HomeMy WebLinkAboutBLD2013-00240 BUILDING PERMIT APPLICA N Review T e:
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Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368 BLD13-00240
PERMIT#: BLD13-00240 Received Date: 8/6/2013
SITE ADDRESS: 68 LAUREL ST
PORT HADLOCK, 98339
OWNER: MATTHEW B SIMPSON PHONE: 425-894-7519
WENDY A SIMPSON
14525 132ND CT NE
WOODINVILLE WA 98072-4618
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 921063012 Section: 6 Township: 29 N Range: 01 E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2013
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr SAWP OUT PROPANE TANK, SAME SIZE
TYPE OF WORK NON 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: O BEDROOMS: BATHROOMS: D
Exist: Exist:
Prop: Prop: ! AUG 6 2013
Total: Total:
Routing Date: JEFFERSON COUNTY
DEPT.OF COMMUNITY DEVELOPMENT
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $0.00 MEB 08/06/13
State Building Code $0.00 MEB 08/06/13 4.PP V1D
Total: $0.00
Cees AUG 0 0 2013
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DerARTMENT OF commuilkly DEVELOPMENT
621 Sheridan Street I Port Townsend,WA 98368 I Web:www.co.lefferson.wa.us/communitydevelopment
�s�ING�o Tel:360.379.4450 I Fax:360.379.4451 I Email:dcd @co.iefferson.wa.us
Building Permits&Inspections I Development Consistency Review J Long Range Planning J Watershed Stewardship Resource Center
Master Permit Application MLA:
Project Description(include separate sheets as necessary):
SWAT P+�b�t= T A to F 6ucW- r?rPC
81 Tax Parcel Number: (-R a t C') (c,3 0 i a Property Size: (acres/square feet)
Site Address and/or Directions to Property:
&0-0 6-(tit'E— $Try , Al)LOC ►4- `ice 39 9
Property Owner(s)of Record: I TT S IM'P5'*)
Telephone: 4{"D-5 t $ I W Fax: email: S i M FSets-) A77P MS/4,4
Mailing Address: j '1 5 a 5 1 CT N(%- t.}cx=3: /,v�11U E t,,7 A- crtn 2-•
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies ❑ Lot or Road Segregation
J$uilding ❑Critical Areas Stewa •4 ••_° ' V —�\
❑ Demolition Permit ❑Variance(Minor,Maj• • • =•1 z.,17•
❑Single Family ❑Garage Attached/Detached ❑Conditional Use[C(a , ( I or C]**
❑ Manufactured Home ❑ Modular
0 Discretionary"D"or 4 d Use Classifipat'o,(� �
❑ Commercial* ❑Special Use(Essenti.I " -•I Fa¢,bj s)**b U I3 91
❑ Change of Use ❑Boundary Line Adjus
❑ Address ❑ Road Approach ❑Short Plat**
❑Home Business ❑Cottage Industry ❑ Binding Site Plan** JEFFERSON COUNTY
"Nt Propane sw t vd ❑ Long Plat** iEPT.OF COMMUNITY DEVELO7ENT
❑Sign �I" ❑ Planned Rural Resid- '- %-'- •• -n --D 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**
❑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:
DESIGNATION OF AGENT
I hereby designate to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE Date:
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 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 applica f.•. ,�>t.- or - .-nts prior notice.
x" Signatur-j%�.'1►® Date:
1 7 /S
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
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-transfe -.le r- • •sibili for-.••- ing to and complying with the ESA. The Applicant has read this disclaimer and ss)gns and dates it below.
�Signature•..���.%�,.,ic� ____'-'—r-- Date: !!/ �
r —
07/24/2013
■
BUILDER STATEMENT
III
The signer of this statement does hereby certi at 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 project.
Signature: Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
5 Lt& sAi i -P - (36o) 305- 5117 ( )
MAILING ADDRESS: /O 5 j >-16p- a7z- EMAIL:
CONTRACTOR'S LICENSE ?Oar/-14PLOC 12/GJ H 3. 'WAINS
NUMBER: ( NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
New Wood Existing: Sewer
Addition Steel Proposed: Bank Community System
Alteration emodel Concrete Total: Height: Individual System
Repair Masonry SEP Permit#
Demolition 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:
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 j Fireplace Insert i Hot Water Tank t Pellet Stove j Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No
When applying for a 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.
;_q ` . ° on Square Footage Current Proposed For e g - 4 ,ifi t" 4 evs k"
,
Main Floor Heated 7 EH Bld App Review:
2"tl Floor Heated .:,,!,',„,T,-,
Consistency Review:
ti ,
Other Heated {' Base fee:
Mezzanines '
Additional Section:
Heated Basement "
' k Plan Check fee:
Unheated Basement f'-':7'''',:''',;;1;',1:1;',,i State Surcharge fee:
Other Unheated 91 Pot Water Review fee:
j
Garage/Carport ,,T.'F SUBTOTAL
Decks ' " 911/Rd Approach fee:
•Other i�� vt,, i ,hi, TOTAL: $
1
re 4 - Receipt Number:
1
P v � Cash/Check Number:
ESTIMATED COST(REQUIRED) Date:
•Fair market value of all labor and materials foundation to finish
Initials:
07/24/2013
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JEFFERSON COUNTY
DEPT.OF COMMUNITY DEVELOPMENT
Contractors or Tradespeopleenter Friendly Page Page 1 of 2
General/Specialty Contractor
A business registered as a construction contractor with Lftl 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 Hadlock 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
LEVISES915BB LEVI'S ENERGY Construction General Unused 1/2/2009 1/2/2015 Active
SERVICE LLC Contractor
WARMWS*123BN WARM WINDOWS 8 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 ft 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 8/6/2013
Contractors or Tradespeople 'liter Friendly Page
• Page 2 of 2
4 IFUNDINSSCD 286MXX8009648511/07/1985 11/17/2007 ( 11/07/1985
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 8/6/2013
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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#: BLD13-00240 Received Date 8/6/2013
SITE ADDRESS: 68 LAUREL ST Issue Date 8/6/2013
PORT HADLOCK, 98339
APPLICANT: MATTHEW B SIMPSON PHONE: 425-894-7519
WENDY A SIMPSON
14525 132ND CT NE
WOODINVILLE WA 98072-4618
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 921063012 Section: 6 Township: 29N Range: 01E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339 (3g�1 385-5875
Contractor's License SUNSHP*077QP Expires 1Thel/2013
OWNER, MATTHEW B SIMPSON PHONE: 425-894-7519
if different: WENDYA SIMPSON
14525 132ND CT NE
WOODINVILLE WA 98072-4618
PROJECT DESCRIPTION: SAWP OUT PROPANE TANK,SAME SIZE
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 8/6/2014.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: b ic g/2gltg
FinalApproval: DK 436C" 4J /z /' 413 G
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 8/6/2013
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BLD: r3 1- n (3 —0 o.2..90 Date: 6-23 r t3. ••
OWNER: w pp S�k,ennD yt 9� Contact Name: WS''"�'�'(
ADDRESS: 08 - LL�t.41`e_t 9, Pd 4--ge d Contact Number:360 ,• 1_
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t Notes: ti.' t - 0!_•-1 e.-tt. i .• • a.! �' MO s.. :•
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Foundation Plumbing - Framing . Propane Tank Mechanical
Setbacks — Under-ground Framing Underground _ Furnace —
Footing Rough in Air seal Above ground , Gas _
Stemwall __ Hydronic Exterior shear _ Exterior lines )C Oil _
Straps Interior shear Interior lines • Ducts _
Post Hole Ventilation . Appliance _
Underfloor Gas/wood stove_
Man,Honies •
Setbacks _ Insulation. FinalInspection
Foundation — - t
Block&Tie — floor wall ceiling . Address Posted
i