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Home My WebLink AboutBLD2009-00343 • BLD09-00343 BUILDING PERMIT APPLITION Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD09-00343 Received Date: 10/7/2009 SITE ADDRESS: 293973 HWY 101 QUILCENE, 98376 OWNER: BEN STAMPER PHONE: 293973 US HIGHWAY 101 QUILCENE WA 983769558 SUBDIVISION: Block: Lot: T68 PARCEL NUMBER: 702132009 Section: 13 Township: 27 N Range: 02 W CONTRACTOR: NIEMAN CONSTRUCTION CO PHONE: (360)434-0717 P. O. BOX 846 QUILCENE WA 98376-0846 Contractor's License NIEMACC018MZ Expires 8/15/2010 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION Reroof from 3-Tab Composite to New Metal Roof TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP REP MAIN: VALUATION 10,196.00 ADD'L: HEAT TYPE: CODE EDITION: 2006 OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: 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: Type Amount Paid By: Date: Receipt: Approved/Date Permit $195.25 LYK 10/07/09 110964 APPROVED Plan Check $126.91 LYK 10/07/09 110964 State Building Code $4.50 LYK 10/07/09 110964 OCT 7 Total: $326.66 2009 Jefferson County Planning & Building Department 1 Jefferson County Building Division Permit 1COnber: BLD09-00343 Applicant: STAMPER BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2006 International Building Codes To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection. Requests received after 7:00 AM will not be scheduled for that day's inspections. ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries. The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection Inspection Item Date Approval Signature Notes Miscellaneous Existing Roofing Inspection FINAL INSPECTION 4 .L1 t � FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR . III • pilirioke, JEFFERSON COUNTY �j DEPARTMENT OF COMMUNITY DEVELOPMENT -.� .. r, ` '.4 621 Sheridan Street• Port Townsend •Washington 98368 r ep W 360/379-4450 • 360/379-4451 Fax •� OCO htINCs U www.co.jefferson.wa.us/commdevelopment �\\\�\\ Master Permit Application MLA: A- -St�% Project Description(include separate sheets as necessary): r---. IV q CeO ,0/ M 1 Tax Parcel Number: TO 2 / 3200 9 Property Size: (acres/square feet) Site Address and/or Directions to Property: Property Owner(s)of Record: .r'1 and Main r,r1 -(-�,yyt p e1• Telephone: 36 O -- 70 5-- 3 S C 2- Fax: email: Mailing Address: a t 3 ?I5 {-Fw v ( CJ ) t (,Zr,`,(e to n e_ w,i}- f r3-7 o Applicant/Agent(if different from owner): 1 Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies 0 Lot or Road Segregation wilding Y� roc- 0 Critical Areas Stewardship Plan ❑ Demolition Permit 71 0 Variance(Minor, Major or Reasonable Economic Use) _.'$ingle Family— ❑ Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C] ❑ Manufactured Home _0 Modular - - 0 Discretionary"D"or Unnamed Use Classification I 0 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** 0 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 to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE 6C/� .-,�.1L, Q 7 14/_1 Date: (U • -C By signing this application form,tlf�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 that he or she wants prior n Signature: / .-1.. J�(�yv.,., �/LJ Date: /O— 7— 6 j 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 tederal 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-transferable responsibility for adheri ''t and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: Date: lu — —7 -C1 ' G:\PermitCenter\###FORMS###\DRD FORMS\Current DAD Forms\Master Permit Application 5-29-08.doc . ! BUILDER STATEMENT The signer of this sjatement does hereby that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be ass„urfing4he res onsibi th General Contractor for the proposed project. Signature: L, Date: , / GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: Mf.',tk/ a'/s' ' /& Ct CO dirg1-P-?/7 ( ) MAILING ADDRESS: .:o� ,aw►C 646 , Q�,)�Mt (p,ii- EMAIL: /7/ � L/��(�Gy,n iile.,�/71 CONTRACTOR'S LICENSE r, �/�'.F Q jA V WAINS / d de, NUMBER: �'vrn Frets G 18 M Z— NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New Wood Existing: 1 ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System •g.Alteration/Remodel ❑ Concrete Total: _ Height: Individual System ❑ Repair ❑ Masonry SEP Permit# Li 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 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: i Underground Tank 1 Above ground Tank Size of Propane Tank: 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 Main Floor Heated EH Bld App Review: 2`d Floor Heated Consistency Review: Other Heated Base fee: /9 Mezzanine Additional Section: Heated Basement Plan Check fee: 12 / . q / Unheated Basement State Surcharge fee: --- yii- ,l Other Unheated Pot Water Review fee: (� Garage/Carport SUBTOTAL 3Z(4_,C2-� Decks 911/Rd Approach fee: Other TOTAL: $ 3 2 , t Receipt Number: f e_W inVe-iI Cash/Check Number: rgof {00'F ( ESTIMATED COST(REQUIRED) Date: •Fair rket value of all labor and materials foundatio)h,to finish /0J f�?S� �0 /� Initials: 1 G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc xi O c. m z a 3 m a XI m rim f�- �,l r 1--_____ 71 r m D v v 73 co co \io C o 00 __I r m -+ co go"‘"i "ti 0 t t lel .3:. 1 . J z f / a 3 s` m o I —. j NCIN m cn ..nr,(1) / cn Pe O a m z ,I its) c 3 Co m 7 O -n rn cn z. 73 m -o • a 73 O v z