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HomeMy WebLinkAboutBLD2014-00314 - MECHANICAL I BUILDING PERMIT APP TI ON BLDI4-00314 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00314 Received Date: 8/29/2014 SITE ADDRESS: 3830 DOSEWALLIPS RIVER RD BRINNON, 98320 OWNER: DE ETTE W BRODERSON JR PHONE: 360-796-4253 3830 DOSEWALLIPS RD BRINNON WA 98320-9698 SUBDIVISION: Block: Lot: PARCEL NUMBER: 602291014 Section: 29 Township: 26 N Range: 2V1 CONTRACTOR: PRICE JONES LLC PHONE: 360-377-6119 P.O. BOX 4084 BREMERTON WA 98312 Contractor's License PJSHOHE914KL Expires 5/13/2015 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP INSTALL NEW DUCTLESS HEAT PUMP TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC VALUATION MAIN: CODE EDITION: 2012 ADD'L: HEAT TYPE: HTP 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: outing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $152.00 SRE 08/20/14 151460 App ROVED Total: $152.00 AUG 2 9 2UV Jefferson County DCD \\tidemark\data\forms\F_BLD_App_Bld.rpt 8/29/2014 �,gON C 2f po �w 1 bei. JEFFEI N COUNTY W _ ,� DEPARTMENT OF COMMUNITY DEVELOPMENT _ I, ' "� 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax 4,„gsp� www.co.jefferson.wa.us/commdevelopment BIND Master Permit Application MLA: Project Description(include separate sheets as necessary):a f 1- 111)0-"I Tax. Parcel Number: 6Daa eno �- Property Size: (acres/square feet) Site Address and/or Directions to Property: •li - 6,/4l(,`, t K, 67-i0 _ /4 . 320 Property Owner(s)of Record: Telephone: 360ty Fax: email: I Mailing Address: Applicant/Agent if different from owner): kr.p.30--0.0 L� 1 ■Telephone: - Fax: email: r e D,t MO-' I' Mailing Address: G .' , .,, 0 • ` 'i ,f 9f 3 2 What kind of Permit?(Check each box that applies ❑ Lot or Road Segregation ❑Building 0 Critical Areas Stewardship Plan — ❑ Demolition Permit ❑Variance(Minor, Major or Re—••-b ❑ Single Family ❑Garage Attached/Detached ❑Conditional Use[C(a), C(d),or el ` -xJ LS IV V L� ❑ Manufactured Hone .❑ Modular - ❑ Discretionary"D”or Unnamed ssmcation r`i Commercial* ❑Special Use(Essential Public =:- ies)** ❑ Change of Use ❑ Boundary Line Adjustment AUG 2 8 2014 ❑ Address___ ❑ Road Approach_ ❑Short Plat** ❑ Home Business ❑Cottage Industry ❑ Binding Site Plan** ❑ Propane ❑ Long Plat** R ,,N,�000NTY Ji jn ❑ Plannea Rural Residential Developnb OF G ouNri T ❑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: J DESIGNATION OF AGENT I hereby designate. /if't(� D✓(�, �� to act as my agent in matters relating to this ap lication for permit(s). ap / OWNER SIGNATURE Ate .t,410 .�.,i Date: 1 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 Jeff- on County and its employees,representatives or agents for the sole purpose of application review and any required later inspections. Staff -.'.T'-$ .•.right of entry will be assumed unless the applicant informs the County in writing at the time of the app'' "/./ /s/� o_;,:•' - Signature: / /%/ Date: y -„27- /c-7 ....„..........__...._ The action or a h ns Applican 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 wit' • --= on County development code.The Applicant acknowledges that he,she or it holds individual and non-transfer e/r� it . dherin• . - .r ••.-ying with the ESA. The Applicant has read this dis men a s ns an it below. Signature: i% . Date: �'� �� G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc • BUILDER STATEMENT 0 The signer of this statement do:$ hereby - i t.: they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be ass •••'ng the po. „o :. t•- - :1 Contractor for the proposed project. Signature: _ Date: _._y-,2/- /c7 NERAL CONT CTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: Fif MAILING ADDRESS: / %_ 4'22 !� I.t.°K�!rte // EMAIL: 4-C J0, LLB--Cg 64 }r•437-� CONTRACTOR'S LICENSE a5/7/0/.../E 917,// - �, WAINS NUMBER: r/f-�/�_ NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: r; New 0 Wood Existing: 0 Sewer C Addition ❑ Steel Proposed: Bank ❑ Community System , ❑ Alteration/Remodel ❑ Concrete Total: — Height: ❑ Individual System 0 Repair ❑ Masonry — SEP Permit# E Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: ❑ Public Total: Name of System: If this is a Commercial Project you must answer the following: r- --'Numberpf-Park-ingSpaces: Current: Proposed: Number of ADA Parkin. •_>- ` t C Ni.in-betpf occupants(includes owners,tenants,employees,etc) Current c t ' �'' IBC Occupancy: IGC Type of construction: Will you have •d,•. lJ If this is a Propane Tank and/or Appliance Installation permit,mark all items below that a• L.��,'.. i Underground Tank i Above ground Tank Size of Propane Tank: _ 1 2 V4 i Heat Stove i Cook Stove i Woodstove i Fireplace Insert t Hot Water Tank i Pellet St•�(• ��Other y 2 t 19-this appliance being installed in a Manufactured/Mobile Home? Yes / No \A ti�C00� ..kVhen'applying for a permit to install a propane tank you must also submit a site plan shows g all o theluu . • .off N.1 • '- lines,tank location and size,distances from the propane tank to all property lines,buildings\and ic--.3:','‘-L'' •mponents, including the reserve area. -I Square Footage Current Proposed For Office Use Only, Amount Revision Main Floor Heated EH Bld App Review: 2n4 Floor Heated Consistency Review: Other Heated Base fee: r`r-- D Mezzanine I- Additional Section: I Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated - Pot Water Review fee: �OT ' " 'U —Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: -Other TOTAL: $ /`7 f 00 1 s Receipt Number: /5/ 4-66 Cash/Check Number: 5,1- G ESTIMATED COST(REQUIRED) Date: I •Fair market value of all labor and materials foundation to finish X g3114 Initials: !!! .p G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc PJ'S HOME ENERGY SERVICES Page 1 of 2 • • Washington State Department of Labor & Industries PJ'S HOME ENERGY SERVICES Owner or tradesperson 2800 Erlands Point Road NW JONES, DETRICK K BREMERTON,WA 98312 360377-6119 Principals KITSAP County JONES, DETRICK K, PARTNER/MEMBER Jones, AMELIA E, PARTNER/MEMBER Doing business as PJ'S HOME ENERGY SERVICES WA UBI No. Business type 602 845 638 Limited Liability Company Parent company PRICE JONES, LLC 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. PJSHOHE914KL Effective—expiration 05/13/2009—05/13/2015 Bond Lexon Ins Co $12,000.00 Bond account no. 9813125 Received by L&I Effective date 04/30/2012 04/30/2012 Expiration date Until Canceled Bond history Insurance .............................. Western National Assur Co $1,000,000.00 Policy no. CPP0013881 Received by L&I Effective date 12/17/2013 01/11/2011 https://secure.lni.wa.gov/verify/Detail.aspx?UBI=602845638&LIC=PJSHOHE914KL&SAW= 8/29/2014 PJ'S HOME ENERGY SERVICES Page 2 of 2 • Expiration date 01/11/2015 Insurance history Savings No savings accounts during the previous 6 year period. Lawsuits against the bond or savings No lawsuits against the bond or savings accounts during the previous 6 year period. L&I Tax debts No L&I tax debts are recorded for this contractor license during the previous 6 year period, but some debts may be recorded by other agencies. License Violations Infraction no. ESEA000588 Satisfied Violation date RCWAA/AC 11/08/2012 19.28.041 RCW Violation city Violation amount KINGSTON $500.00 Type of violation ELECTRICAL CITATION Description Offering to perform,submitting a bid for, advertising, installing or maintaining cables, conductors or equipment that convey or utilize electrical current without having a valid electrical contractor license. Workers' comp Do you know if the business has employees? If so, verify the business is up-to-date on workers' comp premiums. L&I Account ID Account is closed. 128,982-01 Doing business as PJ'S HOME ENERGY SERVICES Estimated workers reported N/A L&I account representative T4/TERRI MADISON(360)902-4654-Email: KIRT235©Ini.wa.gov Workplace safety and health No inspections during the previous 6 year period. ©Washington State Dept.of Labor&Industries.Use of this site is subject to the laws of the state of Washington. , Access Washington 4;�txta139xs[;vp,p;ggr7 wo,, https://secure.lni.wa.gov/verify/Detail.aspx?UBI=602845638&LIC=PJSHOHE914KL&SAW= 8/29/2014 Parcel Details Page 1 of 2 • • f erson County Home County Info Departments Search 4 Parcel Number: 602291014 SEARCH Parcel Number: 602291014 Printer Friendly Owner Mailing Address: DE ETTE W BRODERSON JR 3830 DOSEWALLIPS RD BRINNON WA98320-9698 Site Address: 3830 DOSEWALLIPS RD BRINNON 98320 Section: 29 School District: Brinnon (46) Qtr Section: NE1/4 Fire Dist: Brinnon (4) Township: 26N Tax Status: Taxable Range: 2W Tax Code: 0440 Planning area: Brinnon (11) Sub Division: Assessor's Land Use Code: 1100 - Residential - Single Unit Property Description: S29 T26 R2W TAX 26 BND TGTH THRU BLA #94006 Tax,A/V, Sales, Photos, and Permit Data Bldg Data Map Parcel Plats&Surveys Septic Monitoring Info ................... Jefferson County HOME I COUNTY INFO I DEPARTMENTS I SEARCH ....._ r ..._... . ._. ..:a .,, _.: ... Best viewed with Microsoft Internet Explorer 6.0 or later Windows- Mac http://www.co.jefferson.wa.us/assessors/parcel/parceldetail.asp?Parcel_NO=602291014 8/29/2014 Jefferson County Building Division Permit Number: BLD14-00314 Applicant: BRODERSON JR BUILDING PERMIT INSPECTION APPROVALS Applicable Code: 2012 International Building Codes To schedule inspections, call (360)379-4455 no later than 3:00PM the day before the inspection is needed. Requests received after 3:00 PM will not be scheduled for the next day's inspections. ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries. The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection Inspection Item Date Approval Signature Notes Mechanical Systems 011.1?)1q /1 INSTALL DUCTLESS HEATPUMP A final inspection will not be scheduled until all of the following are completed and signed off by the applicable Department: • Building Permit Conditions are met • Septic Permit Final/Complete for any building containing plumbing • Land Use Conditions met and signed off • Public Works Permit Final(where applicable) FINAL INSPECTION ,,1 1 � I FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR • • CONDITIONS for Building Permit# : \\tidemark\data\forms\F_BLD_Permit_BIdg.rpt 8/29/2014 • • BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD14-00314 Received Date: 8/29/2014 SITE ADDRESS: 3830 DOSEWALLIPS RIVER RD Issue Date 8/29/2014 BRINNON, 98320 Expiration Date 8/29/2015 OWNER: DE ETTE W BRODERSON JR PHONE: 360-796-4253 3830 DOSEWALLIPS RD BRINNON WA 98320-9698 SUBDIVISION: Block: Lot: PARCEL NUMBER: 602291014 Section: 29 Township: 26 N Range: 2V1 CONTRACTOR: PRICE JONES LLC PHONE: 360-377-6119 P.O. BOX 4084 BREMERTON WA 98312 Contractor's License PJSHOHE914KL Expires 5/13/2015 PROJECT DESCRIPTION: INSTALL NEW DUCTLESS HEAT PUMP TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC VALUATION MAIN: CODE EDITION: 2012 ADD'L: HEAT TYPE: HTP OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: Type Amount Paid By: Date: Receipt: BEDROOMS: BATHROOMS: Permit $152.00 SRE 08/20/14 151460 Exist: Exist: Total: $152.00 Prop: Prop: Total: Total: Directions to Site: HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED BUILDING INSPECTION HOT-LINE 379-4455. Request must be received by 3pm the day before the inspection is needed. Office Hours 9:00 am -4:30 pm MONDAY- THURSDAY HOT LINE AVAILABLE 24 HOURS A DAY 4c�ON �O ? °, JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 9SRIN'O' Date: /6 /,1/ Time Received: - f Gpm Mon. Cce: W d. T ur. Fri. Date: (n 1.20r � 6 14 BLD: IA--- VD 3) -4 Contact Name: FA.O,$"( Owner: &Aair( / _.Z Contact Number: 360 rM 3 Address: �� ( .5 - f Vii' n� Notes: IL�"- Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Under ground Furance Footing Rough In Air Seal Above ground Gas S*emwall 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 DeilD NO. 15): 46Q/.4_ ei--- , ' RECEIVED FROM P DATE r! f2 c _ ‹..i OVA LGC DESCRIPTION BARS# AMOUNT 4 Aa.as 1 i CURRENCY et , 0 , 150 0C/11 COIN CIL1/7- il* or) -J, + ,•'-' - , 5e - CHECK rl , 1' n n 1 ti, / 1 I bloc? agit oi- 3, -; C5 - ,. 110 t 0 . / RECEIVED BY :1 . ... A / /...., ...(44/1 - TOTAL / 7/,