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Home My WebLink AboutBLD2008-00348 IJILDING PERMIT APPLICA•N BLD08-00348 Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD08-00348 Received Date: 8/1/2008 SITE ADDRESS: 72 BEVERIDGE LN NORDLAND, 98358 OWNER: SCOTT BRINTON PHONE: 360-379-1792 RACHAEL VAN LAANEN PO BOX 285 NORDLAND WA 983580285 NORDLAND SUBDIVISION: Block: 5 Lot: + PARCEL NUMBER: 976200501 Section: 33 Township: 30 N Range: 01 E CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP INSTAL CERTIFIED COMPOSTING TOILET (IN PLACE OF FLUSH TOILET)-NO MLA REQ'D TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 150.00 ADD'L: HEAT TYPE: CODE EDITION: 2006 HEAT BASE: HEAT TYPE: OCCUPANCY: OCCUPANCY: UNHEATED: #OF STORIES: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: frftc Type Amount Paid By: Date: Receipt: Approved/Date Permit $38.75 AMS 08/01/08 100599 APPROVED Plan Check $25.19 AMS 08/01/08 100599 A State Building Code $4.50 AMS 08/01/08 100599 OCT Total: $68.44 2008 Jefferson County Planning & Building Department Je.Person County Building Di�sion Permit Num': BLD08-00348 Applicant: BRINTON 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 Rough-in Plumbing Airseal rFINAL INSPECTION FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR i • Lisa Yobbagy-Keller From: Lisa Yobbagy-Keller Sent: Monday, October 19, 2009 8:51 AM To: Linda Atkins Cc: Susan Porto Subject: BLD09-348 Frank Benskin inspected that the condition for the composting toilet were decommissioned. Ydaak ,eiJa.7(effeA, e,YY Permit Technician II Dept of Community Development lisa@co.jefferson.wa.us (360) 379-4450 All e-mail sent to this address will be received by the Jefferson County e-mail system and may be subject to Public Disclosure under Chapter 42.56 RCW. Please note: DCD hours have changed as of December 1, 2008. Our office is open to the public 9:00 am - 4:30 pm Monday thru Thursday and closed on Fridays. i 'c;'444 Cbb,, JEFFERSON•LINTY • DEPARTMENT OF COMMUNITY DEVELOFMEJVT�'. . g� Ty, Sheridan Street • Port Townsend s i�ygtdii 9E33B8ili j 360/379-4450 • 360/379-4451 Fax �•� '� pv www.co.jefferson.wa.us/commdevelopment s, NG' AUG — 1 2008 Master Permit Application �IMLA: N 0 r �E-Q 'D Project Description (include separate sheets as necessary): 14fEpN COU 110CD /I - l5'T C-e✓- \c,`ek COWL -Oft '�O( 1.e.: p ll.Ge d T' r/(J31 e:1) Tax Parcel Number: rAp 2()0 5—U/ Property Size: Set c-at-5 (acres/square feet) Site Address and/or Directions to Property: '''7,. k,✓(LI iD G^) (A F) Nog-O Lifivb INA- 9 '3 T Property Owner(s)of Record: 't(t-f4E-L 1/4-pu 1.44-Ne N it S'co T 1- 6(L!nl 7-a 1U Telephone: 3 tv 0 - E5 , 9 17 v- Fax: email: Mailing Address: Po Lox 285 AJ'g_o t-4-A1 ,:"_ 0.//9- 16 3 5 SS Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: Whit kind of Permit?(Check each box that applies uilding 0 Critical Areas Stewardship Plan Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]** ❑ Manufactured Home 0 Modular 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* 0 Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment ❑ Address 0 Road Approach 0 Short Plat** ❑ Home Business 0 Cottage Industry 0 Binding Site Plan** ❑ Propane 0 Long Plat** 0 Sign 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** ❑Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions** ❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development** ❑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 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 application that hei or he wants prior notice. ,Signature: F-rwv�.pl,(,�or 4t4 t.i.vk Date: 7!410 s 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 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-transferable"respopnsibillii"ty"f'or adhering to and complying with the ESA. The Applicant has read this disclaimer an ,signs and dates it below. Signature: �.L1,(!v�,kt,(,L tf O( ►AJ4.M.. Date: 1/2- D G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc • BUILDER STATEMENT 1111 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 responsibilit of the General Contractor for the proposed project. IlIc Signature: 9 kk/A �LUit `. Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: �( ( ) ( ) �/MAILING ADDRESS: �/�� "'"C/_ EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System LI Repair ❑ Masonry SEP Permit# El 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: 1 Underground Tank 1 Above ground Tank Size of Propane Tank: i Heat Stove 1 Cook Stove 1 Woodstove 1 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: 36.115 Mezzanine Additional Section: Heated Basement • Plan Check fee: a5. I 1 Unheates J / j� }� State Surcharge fee: 11J' 4. 5D Other Unheated Pot �n Pot Water Review fee: �— Garage/CarpoRWrrG - 1 �0t3 SUBTOTAL ( 38. 4 - Decks -PV'1lli CliUIt� HD911/Rd Approach fee: � 1 Other TOTAL: $ (�8 _C-14 Receipt Number: 1005 961 Cash/Check Number: 111+ ESTIMATED COST(REQUIRED) Date: Q l • O� •Fair market value of all labor and materials foundation to finish '0 u — Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc