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HomeMy WebLinkAboutBLD2013-00297 BLD13-00297 UILDING PERMIT APPLICA116 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD13-00297 Received Date: 9/23/2013 SITE ADDRESS: 1893 S JACOB MILLER RD PORT TOWNSEND, 98368 OWNER: MADELEINE C HOUSTON PHONE: 360-385-1489 PO BOX 751 PORT TOWNSEND WA 98368-0751 IRVING PARK ADDITION SUBDIVISION: Block: 14 Lot: 1-10 PARCEL NUMBER: 963301401 Section: 16 Township: 30 N Range: 01 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 REMOVE 250 GAL PROPANE TANK AND INSTALL (2) 120 GAL TANKS IN DIFFERENT LOCATION TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION : ADD L. HEAT TYPE: PRO CODE EDITION:O 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 MEB 09/23/13 145385 APPROVED Total: $152.00 SEP 2 3 2013 Jefferson County DOD \\+irlcmar1Arla+a\forme\G' RI Il Ann Rlrl rn+ OP)4/1f111 �4' ,SON 6. JEFFERSO•OUNTY • DEPARTMENT OF COMMUNITY DEVELOPMENT 'w ` 1 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax NT o www.co.jefferson.wa.us/commdevelopment $IN Master Permit Application MLA: Project Description(include separate sheets as necessary): irT laililii✓ � e04k k w i -4W o 120 -1-z ks d- w 'want Pt pi l iv Cau r ,-eu s-h live Tax Parcel Number. q6, 3 3 O \ `F 0 l Property Size: (acres/square feet) Site Address and/or Directions to Property: Iact 3 ' Occb M t\etr R 'r-4- Tott-o-v'- Aft.A Q , 63L Property Owner(s)of Record: ?\CtcppA pA V1 e- t-I Q I,t_54-0 Ik Telephone: (20—;SS-- 1`'I-H A Fax: email: Mailing Address: PD,-ox qS 1 1 7634 --iovu-t't'aeti ! WA-- q8 3(,B 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 ❑ Critical Areas Stewardshi• ' . - \-.) ❑ Demolition Permit ❑Variance(Minor, Major o `- •- • _ter • il -- ❑Single Family ❑Garage Attached/Detached ❑ Conditional Use[C(a), C(' to- O Manufactured Home .❑ Modular • • ❑ Discretionary"D"or Unna • e Classification ❑ Commercial* ❑ Special Use(Essential Pu„I `-,ilitieg3 ) 2 3 2013 ❑ Change of Use ❑ Boundary Line Adjustment ❑ Address ❑ Road Approach_ ❑ Short Plat** ❑Jome Business ❑Cottage Industry ❑ Binding Site Plan** JEFFERSON COUNT/ lirPropane ❑ Long Plat** a ON1jY DEVELOPMENT ❑3iyn ❑ Planned Rural Residential I-velo i..,t-.. -• mendments** ❑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 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 appli rr-tion tha he�orI she -nts pri nonotiice.., Signature: aA_A! 1. rts! I ' I U' V Date: a-6 i- 2013 The action or actions 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-trans erable es on ability fo adher' g to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: ;� M Date: aZ.3 W( G:\PermitCenter\###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: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: DV \-ski tAe, 1-npao e- ( ) ( ) 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: O New 0 Wood Existing: 0 Sewer 0 Addition 0 Steel Proposed: Bank 0 Community System V'Alteration/Remodel ❑ Concrete Total: _ Height: ❑ Individual System ❑ Repair 0 Masonry SEP Permit# • Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: 0 Private well 0 Two Party Type of Heat: Proposed: ❑ Public 19u Iryj'(,UA 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 Pro•ane Tank and/or A••liance Installation •-rmit mark all items below that a••I I Underground Tank "Above ground Tan`. , Size of Propane Tank: 1-"-1W V -64-S I Heat Stove I Cook ove 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 /q 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 Amount Revision Main Floor Heated EH Bld App Review: - Floor Heated Consistency Review: Other Heated Base fee: IC2- r 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: 11(4c-( Cash/Check Number: r)r , L ESTIMATED COST(REQUIRED) Date: 1 Z 'Fair market value of all labor and materials foundation to finish J/I(l3 Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc SITE VISIT REPORT (PLOT PLAN) JOB DATE: CONTACT: ADDRESS 1$93 5, PHONE #: DIRECTIONS 5R 20 "to S r Tip ( , FAX #: -10 )$°j3 O ZT Email PLANNER: L}� . 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. 4- / o 2sb ." 0 30. ,-3,48x ?let. F rep-, 0:0 P 0- E sC°4111°' Et SEP 2 3 2013 vi, JEFFERSON COUNT( , DEPT.OF COMMUNITY DEVELOPMENT v. , o Or- 25-0 TANK. P_ 2- 12_0 V -1`6,1A 1C.S SiAl2..ck cs2_ IM OV NT" . i w l CotNec-Ttprl 11 • • \\Sunshinel\E\BUSINESS\FORMS\PROJECT PLANNING\SITE VISIT REPORT-PLOT PLAN.doc Contractors or Tradespeople P.er Friendly Page • Page 1 of 1 Electrical Contractor A business licensed by Lill 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*98483 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 a -I Milk -b 01 CO -I -b x -I -I CD CO -- -- 01 -0 CO 01 X O_ n r+ X 01 0 -5 -O 01 O - -O 's -5 0 01 C O. 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O O L CO O I--1 p � T Z O N T so O C O H CO 77 lGASCheck 644296 GASCheck - Gas Appliance System Check Account Number '-'1.--` D (--() 2.--t Invoice Number 219 61 G' Date /a t34 ,r3 Name t--11-- ;/Qe ` I {-1,( t d Company/Branch S‘a"— 4— ""-- 14.41741".4L"' Address,11)q& I - •,��-.41 C a eJ ,--71 L L- " __.. j Call Taken By City' w/� '�- State' C)17 ZipCi3(d Telephone(Work) (Home) Appliance Check s 1 ietiF*-iccoYfat-e e 3a `4_ !!a °3../c--00 ys o WW2.,. . EiSZ 8r # 37 Qa.ea 4./2- . : oK a!`` oft. t S4;a x X- e z ,R r_tr.i. "14-fat-ii.j,iiitIMETill do i+4,44. `A ,��; tyc, P✓ /A., E zi 4 3�c f @q ! Container Check /2-4? 9 ?`3 /2.3 4%,,ZPICTig4 ratty) 2.4)fZ- o/C. M t 44.. gs y 1 1� 1 Pressure Test Of Applicable) Piping Check I `' fZ:77: f=: :4-', _ ;_' Pressure Held , e7-2:r-- S Work Order Y N $ 4--- INLI o K System Leak Check G 5 5 7- Mill ©ic.. ozizizzni, .r.3,--7,,ttww.77_,...omi Pressure Held 4I7' - ■ MI c4C 1• S— 9r�--- A� �f� Work Order _ / N Regulator Check .lp!. m '7r-...11,f.l.) c::› oSact z.. L. tr Yale y 674 7 !o,?— /!, ,s"' Safety Information Supplied: Comments:Please note all repairs and corrections made:dlong with any recommended actions. PRC 005625 ©PERC 2007 PROPANE Ek�EPfl W4L ENERGY CUSTOMER COPY • 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#: BLD13-00297 Received Date 9/23/2013 SITE ADDRESS: 1893 S JACOB MILLER RD Issue Date 9/23/2013 PORT TOWNSEND, 98368 APPLICANT: MADELEINE C HOUSTON PHONE: 360-385-1489 PO BOX 751 PORT TOWNSEND WA 98368-0751 1-10 SUBDIVISION: IRVING PARK ADDITION Block: 14 Lot: PARCEL NUMBER: 963301401 Section: 16 Township: 30N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 ((336g0�)l 338g55-5875 Contractor's License SUNSHP*077QP Expires 1'(/17/2013 OWNER, MADELEINE C HOUSTON PHONE: 360-385-1489 if different: PO BOX 751 PORT TOWNSEND WA 98368-0751 PROJECT DESCRIPTION: REMOVE 250 GAL PROPANE TANK AND INSTALL(2) 120 GAL Directions TANKS IN DIFFERENT LOCATION 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 9/23/2014. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: 10- V- /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 9/23/2013