HomeMy WebLinkAboutBLD2008-00417 I ILDING PERMIT APPLICA N BLD08-00417
Review Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD08-00417 Received Date: 9/18/2008
SITE ADDRESS: 97 MARTINGALE PL
PORT LUDLOW, 98365
OWNER: ALFRED J THIEDE PHONE: 360-437-0612
97 MARTINGALE PL
PORT LUDLOW WA 983659559
BAYVIEW VILLAGE DIV 3
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 931900048 Section: 16 Township: 28 N Range: 01 E
CONTRACTOR: B PARKER ENTERPRISES PHONE: 206 818 4184
70 MERIDETH STREET
PORT LUDLOW WA 98365
Contractor's License BPARKPE925BG Expires 1/7/2010
REPRESENTATIVE: B PARKER ENTERPRISES PHONE: 206-818-4184
70 MERRIDITH ST
PORT LUDLOW WA 98365
PROJECT DESCRIPTION REROOF - NO MLA REQ'D
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION 3,500.00 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: rQ h Ct 1.
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $97.25 AMS 09/18/08 102668
Plan Check $63.21 AMS 09/18/08 102668
State Building Code $4.50 AMS 09/18/08 102668
Total: $164.96
Jefferson County Building Diveion Permit Numb- .
Applicant:
BUILDING PERMIT INSPECTION APPROVALS applicable Code: 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
FINAL INSPECTION 7)< ' -car - -I
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
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CONDITIONS for Building Permit# :
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DEPARTMENT OF COMMUNITY DEVELOPMENT
I, `4 1 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
q p� www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: not'Y\ ( ('-', V '
Project Description (include separate sheets as necessary):
)L f L(90
Tax Parcel 93l
� �C !) t/ � Property
Number: Size: (acres/square feet)
Site Address and/or Directions to Prop�eerty:
1-1 Yv\et_it -t- )r1cj C.` t.C.._ 1
Property Owner(s)of Record: `L/A ,f 4cl '7-i -/!.l�iy,
Telephone: Fax: email:
Mailing Address: 97 Mf21-2.ji NI(g(rA-t-1i 49I PO(LrLu 10 Lou-) w Vfi5e<
Applicant/Agent(if different from owner):
Telephone: `''37 OC;c — Fax: email:
Mailing Address: -4i44t,,v{
What kind of Permit?(Ct,�eck each box that applies
"' uilding Y •�O 0 Variance(Minor, Major or Reasonable Economic Use)
❑ Demolition Permit 0 Conditional Use[C(a), C(d),or C]**
❑ Single Family 0 Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification
❑ Manufactured Home 0 Modular 0 Special Use(Essential Public Facilities)**
0 Commercial* 17 Boundary Line Adjustment
❑ Change of Use ❑ Short Plat**
❑ Address 0 Road Approach 0 Binding Site Plan**
❑ Home Business 0 Cottagelndustry 0 Long Plat**
❑ Propane ❑ Planned Rural Residential Development(PRRD)/Amendments**
0 Sign 0 Plat Vacation/Alteration**
❑Allowed"Yes" Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions**
❑ Stormwater Management 0 Shoreline Management Substantial Development**
0 Site Plan Approval Advance Determination (SPAAD)* 0 Shoi,lline Management Variance
❑ Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* 0 Jefferson County Shoreline Master Program Amendment
0 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:
DESIGNATION OF AGENT
I hereby designate U.) 1 Nil. 44t'.'ti.4 to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE (f, Q'
/ ��<:/l Z�(.Cy�j Date: o��2 I ��(>
By signing this application form,t e owner/a nt attests that the informationti 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 requ' d later inspections. Staffs access and(Olt of entry will be assumed unless the applicant informs the County in writing at the
time of the applic io ha Se r e wa s rior note �' w�f //
R q /
Signature: r` i /44/1Af Date: ` ; Gcf f
c
The action or actions Applicant will unf ertake as a result of the issuance of this permit may negatively impact upon one or more threatened or
endangered species and could lead ro 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
y/I ibiliiy for adhering to and co!p. Ihg with the ESA. The Applicant has read this disclaimer and igns and dates it below.
Signature: ` a'/ `�"3 ��c� - 7.��t f/ Date: ,�
6 y
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc
• BUILDER STATEMENT •
The signer of this statement s 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 r si ility of the General Contractor for the proposed project.Signature: Li `// �j Date: —/e1-o e
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
2 PA--c Kama- b>�, (2O(,) 0/ Nyy ( )
MAILING ADDRESS: 7, /10 i- S F- EMAIL:
CONTRACTOR'S LICENSE � 11 WAINS
NUMBER: g 0i4-1Zir�1 �0 6- W NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
n-Newer RKy.11-ou ri ❑ Wood Existing: ❑ Sewer
Addition 0 Steel Proposed: Bank ❑ Community System
❑ Alteration/Remodel 0 Concrete Total: Height: ❑ Individual System
❑ Repair 0 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:
1 Underground Tank 1 Above ground Tank Size of Propane Tank:
1 Heat Stove 1 Cook Stove 1 Woodstove 1 Fireplace Insert 1 Hot Water Tank 1 Pellet Stove 1 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: j—1 aS
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee: l '
�T • 5
Other Unheated Pot Water Review fee: \
Garage/Carport SUBTOTAL \9
Decks 911/Rd Approach fee:
e \C \c h'r-
Other TOTAL: $ 1 cot, Cr_
Receipt Number: \;JaGLp 4
Cash/Check Number:
ESTIMATEb COST(REQUIRED) Date: q )'B 8
•Fair malue of all labor and mat�4rials foundation to finish
ICJ Initials:
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G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc