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Home My WebLink AboutBLD2013-00252 UILDING PERMIT APPLICA*N BRp1e 002 2 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD13-00252 Received Date: 8/16/2013 SITE ADDRESS: 307293 HWY 101 BRINNON, 98320 OWNER: PATRICK M RODGERS TRSTEE PHONE: 360-301-5650 BONNIE L RODGERS TRUSTEE PO BOX 62 BRINNON WA 98320-0062 SUBDIVISION: Block: Lot: PARCEL NUMBER: 502023019 Section: 2 Township: 25 N Range: 02 W CONTRACTOR: BRENNAN HTG &NC LLC PHONE: 206-248-7900 4601 S 134TH PL SEATTLE WA 98168 Contractor's License BRENNHA971R9 Expires 12/29/2013 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI INSTALL DUCTLESS HEAT PUMP 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: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: JA, Type Amount Paid By: Date: Receipt: Approved/Date Permit $228.00 JLA 08/16/13 142395 APPROVED Total: $228.00 APPROVED AUG 16 2013 Jefferson County DCD MiAemo r4\A ofo\forme\F PI n nn PIA rnf R/1 C./9(11Z . w eLpi -5-25 Z noN • g8 JEFFERSOtCOUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: '%` \$in e sePc4A-Q tg s S rY): $3 ‘t)i -j' s Tax Parcel Number. "O (DQ 9 bt Property Size: (acres/square feet) Site Address and/or Directions to Property: 3b`q- (1( ) v s �y 1 car v r■b r� �0- Q '8za o Property Owner(s)of Record: C1.. `-""'l S Telephone' 00 - b\ • Jam" o Fax: email: Mailing Address: 4O tO•( lQ a gri r n or\ W ' S = __ o Applicant/A•ent(if different from owner): " .1• % MR. Telephone;.. 00 Fax:• O .c .. i 0 email: i.; II' • ilu ' d Mailing Address: - 0 W .11111111-{... • + • • • N■ IL t . CO(Y-.) What kind of Permit?(Check each box that applies ❑Building ❑Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use) -8ingle Family 0 Garage Attached/Detached 0 Conditional Use[C(a),C(d),or C]** Manufactured Home 0 ❑Discretionary"D"or Unnamed Use Classification D rY ❑ Commercial* ❑Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment O Address 0 Road Approach ❑Short Plat** O Home Business 0 Cottage Industry ❑Binding Site Plan ** O Propane ❑Long Plat'"' ❑Sign ❑Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration** O Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions** O Site Plan Approval Advance Determination(SPAAD)* 0 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 0 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: D SIGNATION OF AGENT I hereby designate ./nY A�V1 to ra-ctt as�my�,aggpt in matters relating to this application for permit(s). OWNER SIGNATURE `7l Q V\.__QI i c 13.]o-` 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. Staff's 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: 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-transferable responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: Date: G:\PemutCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc • • 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: ENERAL CONTRACTOR OR ANUFACTURED HOME INSTALLER: PHONE: FAX: (] .i !s.a� fy . L (tea' �. R t� ( O) q 3t CI 5 MAILING ADDRESS: \ 1RW• ,t i `� _ ai _ i • a • �� AL go CONTRACTOR'S LICENSE C)(t i. • --AA 0 c\ 12 itye,INS CO flrl 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/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: 0 Private well ❑ Two Party Type Qf Heat: Proposed: ❑ Public .1..f...C.... 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 / No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: i Underground Tank 1 Above ground Tank Size of Propane Tank: I Heat Stove I Cook Stove I Woodstove I Fireplace Insert I Hot Water Tank I Pellet Stove i 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, includin• the reserve area. i iJ n F t t�iS 1�,��c �' '� r,�' ��4: � �7 �E P��I '�<,}�4�1 y Nil_ T t S•uare Foota•e Current Pro•osed ,: ' .T,I tf 2�"S :" 'rl,.'�v k i 1a4 ' . 4fi; u�. ,°y�A,t'i�lt�l��ra t►t.^,. t, "s�E. ti L..,_.�,..'.0; Main Floor Heated ''-.li 4+- EH Bld App Review: no i-. ,, 2 Floor Heated ': k f-uii -' ,i Consistency Review: 1,o ', ,rA," Base fee: Other Heated _-� ,1.?4, Mezzanine " ^��,1E �� Additional Section: Heated Basement �'�• ��; Plan Check fee: Unheated Basement i - State Surcharge fee: Other Unheated ^k 1 ` 4: Pot Water Review fee: his ":44`,47":1:,,,,,r., Garage/Carport '= -- .•: SUBTOTAL Decks � ` , y 911/Rd Approach fee: Other 1v w 4,1i ,' TOTAL: $ 1n li'4¢ '- Receipt Number: kr x Cash/Check Number: ESTIMATED COST(REQUIRED) Date: .Fair market vat ,,,f la.b�oMr and materials C) to finish ;L- , ✓ — Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc r , �: i`a',a , v Z. ��} •%"` ' Aar* Y k ' ,06%-- :,' �, ( 5= �' , .— »u. " y.' mss,,"•ate,a.';'-v4<" '*h^+ Tw' ' - ,9,4'- z" a �> 5 N .F - s h 3 1 ' rk) 43 p3.„ HOM PHONE DATE 40 °" ADDRESS WORK PHONE G REP 1 a T Li' - r - � � MP CODE COSTCO STORE# tae 1 EXISTING ;. LOCATION WP 1444 I if ti.i, ii., ° A Le"'rid * id' .,S.,. le r GENERAL S k,, i c-- DESCRIPTION ,,, ,,, 14 r i i • £, OF WORK kf iii Fm+. 0 Ai 44 1i • R ,.• A,,,,e„,,,(1 TO SE DONE 4 r" i ,,,,,,:,,,c..." 4, i P,44, r.,,a di. `i 4 41 1 " , CUSTOMER TO PROVIDE x ' $ EIIIIIIIIIIIIIIIIIMIRII IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIMIIEIIIIIIIIIIIIIIEIIIIIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIINIIIIIIIIIIIEZIIIIIIIIIIIIIEIIIIIIIIIIIIIIIIIIIIIINII IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIEIIIIIIIIIIIIIIIIIIIIIIIIIIII EXTENDED WAR NTY ° 1301.11111111111111ntIdgrM111111 EMERGENCY EARTHQUAKE SHUT-OFF M Tale: .' ELECTRONIC AIR CLEANER POWER DUCT CLEANING INIIIIIIIIIIIIEIIIIIIIIIIIIIIIIIIIIIIIIIII' SUB-TOTAL 1111111111111111111111111111111111111 1,o; TAX # . iiiiiiiiiiiiiiiiiiiiiMi 'TOTAL $ 4 0 4) '' $ We Propose manias and In anaandedvas andl above specidcationn, Al motored to garosarbooti to be as gaged,AA work a to be eta stregordel 0, . Any be ate Via` a>Ortt* oboe not mead weit ALL adetrt0e.end agar bersobertagenter,.waged in en agetral etager, 14301 MMen 0414*,and WM beam.an staa awn*mar and goes the gamete Thane BID_... vALID Foci so DAyou tar eitegne tw tat meow your 14%9C needs. ys. a A a-: b " of Proposal " , I k .! �. he, ' ' ogre***Met gene and ooneetems of go cff.I reserve+Mhe right to remote' ment wage(3)3wee work t of the below work has c nanea♦oe wie I far any ends r gamey tees*t tit not m Dote 04 Contractors or Tradespeople Primer Friendly Page Page 1 of 2 • General/Specialty Contractor A business registered as a construction contractor with LEtI 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 BRENNAN HEATING a A/C LLC UBI No. 602346866 Phone 2062487900 Status Active Address 4601 S 134Th Pl License No. BRENNHA971R9 Suite/Apt. License Type Construction Contractor City Seattle Effective Date 12/29/2003 State WA Expiration Date 12/29/2013 Zip 98168 Suspend Date County King Specialty 1 General Business Type Limited Liability Company Specialty 2 Unused Parent Company Other Associated Licenses License Specialty Effective Expiration icense Name Type Specialty 1 Status 2 Date Date Heating/Vent/Air TRANSWT872KB TRANSFORMATIVE Construction-Conditioning Unused 5/8/2013 5/8/2015 Active WAVE TECHS LLC Contractor And Refrig (Hvac/R) MIKE'S Construction MIKESMS922L6 MECHANICAL Contractor General Unused 6/26/2008 6/26/2014 Active SERVICES LLC FLOORSL012JL FLOORING Construction General Unused 4/13/1999 4/6/2003 Archived SOLUTIONS LLC Contractor GUTTER HELMET Construction Out Of GUTTEHW995PH OF WESTERN WA Contractor General Unused 10/8/2001 10/8/2007 Business LL EMPIRE Construction EMPIRPS891PS PROTECTION a Contractor General Unused 10/10/2011 10/10/2013 Suspended SAFETY Business Owner Information Name Role Effective Date Expiration Date ERDAHL, DARRIN PAUL Partner/Member 12/29/2003 Bond Information Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date 2 FEDERATED MUTUAL 9127230 12/22/2004 Until Cancelled $12,000.00 11/04/2004 INS CO 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 4 Federated 9820726 07/13/2007 07/13/2014 $1,000,000.0006/10/2013 Mutual 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 https://fortress.wa.gov/lni/bbip/Print.aspx 8/16/2013 Contractors or Tradespeople Primer Friendly Page Page 2 of 2 • Infraction/Citation Date RCW Code Type Status Violation Amount PPEJP00330 9/14/2012 18.106.020 PLUMBER INFRACTION Satisfied $250.00 https://fortress.wa.gov/lni/bbip/Print.aspx 8/16/2013 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#: BLD13-00252 Received Date 8/16/2013 SITE ADDRESS: 307293 HWY 101 Issue Date 8/16/2013 BRINNON, 98320 APPLICANT: PATRICK M RODGERS TRSTEE PHONE: 360-301-5650 BONNIE L RODGERS TRUSTEE PO BOX 62 BRINNON WA 98320-0062 SUBDIVISION: Block: Lot: PARCEL NUMBER: 502023019 Section: 2 Township: 25N Range: 02W CONTRACTOR: BRENNAN HTG &NC LLC PHONE: 206-248-7900 4601 S 134TH PL SEATTLE WA 98168 Contractor's License BRENNHA971R9 Expires 12/29/2013 OWNER, PATRICK M RODGERS TRSTEE PHONE: 360-301-5650 if different: BONNIE L RODGERS TRUSTEE PO BOX 62 BRINNON WA 98320-0062 PROJECT DESCRIPTION: INSTALL DUCTLESS HEAT PUMP 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 8/16/2014. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApprovai: 61-1-4.--i�7 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 8/16/2013 IliZrair:it;k.."-.7e1 V _ Date 8/Z43 'time received t ' 0 pm Mon. Tues. ed- Thur. -P . BED: /3 - Date: ?/4 OWNER: VA a 0 'r5 Contact Name: ( ADDRESS: 6 ' /0 ) Contact Number:360 36/–5656 - - 206 v , Notes: ' ge-4/ liVAc...- 4.,s-roz_. Foun P dation lun__ ,h4b • Frar__L_Ailn Propane Tank Mechanical ' • - Setbacks Under-ground Framing Underground Furnace Footing Rough In /*seal Above ground • Gas Stemwall _ Hydronic Exterior shear Exterior lines Oil _ Straps Interior shear Interior lines . Ducts #— Post Hole ' Ventilation Appliance Underfloor . Gashvood stove Man-Homes ' Setbacks ' Insulation , Final Inspection ;..1 • . Block unde,artioen• floor. _wall ceiling Address Posk ' 1 _____