HomeMy WebLinkAboutBLD2009-00087 ()BUILDING PERMIT APPLIC•ON BR eview
Type
87
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD09-00087 Received Date: 3/24/2009
SITE ADDRESS: 206 OLYMPUS BLVD
PORT LUDLOW, 98365
OWNER: JOHN J TERPSTRA JR PHONE: 360-437-0994
JANET E TERPSTRA
206 OLYMPUS BLVD
PORT LUDLOW WA 98365-9414 OLYMPUS BEACH
SUBDIVISION: Block: Lot: 50+
PARCEL NUMBER: 978900029 Section: 4 Township: 28 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: LINDBERG & SMITH ARCHITECTS PHONE: (360)452-6116
319 S PEABODY ST STE B
PORT ANGELES WA 98362
PROJECT DESCRIPTIOr INTERIOR REMODEL - RELOCATE FURNACE & REMOVE NON
BEARING WALLS
NO MLA REQ'D
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ALT MAIN:
VALUATION 10,000.00 ADD'L: HEAT TYPE:
CODE EDITION: 2006 HEAT BASE: HEAT TYPE:
OCCUPANCY:
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total:
Routing Date:
a51oq is
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $181.25 KAS 03/24/09 105604 APPROVE Plan Check $117.81 KAS 03/24/09 105604
State Building Code $4.50 KAS 03/24/09 105604 MAR 31 2009
Total: $303.56 Jefferson County Planning
&Building Department
Jefferson County Building Oision Permit Nu•r: BLD09-00087
Applicant: TERPSTRA JR
BUILDING PERMIT INSPECTION APPROVALS \pplicable Code: 2006 International Building Codes
To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection.
Requests received after 7:00 AM will not be scheduled for that day's inspections.
ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries.
The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection
Inspection Item Date Approval Signature Notes
Framing
Mechanical Systems
Miscellaneous
FINAL INSPECTION
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
°Nc �. ` t, '. rEj � .
4 ° JEFFERScOUNTY
'�' ` 1j DEPARTMENT OF COMMUNITY DEVELOPMENT
r1
`� 621 Sheridan Street• Port Townsend •Washington 98368 2 4 �wj
360/379-4450 • 360/379-4451 Fax
1qs 0 www.co.jefferson.wa.us/commdevelopment
JEEEERSON COUNTY HD
Master Permit Application MLA:
Project Description(include separate sheets as necessary):
I VTIMIC . zm b rAt . - 1251 Lar,c,Ttr ac t iZr/L$" ANiz r NoN,) IWAZt NG IA)ALI,4
Tax Parcel Number: ' .78Cj OO O2el Property Size: hi , )3.5" , 0 2 (acres/s..235 eet)
Site Address and/or Directions to Property:
20tie 0(,11MFVrS I3t.V0 . )) pD T L.01)1_aw C14b3415
Property Owner(s)of Record: J 01-\N ie J ANIsT' TE12-12STI7...4
Telephone: D( 4 3-1 -4=4,14 Fax: email:
Mailing Address: O ea OLclinn • 4sL.V Q. • "oSzr l,.vpt_Dw ts.rA of65e0s'
Applicant/Agent(if different from owner): .13,,t1RLtt"r'S S N1 17L 1 LI N061,T2.4 11.1 SM 014 9i f f -c7S
Telephone: 3C00 f 4Z- C,ol►(, Fax: & /4S2 --704+ email: GCOtJ'TAG1-0,WND.41"11) .461.11
Mailing Address:
What kind of Permit?(Check each box that applies
•-Nguilding 0 Critical Areas Stewardship Plan
❑ Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a),C(d),or C]**
❑ Manufactured Home ❑ Modular 0 Discretionary"D"or Unnamed Use Classification
❑ Commercial* 0 Special Use(Essential Public Facilities)**
0 Change of Use ❑ Boundary Line Adjustment
❑ Address 0 Road Approach ❑Short Plat**
❑ Home Business 0 Cottage Industry 0 Binding Site Plan**
❑ Propane ❑Long Plat**
❑ Sign ❑ Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration**
❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions**
❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development**
❑Temporary Use 0 Shoreline Management Variance
0 Wireless Telecommunication* ❑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 svrl; to act as my agent in matters relating to this application for permit(s).
L��WNER SIGNATURE ` �.. ! Date: 3 20)j
By signing this application'f,rm,the o er/a.-nt attests that the information provided herein,and in any attachments,is true and correct to the best of
his,her or its knowledge. A materi I - = ood or any omission of a material fact made by the owner/agent with respect to this application packet
may result in this,Rermit b-' g nu - d 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 i spections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the applicatio hat he •,ie want prior notice.-(Signatures .' Date: 3/2 f 0cj
The action or actions' plicant w I derta e as a result of the issuance of this permit may negatively impact upon one or more threatened or
endangere ecies • •uld le.• to : •• ential"take"of an endangered species as those terms are defined in the federal law known as the
"Endangered ' s Act"or' '."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'f you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-t le 'bill for adhering to and complying with the ESA. The Applicant has read this disclairi7er and signs and dates it below.
-Signature: Date: 3 ,/Z ..
G:\Permi S## FORMS\Master Permit Application 5-29-08.doc
r
• 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: IF cat v ih �I ,.
ownr 1(D ) 437 -alai+ ( ) li
MAILING ADDRESS: EMAIL: �j �+{�j
CONTRACTOR'S LICENSE WAINS MAR 2 4 2CJ�
NUMBER: NUMBER
ARCHITECT/ENGINEER: 1_1 MDFajty 5MI7I4 Apziu1 r - PHONE ( )[62-6(/(t .�LFAx:( � 7)Q. ,
MAILING ADDRESS: ?�. > . 4P� 9T , Ff A , I T� ib Z. EMAIL NTADT'(1\.;1 7\?1b.dgQL•1►3. 'thvyN
Project Type: Frame Type: 111 Bathrooms: ,i Shoreline: Type of Sewage Disposal:
❑ New X Wood Existing: ` - ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank ❑ Community System
Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System
❑ Repair ❑ Masonry SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: 2. Setback: ❑ Private well ❑ Two Party
Type of Heat: Proposed: ?c ❑ Public
Total: Z 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 i Above ground Tank Size of Propane Tank:
i Heat Stove i Cook Stove 1 Woodstove 1 Fireplace Insert i 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 I EH Bld App Review:
2' Floor Heated (pnD Consistency Review:
Other Heated Base fee: 1 G l J� G�a
D .J
Mezzanine Additional Section: �_
Heated Basement r Plan Check fee:
P — Irlr8J
Unheated Basement State Surcharge fee: 4 50
Other Unheated _ Pot Water Review fee:
Garage/Carport ,600 SUBTOTAL 3 03 C
"C �lP
Decks Ik _ 911/Rd Approach fee:
Other e o\1 \n TOTAL: $ 605.a)
"C Receipt Number: I 0 5(00 t
Cash/Check Number: I I j�rl/'
ESTIMATpeOS-T(REQUIRED)- Date: `(�] i
•Fair m et v lue of all labor and materials fo dation to finish a J
Z 1 O D d .." I Initials:
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
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