The URL can be used to link to this page

Home My WebLink AboutBLD2015-00154 - 01 PERMIT APPLICATION � BLD15-00154 1"'{JILDING PERMIT APPLICATI..�1 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD15-00154 Received Date: 5/5/2015 SITE ADDRESS: 970 BEE MILL RD BRINNON, 98320 OWNER: SEATTLE COUNCIL PHONE: 360-796-4427 OF BOY SCOUTS OF AMERICA PO BOX 440408 SEATTLE WA 98114-4408 SUBDIVISION: Block: Lot: 1+ PARCEL NUMBER: 602131002 Section: 13 Township: 26 N Range: 2V1 CONTRACTOR: BIRD ELECTRIC PHONE: 360-779-2112 22930 STOTTLEMEYER RD POULSBO WA 98370 Contractor's License BIRDEC*270JS Expires 2/28/2016 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIO(' NEW FIRE ALARM SYSTEM IN CAMP PARSON DINING HALL TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: 14,000 TYPE OF IMP NEW MAIN: INDUSTRIAL: VALUATION 14,000.00 ADD'L: HEAT TYPE: CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: NUMBER OF EMPLOYEES: WATER SYSTEM: BATHROOMS: Exist: Prop: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $201.00 SRE 05/05/15 155974 Plan Check $130.65 SRE 05/05/15 155974 APPROVED State Building Code $4.50 SRE 05/05/15 155974 Total: $336.15 JUN - I 2015 .Jefferson County DCD \\tidemark\data\forms\F_BLD_App_Bld.rpt 5/5/2015 0 �4SON e0 DEPARTMENT OF COMMUNITY DEVELOPMENT 4� 621 Sheridan Street,Port Townsend,N'.98368 !4•-! Tel:360.379.4450 lax:3GC�.3-9 44i 1 N'a el)wawa c,tiaeffer«>n.wa us%commmnindevelopment (�' 2 �7 (� *al:ty E_mail dcd(u,co.Jefferson.�z t.n5 ' ' ! L�-- '` ?"' 11 \ MING ! PERMIT APPLICATION ' I MAY - 5 2015 Steps in the Permit Process: it t i ,,. Ary -Review application checklist to ensure all information is completed prior to submitting application. .'..n"C0A'thLINIiY DEVELOPMENT -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: 449i- f i'j «- 002 Site Address and/or Directions to Property: (170 `13k----- MJL.L RA. 3rr�(A1)L.)0/.1.., 1.41,4 . "it'* Access(name of street(s)) from which access will be gained: )54a I.4tLL. i O Present use of property: Description of Work(include proposed uses): r i�I 4 i/!'T"- /,t,,!,; T AL_L /,kJ Di:L-'/'t.1 r/,9/-�- 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: Goec .�m t • i 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(i.e., County email is not blocked or sent to"junk mail"). Applicant/Property Owner information Property Owner: Name: 5' -. I TI-E 1Oi ��S O\ c�G rL' _2 !'Sy ° JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street Port Townsend, WA 98368 PROJECT #: 0 /r ` 1,5 DESCRIPTION: 71.'1/4-o-,'-. 2-:,-A—. I!u--c.�`- _______V;,4-e- aZo—,--,--2,_ , arc t.,,,_. 4 REQUESTED BY: DATE: APPROVED BY: DATE: SERVICES COMPLETED BY: - _ .,rti,� DATE: t J/9/i r 5.- CODE OFFICIAL REVIEW HOURS: /. NOTES: C2 ❑ REPORT ATTACHED: YES NO ,t JEFFERSONUNTY • 56 1 79 1 (iif C DATElf,i , , t ,,,,, /, -, , ......,/ .,..) f RECEIVED FROM`... 2 7f17 " /P c f: --0)--4 DESCRIPTION BARS# AMOUNT CURRENCY ',,-. i", �y�' COIN CHECKS —# > J Z CO ,". „xj,ily . ;‘, •-. ,i 6 1 eiC m Js33) , 2 0 *` ,..v. • , _tit/Lt.) 37 RECEIVED BY 7i � 4 +1 °�@ TOTAL ` x r + .v.x.. .. wh,.�AvuSt..uae�rcemnuaa'n.a�5vi VOICE D 6/1/2015 I e ID: DCD15BLD15-00154 �_.SaN cam JEFFERSON COUNTY w� , DEPARTMENT OF COMMUNITY DEVELOPMENT -< 621 Sheridan Street I Port Townsend, WA 98368 360-379-4450 email: dcd@co.jefferson.wa.us q 'o www.co.jefferson.wa.us/commdevelopment ,,,,) Date Due: BILLING ADDRESS: 7/1/2015 SEATTLE COUNCIL OF BOY SCOUTS OF AMERICA PO BOX 440408 SEATTLE WA 98114-4408 Fire Marshall Review 273.00 REMIT TO: Total Amount Due: $273.00 Jefferson County DCD 621 Sheridan St. Port Townsend, WA 98368 Please return the above portion with your payment Permit Number: BLD15-00154 Fire Marshall Review 273.00 Total Amount Due: $273.00 Payment is accepted by cash, check, debit or credit card (Visa, Mastercard, Discover, American Express) To pay by credit card, go to www.co.jefferson.wa.us/commdevelopment, and click on the "Online Credit Card & echeck Payments" link on the left side of the page. (questions: call 360-379-4450) C-211\r\C-k-alk,t A-8Q) 6-ka.C-6,e— LO/ \C 1--CC_ 1 ici . M Mu4 (CI \OWV411 Int car, • • ( sON co DEPARTMENT OF COMMUNITY DEVELOPMENT �� 621 Sher:dan Street,Port Townsend,A\'_1 98368 Tel 301.3-0 4-}51) Fax_360.3-9.4451 FWeb wit-wco.lefYerson.wa.us/commucun-development L' ��f(L i mail.dcd(a,co ietfersomwa.us ` 'fsIf j N y SUPPLEMENTAL APPLICATION ! Li ` MAY - 5 2015 RESIDENTIAL OR COMMERCIAL BLDG PEIVIIT For Department Use Only „hay Receipt#: '.PLafkgETYDEUELflPt9ENT Related Application#s: Payment#: Site Information Owner Name: SFATTLl� LIPt- pr 60.1 3GGk.75 oF Assessor Tax Parcel#: Type of Building Ait-lGr New x Replacement Relocated Addition Repair Demolition Select One: *A separate permit is required Single Family Residence Modular Other list Proposed Building/Project Number of floors # new bedrooms existing total bed #new bathrooms existing total bath Heat Source Select all that apply: Electric Heating Oil Wood Propane Enter the square footage (sq/ft)that applies in each field: Structure ExistingS Ft q/ Proposed Sq/Ft ICC Valuation (Office Use) Residential/Commercial Main Floor Residential/Commercial Second Floor Additional Floors- heated/unheated Basement- unfinished g space or habitable r IDe a�h� - asemertarniRhed eted / ;Garage 2ncd fl fi^ Carport -2 walls or less Deck- uncovered Covered porch Other(shed, barn, pole bldg,etc.) Estimated Cost of Project (Required): $ c.) 90 — • • List existing buildings on property (i.e. house, garage, accessory dwelling unit, shed, barn, mobile home, other): All Existing Buildings on Property Use 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: Print Name: Date: 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: �% J��' ` Fe Print Name: t► Jv -/SEC IL Date: 3.- S /� LFor rtme se 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 Road Approach Total Fees Receipt 14 Date: Cash/Check/CC: • • Sally Ellis From: Ken McEdwards <kenmcedwards@gmail.com> Sent: Tuesday, May 05, 2015 9:48 AM To: Sally Ellis Subject: Camp Parsons Hi Sally, i ) r M `I/ - 52015 Please allow Brian from Bird Electric to pick up the Fire alarm permit for me. L I Lj Thank you c0"[Amy DEVR Or ENT Ken McEdwards 1 BIRD ELECTRIC CORP • Page 1 of 3 am Home inicio en.Espanol Contact rSearch L&I 1 )1=i A-Z Index Help My Secure L&I Safety Claims&Insurance Workplace Rights Trades&Licensing 0 Washington State Department of Labor & Industries BIRD ELECTRIC CORP Owner or tradesperson 22930 STOTTLEMEYER RD NE BIRD,ROBERT A POULSBO,WA 98370 360-779-2112 Principals KITSAP County BIRD,ROBERT A MORLEY,VON W,VICE PRESIDENT BIRD,ROBERT A,AGENT BIRD,LAUREL A (End:02/22/2012) Doing business as BIRD ELECTRIC CORP WA UBI No. Business type 600 092 665 Corporation ILicense Verify the contractor's active registration/license/certification(depending on trade)and any past violations. Electrical Contractor Active. Meets current requirements. License specialties GENERAL License no. BIRDEC*270JS Effective—expiration 04/10/1973—02/2812016 Designated administrator Active. BIRD,ROBERT A SR Meets current requirements. License type License no. Master Electrician BIRD*RS9740C Bond CBIC $4,000.00 Bond account no. SD7090 Received by L&I Effective date , f \\� 07/09/2001 07/01/2001 L. Expiration date Until Canceled i I r Savings MAY - 52015 No savings accounts during the previous 6 year period. I jU License Violations �1 JiJTY infraction no. `.'' COt MUN!TY DEVELOPMENT EJONV02735 Satisfied Issue date RCWJWAC 09/12/2012 19.28.101 RCW https://secure.lni.wa.gov/verify/Detail.aspx?UBI=600092665&LIC=BIRDEC*270JS&SAW= 5/5/2015 BIRD ELECTRIC CORP Page 2 of 3 Violation city • Violation amount • POULSBO $250.00 Type of violation ELECTRICAL CITATION Description Failing to request an inspection within 3 business days after completion of the installation or 1 business day after energizing, whichever occurs first as referenced in WAC 296-46B-900(10)(a),effective after 12/30/2008 see WAC 296-46B-901(10)(a). Infraction no. EJONV02737 Satisfied Issue date RCWNVAC 09/12/2012 19.28.101 RCW Violation city Violation amount POULSBO $250.00 Type of violation ELECTRICAL CITATION Description Covering or concealing installations prior to inspection. Infraction no. EJONV02733 Satisfied Issue date RCW/WAC 09/12/2012 19.28.101 RCW Violation city Violation amount POULSBO $1,000.00 Type of violation ELECTRICAL CITATION Description Failing to obtain or post an electrical/telecommunications work permit prior to beginning the electrical/telecommunication installation or alteration as referenced in WAC 296-46B-900 (3)(6),effective after 12/30/2008 see WAC 296- 46B-901. Infraction no. ESLOD00346 Satisfied Issue date RCWIWAC 01/12/2012 19.28.271 RCW Violation city Violation amount Poulsbo $500.00 Type of violation ELECTRICAL CITATION Description Employing an individual for the purposes of chapter 19.28 RCW who does not possess a valid certificate of competency or training certificate to do electrical work. Infraction no. ECHIR00686 Satisfied Issue date RCW/WAC 10/24/2011 19.28.101 RCW Violation city Violation amount POULSBO $250.00 Type of violation ELECTRICAL CITATION Description https://secure.lni.wa.gov/verify/Detail.aspx?UBI=600092665&LIC=BIRDEC*270JS&SAW= 5/5/2015 BIRD ELECTRIC CORP Page 3 of 3 Failing to obtain or post an • • electrical/telecommunications work permit prior to beginning the electrical/telecommunication installation or alteration as referenced in WAC 296-46B-900 (3)(6),effective after 12/30/2008 see WAC 296- 46B-901(3)(6). infraction no. EROMA00559 Satisfied Issue date RCWt1fdAC 03/10/2010 19.28.271 RCW Violation city Violation amount Poulsbo $500.00 Type of violation ELECTRICAL CITATION Description Employing an individual for the purposes of chapter 19.28 RCW who does not possess a valid certificate of competency or training certificate to do electrical work.Re:Kevin M. Holt,inactive certificate. 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. 342,504-00 Doing business as BIRD ELECTRIC CORP Estimated workers reported Quarter 1 of Year 2015"31 to 50 Workers" LW account representative T1/IDA HAYNES(360)902-5635-Email:HAYN235@Ini.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 10/10/2011 Violations inspection no. 314954884 Location 1600 Chester Ave Bremerton,WA 98337 Washington State Dept.of Labor&industries.Use of this site is subject to the laws of the state of Washington. https://secure.lni.wa.gov/verify/Detail.aspx?UBI=600092665&LIC=BIRDEC*270JS&SAW= 5/5/2015 • 45ON e DEPARTMENT OF COMMUNITY DEVELOPMENT '444., , 621 Sheridan Street,Port Townsend,WA 98368 � n V l u W, Tel:360.379.4450 Fax:360.379.4451 — I I Web:wcaw.co.iefferson.wa.us/communitvdevelopment ! E E-mail:dcd@co.jefferson.wa.us ; n''t I MAY - 5 2015 '' h _ 1 k'No S � LI PERMIT FEES WORKSHEET Cr COMMUNITY DEQ/ELOPMENT Name Camp Parson Parcel# 602131002 Estimated Cost of Project $14,000.00 Permit# Building Base Fees Building Base $201.00 Plan Check Review $130.65 Land Use Review Septic Review Potable Water Technology/Scan $19.50 State Fee $4.50 Other Fees Shoreline Exemption Zoning Fire Marshall $78.00 Zoning New Address Public Works Total Fees $433.65 Office Use Only Receipt Number: 5597-t4. Cash/Check/CC: C09I Date: 5/3/ I S