HomeMy WebLinkAboutBLD2008-00295 ItUILDING PERMIT APPLICAAON BLD08-00295
Review Type: I
Jefferson County Department of Community Development
621 Sheridan Street Pcrt Townsend, WA 98368
PERMIT #: BLD08-00295 Received Date: 7/1/2008
SITE ADDRESS: 193 DONALD RD
QUILCENE, 98376
OWNER: ROBERT W MOSER PHONE: 360-765-3004
MARILYN J MOSER
365 DONALD RD
QUILCENE WA 983769610
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 501044007 Section: 4 Township: 25 N Range: 01 W
CONTRACTOR: TBD PHONE: 205-807-2541
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP REPAIR & REPLACE FAILING (COLLAPSING) WALLS - NO MLA
REQ'D
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP REP MAIN: 2,000
VALUATION 100,000.00
CODE EDITION: 2006 ADD'L: HEAT TYPE: PRO
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: OTHER: 0 SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS:
Exist: 3 Exist: 3
Prop: 0 Prop: 0
Total: 3 Total: 3
Routing Date: CO 1 1 / (f_j(
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $993.75 AMS 07/01/08 100506 APPROVED
Plan Check $645.94 AMS 07/01/08 100506
State Building Code $4.50 AMS 07/01/08 100506 JUL3 2008
Total: $1,644.19
Jefferson County Planning
&Building Department
•
Jefferson County Building Division Permit Number: BL -•
D08 00295
Applicant: MOSER
BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2006 International Building Codes
To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection.
Requests received after 7:00 AM will not be scheduled for that day's inspections.
ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries.
The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection
Inspection Item Date Approval Signature Notes
Setbacks
kVA
Erosion Control
Foundation Footing '� ,A, 4 (Z--0 a5t ER_ R km41 "Fif�
ucr
Footing Drains ,--T--��
Foundation Stem Wall
Straps(hold downs) ., C
`� d AAS r E2 6v(2 Lac) oR 7diieV06
Ext. Shear Wall Nailing tDt21/D$ Ilk�f 4 - - ) f, 1S1 Di- lb-(4
Framing
Blocking kiA
Airseal
. N
Insulation: Walls /
ze.lo i;PF 2)1z.
Insulation: Floors
Wallboard Nailing
Propane Tank
Address Posted
FINAL INSPECTION 6.4?_,q pc,_
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
it II:,A. ,/I , wow--
��g ON p�� JEFFERSC.OUNTY
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wk `� DEPARTMENT OF COMMUNITY DEVELOPMENT JUL 0 GU�
`i ` � 621 Sheridan Street • Port Townsend •Washington 98368
. 360/379-4450 • 360/379-4451 JEffERSON COUNTY HD�`SiiING�O www.co.jefferson.waus/commdevelopmentFax
Master Permit Application MLA: N(') YYl LA 'me.c J c
Project Description (include separate sheets as necessary):
'Kip,,- ii10\,a.£. � ,sfi►a� cap, --ta,rA_ii) 41a1I %u- " wiLi,
43 Tax Parcel Number: a 1. OH.o r., .1 4 Dk�94-•�.g4 i dl Property Size: if -74 ± ;-acres quare feet)
Site Address and/or Directions to Property:
S JQit-acA >�-ac,, Ow"( e- , y�-3 I,
Property Owner(s)of Record: '-v/ f,rt: 1-d. (�1-,t r li'<0
K --1. qo 5,t r
Telephone: (�Wt,') rt(✓S-5o61=-� Fax: (. ) �,5-- ''',)6 U,
email: N� ,Lc if.T�0111 i iL Cn. vd'
Mailing Address: SC, J0(,2 ( r 't-a1A '(c4 o. /
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies
6uilding 0 Critical Areas Stewardship Plan
❑ Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
[I'Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a),C(d),or C]**
❑ Manufactured Home 0 Modular ❑ Discretionary"D"or Unnamed Use Classification
❑ Commercial* 0 Special Use(Essential Public Facilities)**
❑ Change of Use 0 Boundary Line Adjustment
❑ Address 0 Road Approach ❑ Short Plat**
❑Home Business 0 Cottage Industry 0 Binding Site Plan**
❑ Propane 0 Long Plat**
❑ Sign 0 Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes"Use Consistency Analysis ❑ Plat Vacation/Alteration**
❑ Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions**
❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development**
0 Temporary Use 0 Shoreline Management Variance
❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment
❑Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment
*May require a Pre—Application Conference 0 Tree Vegetation Request
**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 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 requiater inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the applicatio t t e,or she w t pri r o ice.
Signature: k ? Q £ c/
Date: if li )7-‘)()r)
The action or actions Appticarwill utddrtake 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 ar in compliance with th Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transferable e nsibility for adheri g to d mplylingJwith the ESA. The Applicant has read this discla' er and signs and dates it below.
Signature: f C/ Date: / 1 c,7-L,")
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
immilmit
0 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:
0 ekal &wSt u-r yi/�n1�t ,p /�, 9,S%-v (.'�[.v) `l9(..- .ZeLo Q (3e-4) 491,'43If 9
MAILING ADDRESS: A2,`f'10 .T 11- �tk sik "I i� trio-RA)AI��+EMAIL: ��tI ti6�1-.iym/n1�',iyt rc l4A-l6 1• �jl t4 _
CONTRACTOR'S LICENSE WAINS ��`� L
NUMBER: Mi-j r 4(�: p.0 f' NUMBER
ARCHITECT/ENGINEER: ej Ai r)OW rr�1,A PHONE (3i,�)L�6 ���� FAx ( )
MAILING ADDRESS: 22.d �.1g'66,/ 'P 1t ,,i4,,, W gg31�z., EMAIL ILybt i r„f/a,ol,/t-,piN-. C otvL
Project Type: Fr me Type: b Shoreline: --/)Bathrooms: Shoree: J Type of Sewage Disposal:
❑ New e Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank ❑ Community System
'fist"`'" Total: 3 Height: Individual Sys in
❑ Alteration/Remodel li Concrete or'tk � u
Repair ❑ Masonry SEP Permit#
0 Demolition 0 Other: Bedrooms: Water Supply:
Existing: S Setback: i3 Private well ❑ Two Party
Type of Heat: Proposed: ❑ Public
17(2(114, t, 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:
1 Underground Tank 1 Above ground Tank Size of Propane Tank:
i Heat Stove 1 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:
2nd Floor Heated Consistency Review:
Other Heated Base fee: ei g 3. 3
Mezzanine Additional Section:
Heated Basement Plan Check fee: G LI J (1 U
I
Unheated Basement State Surcharge fee: `4 .5 0
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL lD LH_ 11
Decks 911/Rd Approach fee: le..)( t S+
Other TOTAL: $ I C04 4, ( 9
Receipt Number: l 5OCP
Cash/Check Number: n 1 �0
or'�t.-� I j 165ESTIMATED COST(REQUIRED) Date: ^C�Q
.Fair market value of all labor and materials foundation to finish
IPioo1 POO °% Initials:
•
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
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