HomeMy WebLinkAboutBLD2013-00303 ItUILDING PERMIT APPLICAN BLD13-00303
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD13-00303 Received Date: 9/30/2013
SITE ADDRESS: 232 SAND RD#
PORT TOWNSEND, 98368
OWNER: CLAUS JANSSEN PHONE:
TERESA JANSSEN
232 SAND RD
PORT TOWNSEND WA 983689656
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 001184015 Section: 18 Township: 30 N Range: 01 W
CONTRACTOR: EVERWARM INC PHONE: (360)452-3366
257151 HWY 101
PORT ANGELES WA 98362
Contractor's License EVERWI*088NL Expires 8/17/2014
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr WOOD STOVE SWAP OUT, SAME FOR SAME
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP MEC MAIN:
VALUATION 2,359.00 ADD'L: HEAT TYPE: EEE
CODE EDITION: 2012 HEAT BASE: HEAT TYPE: WOD
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: wAPPQ Wei/E D
Permit $152.00 MEB 09/30/13 145407
Total: $152.00 SEP 3 0 2013
Jefferson County DCD
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Everwarm Hearth & Home Sales Order
257151 Hwy 101 E
Port Angeles, WA 98362 Sales Order ID: 37849
Customer ID: 10195
Employee ID: Colette
Ordered: 9/26/2013
Invoiced:
Ship To: Distribution: Installed
Claus Janssen Claus Janssen
232 Sand Rd. 232 Sand Rd.
Port Townsend, WA 98368 Port Townsend,WA 98368
(360) 385-2012
Qty Item List Price Unit Price Discount Total
1 ENDEAVOR KIT-LOPI ENDEAVOR KIT $2,399.00 $2,399.00 $251.00 $2,148.00
-96100634-Small Black Door Shell Kit,answer,endeavor,revere
1 -99200105-Leg Kits,Sculptured Blk Steel
1 -99200134-Adjustable Outside Air Boot For Lopi/avalon
1 -99000118-Rear Mount Fan(new) -$251.00
Vender Promotion good through 09/30/2013
1 -99800203-Endeavor, Cast Ashlip, GS Ready,must add options
1 WBAF-Wood Burning Appliance Fee $30.00 . $30.00 $30.00
1 CD330-Inferno Stove Top Thermometer $25.00 $25.00 $25.00
1 MBS 8 INSULATED PLUG-MBS 8"Insulated Plug $70.00 $70.00 $70.00
in stock,we believe will fit,can paint black if fits(if not must order HT2817P-8"tee plug crimped
ADD$55.00+15.00 shipping
1 PIPE AND LABOR PACKAGE-Pipe and Labor Package $995.00 $995.00 $995.00
chip thru to terra cotta,install Insulated pipe thru wall,DS off stove w145 elbows,outside air thru
brick into crawl
1 MAINTENANCE,2-STORY WOOD,EXT-2-story Wood Maintenance, $250.00 $250.00 -$250.00 $0.00
Extended Area-Complimentary
Courtesy Sweep at time of install.
Sub Total $3,268.00
Deposits/Invoices Terms:Due On Receipt Taxes $291.42
09/26/2013 Deposit- Mastercard-***6727- Auth 04535Z $1,200.00 Total $3,559.42
Not Swiped
Deposits -$1,200.00
Invoices $0.00
Order Balance $2,359.42
HOMEOWNER TO OBTAIN THEIR OWN PERMIT
HOMEOWNER TO OBTAIN THEIR OWN CARBON MONOXIDE DETECTOR
EVERWARM WILL HAUL AWAY EXISTING STOVE.
Terms And Conditions
Permits are required for all new or altered hearth appliances and/or venting systems,and for any gas plumbing work. Where allowed by law
homeowners may choose to obtain the permit themselves or pay Everwarm to obtain the permit on their behalf. Unless otherwise specified on this
document the homeowner will be responsible for obtaining the required permit. By signing this document homeowners acknowledge they have been
257151 Hwy 101 E, Port Angeles, WA 98362, (360)452-3366,Fax:(360)452-3367,everwarm @olypen.com
IIIIIIIIIIIIIIIIIIIII Accepted Date
Thursday, September 26, 2013,8:43:44 AM Received By Date
Printed By shelbyd Page 1 of 2
lIsON cod JEFFERSONUNTY •
\,a l DEPARTMENT OF COMMUNITY DEVELOPMENT
I' '` 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
q gyp' www.co.jefferson.wa.us/commdevelopment
`�l41NG'
Master Permit Application MLA:
Project Description(include separate sheets as necessary):
T n,--a.t I n t ab c s4Dve Csiozie ,00- dC
Tax Parcel Number: O ( ( $ y O t 5 Property Size: (acres/square feet)
Site Address and/or Directions to Property:
2-3 2 S an o Roet, * r-(- (c'�wYts-e �� tiM ag 36 E
Property Owner(s)of Record: --re?SZ et nd Clay us ,f u 1)S,_._ :7 1/1
Telephone: 3c�0 3gS— ��I _ Fax: email:" f et nsse .12 e�v►n f vv'
Mailing Address: 2 3-2 S'Ct.vt(k (3� ��fi —I-6w Vd en of L'Jv`j -' X18 3 J
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check e- + - lies ❑ Lot or Road Segregation
(Building - '- -- ❑ Critical Areas Stewardship Plan
❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use)
8 Single Family ❑Garage Attached/Detached ❑ Conditional Use[C(a),C(d),or C1**
❑ Manufactured Home .❑ Modular - ❑ Discretionary"D"or Unnamed Use Classification
❑ Commercial* ❑ Special Use(Essential Public Facilities)'"""
❑ Change of Use ❑ Boundary Line Adjustment
❑ Address ❑ Road Approach_ ❑ Short Plat**
❑Home Business ❑Cottage Industry ❑ Binding Site Plan**
❑ Propane ❑ Long Plat**
❑ ,iyn .. ❑ Plannea Rurai Residential Development (PRRD)/Amenaments**
❑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
[3 Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment
*May require a Pre—Application Conference El 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 appl'leation that he or nts prior notice. q /
Signature: /�— Date: I 3//3
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-transfer-de responsibilit •hering to and complying with the ESA. The Applicant has read this disclaimer and si s and dates it below.
Signature: . �� , _ 1/ .a Date: 7/AZ.) )"
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(-O et)?co-'7 a6tz FAX:
60-eruJd,r'vi (-{moot+k evtirt 44 e (36 (f5a -,3 6 ( )
MAILING ADDRESS: 51 EMAIL:
CONTRACTOR'S LICENSE ��_ ,..,-'t Art r.D 1(b.s j�W 71 C.'�7'34,2 WAINS wW� e u�r wc,r Milk -COW
NUMBER: EVE ._.(ki I,Iv 0 g'g N L 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 ❑ Masonry SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Proposed:Type of Heat: Pro p ❑ Public
(A)6n int 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:
1 Underground Tank 1 Above Size of Propane Tank:
I Heat Stove 1 Cook Stov 1 Woodstov 1 Fireplace Insert 1 Hot Water Tank 1 Pellet Stove i Other
Is this appliance being insta anufactured/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 ForOffce Use Only Amount. Revision
Main Floor Heated EH Bld App Review:
22 Floor Heated Consistency Review:
Other Heated Base fee: 1 frt..)
Mezzanine Additional Section: I
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL
Decks 911/Rd Approach fee:
Other TOTAL: $
Receipt Number: 145-14v
Cash/Check Number: n
ESTIMATED COST(REQUIRED) Date: at 3t) l S
•Fair market value of all labor and materials foundation to finish
Initials:
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
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Contractors or Tradespeople Per Friendly Page • Page 1 of 2
General/Specialty Contractor
A business registered as a construction contractor with LEI to perform construction work within the scope of
its specialty.A General or Specialty construction Contractor must maintain a surety bond or assignment of
account and carry general liability insurance.
Business and Licensing Information
Name EVERWARM INC UBI No. 601361016
Phone 3604523366 Status Active
Address 257151 Hwy 101 License No. EVERWI*088NL
Suite/Apt. License Type Construction Contractor
City Port Angeles Effective Date 8/13/1992
State WA Expiration Date 8/17/2014
Zip 98362 Suspend Date
County Clallam Specialty 1 General
Business Type Corporation Specialty 2 Unused
Parent Company
Other Associated Licenses
Specialty Specialty Effective Expiration
License Name Type 1 2 Date Date Status
EVERWBP1100G EVERWARM BUILDING Construction General Unused 9/7/1989 8/4/1992 Archived
PRODUCTS Contractor
EVERWI*1900A EVERWARM Construction Insulation Unused 9/1/1981 8/4/1989 Archived
INSULATION Contractor
TERRYMI223DF
TERRY MCCARTNEY Construction Insulation Unused 3/6/1978 8/31/1982 Archived
INSULATION SER Contractor
Business Owner Information
Name Role Effective Date Expiration Date
MCCARTNEY,TERRENCE J President 08/13/1992
MCCARTNEY,VIRGINIA RIMSTAD Secretary 08/13/1992
Bond Information
Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date
4 TRAVELERS CAS& 206809004 08/02/2001 Until Cancelled $12,000.00 08/09/2001
SURETY CO
Assignment of Savings Information No records found for the previous 6 year period
Insurance Information
Insurance Company Name Policy Number Effective Date Expiration Date Cancel Date Impaired Date Amount Received Date
22 Nautilus Ins Co NN277071 01/20/2013 01/20/2014 $1,000,000.00 01/03/2013
21 Nautilus Ins Co NN181437 01/20/2012 01/20/2013 $1,000,000.0001/17/2012
20
NAUTILUS INS NN092832 01/20/2011 01/20/2012 $1,000,000.0001/13/2011
19
NAUTILUS INS BN949516 01/20/2010 01/20/2011 $1,000,000.0001/20/2010
18
NAUTILUS INS NC847690 01/20/2010 01/20/2011 $1,000,000.0001/19/2010
17
NAUTILUS INS NC847690 01/20/2009 01/20/2010 $1,000,000.0001/16/2009
16
NAUTILUS INS NC747383 01/20/2008 01/20/2009 $1,000,000.0001/09/2008
FIRST
15 SPECIALTY INS FGL22900346770201/20/2007 01/20/2008 $1,000,000.00 01/19/2007
CORP
https://fortress.wa.gov/lni/bbip/Print.aspx 9/30/2013
Contractors or Tradespeople Pr.Friendly Page • Page 2 of 2
Summons/Complaint Information No unsatisfied complaints on file within prior 6 year period
Warrant Information No unsatisfied warrants on file within prior 6 year period
Infractions/Citations Information No records found for the previous 6 year period
https://fortress.wa.gov/lni/bbip/Print.aspx 9/30/2013
• I
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#: BLD13-00303 Received Date 9/30/2013
SITE ADDRESS: 232 SAND RD# Issue Date 9/30/2013
PORT TOWNSEND, 98368
APPLICANT: CLAUS JANSSEN PHONE:
TERESA JANSSEN
232 SAND RD
PORT TOWNSEND WA 983689656
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 001184015 Section: 18 Township: 30N Range: 01W
CONTRACTOR: EVERWARM INC PHONE: (360)452-3366
257151 HWY 101
PORT ANGELES WA 98362
Contractor's License EVERWI*088NL Expires 8/17/2014
OWNER, CLAUS JANSSEN PHONE:
if different: TERESA JANSSEN
232 SAND RD
PORT TOWNSEND WA 983689656
PROJECT DESCRIPTION: WOOD STOVE SWAP OUT, SAME FOR SAME
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 9/30/2014.
REQUIRED INSPECTIONS:
Tank/Line/Appliance:
FinalApproval:
ICI
II
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 9/30/2013
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Date 44' time received t Z'41" am 6rpri Mo Tues. ,Wed: Thur. -Fri.
BLD: 13 - d0363 Date: /0/2.//_>3 1
OWNER: Contact Warner.ADDRESS: -- Z-31 �-1 Contact Number 360 585 ' 12 �,;:_•
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Notes: -
-� 355 -35-C
•
Foundation Plumbing - Framing' " Propane Tank " Mechanical - '
echanical '
Setbacks Under-ground Framing Underground _ Furnace •
Footing Rough in Alrseal Above ground Gas
Stemwall __ Hydronic Exterior shear Exterior lines Oil
Straps Interior shear Interior lines • Ducts f ,
Post Hole Ventilation . . Applian
Underfloor G ve
Man=Honies
Setbacks S " Insulation. Final Inspection
Foundation _• . ,.
Block&Tie floor _wall ceiling. . Address Posted '
4