HomeMy WebLinkAboutBLD2013-00268 41kUILDING PERMIT APPLICAtN BLD13-00268
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD13-00268 Received Date: 8/30/2013
SITE ADDRESS: 1763 OAK BAY RD
PORT HADLOCK, 98339
OWNER: ALLAN BROWN PHONE:
VICKI BROWN
21015 6TH AVE S
DES MOINES WA 98198-3268 SURACE/LARSON SHORT PLAT
SUBDIVISION: Block: Lot: 1
PARCEL NUMBER: 921073022 Section: 7 Township: 29 N Range: 01 E
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 DESCRIPTIOII INSTALL OF 120 GAL PROPANE TANK
TYPE OF WORK RES 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:
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $76.00 MEB 08/29/13 142441 APPROVED
���Ifs®
Total: $76.00 x\44
AUG 3 0 2013
Jefferson County DCD
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CERTIFICATE OF OCCUPANCY
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
(360)379-4450 FAX(360)379-4451
Carl Smith, Director/Building Official
PERMIT#: BLD13-00268
SITE ADDRESS: 1763 OAK BAY RD# Issue Date: 08/30/2013
PORT HADLOCK, 98339 Final Date: 9/13/2013
APPLICANT: ALLAN BROWN PHONE:
VICKI BROWN
21015 6TH AVE S
DES MOINES WA 98198-3268
SUBDIVISION: SURACE/LARSON SHORT PLAT Block: Lot: 1
PARCEL NUMBER: 921073022 Section: 7 Township: 29 N Range: 01 E
PROJECT DESCRIPTION: INSTALL OF 120 GAL PROPANE TANK
THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2012
EDITION.
OCCUPANCY GROUP:
TYPE OF CONSTRUCTION:
SPRINKLER SYSTEM yes no
THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 9/13/2013
\\tidemark\data\forms\F_BLD_Occupancy.rpt 10/8/2013
, 111 6
SITE VISIT REPORT
(PLOT PLAN)
r
JOB A\ ot V DATE: 71Z-CA 13 CONTACT:
ADDRESS I 7( 3 aak day PHONE #:
ASS S P$..S C-Oi Tb Q( 13'1:r3 f.1' FAX #:
1,Z tivi t or4 Lt"F.'r Email ,V L'81OW IN o�. r1 c-04:7-1 rs r"
PLANNER: �oW�. ,
Include all street names adjacent to property,property lines,tank,appliance&piping locations,distances of tank to property lines and
buildings,septic,wells,wetland areas distance to water bodies.
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Contractors or Tradespeople Peter Friendly Page • Page 1 of 2
General/Specialty Contractor
A business registered as a construction contractor with Lal 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 SUNSHINE PROPANE UBI No. 600342368
Phone 3603855797 Status Active
Address 10853 Rhody Dr License No. SUNSHP*077QP
Suite/Apt. License Type Construction Contractor
City Port Hadlock Effective Date 11/17/1993
State WA Expiration Date 11/17/2014
Zip 98339 Suspend Date
County Jefferson Specialty 1 General
Business Type Corporation Specialty 2 Unused
Parent Company ENVIRONMENTAL HOUSING INC
Other Associated Licenses
Specialty Specialty Effective Expiration
License Name Type 1 2 Date Date Status
LEVISES915BB LEVI'S ENERGY Construction General Unused 1/2/2009 1/2/2015 Active
SERVICE LLC Contractor
WARMWS*123BN WARM WINDOWS Et Construction General Unused 1/15/1988 11/17/1993 Archived
SUNSHINE Contractor
ENVIRH*204Q5 ENVIRONMENTAL Construction General Unused 11/25/1980 11/17/1988 Archived
HOUSING INC Contractor
Business Owner Information
Name Role Effective Date Expiration Date
EWING,MICHAEL HOYT Member 01/01/1980
FLANDERS, RONALD LEE Member 11/05/2010
CHAWES, RICHARD HENRY President 11/05/2010
SIMPSON, LAURA ANNE Secretary 11/05/2010
YOURISH, ROBERT B Treasurer 01/01/1980
LEMLEY, DAVID BARRY Vice President 11/05/2010
PETERSEN,JAMES 01/01/1980 11/05/2010
SPRING, PERRY 01/01/1980 11/05/2010
CHAWES, RICHARD 01/01/1980 01/01/1980
YOUNT, JO 01/01/1980 01/01/1980
ROSS, LEVI K 01/01/1980 01/01/1980
Bond Information
Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date
7 TRAVELERS CAS 8 206086406 11/17/2001 Until Cancelled $12,000.00 10/23/2001
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
United States
23 Fire Insurance 506-871834-3 11/17/2012 11/17/2013 $1,000,000.00 11/15/2012
C
22 FEDERATED 633829 11/17/2008 11/17/2009 $1,000,000.00 11/13/2008
SERVICE INS CO
21 FEDERATED 633829 11/17/2006 Until Cancelled $1,000,000.00 11/09/2006
SERVICE INS CO
https://fortress.wa.gov/lni/bbip/Print.aspx 8/30/2013
Contractors or Tradespeople Peer Friendly Page • Page 2 of 2
1.4 FIREMAN'S 1286MXX80096485111/07/1985 11/17/2007 I 11/07/1985
FUND 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 8/30/2013
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JEFFERSO COUNTY ��, ,���1[ � , ,4)
th let, DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street• Port Townsend •Washington 98368
A 0, ,• 360/379-4450 . 360/379-4451 Fax AUG 2 9 2013
O www.co.jefferson.wa.us/commdevelopment
Master Permit Application '', .� a + � C#ILA:
ProjRol Description(include separate shee as *:ssary):
Tr --a..,.�_ h `Y1 ,
Tax Parcel Number: cj,2[ C) 15O 2:3— Property Size: (acres/square feet)
Site Address and/or Directions to Property:, t - CFD r-A-c-- &De. Lf) (.k.. tu-Pc 5s 1:),9
Property Owner(s)of Record: : I VI t ,. 1 •
Telephone: Fax: mail:
Mailing Address:a I 01.6— t [�t . s. 1)G—S r"to t 06S, I ��6 [9.,
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies
OBuilding ❑Critical Areas Stewardship Plan
❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use)
O Single Family 0 Garage Attached/Detached ❑Conditional Use[C(a),C(d),or Cj**
❑ Manufactured Home 0 Modular ❑ Discretionary"D"or Unnamed Use Classification
❑ Commercial* ❑Special Use(Essential Public Facilities)**
❑ Change of Use ❑Boundary Line Adjustment
❑ Address 0 Road Approach 0 Short Plat**
O Home Business ❑Cottage Industry 0 Binding Site Plan**
O Propane 0 Long Plat**
O Sign ❑Planned Rural Residential Development(PRRDyAmendments**
❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration**
O Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions**
O Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development**
O Temporary Use ❑Shoreline Management Variance
O Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendment
O Forest Practices Act/Release of Six-Year Moratorium 0 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 ./%t.7..__— Date: c'�/� ,/-
By signing this application f•',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 attomey'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 applica I • ors - wan ,.•- •rior notice. -��
Signature: �j_. _ - Date: o/ %,
The action or actions ' •plicant 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 -s•o/ibility fo -d...„-- • g to and complying with the ESA. The Applicant has read this discla�and signs and dates it below.
Signature: /" iu � _ Date: ere/e_1.3
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
• • K
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 f
they will be assuming the responsibi ity-of the General Contractor for the proposed p . ect.
Signatureco A Q Date: A 1 /3
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
Su t^.5V� y`.'C ('�, ( ( ) (
MAILING ADDRESS: C•/ �" 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 0 Community System
❑ Alteration/Remodel ❑ Concrete Total: Height: 0 Individual System
❑ Repair 0 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(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 ,IC4bove ground Tank Size of Propane Tank: t
I Heat 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 / 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 size,distances from the propane tank to all property lines,buildings and septic system components,
includin• the reserve area.
'ff-: :'1C'?'7'S•uare Foota a Current Pro•osed ' _' -'' "�" yy, 1 ' • A '' �' l:
Main Floor Heated '4`P EH Bld App Review:
2' Floor Heated . Consistency Review:
f'
Other Heated PrtMq p21 Base fee:
Mezzanine ` �� '" Additional Section:IlliVi
Heated Basement , to
Plan Check fee:
Unheated Basement '-� r State Surcharge fee:
Other Unheated ", s ';, Pot Water Review fee:
Garage/Carport SUBTOTAL
Decks ,, R" ` 911/Rd Approach fee:
Other TOTAL: $
1 z:a ,-0 r Receipt Number: Lt^d
i r%:*f Cash/Check Number: .1 416
ESTIMATED COST(REQUIRED) Date: 8-361-13
.Fair market value of all labor and materials foundation to finish
Initials: " (t„ (inn
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
6 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#: BLD13-00268 Received Date 8/30/2013
SITE ADDRESS: 1763 OAK BAY RD Issue Date 8/30/2013
PORT HADLOCK, 98339
APPLICANT: ALLAN BROWN PHONE:
VICKI BROWN
21015 6TH AVE S
DES MOINES WA 98198-3268 1
SUBDIVISION: SURACE/LARSON SHORT PLAT Block: Lot:
PARCEL NUMBER: 921073022 Section: 7 Township: 29N Range: 01E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339 33gg��1355-5875
Contractor's License SUNSHP*077QP Expires 1�/TT/2013
OWNER, ALLAN BROWN PHONE:
if different: VICKI BROWN
21015 6TH AVE S
DES MOINES WA 98198-3268
PROJECT DESCRIPTION: INSTALL OF 120 GAL PROPANE TANK
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 8/30/2014.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: . 6 1 J 113/3
FinalApproval: Pi -a 0#
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 8/30/2013
•
Date 9 - time received 3" ille am 4;15 -
Mon. Tues. ,Wed: Thur.
• BIM: I3 - b,07.6(3 r
Date: �/% 1
OWNER: li2ciwa Contact Name:
ADDRESS: 77 /far A _ p Contact Number 3 60 385-57'f7 •
t Notes: , . 206 `, rF
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•Hornes
Setbacks Insulation. Final inspection =n
Foundation .
�y. sV
Block&Tie floor wall ceiling . Address Posted
i
JEFFERSON •UNTY OC,'D • NO. 142441
DATE 8.a9_ !3
RECEIVED FROM SuRcoc .
DESCRIPTION BARS# AMOUNT
CURRENCY `IRace ( C,dif..1.,. COIN �(J
-4 or70 CHECKS J
$„ C
¢ � � O�
.mg
, ,,„.1 -,e...7, - _ _,;,. ' , 1,-„,,,,
o
RECEIVED BY el TOTAL (Y/
i