HomeMy WebLinkAboutBLD2010-00002 BUILDING PERMIT APPLICASN B RD10 00eview 002
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD10-00002 Received Date: 1/4/2010
SITE ADDRESS: 131 CHIMACUM CREEK DR
PORT HADLOCK, 98339
OWNER: JOHN B KOCH PHONE:
PATRICIA A KOCH
131 CHIMACUM CREEK DR
PORT HADLOCK WA 98339-9422 CHIMACUM CREEK ESTATES DIV 2
SUBDIVISION: Block: Lot: 42
PARCEL NUMBER: 943700043 Section: 2 Township: 29 N Range: 01 W
CONTRACTOR: PAUL DAVIS RESTORATION PHONE: 360-377-1647
4231 OLYMPIC DRIVE
BREMERTON WA 98318
Contractor's License PAULDDR948R6 Expires 12/26/2010
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr REPLACE INTERIOR FRAMNG, FIRE BOX & CHIMNEY DAMAGE
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP REP MAIN:
VALUATION 14,000.00 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: Exist:
Prop: Prop:
Total: Total:
Routing Date:
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $237.25 LYK 01/04/10 113792
Plan Check $154.21 LYK 01/04/10 113792
State Building Code $4.50 LYK 01/04/10 113792
Total: $395.96
Jefferson County Building Derision Permit Nurr: BLD10-00002
Applicant: KOCH
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
Framing /,},?mid ,,(y
Airseal rA
Insulation: Walls 2 _‘C
'1Y--
Insulation: Floors
Insulation: Ceiling 1/4/2010
Wallboard Nailing
FINAL INSPECTION ; )
�l I U
1
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
• 0
/�jI ii.
r P a
..Ci
T ,4'1'---. 10'6' ,_ •_, 11'9' -I T
Gi O }-+ - - 12' --1• 14' . 0
47
o
L
' n
s
m I �
1
5 4'-� `5'2' G7
6
< J•1 1 ` L. 68 1
\ C�12'4' 11.
10 15 10 Z \
ID CA K 0 16'11' 11'3' 1 II
0 C m
I 29' 1
Ou' O ° ° °' 1 C) '°'
tlii ' . E •i i p. .11 r -r) r '' P) '' .' -° 0
3 11.
w s �A. m 0 0 DM N I � 0 r
.� M o < Z N CJ . ,C) U3 r Q L ,fi,7
< g
g Er) 0 p, 4 5 y 3 .1 - P O
cam' Fri 0 0
�) 11 2 m 4
sP
s r Q
A
v L )
ON - •
liok6 JEFFERSONtOUNTY
\ r� DEPARTMENT OF COMMUNITY DEVELOPMENT
❑ �
'' , oc 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • -4451
4, 6 www.co.jefferson.wa.us/360/379commdevelopmentFax
1;r N
Master Permit Application MLA: t,C f -A4•
Project Description(include separate sheets as necessary):
'l' O1 OCt t k_ It_11 CN .-► aA--tLat.y J 4-1 io _� I_c_�4- dc,AA,)-e
Tax Parcel Number: CII 7Q)c43 Property Size: � (acres/square feet)
Site Address and/or Directions to Property:
•
\3 V QVAVAt.0 C Me-AL \)(s. t od(-.
Property Owner(s)of Record: t L i �( .kk tt//
Telephone3V) 3 by-7- Fax: email:PANV aT C'Pbr^(.:9).4Jc:1`
Mailing Address: ` LJ2;3i 09,11 p1 C Okr lam` c IXr\_/rTU.� IAA . .
Applicant/Agee�nt""(if different from owner): h""
Telephone: :7tc O) 3' 9 ._/b`/ Fax: email:
.57: •1,e._
Mailing Address:I-12<3 I OLPMpLe XD d' kV 73/?2t"?yrra`- AL0It i t1 M 7
What kind of Permit?(Check each box that applies 0 Lot or Road Segregation
Building �i 4 ❑Critical Areas Stewardship Plan
Demolitio Pe it ❑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* ❑Special Use(Essential Public Facilities)**
❑ Change of Use ❑ Boundary Line Adjustment
❑ Address ❑ Road Approach ❑Short Plat**
❑ Home Business ❑ Cottage Industry ❑Binding Site Plan**
❑ Propane ❑Long Plat**
❑ Sign ❑ Planned Rural Residential Development(PRRD)/Amendments**
❑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**
0 Temporary Use ❑Shoreline Management Variance
El 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 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 V,PJJ �. t)JV�' to act as my agent in matters relating to this application for permit(s).
—OWNER SIGNATUR� i , ,--z Date: I T f 3( J 09
By signing this application fo ,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 rovide a ss and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any uired later. pections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the appli n t he wants prior notice. *je,
--Signature: Date:
e
The action or action pplicant ill undertake as a result of the issuance of this permit may negatively impact upon on or more threatened or
endangered species d 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 adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
= Signature: Date:
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
• •
BUILDER STATEMENT
The sig -r of \is statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will ,+ a s 1�ing the responsibility of the General Contractor for the proposed proje
,. Signature \� U Date: 1`� vo
eENERAL CO \ 'CTO OR MANUFACTURED HOME INSTALLER: PHONE: FAx:
("U L . LS Ck b.) c3 3��•I� 3 )3 i3
ILING ADDRESS: a i i O( \ll EMAIL: ,j
�t23 I �(�+ P r 1�rcr
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: J PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New Wood Existing: L,>v_ ❑ Sewer Eli crn AJ
❑ Addition ❑ Steel Proposed: .♦, Bank I ❑ Community~ i
❑ Alteration/Remodel ❑ Concrete Total: _ Height: ❑ Individual System
;Repair ❑ Masonry SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type of Heat: ProposedTotal: i--- N-Public
/�' j� ; Name of System: •
1,04-000
If this is a Commercial Project you must answer the following:
Number of Parking Spaces: Current: 'Z Proposed: 2_,, Number of ADA Parking Spaces:
Number of occupants(includes owners,tenants,employees,etc) Current 2— Proposed `'7
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 1 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:
Zorn_ 21YYO _ ,
2nd Floor Heated Consistency Review:
Other Heated Base fee: C
Mezzanine Additional Section: __--_N
Heated Basement Plan Check fee: 1 •c -J
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL 9
Decks 911/Rd Approach fee:
Other TOTAL: $, .-I
Receipt Number: 113']QD
Cash/Check Number: -5^ m
STIMATED COST(REQUIRED) Date:
•Far rketvalbe-of-aq andTrraterials foundation to finish
I Li/ 000 pf Initials:
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc