The URL can be used to link to this page

Home My WebLink AboutBLD2013-00343 •UILDING PERMIT APPLICASN BLD13-00343 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD13-00343 Received Date: 10/31/2013 SITE ADDRESS: 52 CHURCH RD OWNER: BRINNON COMMUNITY CHURCH PHONE: SUBDIVISION: Block: Lot: PARCEL NUMBER: 602344020 Section: 34 Township: 26 N Range: 02 W CONTRACTOR: CSW PHONE: 360-697-2493 PO BOX 589 POULSBO WA 98370 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr INSTALL DUCTLESS HEAT PUMP INTO SCHOOL/CHURCH TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: TYPE OF IMP MEC MAIN: INDUSTRIAL: VALUATION ADD'L: HEAT TYPE: HTP 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: NUMBER OF EMPLOYEES: WATER SYSTEM: BATHROOMS: Exist: Prop: Total: Routing Date: Type Amount Paid By: Date: Receipt: Appr `d/Dark Permit $152.00 MEB 10/31/13 145511 APPROVED Total: $152.00 OCT 31 2013 Jefferson County DCD MirlomnrIArio+.a fnrmc\G Pin Ann PH rn4 Iris oni • • -3 1-(.. �S°N 00 �4w o� JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street I Port Townsend,WA 98368 I Web:www.co.iefferson.wa.us/communitydevelopment s Hrli01 Tel:360.379.4450 I Fax:360.379.4451 I Email:dcda_co.iefferson.wa.us Building Permits&Inspections I Development Consistency Review I Long Range Planning I Watershed Stewardship Resource Center Master Permit Application MLA: Project Description(include separate sheets as necessary): Brinnon Community Church — I1 ( JL �•.� G k.-►'�� r < Tax Parcel Number: &0 2 34 Lk U 20 , Property Size: (acres/square feet) Site Address and/or Directions to Property: 52 Church Rd, Brinnon, WA 98320 Property Owner ,�s)of Record: '✓? 1\ innh"cd A... e,,GI Lb/J.\ . Telephone:360-796-4708 Fax: email: Mailing Address: 52 Church Rd,Brinnon,WA 98320 Applicant/Agent(if different from owner): Telephone:360-697-2493 Fax: 360-697-2493 email: cswelectric @gmail.com Mailing Address: PO Box 580,Poulsbo,WA 98370 What kind of Permit?(Check each box that applies ❑Lot or Road Segregation wilding El Critical Areas Stewardship Plan El Demolition Permit El Variance(Minor, Major or Reasonable Economic Use) El Single Family El 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 El Boundary Line Adjustment El Address El Road Approach El Short Plat** El Home Business ❑Cottage Industry ❑Binding Site Plan** El Propane El Long Plat** El Sign El Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis El Plat Vacation/Alteration** ❑Stormwater Management El Shoreline Master Program Exemption/Permit Revisions** El Site Plan Approval Advance Determination(SPAAD)* El Shoreline Management Substantial Development** El Temporary Use El Shoreline Management Variance ❑Wireless Telecommunication* El Comprehensive Plan/UDC/Land Use District Map Amendment El Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference El Tree Vegetation Request **Requires a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal,if known: Debbie Page DESIGNATION OF AGENT I hereby designate g to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: 10/21/2013 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 •-quired later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the a p' .ti• th. he r s .nts pri. ..i«.-. Signature: I Date: 10/21/2013 The action or actions Applicant will un.4 ake 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 i• com a fiance wi Al he Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-tran r .e r--.on ':ilitye 'Tr'iv t.a complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: / l' ' Date: 10/21/2013 4 (Y7 1114/21)12 • • 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: 10/21/2013 GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: (360-71)6-4708 ( ) MAILING ADDRESS: 52 Church Rd, Brinnon, WA 98320 EMAIL CONTRACTOR'S LICENSE WAINS n` (y NUMBER: S..,S) ' cE- --v PNUMBER GA.2\a 2Cl ARCHITECT/ENGINEER: PHONE (360-7)36-4708 FAX:( ) MAILING ADDRESS: 52 Church Rd,Brinnon,WA 98320 EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: 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 Ductless Split 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 evotS telleP knaT retaWtoH 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 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: 2na Floor Heated Consistency Review: Other Heated Base fee: 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: L( S Ili Cash/Check Number: r, ESTIMATED COST(REQUIRED) Date: �I •Fair market value of all labor and materials foundation to finish r / Initials: n7 Nn/2012 Contractors or Tradespeople Peer Friendly Page Page 1 of 1 General/Specialty Contractor A business registered as a construction contractor with L8:1 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 CSW ELECTRIC 8:HVAC UBI No. 602886197 Phone 3606972493 Status Active Address Po Box 580 License No. CSWELEH889BT Suite/Apt. License Type Construction Contractor City Poulsbo Effective Date 1/30/2012 State WA Expiration Date 1/30/2014 Zip 98370 Suspend Date County Kitsap Specialty 1 General Business Type Limited Liability Company Specialty 2 Unused Parent Company CSW ELECTRIC LLC Business Owner Information Name Role Effective Date Expiration Date PAGE, DEBORAH CATHERINE Partner/Member 01/30/2012 PAGE,STEPHEN TIMOTHY Partner/Member 01/30/2012 Bond Information Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date 1 Navigators Ins Co 46BCO22949 01/30/2012 Until Cancelled $12,000.00 01/30/2012 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 1 Mid-Century Ins 604785579 12/22/2011 12/22/2013 $1,000,000.00 11/19/2012 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 10/31/2013 • • 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#: BLD13-00343 Received Date 10/31/2013 SITE ADDRESS: 52 CHURCH RD Issue Date 10/31/2013 APPLICANT: BRINNON COMMUNITY CHURCH PHONE: SUBDIVISION: Block: Lot: PARCEL NUMBER: 602344020 Section: 34 Township: 26N Range: 02W CONTRACTOR: CSW PHONE: 360-697-2493 PO BOX 589 POULSBO WA 98370 OWNER, BRINNON COMMUNITY CHURCH PHONE: if different: .. 30 U —44(4-1- - °U PROJECT DESCRIPTION: INSTALL DUCTLESS HEAT PUMP INTO SCHOOL/CHURCH 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 10/31/2014. REQUIRED INSPECTIONS: nK I t://3 FinalApproval: _r_ � vtn- 1 l/(1.-/t3 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 10/31/2013 ...._ . .. . 0 . , • .. . . . . ..-zkv--,...1g,.. ,51-,erw-,,, P:551t427-4 " . . . ./ • - -----..=----, . . • . .. . i .'IL - • ;.:••••- - . _ • • Date_lk:_5-- time received fat Lit am Q. _ . - Mon. 4110 We& Thur. -Pri. . BM: _i3"773"_13___________ . Date:IL— 2-1%---L--------------__ • . . OWNER: • - • • . Contact Narne. . . ,...--....; - ADDRESS: 2 1-- - C.--6 Vg_CiA, . . . - Contact Number.3Q0 710 1/7 20•6 .. , . . Notes: - -• - • . - • - - - . - • :Foundation Plur_t_i ingto. • - Framing • . Propane Tank - Mechanical Setbacks • Under-ground Framing Underground Furnace . Footing Rough in Air seal _ — — Above ground . • Gas Stemwall _ Hydronic Exterior shear Exterior tines Oil — • Straps Interior shear — Interior lines • Ducts 1'- Post Hole • Ventilation . . — Appliance Underfloor _ Gas/wood stove Man-HoMes . . Setbacks " Insulation. . • • • • Final Inspection .... 1 . Foundatfl V • . ----:' . 'il Block&Tie floor wall ceiling. . Address PoStkl • . - .