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HomeMy WebLinkAboutBLD2014-00129 • BUILDING PERMIT APPLICION BLD14-00129 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD14-00129 Received Date: 4/14/2014 SITE ADDRESS: 5391 CAPE GEORGE RD PORT TOWNSEND, 98368 OWNER: DALE R ZUMFELDE TRSTEE PHONE: 407-538-4755 D R ZUMFELDE REV TRUST 7983 DERSINGHAM DR SACRAMENTO CA 95829-1462 OCEAN GROVE ESTATES#2 SUBDIVISION: Block: Lot: PARCEL NUMBER: 977100610 Section: 24 Township: 30 N Range: 02 W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**979OZ Expires 9/7/2014 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION PROPANE TANK SWAP OUT TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC VALUATION MAIN: CODE EDITION: 2012 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 Permit $152.00 JLA 04/14/14 148567 Total: $152.00 APPROVFD Jefferson County DCC \\+irlomerk\r+n+o\fnrn,c\G RI Il Ann 1=2 ,SON c0 JEFFERS.OUNTY • /� tf rt DEPARTMENT OF COMMUNITY DEVELOPMENT _ _ / // r�""/� 621 Sheridan Street. Port Townsend•Washington 98368 _ L�`�" 4. 360/379-4450 • 360/379-4459 Fax .,�' p www.co.jetferson.wa.us/cornmdevelopment '�� ) Master Permit Application MLA: Project Description(include separate sheets as necessary): , .-C,. a rh7rTit /) Irk /: c; ._ 7 4.ilni 4 lio't -?to:� Tax Parcel Number: �f-i 1 O j is,)0 Property Size: (acres/square feet) Site Address and/or Directions to Property: N:5-0.71 di"'_: Gr�e.g." AI r Property Owner(s)of Record: ,� L Ti' {^ 4, v,^ t l d°t Telephone: 76'2' 63 k-I_/755 0 Fax: email: Mailing Address: /i 7/0 405 4 ,7a-,924 .--lip! , t...-s,-;e9/74-7 ,/,.. •(7.4, 'Q Applicant/Agent(it different from owner): _ , AT •10j/,/,,, ,ill7Q4 (/v/76,G, Telephone: <.26 -4/c`/cf Fax 4'/ fi' email: Mailing Address: _____ _ What kind of Permit?(Check each box that applies 0 Lot or Road Segregation ❑Building Cl Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use) ❑ Single Family 0 Garage Attached/Detached O Conditional Use[C(a), C(d),or Cl' ❑ Manufactured Horne ❑ Modular • - ❑Discretionary'D'or Unnamed Use Classification O Commercial' O Special Use(Essential Public Facilities)"" O Change of Use 0 Boundary Line Adjustment ❑ Address 0 Road Approach ❑Short Plat" 0 Home Business 0 Cottage Industry 0 Binding Site Plan" ,Propane _ „ qt/, 6,u 7 O Long Plat” O ciyn ❑P€arineo Rural Residential Development(PRRD)!Arnenoments" ©Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration" O Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions"" 0 Site Plan Approval Acvance Determination(SPAAD)" 0 Shoreline Management Substantial Development" O Temporary Use ❑Shoreline Management Variance O Wireless Telecommunication" 0 Comprehensive Plan/UDC/Land Use District Map Amendment O Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment *May require a Pre–Application Conference ❑Tree Vegetation Request -"Requires a Pre-ARplfcatfon Conference Please identify any other local,state or federal permits required for this proposal, if known: D�SfGNATION OF AGENT 1 hereby designate try (QP 't ,,G1,') i'_.to act as my agent in matters relating to this application for permit(s). \ 4 IUI,L� Date: � � OWNER SIGNATtI/Ct �-�-•i t 1 —� 1 By signing this application form,the ov/ner/agent attests that the information provided herem,and in any attachments,is true and correct to the best of 1 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. Staffs access and right of entry will be assumed unless the applicant informs the C•unty in writing at the time of the appli mat tie or--/�a wants prior n Signature: '') ',1: ," / Date: The action or actions Applican will dertake as a result of the issuance of this permit may negatively impact upon.one or m.re 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 L 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-transferable responsibility for adhering to and complying with the ESA The Applicant has read this disclaimer and signs and dates it below. Signature: Date:, G:\PcrrmrCenter\###I OltMS###\DRI3 FOEL\i5\Current IRE)Pocros\Master Pemvt Awl cation 5-29-08.doc J! _ {t/ 7 1-" 1 L S c l OA— 3�:y /Qj Lt T T C (.7- ( C i\4 e)6-- a 1. ® 4o w N. Ay ri ca 10 4/i2 Q �� 4!0 viz . © >V� - �= J W 3 a k�l S Q. n O o W F ...W . L. is x z O W m u c C 0 1° 'i I �! N -a O LL= i O • J 0 n� rr ai 1 ______ . 1 ;_4 .1,4-1.w, n n I.,1; Q CC 4 W JI�y, ] ¢,MS Li_ 1 ?"n"9t'*S er 0 _ w rt.i 0_I . fl) • V x 3 ,� N1 y 5r3rnS" s+,7-..d lr..0•Y./1z • •I I i J7 . -/- i ai61 '"o • o .nom Jr 1 110 0�� 3 v ...... • CHSINC • • Page 1 of 4 inWashington State Department of Labor & Industries CHSINC Owner or tradesperson PO BOX 518 CASALE, CARL MARTIN AUBURN, WA 98071-0518 253-833-7220 Principals KING County CASALE, CARL MARTIN EGAN,THERESA MARIEMCENROE,JOHN DANIELLILJA, NANCI LEEKASTELIC, DAVID ALLENC T CORPORATION SYSTEM ESTENSON, NOEL (End: 09/21/2012)WESTBROCK, LEON (End: 09/21/2012)BAKER, DAVID A (End: 09/21/2012) Doing business as C H S INC WA UBI No. Business type 600 148 004 Corporation Governing persons AL ANDERSTROM ALLEN J ANDERSON; GARY ANDERSON; GAYLON G BRATLAND; JAMES BAREKSTEN; JAY D DEBERTIN; JEFF HAGEMAN; JOANNE BURMEISTER; JODELL M HELLER; JOHN D JOHNSON; JOHN J SCHMITZ; LORNE E BROWN; MARK PALMQUIST; MICHAEL BERGELAND; NANCI L LILJA; NEOL ESTENSON; PATRICK KLUEMPKE; PAUL CULVER; RICHARD L BALDWIN; RICHARD H BROWNE; SHELDON HAALAND; STEVE CARNEY; STEVEN BURNET; T F BAKER; TYRONNE MOOS; 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. CHSIN**9790Z Effective—expiration 09/09/2003—09/07/2014 ** https://secure.lm.wa.gov/verify/Detail.aspx.UBI—600148004&LIC--CHSIN 97902&SAW= 4/14/2014 Screen 01 • REAL PROPERTY MASTER • Mode: INQUIRY Auto Roll : OFF Parcel # 000977100610 Geo Cd 300224402111 OCEAN GROVE ESTATES #2 Nbhd Cd 5560 BLK 6 LOT 11 Loc ID * Taxpayer Cd ZUMF 1500 ZUMFELDE TRSTEE, DALE R T/P Chg Dt 1/07/2004 * Title Owner T/P Chg Usr JODI Tax Code 0111 Status TX TAXABLE Land Use 1100 RES-SINGLE Affidavit 99162 Vol/Page / C/U Code COMPLETE ADDRESS WINDOW Taxpayer ZUMF1500 DALE R ZUMFELDE TRSTEE D R ZUMFELDE REV TRUST SHIRLEY A SARAGA 7983 DERSINGHAM DR SACRAMENTO CA 95829-1462 Search Key CMD 6: End Window CMD 7: End of Job JOHN L. SCOTT PTT PROPERTY MANAGEMENT TRUST ACCOUNT 7 1 3 6 4 Date:04/11/2014 Check#71364 Account:Chase Checking 0962 Pay to:Jefferson County Dept of Community Development Property Reference = Description Amount CAPE 5391 -5391 CAPE GEORGE ROAD POR... Propane swap out permit swap out propane 41.00 CAPE 5391 -5391 CAPE GEORGE ROAD POR... Propane swap out propane tank swap 9.50 CAPE 5391 -5391 CAPE GEORGE ROAD POR... swap out propane tank tank swap 120.50 171.00 • • • • 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 #: BLD14-00129 Received Date 4/14/2014 SITE ADDRESS: 5391 CAPE GEORGE RD Issue Date 4/14/2014 PORT TOWNSEND, 98368 APPLICANT: DALE R ZUMFELDE TRSTEE PHONE: 407-538-4755 D R ZUMFELDE REV TRUST 7983 DERSINGHAM DR SACRAMENTO CA 95829-1462 SUBDIVISION: OCEAN GROVE ESTATES#2 Block: Lot: PARCEL NUMBER: 977100610 Section: 24 Township: 30N Range: 02W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**979OZ Expires 9/7/2014 OWNER, DALE R ZUMFELDE TRSTEE PHONE: 407-538-4755 if different: D R ZUMFELDE REV TRUST 7983 DERSINGHAM DR SACRAMENTO CA 95829-1462 PROJECT DESCRIPTION: PROPANE TANK SWAP OUT 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 4/14/2015. REQUIRED INSPECTIONS: Installation per Manufacturer Specifications/CO2: dE4) /.4'iJK Sf"/frtclie t�c/fT1r�� lly Tank/Line/Appliance: Final Approval: T1 I-V /.5 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 4/14/2014