HomeMy WebLinkAboutBLD2011-00089 ILDING PERMIT APPLICAN BLD11-00089
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD11-00089 Received Date: 4/14/2011
SITE ADDRESS: 4393 S DISCOVERY RD
PORT TOWNSEND, 98368
OWNER: WENDY R BAILEY PHONE:
KENNETH W BAILEY
PO BOX 1113
GUALALA CA 954451113
SUBDIVISION: Block: Lot: TX 56
PARCEL NUMBER: 001321019 Section: 32 Township: 30 N Range: 01 W
CONTRACTOR: SERVICEMASTER OF OLYMPIC PNSLA PHONE: 360-681-0722
PO BOX 69
CARLSBORG WA 98324
Contractor's License SERVIOP965R7 Expires 2/4/2013
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI REPAIR & REPLACE FIRE DAMAGED ROOF & INTERIOR WALLS
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP REP MAIN: 1,084
VALUATION 33,600.00 ADD'L: 1,039 HEAT TYPE: RAD
CODE EDITION: 2009 HEAT BASE: HEAT TYPE:
OCCUPANCY: R-3 UNHEATED: #OF STORIES:
OCCUPANCY:
OTHER:
CONST TYPE: 5N SHORELINE:
GARAGE: 196
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: 4 Exist: 2
Prop: 0 Prop: 0
Total: 4 o a
Routing Date: �--
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $42.15 LYK 04/14/11 123405
Plan Check $3$3.40 LYK 04/14/11 123405 APPROVE�--
State Building Code $4.50 LYK 04/14/11 123405 APR `Q 2u11
Total: $800.05
Jefferson County Plannin(
& Building Department
ON c._ •
4V--- i 0 JEFFERSON UNTY
tk DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan St • 368
�y 360/379-4450 . 3 q7-3\7 4
www.co.jefferson. a.�la
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Master Permit Application ! ', I APR 1 4 2011 MLA: OD MLA VQE'b
P ect Description indude separate sheets slnegessary):
CO 1 3/�I DEPT OF OMMIJNITY DEVELOPMENT
Tax Parcel Number: er Property Size: (acres/square feet)
Site Address and/or Directions to Property: N 39T S . ®; putty P-A.
Poc- 70_0(\ eil.ct cm ft 9 536't
Property Owner(s) of Record: LL..)42IA.G4.I Q. 1'
Telephone: 7 DI--`NS --Oq/ 1- Fax: .10 - $`6y - 9Y3 L email:
Mailing Address: fD 13t9)l 1113
CC.Ara.)Cc)0. C4 q`�c/t/c
Applicant/Agent(if different from owner): - e.tu ice a, ttC Q 4 -11k4 Oi ;C _re-ii,yKi.k,1
Telephone: 651 0 Z Z Fax: 360 643:3° /f'Po email: ar,t_(fQ. �Sm ____[er+!
Mailing Address: 1 o f;oA (.29 CO,r icsboi0. ut..),4 ctg3Z tj ��-r
What kind of Permit?(Check each box that applies ❑Lot or Road Segregation
,,�SBuilding ❑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
❑ 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)/Amendments**
❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration**
❑ Stomiwater 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:
DECIGNAT!ON OF AGENT •
41 hereby designate cv itt):11 i''.k)O "L_CI CI • -k : to act as my agent in matters relating to this application for permit(s).
J(OWNER SIGNATURE ' A Mg Date: . v/ 1
By signing this application form,the owner/agent attests tha e information provided h.rein,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 tQ provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and apy required later inspect' ns. aff cceSs and right of entry will be assumed unless the applicant informs the County in writing at the
time of th: a plicatidn th- h"o she 1(1" ,Vn -, rior e. ' I L
Signature: w _' G Date: d/
The action ora s ns Applicant will undertake as a result of the issuan 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 Ace 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)eve, if'you are in com 'an with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-tra ,erable re ponsibi i fo dhering to an complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
ri
Signature: \i • / V gt\-- Date: /U`l q 1 ?A1 �^
G:\PermitCenter\###FORMS###\DRD FORMS\Current 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:
SertliC l\O L d e r Of -k%l._..Calyr iC Peetrn 4€1 (30)68/-0 I zz. ( ) 6,3). - 7/v6
MAILING ADDRESS: PO &X 64 ra.ils6n W!4 7'832L) .EMAIL: c aareye5rndire t 'Low
CONTRACTOR'S LICENSE WAINS
NUMBER: oEKVLo?9 1R 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: f Individual System
XRepair ❑ Masonry SEP Permit#
❑ Demolition ❑ Other: . Bedrooms: J Water Supply:
Existing: / Setback: ❑ Private well 0 Two Party
Type of Heat: ` __ - t Proposed: $ Public
cast t.^4.- baSC‘000-4-0\ 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 T Above ground Tank Size of Propane Tank:
I Heat Stove I Cook Stove I Woodstove 1 Fireplace Insert I Hot Water , i Pellet Stove I Other
is this appliance bring 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 mice U x '} v, a- r t' ..,k;:
Main Floor Heated �a j 43 , � k= ' EH Bld App Review:
4J 'i.�
2' Floor Heated , Consistency Review:
St I 10 N,611
Other Heated '- > `� Base fee:
'
Mezzanine /� N/� Additional Section:
Heated Basement P , ,`// 4 Plan Check fee: 3 15 5
Unheated Basement tA /1!t///T State Surcharge fee: _ �LJ
Other Unheated. A Pot Water Review fee:
Garage/Carport ICI ,G SUBTOTAL
Decks A , n n . 911/Rd Approach fee:
/V rf Atb TOTAL $gap .o3
Other ,�I /1,
/�/I .axe 3
Receipt Number: l 2314tn
Cash/Check Number: 100 98
ESTIMATED COST(REQUIRED) Date: ,_
ran materials foundation to finish
33' 6 13 Initials:
�NO -$ /
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
Contractors or Tradespeople Prior Friendly Page Page 1 of 1
General/Specialty Contractor
A business registered as a construction contractor with LW to perform construction work within the scope of
its specialty.A General or Specialty construction Contractor must maintain a surety bond or assignment of
account and carry general liability insurance.
Business and Licensing Information
Name SERVICEMASTER OF OLYMPIC PNSLA UBI No. 602227929
Phone 3606810722 Status Active
Address P 0 Box 69 License No. SERVIOP965R7
Suite/Apt. License Type Construction Contractor
City Carlsborg Effective Date 12/27/2004
State WA Expiration Date 2/4/2013
Zip 98324 Suspend Date
County Clallam Specialty 1 General
Business Type Corporation Specialty 2 Unused
Parent Company
Other Associated Licenses
License Name Type Specialty Specialty Effective Expiration Status
1 2 Date Date
PENINVI973CD
PENINSULA Construction General Unused 2/4/2003 2/4/2005 Inactive
VENTURES INC Contractor
Business Owner Information
Name Role Effective Date Expiration Date
BROWN, EVELYN LENORE President 12/27/2004
BROWN, DAVID JONATHAN Vice President 12/27/2004
Bond Information
Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date
2 LIBERTY MUTUAL INS 015027237 03/18/2008 Until Cancelled
CO $12,000.00 03/28/2008
1 TRAVELERS CAS& 103761084148 01/30/2003 Until Cancelled 04/30/2008
SURETY CO $12,000.00 03/21/2008
Assignment of Savings Information No records found for the previous 6 year period
Insurance Information
Insurance Company Name Policy Number Effective Date Expiration Date Cancel Date Impaired Date Amount Received Date
HARTFORD
5 ACCIDENT& 20SBWTB2762 01/01/2010 01/01/2012 $1,000,000.0012/08/2010
INDEMNITY
HARTFORD
4 ACCIDENT& 20SBWTB2762 01/01/2009 01/01/2010 $1,000,000.0012/08/2008
INDEMNITY
HARTFORD
3 ACCIDENT& 20 SBW TB2762 01/01/2007 01/01/2009 $1,000,000.0012/10/2007
INDEMNITY
HARTFORD
2 ACCIDENT& 20SBWTB2762 01/01/2004 01/01/2007 $1,000,000.00 12/09/2005
INDEMNITY
Summons/Complaint Information No unsatisfied complaints on file within prior 6 year period
Warrant Information No unsatisfied warrants on file within prior 6 year period
https://fortress.wa.gov/lni/bbip/Print.aspx 4/14/2011
10/13/2011 13:44 FAX 3606837148 SERVICE MASTER 2]001
• •
ServieeMaster of the Olympic Peninsula
P.O.Box 69
Carlsborg,WA 98324
Phone: (360)681-0722 Fax: (360)683-7146
' •
facsimile transmittal
To: Rich Fax: 360- 79-4451
From: Evelyn Brown Date: 10-13-111
Re: Insurance Certificate for Claimr#
439'.;S.Discovery Rd.Port Townsend
Permit#BLD11-00089
Company: Service Master of the Olympic Pages: 2 Including Fax Cover Sheet
Peninsula
• • : •• • • • • • • •
fl Urgent CC:'
' •
ID For Review Please Comment U Please Reply 0 Please Recycle
MESSAGE:
CONFIDENTIAL
10%13/2011 13:44 FAX 3606837146 SERVICE MASTER 25002
0ct 1311 12:28p Cathy • 582 p1
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1NStLATION CERTIFICATE "1
'41, ' THE INSULATION HAS BEEN LsiSTALLED IN CONFORMANCE WITH THE
,., f CURRENT THERMAL PERFORMANCE STANDARDS(WASHINGTON /
STATE ENERGY CODE) OR PER.A.PPROVED PLANS,AT THE ADD,1S5 LOCATED BELOW. eft■
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0 Property boundaries . 0 Welk
a Names of adjacent grams O Saatta rank
n Driveways ys end parking spacer D Dcsinfle#d cantor keV Mn if unknown)
R Surface water(pondb,creeica,etc) ❑ North Arrow
a 6uildingg(tgskdence•sheds,garages,rote)
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Jefferson County Building Dion Permit Numb BLD11=00089"
Applicant: BAILEY
BUILDING PERMIT INSPECTION APPROVALS Npplicable Code: 2009 International Building Codes
To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection.
Requests received after 7:00 AM will not be scheduled for that day's inspections.
ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries.
The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection
Inspection Item Date Approval Signature Notes
Framing _i1 / I /°r13
Insulation:Ceiling 10-/3- 1, pr c4� J
Wallboard Nailing r` l
FINAL INSPECTION /a73_ l/
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
BUILDING PERMIT •
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD11-00089 Received Date: 4/14/2011
SITE ADDRESS: 4393 S DISCOVERY RD Issue Date 4/18/2011
PORT TOWNSEND, 98368 Expiration Date 4/18/2012
OWNER: WENDY R BAILEY PHONE:
KENNETH W BAILEY
PO BOX 1113
GUALALA CA 954451113
SUBDIVISION: Block: Lot: TX 56
PARCEL NUMBER: 001321019 Section: 32 Township: 30 N Range: 01 W
CONTRACTOR: SERVICEMASTER OF OLYMPIC PNSLA PHONE: 360-681-0722
PO BOX 69
CARLSBORG WA 98324
Contractor's License SERVIOP965R7 Expires 2/4/2013
PROJECT DESCRIPTION: REPAIR & REPLACE FIRE DAMAGED ROOF & INTERIOR WALLS
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP REP MAIN: 1,084
VALUATION 33,600.00 ADD'L: 1,039 HEAT TYPE: RAD
CODE EDITION: 2009 HEAT BASE: HEAT TYPE:
OCCUPANCY: R-3 UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: 5N SHORELINE:
GARAGE: 196
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: Type Amount Paid By: Date: Receipt:
BEDROOMS: BATHROOMS: Permit $482.15 LYK 04/14/11 123405
Exist: 4 Exist: 2 Plan Check $313.40 LYK 04/14/11 123405
Prop: 0 Prop: 0 State Building Code $4.50 LYK 04/14/11 123405
Total: 4 Total: 2 Total: $800.05
Directions to Site:
HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION
THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED
BUILDING INSPECTION HOT-LINE 379-4455.
Request must be received by 7 am the day the inspection is needed.
Office Hours 9:00 am -4:30 pm MONDAY - THURSDAY
HOT LINE AVAILABLE 24 HOURS A DAY