HomeMy WebLinkAboutBLD2006-00181 BLD06-00181
BUILDING PERMIT APPLICATI N Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD06-00181 Received Date: 4/14/2006
SITE ADDRESS: 106 CAPE GEORGE RD
PORT TOWNSEND, 98368
OWNER: JAY D TJEMSLAND PHONE: 360-379-8250
KRISTY L TJEMSLAND
106 CAPE GEORGE RD
PORT TOWNSEND WA 983689622 IRVING PARK ADDITION
SUBDIVISION: Block: 39 Lot: TR 3+
PARCEL NUMBER: 963303904 Section: 17 Township: 30 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION CONVERT CARPORT TO GARAGE BY ENCLOSING
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP ALT MAIN:
VALUATION 12,256.00 ADD'L: HEAT TYPE: UH
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: # OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: SHORELINE:
GARAGE: 520
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: CAPE GEO
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 0 Prop: 0
Total: 0 Total: 0
Routing Dat :
41140
Type Amount Paid Bv: Date: Receipt: A,pri,A,E(:)5evirs
Permit $223.25 LYK 04/14/06 81032
Plan Check $145.11 LYK 04/14/06 81032
State Building Code $4.50 LYK 04/14/06 81032 ?A'I I 2(3
Total: $372.86 Jefferson County Plannirr
&Building Departmer?
10 •
BUILDING PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD06-00181 Received Date 04/14/2006
SITE ADDRESS: 106 CAPE GEORGE RD Issue Date 05/1/2006
PORT TOWNSEND, 98368
APPLICANT: JAY D TJEMSLAND PHONE: 360-379-8250
KRISTY L TJEMSLAND
106 CAPE GEORGE RD
PORT TOWNSEND WA 983689622
SUBDIVISION: IRVING PARK ADDITION Block: 39 Lot: TR 3+
PARCEL NUMBER: 963303904 Section: 17 Township: 30 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
PROJECT DESCRIPTION: NO MLA REQUIRED-NO CHANGE IN FTPRT
CONVERT CARPORT TO GARAGE BY ENCLOSING
CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT.
SETBAC KS:
UFFER:
Footing:
Foundation:
Stormwater FINAL Approval:
Underground Plumbing:
Underground Insulation:
Shear Wall :
Sheathing:
Framing:
Plumbing:
Propane Tank/ Lines:
Insulation:
Sheetrock:
Septic Sytem Final Approval MUST be obtained before final of structure can be attempted.
Road Approach Final Approval:
Zoning Final Approval:
Final/Occupancy Approva�. S7 ,/1 b
HEALTH DEPARTMENT ND PUBLIC WORKS APPROVAL
O AL 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 10/29/1999
kz4�¢ , COS JEFFERSO•OUNTY (11 ! _ _
14 DEPARTMENT OF COMMUNITY DEVELOPMENT ^ l,, . �;,. L 11
410.1-3 621 Sheridan Street • Port Townsend •Washington 98368 1 _ 1
360/379-4450 • 360/379-4451 Fax
1,9
www.co.jefferson.wa.us/commdevelopment APR 1 4 2006
BIND p
Master Permit Application MLA: /\,, , MLA_ i
,(1
Project Description (include separate sheets as necessary):
A--10 fu a. (LAI )C At` I n-k—a C3c C' cACjh
VV Property
Tax Parcel Number: 000q( 3 3 O3q Oq Size: (acres/square feet)
Site Address and/or Directions to Property: I O(,) CG. ( ( 1 , 7'
Property Owner(s)of Record: 3 C I/ 4k<.,•s-y r µ,s 1a,,
Telephone: 3 ")cl- '3 S d Fax: email:
Mailing Address: Se....6u2, 0 OD 3 2_5- r-r" (l,)c(
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies)
.iZ.Building C]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
Cg"Garage Attached/le ❑ Special Use(Essential Public Facilities)**
❑ Manufactured Hori ❑ Boundary Line Adjustment
❑ Modular ❑ Short Plat**
❑ Commercial* ❑ Binding Site Plan**
❑ Change of Use C] 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
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: `i/S/d ,
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 t9 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-
transferable responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs nd dates it below.
Signature: Date: 'i/.5 ZZ)e-,
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.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: j�, ,, �J Date: t.(/r3/`)t?
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 Es, Wood Existing: ❑ Sewer
O Addition ❑ Steel Proposed: Bank Height: 0 Community System
O Alteration/Remodel ❑ Concrete Total: ❑ Individual System
❑ Repair LI Masonry SEP Permit#
❑ Demolition 0 Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well 0 Two Party
Type of Heat: Proposed: 0 Public
N I A Total: Name of System:
NIA t\-) /A 16
IA
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:
❑ Heat Stove ❑ Cook Stove ❑ Woodstove 0 1 Fireplace Insert ❑ 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: k_)._�JoO
2"°Floor Heated Consistency Review:
Other Heated Base fee:
aD3. �5
Mezzanine Additional Section:
Heated Basement Plan Check fee: I`, 5- , 1
Unheated Basement tate Surcharge fee: 9��
Other Unheated /\ „ of Water Review fee:
Garage/Carport 52.0 SUBTOTAL
Decks 911/Rd Approach fee:
Ir .--4e,----
Other TOTAL: $ LI 3- $
Receipt Number: Q (r� 2
Cash/Check Number:
U3 I01
ESTIMATED COST(REQUIRED) Date:
.Fair market value of all labor and materials foundation to finish .411410(e)
Initials:
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc
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