HomeMy WebLinkAboutBLD2007-00296 11P3
UILDING PERMIT APPLICAfON BLD07-00296
Review Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD07-00296 Received Date: 6/7/2007
SITE ADDRESS: 991 LUDLOW BAY RD
PORT LUDLOW, 98365
OWNER: STEVEN R ROGEL PHONE:
CONNIE R ROGEL
12020 NYANZA RD SW
LAKEWOOD WA 984991440 LUDLOW BEACH TRS 2
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 969000020 Section: 16 Township: 28 N Range: 01 E
CONTRACTOR: TOLLEFSON BUILDERS INC PHONE: (360) 732-4080
PO BOX 100
CHIMACUM WA 98325
Contractor's License TOLLEBI977N9 Expires 3/15/2009
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI REPAIR/REPLACE EXISTING DECK
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP REP MAIN:
VALUATION 15,000.00 ADD'L: HEAT TYPE:
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: # OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: 871 SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: 0 Prop: 0
Total: 0 Total: 0
Routing Date: r / i /01 „
Type Amount Paid By: Date: Receipt: I Approved/Date
Permit $251.25 CJZ 06/07/07 91164 APPROVED
Plan Check $163.31 CJZ 06/07/07 91164
State Building Code $4.50 CJZ 06/07/07 91164
Total: $419.06 JUL 112007
Jefferson County Planning
& Building Department
Jefferson County Building Di ion Permit Nu,: BLD07-00296
Applicant: ROGEL
BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2003 International Building Codes
To schedule inspections, call (360)379-4455 no later than 7:0C 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
Setbacks 11�`l_rA ;
Erosion Control `"1
Foundation Footing � 13 f-vS
Framing _`.��..✓
FINAL INSPECTION 4c-Ii3 Tis
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
• •
CONDITIONS for Building Permit# :BLD07-00296
1.) PRIOR TO BUILDING FINAL INSPECTION RESERVE DESIGNATION FOR SEP78-270
MUST BE APPROVED.
1'1
w,'s° eOc JEFFERS( OUNTY 11/
gq DEPARTMENT OF COMMUNITY DEVELOPMENT
1-3 `4 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
p www.co.jefferson.wa.us/commdevelopment
Master Permit Application I MLA: Pt
Prniect Description(include separate sheet as n cessary):
s G/i Na+ o Fc 4P
Tax Parcel rty
Number: VrOOO O j_O Size: 4ttes z9,99v'/ acres/square feet)
Site Address and/or Directions to Property:
Property Owner(s)of Record: 5'7-EVe A/1D 00111118 4eO .
Telephone:e2S` * 9t'3 -�193b Fax: email:
O Mailing Address:J O f V19Y1?A 12o b 5(,0 LAZEL CAS (j)A. 9kyi99
Applicant/Agent(if different from owner): /OLLEFSO y "&LI L.A(Rs bi
Telephone:340-7 32' (kw Fax:360-?32- 0 fr/ email:
Mailing Address:fa X coo oteleAan• (,()A Qfr3L�
Wtjut kind of Permit?(C ck each achbox that applies --rr-�
Building � A. 17, Gam ❑Variance (Minor, Major or Reasonable Economic Use)
V❑ }emolition Permit ❑ Conditional Use[C(a), C(d),or C]**
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 ❑ 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 ❑ Shoreline Management Substantial Development**
❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Variance
❑Temporary Use ❑ 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:
'p DESIGNATION OF AGENT
I hereby designate I�—kC4-1 I QL_L_ t—� to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE ,„�,L�/ Date:
By signing this application form owner/agent attests that they formation provided herein,and in any attachments,is true and correct to the best of
his,her or it's knowledge. An 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. taffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the applica • -t he or she wa t nor notice.Signature: Date: 4. /4 0°1
The action or action•(pplicant II undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or
endangered specie :rid 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' ou are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-trans-•l: responsibility for Bring to and complying with the ESA. The Applicant has read this disclaimer/end si s and dates it below.
Signature: , 1 1l Date: �c / 4 � 7
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.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:
To«Qiies'cty 'ides (are) -t32- ( 3G0) 73=- c�0 8"7
MAILING ADDRESS: ..D. Sum / �ck EMAIL:
CONTRACTORS LICENSE fei ZS WAINS
NUMBER: 7'off .�I 9 7 77n/ NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX: (
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New es-Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: Height: Individual System
to'Repair ElMasonry SEP Permit# 7 y-2.1
LI Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: P'1 rivate well ❑ Two Party
Type of Heat: Proposed: Mw."4104, ❑ Public
Total: Ec> Name of System:
If this is a Commercial Proiect 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 i Above ground Tank Size of Propane Tank:
Heat Stove Cook Stove 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 BId App Review: (
.17
2"tl Floor Heated Consistency Review:
Other Heated Base fee: 5+` r.aC°
Mezzanine Additional Section:
Heated Basement Plan Check fee: I ` 2 3 I
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL 4il 400
Decks 0/50) • "TN-- 911/Rd Approach fee:
Other TOTAL: $
Receipt Number: I I (G4
Cash/Check Number:
ESTIMATED COST(REQUIRED) iT/S;a00 Date:
.Fair market value of all labor and materials foundation to finisf ' 1 l
`' Initials:
N1Y
i)EV i OPMENT
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit App`tica`tion 12-19-2006.doc
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