HomeMy WebLinkAboutBLD2007-00187 07-
•UILDING PERMIT APPLICAAN BR Review Ty
187
Ype: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD07-00187 Received Date: 5/1/2007
SITE ADDRESS: 110 N RHODODENDRON DR
PORT TOWNSEND, 98368
OWNER: MAX 0 SELISCH PHONE: (360) 379-4189
SUZANNE C SELISCH
110 N RHODODENDRON DR
PORT TOWNSEND WA 98368-9428 CAPE GEORGE COLONY DIV 3
SUBDIVISION: Block: 7 Lot: 8
PARCEL NUMBER: 938400708 Section: 12 Township: 30 N Range: 02 W
CONTRACTOR: DISCOVERY BAY CONST CO INC PHONE: (360) 301-4191
2016 WATER ST, SUITE A
PORT TOWNSEND WA 98368
Contractor's License DISCOBCO90B9 Expires 9/15/2007
REPRESENTATIVE: DISCOVERY BAY CONSTRUCTION PHONE: (360) 301-4191
PO BOX 1410 (360) 385-9697
PORT TOWNSEND WA 98368
PROJECT DESCRIPTION INTERIOR REMODEL AND ADDITON TO LIVING ROOM ON 2ND
FLOOR
NO MLA REQ'D, NO CHANGE IN FOOTPRINT
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ADD MAIN:
VALUATION 150,000.00 ADD'L: 120 HEAT TYPE: EEE
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: CON
WATER SYSTEM: CAPE GEO
BEDROOMS: BATHROOMS:
Exist: 2 Exist: 3
Prop: 0 Prop: 0
Total: 2 Total: 3
Routing Date: 5
/ f f
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $1,273.75 KAS 05/01/07 139879 APPROVED
Check $827.94 KAS 05/01/07 89879
State Building Code $4.50 KAS 05/01/07 89879
Total: $2,106.19 JUN sd 2007
Jefferson County Planning
& Building Department
Jefferson County Building Dtsion Permit Num •r: BLD07-00187
Applicant: SELISCH
BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2003 International Building Codes
To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection.
Requests received after 7:00 AM will not be scheduled for that day's inspections.
ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries.
The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection
Inspection Item Date Approval Signature Notes
Foundation Footing -74 / ) '3 r? AS 0,01/
Footing Drains
Foundation Stem Wall
Underground Plumbing
Under Floor Framing
Straps(hold downs)
Ext. Shear Wall Nailing
Rough-in Plumbing
Framing
Blocking /WA
Airseal
Insulation:Walls u/1
Insulation: Floors AVA
Insulation: Ceiling ` ijr)
Int. Shear Wall Nailing u/A
Wallboard Nailing ' —I Z_v?
Gas Line: Interior q l Z� cst t
Gas Line: Exterior
Eytsr
Propane Tank ,1 zv !C t
Heat/Chimney Clearance N/A
Drywell/Alt Drainage it•/A
Address Posted Ex/s7,
FINAL INSPECTION 5121/4� aj ' -Par +-dela."
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
k.�. 11 c i., JEFFERSOPDUNTY � "��)) ,II ��I1��� Vl
A DEPARTMENT OF COMMUNITY DEVELOPME'N11�i 1 1 ,
` ` 621 Sheridan Street • Port Townsend • Washington 98368
i � 360/379-4450 • 360/379-4451 Fax r. x 7T,M.".www.co.jefferson.wa.us/commdevelopment
IswiNp`Sp rp' ,�
Master Permit Application 1FU+1i 1IN i4$ ilrJ o M R� Q t. `1
Project Description (include separate sheetse as necessary): n o -t- 111',�11\' 1-Ib�m v)01 v,o
. ,p, \ k 41-k Q-✓x a-r of- kv Se (I.-cit. � , ).o 0 o t' Y aC S �' rt f r gi n} et r� ., :
Tax Parcel Q Property I -
Number: l 3� i"1' -7 O`TS Size: (acres/square feet)
Site Address and/or Dir('ectiorns to Property:
K
Property Owner(s)of Record: (41 a -4 S c ci y,n-e_, , Q-A C\--,I
Telephone: )<i H AR Fax: email: —
Mailing Address: S c.p-'¢- rt- a. 6 �V
Applicant/Agent(if different from owner): o}D G v•%.,.tc; )\S r c.v;-e_ Qa C6Nr14-
Telephone:3 6 O 3 01 Fax: 31'S U 4.£ 9 -7 e il: ac Rvh t)mil, n,.
Mailing Address: f'v 124 (c; Kr.
What kind of Permit?(Check each box that applies
❑
Building 0 Variance(Minor, Major or Reasonable Economic Use)
Demolition Permit 0 Conditional Use[C(a), C(d),or C]**
A Single Family 0 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 ❑ Binding Site Plan**
❑ Home Business 0 Cottagelndustry 0 Long Plat**
❑ Propane 0 Planned Rural Residential Development(PRRD)/Amendments**
❑ Sign ❑ Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions**
❑ Stormwater Management 0 Shoreline Management Substantial Development**
El Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Variance
0 Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment
El 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 RO,b 6-'-`i to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE Date: ' / 07
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. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the application that he-or sh wants nor t noice.
Signature: - -1) -i Date: '-f I(. /v7
C
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 resp nsibili or adhering to and complying with the ESA. The Applicant has read this disclaimer an signs and dates it below.
Signature: -�yc - Date: (-1//60-7
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2UOO.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:
DA.Lr=e3 � C Ctn v,c._te (3- ) 30 t w 1°i k ( .' ) 3cd fi q€,R 7
MAILING ADDRESS: c1 EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX: ( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: Qx r
❑ New X Wood Existing: \ e❑ Sewer �'�
❑ Addition ❑ Steel Proposed: Bank ❑ Community System
Alteration/Remodel ❑ Concrete Total: _ Height• )4 Individual System
O Repair Di Masonry \ R SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type of eat: Proposed: ❑ Public
�y.e -t 1 - 6.-c9-.St--c4A,r Total: ) _ N Name of System: Ca-r_GP1 -j.e...„
If this is a Commercial Project you must answer the following:
Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spacers _
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:
i Underground Tank i Above ground Tank Size of Propane Tank:
I Heat Stove I Cook Stove i Woodstove i Fireplace Insert I Hot Water Tank i 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:
2na Floor Heated r � Consistency Review: �6.O
1 k I lab it) r155,6fl —
Other Heated t Base fee: ' �5 7`
Mezzanine (( jf(, y it r i \dditional Section: — _,J
Heated Basement ,/ e Plan Check fee: D -it vt-
Unheated Basement � Y State Surcharge fee: 5aTh
Other Unheated CS ' r�� „�. � Pot Water Review fee:
Garage/Carport l ' SUBTOTAL
Decks��;* .a b �911/Rd Approach fee:
QQtt :tt3�t��
�e 6\�her�l•Au z I -h0 TOTAL: $ t . , ./
Receipt Number: QQ'?I
Cash/Check Number: aafoci5
ESTIMATED COST REQUIRED) Date:
A lmarket vela a abor a materials ndation to finish ! 0
0 o O p Initials: _
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc
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