HomeMy WebLinkAboutBLD2014-00415 - MECHANICAL • BUILDING PERMIT APPLICOION BRLD14-0044115
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD14-00415 Received Date: 11/7/2014
SITE ADDRESS: 40 CEDARVIEW DR
PORT TOWNSEND, 98368
OWNER: JON WALLACE PHONE: 360-344-2756
40 CEDARVIEW DR
PORT TOWNSEND WA 98368-2502
9650
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 965000316 Section: 27 Township: 30 N Range: 1V■
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2014
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP MECHANICAL PERMIT FOR NEW 120 GALLON PROPANE TANK
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP MEC MAIN:
VALUATION ADD'L: HEAT TYPE: PRO
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
Total: APPROVED
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Jefferson County DCD
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Master Permit Application
Project Description(include separate sheets a .necessary):
-F-1$2.0°I.-AcNC ) P, Pi r■_ c-; 6
Tax Parcel Number -1(05 00 ).3 I to Property Size:
Site ddress and/or Directions to.Property:
,,
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o • -e 1 A...) „Dc .
Property Owner(,)of Record: -'11-8 LD b1/4.>AC....(si=)C.
Telephone:3(14- ;--1 5(o Fax: ,_,
email: 1,
Mailing Address: 10 cro.ifle„,o teu.._)43 12_ . t--0(2r--ra,t.L..›0 1,3--.0 L.t..)41
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Applicant/Agent(if different from owner): .10.- UN1,54-1&t...) •1-- -C .'PA f•••-.)'&
Telephone 3% 'L--5— /g—1 Fax: email: I
Mailing Address: 1'0% --14-0C,i...t_ ..f>j .,_ , 4P6 t'2-1---f--1ADI---D-C.)e-/ t)314
What kind of Permit?(Chet.*each box that applies
OBuilding 0 Critical Areas Stewardsh" lan ,
O Demolition Permit 0 Variance(Minor,Major 4,:.,. -_s ... 1r iiv E
0 Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a),C v:- GEIVE::-
0 Manufactured Home .0 Modular 0 Discretionary"D"or Unn ffle ,-- - - -
O Commercial* 0 Special Use(Essential -:dation)**
„
O Change of Use 0 Boundary Line Adjustm rtfl
O Address 0 Road Approach 0 Short Plat jj NOV 6 2014
0 Home Business 0 Cottage Industry 0 Binding Site Plan U U
0 Propane 0 Long Plat**
0 Sign 0 Planned Rural Residen al Developnkstptei r ntr--% •i -rits**
0 Allowed'Yee Use Consistency Analysis 0 Plat Vacation/Alteration'4 DEPT OF COMMON DEV a•
0 Stormwater Management 0 Shoreline Master Program Exemp o 7-= - ...'-
0 Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development**
0 Temporary Use 0 Shoreline Management Variance
0 Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amen•Ment
,
0 Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendmen
May require a Pre-Application Conference 0 Tree Vegetation Request
"Requires a Pre-Application Conference
Please identify any other local,state or federal permits required for this proposal,if known:
'I.
DESIGNATION OF AGENT
I hereby designate to act as my agent in matters relating to this application for pe 1 it(s).
/.
OWNER SIGNATURE /P. 4642_ Date:
. I,1
By signing this appli n form,the owner/agent attests that-me information provided herein,and,in any attachments,Is true and correct to t e 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 l•acket
may result In this permit being null and void. 11
I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorneys fee and
Il
expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit.
1
I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of-•plication
review and any required later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writin•at the
time of the application that he or she wants prior noti.- ----.)
.. d _ .... • P/Signature: r _- i ._ / ‘,.— Date: / di- I 4
The action or. one Applicant will undertake as a re of the II3suance of this permit may negatively impact upon one or more threatened 0
. , i
endangered species and could lead to a potential lake'of an endangered species as those terms are defined in the federal law known as th
"Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken becaus!,Lthis
permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regar•ing your
action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds Ind? •ual
and non-transferable responsibility for adhering to and co• • •with the ESA. The Applicant has read this disclaimer and fgns and dates below.
Signature: PI ......„ ..., z_,,,, _- •1 4_41,44,444,ULate:
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc I
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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 contract° , nd that,
they will be assuming the respon ibir y o the General Contractor for the proposed pr9ject. / / / •
Signature: Date: 11 f J�//V
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 Disp al:
❑ New ❑ Wood Existing:. ❑ Sewer
0 Addition ❑ Steel Proposed: Bank ❑ Community System
❑ Alteration/Remodel 0 Concrete Total: Height: ❑ Individual System {;
El .Repair 0 Masonry SEP Permit#
0 Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ T""o 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 I Above ground Tank Size of Propane Tank:
I Heat Stove I Cook Stove I Woodstove I Fireplace Insert I Hot Water Tank I Pellet Stove I Other
Is this appliance beano installed in a Manufactured/Mobile Home? Yes / No
When tank l cation and permit ze,distances'rom the p pane tank to all property lines,)buildings and/sep c system m comb'• ants,
propane you P showing buildings,
Tines, 1•Hants,
including'the reserve area. t
.. - y, pkullaP a 2 �� dI � k4r�1 x ¢^p �1 a-1 ' �� .� i ii
S.uare Foote.e Current Pro.osed "11`]'.. ]:its ��r ,(c,liii,,, ' ' i , `-� ' u12t 11 i „ �� 7 r.�
Main Floor Heated f q.41
FilMbill"? I
2 Floor Heated
,' "` M s ; Consistency Review:
Other Heated t
■
,, Base fee:
Mezzanine c " Additional Section: i
Heated Basement ? , 4 r,4 F ' Plan Check fee: ,
-�Fil ,.
Unheated Basement --11t1,11.'77-',-'''::--..-,
State Surcharge fee: i
Other Unheated "F," , 3 r Pot Water Review fee: 0 I
'C'4 1.
Garage/Carport SUBTOTAL tit"�
, 4r/, Milt
Decks ,,."!':*!
Other h $ ' `'
TOTAL:
] Receipt Number. /(5 (0 {�
� ��F`: ash/Check Number: j , or
l.-.'f', .,�., ` 0
ESTIMATED COST,(REQUIRED) Date: /1
.Fair market.value of all labor and materials foundation to finish ���(4 1 i
Initials: /' t I
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• I
GAP ennitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc 1
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SITE VISIT REPORT
(PLOT PLAN)
JOB 0" 4 CN A IAkk\ ,et C1Z. DATE: 119°- I q ^1 L .
CONTACT:
ADDRESS -4 0 Ce-I A V V K. .3 ' Jilt , PHONE #: .
DIRECTIONS 'jR \y T b,�''P' t'OS Vc 3 TO k.C&t4 FAX #: .
OP., N1cA t- VikA TO , v V� I 0 RT,Email
I PLANNER: bq\i-iz, 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.
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1 CEDME
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NOV 6 2014 3
JEFFERSON COUNTY
DEPT D OF COMMUNITY DEVELOPMENT
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\\Sunshinel\E\BUSINESS\FORMS\PROJECT PLANNING\SITE VISIT REPORT-PLOT PLAN.doc
SUNSHINE PROPANE Page 1 of 3
. •
0 Washington State Department of
Labor & industries
SUNSHINE PROPANE
Owner or tradesperson 10853 RHODY DR
CHAWES, RICHARD HENRY PORT HADLOCK,WA 98339
360-385-5797
Principals JEFFERSON County
CHAWES, RICHARD HENRY, PRESIDENT
LEMLEY, DAVID BARRY, VICE PRESIDENT
SIMPSON, LAURA ANNE, SECRETARY
YOURISH, ROBERT B, TREASURER
FLANDERS, RONALD LEE, MEMBER
EWING, MICHAEL HOYT, MEMBER
ROSS, LEVI K
(End: 01/01/1980)
CHAWES, RICHARD
(End: 01/01/1980)
YOUNT, JO
(End: 01/01/1980)
SPRING, PERRY
(End: 11/05/2010)
PETERSEN,JAMES
(End: 11/05/2010)
Doing business as
SUNSHINE PROPANE
WA UBI No. Business type
600 342 368 Corporation
Parent company
ENVIRONMENTAL HOUSING INC
License
Verify the contractor's active registration/license/certification (depending on trade)and any past violations.
Construction Contractor Active.
Meets current requirements.
License specialties
GENERAL
License no.
SUNSHP*077QP
Effective—expiration
11/17/1993—11/17/2016
https://secure.lni.wa.gov/verify/Detail.aspx?UBI=600342368&LIC=SUNSHP*077QP&SAW= 11/7/2014
SUNSHINE PROPANE Page 2 of 3
Bond • •
TRAVELERS CAS&SURETY $12,000.00
Bond account no.
206086406
Received by L&I Effective date
10/23/2001 11/17/2001
Cancelation date
11/17/2014
Insurance
FEDERATED SERVICE INS CO $1,000,000.00
Policy no.
633829
Received by L&l Effective date
11/09/2006 11/17/2006
Expiration date
Until Canceled
United States Fire Insurance C $1,000,000.00
Policy no.
506-8751013
Received by L&l Effective date
11/13/2013 11/17/2013
Expiration date
11/17/2014
Insurance history
Savings
(in lieu of bond) $12,000.00
Received by L&I
09/16/2014
Savings account ID Effective date
0770001033 09/10/2014
Lawsuits against the bond or savings
No lawsuits against the bond or savings accounts during the previous 6 year period.
L&I Tax debts
No L&I tax debts are recorded for this contractor license during the previous 6 year period, but some debts
may be recorded by other agencies.
License Violations
No license violations during the previous 6 year period.
Workers' comp
Do you know if the business has employees? If so, verify the business is up-to-date on workers' comp premiums.
L&I Account ID Account is current.
422,171-00
Doing business as
SUNSHINE PROPANE
https://secure.lni.wa.gov/verify/Detail.aspx?UBI=600342368&LIC=SUNSHP*077QP&SAW= 11/7/2014
SUNSHINE PROPANE Page 3 of 3
Estimated workers reported •
Quarter 3 of Year 2014"11 to 20 Workers"
L&I account representative
T1 /JAN BENTLEY(360)902-4652-Email: STR0235 @Ini.wa.gov
Workplace safety and health
No inspections during the previous 6 year period.
0 Washington State Dept.of Labor&Industries.Use of this site is subject to the laws of the state of Washington. Access
w hin to
https://secure.lni.wa.gov/verify/Detail.aspx?UBI=600342368&LIC=SUNSHP*077QP&SAW= 11/7/2014
\ -,1' JEFFERSON COUN• •
'9 DEPARTMENT OF COMMUNITY DEVELOPMENT
O'
Date: u2-"Z Time Received: 2.,40 am/ ;T Mon. Tue. We . Thur. Fri.
Date: ( Z.-3
BLD: t .,Cf(5— Contact Name:
Owner: Contact Number: 360 5-'74'7
Address: 40 C tA) 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 X
Man-Homes Insulation
Final Inspection
Setbacks Floor
Foundation Wall Address Posted
Block & Tile Ceiling
•
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#: BLD14-00415 Received Date 11/7/2014
SITE ADDRESS: 40 CEDARVIEW DR Issue Date 11/7/2014
PORT TOWNSEND, 98368
APPLICANT: JON WALLACE PHONE: 360-344-2756
40 CEDARVIEW DR
PORT TOWNSEND WA 98368-2502
SUBDIVISION: 9650 Block: Lot:
PARCEL NUMBER: 965000316 Section: 27 Township: 30N Range: 1W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339 ((3g � 3g5
Contractor's License SUNSHP*077QP Expires 1'f/167//014-5875
OWNER, JON WALLACE PHONE: 360-344-2756
if different: 40 CEDARVIEW DR
PORT TOWNSEND WA 98368-2502
PROJECT DESCRIPTION: MECHANICAL PERMIT FOR NEW 120 GALLON 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 11/7/2015.
REQUIRED INSPECTIONS:
Installation per Manufacturer Specifications/CO2:
Tank/Line/Appliance:
Final Approval: co--\Lf
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 11/7/2014
JEFFERSON COUNTY j(ID NO.
1 4
DATE li v 14-
RECEIVED FROM SVM 9; PDES CRIPTION # ^ AMOUNT/.-�
CURRENCY /j1d R i�� V V
COIN (/5 Cast / v/e
:a._
F
CHECKS
44 .E
4 9/4 2
it ,!/Y ' . / 11'1c .� m
8
� r e 'E .
124_,RECEIVED BY TOTAL