HomeMy WebLinkAboutBLD2010-00092 BIDING PERMIT APPLICATIc B Review 0092
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD10-00092 Received Date: 3/30/2010
SITE ADDRESS: 131 B ST
PORT HADLOCK, 98339
OWNER: ANDREW N VANCE PHONE: 206-769-9285
2023 E SIMS WAY
PORT TOWNSEND WA 98368-6905
SOUTH PORT TOWNSEND
SUBDIVISION: Block: 8 Lot: 11-12
PARCEL NUMBER: 996400807 Section: 2 Township: 29 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: KENNA POPE PHONE: 360 301 5277
2023 E SIMS WAY#108
PORT TOWNSEND WA 98368
PROJECT DESCRIPTIOP COU FROM UNHTD GARAGE TO HTD REC ROOM & UNHTD
STORAGE
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP COU
VALUATION 5,000.00 MAIN: 300
CODE EDITION: 2006 ADD'L: HEAT TYPE: EEE
HEAT BASE: HEAT TYPE:
OCCUPANCY: R-3
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: 5N OTHER: 140
SHORELINE:
GARAGE:
CONST TYPE: SETBACK:
DECK:
SEWAGE DISPOSAL: CON BANK HEIGHT:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: 2 Exist:
Prop: 0 Prop: 0
Total: 2 Total: iTh
Routing Date: �____
Type Amount Paid By: Date: Receipt: Approved/Date
Change of Use or $426.00 LYK 03/30/10 117488
Total: $426.00 APPROVE D
MAY il 201U
Jefferson County Plannin(
& Building Department
Jefferson County Building Ssion Permit Nu•r: BLD10-00092
Applicant: VANCE
BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2006 International Building Codes
To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection.
Requests received after 7:00 AM will not be scheduled for that day's inspections.
ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries.
The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection
Inspection Item Date Approval Signature Notes
Framing 4/29/2010 J Lvv..14
Insulation: Walls 5/3/2010 ;1^2
Insulation: Ceiling 5/3/2010 r
Wallboard Nailing 5/4/2010
FINAL INSPECTION - ".
{
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
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CONDITIONS for Building Permit# :BLD10-00092
1.) This permit is approved based on approval of a waiver from the bathroom setback to the
existing drainfield. The required setback is 10', the existing separation is 4'. The waiver is
conditioned on there being no footing/foundation drain around the building within 10' of the
drainfield.
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��v�"S1 v Cob JEFFERSON CO TY •
illikti DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street• Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
�•gs�NG�O$ www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: _QO . _ 0E-G ib
Project Description(include separate sheets as necessary):
C l-r 6c G= O5 F'2i� vt 'AiLta "r G f1Ai7 C. ro i A'reJ gee- t�-t,0,4"- ftcG
Tax Parcel Number: C y(04 GU C 3 Property Size: le)
WU 91. N(acres/square feet)
Site Address and/or Directions to Property:
13 i •e;) ' 2, -, LA c t._ Lk)4 9t3S `I
Property Owner(s)of Record: A-1-t:7 2 eA. VANC E -
Telephone:ZC +� C
P l� ��(,� .i- I i_g'Cs Fax: email:
Mailing Address: -0,.3 E, -3y-ii L *i O i�r-- 1-c ni Si �=a lb WA � 6,e
Applicant/Agent(if different from owner): +t< tOPr.
Telephone:_3i,n• '3L)( 523-4 Fax: 5,,!j •• ./`/ • 33 Z email: 14.eivitz_"' eim
Mailing Address: T F, L 1 s•l /E. C—
� , `�,- •Tam cc ,.�� f�!4 j "�l�f�
What kind of Permit?(Check each box that applies PP ❑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)**
•>3CChange of Use 0 Boundary Line Adjustment
❑ Address 0 Road Approach 0 Short Plat**
❑ Home Business 0 Cottage Industry 0 Binding Site Plan**
0 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 ❑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:
yy ' DESIGNATION OF AGENT
�
I hereby designate l /...t/k LL to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE 7-- t411/ i4.
Date: 3 247 •/D
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 informs the County in writing at the
time of the appli tion that or she wants prior notice.
Signature: Gyv"C4--- 3' /U
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 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 resp sibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: G -c„-c.
Date: .5 ` ' /0
G:\PemnitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
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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 t responsibility of the General Contractor for the proposed project.
Signature: �'�'e"e'�--
Date: 3' 2-9 /0 PHONE: FAX:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: ( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'SWAINS LICENSE NUMBER
NUMBER:
ARCHITECT/ENGINEER: PHONE ( ) Fes'( )
MAILING ADDRESS: EMAIL
Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
Project Type: yp Existing: 3 ❑ Sewer
CI ›rWood Bank ❑ Community System
0 Steel Proposed:
❑ AdditionTotal: 93 _ Height: yIndividual System
�Alteration/Remodel ❑ Concrete SEP Permit#
❑ Repairmo ❑ Masonryther: Bedrooms: Water Supply:
❑ Demolition ❑ Other: Existing: i• Setback: ❑ Private well ❑ Two Party
Proposed: ti(,Public
Type of Heat: Total: 1 Name of System:
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11!?ci
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
{BC 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:
1 Underground Tank 1 Above ground Tank Size of Propane Tank:
Heat Stove 1 Cook Stove 1 Woodstove 1 Fireplace Insert 1 Hot Water Tank 1 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.
Current Proposed For Office Use Oinly. Amount Revision
�cS uare Footage EH Bld App Review: r
Main Floor Heated .i t Z - r �
2�Floor Heated
Consistency Review:
Other Heated Base fee: NC
Mezzanine
Additional Section:
Heated Basement
Plan Check fee:
Unheated Basement
State Surcharge fee:
Other Unheated \ 0 Pot Water Review fee:
ATAOL9e
Garage/Carport SUBTOTALAoq
911/Rd Approach fee:
Decks
Other TOTAL: $ ,4c1C1
Receipt Number: l Ifi-- �jg
Cash/Check Number: Ir3
ESTIMATED COST(REQUIRED) Date:
.Fair market value of all labor and materials foundation to finish Initials: --.WOP
G:\PerrnitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc