HomeMy WebLinkAboutBLD2010-00102 BOLDING PERMIT APPLICATICO ML Review Ty 130
Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD10-00102 Received Date: 4/6/2010
SITE ADDRESS: 4900 CENTER RD
CHIMACUM, 98325
OWNER: FLORA C MACE PHONE: 206-545-2838
JOANN KIRKPATRICK JTWROS
4725 37TH AVE NE
SEATTLE WA 981053014
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 801033001 Section: 3 Township: 28 N Range: 01 W
CONTRACTOR: SOUND BUILDING SYSTEMS PHONE (360)437-1219
3546 THORNDYKE RD
PORT LUDLOW WA 98365-8229
Contractor's License SOUNDBS027NM Expires 8/19/2010
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr NEW DETACHED GARAGE POLE BLD - UNHTD, NO PLMB
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION 23,910.00 ADD'L: HEAT TYPE: UH
CODE EDITION: 2006 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: 1,344 SHORELINE:
CONST TYPE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM:
BEDROOMS: BATHROOMS: ,
Exist: 0 Exist: 0
Prop: 0 Prop: 0
Total: 0 Total: 0 ----
Roufnq Date:
1
Type Amount Paid Bv: Date: Receipt: Approved/Date
Permit $377.25 LYK 04/06/10 117515
Plan Check $245.21 LYK 04/06/10 117515 APPROVEL
State Building Code $4.50 LYK 04/06/10 117515 MAY 2D1U
Total: $626.86 .Jefferson County Planning
&Building Department
Jefferson County Building •sion Permit Nulr: BLD10-00102
Applicant: MACE
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 Z�I 1� —
Erosion Control ✓Post Holes 5`1 Z1 (L r
I-.,aisle liwS vla 'Deep
Framing 1'�/'G
Blocking `�{
Drywell/Alt Drainage
Address Posted (l I (1
�L INSPECTION ,/ _l 4_ iv
FINAL INSPECTIO MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
• •
CONDITIONS for Building Permit# :BLD10-00102
1.) See BLD08-00254 for findings and conditions that apply to this project and property.
2.) 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.
3.) The project shall comply with Construction Stormwater Pollution Prevention (SWPP)
Elements#1 through#12 of the Department of Ecology's Stormwater Management
Manual for Western Washington 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.
�gON CO •
/�' L JEFFERSON CONTY
i ` `iq 3 DEPARTMENT OF COMMUNITY DEVELOPMENT
1-7 '' e 4 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
0 www.co.jefferson.wa.us/commdevelopment
14S81N
Master Permit Application MLA: — ('V
Project Descn tion (includes arate heets as necessary):,
tpea) ok _ �,h �
Tax Parcel Number`. 801 03�j on\ Property Size: H O Acx c (acres/square feet)
Site Address and/or Directions to Property: ems. 53 TA8 1- W
L190O Ce)n tear' /RA Ch, ,c�in W W 9$3D 5- k-kE svJ
Property Owner(s)of Record: FL csacIt C Nkic 2 apcLY\C\ 'Kor1, ya\-r(`C1-(.. Ce., ilmmne- "\cn 7103
Telephone: c O(fl - 5t{5-a$3e, Fax: .POlo-a5W5 asa., email: e,,e gnd,•Fy,,rrQ Far'rIA,Any. U
Mailing Address: d'ti` - k P% •
Applicant./Agent(if different from owner): rrv. - s
Telephone: f l O -'1 7 7- / 21 1 Fax: , B- ' -/2- . email: rr,,./ e I t yr @,..,7 t, ,,7,C .--
Mailing Address: 3S y G T1.o.r4i ke p.r.it P+ . J.-�. \u„✓ (A.),,. . 1,7e 5
What kind of Permit?(Check each box that applies
,uilding 0 Critical Areas Stewardship Plan
❑ Demolition Permit lic c f,q er 0 Variance(Minor, Major or Reasonable Economic Use)
❑Single Family )Garage Attached Detac -• 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 0 Binding Site Plan**
❑ Propane 0 Long Plat**
❑ Sign 0 Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes" Use Consistency Analysis 0 Plat Vacation/Alteration**
0 Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions**
0 Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development**
0 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 AGE T
I hereby designates C)_,.,e G •', •' '.L S _nc • act as my ag nt in matters r lating to this application for permit(s).
OWNER SIGNATURE �! AN/ te: l aol0
By signing this application form,the owner/agent attests that t - info ation provi.ed herein,and in ny attachments,is true and correct to the best of
his,her or its knowledge. Any material falsehood or any omiss• 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 ce sequence of the granting of this permit.
I further agree to provide access and right of entry to Jefferson County and its employ:es, representatives or agents for the sole purpose of application
review and any required later inspections. Staffs acres- an• right of entry will be :s•umed unless t - applicant informs the County in writing at the
time of the application that he • - : t prier noti •. t
Signature: �//- .,AA.. L �r/ "2` �olO
■�
The action or actions Applicant will undertake as a result oftAuance of this sermit may negat ely impact upon one or more threatened or
endangered species and could lead to a potential"take"of- .:angered 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-transfer bl a onsibili for a ring to and omplying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature Date: �— �-- / L7
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
0
BUILDER STATEMENT • • .i
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:
GENERAL CONTRACTOR
OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
f aysv�C Pt, t 3aS��� s f e s .J W ) `//`1-/2,.' (3eo) '37-/mot r
MAILING ADDRESS: 7(0 T u p�N /'rviiI&_ ri t +2..,AIoi / I� �,r??L.:5 'KwF�TEFeA.,+7W,..1, co,
CONTRACTORS LICENSE WAINS
NUMBER: SPUN D ICS 0:�7/V/7t NUMBER
ARCHITECT/ENGINEER: t� PHONE (5rri)e,2 k-;2�)J1 FAx:(5v,) 7 7k- ys 5 -7
>t'rkE�i 1—: Yt^i ni�j 11 f� gyp, /�
MAILING ADDRESS: aslOb()/1/,do(✓rv, iio cf,A7 ,,...i3)il Ieiev,)ra.Et1 0,„.`?4 751_ WWw, 13erf`o7.1,i1.-
Prgject Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
iiid New 'Wood Existing: V ❑ Sewer
❑ Addition ❑ Steel Proposed: a Bank ❑ Community System
❑ Alteration/Remodel 0 Concrete Total: G Height: er'Individual System
❑ Repair 0 Masonry SEP Permit#
O Demolition ❑ Other: Bedrooms: Wa,ter Supply:
Existing: v Setback: V Private well Ci Two Party
Type of Heat: Proposed: d ❑ Public
/4 1_ Total: d 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:
1 Underground Tank i Above ground Tank Size of Propane Tank:
I Heat Stove 1 Cook Stove 1 Woodstove 1 Fireplace Insert i Hot Water Tank 1 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:
_ r73"
-2'Floor Heated Consistency Review: �'�i
Other Heated Base fee. 1
Mezzanine Additional Section: a.---
Heated Basement Plan Check fee: g( �
`T5
Unheated Basement State Surcharge fee: 3)
Other Unheated Pot Water Review fee: (7 a n
Garage/Carport SUBTOTAL l •J'�
Decks 911/Rd Approach fee: -t
Other TOTAL: $ot( � (_ c
Receipt Number: 1 113i J
Cash/Check Number:
ESTIMATED COST(REQUIRED) Date: _ I O
•Fair market value of all labor and materials foundation to finish
2-S09 Initials: _
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