The URL can be used to link to this page

Home My WebLink AboutBLD2013-00277 BUILDING PERMIT APPLICA N B 0277 Ree view view Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD13-00277 Received Date: 9/12/2013 SITE ADDRESS: 284566 HWY 101 QUILCENE, 98376 OWNER: ROBERT J GIBSON TRUSTEE PHONE: DIANNA L GIBSON TRUSTEE PO BOX 2007 PORT TOWNSEND WA 983680080 SUBDIVISION: Block: Lot: PARCEL NUMBER: 902363009 Section: 36 Township: 29 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 DESCRIPTIOP TANK SET 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: 3,„, Type Amount Paid By: Date: Receipt: Approved/Date Permit $228.D0 J LA 09/12/13 142496 APPROVED Total: $228:ee ,� \\��' LI i 1 2013 D Jeffew. ,n County DCD \\tidemark\data\forms\F_BLD_App_Bld.rpt 9/12/2013 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#: BLD13-00277 SITE ADDRESS: 284566 HWY 101 # Issue Date: 09/12/2013 QUILCENE, 98376 Final Date: 9/19/2013 APPLICANT: ROBERT J GIBSON TRUSTEE PHONE: DIANNA L GIBSON TRUSTEE PO BOX 2007 PORT TOWNSEND WA 983680080 SUBDIVISION: Block: Lot: PARCEL NUMBER: 902363009 Section: 36 Township: 29 N Range: 02 W PROJECT DESCRIPTION:TANK SET 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 9/19/2013 \\tidemark\data\forms\F_BLD_Occupancy.rpt 10/8/2013 Contractors or Tradespeople Printer Friendly Page Page 1 of 1 • • Electrical Contractor A business licensed by L&l 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 Hadlock Effective Date 1/23/2002 State WA Expiration Date 1/23/2014 Zip 98339 Suspend Date County Jefferson Specialty 1 Hvac/Rfrg Business Type Corporation Specialty 2 Unused Parent Company Other Associated Licenses Specialty Specialty Effective Expiration License Name Type 1 2 Date Date Status ENVIRHI004D9 ENVIRONMENTAL Electrical Hvac/Rfrg Unused 3/29/2000 3/29/2002 Archived HOUSING INC Contractor 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 Bond Bond 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 9/12/2013 °N + I • \3 rz�� - JEFFERSON COUNTY bDEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax p www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Project Description dude separate sheets as necessary): I&- -sw. Tax Parcel Nurnberg t) '.j(p 'Q CD l Property Size: (acres/square feet) Site Address and/or Directions to Property: °6'-(/ 57P 60 thiti / ) / Property Ownerfs)of Record: �2 i2 1 £b t1LV1 C9 t DA/IV-1 Telephone: - 1 to 5 (3L[\ l=ax: email: Mailing Address: P. n. k 2--o O-1 f2-" Ia W ix3 s 1.0l0t V..)6 41 3,(D Ct Applicant/Agent(if different from owner): 6-wric511.i r'_.C_.) r-r'oloavL„.t.-_ Telephone: v38 5' S`)411 Fax: email: Mailing Address: 10c6 5'J (41-4001 00 C2 $o2X a.IAOLOcke . What kind of Permit?(Check each box that applies ❑Building ❑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** ❑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/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 thi application for permit(s). OWNER SIGNATURE "' Date: �5 /A-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 • ed I =r inspect' taff's access and right of entry will be assumed unless the applicant informs the County in writing at the time of the ap.i �1r,,n th e/ e - to, 'or notice. 9.45 Signature: t' .`�. Date: /3 The action or actions Applicant ill 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' ou are in compliance ' the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-t :nsfera• :/respo b" fo\< �`e g to and complying with the ESA. The Applicant has read this disciajmq[an igns and dates it below. Signature: — _. 11 ., Date: '1/5/13 G:\PermitCentet\###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 assumin the responsib'lit of ill General Contractor for the proposed proj Signature: C== ` Date: L`0 Lt 1 �3 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: 0 Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ 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 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/ ' nce Installation permit,mark all items below that apply:. I Underground Tank round Tan Size of Propane Tank: 1 2-6 Heat Stove 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 I. 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. alLIPINAO 1.t+ 440..f.47 S•uare Foota e Current Pro•osed ls� , ' t .. , r �� :_. .., .. e Main Floor Heated r T EH Bid App Review: 2"°Floor Heated Isei rt, I` Consistency Review: Other Heated k r,� r, Base fee: Mezzanine ' Additional Section: �, � �� r Heated Basement s a . qfrX Plan Check fee: Unheated Basement fi: _ . 1 State Surcharge fee: Other Unheated` ''; Pot Water Review fee: Garage/Carport 104--Miffi SUBTOTAL Decks • 911/Rd Approach fee: Other TOTAL: $ Receipt Number: Cash/Check Number: '3 �trV],N ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish Initials: G:\PemtitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc • 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#: BLD13-00277 Received Date 9/12/2013 SITE ADDRESS: 284566 HWY 101 Issue Date 9/12/2013 QUILCENE, 98376 APPLICANT: ROBERT J GIBSON TRUSTEE PHONE: DIANNA L GIBSON TRUSTEE PO BOX 2007 PORT TOWNSEND WA 983680080 SUBDIVISION: Block: Lot: PARCEL NUMBER: 902363009 Section: 36 Township: 29N Range: 02W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 336g0�1385-5875 Contractor's License SUNSHP*077QP Expires 1 /17/ 013 OWNER, ROBERT J GIBSON TRUSTEE PHONE: if different: DIANNA L GIBSON TRUSTEE PO BOX 2007 PORT TOWNSEND WA 983680080 PROJECT DESCRIPTION: TANK SET 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 9/12/2014. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: T1 It Ut./G_ ct-1-7-13 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 9/12/2013 t../ • Date 61"—./12 Mime received V,— am Mon. .Wed: Thur. Frl. • BLD: `° Date: /7 OWNER: v Contact Nemec j� ADDRESS: O "tS rig-Le/7f /0 I Contact Number 360- �'3 5797; Notes: �/�ii 1 I�� 206 : d o a, Foundation Plumbing - Framing Propane Tank • Mechanical ' Setbacks _ Under-ground Framing Under ground Furnace Footing Rough In Air seal Above ground _ Gas — Stemwall __ Hydronic Exterior shear Exterior lines Oil —_ Straps Interior shear Interior lines •• Ducts Post Hole Ventilation -- Appliance _ Underfloor Gas/wood stove Man.Honies — Setbacks Insulation. _ Final inspection Foundation g Add Block&lie _ floor wall ceiling to � Address Posted i