HomeMy WebLinkAboutBLD2007-00522 itILDING PERMIT APPLICATS BLD07-00522
Review Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD07-00522 Received Date: 9/27/2007
SITE ADDRESS: 21 FOXFIELD DR
PORT TOWNSEND, 98368
OWNER: JOSEPH W NUTSFORD PHONE: (360) 385-0521
JOEEN M NUTSFORD
21 FOXFIELD DR
PORT TOWNSEND WA 98368-9524 KALA POINT#1
SUBDIVISION: Block: Lot: 1
PARCEL NUMBER: 964700001 Section: 34 Township: 30 N Range: 01 W
CONTRACTOR: RAMPANT LION CONSTRUCTION PHONE: (360) 302-1248
1021 17TH ST
PORT TOWNSEND WA 98368
Contractor's License RAMPALC931 KC Expires 2/3/2009
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP REPLACE INTERIOR STAIRS - NO MLA REQ'D
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ALT MAIN:
VALUATION 9,500.00 ADD'L: HEAT TYPE:
CODE EDITION: 2006 HEAT BASE: HEAT TYPE:
OCCUPANCY:
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: ki
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $181.25 KAS 09/27/07 93352 APPROVE[
Plan Check $117.81 KAS 09/27/07 93352
State Building Code $4.50 KAS 09/27/07 93352 OCT .3 2007
Total: $303.56 Jefferson County Planning
&Building Department
Jefferson County Building Dion Permit Numb BLD07-00522
Applicant: NUTSFORD
BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2006 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 /0�/2-0,7
Framing /012--d7
ih,Gk 41_41/l►4..S Lyc c I?
FINAL INSPECTION -i ff.. �rP t4 J0L
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
.¢,SON cor,, JEFFERSONOUNTY • RECEIVED
AI
DEPARTMENT OF COMMUNITY DEVELOPMENT
`'4 621 Sheridan Street • Port Townsend •Washington 98368 SEP 2 7 2007
360/379-4450 • 360/379-4451 Fax
4/SN0C*0 www.co.jefferson.wa.us/commdevelopment
EffIRSON COUNTY BCD
Master Permit Application MLA: r\J0 11/44 LA F f `.3)
Project Description (include separate sheets as necessary):
L .
c
Tax Parcel Property
Number: `-3 f, L - 70a-50 f Size: 7 ZC.)c)o s a S,4t- (acres/square feet)
Site Address and/or Directions to Property: 2 ) c. c.=,x,4i ' ) t ,
C=.,r\- \-,0,..}'-C \\d -,,i Z rvt sz 'Q 1C11 L r 4 i h-} , s' c"0-. 'Y-1!Yti c-\Y i C Lr.c 1 , C-',Y j 1.--.
Property Owner(s)of Record: '3.oS,T r,- i,J 1\1 wk-&64 p,=;� v-u -
o^s
Telephone: ! b n a-j -0 , 'L f Fax: email: Le L4-
Mailing Address: 2 J ro/ C . c/ *0 r. 2O el- "\o,,s,,, < \,4 4 a1 3 L S/
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies
jBuilding 0 Variance(Minor, Major or Reasonable Economic Use)
❑ Demolition Permit 0 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* ❑ Boundary Line Adjustment
❑ Change of Use 0 Short Plat**
❑ Address ❑ Road Approach 0 Binding Site Plan**
O Home Business 0 Cottagelndustry 0 Long Plat**
O Propane 0 Planned Rural Residential Development(PRRD)/Amendments**
❑ Sign 0 Plat Vacation/Alteration**
0 Allowed "Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions**
❑ Stormwater Management 0 Shoreline Management Substantial Development**
0 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
O 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 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. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the appli tion that he or she wants prior notice.
Signature: X _ A- Date: S eyir 2-`) ,2-oc7-7
The action or ac ions 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-transfer)ble re ponsibilit or a ering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: P rtiy. ,4 Date: S-c.i.o-1-- 2-"7 ) ..)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.
)i,o(j/k
Signature: 114.1.—, Date: 4_,,,Oh -7 7-00
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
AmpAN;- Dui.) CGN fiP�C�-C1c ti� 666 2—j71-6-� ( )
MAILING ADDRESS: �07 ( (�-'Y� Po "�J��+�A eri f� EMAIL:
CONTRACTOR'S LICENSE '=\+ WAINS
NUMBER: Li G OW PA1_,C,°1 3 ( NUMBER
ARCHITECT/ENGINEER: N e-T_ ENn j N a:Q(Ne,24 51j'rl�� PHONE (900. O-& FAX: ( )
MAILING ADDRESS:
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank ❑ Community System
44 Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System
❑ Repair ❑ Masonry yz SEP Permit#
Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type of Heat: Proposed: ❑ Public
Faccu-)4 r e F(FAV C Total: Name of System:
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:
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:
2nd Floor Heated j Consistency Review:
Other Heated RE�-�E�t�V � Base fee: -^
� / tSI.A5
Mezzanine Additional Section:
SE? 2 7 2007 /. gl
Heated Basement Plan Check fee:
Unheated Basement JEFFERSON COUNj j BCD State Surcharge fee: 50
Other Unheated Pot Water Review fee: _
Garage/Carport SUBTOTAL
03 •ND
Decks 911/Rd Approach fee:
E)CtSi-t , J
Other l TOTAL: $ 303 5r!p
�,r�isw am. S ;-r(
Receipt Number: 9335D,
Cash/Check Number: J 5�
ESTIMATED COST(REQUIRED) Date:
`� a� ��
•Fair market value ofalltabor and materials foundation to finish '1 I�
Initials:
9 4 ocm `'L-______) ri--- ----
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc
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z $ o 2 Q " TAX PARCEL # 964-700-001 SOILS APPLICA ►�/�, 'IYL.
0 N - Gi N �, 863 CARLSBORG ROAD, SUITE A,
m o CONVENTIONAL GRAVITY SYSTEM FOR SEQUIM, WA 98382
C4 JOSEPH & JOEEN NUTSFORD PH (360) 683-6300 FAX (360) 683-5652