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Home My WebLink AboutBLD2013-00307 ItUILDING PERMIT APPLICAIN BLDI3-00307 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD13-00307 Received Date: 10/2/2013 SITE ADDRESS: 110 ROBIN LN# PORT LUDLOW, 98365 OWNER: CHARLES E MC CARTY PHONE: 360-509-6167 19688 ROSEBUD PL NE POULSBO WA 98370-8547 BRIDGEHAVEN DIV 8 SUBDIVISION: Block: Lot: PARCEL NUMBER: 935900029 Section: 9 Township: 27 N Range: 01 E CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2014 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr SWAP OUT 120 GAL PROPANE TANK TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP MEC VALUATION MAIN: CODE EDITION: 2012 ADD'L: HEAT TYPE: PRO OCCUPANCY: HEAT BASE: HEAT TYPE: EEE OCCUPANCY: UNHEATED: #OF STORIES: 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 MEB 10/02/13 145414 APPROVED Total: $152.00 G OCT 0 2 2013 Jefferson County DCD \\+irlomnrlArl +o\forme\G RI Il Ann PIA rn+ Iniwl\1Z g 6t4 ON 00 JEFFERSO OUNTY 3 ^ o rDEPARTMENT OF COMMUNITY DEVELOPMENT ti 621 Sheridan Street• Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax / ,47N0,89 www.co.jefferson.wa.us/commdevelopment S` N Master Permit Application MLA: Project Description(include separate sheets as necessary): and 17�,� Su7,p- or,r f t70J... ( Tax Parcel Number: Ec-C ,v 0 0 20\ Property Size: (acres/square feet) Site Address and/or Directions to Property: Property Owner(s)of Record: J Telephone: 3e- S •-6ii Fax: email: ittA, t.7�fwcr4d��eJlPego/ Mailing Address: /76.811 4 eL✓1/ ?Lk. "Pi,Alf ,f ,,/cL, 0,44 Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies ❑ Lot or Road Segregation uildin 9 El 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 ❑ Commercial* ❑Special Use(Essential Public Facilities)** ❑ Change of Use ❑ Boundary Line Adjustment ❑ Address ❑ Road Approach_ ❑ Short Plat** ❑Home Business ❑Cottage Industry ❑ Binding Site Plan'"`* gPcopane Jt ❑ Long Plat** iyri ` ❑ Plannea Rural 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 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 applicati • t he • •- • • -- Lice. /do Signature: /� 7 % Date: re /d r 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-transfera• •onsib" • •__and complying with the ESA. The Applicant has read this disclaim an signs and dates it below. Signature: Date: .re ,x,/"")* 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: (.."/.007 i `7.4;1lui-s 4 ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: ❑ Sewer ❑ Addition 0 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 Type of Heat: Proposed: ❑ Public Total: Sett ftt 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 Above ground Tank Size of Propane Tank: 1 H• eat Stove 1 Cook Stove I Woodstove I Fireplace Insert I Hot Water Tank I 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: Mezzanine Additional Section: 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: 1 (t c(,r ,14 Cash/Check Number: C ESTIMATED COST(REQUIRED) Date: t U r /2 •Fair market value of all labor and materials foundation to finish r Initials: e i"WC� G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc >- • • CC LCD H O = O C3 LL CV _0 Z L� � o H O LID -J O CI) - d- CO -, CU o "O - CO J O O L CO -0 X CC "O +J O Z C U O = H W O O CO +, "O H O O I -• 7 L L L CO ti Q J7 U U U LLJ Z O CC O J CL C1 = � U I•- H O O O N CO O = O U CC "O N- UJ C = 3 T1- 3 1— so \ O Lo O co J U C] CO -O CE Z 1 C g .-- H W O -- CO LLJ 3 } Z 1•- 3 ✓ N CO I- CO F- CO CO CO CC J CO '0 CC CO LLJ W CO Q Cl CJ) C W CO I-I J J Li..J C.3 W CL 07 O CC CO CC O O O Q Q iDi U = Q •- CC .— Z 2 X ■ O X CO 3 CO CL CV LI C-3 Q ¢ LLJ r,. 1- W CO C3 J CV Q - W O = CC 2 } I- Up CC O U L LI 'O W I- X L LI LIJ CO '.., CC C-1 CO CC I- CO _I J CO UJ 0 Q O CL CC 00 J O I-I CJ CO 10 = Q LO = N CC CO 7 0- O 2 CA O CO m CV C..) +1 '` U U O- M 4.0 - +J O CTf O CO > CV LO O CV O r- O CJ7 U LSD X Cr) U LO CT) O f• O r- O � NI- LO O O -0 C. CO O CU U N CV r- .- a # C O V N •• L. 2 L x Y C — Ca O +, C) U N C) a N -- = E L N U CO CO 'O > CO U L L C1 - O CO O. C- 0 CO X i+ U "O X 10 CO 0- CO -- -- CO O F- I- X 4- I- CO 03 c} 3E * I- i Contractors or Tradespeople liter Friendly Page • Page 1 of 2 General/Specialty Contractor A business registered as a construction contractor with L&I 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 C H S INC UBI No. 600148004 Phone 2538337220 Status Active Address Po Box 518 License No. CHSIN**9790Z Suite/Apt. License Type Construction Contractor City Auburn Effective Date 9/9/2003 State WA Expiration Date 9/7/2014 Zip 980710518 Suspend Date County King 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 CENEX LAND Construction CENEXL0017K8 O'LAKES Contractor General Unused 5/28/1999 1/1/2001 Archived AGRONOMY CO CENEX HARVEST Construction CENEXHS022N Q STATES Contractor General Unused 8/18/1998 9/6/2004 Archived COOPERTVS CENEXSM033QM CENEX SUPPLY a Construction General Unused 11/14/1997 11/21/1998 Archived MARKETING Contractor CENEXSM065Q1 CENEX SUPPLY a Construction General Unused 11/21/1994 11/21/1997 Archived MARKETING INC Contractor CENEXI*064D2 CENEX INC Construction General Unused 3/22/1994 9/30/1998 Archived Contractor CENEXVS099R0 CENEX VALLEY Construction General Unused 12/20/1991 11/21/1994 Archived SUPPLY Contractor CENEX**1480T CENEX Construction General Unused 9/30/1986 9/30/1994 Archived Contractor FARMEUC186K7 FARMERS UNION Construction General Unused 5/27/1982 9/30/1986 Archived CENTRAL EXCH INC Contractor CENEXZT8930R CENEX ZIP TRIP Construction General Unused 12/11/2012 12/11/2014 Suspended Contractor Business Owner Information Name Role Effective Date Expiration Date C T CORPORATION SYSTEM Agent 09/09/2003 CASALE,CARL MARTIN President 09/21/2012 LILJA, NANCI LEE Secretary 09/21/2012 KASTELIC, DAVID ALLEN Treasurer 09/21/2012 EGAN,THERESA MARIE Vice President 09/21/2012 MCENROE,JOHN DANIEL Vice President 09/21/2012 ESTENSON, NOEL President 09/09/2003 09/21/2012 BAKER, DAVID A Secretary 09/09/2003 09/21/2012 WESTBROCK, LEON Vice President 09/09/2003 09/21/2012 Bond Information Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date 5 Liberty Mutual Ins Co 585203444 11/21/2012 Until Cancelled $12,000.00 10/05/2012 4 TRAVELERS CAS ft 103502492 09/01/2001 Until Cancelled 11/21/2012 $12,000.00 09/06/2001 SURETY https://fortress.wa.gov/lni/bbip/Print.aspx 10/2/2013 Contractors or Tradespeople Peter Friendly Page • Page 2 of 2 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 Old Republic MWZY300224 09/01/2013 09/01/2014 $1,000,000.0009/03/2013 Ins Co 21 Old Republic MWZY59821 09/01/2012 09/01/2013 $3,000,000.00 08/28/2012 Ins Co 20 Liberty Mutual EB1641004264021 09/01/2011 09/01/2012 $1,000,000.00 09/07/2011 Ins Co 19 LIBERTY EB1641004264020 09/01/2009 09/01/2011 $1,000,000.00 09/07/2010 MUTUAL INS CO 18 LIBERTY EB1641004264028 09/01/2008 09/01/2009 $1,000,000.00 08/29/2008 MUTUAL INS CO 17 LIBERTY EB1641004264027 09/01/2005 09/01/2008 $1,000,000.00 08/20/2007 MUTUAL INS CO 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 10/2/2013 ��SO\ co JEFFERSON CO •6LV! iA Lu b..O'SL- G` } " DEPARTMENT OF COMMUNITY DEVELOPMENT Date: 7_7,9 Time Received: 9'9-7 0/pm Mon. Tue. Wed. hur. ' Fri. Date: // m.- 1a ' BLD: /3- 3 0 7 Contact Name: Owner: Contact Number: 360 $7j9 j/6.7 Address: HO , ' '- Pe,--7-Lode_o tl 206 Notes: / / ? z 4° 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 • S 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#: BLD13-00307 Received Date 10/2/2013 SITE ADDRESS: 110 ROBIN LN # Issue Date 10/2/2013 PORT LUDLOW, 98365 APPLICANT: CHARLES E MC CARTY PHONE: 360-509-6167 19688 ROSEBUD PL NE POULSBO WA 98370-8547 SUBDIVISION: BRIDGEHAVEN DIV 8 Block: Lot: PARCEL NUMBER: 935900029 Section: 9 Township: 27N Range: 01 E CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2014 OWNER, CHARLES E MC CARTY PHONE: 360-509-6167 if different: 19688 ROSEBUD PL NE POULSBO WA 98370-8547 PROJECT DESCRIPTION: SWAP OUT 120 GAL PROPANE TANK 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 10/2/2014. REQUIRED INSPECTIONS: Tank/Line/Appliance: efNAT / �c+%WC / fi,/ , 4,0-4, FinalApproval: 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 10/2/2013