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Home My WebLink AboutBLD2013-00291 UILDING PERMIT APPLICA N BLDI3-00291 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD13-00291 Received Date: 9/19/2013 SITE ADDRESS: 80 HELM LN PORT LUDLOW, 98365 OWNER: JOHN W ZALAHA TRUSTEE PHONE: 360-437-0306 LORNA M ZALAHA TRUSTEE 46 VILLAGE WAY PMB 182 PORT LUDLOW WA 98365-9762 PORT LUDLOW NO. 1 AREA 1 SUBDIVISION: Block: Lot: PARCEL NUMBER: 990400125 Section: 9 Township: 28 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 DESCRIPTION FIREPLACE INSERT AND PIPING 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: Type Amount Paid By: Date: Receipt: Approved/Date Permit $152.00 JLA 09/19/13 145372 Total: $152.00 APPROVED SEP 19 2013 Jefferson County DCD \\+irinmor4\rlo+o\forme\F RI fl Ann Rid rn+ 0/10/7!111 itt -9 °°—VP JJEFFERSI1PCOUNTY ` A DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend•Washington 98368 360/379-4450 • 360/379-4451 Fax 161:ZiNeiv- www.cojefferson.wa.us/commdevelopment Master Permit Application MLA: Project Description(include e—separate^sheets 'as$necessary): w, Tax Parcel Number: -1 q 01(O 01.9\5- Property Size: (acres/square feet) Site Address and/or Directions to Prope %o i- 1 t•) v2r Li.OtARJ Property Owner(s)of Record:cl O Telephone: 93-7— D" () - Fax: email: Mailing Address: Wm _ • 'H h I$ d u I . Applicant/Agent(if different from owner): /AA/5M i t3 ��PArJ Telephone: -"(N5-- ' 1(in Fax: 5%5' S -1 :5- email: Mailing Address: (D%53 t 1 Po _T et1 POVbC What kind of Permit?(Check each box that applies ❑Building ❑Cri' ❑ Demolition Permit ❑Val ❑Single Family ❑Garage Attached/Detached ❑Co ❑ Manufactured Home ❑ Modular ❑Dit ❑ Commercial* ❑Sp ❑ Change of Use ❑Bc w ❑ Address ❑ Road Approach ❑Sh . ❑Home Business ❑Cottage Industry ❑Bii ❑Propane ❑Lc ❑Sign ❑PI, r its** ❑Allowed"Yes"Use Consistency Analysis ❑PI ❑Stormwater Management ❑SI ❑Site Plan Approval Advance Determination(SPAAD)* ❑SI ❑Temporary Use ❑S ❑Wireless Telecommunication* ❑C lent ❑Forest Practices Act/Release of Six-Year Moratorium ❑J *May require a Pre—Application Conference ❑T Please identify any other local,state or federal permits regl DESIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application forr�permit(s). 0 OWNER SIGNATURE /e 111LI �� _�.L Date: 3P.i�I . l l(2 ,2t Jl By signing this application form,the ow 4-gent 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 applica •n that he or she wants prior notice. Signature: we✓1110 : Date: :ie • The action or actions Applican 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-transfe :•le responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: al/AA .'9 l / Date: 5t pt. (tor 20 13 G:\PermitCenter\###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 assu ing the responsibility of the General Contractor for the proposed p ed. Signa� JC QLA Date: � 1'1 [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 0 Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: 0 Individual System ❑ Repair ❑ Masonry SEP Permit# CI ❑ 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 Prolect 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 1 Above ground Tank Size of Propane Tank: i Heat Stove I Cook Stove 1 Woodsto Fireplace Inse • i Hot Water Tank i Pellet Stove I Other Is this appliance being installed in a ManufacturedTRfobile 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, includin• the reserve area. S uare Foota a Current Pro osed .: :' ;�4 i 1 :--, o � I ° �� aig M ° ,.*.. Main Floor Heated EH Bid App Review: 2f0 Floor Heated WI,' a`=; Consistency Review: Other Heated .';. Base fee: r4 Mezzanine ';�p . 1 Additional Section: Heated Basement 'Aizr -,,-t,ttrin Plan Check fee: Unheated Basement 45 State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport ° v4 SUBTOTAL ' Decks '' ,! tI 7 911/Rd Approach fee: Other �" '' It Other . TOTAL: $ - T fl g r' 1 Vin' '' Receipt Number: �a� ;-' � Cash/Check Number: ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish Initials: GAP ernutCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc • r • • • •t _ • m. SZT VISIT.REPORT .• ••• (PLOT PLC • •JOB. "SoN►J.4 . oR..)A_• • �. NTAC • - • ADDRESS •. P IONE #: •DIRECTIONS' F•• • • Email .. . PLANI t: . •• • • • • • • • • • • • • • • • • • . r . r • • • •• :s : r . ,� 0 V T • ' ; • • r. _ < r • h I t F • • • • • • • • • � t k Y _ . ,• • Y. . • • • • • • :i ,. • • • Contractors or Tradespeople Ster Friendly Page • Page 1 of 1 Electrical Contractor A business licensed by L&I 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 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 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 $4,000.00 01/23/2002 Assignment of Savings Information No records found for the previous 6 year period Insurance Information No records found for the previous 6 year period Summons/Complaint Information Summons and Complaints are not filed with the department for this contractor type Warrant Information Warrants are not filed with the department for this contractor type Infractions/Citations Information No records found for the previous 6 year period https://fortress.wa.gov/lni/bbip/Print.aspx 3/12/2013 44,4•/: ... JEFFERSON COUNTY Q> _ DEPARTMENT OF COMMUNITY DEVELOPMENT sy.Atxoo Date: f?__ty Time Received: 2 5/ am/pm Mon. Tue. Wed. 4011, Fri. Date: 12—(Lfl BLD: 12— Z' ! Contact Name: Owner: Contact Number: 360 ff$-5-797 Address: 'Ft) Ft 61.04 206 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 Setbacks Floor Foundation Wall Address Posted Block&Tile Ceiling - -- , , , - . •.,,,..:.*:7:".;1:,...-- Z./ • - ..,,,,,.. .4,1 - - - . ... - . . . • • - vs..V.0. 2.4-14`70• . . . . - . . _ .1.ii, ..,1,• - . . Date 1./2-- t ( 'time received V,0 ) am rig) Mon. TueS. e Thur. --Fri. - - Date: . . OWNER: . - - Contact Name: ,p, i t . . ADDRESS: .3Lii f---e. t(A.L. .1----vL Contact Number 360 3g5-...,C7- _ '7 - _ Notes: 206 4 31-03,00 . ti4- a-c6 - • Foundation Plumbing - Framing Propane Tank - Mechanical . ■ Setbacks Under-ground Framing • . . Under ground Furnace Footing — Rough in Air seal Above ground - Gas Stemwall _— Nydronic Exterior shear Exterior lines t." Oil • Straps Interior shear Interior lines .c./. Ducts Post Hole Ventilation • Appliance Underfloor . Gas/wood stove Man-Homes S Setbacks Insulation. Final Inspection Foundation • '.= •,-,1 ... Biod<&Tie floor wall ceiling. • Address Posled s 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#: BLD13-00291 Received Date 9/19/2013 SITE ADDRESS: 80 HELM LN Issue Date 9/19/2013 PORT LUDLOW, 98365 APPLICANT: JOHN W ZALAHA TRUSTEE PHONE: 360-437-0306 LORNA M ZALAHA TRUSTEE 46 VILLAGE WAY PMB 182 PORT LUDLOW WA 98365-9762 SUBDIVISION: PORT LUDLOW NO. 1 AREA 1 Block: Lot: PARCEL NU M BE R: 990400125 Section: 9 Township: 28N Range: 01E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 5875 Contractor's Licens e SUNSHP*077QP Expires 1 /1 2013 OWNER, JOHN W ZALAHA TRUSTEE PHONE: 360-437-0306 if different: LORNA M ZALAHA TRUSTEE 46 VILLAGE WAY PMB 182 PORT LUDLOW WA 98365-9762 PROJECT DESCRIPTION: FIREPLACE INSERT AND PIPING 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 9/19/2014. REQUIRED INSPECTIONS: Tank/Line/e/Applians FinalApproval: 1 2-1 `i 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 9/19/2013 JEFFERSON COUNTY NO. 145372 DATE ‘7I3 RECEIVED FROM ( 1/,�� `,, I I J 0t7 V DESCRIPTION mil'"' BARS# AMOUNT CURRENCY (1214 sist / 2 ,(J COIN ! q ozia.)/2S if ? C o RECEIVED BY <-34 TOTAL , J5i