HomeMy WebLinkAboutBLD2005-00529 IUILDING PERMIT APPLICAIN BLRDOe 00529
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD05-00529 Received Date: 8/17/2005
SITE ADDRESS: 293 MYRTLE ST
PORT TOWNSEND, 98368
OWNER: ROBERT D MALECKI PHONE: 360-385-9520
DIANE L MALECKI
293 MYRTLE RD
PORT TOWNSEND WA 98368 OCEAN GROVE ESTATES#2
SUBDIVISION: Block: 7 Lot: 6
PARCEL NUMBER: 977100702 Section: 24 Township: 30 N Range: 02 W
CONTRACTOR: PHONE:
PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION CONVERTING EXISTING 2ND FLOOR OF GARAGE TO HEATED
CRAFT ROOM
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP ALT MAIN:
VALUATION 39,169.00 ADD'L: HEAT TYPE: EEE
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY: R-3 UNHEATED: #OF STORIES:
OCCUPANCY:
CONST TYPE: 5N OTHER: 437 SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL: CMY
WATER SYSTEM: CITY
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop: 1
Total: Total: 1
Routing Date:8/ j
11/0S
Type Amount Paid Bv: Date: Receipt: Approved/Date
Permit $542.75 SLE 08/16/05 76287 f P P R c\/E r
Plan Check $352.76 SLE 08/16/05 76287 V 1�
State Building Code $4.50 SLE 08/16/05 76287 AUG 2 5 2005
Total: $900.01 Jefferson County Planning
& i d' epartment
•
• BUILDING PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD05-00529 Received Date 08/17/2005
SITE ADDRESS: 293 MYRTLE ST Issue Date 08/25/2005
PORT TOWNSEND, 98368
APPLICANT: ROBERT D MALECKI PHONE: 360-385-9520
DIANE L MALECKI
293 MYRTLE RD
PORT TOWNSEND WA 98368
SUBDIVISION: OCEAN GROVE ESTATES#2 Block: 7 Lot: 6
PARCEL NUMBER: 977100702 Section: 24 Township: 30 N Range: 02 W
CONTRACTOR:
PROJECT DESCRIPTION: CONVERTING EXISTING 2ND FLOOR OF GARAGE TO HEATED
CRAFT ROOM
CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT.
SETBACKS:
UFFER:
Footing:
Foundation:
Stormwater FINAL Approval:
Underground Plumbing:
Underground Insulation:
Shear Wall :
Sheathing:Framing /Ci� `cif
Plumbin / Lei-Os----
Propan Tank/ Lines:
Insulation: ( /G/j3// ;* 4,‹ :5014.- O K ley/3lo6
gl-
Sheetrock:
Septic Sytem Final Approval (If not on sewer):
Road Approach Final Approval:
Zoning Final Approval:
Final/Occupancy Approval: !a a--0�
HEALTH DEPARTMENT_)try
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. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:00 a.m. -4:30 p.m.
HOT LINE AVAILABLE 24 HOURS A DAY
I:\F_BLD_Permit_Buildng.rpt 10/29/19
IllAiNE12 BUILDER STATEMENT 41
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: ,! zMX._ - -"N al{ -1 4 \ Date: ( , / . , ). 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 IR Wood Existing: 0 Sewer
❑ Addition 0 Steel Proposed: i Bank )3(Community System
Alteration/Remodel ❑ Concrete Total: r Height: ❑ Individual System
❑ Repair ❑ Masonry SEP Permit# (3 1—3-.,
[1 Demolition 0 Other: Bedrooms: Water Supply:
Existing: Setback: Li Private well [] Two Party
Type of Heat: Proposed: )Q Public
4�i c�c /-r i L✓ Total: (Name of System:
�'11h� �tJ : I Pi'tLT 1(jAvvSLA. 1
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 I Underground Tank I Above ground Tank Size of Propane Tank:
LI Heat Stove ❑ Cook Stove f] Woodstove I 1 Fireplace Insert i Hot Water Tank I 1 Pellet Stove 0 Other
Is this appliance being 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 For Office Use Only
Current Proposed Amount
Main Floor Consistency Review:
2""Floor Base fee: 51a • 7 S
3f°Floor Additional Section. 1
I
Mezzanine: Plan Check fee: 35 , 7(0
.ENT
Heated Basement State Surcharge fee: -------
1.
Unheated Basement Pot Water Review fee:
?rdv(LnA, o—k ocN01— (085 — r
Other Unheated 911/Rd Approach fee:
Garage/Carport
TOTAL: $ CVO.
O i
Decks Receipt Number:
.76.ag7
Other 4 7 QGhtf�l6 Cash/Check Number: (0�,
ESTIMATED COST(REQUIRED) Date: (^
•Fair market value of all labor and materials found ion to finish (a /142`0J a�p & C) Z) , (j Ci Initials:
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
��¢soly cow JEFFERSO$OUNTY • No I`1 LA
W j DEPARTMENT OF COMMUNITY DEVELOPMENT R _V1
`� ik
kilo
621 Sheridan Street • Port Townsend •Washington 98368
IG 360/379-4450 S.
360/379 4451 Fax - ,
q O www.co.jefferson.wa.us/commdevelopment
sN�z AUG 16 2005 1 r
Master Permit Application M A.
•
V
Project Description(include separate sheets as necessary): !ENT
C-c, l.) fir F 12-- C_yc i S 7-/A/C G-A-+ G-€.. -14:7 -1--C - f.cw/MC- /2-0 Q P/
Tax Parcel ..-7 t1 Property ��11
Number: ) / / / D 0 7 D D---, Size: e o� ) D (acres/square feet)
Site Address and/or Directions to Property: a 9 3 (Y) y t2..7--I q, (L D t P o t2T TO w Al S C.4N D
Property Owner(s)of Record: R 0 iSrcTZT A i. 0 et 1 A N ti, Y1 A LS..-ty K /
Telephone: '- t- C - :3 W. - cl S.2 0 Fax: email:
Mailing Address: -'2 9 .3 m y r .ri___ct_, )1..r . Jo D 2T TD UI A)s l__to/'\ I`i) H c) g' 3 (o v
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies)
, Building ❑ Variance(Minor, Major or Reasonable Economic Use)
❑ Demolition Permit ❑ Conditional Use[C(a), C(d),or C]**
❑ Single Family ❑ Discretionary"D"or Unnamed Use Classification
❑ Garage Attached/Detached ❑ Special Use(Essential Public Facilities)**
❑ Manufactured Home ❑ Boundary Line Adjustment
❑ Modular ❑ Short Plat**
❑ Commercial* ❑ Binding Site Plan**
ist Change of Use ❑ Long Plat**
❑Address I I Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments**
❑ Propane ❑ Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions**
El Stormwater Management ❑ Shoreline Management Substantial Development**
❑ Site Plan Approval Advance Determination(SPAAD)* f7 Shoreline Management Variance
❑Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* CI Jefferson County Shoreline Master Program Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium
*May require a Pre-Application Conference **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 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,her or it's 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.Access and right of entry to this property shall be requested and shall occur only during regular business
hours.
Signature: ,-'� �_ Date: C Cam]_.. . I b , O cj
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 compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transfer()le responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it Oelow.
Signature: i(1Gl -/..x- - �. - J ri--d1�, -Ett- Date: 0-c.t . /,5 1.0 0
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
E O
— m
0
` Z
D
m
c 'C
DD z r rs .
4-\ X f` a
� 73. p
0 m ,' 3
o �
\ x 3sr.gW Jo
0 (' `t.4 p N c1
' 13-0N yu.,nr 3
m IT
-1z.....„ ,_) 7:..i. r Z "--6 Ct 1 is_L-0 tv
zy Z.
\ " Jr I f O G'3!tr o^r '' J tl
Z.t) -eV-. M cr. 43 a3 '"21q1 W M:
ry
Q r' I AO) a •1e- -4 -LaH
ilo'7 QM v{ ')tJ 1 1 "1.4.51►N1
O l•ill AI t►l S N 1 BSI X"3 ?.a 1^i M
< 1 1�^�?a('� a3 3-94-z1�1- o ti311 tt 'f4 15-C
,� 3 0 "�o Y 7/3a n c hX1, `<s.
v ice'mom \ t. -
fs _ c
i'1 F lc - \ /
1. c , m 0 • v-
Z 0 i CO cr '7 i., % -c,:i 7
f CAI O `�� "F by Q t `S/AP r �, ♦ .<
r c� '
y (�, Q, ,/o �r ao rt ,
eo �C t'' U S rri ' i Z
f-crz,1
tr �r
F (‘ ? A. `,1
G > -
3, m
T
vi
v _b I
m / 7 --- b -- QJ
t -%ca jf.
Fri 1, � C�J c � .t -, AI
S r v
-0 D w �'
�
O 2 aa�
,6yth - , r' 33-6 I
1, C e -'3 I' a � r ,,
3 c- (�l zii/ r
� � ! I
d
Z r' "T•-. i1ev fiX')
, * _
cu Z ��
-�
°C' 0 r — j'
CP
a r z I
v r Q 1\ CI
N z
t- w
� � - - , g
PI - Z. --� 45
Lz
"- —) rn
< I
-
O
E n
T T.
rn
11 D I' '
v D '-I �l�°.. r y
1
O m
f*
QV - I `'f'"—
: AN' ��
P > , , �\n `
•
r-w-- 1
C(,.Lif))e-bNr7 'I1-,34,m,M ' 1 ` 33
2
. c- C:. ....0 ". : 1: ci; 15
I- IS
u� p ; �4 7(N
' o
�c -� W . 3 ism
L r i J Z ,a '' b
ID (r 0 777 � L �i
<---' —<,--- 44-F---
Cc,c,1 n7N1,� sa10vH�,'SN
I
D _ ._- —
C
.
m
74FI-
CP m
m
7S r
U >
1 m
D
0
O
rn
cn
r
r
n =
Xo
Z
m
- z
c
3
CO
LvX
0
rn
"o
m
cn
O
Z
m
-o
a
z
0
a
6
c z
1 o
cu
°9