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HomeMy WebLinkAboutBLD2014-00269 - CANCEL • BLD14-00269 BUILDING PERMIT APPLICATION Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00269 Received Date: 7/28/2014 SITE ADDRESS: 687 OLD GARDINER RD SEQUIM, 98382 OWNER: ADRIAN C LIVINGSTON PHONE: 360-477-2603 LINDA JEAN LIVINGSTON 687 OLD GARDINER RD SEQUIM WA 98382-8763 SUBDIVISION: Block: Lot: 2 PARCEL NUMBER: 002331044 Section: 33 Township: 30 N Range: 2V\ CONTRACTOR: PELLET HEAT CO PHONE: 457-1649 230 E FIRST ST PORT ANGELES WA 98362 Contractor's License PELLEHCO80M8 Expires 4/17/2015 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP INSTALL FREE STANDING PELLET STOVE- 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 SRE 07/28/14 151310 ' Total: $152.00 ..g'i,.. u. ... ,L1'S ` <4 _,c°o� JEFF ON COUNTY - ACil ()3Lb\� DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street I Port Townsend,WA 98368 I Web:www.co.iefferson.wa.us/communitydevelopment �Sk'No�o Tel:360.379.44501 Fax:360.379.4451 I Email:dcdaco.iefferson.wa.us Building Permits&Inspections I Development Consistency Review I Long Range Planning I Watershed Stewardship Resource Center Master Permit Application MLA: Project Description(include separate sheets as necessary): Oa. S i,l Pc r S r MSra-c.L 4-17o,) f2Fdnwv.httt, Tax Parcel Number: 00 233 /0lig Property Size: /,, 4 6 (acres/square feet) Site Address and/or Directions to Property: (BSI en.b Grnitia b. 5t uja IAA 483 '2. Property Owner(s)of Record: 4bt24fl CRAXK. Al R L.f 11 J/ &-3 rola Telephone: 31.0- 1-M-+2403 * : 3 J°- / - 72 3,> email: ;t SvpP�.ie 'E"Mitt?ICS Mailing Address: &-3 A-60 Applicant/Agent(if different from owner): SPA SHOP / P 't.t 1'T" co. Telephone: :3(,o-L1 J> "-N ®1/ Fax: 3100 -1/5-2.- 05-03 email: /Y1)1 l g'j t gileP•Coo■- Mailing Address: 2. d`CT 1ff✓r'3T 5T. 0._ G6,�+G ,! s ; LL 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 C "* i Manufactured Home ❑ Modular ❑ Discretionary"D"or U r 1 e f- - •L I ❑ Commercial* ❑Special Use(Essentia n f -�� ❑ Change of Use ❑ Boundary Line Adjust . J" ❑ Address ❑ Road Approach ❑Short Plat** ❑Home Business ❑Cottage Industry ❑ Binding Site Plan** JUL 28 20 4 ❑Propane ❑ Long Plat** ❑Sign ❑ Planned Rural Residen i.: I: elopment(PRRD)/Amen n s* ❑Allowed"Yes"Use Consistency Analysis ❑ Plat Vacation/Alteration • iJ� AUNTY ❑Stormwater Management ❑Shoreline Master Progr.m Exemptio �� . � ii, 1T ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management•ubsts fitiraAi�-r- _ -°rite**` ❑Temporary Use ❑Shoreline Management 'anance ❑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: , DESI NATION OF AGENT I hereby designate A: S' ■ `1.; ! P to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE 0,41 /h _ 44.- - Date: 2-2,3---1 r By signing this application form,the owner/ag-- 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 pr ide access and right of-dry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any requ ed later inspections. Sta access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applicatio that he or h wants •rio'n• ice. I, /� Signature: '4: Date: ✓-2-3 The action or action pplicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species d 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 y' are in compliance wit i Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferal le responsi• it for adh: • and c. plying with the ESA. The Applicant has read this disclaimer and sign and dates it below. � Signature: t +�, , Date: l)-23- I 1 07/24/2013 • S 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 th responsibility of the General Contractor for the proposed project. Signature: 1I A Date: 23`ritt GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: SPA. Ski) / Pcu. 1 ' co- (3t ) lin--y4'a( (3h ') Z-a2),V3 MAILING ADDRESS: 23o-c c7- A QSre sr / e{yes EMAIL: 114,,eL'� �S�JA,#j9 .tvy�r�, CONTRACTOR'S LICENSE WAINS F�� NUMBER: p „L 6I4 W O M 4e NUMBER ARCHITECT/ENGINEER: fl/A v7 PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: 0 New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party T e of He Proposed: ❑ Public (, ":c,-pv 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: _ Underground Tank Above ground tank Size of Propane Tank: F - V 47 I , �1 (Heat Stove Cook Stove Woodstove Fireplace.nsert rehtO i evotS tellefr I frA " v ` Is this appliance being installed in a Manufactured/Mobile Home? es / No J i When applying for a permit to install a propane tank you must also submit a site plan showingrall Of the, ild" g,s pp((operty lines, tank location and size,distances from the propane tank to all property lines,buildings a,dl Septial tet eon bibentt, including the reserve area" gg gg 11-x, ' , l A�mI�&Idils�li§I�€Illisl`V E� ki p° � 3 a -'g, I d s F G a Pti J s 9� la s a E C�' a V,, `° 3 t e 4 Square Footage Current Proposed Oftlsi Uri$Q 1 Ie MEIZI.I afi„r��rl I:. ' t*q`Upt,�- 6h4N, Main Floor Heated �e 4I�a � alx EH Bld App Review: DEPT OF ( V• 111 Y I `'�I1i_rn __. 2 Floor Heated V„.; 4:14d I: ,, Consistency Review: 5 A} Other Heated t ,I„II; Base fee: L Ar§o 4 4 Mezzanine 4k m Additional Section: }Heated Basement r og G, i Plan Check fee: 4,a6,41,043MiNi0g Unheated Basement 4 w A'41 ° p State Surcharge fee: g, Other Unheated 3 'Ak f Q ,: ;; Pot Water Review fee: 4 i Garage/Carport PilliAgiiMilik SUBTOTAL N4, Decks RRr ” %i 911/Rd Approach fee: ta' TOTAL: $ ❑ r �� r* • vv /N-7 .511111 1#.Ei t i{i 8 E' 1'�Ii,Ii : Receipt Number: 151316 9 t tp � Cash/Check Number: / `/ )Ng Ir tp; LI V 'I v ESTIMATED COST(REQUIRED) Date: -71 J/4-•Fair market valu of all labor and mater' is foundation to finish t/ /`?)//1 / U Initials: , 1 , 07/24/2013 • JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT REFUND REQUEST/POSTING MEMO r DATE: 1 , , The amount of j I r { received from for case# : is to be refunded to: t r [ t __ ∎k U I ,)t _ i C i - G} .'I ,// l t.. t \,( f 1. .. C.. �i 1.'.l � �w �l l�i � r � - r ( ` .r E'r 0 I I ' asa result of• < � ;,�, C 4`r'��r � ,�, IBC:-r `�3tI t�.UU ) ,;t Date & number of original receipt: '�y/ �-.� 1 I ) REVENUE FUND CODE NO. REVENUE SOURCE NAME AMOUNT 001-250-000 369.90.00.0000 BAD CHECK FEE 127-000-010 346.23.11.5200 WATER AVAILABILITY FEES-EH H2O 127-000-010 346.23.11.5400 DCD BLDG REVIEW-SEPTIC 127-000-010 346.23.11.5800 SHORT/LONG PLAT FEES 143-000-010 322.10.00.0000 BUILDING BASE &INSPECTIONS I c--4)-2,_ cG k (C '°`' 17 ( 322.10.10.0000 BUILDING PERMIT RENEWAL FEE 143-000-010 322.40.80.0000 ADDRESSING FEES 143-000-010 341.60.00.0000 DUPLICATING SERVICES 143-000-010 341.75.00.0000 SALE OF MAPS &PUBLICATIONS 143-000-010 345.70.00.0000 DCD TECH ASSIST FEE 143-000-010 345.81.00.0000 SUBDIVISION APPLICATIONS 143-000-010 345.81.20.0000 SHORELINE SUBSTANTIAL DEV. PERM. 143-000-010 345.81.30.0000 CURRENT USE TAX ASSESSMENT APP 143-000-010 345.81.40.0000 ZONING APPROVAL APPLICATIONS 143-000-010 345.81.60.0000 CONVERSION OPTION HARVEST PLAN 143-000-010 345.83.00.0000 PLAN CHECK FEES 143-000-010 345.83.10.0000 FIRE MARSHALL PLAN REVIEW 143-000-010 345.89.00.0000 SEPA/ ENVIRONMENTAL REVIEW 143-000-010 345.89.00.0143 PERMIT SCANNING FEE 143-000-010 346.22.30.0040 DCD WATER REVIEW 143-000-010 389.40.00.0000 CASP - NON-REVENUE CUST DEPOSITS 180-000-010 322.40.40.0000 MISC APPLICATIONS& PERMITS 180-000-010 322.40.50.0000 RIGHT-OF-WAY APPLICATIONS 180-000-010 343.20.10.0000 DEVELOPMENT REVIEW FEES 650-511-000 386.00.00.0000 STATE BUILDING CODE FEES TOTAL REFUND I i...! I r' 0.00 Authorized person signature: Treasurer's check# Date: Treasurer's signature: 1820 JEFFERSON ST • PO BOX 571 PORT TOWNSEND, WA 98368 (360) 385-9150 Received From: • **ORIGINAL** Receipt Number 3294 COMMUNITY DEVELOPMENT Receipt Date 8/15/2014 Clerk TCASH REFUND CK - PELLET HEAT CO ?nRcpt Fund/Dept Description Revenue Paid 2941 143-000 - 010 BUILDING BASE & INSPECTIONS 322 10 0 0 171.00- Total 171. 00- Tender: Refund 171. 00 - • DOCCA -)Q w- _ \)\)CIA 4, a_ pc t€ \(,01 apcess v cturd 171 -U o • • k��SON c0 rj ((1, 9s,'"," JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street Port Townsend, WA 98368 Ci\ ' Carol, Director 0.,, ,eC Evno d 7/ iL‘ cis .-° Fcged 7f Zc/ f FAX TRANSMITTAL DATE: July 28, 2014 TO: Pellet Heat Co. Mike D 0;'\(\- PHONE: 360-457-1649 FAX: te. .-'-i '-C)sb- NUMBER OF PAGES including cover: FROM: Sally Ellis JEFFERSON COUNTY COMMUNITY DEVELOPMENT PHONE: (360) 379-4452 FAX: (360) 379-4451 SUBJECT: New Mechanical Permit COMMENTS: Attached please find the Mechanical Permit for your customer Adrian Livingston at 687 Old Gardiner Rd, If you have any questions or need more information please feel free to contact me. dIVAL 4 @ {)e06.\:- \- ecj- 00 JKA71, owl- sherd inapt vt - i Pa - ,Se if\ nil Htmc - LvL fey akj No � ' �+ i s Ve WC eci Building p Permitsil s ections Development Review Division Long Range Planning (360) 379-4450 46-kdusto 6- I ' O° FAX: (360) 379-4451 PELLET HEAT CO • Page 1 of 2 • N Washington State Department of Labor & Industries IPELLET HEAT CO Owner or tradesperson 230C E FIRST ST DEROUSIE, MICHAEL V PORT ANGELES, WA 98362 360-457-4406 Principals CLALLAM County DEROUSIE, MICHAEL V, PRESIDENT DEROUSIE, KATHY J, VICE PRESIDENT Doing business as PELLET HEAT CO WA UBI No. Business type 601 379 532 Corporation Parent company The DeRousie Company ILicense 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. PELLEHC080M8 Effective—expiration 07/28/1992—04/17/2015 Bond CBIC $12,000.00 Bond account no. SE3000 Received by L&I Effective date 03/28/2002 04/01/2002 Expiration date Until Canceled Insurance Western Heritage Ins Co $1,000,000.00 Policy no. SCP0952468 Received by L&I Effective date 03/25/2014 03/29/2014 Expiration date https://secure.lni.wa.gov/verify/Detail.aspx?UBI=601379532&LIC=PELLEHC080M8&SAW= 7/28/2014 PELLET HEAT CO • Page 2 of 2 • 03/29/2015 IN° Insurance history Savings No savings accounts during the previous 6 year period. Lawsuits against the bond or savings No lawsuits against the bond or savings accounts during the previous 6 year period. L&I Tax debts No L&I tax debts are recorded for this contractor license during the previous 6 year period, but some debts may be recorded by other agencies. License Violations No license violations during the previous 6 year period. IWorkers' 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. 587,845-01 Doing business as PELLET HEAT CO Estimated workers reported Quarter 1 of Year 2014"4 to 6 Workers" L&I account representative T5/LINDA ALGUIRE(360)902-4678-Email: POTH235©Ini.wa.gov IWorkplace 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. Access Washirrgtoe tkPcTSM,W£t AV'541k' https://secure.lni.wa.gov/verify/Detail.aspx?UBI=601379532&LIC=PELLEHC080M8&SAW= 7/28/2014 Parcel Details - Page 1 of 2 0 S. : 0 ° .,.-- i ,o;-, a ; --- e Jefferson County ,,,,,, ,,,,„...„ t, .. %.: k.,,,‘,,,,,, ,,, .,,„,,,, ,,,,,,, ,....„,, , , _,,,,.., ,,,,,,....„ ... ,:,...„,.,, ,=,,, j --,7,----7:-.:',-,74:::::, 13 \ 9, Home .. County Info ..h Do rtmen� Search Parcel Number: 002331044 SEARCH Parcel Number: 002331044 Printer Friendly Owner Mailing Address: ADRIAN C LIVINGSTON LINDA JEAN LIVINGSTON 687 OLD GARDINER RD SEQUIM WA98382-8763 Site Address: 687 OLD GARDINER RD SEQUIM 98382 , Section: 33 School District: Sequim (323) Qtr Section: NE1/4 Fire Dist: Sequim (8) Township: 30N Tax Status: Taxable . t Range: 2W Tax Code: 0781 Planning area: Discovery Bay (5) Sub Division: Assessor's Land Use Code: 1101 - Residential - MH W/Land Property Description: CARYL SHORT PLAT LOT 2 (LESS TAX 60) Tax,AN, Sales, Photos, and Permit Data Bldg Data Map Parcel Plats&Surveys Septic Monitoring Info f W Jefferson County HOME I COUNTY INFO I DEPARTMENTS I SEARCH Best viewed with Microsoft Internet Explorer 6.0 or later Windows- Mac http://www.co.jefferson.wa.us/assessors/parcellparceldetail.asp?Parcel_NO=002331044 7/28/2014 JEFFERSON COUNTY/60CD NO. * 310 DATE Orl/c2g/ )4 RECEIVED FROM / Pelle-/ ile ed CZ- c'll-(j19 DESCRIPTION BARS* AMOUNT CURRENCY kii e..A / 5:2 °t) COIN 1 (11# OV . , CHECKS * .1"9: , . v:bag-5 10441- I :I. iy kid clC 13 0 ki'//_.t /'ll.''ZiS:Eti toj ..• /.7 0 ii1I -0 t . - /, , , // ■ i TOTAL /171 , C7) RECEIVED BY ..—Ar. ,A . ,,,, , ,' ." S MECHANICAL AND DEMOLITION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379- FAX (360)379-445 PERMIT#: BLD14-00269 R-c ' d D to 7/28/2014 SITE ADDRESS: 687 OLD GARDINER R ;1/4. I , I Dat 7/28/2014 SEQUIM, 98382 APPLICANT: ADRIAN C LIVINGSTON — PHONE: 360-477-2603 LINDA JEAN LIVINGSTON 687 OLD GARDINER RD SEQUIM WA 98382-8763 SUBDIVISION: Block: t: PARCEL NUMBER: 002331044 Sectio : 33 Township: 30N Range: 2W CONTRACTOR: PELLET HEAT CO PHONE: 457-1649 230 E FIRST ST PORT ANGELES WA 3 6 Contractor's License PE\ EH 080M8 Expires 4/170/20150503 OWNER, ADRIAN C LIVINGSTON PHONE: 360-477-2603 if different: LINDA JEAN LIVINGSTON 687 OLD GARDINER RD SEQUIM WA 98382-8763 PROJECT DESCRIPTION: INSTALL FREE STANDING PELLET STOVE- 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 7/28/2015. 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 7/28/2014