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HomeMy WebLinkAboutBLD2014-00217 - MECHANICAL •UILDING PERMIT APPLICADON BLD14-00217 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD14-00217 Received Date: 6/17/2014 SITE ADDRESS: 105 NAYLOR CREEK RD CHIMACUM, 98325 OWNER: ANTOINETTE ORR PHONE: 503-467-9608 4892 FLAGLER RD NORDLAND WA 98358-9692 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901272012 Section: 27 Township: 29 N Range: 01 W 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 DESCRIPTIOI' SWAP OUT 2 X 120V TANKS, TEE INTO EXISTING LINE AND SURFACE MOUNT PIPE TO OUTSIDEr2� TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2012 OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: 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 JLA 06/16/14 148784 Total: $228.00 0 P ra 1 JUN 1 7 2014 Jefferson County DCD \I/Irlomarlelrhhlfnrme\G RI Il Ann Rlrl m/ A/17/9,11A Jodi Adams To: Laura Simpson Subject: RE: Orr Permit Yes, that will work. There was a description on the application for this one so I took the description off the site plan. Sorry it was complete. I wilt update the permit on our end as well. Jodi Adams Office Coordinator - DCD Phone 360-379-4494 All e-mail sent to this address has been received by the Jefferson County e-mail system and is there ore subject to the Public Records Act,a state law found at RCW 42.56. Under the Public Records law the County m st release this e-mail and its contents to any person who asks to obtain a copy(or for inspection) of this e-mail unl.ss it is also exempt from production to the requester according to state law,including RCW 42.56 and other sta le laws. From: Laura Simpson [mailto:laura@sunshineprooane.com] Sent: Wednesday, June 18, 2014 9:53 AM To: Jodi Adams Subject: RE: Orr Permit Hi Jodi, This permit should have also indicated a gas heat stove installation as well. The permit only shows tanks ad pipe. Can I write in "heat stove" on the permit? Thanks, Laura From: Jodi Adams [mailto:jadams @co.jefferson.wa.us] Sent: Tuesday, June 17, 2014 1:49 PM To: Laura Simpson Subject: Orr Permit Hi Laura, Here is the building permit for Antoinette Orr. Please let me know if you have any questions. Jodi Adams Office Coordinator Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 Phone 360-379-4494 Fax 360-379-4451 jadamsPco.jefferson.wa.us 1 0 ‘4 -Z, 1 .. k4y-- cor, JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax qs, 0$ www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Project Description(include separate sheets as necessary): Tax Parcel Number: 9 0 I - a r( � - O ( � Property Size': (acres/square feet) Site Address and/)or Directions to Property: �j 4� E C I �l/7 I—�,' I Th\ Property Owner(s)of Record: -PrN'l b r r') '' j E Q62__ � ,) ` n Telephone: T 3-- (C`7�(C a Fax: la 1 1 f Mailing Address: °U• %� IMP 'ril, .V .? f."I• 1 1J ApplicantrAgerg tit different from owner): -Lf-YJ.` o, 4 Cr:Dai )_Q ■ I 1 ---1 Telephone: ‘- - 6 `f Fax Fax: i '- '1 -mall: 1� ' t°r i�Wn�lY Mailing Address: tJ.6 h.1 A. -A -- ° !/ .i ck tr�i ik timica C What kind of Permit?(Check each box that applies ❑Building ❑ 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 Cj" ❑ 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 ❑Cottage Industry ❑Binding Site Plan** ❑Propane ❑Long Plat** ❑Sign ❑Planned Rural Residential Development(PRRD)lAmendments** ❑Allowed"Yes'Use Consistency Analysis ❑ Plat Vacation/Alteration'* ❑Stormwater Management ❑Shoreline Master Program Exem tion/Permit Revisions*" ❑Site Plan Approval Advance Determination(SPAAD)' ❑ Shoreline Management Substan ial 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 p-t '✓ i) i3l :s_ Date: 0 6 / / / V I 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. Staff's access •7,right Of entry will be assumed unless the applicant informs the County in writing at the time of the application that(he or sIttwants prior lice. Signature: L �_ Date: U L// U / 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 compliancey.4th the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferable responsibili forted rin to and complying with the ESA. The Applicant has read this disclaimer and signs/a/� dates it below. Signature' i, .� Date: C., (e." 7//6 1 �/ G:\PeQmt-Center\###FORMS###\DRD FORMS\Master Permit Application 529-08.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 assum' g the responsibility of the General Contractor for the proposed prof i r . Signature: —0 Date: (O 1 'J ` I 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: ❑ 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: 171 Private well 0 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: 1 Underground Tank -Above ground Tank Size of Propane Tank: aK / eat Stove Cook Stove 1.Woodstove 1 Fireplace Insert 1 Hot Water Tank 1 Pellet Stove 1 Other fiance being installed in a Manufactured I 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. y }.�� 5.:. k ri ' # . .. A " , cts" p ' v b$ Square Footage Current Proposed ,,41:i F A d � d:t � x r J s a a,,F• 'g. � ti-0i-..1 e �i6+ a.,r ;c - — Main Floor Heated * r' i ' EH Bld App lgt4R6 2na Floor Heated r;t: ,� Consistency Review: ,,t • a Other Heated t�: ,x ,t,� Base fee: i Mezzanine -, qk Additional Section: Heated Basement ` g Plan Check fee: rtii r- Unheated Basement �y, ',, r! State Surcharge fee: Other Unheated `N, Pot Water Review fee: ,, ,t Garage/Carport 1 1,,:5-c-3; SUBTOTAL 4 'l MAIOHMOAliNnumo0JOId3(1 Decks P` '4,x.0 .j, 911/Rd Approach fee: A1N1103 NOSPUJ3i At Other 4:.,1411, . ' TOTAI4 I I I:, ' `° ill �1O ' I. Nnr { 1"01:,:l gym , Receipt Number. + r 3 , r Cash/Check Number. , i n ESTIMATED COST(REQUIRED) i R Date: V u -'I NJ �. •Fair market value of all labor and materials foundation to finish j Initials: G.\PettnilCenter\###FORMS###\DRD FORMS\Man=Permit Application 5-29-08.doc SITE VISIT REPORT • (PLOT PLAN) JOB l ON\ 0126)--. DATE : SIS\I k CONTACT: ADDRESS /O S N as•St0c ( - PHONE #: DIRECTIONS FAX #: Email PLANNER: `)A gyp-{, ')_ . 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. 1 ©0 1,1 o 5 � h8 su m o•►� r�T Inoo�j io R�s� � S3����` i t f 9-ra rs woe° p∎N3 , �,,e._—=N STVti�l %� T� 0 6,01 u10 t o o t \ST1 4a S t...¢At m ors �a�iZ t 1t70� Olt, x 1 Z,o V Tel VA 1Ls 1 V�1a�n t � 1) 'ekISTI� 41-.1 rZf 5,uckcncR.. e.�D 1 � O O Cor'.Q, � 1-1,F Cas\rn Q �, 4 • Sunshinel\EIEUSINESSIFORMSIPROJECT PLANNING SITE VISIT REPORT-PLOT PLAN.doc __. _._ _ FiO ^�- JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT & r rHl`GZ Date:6/pubbij Time Received: g. a7 amypm/ Mon. Tue. Wed. Thur. r�p�l� Date: 5 /Ao l BLD: I Contact Name: /�i�l7J!cli► Owner: ,,y r i Contact Number: e 5 3— i 7- 7 4O Address: /O-6 it (,rye-P ' / – — Notes: -jar k__ 5.temvp-mss -I- Azi 0 95-10-me, Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Underground 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 Man-Homes Insulation Final Inspection Setbacks Floor Foundation Wall Address Posted Block&Tile Ceiling love 8 c% JEFFERSON JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT -,'THING,,,,+/ Date: //�Time Received: eZ 3 SI am/00 Mon. Wed. Thur. Fri. ((( Date: 2//3— KC): /Y /42,/ 7 Contact Name: Owner: Contact Number: 360 Address: / 97 NAIL,- Pyf L 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 Man-Homes Insulation Final Inspection Setbacks Floor Foundation Wall Address Posted Block&Tile Ceiling I JEFFERSON COOJTY bC D .No. 148784 DATE NI 1 t' x) ! 1 %kRECEIVED FROM S-' U-n try i4-(5-paion..t., DESCRIPTION ,/� BAHS# AMOUNT CURRENCY y�t�� YID,�t.,�.�' 2,24.& COIN ld�` {J\ I�`.Yif 11-, CHECKS �` c-V, \ Z'IZ0\Zr!, Q C O K rn 13 n 0 RECEIVED BY TOTAL c:2-`41 - 5 1 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, WA98339 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 11/17/1993-11/17/2014 https://secure.lni.wa.gov/verify/Detail.aspx?UBI=600342368&LIC=SUNSHP*077QP&SAW= 5/8/2014 Screen: 01 REAL PROPERTY MASTER Mode: INQUIRY • Auto Roll : OFF Parcel # 000901272012 eo Cd 290127206210 S27 T29 R1W Nbhd Cd 4280 TAX 22 Loc ID * Taxpayer Cd ORR* 0015 ORR, ANTOINETTE T/P Chg Dt 11/15/2013 * Title Owner T/P Chg Usr JA Tax Code 0211 Status TX TAXABLE Land Use 1100 RES-SINGLE Affidavit 120118 Vol/Page / C/U Code COMPLETE ADDRESS WINDOW Taxpayer ORR*0015 ANTOINETTE ORR 4892 FLAGLER RD NORDLAND WA 98358-9692 Search Key CMD 6: End Window CMD 7: End of Job • • 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#: BLD14-00217 Received Date 6/17/2014 SITE ADDRESS: 105 NAYLOR CREEK RD Issue Date 6/17/2014 CHIMACUM, 98325 APPLICANT: ANTOINETTE ORR PHONE: 503-467-9608 4892 FLAGLER RD NORDLAND WA 98358-9692 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901272012 Section: 27 Township: 29N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 1/ 7 14-5875 Contractor's License SUNSHP*077QP Expires 1 1 !20 OWNER, ANTOINETTE ORR PHONE: 503-467-9608 if different: 4892 FLAGLER RD NORDLAND WA 98358-9692 PROJECT DESCRIPTION: SWAP OUT 2 X 120V TANKS, TEE INTO EXISTING LINE AND Directions SURFACE MOUNT PIPE TO OUTSIDE /, i To Site: '� " / 1°c=L' 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 6/17/2015. REQUIRED INSPECTIONS: Installation per Manufacturer Specifications/CO2: Ta : EscrLirnE.cl `ii, i�a ?/01"/ Final Approval: $-J 5I'S 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_Permit_Propane.rpt 6/17/2014 • • SITE VISIT REPORT (PLOT PLAN) JOB k 09.12. DATE: 51S\ Lk CONTACT: ADDRESS /O S" Q of Ir:■ , RD , PHONE #: DIRECTIONS FAX #: Email PLANNER: "3.-)e\ Include all street names ad'acent to nronerty property lines tank appliance&piping locations distances of tank to propert y lines and buildin•s settle wells wetland areas distance to water bodies. 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