HomeMy WebLinkAboutBLD2008-00012 tUILDING PERMIT APPLICA)N BLD08-00012 Review
Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD08-00012 Received Date: 1/11/2008
SITE ADDRESS: 7251 OAK BAY RD
OWNER: RONALD JASIECKI PHONE: 360-437-0136
KRISTINE JASIECKI
7251 OAK BAY RD
PORT LUDLOW WA 983659441 R.J. BERNARD SHORT PLAT
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 978900109 Section: 4 Township: 28 N Range: 01 E
CONTRACTOR: WHITEY JOHNSON PHONE: (360) 779-9884
PO BOX 1110
SUQUAMISH WA 98392
Contractor's License WHITEJG952DN Expires 3/15/2009
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr REPAIR ROOF TO EXISTING SFR - NO MLA REQUIRED
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION 12,000.00 ADD'L: HEAT TYPE:
CODE EDITION: 2006 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total:
Routing Date: ` —
1 ( _0 L'
I lJ
Type Amount Paid Bv: Date: Receipt: Approved/Date
Permit $209.25 CJZ 01/11/08 95759
Plan Check $136.01 CJZ 01/11/08 95759 APPROVE(
State Building Code $4.50 CJZ 01/11/08 95759 G L `
Total: $349.76 JAN ! ' 2011A
Jefferson County Planning
&Building Department
•
Jefferson County Building Division Permit Num.: BLD08-00012
Applicant: JASIECKI
BUILDING PERMIT INSPECTION APPROVALS \pplicable 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
Framing 7//s/Df
5-rgAP5 1/1. /RGI'1T $/9C,_
FINAL INSPECTION ccr/0cti' c� (IA r
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
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�)gON cb6, JEFFERSOWOUNTY •
ai DEPARTMENT OF COMMUNITY DEVELOPMENT
�`\`Z' 621 Sheridan Street • Port Townsend •Washington 98368
$ 360/379-4450 • 360/379-4451 Fax ��p N 1 1 2008
q p www.cajefferson.wa.us/commdevelopmgN
Master Permit Application MLA: \,D *\CPC 'kQ.
Project Description (include separate sheets as necessary):
e /&--
Tax Parcel Property
Number: i /g-- I - l U 7 Size: , }2 acres quare feet)
Site Address and/or Directions to Property:
`l Z 5( 0 GC' c7c�(2T- L-LA 01-01/t-1—
Property Owner(s)of Record: 2c' c' 1-1 tv C ()ArS i c c--1C:t
Telephone: �(00 4�7 G I3 t, Fax:06.o 457 'GR75 email:
Mailing Address: 77 er.-i-: tom/ 2n .-oeT' Lt tr un&y- LOA- cie3L
Applicant/Agent(if different from owner): (,(74-t-t Tn-y-- ,H-•-, i
Telephone d —"7o( e?F3S4 Fax: .,C,,b 51:31 j✓3 .3O25 f,L ps G�c�bC,(34-,
Mailing Address:
What kind of Permit?(Check each box that applies
Building P.r'c'P R --Ft,cl 0 Variance(Minor, Major or Reasonable Economic Use)
❑ Demolition Permit ❑ Conditional Use[C(a), C(d),or C]**
❑ Single Family 0 Garage Attached/Detached ❑ Discretionary"D"or Unnamed Use Classification
❑ Manufactured Home ❑ Modular ❑ Special Use(Essential Public Facilities)**
❑ Commercial* ❑ Boundary Line Adjustment
❑ Change of Use ❑ Short Plat**
❑ Address El Road Approach 0 Binding Site Plan**
❑ Home Business ❑ Cottagelndustry 0 Long Plat**
❑ Propane 0 Planned Rural Residential Development(PRRD)/Amendments**
❑ Sign ❑ 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 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:
l DESIGNATION OF AGENT
I hereby designate YA.kiNaViiv,
1.U+tt't-\� - dr. I to act as my agent in matters relating to this application for permit(s).
�/ OWNER SIGNATURE A., • L'{.�j . X 1(A _ Date: ( (. - I (7 0By 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 requyed later inspections. Staffs access and right of entry will be assumed unless the applicant informs the C unty in writing at the
time of the appli n h t I or e w lnt p or notice.
Signature: !�'`-- Date: a//// ",
The action or actions Applic nt 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 responsibility for dhering to arltlomplying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
X Signature: I C/L 0Date: l ' to) - (-) P }
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 PHONE: FAX:
i°It t r�-1 cJb i+t)cU,-) &C-10. Co L)1-c2. i/‘-<, (-- 7) -77 q g081- ( o) .s 48 3 505
MAILING ADDRESS: 117C9. 'cab 110 SU3,{P1M I S Hi I,,/t*S_ EMAIL:
CONTRACTORS LICENSE WA-
NUMBER: w H r're Li a C v p NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX: (
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New Li Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System
XRepair ❑ Masonry SEP Permit#
❑ Demolition Li Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type of Heat: Proposed: ❑ Public
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:
Underground Tank I Above ground Tank Size of Propane Tank:
Heat Stove Cook Stove Woodstove I 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
Main Floor Heated EH Bld App Review:
2nd Floor Heated Consistency Review:
Other Heated Base fee:
arDC. a5
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee: 4' r O
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL 3 -1 l ^
Decks 911/Rd Approach fee: �..`1
etY-15k�^�
Other C2icAopc, R � TOTAL: $ 3LG
L-Ovs-12_, C ke,r\ ,u Receipt Number: - 16-1 C71
Cash/Check Number: (QC2
ESTIMATED COST(REQUIRED) Date: 1 2008 ( -- t l --08
air mark ue la and materials foundation to finish
Initials:
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc