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Home My WebLink AboutBLD2013-00060 • BUILDING PERMIT APPLI ION BLD13-00000 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD13-00060 Received Date: 2/20/2013 SITE ADDRESS: 111 HIGHLAND DR PORT LUDLOW, 98365 OWNER: JACK R MARTIN TRUSTEE PHONE: 360-437-2265 JACK MARTIN LIVINIG TRUST 111 HIGHLAND DR PORT LUDLOW WA 98365-9748 SOUTH BAY#1 SUBDIVISION: Block: Lot: 3 PARCEL NUMBER: 995500003 Section: 21 Township: 28 N Range: 01 E CONTRACTOR: AIR FLO HEATING COMPANY INC PHONE: 360-683-3901 221 W CEDAR SEQUIM WA 98382 Contractor's License AIRFLI*206DG Expires 4/25/2014 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION HEAT PUMP TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC VALUATION MAIN: CODE EDITION: 2009 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: 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 FEB 2 0 2013 Jefferson County DCC \\tidemark\data\forms\F_BLD_App_Bld.rpt 2/20/2013 CERTIFICATE OF OCCUPANCY Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 (360)379-4450 FAX(360)379-4451 Carl Smith, Director/Building Official PERMIT#: BLD13-00060 SITE ADDRESS: 111 HIGHLAND DR Issue Date: 02/20/2013 PORT LUDLOW, 98365 Final Date: 3/14/2013 APPLICANT: JACK R MARTIN TRUSTEE PHONE: 360-437-2265 JACK MARTIN LIVINIG TRUST 111 HIGHLAND DR PORT LUDLOW WA 98365-9748 SUBDIVISION: SOUTH BAY#1 Block: Lot: 3 PARCEL NUMBER: 995500003 Section: 21 Township: 28 N Range: 01 E PROJECT DESCRIPTION: HEAT PUMP THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2009 EDITION. OCCUPANCY GROUP: TYPE OF CONSTRUCTION: SPRINKLER SYSTEM yes no THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 3/14/2013 \\tidemark\data\forms\F_BLD_Occupancy.rpt 3/20/2013 ,¢,gON cod, JEFFEQON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 1 s `'d 621 Sheridan Street• Port Townsend •Washington 98368 "� 360/379-4450 • 360/379-4451 Fax 644rIN ,gyp www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Project Description(include separate sheets as necessary): Tax Parcel Number: (31' SS 00003 Property Size: (acres/square feet) Site Address and/or Directions to Property: it t i-ii Gt t.INN ) M.. Pork Ukx.d\o" ) ,WP cV63laS Property Owner(s)of Rec rd: aU(. cfa 'rtn Telephone: 4 31- gyp Fax: email: Mailing Address: S. 1"%elQi Applicant/Agent(if different from owner): 'f't%r V.O *ee 1/4,r Telephone: 3 00 AA%3.-310 I Fax: le fd 3"3-, ` cj I email:el∎es. o kto hazk ult.Cant ` Mailing Address: aa`t Vi-CedaY SA . _,_ ► ;. > ' What kind of Permit?(Check each box that applies ❑Building ❑Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use) tkaingle Family ❑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 ❑Boundary Line Adjustment ❑ Address ❑Road Approach ❑Short Plat** ❑Home Business O Cottage Industry ❑Binding Site Plan** ❑ Propane ❑Long Plat** ❑Sign ❑Planned Rural Residential Development(PRRD)IAmendments** ❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration** ❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions** o Site Plan Approval Advance Determination(SPAAD)* 0 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 'I 1�1 111.1C to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE .s.` t i 1>1♦ - Date: 2 /7 /3 By signing this applicst'•n form,the ownerfagent 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 attorneys 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 a•plicatio that he or she wa o is prior notice. Signature: t ,- IL,/ „ Date: -2 '1 / l 3 The actio • 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. My 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-tran erabl responsibbir for adh=ri •to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: its. A- Date: -7. - /V- /3 G:\Pe nitCenter\###FORMS###\DRD FORMS\Master Permit.Application 5-29-O8.doc 1 � 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: t 1K F 1 k) 1,-* ) ,Z3-3' o f 8/42o)610-3111 MAILING ADDRESS: A 1 D 6 egok AN EMAIL: CONTRACTOR'S LICENSE `'C WAINS A R NUMBER: ' )(01)6-- NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: O New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ,tAlteration/Remodel 0 Concrete Total: Height: ❑ Individual System ❑ Repair 0 Masonry SEP Permit# 0 Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: ❑ 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 1 Other 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, includin• the reserve area. S•uare Foota!a Current • •.._ed :e� . v, `07 �y, _ ` . _ - -- . t.,6,--:,,,,,-, . Main Floor Heated �� EH Bid App Review: 2n0 Floor Heated �` �^ �� LL- Consistency Review: Other Heated ,.,, Base fee: Mezzanine i ,,. T Additional Section: Heated Basement Plan Check fee: L Unheated Basement '- State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 4 911/Rd Approach fee: Othe /151'3 TOTAL: $ P�M� , '-r Receipt Number. n . ; Cash/Check Number. ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and matri /11 ndation to finish 3 tr1� Initials: NO . G:\PemritCen ter\###FORMS###\DRD FORMS Waster Permit Application 5-29-08.doc Contractors or Tradespeopleeinter Friendly Page Page 1 of 1 • Electrical Contractor A business licensed by LEI 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 AIR FLO HEATING CO INC UBI No. 600347761 Phone 3606833901 Status Active Address 221 W Cedar St License No. AIRFLHCOO9C8 Suite/Apt. License Type Electrical Contractor City Sequim Effective Date 2/28/2000 State WA Expiration Date 2/28/2014 Zip 983823320 Suspend Date County Clallam Specialty 1 Hvac/Rfrg Ltd Energy Business Type Corporation Specialty 2 Unused Parent Company Master Electrician INFORMATION License BERSOJR975LB Name BERSON,JOEL RAY Status Active Business Owner Information Name Role Effective Date Expiration Date BEQUETTE,MICHAEL 01/01/1980 FULLAWAY,MICHAEL ,01/01/1980 LEVINSON, WILLIAM R Agent 01/01/1980 BEQUETTE,MARK A President 01/01/1980 BERSON,JOEL R Secretary 02/12/2010 BERSON,JOEL R Treasurer 02/12/2010 BEQUETTE,SANDRA A Vice President 01/01/1980 Bond Information IBondlBond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date 4 CBIC si6233 07/06/2010 Until Cancelled $4,000.00 05/19/2010 2 COLONIAL AM CAS& LPM4054452 07/06/2001 Until Cancelled 08/21/2010 $4,000.0007/18/2001 SURETY OF MD 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 2/20/2013 co 0 a' S L 0 13 2 oal a u)m r m ,K Ea 0 o � � O Cn= L o n o o --1 c CCD v v =- 0 o ` ` = z ' CD •n o y 0,,.. om m o W o O C N m° m , y 1 /1 ♦ ^n o a- -1 m O (N ' O " c ' a F C C `rn a O o o . / i 11 n m o a c D 'A �0 g" o w n 0 77= N ° ' D CD C 0 - Q. 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YfTtM • 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#: BLD13-00060 Received Date 2/20/2013 SITE ADDRESS: 111 HIGHLAND DR Issue Date 2/20/2013 PORT LUDLOW, 98365 APPLICANT: JACK R MARTIN TRUSTEE PHONE: 360-437-2265 JACK MARTIN LIVINIG TRUST 111 HIGHLAND DR PORT LUDLOW WA 98365-9748 3 SUBDIVISION: SOUTH BAY#1 Block: Lot: PARCEL NUMBER: 995500003 Section: 21 Township: 28N Range: 01E CONTRACTOR: AIR FLO HEATING COMPANY INC PHONE: 360-683-3901 221 W CEDAR SEQUIM WA 98382 Contractor's License AIRFLI*206DG Expires 4/25/2014 OWNER, JACK R MARTIN TRUSTEE PHONE: 360-437-2265 if different: JACK MARTIN LIVINIG TRUST 111 HIGHLAND DR PORT LUDLOW WA 98365-9748 PROJECT DESCRIPTION: HEAT PUMP 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 2/20/2014. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: \'4' 1:b 4.1 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 2/20/2013