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HomeMy WebLinkAboutBLD2013-00133 • BUILDING PERMIT APPLICIPlION BLD13-00133 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD13-00133 Received Date: 4/24/2013 SITE ADDRESS: 775 RHODODENDRON DR QUILCENE, 98376 OWNER: WILLIAM C POWER PHONE: LINDA A POWER 212 DOYEN ST BREMERTON WA 983375503 SUBDIVISION: Block: Lot: PARCEL NUMBER: 601031008 Section: 3 Township: 26 N Range: 01 W CONTRACTOR: DOUBLE D ELECTRICAL INC PHONE: 360-385-1130 PO BOX 957 PORT HADLOCK WA 98339 Contractor's License DOUBLDE982PD Expires 10/4/2011 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP Propane Tank TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2009 HEAT BASE: HEAT TYPE: OCCUPANCY: 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 $228.00 MKF2 04/24/13 142021 Total: $228.00 APPROVED E® APR 2 4 2013 Jefferson County DCD 11 1irlemork\rlofo\fnrmc\r RI n Ann PIA rM A/7A i9nlz 1 • • • z 71- \Sl tJ.. 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' \� / / i I r / � � w 11 LO z / / m p3a ( / LozD MIw C O Z O b I N*v ON 0. ..i \ \ to2 (■t - N9Z - S o/tMN) 0 d IJg$— w LI 3 _ v za < F a gB� zQo — n " �1d ,n °� u v�a w g '".s ''' ''E N 4 F f • NFOON — O 0u0? u rt W S' {6{� SR 1 leryie;*?$•°11 JEFFERS.COUNTY • z7 A DEPARTMENT OF COMMUNITY DEVELOPMENT 'w 4 621 Sheridan St reet • Port Townsend • Washington 98368 iilbo, G 360/379-4450 • 360/379-4451 Fax D IE C E n V E l ,`S ,S p www.co.jefferson.wa.uslcommdevelopment 87Np Master Permit Application MLA: 11 APR 2 4 2013 ` 1=-1 Project Description(include separate sheets as necessary): JEFFERSON COUNTY r a('°' ` }a‘ -\ -• OFPT.OF COMMUNITY Ul VELUPMtrvI G oc\ Property Size: tacressquare feet) Tax Parcel.Number. � \ 1st ti( � Site Address and/or Directions to Property: -}1-ri V VnrUh r Property Owner(s)of Record: %'.\\ Q nwfr Telephone: -t./3 - S''* 1 - 61 S Fax: email: Mailing Address: -1-\i,_ tl of c-'- S \43 r vvNQ-A-rr-. \O14•cl`7 ) 1 Applicant/Agent(if different from owner): `'nvn b\e— `O E` -r \''c',L,.•\ Telephone: 7.& t,- 1sc- \\3 a+ Fax: email: p,\ r 0 ALeAtc)Ce,c."\•(,ov-, Mailing Address: Q.V. fox A -1- P,,,\- \<-7A\ur✓k \AN- 1 \ What kind of Permit?(Check each box that applies ❑ Lot or Road Segregation ' 88uilding ❑ Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family ❑ Garage Attached/Detached ❑ Conditional Use[C(a), C(d), or C]** ❑ Manufactured Home .❑ Modular ❑ Discretionary"D"or Unnamed Use Classification I ❑ Commercial* ❑Special Use(Essential Public Facilities)** O Change of Use ❑ Boundary Line Adjustment ❑ Address _❑ Road Approach_ El Short Plat** ❑ Home Business ❑Cottage Industry ❑ Binding Site Plan** li¢Propane ❑ Long Plat** . ❑ Sig ❑ Plannea Rural Residential Developmeht(PRRD)/Amenaments** ❑Allowed"Yes"Use Consistency Analysis ❑ Plat Vacation/Alteration'" ❑ Stormwater Management ❑ Shoreline Master Program Exemption/Permit Revisions** ❑ Site Plan Approval Advance Determination (SPAAD)* ❑ 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_ to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: 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 required later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applicatio a or she wants prior notice. Signature: / Date: y—).-y - 11 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-transferable r ponsibility for adherin to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: Date: l-Lu{- \2 . r.n.___."- \11L43➢r1I,\tC$J *4'nU it ur,"xxCl e". .limn c_ -%NS n__:. e__1:__-:—[ nn no L . • • 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 responsibifityof the General Contractor for the proposed project. Signature:° Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL CONTR,4LlOR'S LICENSE " ^"- WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: 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 C Two Party Type of Heat: Proposed: ❑ Public Total: Name of System: If this is a Commercial Project 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 1 Above ground Tank Size of Propane Tank: f Heat Stove i Cook Stove i Woodstove 1 Fireplace Insert 1 Hot Water Tank 1 Pellet Stove i 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, including the reserve area. Square Footage Current Proposed For Office Use Only Amount Revision Main Floor Heated EH Bld App Review: 2 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: Cash/Check Number: ESTIMATED COST(REQUIRED) Date: Fair market value of all labor and materials foundation to finish Initials: .. .r.____,.uuaannnxrcaauu\non cnoue\r., non c,.—,.\u nom...:.e..a:.....:.. ,c xf na.l.,.. Contractors or Tradespeopleetail • Page 1 of 2 Washington State Department of k, Labor & Industries Contractors or Tradespeople Detail Return to List > Start a New Search > Printer friendly Verify Workers' Comp Premium Status Check for Dept. of Revenue Account About Electrical Contractor A business licensed by L&I 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 DOUBLE D ELECTRICAL INC UBI No. 602097450 Phone No. (360)385-1130 Status Active Address Po Box 957 License No. DOUBLDE982PD Suite/Apt. License Type J Electrical Contractor City Port Hadlock State WA Effective Date 10/4/2002 Zip 98339 Expiration Date 10/4/2014 County Jefferson Suspend Date J Business Type Corporation Specialty 1 General Parent Company Specialty 2 d Unused B Other Associated Licenses License Name Type Specialty Specialty Effective Expiration Status 1 2 Date Date DOUBLDE027PL DOUBLED Electrical General Unused 10/13/1998 10/13/2002 Archived ELECTRIC Contractor Electrical Administrator INFORMATION License WOODSJJ024NI Name WOODS,JASON JOHN Status Active Q Business Owner Information Q Hide All Name Role Effective Date Expiration Date WOODS,JASON JOHN Agent 10/04/2002 https://fortress.wa.gov/lni/bbip/Result.aspx 4/24/2013 Contractors or Tradespeople1etail • Page 2 of 2 WOODS,JASON JOHN President 10/04/2002 © Bond Information Bond Bond Company Bond Account Effective Expiration Cancel Date Impaired Bond Received Name Number Date Date Date Amount Date American States Until 325222627 04/20/2012 3 $4,000.00 05/15/2012 Insurance Co Cancelled American States 2 6772667 10/04/2011 05/15/2012 $4,000.00 10/19/2011 Insurance Co 1 CBIC 5E0309 10/04/2002 Until 10/28/2011 $4,000.00 10/17/2002 Cancelled • Assignment of Savings Information J No records found for the previous 6 year period B Insurance Information J No records found for the previous 6 year period ® Summons/ComplaInt Information 1 Summons and Complaints are not filed with the department for this contractor type 9 Warrant Information J Warrants are not filed with the department for this contractor type 2 Infractions/Citations Information J Infraction /Citation Date RCW Code Type Status Violation Amount EANMI00239 3/18/2010 19.28.101 RCW ELECTRICAL CITATION Satisfied $250.00 EANMI00237 3/18/2010 19.28.101 RCW ELECTRICAL CITATION Satisfied $250.00 EMITP00337 9/14/2012 19.28.101 RCW ELECTRICAL CITATION Satisfied $0.00 EVANS00556 7/20/2010 19.28.101 RCW ELECTRICAL CITATION Satisfied $500.00 ESEA000386 10/13/2010 19.28.101 RCW ELECTRICAL CITATION Satisfied $1,000.00 EHULR00275 10/28/2011 19.28.101 RCW ELECTRICAL CITATION Satisfied $0.00 CO Washington State Dept.of Labor&Industries.Use of this site is subject to the laws of the state of Washington. Access ■Washington1p ,....r.i State G>xrrnnent WO,IHI< https://fortress.wa.gov/lni/bbip/Result.aspx 4/24/2013 • 0 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 #: BLD13-00133 Received Date 4/24/2013 SITE ADDRESS: 775 RHODODENDRON DR Issue Date 4/24/2013 QUILCENE, 98376 APPLICANT: WILLIAM C POWER PHONE: LINDA A POWER 212 DOYEN ST BREMERTON WA 983375503 SUBDIVISION: Block: Lot: PARCEL NUMBER: 601031008 Section: 3 Township: 26N Range: 01W CONTRACTOR: OWNER, WILLIAM C POWER PHONE: if different: LINDA A POWER 212 DOYEN ST BREMERTON WA 983375503 PROJECT DESCRIPTION: 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 4/24/2014. REQUIRED INSPECTIONS: Tank/Line/Appliance: cll(} TA-0.1 K L ci -t1 S-L-&Eu _ ? 113o'i3 FinalApprovall (42mit-'13 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 1\tidemark\data\forms\F_BLD_Perm it_Propane.rpt 4/24/2013 4