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Home My WebLink AboutBLD2013-00263 • • BLD13-00263 BUILDING PERMIT APPLICATION Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD13-00263 Received Date: 8/27/2013 SITE ADDRESS: 693 HWY 20 PORT TOWNSEND, 98368 OWNER: BENJAMIN W JENNETT PHONE: LINDA L PEARSON 693 STATE ROUTE 20 PORT TOWNSEND WA 983689383 NOVAK SHORT PLAT SUBDIVISION: Block: Lot: PARCEL NUMBER: 902243036 Section: 24 Township: 29 N Range: 02 W CONTRACTOR: TOLLEFSON BUILDERS INC PHONE: (360) 732-4080 TODD HULBERT PO BOX 100 CHIMACUM WA 98325 Contractor's License TOLLEBI977N9 Expires 3/16/2015 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION BATHROOM REMODEL, same footprint, same plumbing, cosmetic TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 25,000.00 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: 3 Exist: 3 Prop: Prop: Total: 3 Total: 3 Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $322.00 MEB 08/27/13 142425 Plan Check $209.30 MEB 08/27/13 142425 APPROVED State Building Code $4.50 MEB 08/27/13 142425 2013 Total: $535.80 Jet rFcr 0;A:r ty DCi \%41r4cmmr41r1.4.\forme\G 1:21 11 Ann Mei rni S2P)7P)!11 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#: BLD13-00263 SITE ADDRESS: 693 HWY 20 Issue Date: 08/27/2013 PORT TOWNSEND, 98368 Final Date: 12/31/2013 APPLICANT: BENJAMIN W JENNETT PHONE: LINDA L PEARSON 693 STATE ROUTE 20 PORT TOWNSEND WA 983689383 SUBDIVISION: NOVAK SHORT PLAT Block: Lot: PARCEL NUMBER: 902243036 Section: 24 Township: 29 N Range: 02 W PROJECT DESCRIPTION: BATHROOM REMODEL, same footprint, same plumbing, cosmetic 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 12/31/2013 \\tidemark\data\forms\F_BLD_Occupancy.rpt 1/23/2014 45ON c " ° JEFFERSON COUNTY I (J ---_ N,rNNO.t0 DEPARTMENT OF COMMUNITY DEVELOPMENT 1' Date: ( ()Time Received: ,;L‘-?-tj am/pm Mon. Tue Wed. Thur. Fri. Date: 1 2---3 BID: ' l r 2 C Contact Name: Owner: Sr Knelt- Contact Number: 360 4 I — 2 ,7 4 Address: VP7 Sf• 0-0 206 Notes: Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Under ground Furance Footing Rough In Air Seal Above ground Gas Stemwall Hydronic Exterior shear Exterior lines Oil Straps Hot.Water Htr Interior shear Interior lines Ducts Post Hole Ventilation Appliance Underfloor Gas/Wood stove Man-Homes Insulation Final Inspection X Setbacks Floor Foundation Wall Address Posted Block&Tile Ceiling • • / JEFFERSON COUNTY DCD Contact the Building Department , BUILDING PLAN REVIEW at 379-4450,prior to maldng changes \-__N-v-■g c/■- ' or revisions to the approved plans ' peLAPPROVED AS SUBMITTED t:-.. .,:.,-'-: r,°,,,1-,r tr'e r-,--c-.0-,,,r d' 0.7,r r=7,,,..'''.r•••• • e, ,,1 , :L--,,, f',.., 'r ' ',, o'',„ 5.k.'. 1° 1,,,,'e, 7,'"•-' O APPROVED AS NOTED f..d J.'' ie -:',• an "r. '''''''.'1"11'.V.'reK,"C V'''' i.j.t LtrTib,..,i 0 REJECTED Date 6)-7-1- Reviewergra....... ---------_ . -- 121-8" , I* r--)4 •ex---\v-c..... 1"po, 8 5/8" - r'-e -- .c)LA- ___ 1, 3. , 81-11 3/8" 1 w 0-11 sitt,p0,_it., , 3068 ; i; ! i 7-4, ,--1•1:C7-< /:—_,--_—_-17;, '''''',4-1, = i : v.--z_T __, "Cr l I 'Ti s\ il13-1/3F' CO i357 3 1 t / ../c..... { , 2 i / --- - - MSTR BATH Plan I D, . ,r?' =- ib N-- . .... t-E . 9' \)!A . '--/ -?-5-613-- - ---,,------ -:-_- ---------,;, F- ,..., .1 gyp , ri„,, . ,__., * . I 7`--- __ otEtra faxsairm,,....-?,,,,,. .rtraw...,:n,,,:?,..:=';-:- 62 40DH FILE COPY. 1,-11 11/16" 2'-6 5/16" 15 _ CfEOVE 11 1----,-- —. 2'-6" -> --- -,, 179 scj ift I U1 ,- - 7' ----- ------ 51-4 1/2" ----- --)1 AUG 27 2013 , i LI j1 -V/ , — 121-8" ,, 4 JEFFERSON COUNTY DEPT.OF COMMUNITY DEVELOPMENT Vt-DIV vr.4. M tN, u....1t1/4(...L. puk) \ . Ris 4- IrVeies _ cins tive—stri-stNE. _ tvosuA-44.3-100 S. 15 .-toc-14- Tc2fmt- a...) —) -e1AAa- -- 1,,,,. Llt•.)E-4...) CArz). 7.-4-)C I b 0 x clo 14 Co-\1- . Stoo. s*- 1 .2.9i tv 1.--..M . ON C, • � b t - 263 �- '0 JEFFERSON COUNTY C� { II V 4, kali DEPARTMENT OF COMMUNITY DEVELOPMENT 4 jll I 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 •• 360/379-4451 Fax AUG 2 7 2013 www.co.jefferson.wa.us/commdevelopment L ,A1 2) axe Master Permit Application MI-4: JEFFERSON COMMUNITY DEPT OF COMM�NfN 11fUFf f1PMFNT .� Project Description(include separate sheets as necessary): In4T'--rc -c Rr VHC)c_sie.i Tax Parcel Number. (..YD__. z'-/3 0 3(0 Property Size: (, 7 4c.rr. (acres/square feet) Site Address and/or Directions to Property: (.Q41 3 S ,rte I'T. 2 o Property Owner(s)of Record: e-e✓) 3— 1,1i.c.P0,, PeCfs c)--N Telephone: 3c v 3 15-S— CA Z5 2- Fax: email: Mailing Address: G C1 3 ' T a T 7 C) Applicant/Agent(if different from owner): '1--ex(a 1.4-01‘c.el-1 Telephone: 3 Coc7 S'3 t 7 3- -N Fax: email: Mailing Address: 00 loth( _j c90 ( L '.-t4 C c,0- 6453 3 2 What kind of Permit?(Check each box that applies ❑Lot or Road Segregation 10 uiIding ❑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 ❑Short Plat** ❑ Home Business ❑Cottage Industry ❑Binding Site Plan** ❑ Propane ❑Long Plat** ❑Glyn ❑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/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 7S4 a to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE l/ Date: 7 v25'",/3 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 application tha e or she wants prior notice. Signature: ® ..02,1x..c..04.-- Date: 7"_, --5/3 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. Signature: �—.(1._ PedAo.,er---- Date: 7'—a3 `A3 G:\PermitCenter\###FORMS###\DRD FORMS\Current 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 t e respo sibility of the General Contractor for the proposed project. Signature: o Date: ?- -2S'- (3 GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: q �3�, l�-e�,� (3106)(--3r z37/ ( ) MAILING ADDRESS: EMAIL.jai( /,,� ^__ ' O CONTRACTOR'S LICENSE ^ �ro�"�'b�: to-C1'S r G��'` TO LL 'O\ WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAx:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ft Wood Existing: 3 ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System • Alteration/Remodel ❑ Concrete Total: 3 Height: .Individual System ❑ Repair ❑ Masonry SEP Permit# nP$$- kp( . ❑ Demolition ❑ Other: Bedrooms: W ter Supply: Existing: 3 Setback: x Private well ❑ Two Party Type of Heat: Proposed: r(-e_ n'C Total: 3 0 m Name of System: If this is a Commercial Project you must answer the following: J 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: 1 Heat Stove i Cook Stove 1 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, including the reserve area. S•uare Foota•e Current Pro•osed - �' ' 'office� ` e Mio .:t Revision Main Floor Heated EH Bld App Review: ' m Floor Heated Consistency Review: Other Heated Base fee: 2 J n• Mezzanine Additional Section: ...-----_ Heated Basement Plan Check fee: -ri 30 Unheated Basement State Surcharge fee: /__ er Other Unheated it Water Review fee: `7 Garage/Carport SUBTOTAL q ?�Decks 5 911/Rd Approach fee: ' Other TOTAL: $ Receipt Number: ( LiZCf ZS Cash/Check Number: z/ 3s- ES IMATFD_C ST(REQUIRED) Date: /Z 3 • it martcet value of all a and materials foundation to finish Initials: s. G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc • • ,c ON NINO'O JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street Port Townsend, WA 98368 Al Scalf, Director Letter of Representation When an applicant for a permit is not the owner of the property it is necessary for the property owner to submit a letter of representation. The letter needs to have the owner's original signature. An example is below:. Date To Whom It May Concern: I, John Doe, owner of 123 Fir Street, Parcel# 123-456-789, give permission to Tom Sawyer to apply for a permit on the above referenced property. Sincerely, D 1E0 m AUG 272013 Date JEFFERSON COUNTY DEPT.OF COMMUNITY DEVELOPMENT To Whom It May Concern: , owner of e4 3 '". 2 0 (property owners name) (address or legal description) ,� Parcel# , give permission to r /tuL , (par I 'mbar) (applicant's name) to apply for a s ermit from Jefferson County on the above (type of p it) referenced property. Sincerely, Building Permits/Inspections Development Review Division Long Range Planning (360)379-4450 FAX: (360) 379-4451 G:1PematCenterWORMS1Letter of Representation.doc Contractors or Tradespeople Peter Friendly Page • Page 1 of 2 General/Specialty Contractor A business registered as a construction contractor with Lfxl 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 TOLLEFSON BUILDERS INC UBI No. 601222162 Phone 3607324080 Status Active Address Po Box 100 License No. TOLLEBI977N9 Suite/Apt. License Type Construction Contractor City Chimacum Effective Date 8/29/2003 State WA Expiration Date 3/16/2015 Zip 98325 Suspend Date County Jefferson Specialty 1 General Business Type Corporation Specialty 2 Unused Parent Company Other Associated Licenses Specialty Specialty Effective Expiration License Name Type Status 1 2 Date Date TOLLSCI107D6 TOLLSHARK Construction General Unused 3/26/1990 3/15/2005 Archived CONSTRUCTION INC Contractor TOLLSHARK Construction TOLLSCC217NO CNST/CUSTOM Contractor General Unused 8/20/1979 8/20/1990 Archived WOODWORK Business Owner Information Name Role Effective Date Expiration Date HULBERT,TODD J President 02/15/2013 ADAMSON, KAY J Secretary 02/15/2013 COLE, RICHARD TYLER Vice President 06/12/2013 TOLLEFSON, RICK F President 08/29/2003 02/15/2013 MAYSHARK, HOLLY H Secretary 08/29/2003 02/15/2013 Bond Information Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date TRAVELERS CAS Ft 5 206085510 03/15/2002 Until Cancelled $12,000.00 01/25/2002 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 19 Houston TEN-12582 05/15/2013 05/15/2014 $1,000,000.0005/14/2013 Specialty Ins Co 18 Houston TEN-11142 05/15/2012 05/15/2013 $1,000,000.0005/15/2012 Specialty Ins Co Contractors 17 Bonding a C11SJ6295 05/15/2012 05/15/2013 05/15/2012 $1,000,000.0005/09/2012 Insuranc American 16 Safety 10TSRGL376200 05/15/2011 05/15/2012 $1,000,000.00 05/12/2011 Indemnity Co AMERICAN 15 SAFETY 10TSRGL307300 05/15/2010 05/15/2011 $1,000,000.00 05/14/2010 INDEMNITY CO 14 10TSRGL236700 05/15/2009 05/15/2010 $1,000,000.00 05/14/2009 https://fortress.wa.gov/lni/bbip/Print.aspx 8/27/2013 Contractors or Tradespeople Fitter Friendly Page Page 2 of 2 AMERICAN SAFETY INDEMNITY CO AMERICAN 10TSR-GL1161- 13 SAFETY 00 05/15/2008 05/15/2009 $1,000,000.00 05/14/2008 INDEMNITY CO AMERICAN 10TSRGL1161- 12 SAFETY 00 05/15/2007 05/15/2008 $1,000,000.00 05/16/2007 INDEMNITY CO AMERICAN 11 SAFETY 10TSRGL 05/15/2007 05/15/2008 $1,000,000.00 05/14/2007 INDEMNITY 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 8/27/2013 • • r CC Ca H O = O 13 LL_ N -0 Z LJ_ -, O H O LO O -- -- CO `• CC c+- a) — NI- LC] -3 Lu O O - If3 J O O L CD -0 X CC "O +I CO Z C C-) O = I-1 LU O O U3 -4--, "O H O CO I •• 7 L .0 L 00 I` CC J] 0 C-) U LLJ Z O 0: O J 0. 0_ X � U I- I- O O CO CO CI) CI) CO N "O CT) = O I U CO CC "O CO WI C = 3 CO 3 I- CO � O CO O CO J U C3 O] -0 CE = C X I-I LO7 3 3 I- O ¢ 3 } • • I- CLI 3 I- LCD F- Z CO LLJ -0 CC O Q H LL.I CID Z Z LLJ C- W • J X J W Z O I- Lu CZ d' 0_ Q m Cr LLJ CO = O O CU Q O LY O Z -- CZ N I- Z X ■ O Q 0: W CO C1 O O LL Q CM X Lu CA O7 O m I— 0_ w Z O J CLI 2 w Z I- 3 X CC CO . I- H J Q O U W 'O I- X W X I-- I- CC U Y N I- I- O J Q Q 07 Q W O 0_ -3 O I— O >. I— Z N OO -, Z Z co Cr m O O Z 7 0_ O Lu H CA O co Z J W +, � U CO J CO 0_ OO - +I O CO O CO 7 CO O O CO CO CO � . CV Z CV Z Lu r— . O L O7 —D 07 O LO O O CO O O O "O L LO7 O CO U N � C*7 O ## C O Z CL) .. L 3 s_ Z Y C — N O A--, N Lu N OD = Cn -- _ - L CV o (O CI) 'Q 7 OD U L. L C2 - O O O1 L U CO X -1-• U "Cl X O CO 0_ CO -- -- co m I— I— X ci- I- Cn CO ci- X * 1— tC Jefferson County Building Pision Permit Niter: 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 0 _.\'L) ., FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR • • • CONDITIONS for Building Permit# : \\tirlamark\riata\fnrmc\F RI 11 Permit Rlrin rnt R/27/9(111 • BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD13-00263 Received Date: 8/27/2013 SITE ADDRESS: 693 HWY 20 Issue Date 8/27/2013 PORT TOWNSEND, 98368 Expiration Date 8/27/2014 OWNER: BENJAMIN W JENNETT PHONE: LINDA L PEARSON 693 STATE ROUTE 20 PORT TOWNSEND WA 983689383 NOVAK SHORT PLAT SUBDIVISION: Block: Lot: PARCEL NUMBER: 902243036 Section: 24 Township: 29 N Range: 02 W CONTRACTOR: TOLLEFSON BUILDERS INC PHONE: (360) 732-4080 TODD HULBERT PO BOX 100 CHIMACUM WA 98325 Contractor's License TOLLEBI977N9 Expires 3/16/2015 PROJECT DESCRIPTION: BATHROOM REMODEL, same footprint, same plumbing, cosmetic TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 25,000.00 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: Type Amount Paid By: Date: Receipt: BEDROOMS: BATHROOMS: Permit $322.00 MEB 08/27/13 142425 Exist: 3 Exist: 3 Plan Check $209.30 MEB 08/27/13 142425 Prop: Prop: State Building Code $4.50 MEB 08/27/13 142425 Total: 3 Total: 3 Total: $535.80 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