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Home My WebLink AboutBLD2013-00270 • BUILDING PERMIT APPLIC ON BLD13-00270 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD13-00270 Received Date: 9/3/2013 SITE ADDRESS: 256 WILDWOOD SHORES BRINNON, 98320 OWNER: JOSEPH BUCHMAN PHONE: BARBARA BUCHMAN JTWROS 1223 SPRING ST APT 501 SEATTLE WA 981043572 SEEDS &REHE SHORT PLAT SUBDIVISION: Block: Lot: PARCEL NUMBER: 502142010 Section: 14 Township: 25 N Range: 02 W CONTRACTOR: AIR FLO HEATING COMPANY INC PHONE: 360-683-3901 221 W CEDAR SEQUIM WA 98382 Contractor's License AIRFLI*206DG Expires 4/25/2014 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP LIKE IN KIND REPLACEMENT OF HEAT PUMP SYSTEM TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION 9,461.00 ADD'L: HEAT TYPE: EEE 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 Permit $228.00 MEB 08/29/13 142438 APPROVED Total: $228.00 SEP 0 3 2013 Jefferson County DCD \\tidemark\data\forms\F_BLD_App_Bld.rpt 9/3/2013 i q■-, - 1' '''i ' '' -'-',1 \ r T r-.;1-r- +Ili-IN& JEFF ON COUNTY l � DEPARTMENT OF COMMUNITY DEVELOPMENT 14k-4 ''d 621 Sheridan Street• Port Townsend •Washington 98368 A'' 360/379-4450 • 360/379-4451 Fax MG 2 9 2013 (,, www.co.jefferson.wa.us/commdevelopment SO Master Permit Application MEFE11lf COUNTY DED Project Description(include separate sheets as necessary): EKE (14 KA 0D QE01.-6C-etke01' o vkEivr Mkt) .s`i b €M Tax Parcel Number: SO,Q, `LA,' -O . 0 Property Size: (acres/square feet) Site Address and/or Directions to Property: Property Owner(s)of Record: . - .p s'ta s�t �� __ v Telephone: — • • — I 4' Fax: email: Mailing Address: laa-3 Spy l nc, 1-Yee....-F-76-3---9 So\ Applicant/Agent(if different from owner): 'err): Al r I O 4ea-rt nc Telephone: 31e0-Web-a:AO 1 Fax: le 83" 361`1 e email:e11e.heoS11C 10 jhf]. hh Mailing Address: 2.11 W W. Cedar Si• WiCitW�t•n , ,W p1 g838� c ' What kind of Permit?(Check each box that applies ❑Building ❑Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use) Pli,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 ❑Cottage Industry ❑Binding Site Plan** ❑Propane ❑Long Plat" ❑Sign ❑Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/A(teration*" ❑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'{dentify y her / cal,stet or federal permits required for this proposal, if known: DESIGNATION OF AGENT I hereby es gn 4 1 t^-1 U }ie&t'1 rn to act as my agent in matters relating to thI appli tion for permit(s). OWNER SIGNATURE `J Date: 2-- \ 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 .uired later . spe;'ons. / ffs access :nd right of entry will be assumed unless the applicant informs the unty in writing at the time of the appf-ti',' that h: or; : ..:n•.-. : notice. Signature: A / 5 ')' L. Date: ism The action or a IF 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-transfera 1 res..-sibili 'm,.r ad C'ng to• and�.r plying with t e ESA. The Applicant has read this d.- er and =', =and dates it below. Signature: ,4 -il1li Date: �� G:\PeurritCentet\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc +,.__..do • BUILDER STATEMENT ID e The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed conttaaters and that ' they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MficUFACTURED HOME INSTALLER: PHONE: FAX: t FLo t4E fry k0 & 344)6S33614)I 34a)643-5'11 I MAILING ADDRESS: _ e1)*& E e. EMAIL: 1 `_.,_/, r 4-yyi , CONTRACTOR'S LICENSE WAINS t NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: O New 0 Wood Existing: O Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System O Alteration/Remodel 0 Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# O Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well 0 Two Party Type o eat: Proposed: ❑ Public C. Total: Name of System: If this is a Commercial Eroiectyou must answer the following: Number of Parking Spaces: Current: Proposed: Number of Q 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 P • •, e T_,nk a •r A ; ce Installation •-rmit ma a I i s below 1.= 1 Underground Tank 1 Above ground Tank Size of Propane Tank: 1 Heat Stove 1 Cook Stove 1 Woodstove 1 Fireplace Insert 1 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 properly 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.• ed :t Main Floor Heated EH Bid ° •p Review: 2"°Floor Heated Consistency Review: Other Heated Base fee: 1 v2 --� Q ` ^ vc Mezzanine Additional Section: Heated Basement :' Plan Check fee: - Unheated Basement f State Surcharge fee: Other Unheated °i Pot Water Review fee: Garage/Carport SUBTOTAL Decks ... _ 911/Rd Approach fee: Other ueici. N M 11461 ', TOTAL: $ _ a a� Receipt Number. 5, i Cash/Check Number: 9 1 ( , ESTIMATED COST(REQUIRED) Date: 8 -90t-13 .Fair market value of all labor and materials foundation to finish # 6146( dp Initials: s G:\PemritCenter\###FORMS###\DRD FORMS\Master Permit Application S-29-08.doc a -I XO -i 01 o -I fi x -1 --I co o —• —• m -o co O 1 x O_ CD r-I- x 03 0 -3 -O 01 O - -O -3 -I 0 0) C O- CD 01 0 CD 7- CO CC -• CD CC CD m C CD r+ O CD - 7 7C' n -I E '3 -- CD = o = # CC N -P CD CD co co -P -3 C1 O O G'I � � O O CJ1 O CO Oo CO N C O C7 no 2 -P no N 03 O Ul C CO O O O ■ F - 01 03 CA -' Oo L CD `� r+ C CO r— CO G7 m no 3> O O -0 C CD C O m CD a ry 70 CO 3 d N 2 CO -I m O -I CO o m -0 CO 3 C- o -I 3> v I- CD -1 3> �. cn c3 XI I- CO 70 = m X Z m C- m C7 rn "0 3> —I - 3> S?e Po 3> 3 70 co m co N I- CI H CO C -1 C. m --♦ 70 CJl Z c n n a O r— m O v Cr) X o cl = o �. oc cn 2 ry 73 -• 3> 2 3 C7 D rn 3> rn -‘ O CO 3 n 7J 00 -0 v � -o rn -I 3> Z m r— = C— cn N m O CO Z CO m = 70 C_ CO a cn O � --1 -' -0 C- 70 -P -< X o —I —I X —I -N —• -P X H —, 3 O 1 01 70 Z -0 3> C1 CO O O 0 c7 1— I- CO O cn , cn o m a -1 E � X c O —I m N C3. 73 co O C 0- CA CD CD O o -1 -1 n � 3 v -o r— C7 70 O Z rn c-) C7 0 CS D --J CO 3 S 3 C -- I CO CO H C1. r-1- cn v O M H C v c7 O Z CO r+ CZ 70 3 CL CI -3 O O I- - O_ O rn C.. CO no — CD -1, 3> -\ CO -- -- O C- CA O H O `� m Z CS N -T1 .] O C O I-1 'J 70 Contractors or Tradespeople Printer Friendly Page Page 1 of 1 • • Electrical Contractor A business licensed by LEI to contract electrical work within the scope of its specialty. Electrical Contractors must maintain a surety bond or assignment of savings account.They also must have a designated Electrical Administrator or Master Electrician who is a member of the firm or a full-time supervisory employee. Business and Licensing Information Name AIR FLO HEATING CO INC UBI No. 600347761 Phone 3606833901 Status Active Address 221 W Cedar St License No. AIRFLHCOO9C8 Suite/Apt. License Type Electrical Contractor City Sequim Effective Date 2/28/2000 State WA Expiration Date 2/28/2014 Zip 983823320 Suspend Date County Clallam Specialty 1 Hvac/Rfrg Ltd Energy Business Type Corporation Specialty 2 Unused Parent Company Master Electrician INFORMATION License BERSOJR975LB Name BERSON,JOEL RAY Status Active Business Owner Information Name Role Effective Date Expiration Date BEQUETTE,MICHAEL 01/01/1980 FULLAWAY,MICHAEL 01/01/1980 LEVINSON, WILLIAM R Agent 01/01/1980 BEQUETTE,MARK A President 01/01/1980 BERSON,JOEL R Secretary 02/12/2010 BERSON,JOEL R Treasurer 02/12/2010 BEQUETTE,SANDRA A Vice President 01/01/1980 Bond Information Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date 4 CBIC si6233 07/06/2010 Until Cancelled $4,000.0005/19/2010 2 COLONIAL AM CASE LPM4054452 07/06/2001 Until Cancelled 08/21/2010 $4,000.00 07/18/2001 SURETY OF MD Assignment of Savings Information No records found for the previous 6 year period Insurance Information No records found for the previous 6 year period Summons/Complaint Information Summons and Complaints are not filed with the department for this contractor type Warrant Information Warrants are not filed with the department for this contractor type Infractions/Citations Information Infraction/Citation Date RCW Code Type Status Violation Amount EDORN00206 3/28/2013 19.28.161(6)RCW ELECTRICAL CITATION Satisfied $250.00 https://fortress.wa.gov/lni/bbip/Print.aspx 9/3/2013 i • 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#: BLD13-00270 Received Date 9/3/2013 SITE ADDRESS: 256 WILDWOOD SHORES Issue Date 9/3/2013 BRINNON, 98320 APPLICANT: JOSEPH BUCHMAN PHONE: BARBARA BUCHMAN JTWROS 1223 SPRING ST APT 501 SEATTLE WA 981043572 SUBDIVISION: SEEDS& REHE SHORT PLAT Block: Lot: PARCEL NUMBER: 502142010 Section: 14 Township: 25N Range: 02W CONTRACTOR: AIR FLO HEATING COMPANY INC PHONE: 360-683-3901 221 W CEDAR SEQUIM WA 98382 Contractor's License AIRFLI*206DG Expires 4/25/2014 OWNER, JOSEPH BUCHMAN PHONE: if different: BARBARA BUCHMAN JTWROS 1223 SPRING ST APT 501 SEATTLE WA 981043572 PROJECT DESCRIPTION: LIKE IN KIND REPLACEMENT OF HEAT PUMP SYSTEM 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 9/3/2014. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApprovai: 11+13 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 9/3/2013 • • \\tidemark\data\forms\F_BLD_Permit_Propane.rpt 9/3/2013 AIR FLO HEATING COMPANY Check Number: 41175 4117 5 Jefferson County Building Department Date Description Amount 08/27/2013 Permit for Buchman 228.00 • JEFFERSON COUNTY DCV) NO. 14^2438 DATE 8.aq-3 R IVED FROM ■ ` � �• L�l DE IPTION BARS# AMOUNT �1Z ,5e �� l oCURRHEECCNOC;Y CD r� o 50� iaa o M m lia, 0 O' �WM�e °ate g° . ., RECEIVED BY TOTAL I