HomeMy WebLinkAboutBLD2013-00379 BLD13-00379
BUILDING PERMIT APPLICATION Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD13-00379 Received Date: 12/2/2013
SITE ADDRESS: 90 E RHODODENDRON DR
PORT TOWNSEND, 98368
OWNER: MARILYN J MITCHELL PHONE: 360-385-3277
RODERIC J MITCHELL
90 E RHODODENDRON DR
PORT TOWNSEND WA 98368-9483 CAPE GEORGE COLONY DIV 3
SUBDIVISION: Block: 6 Lot: 10
PARCEL NUMBER: 938400609 Section: 12 Township: 30 N Range: 02 W
CONTRACTOR: PENINSULA HEAT INC PHONE: 360-681-3333
PO BOX 173
CARLSBORG WA 98324
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI INSTALL HEAT PUMP AND AIR HANDLER
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP MEC MAIN:
VALUATION ADD'L: HEAT TYPE:
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: pgoved
Permit $152.00 MEB 11/27/13 145588 APPROVED
Total: $152.00 DEC 0 2 2013
Jefferson County DCC
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DEPARTMENT OF COMMUNITY DEVELOPMENT
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Master Permit Application MLA:
Project Descrtptlon(include separate sheets as necessary)
TA1 7kLL eiV'AT Puno Ai H foleic-
Tax Parcel Number: 5 301/04940q Property Size- acres/square feet)
Site Address andior Direclona to Property:
Property Owner's)of liteccord: F4 De l G .__ Pi rk'L yf M I1 Tc.RE11+--
Telephone. 3 4O- Ms-- 12.1-1 Fax emelt'
Mating Address: gal E• AitodedeeetankLeirt. Pr W .
AppecanVAgent(If different from owner): P Fa`l rlli 5t1 t- t4i4T 10• _
Telephone: 340--4Rl-3 313 'ex Ze-42 2 L email:�1't'Kitt14lw}'•tai•--+
P.tafing Address: 1 Q f�eDC i +Z C�.l�S o , %.i) Z
What kind of Permit?(Check each box that applies =Lot or Road Segregation `
AButding =Critical Areas Stewardship Plan
Demolition Permit _'Variance(kronor.Major:r Reesonaole Economic Ilse)
Single Family _Garage At:ectree r Detached =Conditional use pCIa).CO).or CI n
= Manufactured*tome 7, Modular .7 Discretionary`D"or Unnamed Use Clasatflcayors
Commercial` 44,}- 'oft. =Special Lille(Essential Public Facilities)TM
Change of Use =Boundary'Line Adjustment
Address =Road Approach =Short Plat"-
Z. Hone Business 7 Cottage Rtdusrry 7 Binding Site Flan'•
Propane 7 Long Plat*`
Sign Planet Rural Residential Development itatRDuAmendments"
Allowed"`!es"Use Consistency Analysis =¢tat VacetiolvAtteration"°
=Seirmwater Management =Shoreline Master Program Exemption:Pear It Revisions**
Site Plan Approval Advance Determination(SPAAD)• =Shoreline Management Substantial Development'*
7.Temporary Use -'Shoreline Management Variance
=Wireless Telscornmunicatior•' =Comprehensive FlanrUDCtt-and Use District Map Amendment
Forest Practices ActiReiease of Six-Year Moratorium Jefferson County Shoreline Master Program Amendment
May require a Pre-*wheelie'Conference =Tree Vegetation Request
'`Requires a Pre-Appicaoorr Conference
Please identify any other local,state or federal permits required for this proposal,if known:
jij r DESIGNATION OP AGENT
hereby designate soft �u, to act as fry agent in matters relating to this- at* for pe'rntt s)
Owa+eR 9r.r+An;f>F 1L ! / Date: 3
•
Br s,grsng this of ohcatron f am,the owner.,-t attests the She!nf>•rr»sun provided nerein-and in any steersmen is tru and Crxrect to vie Pest 3
"iii net or is kno*iedge. ins material falsehood or am onassion d a rr:ate rrai`act made br the o*ne':aoeni with respect to this appi?caben rack
may reset in to 5 oarma nerd rue and void
further agree to sari. indernr h,and,^old narrriess.teiferson Count;against all trabiateee six/cements.court costs reasonable alIC'nSv 5 fees and
eroenses wtrcn may it any war acme against Jefferson county as a'esr/t Cl of r consequence c#the grarri'g ar ohs perms
I further agree tc crovide access and"fight ii entry to Jeffersor County acrd a5 employees repreeenratrve5 or agents for Ste scve purpose V'app :trim
review and dry required tat- snect ons Staffs access and right of-. i ail be assumed unless the appicari Moans a Cowry n wilting in'he
rime fr rrie lippe ceeort t-� -: a warms
px ft... f ,'
Sgeature 1_4 / t�ia.�
Tire actor or actions Az-rcant vain urxlertak-fs a-esJlt 3 the issuance Or—its permit may receivtt'rrpact upon ,.re or ore tnrealenec or
endarrtered species end Could lead to a potential"take`If af'endangered species as~nose terms are defined in the redera raw+o rc�wr.as tree j
Endangered Species Act or ESA'Jefferson Count}makes no assurances to the applicant that the dui ars that wilt be undertaken because this
oenrin has been issued it not cidate the ESA Ans mended: group or agency Can'•ie a emu on eerie of an endangered xpecres,egarding sour
actcurrisr'even If yoke are in c rice wfh the e:;.. • —.:ntv devj....ent code.The Apolicart a:Amo4a'edges that he 5- oi it r .indtr dual
and non-transferable r ....1.'y for aaher o. . th:.: The kart has read this iliSCiarin+ ..,...c,.•z'e h
oil �. ' '
Signature Date: . .
• BUILDER STATEMENT III
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 wiu be assuming the responsibility of the General Contractor for the proposed project.
Signature: Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
Prxil 5aL-A gar Co . (3G0 ifer- 3f (360? b1S/-ao�lb
MAIUNG ADDRESS: �.0. �( ,?3 Cs�t ls&IDty, &A' EMAIL: /jI�ry� � L �' uc`,
CONTRACTOR'S LICENSE �f WAINS�•V' {7
NUMBER'. PENIN I • V � NUMBER
ARCHITECT/ENGINEER: r PHONE ( ) FAX:( )
MAIUNG ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: ShoreNne: - Type of Sewage Disposal:
New • Wood Existing: Sewer
Addition Steel" • Proposed: Bank Community System
AReration/Remodel• Concrete Total: Height: Individual System
Repair Masonry SEP Permit#
Demolition Other. Bedrooms: Water Supply:
Existing: Setback: Private wel Two Party
of eat: - Proposed: Public
AT purr iC • Total: Name of System: ,
Iffff this is a Commercial Protect 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:
Underground Tank Above ground tank Size of Propane Tank:
Heat Stove Cook Stove Woodstove Fireplace.nsert rehtO I evotStelleP I knaT retaWtoH I
Is this appliance being installed in a Manufactured I Mobile Home? Yes
When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,at property
lines,tank location and size,distances from the propane tank to at 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:
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 ( �a lit,
Decks 911/Rd Approach fee:
Other TOTAL: $ /` mD
Receipt Number:
Cash/Check Number:
ESTIMATED COST(REQUIRED) Date:
,Far market value of all labor and materials foundation to finish
Initials:
0-/24/2013
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Contractors or Tradespeople 1ter Friendly Page • Page 1 of 1
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 PENINSULA HEAT INC UBI No. 601737680
Phone 3606813333 Status Active
Address Po Box 173 License No. PENINI*0440W
Suite/Apt. License Type Construction Contractor
City Carlsborg Effective Date 9/16/1996
State WA Expiration Date 10/18/2014
Zip 98324 Suspend Date
County Clallam Specialty 1 General
Business Type Corporation Specialty 2 Unused
Parent Company
III
Business Owner Information
Name Role Effective Date Expiration Date
LOFSTROM, KENNETH JOHN President 01/01/1980
LOFSTROM,MARY E Secretary 01/01/1980
Bond Information
Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date
2 CBIC SA4812 09/16/2001 Until Cancelled $12,000.00 07/02/2001
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
17 Ohio Security BKS 55013351 04/26/2013 04/26/2014 $1,000,000.00 03/29/2013
Ins Co
16 Ohio Security BKS55013351 04/26/2012 04/26/2013 $1,000,000.00 04/20/2012
Ins Co
15 Continental CWP2928683 04/26/2011 04/26/2012 $1,000,000.00 04/18/2011
Western Ins Co
14 North Pacific C07163306 04/26/2011 04/26/2012 $1,000,000.00 03/24/2011
Ins Co
13 NORTH PACIFIC C06163306 04/26/2010 04/26/2011 $1,000,000.0004/23/2010
INS CO
12 NORTH PACIFIC C05163306 04/26/2007 04/26/2010 $1,000,000.0003/27/2009
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 12/2/2013
S60 - 681 i 20� ,
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#: BLD13-00379 Received Date 12/2/2013
SITE ADDRESS: 90 E RHODODENDRON DR Issue Date 12/2/2013
PORT TOWNSEND, 98368
APPLICANT: --MARILYN J MITCHELL PHONE: 360-385-3277
RODERIC J MITCHELL
•! , .s.•9 ► -., a-
PORT TOWNSEND WA 98368-9483 10
SUBDIVISION: CAPE GEORGE COLONY DIV 3 Block: 6 Lot:
PARCEL NUMBER: 938400609 Section: 12 Township: 30N Range: 02W
CONTRACTOR: PENINSULA HEAT INC PHONE: 360-681-3333
PO BOX 173
CARLSBORG WA 98324
OWNER, MARILYN J MITCHELL PHONE: 360-385-3277
if different: RODERIC J MITCHELL
90 E RHODODENDRON DR
PORT TOWNSEND WA 98368-9483
PROJECT DESCRIPTION: INSTALL HEAT PUMP AND AIR HANDLER
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 12/2/2014.
REQUIRED INSPECTIONS:
Tank/Line/Appliance:
FinalApproval:
(),,
11- 1- P1
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 12/2/2013
4.F"5 ON JEFFERSON COUNTY
r�y� DEPARTMENT OF COMMUNITY DEVELOPMENT
9y0
Date: j/1 Time Received: egT7 Opm Mon. Tue. Wed. Thur. d
1 Date: /1/71/
BLD: /3 a037 9 Contact Name:
Owner: gi-n•JjbL Contact Number: 360 3J5 3277
Address: 206
Notes: geliT gM-P
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 COU•Y ail) O. 145558
DATE 11.'2;1-1 3
RECEIVED FROM çk'\ "v.)`J\c_ z \y ,
DESCRIPTION BARS# AMOUNT
f. CURRENCY t- j\ K
COIN
. . � l ®° I � n c
o
.
B
„ 0
RECEIVED BY TOTAL IS 130
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