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Home My WebLink AboutBLD2015-00185 - 01 PERMIT APPLICATION BUILDING PERMIT APPLICATIN BLD15-00185 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD15-00185 Received Date: 6/4/2015 SITE ADDRESS: 124 E GO-ONNA DR QUILCENE, 98376 OWNER: VZW BRINNON VERIZON PHONE: 124 E GO-ONNA BEACH DR. QUILCENE WA 98376 9550- GO-ONNA BEACH TRACTS#2 SUBDIVISION: Block: Lot: 31 PARCEL NUMBER: 955000031 Section: 27 Township: 26 N Range: 1\A CONTRACTOR: MACDONALD-MILLER FACILITY SOLUTIONS PHONE: 206-768-4278 P.O. BOX 47983 SEATTLE WA 98146 Contractor's License MACDOFS980RU Expires 1/3/2017 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION REMOVE AND REPLACE WITH NEW 2 4-TON WALL MOUNTED AC UNITS PER PLANS. RECONNECT TO EXISTING GRILLES. TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: TYPE OF IMP MEC MAIN: INDUSTRIAL: VALUATION 15,000.00 ADD'L: HEAT TYPE: 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: NUMBER OF EMPLOYEES: WATER SYSTEM: BATHROOMS: Exist: Prop: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $0.00 SRE 06/04/15 APPROVED Plan Check $0.00 SRE 06/04/15 State Building Code $0.00 SRE 06/04/15 JUN - 8 2015 Total: $0.00 Jefferson County DCD \\firinrnnr4binia\fnrmc1F RI fl Ann Rlri rni R/d/9l11r. • • , 4��°� 0o� DEPARTMENT OF COMMUNITY DEVELOPMENT $ 621 Sheridan Stall.,Putt Townsend,\\t3 98368 „ -< Tei:360 37rt9.4450 115ne:360379.4451 wa, ,,,,,,,, ieIttI .m s" 1 /chmmurr'rq(I& cini1mant IS-mad:ecdtcu,jl tM cst m.tea Als t 'SW I N f3�OC PERMIT APPLICATION Steps in the Permit Process: -Review application checklist to ensure all information is completed prior to submitting application. -Make sure septic has been applied for and water availability has been proven. -Make an appointment to meet with the Permit Technician by calling 360-379-4450. -This is not a standalone application;it must be accompanied by a project specific supplemental application. -Fees will be collected at intake. Additional fees may apply after review and payment is required before permit is issued. For Department Use Only Building Permit N Related Application Its: MIA It µ Site Information Assessor Tax Parcel Number: 955000031 Site Address and/or Directions to Property:124 E Go Onna Dr. Quilcene, WA 98376 -take WA-3N, left @ WA- 104W, left @ S Point Rd, Slight right onto Thorndyke Rd, left onto Cayle Rd, left onto E Go Onna Dr. Access(name of street(s)) from which access will be gained: Property will be off E Go Onna Dr on the right. ou will have to meet a MacDonald Miller Tech because the site is secured by a fence & locked gate Present use of property: private/Verizon Wireless Description of Work(include proposed uses): Remove and replace with new(2)4-ton wall mounted AC units per plans. Reconnect to existing grilles. Wastewater-Sewage Disposal This property is served by Port Townsend or Port Ludlow sewer system? YES NO If not served by sewer identified above,identify type of septic system below: Type of Sewage System Serving Property: Septic Septic Permit q: Community Septic Name of System: Case ft: Are other residences connected to the septic system? Additions or repairs to sewage system: Is it a complete or partial system installation: Complete Partial _„__ Has a reserve drainfield been designated? Yes _ No Date of Last Operations&Maintenance check: Attach last report to application Describe or attach any drainfield easements,covenants or notices on title,which may impact the property: N/A • • The authorized agent/representative is the primary contact for all project-related questions and correspondence. The County will mail /e-mail requests and information about the application to the authorized agent/representative and will copy(cc)the owner noted below. The authorized agent/representative is responsible for communicating the information to all parties involved with the application. It is the responsibility of the authorized agent/representative and owner to ensure their mailbox accepts County email County email is not blocked or sent to"junk mail"), Applicant/Property Owner Information Property Owner: Name: Address: Phone#: _ E-mail Address: ✓ Please contact Authorized Agent/Representative with project info.(select only one). Property Owner Signature: '' z;'' -ti (4., 47.4 41. Date: Cr,-n2- gttt Note: For projects with ntultiipie owners,attach a separate sheet with each owner(s)information and signatures. Applicant: Authorized Agent/Representative(it other than owner) Name: DARLA DOLL Address: 7717 DETROIT AVE SW SEATTLE, WA 98106 Phone#: (206) 768-4278 E-mail Address: darla.doll r{i macminer,com Professional: Is this an Authorized Agent/Representative for this project? _ NO YES Engineer ve Architect Surveyor Contractor Consultant Name: LEWIE THOMSON License MACDOFS980RU Address: 7717 DETROIT AVE SW SEATTLE, WA 98106 Phone It (206) 905-3736 E-mail Address: lewie.thomson@macmiller.com Professional: is this an Authorized Agent/Representative for this project? NO YES / Engineer Architect Surveyor Contractor Consultant Name: LEWIE THOMSON License# MACDOFS980RU Address: 7717 DETROIT AVE SW SEATTLE,WA 98106 Phone#: (206) 905-3736 E-mail Address: lewie.thomson @macmiller.corn Professional: Is this an Authorized Agent/Representative for this project? NO YES *� Engineer Architect Surveyor Contractor Consultant Name: LEWIE THOMSON License# MACDOFS980RU Address: 7717 DETROIT AVE SW SEATTLE, WA 98106 Phone#: (206) 905-3736 E-mail Address: lewie.thornson @macmiller.com 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 or her 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 making any Issued permit null and void. I further agree to that all activities I intend to undertake or complete associated with this permit will be performed in compliance with all applicable federal,state and county laws and regulations and I 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. Applicant may request notice of the County's inter • • ter upon the property for visits related to this application and subsequent permit issuance, Signatu Print Name: DARLA DOLL Date: 05/29/2015 • • ° DEPARTMENT OF COMMUNITY DEVELOPMENT GSA & 6 21 ShtndtoSuttia,Pur€ tutrtsend,WA 48368 j el.360.379,4450 i Pax:360 379.4451 G VC ct,:teWis to iCiTer natvastxlrnmmunitrdct•ciaprncnt .-1113/1 dtiifntC0 ietWrsOrt.vi:Ltti 6t SUPPLEMENTAL APPLICATION RESIDENTIAL OR COMMERCIAL BLDG PERMIT For Department Use Only Receipt#: Date: Related Application#s: Payment#: Site Information Owner Name: Yee ;2,.0101 (,t,,,,) t k t► f�-SS Assessor Tax Parcel#: CIS C.,0000 J Type of Building New Replacement Relocated Addition Repair X Demolition *A separate permit is required Select One: Single Family Residence Modular Other list Proposed Building/Project Number of floors H new bedrooms 0 existing ,: total bed _ It new bathrooms existing of total bath gtf Heat Source Select all that apply: Electric ---a Heating Oil Wood Propane Enter the square footage(st1/ft)that applies in each field: Structure Existing Sq/Ft Proposed Sq/Ft ICC'Valuation(Office Use) Residential/Commercial Main Floor Residential/Commercial Second Floor Additional Floors-heated/unheated Basement-unfinished Basement-finished space or habitable Detached Garage-heated/unheated Attached Garage-heated/unheated Garage 2nd ft-unfinished storage Garage 2nd fl-finished space or habitable Carport-2 walls or less Deck-uncovered Covered porch Other(shed,barn,pole bidg,etc.) Av f. 2_On 5' AY Estimated Cost of Project(Required): $ )5� 000 • • list existing buildings on property(Le.house,garage,accessory dwelling unit,shed,barn,mobile home,other): All Existing Buildings on Property Use /r 0-4.11 l u B r �e L�t SA G.� C % o 0 it Ala Al t r•• S.G Builders Statement The signer of this statement certifies 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: • "rte - Print Name: /14,./1- Date: °3° Gts 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 or her 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 making any issued permit null and void. Signature: Print Name: -C)44-LA o 1 ) Date:b/ r I For Department Use Only Building Permit Fees Building Base Plan Check Review Land Use Review $234.00 Septic Review $80.00 Potable Water $109.00 Technology/Scan $19.50 State Fee $4.50 Other Fees Shoreline Exemption Zoning Zoning Other New Address Road Approach Total Fees Receipt Date: Cash/Check/CC: 6 • SITE SPECIFIC FINANCIALS- BID DOCUMENT PROJECT INFORMATION VZW Project Manager: 'Travis]. Nichols Site Name: WA1 Brinnon Site Project #: 20151213942 Construction Manager: Travis J. Nichols CONTRACTOR INFORMATION a' it ess Company: MacDonald Miller Facility Solutions Contact: Bradley K Oland Address: 7717 Detroit Avenue SW City, State, Zip: Seattle, WA 98106 Office Phone: 206-768-3910 Mobile Phone: 206-255-7610 TOTAL BID: I ;15,000.00 AGC CAT. NO. DESCRIPTION HOURS LABOR LABOR MATERIAL FEES TOTAL LABOR RATE TOTAL COST 00 0001 PERMITS 20 $95.00 $1,900.00 $900.00 $2,800.00 00 0002 SURVEY FEES $0.00 $0.00 00 0003 ENGINEERING FEES $0.00 $600.00 $600.00 00 0004 ARCHITECTURAL FEES $0.00 $0.00 00 0013 SOILS $0.00 $0.00 01 0010 INSURANCE&BONDS $0.00 $0.00 01 0400 SUPERVISION&COORDINATION 16 $137.50 $2,200.00 _ $2,200.00 01 0600 TESTING $0.00 $0.00 01 2000 PROJECT MEETINGS $0.00 $0.00 01 5100 TEMPORARY UTILITIES $0.00 $0.00. 01 5300 EQUIPMENT RENTAL $0.00 $0.00 01 5900 FIELD OFFICES&SHEDS $0.00 _ $0.00 01 7000 CLOSE OUT&CLEANUP $0.00 $0.00 01 8000 TRUCKS/MILEAGE $0.00 $0.00 01 8100 TRAILERS $0.00 $0.00 01 8200 FUEL $0.00 $0.00 01 8300 TRAVEL TIME/PER DIEM $0.00 $0.00 01 9000 OVERHEAD&PROFIT $0.00 $0.00 01 9200 TAXES $0.00 $0.00 02 1000 SITE PREPARATION&DEMOLITION 6 $125.00 $750.00 $750.00 02 1100 ROAD IMPROVEMENT/CONST. $0.00 $0.00 02 2000 EARTHWORK/EXCAVATION $0.00 $0.00 02 5000 PAVING&SURFACING $0.00 $0.00 02 7800 POWER - TO SITE $0.00 $0.00 02 7900 TELCO - TO SITE $0.00 $0.00 02 8000 SITE IMPROVEMENTS $0.00 $0.00 02 8001 FENCING _ $0.00 $0.00 02 8500 IRRIGATION SYSTEMS $0.00 $0.00 02 9000 LANDSCAPING $0.00 $0.00 03 1000 CONCRETE FORMWORK $0.00 $0.00 03 6000 GROUT $0.00 $0.00 03 8000 TOWER FOUNDATION $0.00 $0.00 03 8001 CATHODIC PROTECTION $0.00 $0.00 03 8002 TOWER MAINTENANCE $0.00 $0.00 03 8050 TRANSPORT/ERECT TOWER $0.00 $0.00 03 9000 BUILDING FOUNDATION $0.00 $0.00 03 9001 BUILDING MAINTENANCE $0.00 $0.00 03 9050 TRANSPORT/SET BUILDING $0.00 $0.00 Page 1 of 2 0 AGC CAT.NO. DESCRIPTION HOURS LABOR LABOR MATERIAL FEES TOTAL LABOR RATE TOTAL COST I 04 0000 IMASONRY I I $0.001 I i $0.00 I 05 0000 (METALS I $0.001 I I $0.00 06 1000 ROUGH CARPENTRY $0.00 $0.00 06 2000 FINISH CARPENTRY $0.00 $0.00 07 2000 INSULATION $0.00 $0.00 07 2500 FIREPROOFING $0.00 $0.00 07 3000 SHINGLES&ROOFING TILES $0.00 $0.00 07 6000 FLASHING&SHEETMETAL $0.00 $0.00 I l 08 0000 (DOORS&WINDOWS I I I $0.001 I I $0.00 09 2600 DRYWALL $0.00 $0.00 09 5700 FLOOR COVERING $0.00 $0.00 09 9000 PAINTING $0.00 $0.00 11 8000 TELECOMMUNICATIONS EOUIP. $0.00 $0.00 T 11 8010 RADIO INSTALL $0.00 $0.00 11 8011 VENDOR INSTALL/RF EOUIP/MISC $0.00 $0.00, 118012 CDMA $0.00 $0.00 13 1260 ICE BRIDGE $0.00 $0.00 13.1400 ANTENNA/COAX INSTALL $0.00 $0.00 13 1450 MICROWAVE INSTALL $0.00 $0.00 15 4000 PLUMBING $0.00 $364.00 $364.00 15 5000 HVAC 28 $125.00 $4,500.00 36 ##### $5,536.00 16 1050 POWER EQUIPMENT INSTALL $0.00 $0.00 16 1051 VENDOR INSTALL/PWR EQUIPMENT $0.00, $0.00 16 2000 GENERATOR/POWER BACKUP $0.00 $0.00 16 5000 LIGHTING&ELECTRICAL _1.6 _ $125.00 $2,000.00 $750.00 $2,750.00 16 6000 GROUNDING $0.00 $0.00 16 7000 ALARMS $0.00 $0.00 XO 0001 PRE-FAB BUILDING-PURCHASE $0.00 $0.00 XO 0002 TOWER-PURCHASE $0.00 $0.00 XO 0003 GENERATOR-PURCHASE $0.00 $0.00 XO 0004 COAX CABLE-PURCHASE $0.00 $0.00 XO 0005 J ARDWARE-PURCHASE $0.00 $0.00 XO 0006 GROUNDING KITS-PURCHASE $0.00 $0.00 Note:If sales tax is applicable, • I: enter sales tax rate and tax will be calculated on materials only. SALES TAX RATE: I I SALES TAX TOTAL:I $0.00 GRAND TOTAL: I $15,000.00 Bradley K.Oland 3/4/15 Contractor Signature Date Page 2 of 2 • �kw4sON co6:4 DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street,Port Townsend,WA 98368 w a V I Tel:360.379.4450 Fax:360.379.4451 Web:uww.co.Jefferson.wn.us/communitydevelopmcnt E-mail:dcdCa,co.iefferson.wa.us N C;C9 PERMIT APPLICATION Steps in the Permit Process: -Review application checklist to ensure all information is completed prior to submitting application. -Make sure septic has been applied for and water availability has been proven. -Make an appointment to meet with the Permit Technician by calling 360-379-4450. -This is not a standalone application;it must be accompanied by a project specific supplemental application. -Fees will be collected at intake. Additional fees may apply after review and payment is required before permit is issued. For Department Use Only Building Permit# Related Application#s: MLA# Site Information Assessor Tax Parcel Number: 955000031 Site Address and/or Directions to Property:124 E Go Onna Dr. Quilcene, WA 98376 - take WA-3N, left @ WA- 104W, left @ S Point Rd, Slight right onto Thorndyke Rd, left onto Cayle Rd, left onto E Go Onna Dr. Access(name of street(s)) from which access will be gained: Property will be off E Go Onna Dr on the right. You will have to meet a MacDonald Miller Tech because the site is secured by a fence & locked gate Present use of property: private / Verizon Wireless Description of Work(include proposed uses): Remove and replace with new (2) 4-ton wall mounted AC units per plans. Reconnect to existing grilles. Wastewater-Sewage Disposal This property is served by Port Townsend or Port Ludlow sewer system? YES _ NO If not served by sewer identified above, identify type of septic system below: Type of Sewage System Serving Property: _ Septic Septic Permit#: _ Community Septic Name of System: Case#: Are other residences connected to the septic system? Additions or repairs to sewage system: Is it a complete or partial system installation: Complete _ Partial Has a reserve drainfield been designated? Yes _ _ No Date of Last Operations& Maintenance check: Attach last report to application Describe or attach any drainfield easements, covenants or notices on title,which may impact the property: N/A � 1 JUN - 4 2.015 V IEFFERSON GOUNN Permit Application Page 1 of 2 i rcC?.Of DO;,�MONIlY pf�lELOPMENI . The authorized agent/representative is tSrimary contact for all project-related questiorSd correspondence. The County will mail /e-mail requests and information about the application to the authorized agent/representative and will copy(cc)the owner noted below. The authorized agent/representative is responsible for communicating the information to all parties involved with the application. It is the responsibility of the authorized agent/representative and owner to ensure their mailbox accepts County email(i.e., County email is not blocked or sent to"junk mail"). Applicant/Property Owner Information Property Owner: Name: ddress: Phone#: • E-mail Address: I Please contact Authorized Agent/Representative with project info. (select only one). Property Owner Signature: Date: Note: For projects with multiple owners,attach a separate sheet with each owner(s)information and signatures. Applicant: Authorized Agent/Representative(if other than owner) Name: DARLA DOLL Address: 7717 DETROIT AVE SW SEATTLE, WA 98106 Phone#: (206) 768-4278 E-mail Address: darla.doll @macmiller.com Professional: Is this an Authorized Agent/Representative for this project? NO YES I Engineer I Architect Surveyor Contractor Consultant Name: LEWIE THOMSON License# MACDOFS980RU Address: 7717 DETROIT AVE SW SEATTLE, WA 98106 Phone#: (206) 905-3736 E-mail Address: lewie.thomson @macmiller.com Professional: Is this an Authorized Agent/Representative for this project? NO YES if Engineer Architect Surveyor Contractor Consultant Name: LEWIE THOMSON License# MACDOFS980RU Address: 7717 DETROIT AVE SW SEATTLE, WA 98106 Phone#: (206) 905-3736 E-mail Address: lewie.thomson@macmiller.com Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: LEWIE THOMSON License# MACDOFS980RU_ Address: 7717 DETROIT AVE SW SEATTLE, WA 98106 Phone#: (206) 905-3736 E-mail Address: lewie.thomson @macmiller.com 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 or her 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 making any issued permit null and void. I further agree to that all activities I intend to undertake or complete associated with this permit will be performed in compliance with all applicable federal, state and county laws and regulations and I 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. Applicant may request notice of the County's intent to enter upon the property for visits related to this application and subsequent permit issuance. Signature Print Name: DARLA DOLL Date: 05/29/2015 MACDONALD/MILLER FAC SOIL Page 1 of 3 Home Iniclo en Espanol Contact Search L&I SE Afit�it A-Z Index Help My Secure I&I Safety Claims&Insurance Workplace Rights Trades&Licensing 416) Washington State Department of Labor & Industries MACDONALD/MILLER FAC SOL INC Owner or tradesperson ATTN:LEE PYFROM PO BOX 47983 SEATTLE,WA 98146 Principals 206-768-4180 SIMONDS,DERRICK R,PRESIDENT KING County WEBSTER,MARK E,VICE PRESIDENT GEBHARDT,STEPHANIE WETTACH,TREASURER HOEL,STEPHANIE W,MEMBER SIGMUND,FREDRIC,PRESIDENT (End:01/04/2011) LOVELY,STEVE C,VICE PRESIDENT (End:01/04/2011) HACK,RICHARD,SECRETARY (End:01/04/2011) KOPET,TYLER,TREASURER (End:01/04/2011) TURLEY,DOUGLAS,CHIEF EXECUTIVE OFFICER (End:01/04/2011) TURLEY,DOUGLAS,CHIEF OPERATING OFFICER (End:01/04/2011) GOUGH,DAVID ANTHONY,DIRECTOR (End:08/29/2014) Doing business as MACDONALD/MILLER FAC SOL INC WA UBI No. Business type 602 254 260 Corporation Governing persons FREDRIC J SIGMUND STEVE C LOVELY; TYLER C KOPET; (/ License r� 1� � v � +1 .....). Verify the contractor's active registration/license/certification(depending on trade)and any past violations. ` ---- ��'J Construction Contractor 1 __.. . ... .__....__ .... Active. — Q `C Meets current requirements. JUN License specialties GENERAL lEE(CZ031 �� 11p", NS License no. . y Pcr`T r ,,.�--. Effective—expiration 12131/2002—01/03/2017 https://secure.lni.wa.gov/verify/Detail.aspx?UBI=602254260&LIC=MACDOFS980RU&SAW= 6/4/2015 MACDONALD/MILLER FAC SC • Page 2 of 3 Bond LIBERTY MUTUAL INS CO $12,000.00 Bond account no. 023006951 Received by L&I Effective date 12/31/2002 12/11/2002 Expiration date Until Canceled Insurance Liberty Mutual Ins Co $2,000,000.00 Policy no. TB7-661-066178-033 Received by L&I Effective date 12/05/2014 12/31/2013 Expiration date 12/3112015 Insurance history Savings No savings accounts during the previous 6 year period. 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. 252,457-05 Doing business as MACDONALD MILLER FACILITY Estimated workers reported Quarter 1 of Year 2015"Greater than 100 Workers" L&l account representative T3/KENT ANDERSON(360)902-6963-Email:ANDN235 @lni.wa.gov Workplace safety and health Check for any past safety and health violations found on jobsites this business was responsible for. Citation issue date 06/18/2012 No violations Inspection no. 315908400 Location 18650 Alaska Service Rd SeaTac,WA 98158 Citation issue date 12/16/2009 No violations Inspection no. 313842668 Location 601 S.152nd St Burien,WA 98198 https://secure.lni.wa.gov/verify/Detail.aspx?UBI=602254260&LIC=MACDOFS980RU&SAW= 6/4/2015