The URL can be used to link to this page

Home My WebLink AboutBLD2014-00104 IMOILDING PERMIT APPLICATI BLD14-00104 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00104 Received Date: 3/20/2014 SITE ADDRESS: 333 BAYCLIFF DR PORT TOWNSEND, 98368 OWNER: MARK KLEINMAN PHONE: 360-574-0097 PILAR KLEINMAN 12409 NW 48TH CT VANCOUVER WA 98685-3317 KALA POINT#5 SUBDIVISION: Block: Lot: 276 PARCEL NUMBER: 965000161 Section: 27 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 DESCRIPTIOr REPLACE OLD PROPANE FIREPLACE WITH NEW ONE 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 03/17/14 148467 Total: $152.00 APPROVED Jefferson County DCL \\4irlcmerlArlefa\fnrmo\G RI fl nnn R1.1 rnf Z/9N9r11A ��5°N 00 JEFFERSON COUNT). •1. . " DEPARTMENT OF COMMUNITY DEVELOPMENT Date: 4` Time Received: W.59/ .0— pm on. Tue. Wed. Thur. Fri. Date: BLD: /i— /t Contact Name: Owner: Contact Number: 360er0.2 5-/ 7 ,..ri0V Address: 3 3 3 8A-7 LL/{F 206 Notes: 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.-"K Man-Homes Insulation Final Inspection Setbacks Floor Foundation Wall Address Posted Block&Tile Ceiling , V' i cao JEFFERSON•UNTY 0 .si SON 4 ' rA DEPARTMENT OF COMMUNITY W : '' ' ' 621 Sheridan Street • Port Townsend •• Washington 98368 360/379-4450 • 360/379-4451 Fax 4qs Cx`to www.co.jefferson.wa.us/commdevelopment tini Master Permit Application MLA: Project Description(include separate sheets as necessary): _ /�v6PGALE e)t-I p,-,, n,2- ;/ --,Le G- r e,/.- ✓riC Tax.Parcel Number: el(p 0-13i ,to ( Property Size: (acres/square feet) Site Address and/or Directions to Property: 73-3 liAY (ter /�, 1 -,' C-i f r,, g �-A Property Owner(s)of Record: TI A. t L. / • r- _ A. . Telephone:366- $---N d c`11 Fax: email: Yy!0-v-k jp y Cµ-r +P c)c.,1i z n �„ Mailing Address: /Z. Zl O' N U ( vim(t 3 (/, t-J J t/(r t Ar A s‘,.&..5- Applicant/Agent(if different from owner): Telephone: Fax: email: _ Mailing Address: 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) ❑ Single Family ❑Garage Attached/Detached ❑Conditional Use[C(a), C(d),or CI** ❑ Manufactured Home .❑ Modular - - ❑ Discretionary"D"or Unnamed Use Classification 0 Commercial* ❑ Special Use(Essential Public Facilities)** ❑ Change of Use ❑ Boundary Line Adjustment ❑ Address ❑ Road Approach_ ❑Short Plat** ❑ Home Business ❑ Cottage Industry ❑ Binding Site Plan** RI Propane j2.{_pi 4.,,,e- o t d. 6.r ,c,ree(� , cm,,,` ❑ Long Plat** , o Div ❑ Plannea kurai 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 A.1r to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE /` Date: 3//-7//L✓ 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 application that he or she wants prior notice. Signature: Date: 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-transferable responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: Date: G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.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: • S J l� 1 ►1 )v\ e, pr o p b.- r, Z. (1 v ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: I Shoreline: Type of Sewage Disposal: L New ❑ Wood Existing: Sewer Li Addition 0 Steel Proposed: Bank I 0 Community System 0 Alteration/Remodel ❑ Concrete Total: Height: 0 Individual System 0 Repair ❑ Masonry — SEP Permit# _ Li 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:_ 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: l Underground Tank I Above ground Tank Size of Propane Tank: I Heat Stove I Cook Stove I Woodstove 1 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, 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: )S2_�O Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review feel • Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $ Receipt Number: /a -7 Cash/Check Number: 3(9 G ESTIMATED COST(REQUIRED) Date: 1 L.� •Fair market value of all labor and materials foundation to finish 1-17-/ / Initials: G:\PermitCenter\###FORMA###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc SUNSHINE PROPANE Page 1 of 3 0 0 • Washington State Depat hoent of 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 LEMLEY, DAVID BARRY SIMPSON, LAURA ANNE YOURISH, ROBERT B FLANDERS, RONALD LEE EWING, MICHAEL HOYT 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 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 Bond TRAVELERS CAS&SURETY $12,000.00 Bond account no. 206086406 Received by L&I Effective date 10/23/2001 11/17/2001 https://secure.lni.wa.gov/verify/Detail.aspx?UBI=600342368&LIC=SUNSHP*077QP&SAW= 3/20/2014 SUNSHINE PROPANE Page 2 of 3 Insurance • United States Fire Insurance C $1,000,000.00 Policy no. 506-8751013 Received by L&I Effective date 11/13/2013 11/17/2013 Expiration date 11/17/2014 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. 422,171-00 Doing business as SUNSHINE PROPANE Estimated workers reported Quarter 4 of Year 2013"11 to 20 Workers" L&I account representative . TO/CAROLYN CRAWFORD(360)902-4715-Email: CRAI235 @Ini.wa.gov • Workplace safety and health No inspections during the previous 6 year period. https://secure.lni.wa.gov/verify/Detail.aspx?UBI=600342368&LIC=SUNSHP*077QP&SAW= 3/20/2014 Screen: 01 REAL PROPERTY MASTER Mode : INQUIRY . Auto Roll : OFF Parcel # 000965000161 Ge Cd 300127204111 KALA POINT #5 Nbhd Cd 5391 LOT 276 Loc ID * Taxpayer Cd KLEI 5000 KLEINMAN, MARK T/P Chg Dt 11/13/2009 * Title Owner T/P Chg Usr JA Tax Code 0111 Status TX TAXABLE Land Use 1100 RES-SINGLE Affidavit 113620 Vol/Page / C/U Code COMPLETE ADDRESS WINDOW Taxpayer KLEI5000 MARK KLEINMAN PILAR KLEINMAN 12409 NW 48TH CT VANCOUVER WA 98685-3317 Search Key CMD 6: End Window CMD 7: End of Job • 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#: BLD14-00104 Received Date 3/20/2014 SITE ADDRESS: 333 BAYCLIFF DR Issue Date 3/20/2014 PORT TOWNSEND, 98368 APPLICANT: MARK KLEINMAN PHONE: 360-574-0097 PILAR KLEINMAN 12409 NW 48TH CT VANCOUVER WA 98685-3317 276 SUBDIVISION: KALA POINT#5 Block: Lot: PARCEL NUMBER: 965000161 Section: 27 Township: 30N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 ((33 1385-5875 Contractor's License SUNSHP*077QP Expires 11/1V/2014 OWNER, MARK KLEINMAN PHONE: 360-574-0097 if different: PILAR KLEINMAN 12409 NW 48TH CT VANCOUVER WA 98685-3317 PROJECT DESCRIPTION: REPLACE OLD PROPANE FIREPLACE WITH NEW ONE 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 3/20/2015. REQUIRED INSPECTIONS: Installation per Manufacturer Specifications/CO2: Tank/Line/Appliance: Final Approval: " Y 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_Perm it_Propane.rpt 3/20/2014