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Home My WebLink AboutBLD2013-00306 • BUILDING PERMIT APPLIC ON BLD13-00306 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD13-00306 Received Date: 10/1/2013 SITE ADDRESS: 71 W MARKET ST# PORT HADLOCK, 98339 OWNER: JOHN W CHRISTIANSEN PHONE: CHARLENE CHRISTIANSEN 71 W MARKET ST PORT HADLOCK WA 983399664 HARRISBURG SUBDIVISION: Block: Lot: PARCEL NUMBER: 956700502 Section: 2 Township: 29 N Range: 01 W 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 DESCRIPTION INSTALL 120 GAL PROPANE TANK AND PROPANE GAS STOVE TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION ADD'L: HEAT TYPE: PRO 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 $228.00 MEB 10/01/13 145410 H'� �®"�® Total: $228.00 APPROVED OCT 012013 Jefferson County DCD \firlcm.rWrhfe\fnrn.c\C RI II Ann RIrH rn+ 1(V1/9(114 • 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#: BLD13-00306 Received Date 10/1/2013 SITE ADDRESS: 71 W MARKET ST# Issue Date 10/1/2013 PORT HADLOCK, 98339 APPLICANT: JOHN W CHRISTIANSEN PHONE: CHARLENE CHRISTIANSEN 71 W MARKET ST PORT HADLOCK WA 983399664 SUBDIVISION: HARRISBURG Block: Lot: PARCEL NUMBER: 956700502 Section: 2 Township: 29N Range: 01W 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, JOHN W CHRISTIANSEN PHONE: if different: CHARLENE CHRISTIANSEN 71 W MARKET ST PORT HADLOCK WA 983399664 PROJECT DESCRIPTION: INSTALL 120 GAL PROPANE TANK AND PROPANE GAS 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 10/1/2014. REQUIRED INSPECTIONS: Tank/Line/Appliance: Movi, 'r'C •ROwI_ --- /00/6 X FinalApproval: q- (0 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 10/1/2013 0O JEFFERS OUNTY • 6t,i ■, - )C�b ' le ' A DEPARTMENT OF COMMUNITY DEVELOPMENT ` '4 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax t5 www.co.jefferson.wa.us/commdevelopment ..14WINd . Master Permit Application MLA: Project Description(include separate sheets as necessary): 4-4.‘&,. ry 120 Tax Parcel Number: q g (p 0 SZ)2 Property Size: (acres/square feet) Site Address and/or Directions to Property: - Property Owner(s)of Record: ,1 UL►«. Gv k i4, 1*t 4^ N/l.-■ . Telephone: -� t Fax: email: —R Mailing Address: (,-). \c -Cu/1- (i)0/4— g or.� G 3 Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies ❑ Lot or Road Segregation V3uilding ins It V--i -k-x,4+.• ❑ Demolition Permit ❑ Critical Areas Stewardship Plan ❑Variance(Minor, Major or Reasonable Economic Use) ❑Single Family ❑ Garage Attached/Detached ❑Conditional Use[C(a), C(d),or C]** ❑ 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** ❑ sign ❑ Planned 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)* 0 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 application that he or she wants prior notice. / 1,ignature: , iw�- "717 • Date: 10/i /,/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 le responsibility for adhering to and complying with the ESA. The Applicant has read this disclaim%r a is and dates it below. • ignature: �,At c�•l . Date: /'0/ /,Y(s • 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 CONTRACT R OR MANUFACTURED HOME INSTALLER: PHONE: FAX: �� k ( ) ( ) 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: X--New 0 Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System O Alteration/Remodel ❑ Concrete Total: - Height: 0 Individual System O Repair ❑ Masonry SEP Permit# O Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well 0 Two Party Type of Heat: Proposed: ❑ Public V?)c3 a.v..e 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 FoodService? Yes / No ' If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: I Underground Tank I Above ground Tank Size of Propane Tank: I Heat Stove I 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 BId App Review: 22 Floor Heated Consistency Review: Other Heated Base fee: ' 2 - 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: 'q J�+"L!` O Cash/Check Number: (.0 l�( ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish 10J t j Initials: Pry, . . G:\FemritCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc Contractors or Tradespeople lister Friendly Page • Page 1 of 2 General/Specialty Contractor A business registered as a construction contractor with L£tl 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 CENEXHS022NQ STATES Contractor General Unused 8/18/1998 9/6/2004 Archived COOPERTVS CENEXSM033QM CENEX SUPPLY 8 Construction General Unused 11/14/1997 11/21/1998 Archived MARKETING Contractor CENEXSM065Q1 CENEX SUPPLY& 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 FARMERS UNION Construction FARMEUC186K7 CENTRAL EXCH INC Contractor General Unused 5/27/1982 9/30/1986 Archived 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 58S203444 11/21/2012 Until Cancelled $12,000.00 10/05/2012 4 TRAVELERS CAS& 103502492 09/01/2001 Until Cancelled 11/21/2012 $12,000.00 09/06/2001 SURETY https://fortress.wa.gov/lni/bbip/Print.aspx 10/1/2013 Contractors or Tradespeople .ter Friendly Page • Page 2 of 2 Assignment of Savings Information No records found for the previous 6 year period Insurance Information Insurance r�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 $1,000,000.00 09/03/2013 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 EB164100426402009/01/2009 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 EB164100426402709/01/2005 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 II III II II https://fortress.wa.gov/lni/bbip/Print.aspx 10/1/2013 D-- ! • CC H _ Q LL _0 Z LL O H O -3 -^ •• � C- CD — N LJJ O 'O — Nt J O O L CD -0 M O: -0 -1-1 CO Z C U 0 = H LLI O 0 CO i-+ ^O H O CO I O .0 L L CJ] L� CL .o U U C.) 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S.31.VeZf.NP; . :...:&FAI",:,,,,t;•- • . . , . .1 , , - ;12.7.. ..,:k.-.^.74-4<r„ty..24. 0; W'X'..7.'"j w.arita-1.-t..4• Alll' -4-..-w.t.t.....t,...-,...:.,-'4.....--•=....-..e. • . - . . _ Datel.Elf:9—_---'time received q 5-t) D Pm Mon. Tue . ‘Wed; ( ....-3ur -Fri. BLD: t3 - 301.0 Date: OWNER: . - Contact Warner. . ., A i . ADDRESS: 71 w. n A P__Kfr-t- . Contact Number.360 7-6 111 206 Notes: f-. . - . " . Foundation Plumbing. - Framing Propane Tank - Mechanical -. - ------ — Setbacks Under-ground Framing Under ground Furnace Footing Rough in Air seal Above ground Gas Stemwall Hydronic Exterior shear Exterior lines Oil Straps _ Interior shear Interior lines . Ducts I Post Hole " Ventilation Appliance Underfloor _ Gas/wood stove Man-Homes - • Setbacks Insulation. Final inspection .•--• Foundation- ..-.s :.. Block&Ile floor wall ceiling. Address Posfed • :: III ___ • /e,l_SON BOO JEFFERSON COUN -` DEPARTMENT OF COMMUNITY DEVELOPMENT Date: q Time Received: Cd , 3 am/pm Mon. Tue. Wed. Thur. Fri. Date: BLD: ?�-1070(; Contact Name: Owner: C, r -c., .,s r',,rte,. Contact Number: 360 . cj_-57 7,(:, Address: 206 Notes: 11 MI "IT 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 K...._ Setbacks Floor Foundation Wall Address Posted Block&Tile Ceiling