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Home My WebLink AboutBLD2006-00598 • BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD06-00598 Received Date 10/18/2006 SITE ADDRESS: 370 SCHOOLHOUSE RD Issue Date 10/18/2006 BRINNON, 98320 APPLICANT: ARNOLD L SMITH PHONE: ANGELA J SMITH PO BOX 135 BRINNON WA 983200135 SUBDIVISION: Block: Lot: PARCEL NUMBER: 502022002 Section: 2 Township: 25 N Range: 02 W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License: CHSIN**9790Z Expires: 9/7/2008 PROJECT DESCRIPTION: NO MLA REQ'D INSTALLING A/G 250 GALLON PROPANE TANK 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: Plumbing: Propane Tank/ Lines: l 0 P ,a (407 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: 10 `14'4 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 • BLD06-00598 BUILDING PERMIT APPLICATION Review r :I y� Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00598 Received Date: 10/18/2006 SITE ADDRESS: 370 SCHOOLHOUSE RD BRINNON, 98320 OWNER: ARNOLD L SMITH PHONE: ANGELA J SMITH PO BOX 135 BRINNON WA 983200135 SUBDIVISION: Block: Lot: PARCEL NUMBER: 502022002 Section: 2 Township: 25 N Range: 02 W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2008 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI` NO MLA REQ'D INSTALLING A/G 250 GALLON PROPANE TANK TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: CODE EDITION: 2003 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: 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 $51.00 DJK 10/18/06 85168 Total: $51.00 • • 011N A. Op JEFFERSON COUNTY Vie EC It ; W ' � DEPARTMENT OF COMMUNITY DEVELOPMENT "4` 621 Sheridan Street• Port Townsend •Washington 98368 OCT 18 2006 360/379-4450 • 360/379-4451 Fax 4"S www.co.jefferson.wa.us/commdevelopment , , ktrra't° JEf ffRrSIIN� (I�EY UCU Master Permit Application MLA: \LO n 6- set'� Project Description(include separate sh�ejis as necessary /'/, /—M/24t.e, /4 7A/ /A/S Tax Parcel Property Number: Sot 022 002 / Size: , 0-e-s (acres/square feet) Site Address and/or Directions to Property: 3 70 Sdooam.f°t_ ?f,�Za Property Owner(s)of Record:"4"4.6„Ia 4 cYi a,�i Telephone:3, 'o -3o; C//7 / Fax: email: Mailing Address: Rd. ,eon /3 S &/`iN.�ON GrI� 9R3za Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) igBuilding ❑Variance(Minor, Major or Reasonable Economic Use) l j Demolition Permit ❑Conditional Use[C(a),C(d),or C]** Ii Single Family ❑Discretionary"D"or Unnamed Use Classification Q Garage Attached/Detached ❑Special Use(Essential Public Facilities)** ❑Manufactured Home °Boundary Line Adjustment d Modular °Short Plat** Q Commercial* °Binding Site Plan** Q Change of Use ❑Long Plat** O Address i Road Approach °Planned Rural Residential Development(PRRD)/Amendments** I Propane ❑Plat Vacation/Alteration** DAllowed"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 required later inspections. Staff's access and right of entry will be assumed unless the applicant informs the County in writing at the time of the appli that or wants notice. Signature: Date: l'O —/7- i lc 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 th fferson County development code.The Applicant acknowledges that he,she or it holds individual resp non-transf le ibili a ng to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature.' ic- � 'pY — Date: / - /g-Q 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 assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: C /7/ r C€,ne_>c ( ) ( ) 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 ❑ Wood Existing: 0 Sewer ❑ Addition ❑ Steel Proposed: Bank ❑Community System ❑ Alteration/Remodel 0 Concrete Total: Height: Q Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well 0 Two Party Type of Heat: Proposed: ❑Public Total: Name of System: 0 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 PlAbove ground Tank Size of Propane Tank: 2.570 0 Heat Stove ❑Cook Stove ❑Woodstove ❑Fireplace Insert 0 Hot Water Tank 0 Pellet Stove In 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 3G� EH Bld App Review: 2nd Floor Heated Consistency Review: Other Heated Base fee: Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL .50 Decks 911/Rd Approach fee: Other TOTAL: $ Receipt Number: 5 Cash/Check Number: Q 30 ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish I I Initials: D:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05-2.doc -o 73 o O rn 2r\ . ran 1 \\ i I O I 0 r 1 O n I fl '� \' NI I- 1 O ,I \ ' N i \ ' j i Wm }�•t6 � D � t x.• 1- oII o 1 N. O v I q r m -1 i 7-71 co --( • r O n X 'T' Z Z Z 3 m :1_. SN v Ii W i m w O ti m ry t q v % • '' i . 1- 5 X N 1 -T-) O 713 = o A 00 -- N) l N el S M 1 � 1. 1 0 \i Le