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Home My WebLink AboutBLD2009-00131 UILDING PERMIT APPLICAJN B Review D09 00p1e31 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD09-00131 Received Date: 4/28/2009 SITE ADDRESS: 170 WINDSHIP DR PORT TOWNSEND, 98368 OWNER: SANDRA PITELKA TRSTE PHONE: LOUIS F PITELKA TRUSTEE 170 WINDSHIP DR PORT TOWNSEND WA 98368-2513 KALA POINT#1 SUBDIVISION: Block: Lot: PARCEL NUMBER: 964700048 Section: 26 Township: 30 N Range: 01 W CONTRACTOR: ERIC CLARK CONSTRUCTION PHONE: (360) 301-1156 190 N VICTORY AVE PORT TOWNSEND WA 98368 Contractor's License ERICCCC941JS Expires 4/18/2010 REPRESENTATIVE: ERIC CLARK PHONE: (360) 301-1156 190 N VICTORY AVE PORT TOWNSEND WA 98368 PROJECT DESCRIPTION REPLACE DECK BOARDS, RAILING, JOISTS AS NEEDED - NO MLA REQ'D TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP DEK MAIN: VALUATION 12,000.00 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: II II Type Amount Paid By: Date: Receipt: Approved/Date Permit $209.25 KAS 04/28/09 108337 AP P R®V E E Plan Check $136.01 KAS 04/28/09 108337 State Building Code $4.50 KAS 04/28/09 108337 APR ag 2009 Total: $349.76 Jefferson County Plannint &Building Department Jefferson County Building •sion Permit Nurar. BLD09-00131 Applicant: PITELKA TRSTE 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 Framing FINAL INSPECTION C).- . FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR C sCsON JEFFERSONtOUNTY R�- <<' i) ��-� D ' DEPARTMENT OF COMMUNITY DEVELOPMENT S 'P�3- 621 Sheridan Street• Port Townsend •Washington 98368K4360/379-4450 • 360/379-4451 Fax ��p� www.co.jefferson.wa.us/commdev� �� couNn fr� Master Permit Application MLA: Proje Description(includeseparate sheets as necessary):, pL Aft! t)e -t4 ikt14'.6 iiAlt.,4 P4(4, ( )01 5 01 ►^i 1 k ej:i Tax Parcel Number: I lP 4 ?OC- O 2÷0 Property Size: (acres/square feet) Site Address and/or Directions to Property: \. UJ1ND i--A\ P Oa Ui - Cta -� 3 Property Owner(s)of Record: c3v `j4i1-4 t--e.I_,., Telephone: Fax: email: Mailing Address: 1. W 1i...iOSi-1 1 P .c)(2.. T• 7 • tJ , qi3 3 rn Applicant/Agent(if different from owner): 1=17--.1 C_ ( _Cts.e-ti----- Telephone: 'CO . icy l ' 1 1'S Fax: email: Mailing Address: rto 14, \1c,^Toi Y ,ej'a P7C. t,..1P , G't b-3 (2.f What kind of Permit?(Check each box that applies 0 Lot or Road Segregation Building ❑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 - ❑ Discretionary"D"or Unnamed Use Classification ❑ Commercial* ❑Special Use(Essential Public Facilities)** ❑ Change of Use ❑ Boundary Line Adjustment ❑ Address 0 Road Approach ❑Short Plat** ❑ Home Business 0 Cottage Industry ❑ Binding Site Plan** ❑ Propane 0 Long Plat** ❑ Sign - • 0 Planned Rural Residential Development(PRRD)/Amendments** . ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** ❑Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions** ❑ Site Plan Approval Advance Determination(SPAAD)* 0 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 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 1F'►7 t� C PAP,V /� to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE �` 4 ' X J-SI✓ J c Date: L n'/ _ ZOD 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 application t he or she wants,ert,,n ice. Signature: ' "" l2[ i/ J Date: £ , v?S- 4c7e, `� 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-trantferable ponsibility/ for adherigg t an complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: 7\ (.(i�it rGc� k )-J� Date: ✓ —2 8J .,00 7 G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc • 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: ?--:_iC- Pe-- -- :5c.) '- I ( ) MAILING ADDRESS: no A,, 'Jk Co?-ar�. A.V E. ia„. EMAIL: CONTRACTOR'S LICENSE 1 WAINS NUMBER: Eig-t ALL 94 r S NUMBER ARCHITECT/ENGINEER: i J`A PHONE ( ) FAX:( ) MAILING ADDRESS: ��"/ EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: El New A Wood Existing: ❑ Sewer ❑ Addition 0 Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel 0 Concrete Total: _ Height: ❑ Individual System 14 Repair ❑ Masonry SEP Permit# 0 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 Pal king Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: H o have Food Service? Yes / No ' i, If this is a Propane Tank and/or Appliance Installation permit,mark all itekit6 bbio t apply:lL44 I Underground Tank i Above ground Tank Size of Propane Tank: i Heat Stove i Cook Stove i Woodstove i Fireplace Insert i Hot Water Tank ii Pellet Stove 'I Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / No AeR 2 S 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 fines,buildings and septic system components, including the reserve area. t Square Footage Current Proposed For Office Use Only ; Amount ,.,Revision Main Floor Heated EH Bld App Review: 2"d Floor Heated Consistency Review: Other Heated Base fee: olb n 25 Mezzanine Additional Section: l Heated Basement Plan Check fee: 13(1:;i-G 1 Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL 1 C ,- Decks -I SOt 911/Rd Approach fee: Other TOTAL $ 3[f . 7 r-, Receipt Number: l O 655.7 Cash/Check Number: l ESTIMATED COST(REQUIRED) Date: g / •Fair ma value-ofajtlaboFan ateri7sfoundation to finish 09 /07,, 000. C9 O -I- in.-, — Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc