HomeMy WebLinkAboutBLD2010-00100 EOLDING PERMIT APPLICATI$ BLD1 0-001 00
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD10-00100 Received Date: 4/5/2010
SITE ADDRESS: 1671 EAST QUILCENE RD
QUILCENE, 98376
OWNER: ERIC C ANDERSON PHONE:
SANDRA M SHEA
18317 2ND AVE SW
NORMANDY PARK WA 981663965 QUILCENE BAY VISTA
SUBDIVISION: Block: Lot: 11
PARCEL NUMBER: 701195003 Section: 19 Township: 27 N Range: 01 W
CONTRACTOR: NIEMAN CONSTRUCTION CO PHONE: (360)434-0717
P. O. BOX 846
QUILCENE WA 98376-0846
Contractor's License NIEMACC018MZ Expires 8/15/2010
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION NEW 2ND STORY ADDITION TO EXISTING SFR
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ADD MAIN:
VALUATION 45,500.00 ADD'L: 428 HEAT TYPE: EEE
CODE EDITION: 2006 HEAT BASE: HEAT TYPE:
OCCUPANCY: R-3 UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: 5N GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS:
Exist: 2 Exist: 1
Prop: 0 Prop: 1
Total: 2 Total: 2�_
Routing Date:
.—. 3 10
Type Amount P v: Date: Receipt: Approved/Date
Permit $6'03.35 LYK 04/05/10 117513 APPROVE
Plan Check $392.18 LYK 04/05/10 117513 Q
State Building Code $4.50 LYK 04/05/10 117513 , 101a
Potable Water Application $98.00 LYK 04/05/10 117513
Total: $1,098.03 Jefferson County Planning
& Building Department
Jefferson County Building •sion Permit Nu•r: BLD10-00100
Applicant: ANDERSON
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
Setbacks
Erosion Control
Foundation Footing
Footing Drains
Foundation Stem Wall
Underground Plumbing
Under Floor Framing
Straps(hold downs)
Ext. Shear Wall Nailing
Rough-in Plumbing
Framing
Blocking
Airseal
Insulation: Walls
Insulation: Floors
• Insulatiory Ceiling
Int. Shear Wall Nailing
• Wallboard Nailing
Gas Line: Interior
Gas Line: Exterior
Propane Tank
Heat/Chimney Clearance
Drywell/Alt Drainage
Address Posted
FINAL. INSPECTION C ! ett(
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
• •
CONDITIONS for Building Permit# :BLD10-00100
1.) Any portion of the septic system must maintain 10' min. setback from the water line.
2.) FUTURE PERMITTING ON THIS PROPERTY MAY REQUIRE THE EXISTING SEPTIC
SYSTEM TO BE LOCATED AND VERIFIED BY HEALTH STAFF AS IT WAS NOT
DURING INSTALLATION IN 1989
SON COS •
JEFFERSON •CO TY
W ' \� DEPARTMENT OF COMMUNITY DEVELOPMENT
0-1 A. 04 621 Sheridan Street• Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
�IsztrisTer
p� www.co.jefferson.wa.us/commdevelopment •
LOJC(ST gpliDetIv•
Master Permit Application MLA: kt 11I QeDip
Project Description(include
�separate
`sheets as necessary):
2rtf _ 17� /-Loon .InE.xtSr
Tax Parcel Number: 1,44V( 14 1:2,� Property Size: (acres/square feet)
Site Address and/or Directions to Property:
I pi, ,41,,
•
Property Owner(s)of Record: ZVI r_►.11i�a`,►���1V1►1
Telephone: __� Al _ /✓oe. Fax: -,il//J�A/ � - ir►_TT.2.%r►
Mailing Address: (f t' (� s "' j 4'w -fi 'r�i i -l: ►•�� ,,i,,or, �-.1ww _,
Applicant/Agent(if different from owner): / frr
Telephone: Fax: email:
Mailing Address:
at kind of Permit?(Check each box that applies 0 Lot or Road Segregation
uilding 0 Critical Areas Stewardship Plan
❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use)
Single Family AM. 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**
❑ Home Business 0 Cottage Industry ❑Binding Site Plan**
O Propane ❑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 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,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 pro ;• -ss and • -ntry to Jefferson County and its employees, representatives or agents for the sole purpose of application
review and any r-•wire• :tecins•- ions staff .we ss and right of entry will be assumed unless the applicant informs the County in writing at the
�time of the ap-. ' tiyO• he or Ale - • '•,no. - Of
—.0'Signature: _,A//d/ <_tile.", � Date:
The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon a 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 i -= ill not viol- - e . Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)eve• you . • oompl':nce .' ' e Je• •n County development code.The Applicant acknowledges that he,she or it holds individual
and non-tra eray i •onsibi y fo ad/i . o -•. )m i h the ESA. The Applicant has read this disci 'm and nnssland dates it below.
�`Signature: �•/��/ �17 , ; �./A z Date: �V
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:
G}LE�NbERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER:y� PHONE:PHO) �//,', FAX:
MAILING ADD rico i T'Jl�l �/i9 7 1,41 91 ( )
•
CONTRACTORS LICENSE AINS 9%M Can
NUMBER: NUMBER
ARCHITECT/ENGINEER: GJ i VA SM d ii i PHONE t A .• • : .,,!r
MAILING ADDRESS: O(1Tr- v "''�'1J r _ f/)4t-41� 'y IL i�E✓,./ia. 0 z/ii1e'��-1��`/ ,y
Project Type: F me Type: Bathrooms: pe of Sewage Dtsp•sal:
❑ New Wood Existing: ___1— ❑ Sewer
Addition ❑ Steel Proposed: ( Bank ❑ Community System
Alteration/Remodel ❑ Concrete Total: 2 Individual System
❑ Repair ❑ Masonry SEP Permit# al-207
Bedrooms: Water Supply:
Ll Demolition ❑ Other: pP Y
Existing: rivate 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 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:
/,
Floor • +s Consistency Review: t) `C.Ci Tat..r
�
Other Heated Base fee: (00 ,?,5
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee:
I a.40,
Garage/Carport
SUBTOTAL
(;(10C1-
Decks 911/Rd Approach fee:
Other TOTAL: $ S V J
Receipt Number: I '-r'13
Cash/Check Number:
a10
ESTIMATED COST(REQ _ Date:
•Fair market val e of or and materials found ' n to finish -5_I-
��w„ Initials: - '
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
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