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Home My WebLink AboutBLD2006-00479 BLD06-00479 tUILDING PERMIT APPLICATION Review T Ype Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00479 Received Date: 8/21/2006 SITE ADDRESS: 71 STARK RD PORT LUDLOW, 98365 OWNER: RICHARD OSBURN PHONE: 360-437-0671 SALLY L OSBURN 71 STARK RD PORT LUDLOW WA 983659513 SUBDIVISION: Block: Lot: TX 34 PARCEL NUMBER: 821344046 Section: 34 Township: 28 N Range: 01 E CONTRACTOR: ACE CONSTRUCTION PHONE: (360)373-7875 PO BOX 4627 BREMERTON WA 98312-0407 Contractor's License ACECOI*044BB Expires 12/21/2007 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI INSTALL TIE-DOWNS ON EXISTING STRUCTURE TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP REP MAIN: VALUATION 750.00 ADD'L: HEAT TYPE: CODE EDITION: 2003 HEAT BASE: HEAT TYPE: OCCUPANCY: OCCUPANCY: UNHEATED: # OF STORIES: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $38.75 LYK 08/21/06 84729 APPROVED Plan Check $25.19 LYK 08/21/06 84729 State Building Code $4.50 LYK 08/21/06 84729 AUG 2 2006 Total: $68.44 Jefferson L ouniy Planning l Building Department 0 IT BUILDING PIERMIT County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD06-00479 Received Date 08/21/2006 SITE ADDRESS: 71 STARK RD Issue Date 08/21/2006 PORT LUDLOW, 98365 APPLICANT: RICHARD OSBURN PHONE: 360-437-0671 SALLY L OSBURN 71 STARK RD PORT LUDLOW WA 983659513 SUBDIVISION: Block: Lot: TX 34 PARCEL NUMBER: 821344046 Section: 34 Township: 28 N Range: 01 E CONTRACTOR: ACE CONSTRUCTION PHONE: (360)373-7875 PO BOX 4627 BREMERTON WA 98312-0407 Contractor's License: ACECOI*044BB Expires: 12/21/2007 PROJECT DESCRIPTION: INSTALL TIE-DOWNS ON EXISTING STRUCTURE CALL IN FOR THE REQUIRED INSP5CTIONS THAT APPLY TO YOUR PROJECT. SETBACKS: N (/ A UFFER: I� (A Footing: I\1 //h Foundation: N 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 Approval: (.. , 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 I:\F_BLD_Permit_Buildng.rpt 10/29/19 • • 41 '.4 °N COG\ JEFFERSON COUNTY ' ,A DEPARTMENT OF COMMUNITY DEVELOPMENT '' -. 's4 i 621 Sheridan Street• Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax 4.,4 www.co.jefferson.wa.us/commdevelopment S�Na,'1� Master Permit Application MLA: 14-0 rY1LA (F Q Project Description(include separate sheets as necessary): A ' / /!= ./Doc_eiWit/ J=kiS 7-7VC -1-1 /ei/4->_ i4 '21 i LC,,ill, 'yvsn4/tt /"e -!G/ergs Tax Parcel Property i _ Number: 1-7 3 � �� Size: ?v) c, ?GC)! ' -c�res/square feet) Site Address and/or Directions to Property: 7/ S:�,. K kl040 ,,e,f/ _64J4:A) u_c,C. Q.16,i-! Property Owner(s)of Repord: //4-«.4ZJ cf a-jZ� OS3e/�% Telephone: ..lam" 3 7 D6'i i Fax: email: -" 4L. r9F d,G.41 Mailing Address: 441 a Applicant/Agent(if different from owner): 4/14- Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) ❑Building ❑Variance(Minor, Major or Reasonable Economic Use) d Demolition Permit ❑Conditional Use[C(a),C(d),or C]** d Single Family ❑Discretionary"D"or Unnamed Use Classification 0 Garage Attached/Detached ❑Special Use(Essential Public Facilities)** 0 Manufactured Home °Boundary Line Adjustment El Modular °Short Plat** Q Commercial* °Binding Site Plan** Q Change of Use °Long Plat** Q Address i Road Approach °Planned Rural Residential Development(PRRD)/Amendments** Q Propane ❑Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisions*" ❑Stormwater Management ❑Shoreline Management Substantial Development** OSite 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 require later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the appli t e she wants prior notice. Signature: !7 v ` 1---- Date: /1..//01; 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 a compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transf e responsibility for adhering to and complying with the ESA. The Applicant has read this disclaim r and signs and dates it below. Signature:, Date: �/ 1- /al D:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05-2.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 assumin ponsi lity of the General Contractor for the proposed project.Signature: , V� Date: 4, K,4 GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: 4 i= G,AA;,� , r- ,o/J //E1 . ( e)) 3"-73 7,p-) - ( ) MAILING ADDRESS: Oe_xroh, /.17 411 r',rt. J EMAIL: CONTRACTOR'S LICENSE 67,f_3 r L. WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New 11 Wood Existing: Y 0 Sewer ❑ Addition ❑ Steel Proposed: Bank ❑Community System ❑ Alteration/Remodel 0 Concrete Total: Height: I Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: 490Li w Existing: v Setback: ❑ Private well 0 Two Party Type of Heat: Proposed: ❑Public Total: 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: O Underground Tank 0 Above ground Tank Size of Propane Tank: d Heat Stove 0 Cook Stove ❑Woodstove ❑Fireplace Insert =Hot Water Tank 0 Pellet Stove p 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: 2"tl Floor Heated Consistency Review: -x--- Other Heated Base fee: Mezzanine Additional Section: Heated Basement Plan Check fee: i a5 c► Unheated Basement State Surcharge fee: i 4T Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL / !1� (off Decks 911/Rd Approach fee: ______.-7 Other TOTAL: $ Receipt Number: Cash/Check Number: ESTIMATED COST(REQUIRED) Date: .Fair mark value of all labor and materials foundation to finish 4ir ri5C) Initials: D:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05-2.doc xi -, mo m 0 .i C. —I tr z N .11 ‘ LsD m r t illr . r, hi m .{� 3 t Q lC 4. fiN. 'w h o ------ r --� t —I ' \ V TI m `� :us .Q co\ (1\ , —_-_—_______ ck , i' 7--‘7"-- t t rr; ' \ 1h y'; � � ! �r' , ik(' t r- 4 3 y m av G v m co cl 'fl f:, _ e O aZ ,� m 4. W vJ � O % m 03' ,--=.7 n A , 4 Z fi