HomeMy WebLinkAboutBLD2009-00334 O
UILDING PERMIT APPLICAN BLD09-00334
Jefferson County Department of Community Development Review Type: I
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD09-00334
SITE ADDRESS: 132 N LYTER AVE Received Date: 10/5/2009
PORT TOWNSEND, 98368
OWNER: BARBARA M SEPERSKY TRSTE
BARBARA M SEPERSKY TRUST PHONE 360 385 0297
132 N LYTER AVE
PORT TOWNSEND WA 98368-2544
SUBDIVISION: IRONDALE
Block: 159 Lot: 25-28
PARCEL NUMBER: 962115909
Section: 35 Township: 30 N Range: 01 W
CONTRACTOR: BUERNER CONSTRUCTION
71 E EUGENE ST PHONE: (360)379-8945
PORT HADLOCK WA 98339
Contractor's License BUERNCC065J1 Expires 5/3/2011
REPRESENTATIVE:
PHONE
PROJECT DESCRIPTIOr SUNROOM ADDITION ON EXISTING PATIO SLAB - UNHTD, NO PLMB
TYPE OF WORK RES SQUARE FOOTAGE
TYPE OF IMP ADD
VALUATION 14,750.00 MAIN:
CODE EDITION: 2006 ADD'L: HEAT TYPE: UH
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: OTHER: 200
CONST TYPE: GARAGE: SHORELINE:
DECK: SETBACK:
SEWAGE DISPOSAL: BANK HEIGHT:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 0 Prop: 0
Total: 0 Total: 0
Routing Date: L-
Type Amount Paid BV: Date: Receipt: Approved/Date
Permit $251.25 LYK 10/05/09 111054 APPROVEE
Plan Check $162.66 LYK 10/05/09 111054
State Building Code $4.50 LYK 10/05/09 111054 OCTSC2ong
Total: $418.41
Jefferson County Planning
& Building Department
Jefferson County Building DDsion Permit Nurlr: BLD09-00334
Applicant: SEPERSKY TRSTE
BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2006 International Building Codes
To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection.
Requests received after 7:00 AM will not be scheduled for that day's inspections.
ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries.
The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection
Inspection Item Date Approval Signature Notes
Setbacks ,
j� -LG vet
Foundation Footing IL? 2c )
Ext. Shear Wall Nailing (,
Framing 2,, p
Airseal
Insulation:Walls
Insulation: Floors
Insulation: Ceiling
FINAL INSPECTION / f P (" 1
FINAL I ECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
eo,N co<>� JEFFE UNTY
4 tti� ` t� DEPARTMF ENT�F COMMUNITY DEVELOPMENT44. •
'4 I 621 Sheridan Street•Port Townsend•Washington 98368
��4 �$, 360/379-4450- 360/379-4451 Fax
_aa�jllvv www.co,efferson.wa.u&commdevelopment
Master Permit Application MLA: ' ) 11(IA e _
s.
Project Description(include separate sheets as necessary): ++-
a, rr.c,Ia 4Q /O' ) Ao' - r�d k c U 'I U VyLU
Tax Parcel 4'6 z //; �O
Number. � Property VVV
Size: 'ta:;1°O() _ (es es/square feet)
Site Address and/or Directions to Property:
i 3 2 . �� � t awyu,x, .d f WL- 983(0 Si
Property Owner(s)of Record: �.�01/thrwe„ �, y
Telephone:3 fo0- �-0 Ate Fax: jJ
-7., j email:
Mailing Address: /�j o'1
i•4/1/142e4etd
Applicant/Agent(if different from r): C� �•
Telephone:3(0O-37' -}�9n0S Fax: email:
Mailing Address: 12./O Q _ P�/'1i`-.4
What kind of Permit?(Check each box that applies
RlBuikiing ❑Variance(Minor,Major or Reasonable Economic Use)
❑ Demolition Permit 0 Conditional Use[C(a),C(d),or C)**
,K Single Family ❑Garage Attached/Detached 0 Discretionary"D'or Unnamed Use Classification
❑ Manufactured Home 0 Modular ❑Special Use(Essential Public Facilities)**
❑ Commercial* 0 Boundary Line Adjustment
❑ Change of Use ❑Short Plat**
❑ Address 0 Road Approach ❑Binding Site Plan'*
❑Home Business 0 Cottagelndustry 0 Long Plat**
❑Propane 0 Planned Rural Residential Development(PRRDyAmendments**
❑Sign 0 Plat Vacation/Alteration-*
❑Allowed"Yes"Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisions**
❑Stormwater Management 0 Shoreline Management Substantial Development**
❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Variance
❑Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* 0 Jefferson County Shoreline Master Program Amendment
❑Forest Practices Act/Release of Six-Year Moratorium ❑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 to act as my agent in matters relating to this appi tion for permit(s).
OWNER$IG'NA Date.
By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and o 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 may result in this permit being null and void.
application packet
I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attome 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 C n time of the appli lion thy}he or she wants prior ry in writing at the
Sgnature: Qk�LK-a't,a Date: c,2m4 '
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
and non-transferable acknowledges that he,she or it holds individual
for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature:
Date: j--- ? -09
C:\Documents and Settings\caul\local Settings\Temporary Internet Files\OI.KR6i\Master Permit Application 12-19-20(K,.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:
g�Cs/�'MQA PHONE FAX: �y�,,,,
MAILING ADDRESS:�./a/p (�ID) 3���$/�S ( ) D"_"�C._.
CONTRACTOR'S LICENSE Pam''�aduu EMAIL: x,� M.
WAIN
NUMBER: {j j,tEk.N CC06,5J I NUMBER
ARCHITECT/ENGINEER:
MAILING ADDRESS: PHONE ( ) FAX:( )
EMAIL
Project Type: Frame Type: Bathrooms:
IJ New Wood Shoreline: Type of
Existing: ❑ SewerSewage Disposal:
Addition ❑ Steel Proposed: a
Alteration/Remodel ❑ Concrete Total: Bank 0 Community System
❑ Repair �` Height ❑ Individual System
❑ Masonry SEP Permit#
Il Demolition 0 Other. Bedrooms:
Existing: ? Water Supply:
Type of Heat: Pry: 0Setback: [I Private well I Two Party
ZP Total: .p 4, ❑ Public
Name of System:
If this is a Commercial Project you must answer the following:
Number of Parking Spaces: Current:
Number of wed: Number of ADA Parking Spaces:
occupants(includes owners,tenants,employees,etc) Current
Proposed
IBC Occupancy: IBC Type of construction:
If this is a Pro ne Tank and/or fiance Installation Vbe you have Food Service? Yes / No
❑Uncle round Tank rrma*all��� that a
ClAbove ground Tank Size of P
❑Heat Stove ❑Cook Stove ❑Woodstove O Fi r'D�^e Tank:
replace Insert ❑Hot Water Tank ❑Pellet Stove ❑Oar
Is this a liana bein installed in a Manufactured/Mobile Home? Yes / No
When applying fora permit to install a propane tank you must also submit a site
lines,tank location and size,distances from the propane tank to allplan showing and/a the gs,all pens,
includi . the reserve area. property lines,build
n9s septic system components,
S•ware Foote! = Current Pro,..:
For O
Main Floor Heated Office Use On Amount Revision
EH Bld App Review
2' Floor Heated11.11=
MI Consistency Review:
Other Heated —
MI Base fee:
Mezzanine - l Z
_ Additional Section:
Heated BasementIIIIIIIIIII
Plan Check fee: 1 I ,
Unheated Basement ` v Cj
IIIIIIIIIII State Surcharge fee: IIIIIMEEIIIIIIIIIIINIEENII
Other Unheated
a OQ IM Pot Water Review fee: 111.111111111111111111
Garage/Carport
NMSUBTOTAL
1111111.1
Decks 8 4
_r 911/Rd Approach fee:
Other __ ,_e
TOTAL: •
i
Receipt Number.
ilnrMUIMIIIIIIIII
11.1 Cash/Check Number.
ES • 6 mm COST(REQUIR::m
Date:
.Fair a¢ value,oof all labor and m- - s foundation to finish111=._
111111111111111111111
wl /7 17 SO Initials: —
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