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Home My WebLink AboutBLD2013-00248 • BLD13-00248 �UILDING PERMIT APPLICATION Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD13-00248 Received Date: 8/13/2013 SITE ADDRESS: 64 LAUREL ST PORT HADLOCK, 98339 OWNER: SUZANNE LAMON PHONE: 360-379-0204 64 LAUREL ST PORT HADLOCK WA 98339-9720 SUBDIVISION: Block: Lot: TX24-I PARCEL NUMBER: 921063006 Section: 6 Township: 29 N Range: 01 E CONTRACTOR: EVERWARM INC PHONE: (360)452-3366 257151 HWY 101 PORT ANGELES WA 98362 Contractor's License EVERWI*088NL Expires 8/17/2014 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI PROPANE STOVE SWAP OUT TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION ADD'L: HEAT TYPE: PRO 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 Propane Tanks/Stoves $76.00 MEB 08/13/13 142379 APPROVED Total: $76.00 AUG 13 2013 Jefferson County DCD 1 Widarn.rNrl.fn%fWane\C RI II Ann P1,1 rn+ S:1/11/1111"4 CERTIFICATE OF OCCUPANCY Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 (360)379-4450 FAX(360)379-4451 Carl Smith, Director/Building Official PERMIT#: BLD13-00248 SITE ADDRESS: 64 LAUREL ST# Issue Date: 08/13/2013 PORT HADLOCK, 98339 Final Date: 9/26/2013 APPLICANT: SUZANNE LAMON PHONE: 360-379-0204 64 LAUREL ST PORT HADLOCK WA 98339-9720 SUBDIVISION: Block: Lot: TX241 PARCEL NUMBER: 921063006 Section: 6 Township: 29 N Range: 01 E PROJECT DESCRIPTION: PROPANE STOVE SWAP OUT THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2012 EDITION. OCCUPANCY GROUP: TYPE OF CONSTRUCTION: SPRINKLER SYSTEM yes no THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 9/26/2013 \\tidemark\data\forms\F_BLD_Occupancy.rpt 10/8/2013 �w$0N `°6 JEW RSON COUNTY �.'`�...a 13 _ U •ti '• '11 ,1'4 DPPARTMENT OF commarry DEVELOPMENT o� 621 Sheridan Street I Port Townsend,WA 98368 I Web:www.co.iefferson.wa.us/communitydevelopment 1sXINdz Tel:360.379.4450 I Fax:360.379.4451 (Email:dcdcco.jefferson.wa.us Building Permits&Inspections 1 Development Consistency Review I Long Range Planning/Watershed Stewardship Resource Center Master Permit Application MLA: . Project Description(include separate sheets s necessary): f Dp�e 9rov€ swap oU Tax Parcel Number: "124 0(93 W b Property Size: (acres/square feet) Site Address and/or Directions to Prope 4:116 Property Owner(s)of Record: LQdMOU Telephone: 'O ?J Q to* Fax: email: Mailing Address: Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies ❑Lot or Road Segregation ❑Building ❑Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use) ❑Single Family ❑Garage Attached/Detached ❑Conditional Use[C(a),C(d),or C]** ❑ Manufactured Home ❑ Modular ❑ Discretionary"D"or Unnamed Use Classification ❑ Commercial* ❑Special Use(Essential Public Facilities)** ❑ Change of Use ❑Boundary Line Adjustment ❑ Address ❑ Road Approach 0 Short Plat** ❑Home Business 0 Cottage Industry ❑ Binding Site Plan** RI Propane ceputtutmeAr., ❑ 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** O Temporary Use 0 Shoreline Management Variance O Wireless Telecommunication* 0 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 ermit s . P ( ) 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 app' lion that a or he wants prior n lice. it Signature: Date: 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-transf- able res.•nsibili for adhering to -nd complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: i/,/ /1 I,/4 4 A A A �a./. Date: 174 j Ol 3 07/24/2013 1 • 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 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: f voi tv7V m , ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE 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 Ci..e■IriatiatIRemodel 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 Proiect 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: i Heat Stove Cook Stove Woodstove Fireplace Insert I Hot Water Tank Pellet Stove Other Is this appliance being installed in a Manufactured/Mobile Home? Yes I 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. Square Footage Current Proposed 1:6 , Main Floor Heated y1 rlq!!1!ti11 EH BId App Review: 2nd Floor Heated -; Consistency Review: Other Heated Base fee: Mezzanine �, "'I Ii''0 Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: k'F Other Unheated Pot Water Review fee: Garage/Carport �'' ' '� SUBTOTAL am(�� Decks ; 911/Rd Approach fee: Other TOTAL: $ r Receipt Number: � err Cash/Check Number: ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish Initials: 07/24/2013 Contractors or Tradespeople titer Friendly Page • Page 1 of 2 General/Specialty Contractor A business registered as a construction contractor with MI 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 EVERWARM INC UBI No. 601361016 Phone 3604523366 Status Active Address 257151 Hwy 101 License No. EVERWI*088NL Suite/Apt. License Type Construction Contractor City Port Angeles Effective Date 8/13/1992 State WA Expiration Date 8/17/2014 Zip 98362 Suspend Date County Clallam Specialty 1 General Business Type Corporation Specialty 2 Unused Parent Company Other Associated Licenses Specialty Specialty Effective Expiration License Name Type 1 2 Date Date Status EVERWBP1100G EVERWARM BUILDING Construction General Unused 9/7/1989 8/4/1992 Archived PRODUCTS Contractor EVERWI*1900A EVERWARM Construction Insulation Unused 9/1/1981 8/4/1989 Archived INSULATION _Contractor TERRYMI223DF TERRY MCCARTNEY Construction Insulation Unused 3/6/1978 8/31/1982 Archived INSULATION SER Contractor Business Owner Information Name Role Effective Date Expiration Date MCCARTNEY,TERRENCE J President 08/13/1992 MCCARTNEY,VIRGINIA RIMSTAD Secretary 08/13/1992 Bond Information Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date 4 TRAVELERS CAS Ii 206809004 08/02/2001 Until Cancelled $12,000.00 08/09/2001 SURETY CO Assignment of Savings Information No records found for the previous 6 year period Insurance Information InsurancelCompany Name Policy Number Effective Date Expiration Date Cancel Date Impaired Date Amount Received Datel 22 Nautilus Ins Co NN277071 01/20/2013 01/20/2014 $1,000,000.0001/03/2013 21 Nautilus Ins Co NN181437 01/20/2012 01/20/2013 $1,000,000.0001/17/2012 20 NAUTILUS INS NN092832 01/20/2011 01/20/2012 $1,000,000.0001/13/2011 19 NAUTILUS INS BN949516 01/20/2010 01/20/2011 $1,000,000.0001/20/2010 CO 18 NAUTILUS INS NC847690 01/20/2010 01/20/2011 $1,000,000.0001/19/2010 CO 17 NAUTILUS INS NC847690 01/20/2009 01/20/2010 $1,000,000.0001/16/2009 CO 16 NAUTILUS INS NC747383 01/20/2008 01/20/2009 $1,000,000.00 01/09/2008 CO FIRST 15 SPECIALTY INS FGL22900346770201/20/2007 01/20/2008 $1,000,000.0001/19/2007 CORP https://fortress.wa.gov/lni/bbip/Print.aspx 8/13/2013 Contractors or Tradespeople Pi liter Friendly Page • Page 2 of 2 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 htt s://fortress.wa. ov/lni/bbi /Print.as x 8/13/2013 p g p p _ . 0 . 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#: BLD13-00248 Received Date 8/13/2013 SITE ADDRESS: 64 LAUREL ST Issue Date 8/13/2013 PORT HADLOCK, 98339 APPLICANT: SUZANNE LAMON PHONE: 360-379-0204 64 LAUREL ST PORT HADLOCK WA 98339-9720 TX24A SUBDIVISION: Block: Lot: PARCEL NUMBER: 921063006 Section: 6 Township: 29N Range: 01E CONTRACTOR: EVERWARM INC PHONE: (360)452-3366 257151 HWY 101 PORT ANGELES WA 98362 Contractor's License EVERWI*088NL Expires 8/17/2014 OWNER, SUZANNE LAMON PHONE: 360-379-0204 if different: 64 LAUREL ST PORT HADLOCK WA 98339-9720 PROJECT DESCRIPTION: PROPANE STOVE SWAP OUT 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 8/13/2014. REQUIRED INSPECTIONS: Tank/Line/Appliance: y-,.FinalApproval: 5"1 TA)Re., `i—26=I 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 8/13/2013 I ....._______ t 6 rn f-------- ,,,.,.4 t 6 s 71. ?c fc3 ,. RI e___, .v. TE 7 /4 ..5 g. 1/4_1_ --#E >1\1 e > .. , i , . & T ' \ ---ft'"' L 1 i (-- ' 1 2 -0 i1 g (1' . -. 7 L __ _________L. . ,>< . ii______, ............._ 7 T \\