Loading...
HomeMy WebLinkAboutBLD2013-00361 BLD13-00361 UILDING PERMIT APPLICA N Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD13-00361 Received Date: 11/13/2013 SITE ADDRESS: 503 WOODDUCK WAY PORT TOWNSEND, 98368 OWNER: PATRICIA C WILLESTOFT PHONE: 503 WOODDUCK WAY PORT TOWNSEND WA 983688638 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001202001 Section: 20 Township: 30 N Range: 01 W CONTRACTOR: SCOTT HOMES PHONE: 360-357-9167 3016 10TH AVE NE OLYMPIA WA 98506 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION INSTALL TWO DUCTLESS HEAT PUMPS 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 $152.00 MEB 11/13/13 145547 APPROVED Total: $152.00 1� G NOV 13 2013 Jefferson County DCD \\+irinm.r4\rh+.\fnrmc\G RI Il Ann RIr1 rn+ 11/1"2/W111 w1s0N 006. JE RSQN COUNTY 4 ` (o I ,= '44. .< DEPARTMENT OF COMM ' !TY DEVELOPMENT 49 sFo� 621 Sheridan Street I Port Townsend,WA 98368 I Web:www.co.iefferson.wa.uslcommunitvdevelooment SA1NG.S Tel:360.379,4450 I Fax:360.379.4451 I Email:dcdeco.iefferson.wa.us Building Permits&Inspections 1 Development Consistency Review I Long Range Planning I Watershed Stewardship Resource Center Master Permit Application MLA' Project Description(include separate sheets as necessary): `IV Tc \\ , t x eth,2—o CA S (acres/square feet) Parcel Number: O 1 —o 2- O� Property Size: Tax (�� � "��� Oda Lde./ . Site Address and/or Directions to Property: SS3 � c Ord 1 '=` Jc. � ..'- ,. ..c. - •.-� Property Owner(s)of Record: r ..S �- - ��A��''•��'r Fax: email: r�lvi.ice__ t1C Telephone:';��Qu•�$S•5q L`l CI_"�, tI C�f'� Td�VL4cCAQA r � 9��4 Mailing Address: 5D3 �i rridb Applicant/Agent(if different from owner): sc�kl�lr�s•� Telephone: ?vlct • '�-1'q ftfl Fax: ` email: e Ltii Mailing Address:Sbt1G l�' -• �E 0k�1"`2 ' (l.4- Q .-(0 What kind of Permit?(Check each box that applies ❑Lot or Road Segregation❑Critical Areas Stewardship Plan ❑Building ❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use) ❑Single Family ❑Garage Attached/Detached ❑ Discretionary e[ (Unnamed Use Classification ❑ Manufactured Home 0 Modular ❑Special Use(Essential Public Facilities)** ❑ Commercial* ❑ Boundary Line Adjustment ❑ Change of Use ❑ Address ❑ Road Approach 0 Short Plat"* ❑Home Business ❑Cottage Industry ❑Binding Site Plan** ❑Propane ❑Long Plat" ❑Planned Rural Residential Development(PRRD)/Amendments*" ❑Sign ❑Allowed ❑Plat Vacation/Alteration"" ter Approval M M anagement Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisions"* ❑Stormwater ❑Shoreline Management Substantial Development"" ❑Site Plan Approval Advance Determination(SPAAD)" 0 Shoreline Management Variance ❑Wireless Use ❑Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication ❑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 application for permit(s). I hereby designate )4/.■age to act as my agent in matters relating to this app' P'P 1 We: /1 - 13- ZO/3 his,skier or this application form,the owner/agent or any tomiss on of a material fact made by the owner/agent ith respect to this application the packet of his,her or its knowledge. Any material falsehood or any 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. Staff's access and right of entry will be assumed unless the applicant informs the County in writing at the time of the cation ttrat•he or he wants prior nob.-. / f,t al � - '� , � 24,13 k / 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-tra'= = -ble rrsponsib'ity for adhering to and «. plying with the ESA. The Applicant has read this disclaimer and sign/dates it below. .-�i-r /i- /3 IIIBUILDER 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 gf the General Contractor for the proposed project. 1110:, ...! LIrA■_1 _+ 061 ii-/3--2-o13 II GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: 5C,O - �-\-txwz., ■vac-. (340)551.Iii(1-7 ( ) MAILING ADDRESS: )k l.[) `piti. Ate k)E EMAIL:CAILIAer4 S .1 OAA...- CONTRACTOR'S LICENSE WAINS NUMBER: ►b` NIb9,aVIi5 NUMBER ARCHITECT/ENGINEER: `.J 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: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: ❑ Public Total: Name of System: If this is a Commercial Proiect 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: Underground Tank Above ground tank Size of Propane Tank: Heat Stove Cook Stove Woodstove Fireplace.nsert rehtO I evotS telleP 1 knaT retaWtoH 1 Is this appliance being installed in a Manufactured/Mobile Home? Yes I o When applying for a permit to install a propane tank you must also submi 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 BId App Review: 2"0 Floor Heated Consistency Review: Other Heated Base fee: 1 d J. 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: (4 5' cif- - Cash/Check Number: ESTIMATED COST(REQUIRED) Date: I�i� /S 'Fair market value of all labor and materials foundation to finish Initials: x,503 Woodduck way,Port Townsend, WA 98368 to 621 Sheridan St,Port Townsend, WA... Page 1 of 2 • Directions to 621 Sheridan St,Port Townsend,WA 98368 Go >81e 3.2 mi—about 9 mins 503 Woodduck way,Port Townsend,WA 98368 1. Head northwest on Woodduck way toward Cougar Ridge Rd go 0.1 mi total 0.1 mi 52013 Goo* Mop date 02013 Mope a� 2.Turn right onto Cougar Ridge Rd r= go 0.5 mi r_ About 1 min total 0.6 mi 02013 Goo* Mrp dee 02013*ogle 41 3.Turn left onto Discovery Rd go 1.0 mi About 2 mins total 1.6 ml 02013*ogle Map M0 410013 0ooge r, 4.Turn right onto S Jacob Miller Rd go 459 ft total 1.7 mi o ea l0; -.•... Ooe ;r_.Foe dal Sena:1311o6V:. ©5.TAbout um left 2 onto State Rte 20 ElWA-20 E go 0.7 mi mins S, total 2.4 mi oy� 02013Googk McP400A20t3.Oeo91e 6.At the franc circle,continue straight onto W Sims Way total 0.3 mi About 48 secs mi ',Park Aun j KdIY Art' lrp'"_. Mrs 62013 Goo* Mop data 02013 Ooogle 7.At the traffic circle,continue straight to stay on W Sims Way go 0.4 ml About 1 min total 3.1 mi https://maps.google.com/maps?f=d&amp;source=s_d&amp;saddr=503+Woodduck+way,... 10/29/2013 . 503 Woodduck way,Port Townsend, WA 98368 to 621 Sheridan St,Port Townsend, WA... Page 2 of 2 S Orly An o lght 8.Turn�ft onto Sheridan St go 0.1 mi Destination will be on the left y,r tr■ total 32 mi 3i�S! 112013 Google Map data ea3C3Oaalga: f621 Sheridan St,Port Townsend,WA 98368 , Jefferson General Hosp 1, S. y nn St. Rh 4•. - _ 611 �Jf;sri aiRol3 Gagies2 Map data 40:013 Oar* big‘ V)ciDA-6 v Vv S )\\ i ` \ vJ i. kA‘C .s ? ' 4u51) https://maps.google.com/maps?f d&amp;source=s d&amp;saddr=503+Woodduck+way,... 10/29/2013 Contractors or Tradespeople Peer Friendly Page • Page 1 of 2 General/Specialty Contractor A business registered as a construction contractor with L£ti 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 SCOTT HOMES INC UBI No. 601919030 Phone 3603579167 Status Active Address 3016 10Th Ave Ne License No. SCOTTHI022R3 Suite/Apt. License Type Construction Contractor City Olympia Effective Date 12/23/1998 State WA Expiration Date 8/25/2014 Zip 98506 Suspend Date County Thurston Specialty 1 General Business Type Corporation Specialty 2 Unused Parent Company Other Associated Licenses Specialty Specialty Effective Expiration License Name Type 1 2 Date Date Status SCOTTH*031N5 SCOTT HOMES Construction General Unused 8/25/1997 8/25/1999 Archived Contractor SCOTTH*0930J SCOTT HOMES Construction General Unused 9/11/1991 9/11/1992 Archived Contractor BERGFAI946LA BERGFORD it Construction General Unused 6/1/2006 6/9/2012 Expired ASSOCIATES INC Contractor Business Owner Information Name Role Effective Date Expiration Date BERGFORD, SCOTT WILLIAM President 12/23/1998 BERGFORD, PATRICIA ANN Vice President 12/23/1998 BERGFORD,WEBSTER THOMAS Secretary 08/16/2010 02/06/2012 BERGFORD, PETER TODD Treasurer 08/12/2010 02/06/2012 MORRISON, DON Treasurer 12/23/1998 08/25/2010 BRADLEY,MIKE Vice President 12/23/1998 08/25/2010 Bond Information No records found for the previous 6 year period Assignment of Savings Information Savings Assignment of Savings Account Number Effective Date Release Date Assignment Type Impaired Date Amount Received Date 3 19265 1/6/2009 Until Bond $12,000.00 1/6/2009 Released 2 1926541 8/21/2001 1/6/2009 Bond $12,000.00 8/23/2001 1 1926540 12/23/1998 1/6/2009 Bond $6,000.00 8/23/2001 Insurance Information Insurance Company Name Policy Number Effective Date Expiration Date Cancel Date Impaired Date Amount Received Date American 156AU164762- 18 Safety 00 01/10/2013 01/10/2014 $1,000,000.00 01/09/2013 Indemnity Co 17 State National 46 0480000207 01/10/2012 01/10/2014 $1,000,000.00 12/31/2012 Ins Co Inc 100 UNITED 16 SPECIALTY INS SCP0726671 01/10/2011 01/10/2013 $1,000,000.00 12/23/2011 CO 15 SCP 0726671 01/10/2010 01/10/2011 $2,000,000.00 01/11/2010 https://fortress.wa.gov/lni/bbip/Print.aspx 11/13/2013 Contractors or Tradespeople POter Friendly Page Page 2 of 2 AMERICAN SAFETY INDEMNITY CO WESTERN 14 HERITAGE INS SCP0726671 01/10/2009 01/10/2010 $1,000,000.00 01/08/2009 CO WESTERN 13 HERITAGE INS SCP0684500 01/10/2008 01/10/2009 $1,000,000.00 06/13/2008 CO 12 PRAETORIAN HFP200001101 07/14/2007 07/14/2008 04/22/2008 51,000,000.00 05/29/2007 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 11/13/2013 • 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#: BLD13-00361 Received Date 11/13/2013 SITE ADDRESS: 503 WOODDUCK WAY Issue Date 11/13/2013 PORT TOWNSEND, 98368 APPLICANT: PATRICIA C WILLESTOFT PHONE: 503 WOODDUCK WAY PORT TOWNSEND WA 983688638 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001202001 Section: 20 Township: 30N Range: 01W CONTRACTOR: SCOTT HOMES PHONE: 360-357-9167 3016 10TH AVE NE OLYMPIA WA 98506 OWNER, PATRICIA C WILLESTOFT PHONE: if different: 503 WOODDUCK WAY PORT TOWNSEND WA 983688638 PROJECT DESCRIPTION: INSTALL TWO DUCTLESS HEAT PUMPS 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 11/13/2014. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: //-/ 7—/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 11/13/2013