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Home My WebLink AboutBLD2013-00256 UILDING PERMIT APPLICA!ON B 0256 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD13-00256 Received Date: 8/21/2013 SITE ADDRESS: 374 SCHWARTZ RD NORDLAND, 98358 OWNER: MARTIN T IVERS TRUSTEE PHONE: PATRICIA P IVERS TRUSTEE PO BOX 173 NORDLAND WA 983580173 SUBDIVISION: Block: Lot: PARCEL NUMBER: 021283004 Section: 28 Township: 30 N Range: 01 E CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**979OZ Expires 9/7/2014 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION INSTALL 500 GAL PROPANE TANK AND GAS LINE TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION ADD'L: HEAT TYPE: EEE CODE EDITION: 2012 HEAT BASE: HEAT TYPE: PRO 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 08/21/13 142414 Total: $228.00 APPROVED AUG 2 1 2013 Jefferson County DCD firlc nor4\rlolo\fnrmc\F RI fl Ann PIA rn+ 52/71/7l11 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#: BLD13-00256 SITE ADDRESS: 374 SCHWARTZ RD# Issue Date: 08/21/2013 NORDLAND, 98358 Final Date: 9/26/2013 APPLICANT: MARTIN T IVERS TRUSTEE PHONE: PATRICIA P IVERS TRUSTEE PO BOX 173 NORDLAND WA 983580173 SUBDIVISION: Block: Lot: PARCEL NUMBER: 021283004 Section: 28 Township: 30 N Range: 01 E PROJECT DESCRIPTION: INSTALL 500 GAL PROPANE TANK AND GAS LINE 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 Alt: t.'° • 40.4: s ,,Q,‘, Alto, .44: . .. k n-> • • \,..ty k"t",40f...- ' •, ; . .: f (s? - ' 1 'No., „._ ,... , „a--; \ .. k. wins. . ,,,,, \ Y„t y 1.". AL....i', ,• . :--- ,4-4--=.4 \ L.777 _ ,..-,,.•4.4.Aiiiiim. ' - •'' 't :?'":1* ' ''''''::. \ ,, . •. \ As ,, '1.-4,—€....,...-.•:.- \ \ \ 1 ‘ kt■ \ *--0 it � � ,, °�._ 3 t .,. ';9 11/ 1 ;tk t.7.4% ‘'` 2 I Z" 6 \ , ' t '1 '��` ' fie' • L.. _ ... ; _. y h R A i n i \ ;?1;14.. l i V a NQLP 4; S — ? ww 1 N.--_:::.\-.'t. , ,• .---4• -K ..,,,, ..:;,,--.......--:::-...-: -,.. . ,O. I. 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U E 0- H 0- Z H CO — d' O CO 7 O O O CT) CO CV CC .- W N 7 N O H CO O CV O .- O CV O O O -O L r- O Cn V a) CV — CO = # C O Cr a) -- L a C_ W Y I C — CU O a--1 CD 7 a) a) = a) •— = H L N U CO a) -O 7 CO U C_ L O — O CO 0- L. U CO X +1 U -O X CO CO 0- CO •- •- CO a) I— I— x 1— co m c+- )E x 1— Q Contractors or Tradespeople aster Friendly Page • Page 1 of 2 General/Specialty Contractor A business registered as a construction contractor with L8J 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 C H S INC UBI No. 600148004 Phone 2538337220 Status Active Address Po Box 518 License No. CHSIN**9790Z Suite/Apt. License Type Construction Contractor City Auburn Effective Date 9/9/2003 State WA Expiration Date 9/7/2014 Zip 980710518 Suspend Date County King 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 CENEXZT893ORCENEXZIPTRIP Construction General Unused 12/11/2012 12/11/2014 Active Contractor CENEX LAND Construction CENEXL0017K8 O'LAKES AGRONOMY Contractor General Unused 5/28/1999 1/1/2001 Archived CO CENEXHS022NQ CENEX HARVEST Construction General Unused 8/18/1998 9/6/2004 Archived STATES COOPERTVS Contractor CENEXSM033QMCENEXSUPPLYB Construction General Unused 11/14/1997 11/21/1998 Archived MARKETING Contractor • CENEXSM065Q1 CENEX SUPPLY£x Construction General Unused 11/21/1994 11/21/1997 Archived MARKETING INC Contractor CENEXI*064D2 CENEX INC Construction General Unused 3/22/1994 9/30/1998 Archived Contractor CENEXVS099R0 CENEX VALLEY Construction General Unused 12/20/1991 11/21/1994 Archived SUPPLY Contractor CENEX**1480T CENEX Construction General Unused 9/30/1986 9/30/1994 Archived Contractor FARMEUC186K7 FARMERS UNION Construction General Unused 5/27/1982 9/30/1986 Archived CENTRAL EXCH INC Contractor Business Owner Information Name Role Effective Date Expiration Date C T CORPORATION SYSTEM Agent 09/09/2003 CASALE,CARL MARTIN President 09/21/2012 LILJA, NANCI LEE Secretary 09/21/2012 KASTELIC, DAVID ALLEN Treasurer 09/21/2012 EGAN,THERESA MARIE Vice President 09/21/2012 MCENROE,JOHN DANIEL Vice President 09/21/2012 ESTENSON, NOEL President 09/09/2003 09/21/2012 BAKER, DAVID A Secretary 09/09/2003 09/21/2012 WESTBROCK, LEON Vice President 09/09/2003 09/21/2012 Bond Information Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date 5 Liberty Mutual Ins Co 58S203444 11/21/2012 Until Cancelled $12,000.00 10/05/2012 4 TRAVELERS CAS 8 103502492 09/01/2001 Until Cancelled 11/21/2012 $12,000.00 09/06/2001 SURETY https://fortress.wa.gov/lni/bbip/Print.aspx 8/21/2013 Contractors or Tradespeople titer Friendly Page • Page 2 of 2 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 Date 21 Old Republic MWZY59821 09/01/2012 09/01/2013 $3,000,000.00 08/28/2012 Ins Co 20 Liberty Mutual EB1641004264021 09/01/2011 09/01/2012 $1,000,000.00 09/07/2011 Ins Co 19 LIBERTY EB164100426402009/01/2009 09/01/2011 $1,000,000.0009/07/2010 MUTUAL INS CO 18 LIBERTY EB1641004264028 09/01/2008 09/01/2009 $1,000,000.00 08/29/2008 MUTUAL INS CO 17 LIBERTY EB164100426402709/01/2005 09/01/2008 $1,000,000.0008/20/2007 MUTUAL INS CO 16 LIBERTY EB1641004264026 09/01/2005 09/01/2007 $1,000,000.0008/29/2006 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 No records found for the previous 6 year period https://fortress.wa.gov/lni/bbip/Print.aspx 8/21/2013 • h - eet, JEFFERSOUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT *4 621 Sheridan Street•Port Townsend•Washington 98368 360/3794450. 360/379-4451 Fax ' www.cojefferson.wa.us/commdevelopment Master Permit Application MLA: Project Description(include separate sheets as necessary): Install propane tank and gas line Tax Parcel Number. 021283004 Property Size: 674054244007 (aer+ee/square feet) Site Address and/or Directions to Property: 374 Schwartz Road, Nordland, WA 98358 Property Owners)of Record: MARTIN IVERS TRUSTEE,PATRICIA P IVERS TRUSTEE,IVERS REVOCABLE TRUST Telephone: 360-385-2083 Fax email: alamo76 @pacbell.net Mailing Address: P.O.Box 173,Nordland,WA 98358-0173 Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies (uilding ❑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 CI** ❑ Manufactured Home ❑ Modular ❑Discretionary°D"or Unnamed Use Classification ❑ Commercial* ❑Special Use(Essential Public Facilities)** ❑ Change of Use ❑Boundary Line Adjustment ❑ Address ❑Road Approach ❑Short Plat*" ❑Home Business ❑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-- ❑Temporary Use ❑Shoreline Management Variance ❑Wireless Telecommunication* ❑Comprehensive Plan/L OC/Land Use District Map Amendment ❑Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment *May require a Pm Applcation 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. My 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 al 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 wiN be assumed unless the apples informs the County in writing at the time oft cation that r she wants prior notice. 6�- Z Signatures Date:20(3 - 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. Sgnature:"7Y� (' Date: 2 a f 3 - (35?--2.4 G:\PennitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.oc • • BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not Neensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed protect. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) 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 ❑ Alteration/Remodel ❑ Concrete Total: Height ❑ Individual System ❑ .Repair ❑ Masonry SEP Permit# 0 Demolition 0 Other Existingng: Setback: 0 Private well ❑ Two Party Type of Pleat: Proposed: ❑ 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(indudes 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 aopiv: I Underground Tank Above ground Tank Size of Propane Tank: 500 sat. Meat 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 1 No When applying fora it to install a propane tank you must also submit a site plan showing an of the builds,all property lines,tank location and size,distances from the propane tank to all properly lines,buildings and sepffc system components, including the reserve area. care Foote,e Current • • . - - Main Floor Heated ' EH Bld App Review: 210 Floor Heated Consistency Review: Other Heated Base fee: 2e Mezzanine ' Additional Section: Heated Basement -4 - ; Plan Check fee: Unheated Basement - y State Surcharge tee: Other Unheated _ Pot Water Review fee: Garage/Carport SUBTOTAL Decks --Z.". ¢ 911/Rd ,. Approach fee: Other TOTAL: $ Receipt Number: (41.41 I 1-i CashlCheck Number: ESTIMATED COST(REQUIRED) Date: 0121/I .Fare market value of all labor end materials foundation to finish 0 Initials: ' ry, • G\PemritC Borer\###FORMS###\DRD FORMS\Maser Pew Application S-29-08.doc S 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#: BLD13-00256 Received Date 8/21/2013 SITE ADDRESS: 374 SCHWARTZ RD Issue Date 8/21/2013 NORDLAND, 98358 APPLICANT: MARTIN T IVERS TRUSTEE PHONE: PATRICIA P IVERS TRUSTEE PO BOX 173 NORDLAND WA 983580173 SUBDIVISION: Block: Lot: PARCEL NUMBER: 021283004 Section: 28 Township: 30N Range: 01E CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**979OZ Expires 9/7/2014 OWNER, MARTIN T IVERS TRUSTEE PHONE: if different: PATRICIA P IVERS TRUSTEE PO BOX 173 NORDLAND WA 983580173 PROJECT DESCRIPTION: INSTALL 500 GAL PROPANE TANK AND GAS LINE 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 8/21/2014. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: "1-4-1.3‘k9 L IOJ1< f—Z, �() 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 8/21/2013 ,.. . t-."",;_tItt';ia• . -, . •,...7.■...JAV-4.1....;...,:....,' " - / . . ....., :,-,..: . . . _ . Date '9 Z4 time rec,eived 2:2.4. el pm _ Mon. Tue .. e_Ocl: Thur. -Fri. BLD: 13 -' 60-2-6(, . . Date: 9/2...G . . . OWNER: biEL E-S - . - - Contact Narrte. . . . . ADDRESS: 374- - 6e-i-iwgr--r Z- - Contact Number.360,VA -ZOB3 206 . . Notes: Foundation Plumbing - Framing' • Propane Tank- Mechanical ,. . ------- --- --- - Setbacks . Under-ground- Framing Underground )k Furnace Footing Rough in Air seal Above ground - Gas ____ Stemwall _ Hydronic Exterior shear Exterior lines )( Oil Straps Interior shear Interior lines ) Ducts -r- . Post Hole • - Ventilation Appliance • Underfloor Gas/wood stove Man-Homes - . • Setbacks • Insulation. . Final Inspection Foundatk)n-- . . Block&Tie floor _wall ceiling. . Address Posted s