HomeMy WebLinkAboutBLD2009-00155 BUILDING PERMIT APPLICA BLD09-00155
N Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD09-00155 Received Date: 5/27/2009
SITE ADDRESS: 162 W PATISON ST
PORT HADLOCK, 98339
OWNER: CHRISTOPHE GRANT III PHONE: 360-385-7548
PATRICIA L GRANT
1240 W SIMS WAY#85
PORT TOWNSEND WA 98368-3058 SEVENTH AV AC TR
SUBDIVISION: Block: Lot: 76+
PARCEL NUMBER: 994200012 Section: 3 Township: 29 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: TRAVIS FLACK PHONE: 360-531-3525
PO BOX 161
NORDLAND WA 98358
PROJECT DESCRIPTIOr ADD INTERIOR WALL & WINDOWS
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP ALT MAIN:
VALUATION 5,000.00 ADD'L: HEAT TYPE: UH
CODE EDITION: 2006
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 0 Prop: 0
Total: 0 Total.
Routing Date:
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $111.25 LYK 05/27/09 108513 APPROVE'
Plan Check $72.51 LYK 05/27/09 108513
State Building Code $4.50 LYK 05/27/09 108513 JUN 0 2009
Total: $188.26 Jefferson County Planning
&Building Department
Jefferson County Building Asion Permit Null: BLD09-00155
Applicant: GRANT III
BUILDING PERMIT INSPECTION APPROVALS \pplicable Code: 2006 International Building Codes
To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection.
Requests received after 7:00 AM will not be scheduled for that day's inspections.
ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries.
The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection
Inspection Item Date Approval Signature Notes
Framing e►`T f'i-Alr_ii J N/1-1./pi IL/ Kdt� Gar
Wallboard Nailing / /1-7
Miscellaneous
FINAL INSPECTION 7/i 9
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
emik
cod JEFFERSO OUNTY •
Gccc7��� ' DEPARTMENT OF COMMUITY DEVELOPMENT
` '4 621 Sheridan Street• Port Townsend •Washington 98368
_,*(5) 360/379-4450 • 360/379-4451 Fax
www.co.jefferson.wa.us/commdevelopment
87N0:
Master Permit Application lY",AY 7 mg/
CO (AA_ Qt-0'i�l
Proj ct Description(include separate sheets as necessary):
it
Tax Parcel Number: g942,6( /2 Property Size: 3.2 7 acres square feet)
Site Address and/or Directions to Property:
// /9 i'SCA7 S; - lo,z i"141Oi oc4.' I/(4 2 S 33 j
Property Owner(s)of Record: Cn'e/S T0?rr7/j £2),ci 2 ay-1,4r/_ie r? 2 G'/Z/f'Y•T
Telephone:.3GG 9-5 75-q/g Fax: — email: e y 3fr S'�f-A$/1 t
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Mailing Address: /.,24' W S„ti5 l s/ 4'sS- %R,.?T TLe/.v� .tip f. 1,e/.q �g36�
- Applicant/Agent(if different from owner): "17'c1 tit.5 r I AcA .
Telephone: O S 31-3�a S- Fax: email: -{(c, e tire/wl,�,err�y4 ;;c,. c am.
Mailing Address: ? D. t- is 16/ A)6C Atr=Ai / ;,JPc CS s SI
What kind of Permit?(Check each box that applies 0 Lot or Road Segregation
❑Building 0 Critical Areas Stewardship Plan
❑ Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
❑ Single Family dGarage Attached/Detached , 0 Conditional Use[C(a), C(d),or C]**
❑ Manufactured Home .0 Modular - 0 Discretionary"D"or Unnamed Use Classification
❑ Commercial* 0 Special Use(Essential Public Facilities)**
❑ Change of Use 0 Boundary Line Adjustment
❑ Address 0 Road Approach 0 Short Plat**
❑ Home Business 0 Cottage Industry 0 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 0 Shoreline Management Variance
❑Wireless Telecommunication* 0 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 l!i4'�V/5 /4/9 c/� to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE c 1 zr-e-r-G i-t-1.__ /51.' Date: 7 6 vzC-td 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 re ired later inspections. St ifs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the a li Yfo th he he wants for notice. 771
//y� �j�c�,�,
Signature: c c �% Date: G iicr ;
The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact up n 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 yo re in compliance with th Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-trans r resp nsibi• for adh ' g to and co f h the ESA. The Applicant has read this disclai er and signs and dates it below.
Signature: Date: .�i ? 2
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
• •
BUILDER STATEMENT ii
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 assu ing the resp sibility of the eneral Contractor for the proposed project.
Signature: Date: Z CG°
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:
❑ New ,( Wood Existing: ❑ Sewer
❑ Addition El Steel Proposed: Bank ❑ Community System
,k(Alteration/Remodel CIConcrete Total: Height: ❑ Individual System
❑ Repair ❑ Masonry SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type of Heat: Proposed: CIPublic
A/DA/!- 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 FoodSeriice? Yes / No
If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply:
i Underground Tank 1 Above ground Tank Size of Propane Tank:
i Heat Stove 1 Cook Stove 1 Woodstove i Fireplace Insert i Hot Water Tank i 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:
2n°Floor Heated Consistency Review:
Other Heated Base fee: I I I '
Mezzanine Additional Section:
Heated Basement Plan Check fee: (-TO 5 4
Unheated Basement State Surcharge fee: A , J:�11
v
Other Unheated Pot Water Review fee:
Garage/Carpoqrt SUBTOTAL
Decks 911/Rd Approach fee:
Other TOTAL $ I g g .2L
Receipt Number: ,0 gSV3
- _ Cash/Check Number:
ES fiIMATED COST(REQUIRED) Date: '
•Fair market value of all labor and materials foundation to finish (
�` ) f C�V O Initials:
G:\PemvtCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
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