HomeMy WebLinkAboutBLD2009-00336 QUILDING PERMIT APPLICA•N ML Review Ty Ty 334
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Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD09-00336 Received Date: 10/5/2009
SITE ADDRESS: 4372 S DISCOVERY RD
PORT TOWNSEND, 98368
OWNER: KARL JON JACOBSEN PHONE: 360-385-2745
SANDRA J JACOBSEN
4250 S DISCOVERY RD
PORT TOWNSEND WA 983689676
SUBDIVISION: Block: Lot: TX15i
PARCEL NUMBER: 001321012 Section: 32 Township: 30 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION STAIRS TO THE BEACH REPLACEMENT
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION 2,288.00 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: 0 Exist: 0
Prop: 0 Prop: 0
Total: 0 ,-T-6faT 0
Routing Date:
Type Amount Paid By: Date: Receipt: Ali'"OV
Permit $83.25 LYK 10/05/09 111056ED
Plan Check $54.11 LYK 10/05/09 111056
State Building Code $4.50 LYK 10/05/09 111056 MAR q 101
Total: $141.86 Jefferson County Planning
& Building Department
Jefferson County Building Divi•n Permit Numbe•BLD09-00336
Applicant: JACOBSEN
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
Setbacks 9/2 747ii/
Post Holes 2-/)--
/L J2)
Framing - l L /, "3
FINAL INSPECTION /2_ �`• j47
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
•
CONDITIONS for Building Permit# :BLD09-06 •
1.) The project shall adhere to the Best Management Practices (BMPs) to control stormwater,
erosion and sediment during construction. BMPs shall address permanent measures to
stabilize soil exposed during construction, and in the design and operation of stormwater
and drainage control systems.
2.) Prior to commencing development activity, proponent is responsible for informing the
Washington Department of Fish and Wildlife (WDFW) in order for WDFW to determine
whether this action is subject to the Washington State Hydraulic Code (Chapter 220-10
WAC). Hydraulic Project Approval (HPA) is required for all hydraulic projects, which are
defined as construction or performance of other work that will use, divert, obstruct, or
change the natural flow or bed of any of the salt or fresh waters of the state.
3.) In addition to Jefferson County permit conditions, the project proponent shall comply with
all conditions set forth by the Washington Department of Fish and Wildlife through
Hydraulic Project Approval.
4.) Prior to commencing development activity, the proponent is responsible for informing the
US Army Corps of Engineers (COE) in order for COE to determine whether a Department
of the Army permit or review is required. Generally, review is required for construction
and dredging in or around navigable waters of the US and for work or fill in hydrologically
connected wetlands. Contact the US Army Corps of Engineers, Seattle District
Regulatory Branch, PO Box 3755, Seattle WA 98124, (206) 764-3495, for more
information.
5.) Work within the jurisdiction of the Shoreline Master Program other than as described
above shall receive separate review from this Department.
6.) Construction shall be in substantial compliance with the site plan submitted on January
26, 2010 as it exists now or is hereafter amended by Jefferson County and/or the
Washington Department of Ecology.
7.) No fill or other material may be placed in the waters or intertidal areas of Jefferson
County.
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Contact the Building Departme•
nt •
at 379-4450 prior to making changes
or revsfons to the approved plans
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. , JEFFERSON COUNTY DCD
,0 „.t-' . BUILDING PLAN REVIEW
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Ty . Z L-,(::, Er APPROVED AS SUBMITTED
0 APPROVED AS NOTED
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NOTICE: Plans are approved excepttnr
any errors or omissions. All work must
pates inspection in conformance with
all applicable codes and regulaticns. FILE COPY
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eed4401.4 o& JEFFERSON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
ti 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
�, , �p www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: LT( " ` d
Project Description(include separate sh ets as necessary): u'„! - ' .,..-.
5 iAtt, io Vew - R(1 14cp
Tax Parcel Number: 00 I —3 1 v I Z. Property Size:Atko)(, zZl 3 47 (acre square fee
Site Address and/or Directions to Property: (�
437Z 5 . D\5c.mv c. . 1" ow,... ft)A
Property Owner(s)of Record: K 5Ab..1 e.e, nI..)
Telephone: 3(ec' -3$_5-275e Fax- NA � t� email: I�ARr`� c, 1J 43P i, CB w1
Mailing Address: 4a5 o S .D i S c o vel. .-I,d• re j 4„0 s,e-Kc/ W A, 1.6360 v
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies ❑Lot or Road Segregation
uilding ❑Critical Areas Stewardship Plan
Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use)
❑ Single Family ❑ Garage Attached/Detached ❑Conditional Use[C(a), C(d),or C]**
❑ Manufactured Home 0 Modular 0 Discretionary"D"or Unnamed Use Classification
❑ Commercial* ❑Special Use(Essential Public Facilities)**
❑ Change of Use ❑Boundary Line Adjustment
❑ Address 0 Road Approach ❑Short Plat**
0 Home Business ❑ Cottage Industry ❑Binding Site Plan**
❑ Propane ❑ Long Plat**
❑Sign ❑Planned Rural Residential Development(PRRD)/Amenciments** -
❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration**
❑ Stormwater Management Shoreline Master Program Exemption/Permit Revisions**
❑Site Plan Approval Advance Determination(SPAAD)* ❑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 ❑Jefferson County Shoreline Master Program Amendment
*May require a Pre-Application Conference ❑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 to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE
Date:
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 th pp do that ;:ir•ske wants prior notice.
SignatureA Date: ID --S - O
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 ar in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non- ar.sfera le resp sibi)ikyfor aering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: `�d�ad( Date: 5 DI
• •
BUILDER STATEMENT
The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,trthey'bre not licensed contractors and that
they will b a sum g th resp sibilit of the General Contractor for the proposed project ' D� JJ
Signature: K. ikCX1� \ Date:
FAx:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: ( )
( )
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:
Wood Existing: ❑ Sewer
U ❑ Steel*New Proposed: Bank I i Community System
Addition
0 Alteration/Remodel 0 Concrete Total: _ Height: 0 Individual System
S,Repair ❑ Masonry SEP Permit#
P Bedrooms: Water Supply:
❑ Demolition ❑ Other: Existing: Setback: C1 Private well 0 Two Party
Proposed: ❑ Public
Type of Heat: 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
Type Occupancy:
IBC T e 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:
i Underground Tank i Above ground Tank Size of Propane Tank:
1 Heat Stove i Cook Stove i Woodstove i 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
4 EH BId App Review:
Main Floor Heated ----'
2nd Floor Heated Consistency Review:
Other Heated Base fee: C;
`� a5
Mezzanine ,mo•o XLtP -4-C1 -
Heated Basement Plan Check fee: J,( 1 I
Unheated Basement State Surcharge fee: 4 :::30
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL V,,
Decks 911/Rd Approach fee:
Other TOTAL: $ 83 1 ,vp
Receipt Number: 1 ` 1 0.5t)
- - I Cash/Check Number:
W. l
ESTIMATED COST(REQUIRED) Date: 1- 5—
•Fai arket value of all labor and materials foundation to finish Initials:
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