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HomeMy WebLinkAboutBLD2012-00373 OUILDING PERMIT APPLICA BLD12-00373 N Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD12-00373 Received Date: 11/15/2012 SITE ADDRESS: 2094 ANDERSON LAKE RD CHIMACUM, 98325 OWNER: JENNIFER LOGUE PHONE: 253-459-5258 9402 187TH ST E PUYALLUP WA 98375-6301 FINNERTY-HANSEN SHORT PLAT SUBDIVISION: Block: Lot: 2 PARCEL NUMBER: 901103011 Section: 10 Township: 29 N Range: 01 W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2012 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr A/G 250 GAL PROP TANK SWAP OUT TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2009 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 Big Date: Receipt: Approved/Date Propane Tanks/Stoves $74.00 LYK 11/15/12 139753 I' Total: $74.00 Jefferson County Plannini Buildinn De'jertment \\firlomorlAriol,\forme\G RI Il Ann PIA rn+ 11/1 R/9!\19 • e SITE VISIT REPORT (PLOT PLAN) 1-612 (. 6c JOB DATE: CONTACT: ADDRESS aoq 4 i'P'oiJ 8.b ill 41°))/4f > PHONE #: DIRECTIONS FAX #: Email . PLANNER: jInclude 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. -\ 401,„v 1...$1:3' �q,d� J� J'1 ii i , Gil J 1 JEFFERSON COUNTY DFPT.OF COMMUNITY DEVELOPMENT P) fiIt- V R 1 j , I .eoN.. .. . JEFFERSON COUNTY'. . .. i • 0i4, _ . . DEPARTMENT OF COMMUNITY DEVELOPM NT 621. Sheridan Street•Port ToWnsenct:.Washington 98368 �• 360137B-4450.• 360/379440' Fax c , • www.co.jefferson wa..usicommdavelopment pA no MU Master P:�er-tt�it A �• iicati•a�n � •� MLA: . PrnjAjflesc tibn(include sepa .sheets , _ = r, 1 ii \/ iCA . ` Irk, _ r L. .L.� C V tr.. Tax Paitel.Number:: .. I)' O. I P oo e • :Size: p i i IIII cacres/squa>e feet) sit.Address and/or Directions to Property: • I �® , / r I,.u r^, z 1 `1 it / • Property Owne s):of Record: • /J ,mss► _i. .. -,rill ' w •Telephone --S - i, . : Fax/'} JEFFERSON Cif © ' 1 . 1' u- I d► �M1"npri1 •,• !'�2 Ind 1 (Viailing Address: -. _ ..,�. �� •App'licant/Agent(ifdifferent •from owner); J ` __ was Telephone: : 385 s79 7 Fax .J8 5". - 875 email 'f* «t .r - co>,. Mailing Address: /"0�- ,.i kH O r .'0;2 : Pi. t/Ric=a c, �.,,)R What kind of.Permit?(Check each-box that applies- O Lot or Road Segregation . C7Buiiding 0 Cnticel Areas St'ewardshipp.Plan 0 Demolition Permit 0 Varia a(Minor,Major or Reasonable Economic:4Alse) 0 0 Maniufactured Home: ; Q M dular Att Detached, 0 Q scret dnary goo U named C] ached.!Detach' • " " Ilse Classification 0 Commercial* •. 0 Special.Use(Essential Public Facilities)** • • 0 Change of Use 0 Boundary Line Adjustment 0 ;Address - •0 Road Approach• 0 Short plat" 0 Home Business . 0 Cottage�lndustry - 0 Binding,-,Site Plan** ,`, Z ropane -[J Loin;Fiat** -- - :, ! : , o Sign 0 Planrre�d Rural Residential Development(PRRR)/Afriendments** • Q Allowed-"Yes"Use'Consistency Analysis 0 Plat Vajcation/Alteration*' Q Stormwater Management - 0 Program Exemption/Permit Revisions" .o Site Plan Approval Advance Determination-,(SPAAD)* CJ Shorelihe Marfagerrleiit Substantial Development" o Temporary Us$ '0 Shoreii4ia�Management Variance Q Wirelesa`Teiet municatlon* 0 Comprrhensiv_e Plan/tJIDC/Land Use District Map Amendment Q Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference 0 Tree Vegetation Request . *Ae•ulres.a Pre-A.•lication Conference Please identify atf r.other locale state or feiteriFpermtta re4uired`ifor•tiiis p•oposal, If knoVyn: . sDESIGNATION OF AGENT , I ereby„design= _ . •t : _ to act as my agent in.matters:relating.to this application for permit(:s). •WNER SIGNATURE �.._.__...L�i1�lilL..a sue+ Date: • d •._ Sy signing this apphcat•n form,the owner gent,attests,thatthe information'provldedherein,.and in any attachments,:is true and cor ectto the.best of • his her or its knowled9e. Any material falsehood for any omission of a mate ial�fact n acfe b 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.t• •- •= access and right.of - e tO:tieffer*Orrs County and:Its employees,representatives or agents for the sole purpose of application review and.•-• y required. -ter inspection- •Staff s.and right•of entry will be,assumed unless the applicant informs.the County,in writing at•.the. t ,time of the -••Iication : at he:or she w- riot •nature. .. /:..d ....�®.� �fii�....:ll !• .\� A. , 1` Pates The action or act•ns Applicant will undertake as'a result of the,,suan'ce of thlt permit may negativelydnipaot upon one or more.threatened or . endangered species and could lead to a:potential."take"of an=endangered species.as.,thoose terms are defined in the federal law known as the . "Endangered Specie- •- or"BSA,"Jefferson County makes jn0 assurances to-the appHcant'ti at the actions that will¢p undertaken because this:. permit has be sued will •t violate t)ie Any dividual•group or agency can file a'lawsuiton behalf of art endangered species regarding..your action(s)e n if you are in••mpliance wit fife, •n County development Code,TheApp icantacknowledg:es that.he,-she or ithoids individual - and non ansferable res••nsibiiity for •,=� -- '',. �,the ESA. The Applicant has read this disc a n igns and dates it below. Sign-ture: pA4,J .Date: II C:•\Pr.mitrrnter\!f##FflRM.C###\nail FfRMC1l:,,e,.,.rTrRTl Fn.,..•\11.1". r»,P�.,.,:r 4....1:...,.;,,,,G In no-1-.. • 1 t • • • •The signer of this statement does hereby certify SUILDERSTATEMEN The sig er of ,t rt►fy that they are the Owners of the parce( rencerl g the responsibil'► of e Signature: G ene'fathor for the prgpo prbjq„ ereln;that they are riot licensed • contratora'and that GENERAL CONTRACTOR Dt �: s Ltl'► *1.17 E' ER: , •MAICJNG ADDRESS: FAX:• . .CONTRACTOR'S LICENSE ° t P.`o ::fir � . t& p ?S NuMeaR: � �3 • 6� 3 *it- ARCHIer/ENGttR: MAILING ADDRESS: Project Type: ', -0 •New • Frame Type: atMrooms: 0 Addition 0 Wood Existing: . Shorelin•b Altet~afio TYpa of Sewage bisposal: model 0 Steel . Proposed: 0 Cower•o Alter 0 Concrete ,,._ .Heig 0 Conimua S d Masanry Total •0 Demolition tier ., to • f� ,IVIae onrY B rooms. t den if Ys 0 alai In IVt _•�� System t ' �` Srrp P$muf# ���t�"e�Ceatt:' , -..: ..;-'*'..^."�. _ :Existing: k. .•ed Setback: - ater-Supp1Y: _ . Total ❑ fiwa Party:•O Private welt if this:s a Co �] Rublic • uercla Preen. . .� " mama of 5ystetri;• Number of Park, must er thr# .�llawin•i Spaces: Curta�n>~r • . _ • :Nu:Number of°pants(includes ' p �sosstl r o kakinere;tendrt{s,etta to Number of s •.Parkin $ p cY � yogis,etc) Curn�rf g Paces: ., f thief- . .."T• --• .• IBC,;'Type cbnstructint7. p,:. ed `" """.•b. . -,► , ® ., 'iit you have Fo..-!Q� 1 lltrdc:r$t+otand rink • � ' a cG tL , l'-':i$e L• tna L - �avtre7 • ..veground'Ta II ®e ow4•at : / N i Heat'stove i cook Sto � ;,,,®_. ,- . Sala of Propane ark i i this a I an b o stove f Firepl insert i ins:.II a. dl '• Hat Water -. •t i?ellot: to"''I••a M n � ``t�In H.me?• res / �. .Other I�ie�ej ���•If�ra�e1.s�Jt�cr'�ix�` �•lints,teak Iyi •te�and size,tllns r* ` rr srt►ustarsori �t site /an b includjn . a,V'e ardea.: i tank o iii pig a.. .> fife bu � .. � � �ail:ot Iidin �; � lines,builail}T �. >tllpraperfjr•r3.uare Foote_e � y � � � antl septic system co • Current x n t»pansnts, Maul:= fCCr Heat 9 ' .ose K ,z`,` f ..t . y� 5 YL 2 `. ;{� a r lea -r f w3",' ZH eIU R. Y �..� � i f ��P ! I��� �� h 4r� � 9�� k�f' r t y Fi00r Heated £'' , • . '': , ,.,. linri :. ,' h x "�� Consi•Other HeatQd' '. stency F! • . ' `M • 7� � a>�t�i�� Base fe✓3.' . atilne .a �t}} • j�� -ante y Y -u z,�,.jj , Addltidr<04 M!.MIIIIPZIMIMIIIIIIIINIIIIII �Y r ? t� Platt Checkf Unheated B etttent ?} •of r, :• eaten ••n, lARA: State Surcharge 4 , k ..� P`ot'water 7ev Garage[Ca s r i t fee:• rport: • • Q P`R%19x ; 3:U ;�T- • D cks i,t x'A 1 ' 911/Rd Approa a fee : w Other r EI` x ,sR iot Nu ma -§E - f k"1 i C iSh CheckA I rttkrer ,.. • ., fr e ' ° t , m0 fST1MW7 COS REQUI Ep ip,. . ...,,. bate. x ti +Fairy a otvafue ofapl aborandtherialsioundation .r Inil . ti \Perrnitcenter\###FORMS###\DID FORMS\Caren tbRD Pori Master Permit rl ltc ou S-24-0 • 8doc Contractors or Tradespeople Prir o Friendly Page • Page 1 of 2 General/Specialty Contractor A business registered as a construction contractor with L£tI 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 SUNSHINE PROPANE UBI No. 600342368 Phone 3603855797 Status Active Address 10853 Rhody Dr License No. SUNSHP'077QP Suite/Apt. License Type Construction Contractor City Port Had lock Effective Date 11/17/1993 State WA Expiration Date 11/17/2014 Zip 98339 Suspend Date County Jefferson Specialty 1 General Business Type Corporation Specialty 2 Unused Parent Company ENVIRONMENTAL HOUSING INC Other Associated Licenses Specialty Specialty Effective Expiration License Name Type 1 2 Date Date Status LEVISES915B6 LEVI'S ENERGY Construction General Unused 1/2/2009 1/2/2013 Active SERVICE LLC Contractor WARMWS'1236N WARM WINDOWS& Construction General Unused 1/15/1988 11/17/1993 Archived SUNSHINE Contractor ENVIRH'204Q5 ENVIRONMENTAL Construction General Unused 11/25/1980 11/17/1988 Archived HOUSING INC Contractor Business Owner Information Name Role Effective Date Expiration Date EWING,MICHAEL HOYT Member 01/01/1980 FLANDERS, RONALD LEE Member 11/05/2010 CHAWES, RICHARD HENRY President 11/05/2010 SIMPSON, LAURA ANNE Secretary 11/05/2010 YOURISH, ROBERT B Treasurer 01/01/1980 LEMLEY, DAVID BARRY Vice President 11/05/2010 PETERSEN,JAMES 01/01/1980 11/05/2010 SPRING, PERRY 01/01/1980 11/05/2010 CHAWES, RICHARD 01/01/1980 01/01/1980 YOUNT,JO 01/01/1980 01/01/1980 ROSS, LEVI K 01/01/1980 01/01/1980 Bond Information Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date 7 TRAVELERS CAS& 206086406 11/17/2001 Until Cancelled $12,000.00 10/23/2001 SURETY 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 United States 23 Fire Insurance 506-871834-3 11/17/2012 11/17/2013 $1,000,000.00 11/15/2012 C 22 FEDERATED 633829 11/17/2008 11/17/2009 $1,000,000.00 11/13/2008 SERVICE INS CO 21 FEDERATED 633829 11/17/2006 Until Cancelled $1,000,000.00 11/09/2006 SERVICE INS CO https://fortress.wa.gov/lni/bbip/Print.aspx 11/16/2012 Contractors or Tradespeople Prie Friendly Page • Page 2 of 2 20 FEDERATED 633829 11/17/2005 11/17/2006 $1,000,000.00 11/09/2005 SERVICE INS CO 4 FIREMAN'5 286M)0(80096485 11/07/1985 11/17/2007 11/07/1985 FUND 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 11/16/2012 PROPANE/PELLET/WOOD STOVE & TANK INSTALLATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD12-00373 Received Date 11/15/2012 SITE ADDRESS: 2094 ANDERSON LAKE RD Issue Date 11/16/2012 CHIMACUM, 98325 APPLICANT: JENNIFER LOGUE PHONE: 253-459-5258 9402 187TH ST E PUYALLUP WA 98375-6301 2 SUBDIVISION: FINNERTY-HANSEN SHORT PLAT Block: Lot: PARCEL NUMBER: 901103011 Section: 10 Township: 29N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 (3 ) 3g5-5875 Contractor's License SUNSHP*077QP Expires 1T/1 2012 OWNER, JENNIFER LOGUE PHONE: 253-459-5258 if different: 9402 187TH ST E PUYALLUP WA 98375-6301 PROJECT DESCRIPTION: A/G 250 GAL PROP TANK SWAP OUT 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 11/16/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: A 5mAtia Girt' OW 47/1/, FinalApproval: 'Rcr r 1/1a- i 11)/e/I BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:00 a.m. -4:30 p.m. HOT LINE AVAILABLE 24 HOURS A DAY \\tidemark\data\forms\F_BLD_Permit_Propane.rpt 11/16/2012