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HomeMy WebLinkAboutBLD2014-00155 IN3 UILDING PERMIT APPLICAON BLDI4-00155 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00155 Received Date: 5/2/2014 SITE ADDRESS: 81 HILLER DR PORT HADLOCK, 98339 OWNER: JACK S CLOGSTON PHONE: 360-385-3365 PO BOX 1075 PORT HADLOCK WA 98339-1075 HILLERS WF TR INC TL SUBDIVISION: Block: Lot: PARCEL NUMBER: 960300007 . Section: 7 Township: 29 N Range: 01 E 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 TANK SWAP TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC VALUATION MAIN: CODE EDITION: 2012 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: • OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: 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 05/02/14 148620 q g O Total: $152.00 A P MAY - 2 2014 Jefferson County DCD 1\firlcmer4\rlofo\fnrmo\f= RI fl Ann Rlrl rnf cP)(7(11 A • _r Or s rNititt4, JEFFERSON COUNTY :y. :. DEPA360/379 RT-4M45 ENT©360/379=IF-COMMUN451 Fax ITY,DEVELOPMENT. , , 621 Sheridan Street• Port Townsend•Washington 98368 ‘vvvvy.co.jeffersCin:Cifia.US/CorrirndfrvelopiTierit Master Permit Application MLA: Project Description(include sap" to°sheets as necessary).- - . :�., Tax Parcel,Number.. - l� jC�C 0 C� Property Size: (acres/square feet)`V Site Address and/or Directions to Property. IC 6 4 . Le Property Owners)of Record: ''• AA _ —ilia Telephone:- tj—.. a' Fax: ' email: Mailing Address: �?, Appticant/Agent(if different from owner):,_.. Ui, I r i Telephone:3"i, "'--1 Fax: , email: Mailing Address: 0 °'S 4arli 0 ► ,e r�iWit. s What kind of Permit?(Check each box that applies` _ OBuilding 0 Critical`Areas"S` r, ;p� I' 0 Demolition Permit 0 Variance(Mirror „ ---j. - -. 0 Single Family O Garage Attached/Detached 0°Conditional U - ” C(d),or C14'* ' 0 Manufactured Home ,'0 Modular~ 0 Discretionary'i Unna U la ratio O Commercial'* 0 Special Use( e- -I,Ptfbiir aeil�es 4 0 Change of Use - „0 Boundary Lin •j < -nt 0 Address 0 Road Approach'_ 0 Short Plat'" L.. Home Business 0 Cottage Industry 0 Binding'Site Ian"" 1€FreRsoN COUNTY' Propane 0l ong`Plat*" ` 1�r.T OF COMMUNfiyfl:VF1i ' O Sign 0 Planned Rural Resides a e eve o• - I- i, :, .ments" , 0_Allowed r`t'es"Use Consistency Analysis 0 Plat Vacation/Alteration,'" O Stormwater Management 0 Shoreline Master Program Exemptition/Permit Revisions,.**. O Site�Plan Approval Advance Determination(SPAMD)1% O,Shoreline Management Substantial Development"" t' `Tempora Use CI°Shoreline Maanagement Variance 0 Wireless Telecommunication*. : [3.Comprehensive-Plan/UDC/Land Use District Map Amendment . o Forest radices Act/Release of Six Year Moratorium 0 Jefferson County Shoreline Master Program Amendment -" * yrequlie a'Pie-Applica ion Conference Q`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 hereby designate ;Jo act as my agent in matters relating to this,application for penpit(s). OWNF S1cw►TURd . /• '" By signing this app n.form,the owner gent attests.that the Information provided herein,and in.any attachments,isstrue and correct to the best of ,v` 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. tl further agree to save,indemnify and bold 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. Stairs access and.right of entry will be assumed,unless the applicant informs the.County in writing at the time of the ap-licatd . he or wa _onor notic e 1 _ / ' ���//! 9 ` Date.. ;.la/, .. - The actio o actions Applicant will.0 dertake as.a'result of the issuance of this permit,may negatively Impact upon one or more threatened or endange -. pecies and could lead • 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.wlll 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 orit holds individual and non-trap b sibil h ring to and complying withftheESA. The Applicant has read this disclaimer and signs and dates it below. Signature: �u;€ pate: - .. ". -�'"i,/ 7 G:\Petmi ###FORMS###\DRD FORMS\Master PeanitApplication 5-29-08.doc ° ; '' • BUILDER STATEMENT • The signer of this statement does hereby certify that they are the Owners of the parcel refer'ended:herein,that they are not licensed contractors and that they will be assumi g the responsibil f the General Contractor for the proposed p ect: Signature: L.�J '("`._ Date '1 y GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: MAILING ADDRESS: :.` EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER,:: ARCHITECT/ENGINEER: r PHONE ( ) FAX ( )a MAILING ADDRESS: EMAIL Project Type: Frame Type: r Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New, ❑ ,Wood. r.:; Existing:.. 0 Sewer ❑ Addition n Steel Proposed: Bank D Community System ❑ Alteration/Remodel ❑ Concrete Total: Height p Individual System ❑ .Repair 0 Masonry SEP Perrnit# O Demolition ,p Other _ Bedrooms: Water Supply: xistin : Setback: p Private well " O°T'wo Party. Type of Heat: Proposed: 0 Public Total; Name of System: � If this is a Commercial Project vou must answer the followinrt: Number of Parking Spaces: Current: Proposed: Number of AQA 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 I• a dlo"A: Rance Installation oennit.mark all items bet at apply: Underground Tank 11 •• > .,• ,• ." r -Size of Propane Tank: X-1 a.(� I Heat Stove 1 Cook Stove 1 Woodstove I Fireplace Insert I Hot Water Tank t Pellet Stove 1 Other Is this appliance beina installed in a Manufactured Mobile+Home? Yes I No When applying lor"e peflnitio,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. I S•uare Foota e Current Pro•osed ., �, `;� , _� 4 ax rn Main Floor Heated e- -.EH Bid App Review: • 2'1°Floor Heated ` • - Consistency Review'. Other Heated a Base fee: /5-2 Mezzanine ;:Additional Section: / Heated Basement Plan Check fee Unheated Basement 4 State Surcharge fee: Other'Unheated 4 Pot Water Review fee:, Garage,/Carport :- SUBTOTAL Decks, LI' 911/Rd Approach fee: Othet TOTAL $ Receipt Number. /4/ Cash/Check Number. ESTIMATED COST(REQUIRED) Date .Fair mancet value of all labor and tnetedals foundation to finish Initials G\PettnitCenter\###FORMS###\DRD FORMS\Master Fetmit Application 5-29-08.doc r i 0 f goo.tirt' SITE VISIT REPORT g_e_caeS----(PLOT PLAN) JOB J co r`�� 54. ._ CLOGSTV A/DATE: 1 1,5- "7" CONTACT: ADDRESS -i ' 6 pittle-,2-- s� PHONE #: O c�—7�6 S7 DI. CTIONS PTi b L.or.�J FAX #: (/9-k.' Z vy P9-/tE 1v1,2... c'Ff-- Email PLANNER: JLL>" . 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. N 4 - i)cll I D ; L! l! [u Q1 i j1 AP ? n 2014 it Q/ i Ii_nT OFJEFFERSON ' NW -______, COMB MITY DF!F VLOPMFNT \\I rA•20s u A., �. K s.10 J , _ I.✓ i-/ e— w Gif 13:91344, TRL4.C R 1w'%u sTh$s- izE Screen: 01 REAL PROPERTY MASTER Mode: INQUIRY Parcel # 000960300007 Elko Cd 292107304211 Auto Roll : OFF HILLERS WF TR INC TL Nbhd Cd 3245 10 Loc ID * Taxpayer Cd CLOG 2500 CLOGSTON, JACK S T/P Chg Dt 10/16/1996 * Title Owner T/P Chg Usr JODI Tax Code 0211 Status TX TAXABLE Land Use 1100 RES-SINGLE Affidavit 80509 Vol/Page / C/U Code COMPLETE ADDRESS WINDOW Taxpayer CLOG2500 JACK S CLOGSTON PO BOX 1075 PORT HADLOCK WA 98339-1075 Search Key CMD 6 : End Window CMD 7: End of Job SUNSHINE PROPANE Page 1 of 3 • • 0 Washington State Department 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, 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= 5/2/2014 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#: BLD14-00155 Received Date 5/2/2014 SITE ADDRESS: 81 HILLER DR Issue Date 5/2/2014 PORT HADLOCK, 98339 APPLICANT: JACK S CLOGSTON PHONE: 360-385-3365 PO BOX 1075 PORT HADLOCK WA 98339-1075 SUBDIVISION: HILLERS WF TR INC TL Block: Lot: PARCEL NUMBER: 960300007 Section: 7 Township: 29N Range: 01E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 (3g�13$5-5875 Contractor's License SUNSHP*077QP Expires 11/17/2014 OWNER, JACK S CLOGSTON PHONE: 360-385-3365 if different: PO BOX 1075 PORT HADLOCK WA 98339-1075 PROJECT DESCRIPTION: TANK SWAP 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 5/2/2015. REQUIRED INSPECTIONS: Installation per Manufacturer Specifications/CO2: lid 61.r/' � J Tank/Line/Appliance: N/ Final Approval: 4/(' W 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 5/2/2014 OAK- 153" RA 1.14 L `�SGN cb JEFFERSON COUNTY a-69 DEPARTMENT OF COMMUNITY DEVELOPMENTas ��`sf/f G�0= Date: ''c ( Time Received: Sd`f a O Mon. (fhe! Wed. Thur. Fri. Date: 6 °,S - BLD: /9 -1 SS- Contact Name: Owner: Contact Number: 360 5-7/ 7 Address: 8/ hide,- 4y 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 Man-Homes Insulation Final Inspection Setbacks Floor Foundation Wall Address Posted Block&Tile Ceiling JEFFERSON COUNTY D NO. 148620 DATE ✓`�7 t/ RECEIVED FROM E��J /171"-(- iltrjtir\-12-- DESCRIPTION BARS# AMOUNT CURRENCY I 152 COIN 'S- - ,;„:1-!1.' . qz„. (9�,l L.2�� / C H E C 5°70 2 CD o rn:� C)a °v Yom.,.X .v i,., RECEIVED BY TOTAL �-