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Home My WebLink AboutBLD2013-00139 • BUILDING PERMIT APPLI•ION BLD13-00139 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD13-00139 Received Date: 5/8/2013 SITE ADDRESS: 5282 CAPE GEORGE RD PORT TOWNSEND, 98368 OWNER: JEREMIAH GORSLINE PHONE: ELIZABETH MACBARRON 5282 CAPE GEORGE RD PORT TOWNSEND WA 983689035 OCEAN GROVE ESTATES SUBDIVISION: Block: Lot: PARCEL NUMBER: 977100206 Section: 24 Township: 30 N Range: 02 W 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 DESCRIPTIOP DUCTLESS HEAT PUMP SYSTEM TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION 4,010.00 ADD'L: HEAT TYPE: CODE EDITION: 2009 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 Permit $228.00 MKF2 05/08/13 142057 AP PROVED Total: $228.00 MAY - 8 2013 Jefferson County DCD \\WVemv4l.lnla\fnrmclF P1 n Ann PI.+ S/A/9M1 C 139 40' oo JEFFSON COUNTY • e a j DEPARTMENT OF COMMUNITY DEVELOPMENT lE��ik' ?TI -4 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax MAY - 8 2013 j www.co.jefferson.wa.us/commdevelopment 1`SFfINO �o Master Permit Application MLA Fl (�) 1. -f"I 1' r n Project Description (include separate sheets as necessary): IgSf+ 1.A. 00LT LOSS 4 e kT P0ItJ.-P S‘‘)S"c e M Tax Parcel Number: q1-7 1 0 0 '2-O 10 Properly Size: (acres/square feet) Site Address and/or Directions to Properly: 5 GI- Z C_ap G�orc r e. `N , Po r t 1 OWf1S'.Q i L.,-.4 Ps- cASS3l0t Property Owner(s)of Record: i e.rC r'v1, .Wri q 1 ■-Zab.e_t-le, 6 of S 1 t n e. Telephone: '1555 - (12_13?- Fax: email: Mailing Address: $•2-$?- Come- Gecrc,G P-4 Poft 7w,,r,Sec / p, a$2.to4 Applicant/Agent(If different from owner): Air C10 feat i n Telephone: 3laO'lo,aj-501�I Fax: IP83— 3q 1r email:e l@nno 1tf" l0 Mailing Address: Z2" yy. ceaa.r S'F• setstudeIN t �'a �+• � r wfl g839?r ' What kind of Permit?(Check each box that applies ❑Building ❑Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use) IIiCSingle 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)" Cl Change of Use ❑Boundary Line Adjustment ❑ Address ❑ Road Approach ❑Short Rat" ❑ Home Business ❑Cottage Industry ❑Binding Site Plan** ❑ Propane ❑Long Plat" ❑ Sign ❑Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis ❑Rat 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 fl t r 1 U r"leat(nq to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE ;!ea . 1...vt-C Date: C ., ., 2 By signing this application form,ttie 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 application that he or she wants prior ice. Signature: %nw� Date: t ' _ // 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 Ac"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 responsibili for Bring to rich complying with the ESA. The Applicant has read this disclaimer a d signs dates it below. Signature (� Dater 7''� 7 GAPemvtCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc 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: ( ) ( ) 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 Disposal: U New ❑ Wood Existing: ❑ Sewer ❑ Addition n 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 Total: _ Name of System: If this is a Commercial Proiecj 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: 1 Underground Tank I Above ground Tank Size of Propane Tank: 1 Heat Stove I Cook Stove 1 Woodstove 1 Fireplace Insert 1 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 Foote te Current Pro,•sad • xc,, ' :••fll'i Main Floor Heated EH Bid App Review 11-714Y5'1.::, 2n°Floor Heated Consistency Review: Other Heated Base fee: Mezzanine - Additional Section: Heated Basement r~` s� 1ni ' 'i Plan Check fee: + Unheated Basement "' Fc l, ,a State Surcharge fee: I Other Unheated ,, ,,, .;94 Pot Water Review fee: LEI Garage/Carport t 4 SUBTOTAL Decks , ' 911/Rd Approach fee: Other r,,',, ,u, s +� TOTAL $ -w - ; Receipt Number t ^ Cash/Check Number ber t -'° Fi ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish Initials: • G:\Perrnitcenter\###FORMS###\DRD FORMS\Master Perrot Application S-29-OS.doc • 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: ' I f- FLb OUCT 00 366 3$5- 536 . .4 483 .6ct"1) MAILING ADDRESS: 1 E V olt 0 01 EMAIL: ■ CONTRACTOR'S LICENSE .p ^ WAINS NUMBER: AI g pL 124(a D U NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New 0 Wood Existing: ❑ Sewer O Addition 0 Steel Proposed: Bank ❑ Community System g Alteration/Remodel ❑ Concrete Total: Height: 0 Individual System O Repair 0 Masonry SEP Permit# O Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: 0 Public Total: — I 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: 1 Underground Tank 1 Above ground Tank Size of Propane Tank: 1 Heat Stove 1 Cook Stove 1 Woodstove 1 Fireplace Insert i Hot Water Tank 1 Pellet Stove 1 Other Is this appliance being installed In a Manufactured/Mobile Home? Yes 1 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. R..,.., .:` T 1+ P i s S•uare Foota.e Current P ..sect ib ::i ii1uv 4F � ll: ti tj'l if . Main Floor Heated R "=- f R i EH Bid App Review: s t 2"°Floor Heated '" ,. Consistency Review: Other Heated kr" Base fee: g `'` Mezzanine - ' Additional Section: c Heated Basement -w,, _, Plan Check fee: Unheated Basement - k M State Surcharge fee: Other Unheated Vs`• -. Pot Water Review fee: € t j „.R , Garage/Carport "',u .' SUBTOTAL Decks rSr ,-?y F 911/Rd Approach fee: Other v TOTAL: $ �9t,Dg, W �V CW SS µ 'r �_ " Receipt Number. !CO 7 05 INK(' 5N `JTt• ' o k 0 4 - Cash/Check Number: ESTIMATED CT(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish ��/u (O . Initials: I `VV G:\PemtitCetwer\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc Contractors or Tradespeopliiinter Friendly Page Page 1 of 1 • Electrical Contractor A business licensed by LW 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 .-rreasurer 02/12/2010 BEQUETTE,SANDRA A Vice President 01/01/1980 Bond Information Bond Bond 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 13 LPM4054452 07/06/2001 Until Cancelled 08/21/2010 $4,000.00 07/18/2001 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 3/12/2013 • • • 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 #: BLD13-00139 Received Date 5/8/2013 SITE ADDRESS: 5282 CAPE GEORGE RD Issue Date 5/8/2013 PORT TOWNSEND, 98368 APPLICANT: JEREMIAH GORSLINE PHONE: ELIZABETH MACBARRON 5282 CAPE GEORGE RD PORT TOWNSEND WA 983689035 SUBDIVISION: OCEAN GROVE ESTATES Block: Lot: PARCEL NUMBER: 977100206 Section: 24 Township: 30N Range: 02W 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, JEREMIAH GORSLINE PHONE: if different: ELIZABETH MACBARRON 5282 CAPE GEORGE RD PORT TOWNSEND WA 983689035 PROJECT DESCRIPTION: DUCTLESS HEAT PUMP SYSTEM 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 5/812014. REQUIRED INSPECTIONS: +� </ Tank/Line/Appliance: -1k-eGt_� TLA,1/41-, FinalApproval: 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\tidem ark\data\forms\F_BL D_Perm it_Propane.rpt 5/8/2013