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Home My WebLink AboutBLD2013-00234 1113UILDING PERMIT APPLICN BLD13-00234 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD13-00234 Received Date: 8/1/2013 SITE ADDRESS: 115 LOOKOUT DR BRINNON, 98320 OWNER: MARK A LORENCE PHONE: QIAN LORENCE 115 LOOKOUT DR BRINNON WA 98320 SUBDIVISION: Block: Lot: PARCEL NUMBER: 502112002 Section: 11 Township: 25 N Range: 02 W CONTRACTOR: AIR FLO HEATING COMPANY INC PHONE: 360-683-3901 221 W CEDAR SEQUIM WA 98382 Contractor's License AIRFLI*206DG Expires 4/25/2014 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP INSTALL DUCTLESS HEAT PUMP SYSTEM TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION 8,364.00 ADD'L: HEAT TYPE: EEE 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 07/31/13 142323 Total: $228.00 APPROVE D AUG 01 2013 Jefferson County DOD \\tidemark\data\forms\F_BLD_App_Bld.rpt 8/1/2013 � 0 l`` aN -JJEFFER.COUNTY rf, ; t \� DEPARTMENT OF COMMUNITY DEVELOPMENT �� ' t4 -'= 'd I 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 9-4451 Fax t� www.co.jefferson.wa.us/commdevelopment .wa.0 us/commdevelopment Master Permit Application MLA: Project Description(include separate sheets as necessary): Tax Parcel Number: S 0 2_11 Z 00 Z Property Size: (acres/square feet) Site Address and/or Directions to Property: 1 IS 1_0oKc)L± Dn v-c- , 6 nnncr 1 v.) �1 Gb320 Property Owner(s)of Record: i n cic L,CIr.e.nC-e, Telephone:. aS 3 - S®°1 -LI0 3a- Fax: email: Mailing Address: . Applicant/Agent(if different from owner): 0...t..2*-- -E-1 c \--e�. '"1(1.. Telephone: 30.0 _to k0 3— 3el01 Fax: 3ls+v (03_3c)11 email: �ai I tLlekk l J aryl Mailing Address: 721 ) . exj2k2 S't Q(Zo _L rn %A)(1,- ei ..)3f:3"- --- ' What kind of Permit?(Check each box that applies DBuilding ❑Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use) js,Single Family ❑Garage Attached/Detached ❑Conditional Use(C(a),C(d),or C]"* ❑ Manufactured Home 0 Modular . ❑Discretionary ED"or Unnamed Use Classification ' ❑ Commercial" ❑Special Use(Essential Public Facilities)** ❑ Change of Use ❑Boundary Line Adjustment ❑ Address ❑Road Approach ❑Short Plat** ❑Home Business 0 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)* ❑Shoreline Management Substantial Development** Q 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 0 Tree Vegetation Request **Requires a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal,if known: k. DESIGNATION OF AGENT I hereby designate OW' t-k O VA.e_,Q \.f14 to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE __.,—.. c) Date: -c:;----1- By signing this application fo ,the ownerfagent 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. Signature: v Date: '? -L —1 • 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 actinn(s)even if you are in compliance with the Jefferson County development cede.The Applicant acknowledges that he she err it holds indivicivai and non-transferable respons Iity for adhering to jnd complying with the ESA. The Applicant has read this diiselimer ar�1t signs_qnd dates it below. Signature: — �--' `�-� Date: Z — t G:\PeanitCenter\###FORMS!###\DRD FORMS\Master Permit Application 5-29-08.doc 0 _.. _0 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 contfaoto s and that they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: t PUD -tt '�_VA 1I G— c5(d) 1083 -3°t6 t 5o) 4(3 -3'11) MAILING ADDRESS: t X l W. l �'\ .. EMAIL: t� CONTRACTOR'S LICENSE �QIiv4##* Ij ?,- O%-1 'V WNAINS NUMBER: IN 1 g. ?—t- l 1-to 62 Q( . NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New 0 Wood Existing: ❑ Sewer O Addition ❑ Steel Proposed: Bank 0 Community System tk Alteration/Remodel 0 Concrete Total: Height: 0 Individual System ❑ Repair 0 Masonry SEP Permit# O Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well 0 Two Party Type of H t' • Proposed: 0 Public L Total: Name of System: If this is a Commercial Prolect 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: 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 1 Pellet Stove 1 Other is this appliance being installed In a Manufactured I 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. S.uare Foota t e Main Floor Heated _ EH Bld App Review: 2"0 Floor Heated Consistency Review: Other Heated Base fee: , Mezzanine Additional Section: � Heated Basement - t-1 Plan Check fee: f Unheated Basement a ,, State Surcharge fee: Other Unheated kr Pot Water Review fee: Garage/Carport .. SUBTOTAL Decks 911/Rd Approach fee: Other ok TOTAL: $ I Receipt Number. /"1 2 3 3 `�Q Z `�� 4,; _ Cash/Check Number ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish 7-31 - 13 p rJ Jo Initials: (J''). • G:\Per itCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc • • ts m H r' = co Cr LL N _a = LL �. O H O CO O O •• •• CV ••• d: 4- CD — N CO 'S LLJ O "O — % J O O L. CO -0 X CC "O -1-i CO 2 C= U Ci = H Lu O ICI CA 4-, "O 1-1 0) C ) 1 .. = .0 t .e a, r-- Q = 0 c! c.3 uJ z d cC o J C- C. �. V U I-- 1- C3 CD m 0 0 1:3 0 C-3 cc -0 w C = _• 3 1- 0 •••■ C J O CO J CJ c) -o ¢ r_ O X O F-1 C`3 -- Ct CV = •- d" Cr) F- .- C) Cb "O cc .- uJ CO Ch C WI CV 6 J uJ LL Cc Lu a — 03 c: V t] (=■ X •6 C.) Z W <'t -- cc cu 3 cc X `�. c J LLJ v 1 c0 LID 1z Z F- CD w C5 0 J CV Lt_1 .-J CC Y = ¢ L, - 1 - C7 CD 2 U w -o CV d- LLJ X Li J 6 J CD b cc U 1— CU U - H 11) _J ..J Z Z 17) C se Z Z O � x w CO IlD _ IX ¢ Up t-1 0 � ¢ C= 7 a. C) d H +•• CC O U3 I - O 44 `. C D X C7 ♦-- Ca J 0 ++ b N O CI3 Dt. O C7 O C7 N • W N CC O c7 0.1 La J CV O CP) C] .- O r 0) b O O -0 Lr d- -- CI c U ID Ni. r-- 4.- _ # C C1 LiJ N •• L 3 L_ GC Y O d 7i m .... Z) J _c a) o 0 0 '7 5► !b o L L C. d 0 O. L U (0 X 4-+ C3 tl X 10 cr3 a 0 RJ a) F- 1-- X C}- 1- U] 03 cs- * B6 1- 41 Contractors or Tradespeople Peter 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 AIR FLO HEATING COMPANY UBI No. 600341761 INC Phone 3606833901 Status Active Address 221 W Cedar License No. AIRFLI`206DG Suite/Apt. License Type Construction Contractor City Sequim Effective Date 3/7/19$0 State WA Expiration 4/25/2014 Dater Zip 98382 Suspend Date County Clallam Specialty 1 Heating/Vent/Air-Conditioning And Refrig (Hvac/R) Business Type Corporation Specialty 2 Unused Parent Company Business Owner Information Name Role Effective Date Expiration Date BEQUETTE,MARK A President '01/01/1980 BERSON,JOEL R Secretary 03/12/2010 BEQUETTE, SANDRA A Vice President 01/01/1980 FULLAWAY,MICHAEL 01/01/1980 04/01/2010 Bond Information Bond Bond Company Name Bond Account Number Effective Date Expiration Date cancel Date Impaired Date Bond Amount Received Date 9 CBIC 515215 62/01/2010 Until Cancelled $6,000.00 02/05/2010 COLONIAL AM CAS 8 Et LPM4050814 04/25/2002 Until Cancelled 02/02/2010 SURETY OF MD $6,000.00 07/22/2001 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 15 American Fire BKA53735233 04/25/2012 04/25/2014 ` &Casualty Co $1;000,000.00 03/26/2013 + 14 West American BKW53735233 04/25/2011 Until Cancelled Ins Co $1,000,000.00 04/13/2011 WEST 13 AMERICAN INS BKW53735233 04/25/2010 04/25/2011 $1,000,000.00 03/29/2010 CO WEST 12 AMERICAN INS BKW53735233 04/25/2009 04/25/2010 $1,000,000.0004/21/2009 CO OHIO CAS INS $1,000,000.0004/24/2008 11 CO BKW53735233 04/25/2008 04/25/2009 10 OOHIO CAS INS BKW533169699 04/25/2005 04/25/2008 $1,000,000.00 04/30/2007 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 8/1/2013 Contractors or Tradespeople*ter Friendly Page • Page 2 of 2 Infractions/Citations Information No records found for the previous 6 year period https://fortress.wa.gov/lni/bbip/Print.aspx 8/1/2013 � Jefferson County Building Division Permit Number: Applicant: BUILDING PERMIT INSPECTION APPROVALS Applicable Code: 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 FINAL INSPECTION r , _1 3 FINAL INSPECTIO MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR • CONDITIONS for Building Permit# Ntiriamark\riata\fnrmclF RI 11 Parmit Rhin rnt • S BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD13-00234 Received Date: 8/1/2013 SITE ADDRESS: 115 LOOKOUT DR Issue Date 8/1/2013 BRINNON, 98320 Expiration Date 8/1/2014 OWNER: MARK A LORENCE PHONE: QIAN LORENCE 115 LOOKOUT DR BRINNON WA 98320 SUBDIVISION: Block: Lot: PARCEL NUMBER: 502112002 Section: 11 Township: 25 N Range: 02 W CONTRACTOR: AIR FLO HEATING COMPANY INC PHONE: 360-683-3901 221 W CEDAR SEQUIM WA 98382 Contractor's License AIRFLI*206DG Expires 4/25/2014 PROJECT DESCRIPTION: INSTALL DUCTLESS HEAT PUMP SYSTEM TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC VALUATION 8,364.00 MAIN: CODE EDITION: 2012 ADD'L: HEAT TYPE: EEE OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: OTHER: GARAGE: SHORELINE: CONST TYPE: SETBACK: DECK: SEWAGE DISPOSAL: BANK HEIGHT: WATER SYSTEM: Type Amount Paid By: Date: Receipt: BEDROOMS: BATHROOMS: Permit $228.00 MEB 07/31/13 142323 Exist: Exist: Total: $228.00 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 heck Number: 41040 41040 AIR FLO HEATING COMPANY Jefferson County Building Depart moue Date Description Amount 07/26/2013 Permit for Lorence Mel Date time time received 'A8 (0 pm ` BLD: r 23Lf= Mon. tgr:Wed: Thur. - Fri. Date:______81_121____________ OWNER: E O Contact Name. ADDRESS: /5 ,(ek c Contact Number:360 : 1t :! l�P� 206 r Notes: Sri 3 5o' 40 2_ Foundation Piu_mbing Framin "---g Pane Tank Mechanical Setbacks Under ground Framing Footing Rough In Air seal Under ground Furnace Stemwall __ Hydronic Above ground _• Gas Straps Exterior shear Exterior lines Oil Straps Interior shear _ Interior lines • . Post Ventilation Ducts 0- Underfloor Gas/wood stove Appliance Man•Homes _ Setbacks Insulation Foundation— Final Inspection Block&Tie • floor :?- °; _wall ceiling. . Address Posted ; JEFFERSON COUNTY NO. 52323 DATE 1. j7��3 RECEIVED A11,, 7-..,. .}-1:1---) DESCRIPTION BARS# AMOUNT CURRENCY ;g`Gr< 5 GW COIN aak P. o z�Z off C'4° U) O R m o RECEIVED BY TOTAL 7-Z-�-- i4-