HomeMy WebLinkAboutBLD2010-00010 MLA10-00009
ICUILDING PERMIT APPLICAION Review Type: i
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD10-00010 Received Date: 1/11/2010
SITE ADDRESS: 4346 S DISCOVERY RD
PORT TOWNSEND, 98368
OWNER: OCEAN GROVE LOT OWNERS ASSOC PHONE: 360-385-7875
DAN NASMAN-MGR
PO BOX 519
PORT TOWNSEND WA 98368-0519
SUBDIVISION: Block: Lot: TX 83
PARCEL NUMBER: 001321039 Section: 32 Township: 30 N Range: 01 W
CONTRACTOR: BROCKMAN BUILDERS PHONE: (360)638-1125
33165 HOFFMAN RD NE
KINGSTON WA 98346
Contractor's License BROCKB1961ON Expires 9/15/2010
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP REPLACE STAIRS TO THE BEACH
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION 5,346.00 ADD'L: HEAT TYPE:
CODE EDITION: 2006 HEAT BASE: HEAT TYPE:
OCCUPANCY:
OCCUPANCY: UNHEATED: #OF STORIES:
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 -�
Routing Date: C. _
tt-1V
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $125.25 LYK 01/11/10 113622 A PPR.
E
Plan Check $81.41 LYK 01/11/10 113622 ov
State Building Code $4.50 LYK 01/11/10 113622 MAY 5 201U
Total: $211.16 Jefferson County Planninc
i Rnilding Department
Jefferson County Building . sion Permit Nu ,r: BLD10-00010
Apoiicant: OCEAN GROVE LOT OWNERS A:
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 ;,�` t� r=NNE,-•
Post Holes a -^, --'
.j --`1^
Framing
FINAL INSPECTION _- `1 C,;�
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
i i
CONDITIONS for Building Permit# :BLD10-00010
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..,.-sON c___ JEFFERSON•OUN DEPARTMENT OF COMMUNITY DEVELOPMENT
•
v o ''4 621 Sheridan Street• Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
�p� www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: ' V 91
Projecscription(include separate sheets as necessary):
_mot' Illt�� �� 1A !VYc C`1 1
Tax Parcel Number: 00 13'Z p I O 3 / Property Size: .36 AN-yteS/S 68 Z.-(acres/square feet)
Site Address and/or Directions to Property
y32/4 s,31 rStevery R oa cI
Property Owner(s)of Record: d eean ('roarer 'ssor_i c-T/ovl Telephone: 361) + 3 ' , 7 8?,5' Fax: email: chi d5/114, L drrp6,ner
Mailing Address: ?b Zvi, f 9 PO or 1 6 wK sefidi lj.J4- 9cf3W
Applicant/Agent(if different from owner): Da.ii Ii in ah I tli.4..144,ier //
Telephone: 3C�D c 3 6S , 7 87SJ d Fax: email: nasilfivhedviiesd of
Mailing Address: S3 yD eve e. L�t el je_ goi4 ?e.rt- i et 005e». I0A- Q 6.3 kr /
What kind of Permit?(Check each box that applies 0 Lot or Road Segregation
❑Building 0 Critical Areas Stewardship Plan
❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use)
❑ Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]**
❑ Manufactured Home ❑ 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*"
0 Propane ❑Long Plat**
❑ Sign - • 0 Planned Rural Residential Development(PRRD)/Amendments**
0 Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration**
❑ Stormwater Management )4 Shoreline Master Prpgrarf emption/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 0 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:
/l`C ti/4
DENATION OF AGENT —
I hereby designate k t l►e) l�, 14S►H4 vt> A,to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE ` ` 7 - --c---t_ -.2.,�,/," Date: 'AVM
s
By signing this application form,the owner/agent attests that the information provided erein,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 notice.
Signature: Date:
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 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 Annl;cation 5-29(1R Me
• •
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:
GENER,AL CONTRACTOR OR MAN1JFAC URED HOME INSTALLER: PHONE: FAX:
-11q-)Ck Lu_B nil ( ) ( )
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 0 Steel Proposed: Bank ❑ Community System
El Alteration/Remodel 0 Concrete Total: Height: ❑ Individual System
❑ Repair ❑ Masonry SEP Permit#
❑ Demolition 0 Other: Bedrooms: Water Supply:
Existing: Setback: 0 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 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 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 fir ice Use Only Amount 1110viision
Main Floor Heated EH Bld App Review:
l 2n°Floor Heated Consistency Review:
Other Heated Base fee: I -5.
Mezzanine Additional Section: .-.-- -
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL
AaL' RP
Decks '
Other TOTAL: $ lord . (Le
Receipt Number: t 13LoZZ
Cash/Check Number:
ESTIMATED COST(REQUIRED) Date: l�
•Far arket value of all labor and materials foundation to finish L..1 -1
tc LC)(,, Initials:
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