►u+..,t 8/14/1 1
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 6/17/2014
•
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#: BLD14-00173 Received Date 5/20/2014
SITE ADDRESS: 2054 VAN TROJEN RD Issue Date 5/20/2014
APPLICANT: DAVID GOHN PHONE:
CANDICE GOHN
PO BOX 502
CHIMACUM WA 98325-0502
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901211011 Section: 21 Township: 29N Range: 01W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
((33 201 -5875
Contractor's License SUNSHP*077QP Expires I'f/1 /
OWNER, DAVID GOHN PHONE:
if different: CANDICE GOHN
PO BOX 502
CHIMACUM WA 98325-0502
PROJECT DESCRIPTION: Propane tank and Gas piping
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 5/20/2015.
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 5/20/2014
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