HomeMy WebLinkAboutBLD2009-00121 • BLD09-00121
UILDING PERMIT APPLICATION Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD09-00121 Received Date: 4/16/2009
SITE ADDRESS: 61 S RHODODENDRON DR
PORT TOWNSEND, 98368
OWNER: RONALD V BEDNARSKI PHONE: 360-379-6554
KAREN A BEDNARSKI
61 S RHODODENDRON DR
PORT TOWNSEND WA 98368-8900 CAPE GEORGE COLONY DIV 3
SUBDIVISION: Block: 7 Lot: 13
PARCEL NUMBER: 938400713 Section: 12 Township: 30 N Range: 02 W
CONTRACTOR: BLACKBIRD CONSTRUCTION PHONE: (360) 808-3466
MATTHEW S OLTS
PO BOX 529
PORT TOWNSEND WA 98368
Contractor's License BLACKCL947RH Expires 11/2/2009
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION REPAIR & REPLACE EXISTING DECKS & STAIRS(686SF) - NOT
OUTSIDE EXISTING FOOTPRINT
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP DEK 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:
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $181.25 LYK 04/16/09 108277 APPROVEr
Plan Check $117.81 LYK 04/16/09 108277
State Building Code $4.50 LYK 04/16/09 108277 APR 1(o 2009
Total: $303.56
Jefferson County PlanninG
&Building Department
4�¢gOly car, JEFFERSOFDUNTY •
W ' \� DEPARTMENT OF COMMUNITY DEVELOPMENT
I, o 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
�,qs pP. www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: ISO M LA t - '
Protect Description(include separate sheets as necessary):
(' 2 paix Ix l S T•ut3 k .J .k-. t- S- t r_S
Tax Parcel Number: (93 ? 0 ..7( Property Size: (acres/square feet)
Site Address and/or Directions to Property:
G/ S, /? c,de- �l- /'o '7
Property Owner(s)/ of Record: Ll,�/�4 L� K�,e� „g&.P/V 1KS K1 .
Telephone:-yr 7O _3 7'7 4 JrT Fax: email:
Mailing Address: E/ S. R D0 b Al.1)� bk , r0�E c •TZ�e�N- it,,)� �.4 5 f s6 J
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies
kiBuilding El Critical Areas Stewardship Plan
El Demolition Permit El Variance(Minor, Major or Reasonable Economic Use)
El Single Family El Garage Attached/Detached El Conditional Use[C(a), C(d),or C]**
❑ Manufactured Home El Modular 0 Discretionary"D"or Unnamed Use Classification
El Commercial* 0 Special Use(Essential Public Facilities)**
El Change of Use 0 Boundary Line Adjustment
❑ Address _ElRoad Approach ElShort Plat**
El Home Business El Cottage Industry ❑ Binding Site Plan** APR 1 6 2009
El Propane El Long Plat**
El Sign El Planned Rural Residential Development(PRRD)/Amendments**
El Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration**
❑Stormwater Management El Shoreline Master Program Exemption/Permit Revisions**
El Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development**
❑Temporary Use El Shoreline Management Variance
❑Wireless Telecommunication* El 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 El 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,gLAC1(g b Cep)J. 772t lcri a,L`to act as my agent in matters relating to
this application for permit(s).
)< OWNER SIGNATURE � 7 77j-C{7. Date: T___7--0 9
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 applic ' that or she wants prior notice. ,L
is Signature: fc Z '7 Date: /--C
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 I responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and 7signs and dates it below.
Signature: 6 Date: T!! 0 F
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc1
Jefferson County Building*vision Permit I ber:
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 1'
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
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0 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:
BkCl./1CCf S1-rcic7,p`i; C., C3�) so • 3 fir; r; ( Y-
MAILING ADDRESS: Pc2& 52f R -Trou/riyvtd 9836E3 EMAIL: SixckbiroiCoet,Srrvc7i'en 67MSN/. CONS
CONTRACTOR'S LICENSE WAINS
NUMBER: b l a c 4 C I 9 3 7 u V L NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shorelin : Type of Sewage Disposal:
I] New K Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: Ba ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: Height: , Individual System
X Repair ❑ Masonry SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type of Heat: Proposed: er Public
Total: Name of System:Grp '
6-ciao,
e
If this is a Commercial Projectyou 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 i Woodstove i 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: Ig I .2s
Mezzanine Additional Section:
Heated Basement Plan Check fee:
I17. 81
Unheated Basement State Surcharge fee: "SD
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL
O
Decks U e 6 /1_2 M e 911/Rd Approach fee:
Other `t- TOTAL: $ 3 ``b
Receipt Number: I b 07-7^-1
Cash/Check Number: O��-J fl
4 ', �t
ESTIMATED COST(REQUIRED) Date:
L •Fair ma et value of all labor and materials foundation to finish
/0 OQ C3.O/l Initials:
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc