HomeMy WebLinkAboutBLD2013-00273 4UILDING PERMIT APPLICAAN BLD13-00273
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD13-00273 Received Date: 9/4/2013
SITE ADDRESS: 152 HUCKLEBERRY PL
PORT TOWNSEND, 98368
OWNER: KAREN C KRUG PHONE: 360-385-3807
CHARLES S JAMES
152 HUCKLEBERRY PL
PORT TOWNSEND WA 983689418 CAPE GEORGE VILLAGE DIV 6
SUBDIVISION: Block: Lot: 7
PARCEL NUMBER: 941400006 Section: 13 Township: 30 N Range: 02 W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2013
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION SWAP OUT PROPANE GAS BOILER FOR NEWS PROPANE GAS
BURNER
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP MEC MAIN:
VALUATION 8,000.00 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: Exist:
Prop: Prop:
Total: Total:
Routing Date:
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $228.00 MEB 09/04/13 142453 APPROVED
Total: $228.00
SEP U + 2013
Jefferson County DOD
\\tidemark\data\forms\F_BLD_App_Bld.rpt 9/4/2013
Contractors or Tradespeoplenter Friendly Page Page 1 of 1
•
Electrical Contractor
A business licensed by LEd 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 SUNSHINE PROPANE UBI No. 600342368
Phone 3603855797 Status Active
Address 10853 Rhody Drive License No. SUNSHP*984B3
Suite/Apt. License Type Electrical Contractor
City Port Had lock Effective Date 1/23/2002
State WA Expiration Date 1/23/2014
Zip 98339 Suspend Date
County Jefferson Specialty 1 Hvac/Rfrg Ltd Energy
Business Type Corporation Specialty 2 Unused
Parent Company
Other Associated Licenses
Specialty Effective Expiration
License Name Type Specialty 1 2 Date Date Status
ENVIRHI004D9 ENVIRONMENTAL Electrical Hvac/Rfrg Ltd Unused 3/29/2000 3/29/2002 Archived
HOUSING INC Contractor Energy
Master Electrician INFORMATION
License CHAWER*954JE
Name CHAWES, RICHARD
Status Active
Business Owner Information
Name Role Effective Date Expiration Date
ROSS, LEVI K Agent 01/23/2002
PETERSEN,JAMES F President 01/23/2002
EWING,MICHAEL H Secretary 01/23/2002
YOURISH, ROBERT Treasurer 01/23/2002
BISHOP, RON M Vice President 01/23/2002
Bond Information
BondlBond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date'
1 (RELIANCE SURETY CO 6086432 03/20/2000 Until Cancelled $4,000.00 01/23/2002
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 No records found for the previous 6 year period
https://fortress.wa.gov/lni/bbip/Print.aspx 9/9/2013
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03 CI
greJEFFERSO (Stib 1 J —2 `
llico. OUNTY 1 j DEPARTMENT OF COMMUNITY DEVELOPMENT
r' ` " 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
,.q 7I1>
4,0 www.co.jefferson.wa.us/commdevelopment
1N
Master Permit Application MLA:
Project Description(include separate sheets ass n ecessa
lr)AP E uT Pieo/ANE (;As &ILf2
/ . n
Tax Parcel Number: I L 0 0 VO 2 Property Size: (acres/square feet)
Site Address and/or.Directions to Property: �
//-6-'S I'd)ei-E, k " V '19p96� ` 1e r 7 ent)4 S /2/1o, /0,12 9d31,Y
Property Owner(s)of Record: 1; / • * , i sn, ht
Telephone: 3 bd -37 9- 5 7D Fax: email: 1(f�L TD @ sP�P/�t1 jn/A/�, ��
Mailing Address: /`t7�. /././jib X,, -Refer . l I /4�I z/iiirl� Z/). C������
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 — l t)/a-/P p(;t 7--s8_ A 86t-e- ❑ 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**
X Propane ❑ Long Plat**
o 3iyn ❑ Piannea kurai 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 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. 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 re•uire• ater i pections. Staffs access and right of entry will be assumed unless the applicant inform- the County in writing at the
time of the appli -�,,- h h- • or she wants prior notice.
Signatur-. 4∎ �ASi Date: _
The action or ac'•ns • 'oilcan Orill undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or
endangered s•-cies 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 - i c• pliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transf- -s,,• sibility for adhering to and complying with the ESA. The Applicant has read this dis lai er 'nd signs nd dates it elow.
Signature: Ir 4d.. . Date: 5� 2
Mr
G:\PeimitCenter\###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 the responsibility of the General Contractor for the proposed project.
Signature: Date:
GENE:*L CONTRACTOR OR MANUF CTURED HOME INSTALLER: PHONE: FAX:
'1.I /. ./i z I,„dr*1il_, 30 38t -5 297 ( )
MAID G ADDRESS: / 43 / 12/4 1 , ,�JQ,�/Ak , SAIL:
CONTRACTORS LICENSE a �►` f�. '/1�/WAINS
NUMBER: - £ i/I�S/J/°4 i7` 7'f /3 NUMBER
ARCHITECT/ENGINEER: �1 /' /Y PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
O New 0 Wood Existing: ❑ Sewer
O Addition 0 Steel Proposed: Bank 0 Community System
O Alteration/Remodel 0 Concrete Total: _ Height: 0 Individual System
O Repair 0 Masonry SEP Permit#
O Demolition 0 Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well 0 Two Party
Type of Heat: Proposed: 0 Public
Total: Name of System:
If this is a Commercial Project 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:
1 Underground Tank 1 Above ground Tank Size of Propane Tank:
1 Heat Stove 1 Cook Stove 1 Woodstove ► Fireplace Insert 1 Hot Water Tank 1 Pellet Stove I Otherl
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.
Square Footage Current Proposed For Office Use Only r Amount Revision
Main Floor Heated EH Bid App Review:
2nd Floor Heated Consistency Review:
Other Heated Base fee:
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL
Decks 911/Rd Approach fee:
Other TOTAL: $
Receipt Number:
Cash/Check Number:
ESTIMATED COST(REQUIRED) Date:
•Fair market value of all labor and materials foundation t f i
St) , 6� Initials:
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
1110 ali
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#: BLD13-00273 Received Date 9/4/2013
SITE ADDRESS: 152 HUCKLEBERRY PL Issue Date 9/4/2013
PORT TOWNSEND, 98368
APPLICANT: KAREN C KRUG PHONE: 360-385-3807
CHARLES S JAMES
152 HUCKLEBERRY PL
PORT TOWNSEND WA 983689418 7
SUBDIVISION: CAPE GEORGE VILLAGE DIV 6 Block: Lot:
PARCEL NUMBER: 941400006 Section: 13 Township: 30N Range: 02W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339 ((33 �)3g5
Contractor's License SUNSHP*077QP Expires 11/167/2013-5875
OWNER, KAREN C KRUG PHONE: 360-385-3807
if different: CHARLES S JAMES
152 HUCKLEBERRY PL
PORT TOWNSEND WA 983689418
PROJECT DESCRIPTION: SWAP OUT PROPANE GAS BOILER FOR NEWS PROPANE GAS
Directions BURNER
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 9/4/2014.
REQUIRED INSPECTIONS:
Tank/Line/Appliance:
FinalApproval: 10 _I( - /3
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 9/4/2013
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