HomeMy WebLinkAboutBLD2008-00410 Review PERMIT APPLICA•N R 00410
Review BType: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD08-00410 Received Date: 9/15/2008
SITE ADDRESS: 466 PIPER RD
QUILCENE, 98376
OWNER: FORREST P STAUSS PHONE: 360-765-0074
VICTORIA A DYER
PO BOX 340
TROUT LAKE WA 98650
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 701174005 Section: 17 Township: 27 N Range: 01 W
CONTRACTOR: ALL WEATHER HEATING & COOLING I PHONE: (360)452-9813
302 KEMP ST
PORT ANGELES WA 98362
Contractor's License ALLWEHCI5OKU Expires 9/1/2002
REPRESENTATIVE: ALL WEATHER HEATING AND COOLING PHONE: 360-452-9813
302 KEMP STREET
PORT ANGELES WA 98362
PROJECT DESCRIPTION HEAT PUMP INSTALLATION - NO MLA REQ'D
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION 18,408.00 ADD'L: HEAT TYPE: HTP
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: /,,I) C' )I /y _O)
(� �-i I
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $307.85 AMS 09/15/08 102659
Plan Check $199.71 AMS 09/15/08 102659 A1DPRcVEE
S tate Building Code $4.50 AMS 09/15/08 102659 SEP IS 2008
Total: $512.06
Jefferson County Planning
& Building Department
Jefferson County Building D�sion Permit Nur,: BLD08-00410
Applicant: STAUSS
BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2006 International Building Codes
To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection.
Requests received after 7:00 AM will not be scheduled for that day's inspections.
ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries.
The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection
Inspection Item Date Approval Signature Notes
Mechanical Systems
FINAL INSPECTION 7-Z(�-09 -
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
/`Include the following itemsur plot plan: •
o Property boundaries ❑ Wells
Li Names of adjacent streets ❑ Septic tank
❑ Driveways and parking spaces ❑ Drainfield (enter NN if unknown)
❑ Surface water(ponds,creeks, etc) y ❑ North Arrow �, \
❑ Buildings(residence, sheds, garages, etc) --it� r LHm � Q� rvl ��
'V -eY0 rY)-tan ie-ra-MPC)r+-
PLOT PLAN-date prepared_ 9 I ).5 JO Pi
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v4SEP 15 2008 1612 EliDYR ' HEC ve. w C.
Por send, . 368
JEFFERSON COUNTY - --1
Permit#or Parcel# i(, JUN I
sting site Sewage 0Evaluation of an Exi stem_O7/3O/OQp8 — ti i 0 I page
JEEEERSIJ C U TY OCR ,
ON O • RECEIVED
cJEFFERSOUNTY
•
W \g DEPARTMENT OF COMMUNITY DEVELOPMENT
(41---1`
' • '� 621 Sheridan Street • Port Townsend •Washington 98368 SEP 1 5 2008
� 360/379-4450 • 360/379-4451 Fax
, O$ www.co.jefferson.wa.us/commdevelopment
S __ JEF
FERSO'� �_ ; ,
Master Permit Application MLA: t m`. req CI
Project Description(include separate sheets as necessary:
t-eat çOvvip inrM II 01tl0
Tax arcel Property / i /
Number: ( ` �� ��� Size: `'- 1 •(j Q,/(P S (acres/square feet)
Site Address and/or Directions to Property:
C9(0 )41oev- cid . ().0 1C �� -e we\ ��37C�
Property Owner(s) f Record: -j��G � S O\ J 5
Telephone: 7j(a(; •1(, 0C 1'1 Fax: email:
Mailing Address: Q (7. QG)c -11-1 (o QVi\(e in e 1 (,J r ci S7(„
Applicant/Agent(if different from owner): Atr (AP Ct'ne- tirati t1 r (CO II n
Telephone: 31,)C-L-f432-"I[j i 3 Fax: `,(,,0-Ci 47Z "-inemai(Rwh( c�-)ntti))<n CGYt'i
Mailing Address: ? . �( ,� p t
What kind of Permit?(Check each box that applies
WA
�tuilding Nike C V 'Ay)t C.CC\ -{v t1V kC..• t tl c tt-1 Ic,t10rtl Variance(Minor,Major or Reasonable Economic Use)
Demolition Permit ❑Conditional Use[C(a),C(d),or C]**
Single Family ❑Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification
❑ Manufactured Home ❑ Modular ❑Special Use(Essential Public Facilities)**
❑ Commercial* ❑Boundary Line Adjustment
❑ Change of Use ❑Short Plat**
❑ Address ❑Road Approach ❑Binding Site Plan**
❑ Home Business ❑Cottagelndustry ❑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 ❑Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment
❑Forest Practices Act/Release of Six-Year Moratorium ❑Tree Vegetaion Request
*May require a Pm—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 designateffi Q MN kC Cl y;(.C;c: k%At to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE kid u 3 � ' Date: 9 `//`
By signing this application form,the owner/agent a ests 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 attomey'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 ap lication that he or she wants prior notice.
Signature: 1 �I n nn i 1 AJy Date: 61—I 0V
O�1
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 lake"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 nferable responsibility for adhering to anti complying with the ESA. The Applicant has read this disdaJgler rnn sigry5 71 dates it below.
Signature:non-tran
1J1wv• "' 'i' ! ) Date: L l/!t
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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: 1 r f'i• ' .,t Y n
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: t I.(���������t�l�I U�f F
FAX:
(-r\� W?on-e v watt c1C) c Coo `\ri 9 (w d y4�-z-01 F)\S (-- (00 I-1 S Z-�Fli
MAILING ADDRESS: -�,Z /.t an p �'�� • EMAIL:cwi'k c GIV\O_e(II cc 01
CONTRACTOR'S LICENSE K ( WAINS
NUMBER: (I) I ,U L E I l 0 14
C\-7- 1 U NUMBER
ARCHITECT/ENGINEER: T 1 `'( ,q�l� PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: F me Type: Bathrooms: Shoreline: Type of Sewage Disposal:
New 'Wood Existing: 1 ! Sewer
Addition 1 Steel Proposed: Bank ; Community System
Alteration/Remodel I ' Concrete Total: Height: i Individual System
Repair Masonry SEP Permit#
Demolition i! Other: Bedrooms: Water Supply:
Existing: Setback: I Private well I Two Party
Type of,Heat: Proposed:
P(-'�� 0,m 9 Total: Name lic 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:
0 Underground Tank 0 Above ground Tank Size of Propane Tank:
❑Heat Stove 0 Cook Stove 0 Woodstove ❑ Fireplace Insert 0 Hot Water Tank 0 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:
2'°Floor Heated Consistency Review:
Other Heated Base fee:
3Cri.ars
Mezzanine Additional Section:
Heated Basement Plan Check fee: `
Unheated Basement I � � '
State Surcharge fee: ` t 5 O
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL - -
5 ► a .xo
Decks 911/Rd Approach fee:
Other �''y�
TOTAL: 5 1 a , ` cc
Receipt Number: lam(,5 C1
Cash/Check Number: a., . ---1 �1
EST ATED COST EQ D) Date: el I 15 l6
.F it market value of all labor and terials foundation to finish
0l7 Initials: CO
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