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HomeMy WebLinkAboutBLD2008-00198 08- UILDING PERMIT APPLICA N BReview viewTy 198 ype: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD08-00198 Received Date: 5/12/2008 SITE ADDRESS: 81 REEF RD NORDLAND, 98358 OWNER: HENRY I NICHOLS PHONE: 835 JEFFERSON ST PORT TOWNSEND WA 983685819 KILISUT REEF ESTATES SUBDIVISION: Block: Lot: 1 PARCEL NUMBER: 021184002 Section: 18 Township: 30 N Range: 01 E CONTRACTOR: CRANSTON CONSTRUCTION PHONE: 379-2730 3DI 23ciu PO BOX 944 PORT HADLOCK WA 98339 Contractor's License CRANSCC070J7 Expires 4/24/2010 REPRESENTATIVE: RANDY CRANSTON PHONE: (360) 379-2730 PO BOX 944 PORT HADLOCK WA 98339 PROJECT DESCRIPTIOr REPAIR ROOF & REPLACE BEAM TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP REP MAIN: VALUATION 8,500.00 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: 5-121b Type Amount Paid By: Date: Receipt: Approved/Date Permit $167.25 LYK 05/12/08 97373 ��� Plan Check $108.71 LYK 05/12/08 97373 ROVE D State Building Code $4.50 LYK 05/12/08 97373 Total: $280.46 JUN `j 2008 Jefferson County Planninr & Building Department Jefferson County Building Dion Permit Num.: BLD08-00198 Applicant: NICHOLS 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 days 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 1 f /�4 , . FINAL INSPECTION /0,6 FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR „t-.¢'go �ly cod, JEFFERSOROUNTY • DEPARTMENT OF COMMUNITY DEVELOPMENT I' 'N•. — 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax kqS p”' www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: LX MLA, e,Q Project n Description(include eparate sheets as necessary):IC ' r oc't' LkS 7Rpc 1)2 kki4.f`Q d 13 extiv Tax Parcel `/ Property Number: 0 ,1- lie T 0 6)' Size3). 00©. 0 d (acres/square feet) Site Address and/or Directions to Property: 9 i kcew R.1 0101'9 4 kilt 16 �11 'k' Iv r i let( se L i r r oki /2.c=t t- ioc; 1 Property Owner(s)of Record: fie K !y i Ica'yu.I iiAlt ciei_ S Telephone: Fax: email: Mailing Address: Applicant/Agent(if different from owner): l I-j ii Ty.K CO h ', t Telephone: 3 6O ` 3)7" � ) 1 G Fax: 36 6- 3 7 y '-I 17 L_ email: ( k h 4 l r it C_ $6 6' ' Mailing Address: f' j.. ? ','t. (c: ii 13 $ i-- PO ri- 'fr1✓14s .rnf qp 3 e What d of Permit?(Check each box that applies wilding 0 Variance(Minor, Major or Reasonable Economic Use) D Demolition Permit 0 Conditional Use[C(a), C(d);ore]** ❑ Single Family 0 Garage Attached/Detached ❑ 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** MAY 1 2 ❑ Address 0 Road Approach 0 Binding Site Plan** 2008 0 Home Business 0 Cottagelndustry 0 Long Plat** ❑ Propane ❑ 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** ❑ 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 Vegetation 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: DESI NATION OF AGENT I hereby designate c " G n S T to act as my agent in matters relating too this application for permit(s). OWNER SIGNATURE J Date: — 7—0?, 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 its 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 a and right of entry will be assumed unless the applicant informs the County in writing at the time of the appl'catio at he or she wants pcjor i . Signature: Date: `J -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 in.' id ,I,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 •.unty development code.The Applicant acknowledges that he,she or it holds individual and non-trans rable esponsibility for adhering to -•• complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: G Date: 1J 2--(�E3 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: J- 1 s 7 HoL4iifi3 i I 'v4 (30) 79r- ( ) MAILING ADDRESS: V d VLy t v o Cok`-i.r EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: F�rain�-`Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New Qj'/ood Existing: ❑ Sewer [1 Addition ❑ Steel Proposed: Bank ❑ Community System ❑ ration/Remodel ❑ Concrete Total: Height: ❑ Individual System Repair ❑ Masonry SEP Permit# Demolition ❑ 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: i Underground Tank i Above ground Tank Size of Propane Tank: i Heat Stove i Cook Stove i Woodstove i Fireplace Insert 1 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:, l 2nd Floor Heated Consistency Review: 01 Other Heated Base fee: o�{ Mezzanine Additional Section: _______.— Heated Basement Plan Check fee: 1 OS 1 I Unheated Basement State Surcharge fee: -21 Other Unheated Pot Water Review fee: n k_l Garage/Carport SUBTOTAL t^^� U Decks 911/Rd Approach fee: Ex 13n'a-1 Other TOTAL: $3 8o . y Receipt Number: 1513 Cash/Check Number: -b g Li ESTIMATED COST(REQUIRED) Date: _ .Fair market value of all labor and materials foundation to finish Y, SOU ,f d 0 Initials: —" G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc