HomeMy WebLinkAboutBLD2009-00388 BLD09-00388
UILDING PERMIT APPLICAWN Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD09-00388 Received Date: 11/23/2009
SITE ADDRESS: 991 LUDLOW BAY RD
PORT LUDLOW, 98365
OWNER: STEVEN R ROGEL PHONE: 360-301-4792
CONNIE R ROGEL
991 LUDLOW BAY RD
PORT LUDLOW WA 98365-8731 LUDLOW BEACH TRS 2
SUBDIVISION: Block: Lot: 19
PARCEL NUMBER: 969000020 Section: 16 Township: 28 N Range: 01 E
CONTRACTOR: WARD CONSTRUCTION PHONE: 360-301-4792
1427 1ST ST
PORT TOWNSEND WA 98368
Contractor's License WARDCC*925N7 Expires 8/27/2010
REPRESENTATIVE: JAMES WARD PHONE: 360-301-4792
1427 1ST ST
PORT HADLOCK WA 98339
PROJECT DESCRIPTIOI INTERIOR REMODEL
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ALT MAIN:
VALUATION 55,000.00 ADD'L: HEAT TYPE: PRO
CODE EDITION: 2006 HEAT BASE: HEAT TYPE:
OCCUPANCY: R-3 UNHEATED: #OF STORIES:
OCCUPANCY:
CONST TYPE: 5N OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS:
Exist: 3 Exist: 3
Prop: 0 Prop: 0
Total: 3 Total: 3 _
Routing Date:
Type Amour-Wald By: Date: Receipt: �igOa ED
Permit $678.75 LYK 11/23/09 113455 AP1It'•{`
Plan Check $441.19 LYK 11/23/09 113455
State Building Code $4.50 LYK 11/23/09 113455 DEC.9I 2009
Potable Water Application $62.00 LYK 11/23/09 113455 Jefferson County Planning
Total: $1,186.44 &Building Department
Jefferson County Building sion Permit Null,: BLD09-00388
Applicant: ROGEL
BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2006 International Building Cc
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
Rough-in Plumbing
Framing
t.�(A k Y13 coc,vt 7oi (=�U -t
Airseal
PrTL-
Insulation:Walls
Wallboard Nailing 3prTk'� +\'/ `} _ i ` 1c1_17)
Address Posted 1'J(
Miscellaneous WINDOW INSTALLATION
FINAL INSPECTION i,ZII� .
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
fox cow JEFFERSOOUNTY
411' r `2 DEPARTMENT OF COMMUNITY DEVELOPMENT
t P`') ` '4 621 Sheridan Street• Port Townsend • Washington 98368
360/379-4450 • 360/379-4451 Fax
,gn, yri www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: ()is
Project Description(includ eparate sheets as necessary):
INtfl,tr oDF-Jc .
Tax Parcel Number:C (4 poDoa0 Property Size: 'cc 7f.3171 I (acres/square feet)
Site Address and/or Directions to Property:
qq I A (tp 6/4-y '<DAP , 6172 i 1 VOI.01-4-1
Property Owner(s)of Record:�-' f I/F Iffjcl,P CDNAiir ,D 6 Ea..
Telephone:3, 0 ' it 3`j ' &"11 q Fax: email:
Mailing Address: q 1 f 1, V P I-. OhJ 4-?/ (O1ti)
.. Applicant/Agent(if different from owner): /-in t 75 (,,V/h(u CO7v RIW -TeX
Telephone: a60, 30 / - 7 9 2- Fax: email:
Mailing Address: a B b X /0... P r 9 J'36 (9--
What kind of Permit?(Check each box that applies ❑Lot or Road Segregation
wilding 0 Critical Areas Stewardship Plan
0 Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use)
❑ Single Family ❑Garage 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 ❑ 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* ❑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' k*di e,S 1/Qr to act as my agent in matters relating to this application for permit(s).
- OWNER SIGNATURE c 1 _ / Date: /(/216q.
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 requ. d later inspections. Staffs access and right of entry will be assumed unless the applicant inform the County in writing at the
time of the appli i n that he or shenti pr' r n / �`
Signature:
/° G Date: / /'?
l
The action or ions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or
endangered pecies 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 yo are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transfer lee re�si i ty for adhe r i no to and complying with the ESA. The Applicant has read this disclaimer nd signs and dates it below.
Signature: uIT Date: f/�y / 7
G:\PemutCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
0 i
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:
FAX:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: '���
MAILING ADDRESS: 0 x a I f r7. T 9 4rrEMAIL:
CONTRACTORS LICENSE f WAINS
NUMBER: ✓Y ��h Cr,-.
✓Y�lL1,e O C'C ?as '7 NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
Wood Existing: ❑ Sewer
❑ New '❑ Steel Proposed. Bank ❑ Community System
❑ Addition Total: - Height: Individual System
'Alteration/Remodel Li Concrete
❑ Repair ❑ Masonry SEP Permit#
❑ Other: Bedrooms: Water Supply:
Li Demolition Existing: Setback: )SZ Private well ❑ Two Party
Proposed: ❑ Public
Ty of Heat: Total: Name of System:
C p5 .SUreent eher414.
If this is a Commercial Project you must answer the following: Number of ADA Parking Spaces:
Number of Parking Spaces: Current: Proposed:
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 i Above ground Tank Size of Propane Tank:
i Heat Stove i Cook Stove i 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.
I Current Proposed For Office Use Only Amount Revision
_Sgu
Main Floorre Footage Heated p EH Bid App Review: 2
Main J
2nd Floor Heated Consistency Review: _ •
Other Heated Base fee: / _-1 Z _7 5
Mezzanine
Additional Section: �O
—
Heated Basement Plan Check fee: /( n I • 19
Unheated Basement State Surcharge fee: ,I.I.50
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTALI call.44
Decks 911/Rd Approach fee:
Other TOTAL: $ 1 aOj, L4
Receipt Number: I 1 `'3(11''
Cash/Check Number: n
IMATED COST RE U Date: l l.l '� .�
.Fair market value of all labor and materials foundation to finish Initials:
G:\PennitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
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