HomeMy WebLinkAboutBLD2009-00026 •BUILDING PERMIT APPLICOION B RD09 OOpe 6
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD09-00026 Received Date: 2/2/2009
SITE ADDRESS: 21 CREEKWOOD PL
PORT TOWNSEND, 98368
OWNER: HARRY HOLLOWAY III PHONE: (360) 385-0537
LUCI HOLLOWAY
PO BOX 596
PORT TOWNSEND WA 983680596 KALA POINT#3
SUBDIVISION: Block: Lot: 453
PARCEL NUMBER: 965000063 Section: 27 Township: 30 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI' CHANGE 1031SF UNHTD TO HTD BASEMENT
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ALT MAIN:
VALUATION 99,832.00 ADD'L: HEAT TYPE: EEE
CODE EDITION: 2006 HEAT BASE: 1,031 HEAT TYPE: WOD
OCCUPANCY: R-3 UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: 5N GARAGE: SHORELINE:
CONST TYPE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: KALA PT
BEDROOMS: BATHROOMS:
Exist: 3 Exist: 2
Prop: 0 Prop: 1
Total: 3 Total: _.._ 3
Rou,tinq Date:
a'-( -09
Type Amount Paid By: Date: Receipt: Apv-oAPPROVEDVe
Permit $993.75 LYK 02/02/09 105345
Plan Check $645.94 LYK 02/02/09 105345
State Building Code $4.50 LYK 02/02/09 105345 FEB I°1 2009
Total: $1,644.19 Jefferson County Planninc
& Building Department
Jefferson County Building •ision Permit Nuer: BLDO9-00026
Applicant: HOLLOWAY III
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 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
Rough-in Plumbing /►
Framing - `
Airseal � r713
Insulation: Walls i c
Wallboard Nailing 5-I11 lDI
Gas Line: Interior
Mechanical Systems 0 9 1i(1
FINAL INSPECTION
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
ggox Co�� CON •
DEPARTMENTJEFFERS OF COMMUNITY DEVELOPMENT
rzi
'4 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
www.co.jefferson.wa.us/commdevelopment
BINW
Master Permit Application MLA:
Project Description (include separate sheets as necessary):
Tax Parcel Number: Property Size: (acres/square feet)
Site Address and/or Directions to Property:
Property Owner(s)of Record:
Telephone: Fax: email:
Mailing Address:
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies
❑Building ❑ Critical Areas Stewardship Plan
❑ Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
❑ Single Family 0 Garage Attached/Detached ❑ Conditional Use[C(a), C(d),or C]**
❑ Manufactured Home ❑ Modular ❑ Discretionary"D"or Unnamed Use Classification
❑ Commercial* 0 Special Use(Essential Public Facilities)**
❑ Change of Use ❑ Boundary Line Adjustment
❑ Address 0 Road Approach ❑ Short Plat**
0 Home Business ❑ Cottage Industry ❑ Binding Site Plan**
❑ Propane ❑ Long Plat**
❑ Sign ❑ Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes"Use Consistency Analysis ❑ Plat Vacation/Alteration**
❑ Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions**
❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Substantial Development**
❑Temporary Use ❑ Shoreline Management Variance
❑Wireless Telecommunication* ❑ Comprehensive Plan/UDC/Land Use District Map Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium ❑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 icide-0-'y - ' agent in matters relating to this application for permit(s).
OWNER SIG, '//r� ///// Date: 7 -Q/
By signing -pplication form,the ow -r/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 o -• • to Jefferson County and its employees, representatives or agents for the sole purpose of application
review and any requir-• - -r i -pecti• . Staffs a. -ss and right of entry will be assumed unless the applicant informs the County in writing at the
time of the applic on th- • -- wants prior
Signature: / . , I .i .L .— Date: 2 - 2
The acti-.n or a '•ns Appl' ant will dertake as a result of the issuance of this permit may negatively impact upon one or more threatened or
endan.- -- pecies and oul• -ad 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 viol- - _ SA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)even if t. - - in • • iance ith e Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-tra• erabl- ep % sibility for`,•.--/�ng to a plying with e ESA. The Applicant has read this disclaimer and sign and dates it below.
Signat itiOor / ./' ` Date:
G:\PermitCentcr\# IS###\DRD FORMS\Master Permit Application 5-29-08.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:
( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
Li New ❑ Wood Existing: [i Sewer
H Addition ❑ Steel Proposed: Bank I] Community System
Alteration/Remodel Li Concrete Total: Height: Li Individual System
f7 Repair ❑ Masonry SEP Permit#
] Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well [I 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 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:
2na Floor Heated Consistency Review:
Other Heated Base fee:
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL
Decks 911/Rd Approach fee:
Other TOTAL: $
Receipt Number:
Cash/Check Number:
ESTIMATED COST(REQUIRED) Date:
•Fair market value of all labor and materials foundation to finish
Initials:
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
4SON op. JEFFERS COUNTY
W q, j DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street• Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
mNGrp www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: L)t`) fl'L . ECM
Project Description(include separate sheets as necessary):
Tax Parcel Property
Number: q (p 000 D L0 3 Size: /Q a/d S q . (acres/square feet)
Site Address and/or Directions to Property:
Z, c(ZE E k PI• , Po O'0 cota400b>
Property Owner(s)of Record: 4h c Lo Lj4'1t 1�p -tl '�Q (.R 4 ( 4 L t -i }Jo rJ
Telephone.MS 0;.-3 7 Fax: -38 - 1.3 I'i email /a&i (�c�WC Q.S f,s 6Ot-C°_.Ut't l
Mailing Address: DO 3 ok S9,6 r o L'T -72;‘,1113 6-Vf WA. '34g
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies
Building ❑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
b Manufactured Home ❑ Modular 0 Special Use(Essential Public Facilities)**
O Commercial* 0 Boundary Line Adjustment
❑ Change of Use 0 Short Plat**
❑ Address ❑ Road Approach 0 Binding Site Plan**
❑Home Business ❑Cottagelndustry 0 Long Plat**
0 Propane 0 Planned Rural Residential Development(PRRD)/Amendments**
❑ Sign ❑Plat Vacation/Alteration**
❑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
0 Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment
0 Forest Practices Act/Release of Six-Year Moratorium 0 Tree Vegetaion 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 4 16S lb to my agent in matters relating to this application for permit(s).
OWNER SIGNATU £'-1 Date: /— /! -65
By signing this on form,the owner/ gent attests 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 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 r try will b assumed unless the applicant informs the County in writing at the
time of the appl" =• .t he . s ••nts pn. n. ' -
Signature. ASS ,��� � ‘^-1 f Date: /'/7 --09
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-transfer onsibility for a nd c9m I itll th SA. The Applicant has read this disclaimer and signs and dates it below.
Signature: Date:
C:\llocuments and Settings\carat\Local Settings\Temporary Internet Files\O1,K86\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 beassumin• t,e ponsii,iii i •f the
contractor for the proposed project.
Signatur h�Vr/�/,,../t a_� _ Date: ""1i"C99
lili
GENERAL CONT- OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
( ) ( )
MAILING ADDRESS: 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: Z Sewer
Addition 1 Steel Proposed: I Bank i Community System
'Alteration/Remodel i i Concrete Total: 3 Height: •ylndividual System
Repair Masonry SEP Permit#
Demolition [ Other: Bedrooms: Water Supply:
Existing: -3 Setback: F i Private well H Two Party
Type of Heat: Proposed: Public ,,��
Total: �i Name of System: /J1_4P,,4 T'
t1r✓ A.)pOy
If this is a Co mercial Proiect 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 I I Above ground Tank Size of Propane Tank:
❑Heat Stove 0 Cook Stove 0 Woodstove 0 Fireplace Insert 0 Hot Water Tai
k 0 Pellet Stove 0 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 L 773 EH Bld App Review.
2"°Floor Heated Consistency Review: _
Other Heated Base fee:
74
Mezzanine 14, Additional Section:
Heated Basement > Plan Check fee:
03 Gq�3I (045c14
Unheated Basement ' t htf0 State Surcharge fee:
11 LI—10110 heA,kv 160
$iiiOther Unheated Pot Water Review fee:
OA
Garage/Carport SUBTOTAL
Decks 911/Rd Approach fee:
Other TOTAL: $ ( 1 1 19
Receipt Number: I cn - 5
Cash/Check Number: I I-15
ESTIMATED COST(REQUIRED) Date:
.Fair mark t value of all labor and materials foundation to finish _.--29-::
I �-D OQ7d �� Initials: C----r- -------)
,
C:ADocuments and Settings\carat\Local Settings\Temporary Internet Mies\O1.K86\Master Permit Application 12-19-2006.doc
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