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Home My WebLink AboutBLD2006-00460 1 -, ,Pre-Pre tf4 a -I ��• • UILDING PERMIT APPLICATI N MRAOW0 Type: pe:l Jefferson County Department: of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00460 Received Date: 8/8/2006 SITE ADDRESS: 3657 OAK BAY RD PORT HADLOCK, 98339 OWNER: ACORN GROWTH LLC PHONE: 360-437-0177 TRSTE OF THE CHATFIELD TR 3659 OAK Y RD PORT HA OCK WA 98339 SUBDIVISION: Block: Lot: T 99 PARCEL NUMBER: 921194071 Section: 19 Township: 29 N Range: 01 E CONTRACTOR: / OW ER/BUILDER PHONE: REPRESENTATIVE: PHONE: ( 11 0'6 PROJECT DESCRIPTION NEW SFR W/AG 250 GAL PROPANE TANK -7)) TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 1,452 VALUATION 107,184.00 ADD'L: HEAT TYPE: EEE CODE EDITION: 2003 HEAT BASE: HEAT TYPE: PRO OCCUPANCY: R-3 UNHEATED: #OF STORIES: OCCUPANCY: CONST TYPE: 5N OTHER: 108 SHORELINE: GARA CONST TYPE: DECKLE 417 SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: ,PWELL BEDROOMS: BATHFZQOMS: Exist: Exist: Prop: 2 Prop: 2 Total: 2 Total: 2 Routing Date: e `s.( 0 Type Amount Paid By: Date: Receipt: Approved/Date Total: ILDING PERMIT APPLICATIJ MLA06-00449 Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00460 Received Date: 8/8/2006 SITE ADDRESS: 3657 OAK BAY RD PORT HADLOCK, 98339 OWNER: ACORN GROWTH LLC PHONE: 360-437-0177 TRSTE OF THE CHATFIELD TR 3659 OAK BAY RD PORT HADLOCK WA 98339 SUBDIVISION: Block: Lot: T 99 PARCEL NUMBER: 921194071 Section: 19 Township: 29 N Range: 01 E CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTION NEW SFR W/AG 250 GAL PROPANE TANK TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 1,452 VALUATION 107,184.00 ADD'L: HEAT TYPE: EEE CODE EDITION: 2003 HEAT BASE: HEAT TYPE: PRO OCCUPANCY: R-3 UNHEATED: # OF STORIES: OCCUPANCY: CONST TYPE: 5N OTHER: 108 SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: 417 BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: PWELL BEDROOMS: BATHROOMS: Exist: Exist: Prop: 2 Prop: 2 Total: 2 Total: 2 Routing Date: (s p �l C Type Amount Paid Bv: Date: Receipt: Approved/Date Total: FROM :JOSS DORN &GAIL LUCAS • FAX NO. :3604370177 S. 11 2006 09:19AM P1 az.ei //' 9 /I iggc-ova let OAr A 4 6- (/ % ? � e r a /Q .7' h �? a / P . � dam`' •tom r e.� i Le# V 6910-7-7 RECEIVED AUG 112 5 1{0. 7- ar ' 7 t1ram 57 d e J6 b _ lo n QRxC,42Jr> - � 3a `l)t c �� , , C0 JEFFEDN COUNTY F- DEPARTMENT OF COMMUNITY DEVELOPMENT `4 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax AUG - 4 2006 o� www.co.jefferson.wa.us/commdevelopment AUG - 4 2006`x • S IN�rS i Master Permit Application IVI Project Description (include separate sheets as necessary): _ +' 1 V G L E. t' N 1--, i;:_ `i UGC.:?C C-c_.//t.' Cr Property Tax Parcel Number: 9 a2// '?f 7/ 1. 7 c' / L Size: square feet) Site Address and/or Directions to Property: 3 6 S Q iq s' ,qt y�/� j>L��'�/��j Gry� k A f� Property Owner(s)of Record: 4-c- .Q/(;' 6/2 Cl L )rt./ Z-L_ C Telephone: : CF IL 3 7-- 7 7 Fax: (c C V T- ct/ 7 7 email: Mailing Address: LQ ,59 c"ff k:' /1 y �uv."7 /Yr/z7 r3 Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit? (Check each box that applies) 6•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** 40 Address I] Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** a.0 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 0 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. VSignature: %r Date: 'y 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- transferable responsib. for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: > �\'' Date: k-(-77c_4-7:, I. 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 donttctors and that they will be assum' g the responsibility of the General Contractor for the proposed project. _1.._- - Signature: . \ .\.,, Date: el 7 c<``,L4 GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: R t'AX: ( ) ( . ) I' MAILING ADDRESS: EMAIL: ,,`Y 'JT CONTRACTOR'S LICENSE WAINS w. ---- NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: K New , 1 Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: aG Bank Height: ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: f ❑ Individual System ❑ Repair ❑ Masonry �` SEP Permit#f.,t'e-'r;-46/30 ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: I Private well ❑ Two Party Type of Heat: Proposed: ,c ❑ Public ffvi �rtTck R��if�Tcsi2 Total: 1 �U Name of System: (rL €c.7e/c) 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 Occu•-I. • IBC T •e of construction: Will you have Food Service? Yes / No 1 s ropa - or`•pp.i•" r: atron permit,mark all items below that apply: ❑ Underground Tank ,l 'Above ground Tank Size of Propane Tank: . 5 C` ,J`' c II Heat Stove r Cook Stove Li Woodstove ❑ 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 tk Main Floor Heated rJ--t EH Bld App Review: /ys.z x(y. ' Cps 2nd Floor Heated ' Consistency Review: J 5 3 Other Heated Base fee: 1 , 032 .S5 Mezzanine 1 Additional Section: Heated Basement Plan Check fee: ` rl 5 Q� c Unheated Basement State Surcharge fee: Y Other Unheated Pot Water Review fee: � 6Re'EAJtfdt'SF_ /6' S- ti5�S;5� G lO • Garage/Carport SUBTOTAL Q O I,i Decks B Approach fee: �/,� °1,� ca 911/RdJ2 Xs. (.5. Other -�- TOTAI,;_...$_ '`i - Receipt Number . .=A,,D •? 'ash/Check Number: ID k ESTIMATED COST(REQUIRED) _. •,, Date AUG — 4 2006 ( � •Fair market value of all labor and materials foundation to finish u`'`/'i,1 O'' 77 8 e/d Initials: IA .ti G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc 'yam _ 1 i r ,.. ..... ............. .. ..... ... -4 ' F -- "-,,,„ ......._. 1 ,.., _ .1. ..o.... , ,L , ,.... 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DINING BEDROOM I LIVING KITCHEN CLOSET BATH I COATS PANTRY 0 ------- - - - - -------- -- - - -- --------- --- - - ------------------------------------- - --------- ----- --- - - - --- - -- ENTRY LL COVERED PORCH ...................................... . . . .... . . ....... ------- ------ - UTILITIES ❑ BAT - - - - - ----------------- --- ----------- ---- - -- -- - ---- - ------------------------------------------ ---------- - -------- - ---- BEDROOM 2 no UCONSERVATORY U 7 Unheated space WeFIOT to b.,Id,.g envelope I elcctn�], no plutubmg DRAWN BY: JOSS DORN 3659 OAK BAY RD LUCAS/DORN RESIDENCE PORTHADLOCK WA 98339 3653 OAK BAY RD. WA 98339 PH, 360 437 0177