HomeMy WebLinkAboutBLD2006-00055 !UILDING PERMIT APPLICATIN BL Review Ty Ty 055
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Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD06-00055 Received Date: 2/9/2006
SITE ADDRESS: 593 MC MINN RD
PORT TOWNSEND, 98368
OWNER: BRIAN C PERCIVAL PHONE: 360-385-9779
CYNTHIA ELMORE
593 MCMINN RD
PORT TOWNSEND WA 983689646
SUBDIVISION: Block: Lot: T 26+
PARCEL NUMBER: 002014002 Section: 12 Township: 30 N Range: 02 W
CONTRACTOR: PAUL KAASE CONSTRUCTION PHONE: (360)385-0221
2021 HILL ST
PORT TOWNSEND WA 98368
Contractor's License PAULKC*061C5 Expires 4/25/2006
REPRESENTATIVE: PHONE:
kick •
PROJECT DESCRIPTION REMODEL BATHROOM
'* AtR".0-k — 'Us oom.QQ-C4t1 .ai;trCVKaL,,A agedLco rv,
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ALT MAIN:
VALUATION 12,000.00 ADD'L: HEAT TYPE: EEE
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY: R-3 UNHEATED: # OF STORIES:
OCCUPANCY:
OTHER:
CONST TYPE: 5N GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS:
Exist: 3 Exist: 1
Prop: )K. Prop: 1
Total: x 3 Total: 2
Routing_Date::
c �= dj I r/L _c
Type Amount Paid Bv: Date: Receipt: a �`•Tr / er ,
Permit $209.25 LYK 02/09/06 78941 v
P
Plan Check $136.01 LYK 02/09/06 78941 MAR `'1 �
State Building Code $4.50 LYK 02/09/06 78941 Jeifers�n Coun
Total: $349.76 & BuildingfY rrment g
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BUILDING PERMIT •
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD06-00055 Received Date 02/9/2006
SITE ADDRESS: 593 MC MINN RD Issue Date 03/9/2006
PORT TOWNSEND, 98368
APPLICANT: BRIAN C PERCIVAL PHONE: 360-385-9779
CYNTHIA ELMORE
593 MCMINN RD
PORT TOWNSEND WA 983689646
SUBDIVISION: Block: Lot: T 26+
PARCEL NUMBER: 002014002 Section: 12 Township: 30 N Range: 02 W
CONTRACTOR: PAUL KAASE CONSTRUCTION PHONE: (360)385-0221
2021 HILL ST
PORT TOWNSEND WA 98368
360-385-0154
Contractor's License: PAULKC*061C5 Expires: 4/25/2006
PROJECT DESCRIPTION: REMODEL EXIST BDRM INTO A BATHROOM
CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT.
SETBACKS: NI A
UFFER: NP
Footing: N P
Foundation: l Pc
Stormwater FINAL Approval: N P'
Utldergmund-'fumbing: 1l 01 -1 -'--Pi t rINNCZ61C1C3
Underground Insulation: N1 c
Shear Wall : N It
Sheathing: NA
Framing:,y /
Plumbing; / 2
Propane Tank/ Lines: NA-
Insulation:
Sheetrock:
Septic Sytem Final Approval MUST be obtained before final of structure can be attempted.See COnc�4.4ttx1S
Road Approach Final Approval: I'Pc
Zoning Final Approval: N Pr
Final/Occupancy Approval: (6y22-06 FP
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. 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
SPECIAL CONDITIONS APPLY - SEE REVERSE
r •
SPECIAL CONDITIONS FOR CA!# BLD06-00055
1.) PRIOR TO OR AT FINAL INSPECTION, INSPECTOR MUST VERIFY TWO BEDROOMS
ONLY
I:\F_BLD_Permit_Buildng.rpt 10/29/1999
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rivl`SO C JEFFERSWCOUNTY i
y DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
.ys' 9
www.co.jefferson.wa.us/commdevelopment FEB - 9 2006
kIN� MLA-Master Permit Application MLA: NO'
I�I, LA- t 2Uiv
PrR ject Description (include separate sheets as necessary):
/4/04LSL a-XIP77i(/G I42H iti To 644-1-,0(Al
Property
Tax Parcel Number: OOZ O/ / OD Z, Size: (acres/square feet)
Site Address and/or Directions to Property: 593 /4evgiN,J /26 p r 1 104._ - q rT-?
Property Owner(s)of Record:
Telephone: c e, • 2 PS' 9 779 Fax: email:
Mailing Address: ,jqg ,(4•11/it),(/,'2 4Q� /DPI, �iJJ1w /J. l/Q},._ 9�?Q'
/
Applicant/Agent(if different from owner): AUL //4/[-s-i=
Telephone: 34,p •1,pS-.Q z . / Fax: c__?(ap • ,3 Ps-. Q/6-././ email:
Mailing Address: ZOZ/ J/j'[. 7 / POeribkJiJS it/B, 4 4-•,• 9r.u?
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**
❑ Change of Use ❑ Long Plat**
❑Address ❑ Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments**
❑ Propane ❑ Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions**
❑ Stormwater Management ❑ Shoreline Management Substantial Development**
❑ Site Plan Approval Advance Determination (SPAAD)* ❑ Shoreline Management Variance
❑ Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* ❑ 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
�J�UL
I hereby designate / 1 ✓4ft to act as my agent in matters relating to this application for permit(s).
/
OWNER SIGNATURE ( gAL( 4 Ceixeyc Date: /•Z 3 • 0 6
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 an right of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application
review and any re I later inspecti s.Access and right of entry to this property shall be requested and shall occur only during regular business
hours.
Signature: Date: 12 3 . 0 6
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 c pliance with t e Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-
transferable respo si ility for a h ng to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: 1? •---G- Date: / • 77 •p 6
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc
0 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:
/ L /gils is c e io�c/ Leo ) #s--.Czz I (-. 0).3' 0 I5
MAILING ADDRESS: Zo 2 / MtL- 6- -- 1 �4 pte36 P EMAIL:
CONTRACTOR'S LICENSE / WAINS
NUMBER: PAJZ/!C 06/c S" NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX: ( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: / Shoreline: Type of Sewage Disposal:
[1 New Wood Existing: ❑ Sewer
❑ Addition LI Steel Proposed: / Bank Height: ❑ Community System
X Alteration/Remodel ❑ Concrete Total: z Individual System
II Repair LI Masonry " S P Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: 3- Setback: X Private well ❑ Two Party
Type of Heat: Proposed: p �J A ID Public
C 64-c• Total: Jt• 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:
❑ Underground Tank ❑ Above ground Tank Size of Propane Tank:
II Heat Stove ❑ Cook Stove ❑ Woodstove ❑ Fireplace Insert LI Hot Water Tank ❑ Pellet Stove ❑ 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 Current Proposed For Office Use Only Amount Revision
Main Floor Heated EH Bld App Review: _
2n°Floor Heated Consistency Review:
Other Heated Base fee:
Mezzanine Additional Section:
Heated,Basement Plan Check fee: C
Unheate Basement State Surcharge fee: uI v ` °
Other Unheated Pot Water Review fee: 0
Garage/Carport SUBTOTAL 7Y
•
Decks 911/Rd Approach fee:
Other TOTAL: $
Receipt Number: 7Wi L-I I
Cash/Check Number:
G�
ESTIMATED COST(REQUIRED) Date: _1 /Cf/�
•F 'r market value of all labor and materials foundation to finish W
/� co Initials: aL-�
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc