HomeMy WebLinkAboutBLD2007-00066 BLD07-00066
BUILDING PERMIT APPLICA•
TT�N Review Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD07-00066 Received Date: 2/22/2007
SITE ADDRESS: 2981 DABOB RD
QUILCENE, 98376
OWNER: RICHARD A REINERTSEN PHONE: (360) 765-4456
2981 DABOB RD
QUILCENE WA 98376-9720
SUBDIVISION: Block: Lot: +
PARCEL NUMBER: 801332003 Section: 33 Township: 28 N Range: 01 W
CONTRACTOR: TOLLEFSON BUILDERS INC PHONE: (360) 732-4080
PO BOX 100
CHIMACUM WA 98325
Contractor's License TOLLEBI977N9 Expires 3/15/2009
REPRESENTATIVE: TOLLEFSON BUILDERS INC PHONE: (360) 732-4080
PO BOX 100
CHIMACUM WA 98325
PROJECT DESCRIPTIOI' FIRE DAMAGE REMODEL(REPL. BURNED STRUCTURE PARTS &
DAMAGED DRYWALL, FLOORS
REPLACE INT. DOOR, EXT. WINDOW & REPL 4' OF INT. WALL)
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP REP MAIN:
VALUATION 35,000.00 ADD'L: HEAT TYPE
CODE EDITION. 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: # OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS:
Exist: 2 Exist: 1
Prop: 0 Prop: 0
Total: 2 Total: 1
Routing Date:
,-1 l
a, )61
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $492.25 KAS 02/22/07 87293 APPROVED
Plan Check $319.97 KAS 02/22/07 87293
State Building Code $4.50 KAS 02/22/07 87293 FEB ';)3 2007
Total: $816.72 Jefferson County Planning
&Building Department
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P.O.Box 100,Chimacum,WA 98325
(360)732-4080•FAX(360)732 4081 •Reg.#TOLLEBI977N9 .07/ mD 8 Rd.
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or revisions to the approved-plans.
Jefferson County Building Dillon Permit Num.: BLD07-00066
Applicant: REINERTSEN
BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2003 International Building Codes
To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection.
Requests received after 7:00 AM will not be scheduled for that day's inspections.
ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries.
The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection
Inspection Item Date Approval Signature Notes
Under Floor Framing N jia
Ext. Shear Wall Nailing N/A
Framing 5-r4tAera in- OK �/ /�
2/28/7 iLL PAQ11AL �l� z/2,7 / C✓ i J lQ%G
Airseal
N/A v
Insulation: Walls N/A
Insulation: Floors NVA
Insulation: Ceiling
Wallboard Nailing i
Ni A kt) lb-9R 1d/y1-1-5
FINAL INSPECTION /D /07 , A1/��- 4,14V
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
/k,�w O6 JEFFERSOIOUNTY
W 1 DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: No T
Project Description(include separate
separate sheets as necessary):
P/R S6rer 14--rrA eyl dap
Tax Parcel Property
Number: 8-D t 33 2 00 3 Size: 4 ' — (acres/square feet)
Site Address and/or Directions to Property:
E 2)Gi?d 4 --,[I1 I t�•.�rrr7,c 1.02• 41( c,
Property Owner(s)of Record: f icbi ler, i ..i.rt2�i v%.
Telephone: etc t\ -- 7 its —y-cf,'c(F Fax: email:
Mailing Address: 5 AI H C
Applicant/Agent(if different from owner): -It!c It' S oti ti,dd C�
Telephone: 2)4>C' 7 3 l- — C '0 Fax: email:
Mailing Address: f.0 'gel tt?r? E 41-Et_ IkAr -t 4Oct,•
What kind of Permit?(Check each box that applies
❑Building 0 Variance(Minor, Major or Reass �\ •l o\44vi t e)1 .' I!
(❑ Demolition Permit 0 Conditional Use[C(a),C(d),or t]
Single Family ❑ Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification
❑ Manufactured Home 0 Modular 0 Special Use(Essential Public Facilities)**
❑ Commercial* 0 Boundary Line Adjustment
❑ Change of Use 0 Short Plat**
❑ Address 0 Road Approach 0 Binding Site Plan**
O Home Business 0 Cottagelndustry 0 Long Plat** IFF1+H\Hi 11 i�I+IIRIl1 11.1,
❑ Propane 0 Planned Rural Residential Devel Dj ndments**
0 Sign ❑ Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions**
0 Stormwater Management 0 Shoreline Management Substantial Development**
O Site Plan Approval Advance Determination (SPAAD)* 0 Shoreline Management Variance
❑ Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* 0 Jefferson County Shoreline Master Program Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium 0 Tree Vegetaion Request
*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 'Mlle �,c J�.c,IAF't�� E to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE It? 'J Date: .' d,2/01
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 re jr 44ater-insaections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the apptt ation hat he or she wants prior notice.Signature: 1 i. Date: g '1/
O 7
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 ifyot afein-compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transferable r sponsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer nd sig s and dates it below.
Signature: Date: dr3-2�Df'
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc
• BUILDER STATEMENT lir-
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.
j
Signature: ►"`e Z% Date: Z _ a 1 ,
,
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
To L) (Sro,c .1�4k=i wc. (344) l S z- C ESc= ( )
MAILING ADDRESS: pp, ri>v X .t:C• (;kz41A u. kicc . EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: #72\11.6Bi4977ti'f1 NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX: ( )
MAILING ADDRESS: EMAIL
Project Type: Fra a Type: Bathrooms: Shoreline: Type of Sewage Disposal:
Li New ood Existing: / .v �c�'� ri Sewer
❑ A ition ❑ Steel Proposed: Bank Community System
❑ Iteration/Remodel 0 Concrete Total: / '" Height: i�I Individual System
Repair ❑ Masonry SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Wat r Supply:
Existing: -Y Setback: lei•'Private well ❑ Two Party
Type of Heat: Proposed: 1 I I Public
pr /1;,c,c Total: Name of System:
4
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
!BC 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:
i Underground Tank 1 Above ground Tank Size of Propane Tank:
Heat Stove I Cook Stove i Woodstove i Fireplace Insert i Hot Water Tank 1 Pellet Stove i 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: __.__...r_
2nd Floor Heated Consistency Review:
Other Heated lr A ,'' Base fee: LI qW �5
Mezzanine Additional Section:
Heated Basement Plan Check fee: 'q t 91
Unheated Basement l(`LLu`IIN j 111\i II �D State Surcharge fee: ,1 '5Q
Crr[nJ V� � ` (� �}
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL
Decks 911/Rd Approach fee: (c)<I S4't
r).;
Other VI t2 E Drim a0i t_ TOTAL: $ (510,1
�J Receipt Number: %'7a6f3
Cash/Check Number: 1 (MO
5
ESTIMATED COST(REQUIRED) \ Date: laa l o�
.Fair market v e of all labor and materials found ion to finish
C7.3,s -/ I) )ci. 1 Initials:
L___________---- ICE:*-
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc