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HomeMy WebLinkAboutBLD2010-00017 BLD10-00017 BUILDING PERMIT APPLICAOM Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00017 Received Date: 1/19/2010 SITE ADDRESS: 114 CRESTVIEW DR PORT LUDLOW, 98365 OWNER: WILLARD J VAN RY TRSTEE PHONE: 541-921-0213 VAN RY LIVING TRUST PO BOX 47 LINCOLN CITY OR 97367-0047 TEAL LAKE VILLAGE SUBDIVISION: Block: Lot: 2 PARCEL NUMBER: 998700002 Section: 21 Township: 28 N Range: 01 E CONTRACTOR: BILLS CUSTOM CARPENTRY PHONE: 360-765-0674 PO BOX 876 QUILCENE WA 98376 Contractor's License BILLSCC954LH Expires 6/8/2011 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP ADD 3 NEW WINDOWS TO EXISTING SFR TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 1,350.00 ADD'L: HEAT TYPE: CODE EDITION: 2006 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: • � f Type Amount Paid By: Date: Receipt: Approved/Date Permit $50.95 LYK 01/19/10 113653 APPROVED c VED Plan Check $33.12 LYK 01/19/10 113653 State Building Code $4.50 LYK 01/19/10 113653 JAN 19 ZWU Total: $88.57 Jefferson County Planning & Building Department Jefferson County Building rillsion Permit Nure': BLD10-00017 Applicant: VAN RY TRSTEE 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 Wallboard Nailing FINAL INSPECTION C FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR • 0 1 ,. .....0 \\ -4--: ---,,. i N•1 ) (3 ..1.> \ 1 ., ;:f'•IR , F..,1 1.0 L'A -0 •'''''I 1 q > \ i o T1 \ r- M 4 i',- •••......./ 7._._.f.;: p .... f" ).it..is, \ • ....• .3... •.4 e)\...-- \ \ X -'- 4..,, • \ 1 ‘ N . * t.' '..:....... \ ik \ p •o` it, ...> ko. Ve,„, ----.... i 4\ 1 \ z 03 Cl/...2 •9 ,.?, 't•'.}-1,4. ' C‘s tiN •.;• ••3,. "\a- (0 A %/ ‘1 7 1.:-A Ci• \ -ii .c. Qt. t..14 g.,k (.•1, ., r---. N..) • m. rtt 8. ut i a! o tp. 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I '.y,"'A':-.;y JAN 1 9 2010 h ,,,A1 ,M.P-1-• if......,,,e,.7 . .1' '.., .-5,.--,, -."-;.4"- • ?.ti,, ks / ,.,,;,......,1,'.-c...,..t ....p.---1.,.?: A 'rj I .-• • ' 1\- t N-,'•:,.• .P.' . *•,-,..y. ...,,,,,„,_ i • f t • (:sow c° JEFFERSO OUNTY • w' efili 't ' \VA DEPARTMENT OF COMMUNITY DEVELOPMENT ', A, '4 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax gN��p www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: l' O 11144, eneQ I___ Project Description(include separate sheets as necessary): APD 3 < '`� x Ye " ppveeLE 1/1/,Y1/4 V1/yDow5 Tax Parcel Number: C t('(�j • (C,'�f-�_ Property Size: /6 ,y Z. s1' • (acres/square feet) Site Address and/or Directions to Property: /// / C,'L-'si t//�n./ ae Pogr-—'L-v,v Property Owner(s)of Record: in/. ✓r VAN /2 , Telephone: '// �1-2/ <>,.�/-�' Fax: email: ,'4�r,: Le- �l.i{,r.I is /( r Mailing Address: f�C, 1 'OA '// , / •,t/ -t)'A/ U'f�"/ (4 V,- (,,j Applicant/Agent(if different from owner): 1//L--1-//F/,-(1/' 'A Z— Telephone:3j<n° 7 66 -I'-7 Fax: e ail: Mailing Address:�� e,/. 76 li/L�4��. it/x-4 �p 3-76 What kind of Permit?(Check`each box that applies 0 Lot or Road Segregation ❑Building 0 Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) ❑Single Family 0 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** JA N 1 9 2010 ❑ Home Business 0 Cottage Industry 0 Binding Site Plan** O 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* 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 t to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE l�1 Date: . i 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 required later inspections. Staffs access and right of entry will be assumed unless the applicant inf rms the County in writing at the time of the application tflat r she wants prigfnoVi ✓ / Signature: Gil lt2-W7 j,.. Date: ` /(.., 67 The action or actions Applicant will undertalte as a res2f 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-transferabl9, ' ti re�spo ility for a nn and complying with the ESA. The Applicant has read this disclaim 9n gns and dates it below. Signature: !�(/ /e" —bi • Date: / 01 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 assum n the r ponsibility of th ener Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACT RED HOME INSTALLER: _` PHONE: FAX: /;/tI 1/"TOM e4-/ef /L / 01,0) 766 -0E71 ( ) MAILING ADDRESS: /le' ,gor 87fj '// /r 9j '.j j AIL: CONTRACTOR'S LICENSE ^G©(r .y,/ ' �G� �^ c WAINS NUMBER: 17 4G— 9zy 4 NUMBER ARCHITECT/ENGINEER: `jfF PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New 2-"Wood Existing: e'6ewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System e'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: Proposed: P-Public U S (p) 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: 1 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 Z0'5-0EH Bld App Review: ri Floor Heated Consistency Review: Other Heated Base fee: 9 '--- Mezzanine Additional Section: Heated Basement Plan Check fee: 3 i2 Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Q Decks 911/Rd Approach fee: Other TOTAL: $ �6D ,J� — vd!/voopvS C3) Receipt Number: l �3 Cash/Check Number: 24 ESTIMATED COST(REQUIRED) Date: � .Fair arket value of all labor and materials foundation to finish 1" 1- l i 4 4'1.' Initials: i3.�U` i G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc