HomeMy WebLinkAboutBLD2014-00457 - MECHANICAL INJILDING PERMIT APPLICATA BLD14-00457
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD14-00457 Received Date: 12/8/2014
SITE ADDRESS: 27 LORDS LAKE LOOP RD
OWNER: WAYNE S BROWN PHONE:
PO BOX 93
QUILCENE WA 98376-0093
SUBDIVISION: Block: Lot: 1
PARCEL NUMBER: 702111038 Section: 11 Township: 27 N Range: 2V1
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2016
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP NEW MECHANICAL PERMIT
NEW 250 GALLON PROPANE TANK & LINES
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP MEC MAIN:
VALUATION ADD'L: HEAT TYPE: PRO
CODE EDITION: 2012 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 SRE 12/08/14 153932 APPROVED
Total: $228.00
DEC 082014
Jefferson County DCD
`MCA4LI '4he Vra o,e I2/EV14 "
\\tidemark\data\forms\F_BLD_App_Bld.rpt 12/8/2014
�4s()N , JEFFERSON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
4
)ate: 0.4 Time Received: z:zO am/pm Mon. Tue. Wed. Fri.
Date: 05//5
3LD: 14 - 4/57 Contact Name:
owner: BP4)r1 Contact Number: 360 .385- 5.7f7
5,ddress: 77 LDRDS LIC Loaf e9 206
Notes:
Foundation Plumbing Framing ropane 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 pp fl dd/ Appliance
Underfloor L ��� i L Gas/Wood stove
Man-Homes Insulation 5M
Final Inspection X
Setbacks Floor
Foundation Wall Address Posted
Block &Tile Ceiling
1-7 -
•
(4"'5°147.-6-6.\\
"5°4Ca JEFFERSON COUNTY
' kilia,..A DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street• Port Townsend •Washington 98368 _3,1
4x 360/379-4450 • 360/379-4451 Fax
$5, www.co.Jefferson.waus/commdevelopment DEC -18 2014 J
l�
Master Permit Application MLA: u,ilyi
Project Description(include separate sheets as necessary): ---
Ir(Drc,arrr r7
�tikrpre Frop.s+cnAt. L-t"r,tio .
Tax Parcel Number, 7 Do_/// 0 3$ V Property Size: (acres/square feet)
Site Address and/or Directions to Property:
a-7 4-os e.„6
Property Owner(s)of Record:
Telephone: 1 ?Jr152._ Fax: email:
Mailing Address: d • 6 c ac. 0‘..a.,,,..„.13)
.. ,r�Q...A....,L-C t.-D ..,r u �'t tS 1 e
Applicant/Agent(if different from owner): 1 ,t-]i i- -1 Febe_(1
Telephone: ' ;11:) a°65---5-191 Fex: 3b S----- .3 1 5 =ec.1A�vua^c (Jr/12 -
Mailing Address: Q
-0)tv-N l
What kind of Permit?(Check each box that applies
❑Building ❑ Critical Areas Stewardship Plan
❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use)
0 Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a),C(d),or C]**
❑ Manufactured Home 0 Modular 0 Discretionary"D"or Unnamed Use Classification
❑ Commercial* 0 Special Use(Essential Public Facilities)**
❑ Change of Use 0 Boundary Line Adjustment
0 Address 0 Road Approach 0 Short Plat**
❑Home Business 0 Cottage Industry 0 Binding Site Plan**
--El Propane ❑Long Plat'"
0 Sign 0 Planned Rural Residential Development(PRRD)/Amendrpents**
0 Allowed"Yes'Use Consistency Analysis ❑Plat Vacation/Alteration**
❑Stormwater Management El Shoreline Master Program Exemption/Permit Revisions'"'
O Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development**
o Temporary Use ❑ Shoreline Management Variance
❑Wireless Telecommunication* El Comprehensive Plan/UDC/Land Use District Map Amen ent
❑Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendmen
*May require a Pre-Application Conference 0 Tree Vegetation Request
**Requires a Pre-Application Conference
Please identify any other local, state or federal permits required for this proposal, if known:
it-
DESIGNATION OF AGENT
I hereby designate to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE �-% S �-- Date: I i - - `V i 41-
By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,Is true and correct to tte 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'acket
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 writin at the
time of the application that he or she wants prior notice.
Signature:
, Date: I k -ZG -z-a-k'-
The action or actions Applicant will undertake as a result of the Issuance of this permit may negatively impact upon one or more threatened o r
endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as th
"Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken becaus :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 roger ing your
action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds ind (dual
and non-transferable°fsponsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs apd dates it below.
Signature: (,_IV, j ,--"
Date: I 6 - L-61"-
C:\PermitC.enter\###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: «—I 4/i`y
•
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: I
I
( ) ( ) t
MAILING ADDRESS: EMAIL: 'P
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL �`_
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage DispiF sal:
❑ New ❑ Wood Existing:. 0 Sewer
❑ Addition 0 Steel Proposed: Bank ❑ Community System'...
❑ Alteration/Remodel 0 Concrete Total: Height: ❑ Individual System
❑ Repair 0 Masonry SEP Permit#
❑ Demolition 0 Other: Bedrooms: Water Supply:
Existing: Setback: 0 Private well 0 Two Party
Type of Heat: Proposed: 0 Public
Total: Name of System:__
i,
If this is a Commercial Protect you must answer the following: f
Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces:
Number of occupants(includes owners,tenants,employees,etc) Current Proposed 1
IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No
If this is a Propane Tank and/or Ap liance Installation permit,mark all items below thatr
I Und Tank ove ground Tank Size of Propane Tank: c7
I Heat Stove Cook Stove i Woodstove t Fireplace Insert I Hot ater Tank I Pellet Stove i Other
s Is appliance being installed in a Manufactured!Mobile Home 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. i
i t` 3'6 i-1.11,41,11 "0tr ' 4' 3m' ririi
'yam i,
Square Footage Current Proposed +Ft a+., 4s"° a , _ 4.:br .:41,p t °Lit. £ 4-� tOn _ sY.
Main Floor Heated fr` `i EH Bid App Review:
Axa l
2na Floor Heated t73 , i „ Consistency Review:
ip;, H
Other Heated ,ifit ", ' Base fee:
Mezzanine .r , Additional Section:
41',. J. � ,..."0s t I it
Heated Basement ,',11, ?T.01 n Plan Check fee:
Unheated Basements State Surcharge fee ,i
v. r Ft �,
Other Unheated on ter, Pot Water Review fee:
rr!ir 't'.4,./.•10,._";
Garage/Carport j1E4 rvm 0W SUBTOTAL ,cL,
F Ali` %d-.n �' I
S. R ll// Ili
Decks =, + 911/Rd Approach fee:
OA P i
{V lI
R
Other ,X or TOTAL: $ II
1 IN h' =1'74,
Receipt Number:
t `r
: ' ,Ti i1
Cash/Check Number:
�F
r
ESTIMATED COST(REQUIRED) Date:
*Fair market value of all labor and materials foundation to finish
Initials: '
G:\PetmitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
• •
SITE VISIT REPORT '.
(PLOT PLAN)
JOB WC(t- c. ) Pa, LCfowr4 DATE : 11 -1 ( - ) 1 .
(......6
CONTACT: .
ADDRESS oma= (/�� S L2 D ; Q v t PHONE #: .
DIRECTIONS FAX #:
Email .
• PLANNER: .I)aw-re.._ L. .
DEC. t 1 L. : - --- --------7
- 82014 iii
t,'%s�C3h:iiiUNI Y DEVELOPMENT
\li
I
9
1.4`IC 3S CS ST
t-------IzAl
Z.D�
Cavi")
4
9 ii ) \
L,n,
,A,4ic
a,DD
•
__________--------------f ' Seffin 1... :
6 c1 6 Po4c eA
• •
N
99,.ft WS
1IleC
---------
'ill]
2 6 IN a
Pi
-,A Ili .L3 1 tl�.\ 4:1-'-'/\—L-1
.O '. g s\�1 a�— �_; iii i a
u u wse 1 1 �'t8 1 4 EOili
d "' A+ O o
r� I;9i.nm5 e1 +fig :4
q r7.1
o
1.15.'f'e: li 1 1 1 iP ? :17 I 0 _ �� I � �
C)
f
1 \A - V�o
V `
§! 4 i 4 Sq -1 / It I.
g N y,x1 � 1 r, "� • // / " _ O
> + ' . � , A / _ . 678'5..1_
N]3 ' 1"/ _.31845 4".
67846 r /S00'35'491Y 115693'
4`
,
ii
ii
V Z c 11/ 845/ BEARING a
4
I‘'
—G�
zmtr. 4y 11 if 5 qI
S
I 1. 8 �.--- m 8
i r NA
It
N fn
ttfal ki
11�� AC, N
klr ca , IiRifF
NN
0
:.C y
Parcel Details Page 1 of 2
• •
tJefferson
County
r_____,__ np - 't.:2-fir:
^53^„.}^ ....'^:rv: wry ^ A�: .yt-.ca'm'
dib I ke t TZ'
' .,� Home ',.' County info Departments Search
Parcel Number: 702111038 SEARCH
Parcel Number: 702111038 Printer Friendly
Owner Mailing Address:
WAYNE S BROWN
PO BOX 93
QUILCENE WA98376-0093
Site Address:
Section: 11 School District: Quilcene (48)
Qtr Section: NE1/4 Fre Dist: Quilcene (2)
Township: 27N Tax Status: Taxable
Range: 2W Tax Code: 0324
Planning area: Quilcene (10)
Sub Division:
Assessor's Land Use Code: 1101 - Residential - MH W/Land
Property Description:
PUMPKIN PATCH SHORT PLATLOT 1
Tax, AN, Sales, Photos, and
Permit Data Bldq Data Map Parcel •fats &Surve s
Septic Monitorinq Info
ivJefferson County HOME I COUNTY INFO I DEPARTMENTS I SEARCH t
Best viewed with Microsoft Internet Explorer 6.0 or later
Windows - Mac
,A - Pe_kurd (paKcc_.0
st,617_ - Øø (c) - \Z- t
http://www.co.jefferson.wa.us/assessors/parcel/parceldetail.asp?Parcel NO=702111038 12/8/2014
SUNSHINE PROPANE Page 1 of 3
• •
Cli)1 Washington State DepatIntent of
Labor & Industries
SUNSHINE PROPANE
Owner or tradesperson 10853 RHODY DR
CHAWES, RICHARD HENRY PORT HADLOCK, WA 98339
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
11/17/1993-11/17/2016
https://secure.lni.wa.gov/verify/Detail.aspx?UBI=600342368&LIC=SUNSHP*077QP&SAW= 12/8/2014
SUNSHINE PROPANE Page 2 of 3
Bond •
No current bond account. See the bond history.
Bond history
Insurance
FEDERATED SERVICE INS CO $1,000,000.00
Policy no.
633829
Received by L&I Effective date
11/09/2006 11/17/2006
Expiration date
Until Canceled
United States Fire Insurance C $1,000,000.00
Policy no.
506-878572-6
Received by L&I Effective date
11/13/2014 11/17/2014
Expiration date
11/1712015
Insurance history
Savings
........................
(in lieu of bond) $12,000.00
Received by L&I
09/16/2014
Savings account ID Effective date
0770001033 09/10/2014
Lawsuits against the bond or savings
No lawsuits against the bond or savings accounts during the previous 6 year period.
L&I Tax debts
No L&I tax debts are recorded for this contractor license during the previous 6 year period, but some debts
may be recorded by other agencies.
License Violations
No license violations during the previous 6 year period.
Workers' comp
Do you know if the business has employees? If so, verify the business is up-to-date on workers' comp premiums.
L&I Account ID Account is current.
422,171-00
Doing business as
SUNSHINE PROPANE
Estimated workers reported
Quarter 3 of Year 2014"11 to 20 Workers"
L&I account representative
T1 /JAN BENTLEY(360)902-4652 - Email: STRO235@Ini.wa.gov
https://secure.lni.wa.gov/verify/Detail.aspx?UBI=600342368&LIC=SUNSHP*077QP&SAW= 12/8/2014
•
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 #: BLD14-00457 Received Date 12/8/2014
SITE ADDRESS: 27 LORDS LAKE LOOP RD Issue Date 12/8/2014
APPLICANT: WAYNE S BROWN PHONE:
PO BOX 93
QUILCENE WA 98376-0093
1
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 702111038 Section: 11 Township: 27N Range: 2W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 1T/16006-5875
OWNER, WAYNE S BROWN PHONE:
if different: PO BOX 93
QUILCENE WA 98376-0093
PROJECT DESCRIPTION: NEW MECHANICAL PERMIT
Directions NEW 250 GALLON PROPANE TANK& LINES
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 12/8/2015.
REQUIRED INSPECTIONS:
Installation per Manufacturer Specifications/CO2:
i
Tank/Line/Appliance: df OX ///5.4c
Final Approval:
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 12/8/2014
JEFFERSON COUNTY DC.0 No. 153932
DATE to/ UJlLI :
o
RECEIVED FROMSAYISkAAe 1 rr' Iy1e---
DESCRIPTION BARS# AMOUNT
CURRENCYaab •'}U
--pAA �SL
fr
`Pay COIN RCCahnI Iq • UCI
f 0 -111 1.�.< 8- C E C
515 - 2
c
•
m
,,,,,,, -, , . ,, ,,..,,,,,,,,,,,.• .,
5y
:, „ „,„.......„ 8
'', Ari 'Y '
RECEIVED BY &KitIll Hip, TOTAL 1;111-` v U