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HomeMy WebLinkAboutBLD2012-00107 THIS BUILDING IS NOT FINALED . PERMIT WAS CANCELLED PRIOR TO RECEIVING ALL INSPECTIONS AND HAS NOT BEEN ISSUED A CERTIFICATE OF OCCUPANCY. ItILDING PERMIT APPLICATI BLD12-00107 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD12-00107 Received Date: 4/2/2012 SITE ADDRESS: 20 BAYVIEW LN PORT TOWNSEND, 98368 OWNER: KATHLENE M TELLGREN PHONE: 360-385-6314 WILLIAM G SMITH III 20 BAYVIEW LN PORT TOWNSEND WA 98368-9617 DISCOVERY BAY HEIGHTS DIV 1 SUBDIVISION: Block: Lot: 28+ PARCEL NUMBER: 947300028 Section: 32 Township: 30 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 DESCRIPTION A/G 120 GAL PROP TANK SWAP OUT - SAME SIZE & LOCATION TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: CODE EDITION: 2009 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: 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 Propane Tanks/Stoves $74.00 LYK 04/02/12 131600 APPROVED Total: $74.00 APR - 2 2012 Jefferson County DCD ,. 0 0 JEFFERSON OUN:TY , err DEPARTMENT OF COMMUNI Y DEVELOPMENT 621 Sheridan Street• Port Toinlnsond •Washington 98368 360/379-4450. 369/379-4461 Fax , www.co�jeffersot .wa..usfcommdevetopment "c ` • Master Permit Application • MLA: I-nC- .Project'Description'(include separate sheets as necessa ) _d.LL° f — / ' LD t* ....a'.d Tax Parcel Number:.a`f 1 )CD �2=; . Property Size: (acres/square feet} Site Address and/or Directions to Property: J1 Property Owner(s)of Record: /t-L-Y '1_S#ll7 ti �" L l . 2 � •Telephone: •81 –ta3/ Fax: email: Mailing Address:.!9J0 6A Vl L- —t ii `T2: t✓k ht W q$3CQ Applicant/Agent(if different from owner); _,,• / .t....tieb Telephone: g85 S79 7 Fax 38 5.-,587'' email: `y d 4-41.1 '-'''e 'c , Mailing Address: , %0 X5.3 , kH e,b )(JP', P% //419, 4-0 c% c.,)A What kind of Permit?(Check each•box that applies 0 Lot or Toad Segregation OBullding 0 Critical Areas Stewardship Plan' 0 Demolition Permit 0 Varlange(Minor,Major or Reasonable Economic Use) O Single Family" 0 Garage Attached/Detached 0 Conditional Use(C(a),.C(d),or C]** 0 Manufactured Home : .El Modular , ' - 0 Discretionary"b"Or Unnamed Use Classification 0 Commercial* '. 0 Special Use(Essential Public Facilities),** 0 Change of Use 0 8ound ry Line=Adjtistnlent O. Address 0 Road Approach . 0 Short Plat** O Home Business O Cottage industry . O Binding..Site:Plan** ,8Z.propane .0 Long.,?)at** ©$ign 0 Planned Rural"Residential Development(PRRD)/Amendments.** El Allowed"Yes"Use Consistency Analysis 0 Plat Vaati►n/Alteration*'t O Stormwater Management 0 Shoreline Master Pr.! - O Site PlanApproYai Advance Determination(SPA/D)* 4 Shoreline Manage e .7 I .• b Temporary Use ,°0 Shoref Managemei�t1 -" : al-Wireless Telecommunication* - 0 Compre ensfvd-Plait/tl o. /Land Use District Map A V ent O Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson Cout ty Slio a Master Program Amend *May require a Pre-Application Conference 0 Tree Vegetatien Req(i tt t APR 2 2012 ' - Re Ores a Prk,A licatlpn Conference Please identify any other local,state or federal permits requires'Ifotr this°pron e!, If known JEFFERSON COUNTY l ereb designate D SIGNATION OF Ay -- --- . . , permit(s). t, y g to act as my e eht in Matters'relatin relating.to this application for GVNEEt SIGNATURE :. Date: 0� �� /z_._ 9 p By signing this application form,the owner/agent attests that the Information rovided herein,and in any attachments,is true and correct to the best of his her or its knowled9e. Any material falsehood`or any of a material fact mete by the"owner/agent with respect to this application packet may result in this permit being null and void i I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,.Judgments,court costs,reasonable attorneys 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 s and tight:of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any required•later inspections. staff's access and right of entry will be assumed witless the applicant informs.the County in writing at.the. r ;„time of the appli• ti n t at he:or she wants prior rtoti . nature: I.•.• is L . si _ -Date: /c3-7 l/2-- The action or actions Applicant will undertake as a result of the issuance of this permitimay seg"atively impact upon one or mote threatened or endangered species and could lead to a potential."take"of an endangered species as:tiiose terms are defined in the federal law known as the "Endangered Species Act”or"ESA,"Jefferson Couhty 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-transferabi esp nsibiiity for adh rin to and complying with the ESA. The Applicant has read this disclaimer and J�igns and dates it below. 1 Sign tune; Date: 'Off--//.-7 /(`� fit. (:•\purr.;fern,,-\###FoRM.S###\11RII RORivMC1c„rrPnrnRn R,,,:.n.\A.f.••...A.,..en:,A..«1:....«:...,G nn no.L.. • • BUILDERSIATEMENT . 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 pfoject: Signature: Date:._ " • GENERAL CONTRACTOR e.° , o r 7• = . ER: PHONE: ' FAX: S LeN S.W 1 n e v 2 P 4... ()64 ) 3 F5- -r 717 (364 3 es-3- 7S MAILING ADDRESS: /O g S? pt p. (.( EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: S CA tit 5'k '?t 07 l Q.e NUMBER PHONE ( ). FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: 0 New 0 Wood Existing: 0 Sewer 0 Addition 0 Steel Proposed: Bank 0 Community System o Alteration/Remodel 0 Concrete Total: Height: 0 Individual System o Repair 0 Masonry SEP Permit ❑ Demolition o Other: . Bedrooms: Water Supply: Existing: . : ' Setback: Type"of Heats Proposed: C1 Private well d Two Party_ 0 Public Total: --�--- Name of System:• If 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 Yes No 4... Jf this is a Probane Tank and/or Appliance Installation permit,mark all items below that apply: 1•Underground Tank k ` Size of Propane Tank: -./c-O :_, t Heat Stove I Cook Stove 1 Woodstove 1 Fireplace Insert 1 Hot Water Tank 1,Pellet Stove 1 Other Is this appliance bein,rt installed in a Manufactured./' Mobile°Home? Yes / No When applying fora 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. — wt ,, ,....,,41,,,,,,,,h'''.1., v try' y +Y r , 'b fi�t a 3 " r .A rr4 c.'rf�s�' d ",...M' , "3l. 41 S.. c :F -t i 'Square Footage Current PrPli' `%� r €3l. 's1�t_4�h, "; ' i; ,`i i �t x� a a `3p s � Main Floor Heated ��,4' .EH BId App Review: 111111111m 2' Floor Heated . • . -y. ` Consistency Review: Other Heater! x 0 1 r, 2' _ • Base fee 7� --- . . Mezzanine ^,`' 4l. r "r ' Additional:Section: Heated Basement ' ,`E s,l,' .. Plan Check fee' Unheated Basement 01,.. ; State Surcharge fee: Other Unheated ,r'�! p{' Pot Water Review fee: Garage/Carport v 4 if " #�• w ,1 , 1 ,, •k SUBTOTAL Decks it � {r X13 ,.. 911/Rd,Approach fee: Others 0 � ` 9 TOTAL . 1101.1111111 � , b �3' y r eg % � y qA Receipt RUmber. I 31 • :` : Cash/Check ESTIMATED D C©ST(REQUIREDj, Date: ••Fair market value of all labor:-and materials foundation to finish 12_ Initials: '=All —.Iles G:\PetmitCenter\###FORMS###\DRD FORMS\Current bRD Forms\lAster Pi,r,nir An.,,irnr.n.«s_am_nc a,, Contractors or Tradespeople Pri,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 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 11/17/2012 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 LEVISES915BB LEVI'S ENERGY Construction General Unused 1/2/2009 1/2/2013 Active SERVICE LLC Contractor WARMWS"1236N WARM WINDOWS a 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 a 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 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 20 FEDERATED 633829 11/17/2005 11/17/2006 $1,000,000.00 11/09/2005 SERVICE INS CO https://fortress.wa.gov/lni/bbip/Print.aspx 4/2/2012 Contractors or Tradespeople Prin Friendly Page • Page 2 of 2 4 FIREMAN'S 1286MXX80096485111/07/1985 11/17/2007 1 111/07/1985 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 https://fortress.wa.gov/lni/bbip/Print.aspx 4/2/2012 • PRO PANE/PELLET/WO OD 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#: BLD12-00107 Received Date 4/2/2012 SITE ADDRESS: 20 BAYVIEW LN Issue Date 4/2/2012 PORT TOWNSEND, 98368 APPLICANT: KATHLENE M TELLGREN PHONE: 360-385-6314 WILLIAM G SMITH III 20 BAYVIEW LN PORT TOWNSEND WA 98368-9617 28+ SUBDIVISION: DISCOVERY BAY HEIGHTS DIV 1 Block: Lot: PARCEL NUMBER: 947300028 Section: 32 Township: 30N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 (36p13 5 Contractor's License SUNSHP*077QP Expires 11/17/202-5875 OWNER, KATHLENE M TELLGREN PHONE: 360-385-6314 if different: WILLIAM G SMITH III 20 BAYVIEW LN PORT TOWNSEND WA 98368-9617 PROJECT DESCRIPTION: A/G 120 GAL PROP TANK SWAP OUT-SAME SIZE& LOCATION 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 4/2/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: 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 I:\F_BLD_Permit_Propane.rpt 10/29/19