HomeMy WebLinkAboutBLD2009-00398 BLD09-00398
•UILDING PERMIT APPLICI3N Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
BLD09-00398 Received Date: 12/3/2009
PERMIT *SITE ADDRESS: 251 WINDROSE DR
PORT LUDLOW, 98365
PHONE: 360-437-5135
OWNER: JURGEN P VEIGEL
JOHANNA H W VEIGEL
251 WINDROSE DR
PORT LUDLOW WA 98365-9597 BAYVIEW VILLAGE DIV 1
Block: Lot: 40
SUBDIVISION:
PARCEL NUMBER: 931900040 Section: 16 Township: 28 N Range: 01
CONTRACTOR: 70 MERID TH STREET KER ENTERPRISES
PHONE: 206-818-4184
PORT LUDLOW WA 98365
Contractor's License BPARKPE925BG Expires 1/7/2010
PHONE:
REPRESENTATIVE:
PROJECT DESCRIPTIOP RE-ROOF
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION 11,750.00 ADD'L: HEAT TYPE:
CODE EDITION: 2006 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
CONST TYPE: DECK: BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total:
Routing Date:
Type Amount Paid Bv:
Date: Receipt: Approved/Date
Permit $209.25 LYK 12/03/09 113486
Plan Check $136.18 LYK 12/03/09 113486
State Building Code $4.50 LYK 12/03/09 113486
Total: $349.93
Jefferson County Building •sion Permit NuOr:
Applicant:
BUILDING PERMIT INSPECTION APPROVALS applicable Code: 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
c7624.4--,_ _
FINAL INSPECTION ,•Z _i L.-cr../ s,,
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
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FOR INFORMATIONAL PURPOSES ONLY-
Jefferson County does not attest to the accuracy of the data contained herein and makes no warranty with respect to its
correctness orvalidity. Data contained in this map is limited by the method and accuracy of its collection.Thu Dec 03
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JEFFERSO OUNTY
III
j, DEPARTMENT OF COMMUNITY DEVELOPMENT
'' 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
/ p www.co.jefferson.wa.us/commdevelopment
81N
Master Permit Application MLA: NO rnLA e ID
Proj Descri9tion(include separate sheets as necessary):
K - '(
Tax Parcel Number: �j/ d� , . 29 Property Size: (acres/square feet)
Site Address and/or Directions p
Property:
•
15/ edAte 2,tk/>' / r/Gtea/ kj/ 6:fV "
•
Property Owner(s)of Record: L , at 9
Telephone: - -Fax: - 7 email:
Mailing Address: 2 ? i-f0'/sy e t i'v' / L 7`LGIQ/1,9' �a 7,erbi 6
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
7t kind of Permit?(Check each box that applies 0 Lot or Road Segregation
uilding 0 Critical Areas Stewardship Plan
❑ Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
N Single Family 4d Garage Attached/Detached ❑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**
0 Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration**
0 Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions**
❑Site Plan Approval Advance Determination (SPAAD)* ❑Shoreline Management Substantial Development**
❑Temporary Use ❑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 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,indem ' and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and
expenses which may in an ay accrue against Jefferson County as a result of or in consequence of the granting of this permit.
I further agree to provi cress and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any req • later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the appli e o he ants prior notice. / y
Signature: Date: / .G — �g
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 co lead to a potential'take"of an endangered species as those terms are defined in the tederal law known as the
"Endangered Species A " r"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this
permit has been issue ill 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 a in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transfer sponsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: Date: /z - - d9
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.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 C TRAC OR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
�1?,( Q'7(L c ( ) ( )
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 ❑ Steel Proposed: Bank ❑ Community System
❑ Alteration/Remodel 0 Concrete Total: _ Height: U Individual System--._
❑ Repair 0 Masonry___.--- _ " SEP Pe
O Demolition ❑ Others Bedrooms: Water-Supply:
Existing: Seck: ❑ Private well ❑ Two Party
Type of Hea • Proposed: ❑ Public
'dotal: 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:
Underground Tank Above ground Tank Size of Propane Tank:
Heat Stove Cook Stove Woodstove i Fireplace Insert Hot Water Tank Pellet Stove 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 Bid App Review:
2"m Floor Heated Consistency Review:
Other Heated Base fee:
Mezzanine Additional Section:
Heated Basement Plan Check fee: oo
O
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL BC/C) q 3
Decks 911/Rd Approach fee:
Other TOTAL: $ 3qq_ q3
Receipt Number: ( 13(4L
Cash/Check Number:
ESTIMATED COST(REQUIRED) Date:
'Fair market value of all labor and materials foundation to finish C�J�]
r7 c5L Initials:
L
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms Master Permit Application 5-29-08.doc