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Home My WebLink AboutBLD2010-00159 UILDING PERMIT APPLICASJN B RD10 001eview p59 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00159 Received Date: 5/18/2010 SITE ADDRESS: 101 HILLER DR PORT HADLOCK, 98339 OWNER: JOE S THOMPSON PHONE: 360-385-0681 101 HILLER DR PORT HADLOCK WA 98339-9718 HILLERS WF TR INC TL SUBDIVISION: Block: Lot: PARCEL NUMBER: 960300006 Section: 7 Township: 29 N Range: 01 E CONTRACTOR: THOMPSON CONSTRUCTION PHONE: (360)385-0681 JOE THOMPSON 101 HILLER DR PORT HADLOCK WA 98339 Contractor's License THOMPC*98700 Expires 6/5/2010 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP NEW ROOF & PITCH CHANGE TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 14,500.00 ADD'L: HEAT TYPE: CODE EDITION: 2006 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: �otal: Routing,Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $251.25 LYK 05/18/10 117700 APPROVED Plan Check $163.31 LYK 05/18/10 117700 State Building Code $4.50 LYK 05/18/10 117700 Total: $419.06 MAY -1 Jefferson County Flammg & Building Department Jefferson County Building "ion Permit Nur•r: BLD10-00159 Applicant: THOMPSON 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 2_/01) Ft-00 ZZ"1 p 14 �'-/G` / ( Rib b cre,(IwG 7J tl'I`t-.I .. FINAL INSPECTION FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR go codJEFFERSOUNTY :Ow ' \ '�, DEPARTMENT OF COMMUNITY DEVELOPMENT 's. `'� 621 Sheridan Street• Port Townsend •Washington 98368 A 360/379-4450 • 360/379-4451 Fax www.co.jefferson.wa.us/commdevelopment l'`SH7NOc Master Permit Application MLA: M1.b ' 2.L r�D)e..jN t) 1&)o,z Project Description(include separate sheets as necessary): k� t,UC_ EX;STIAi :i /ivlJ QC 8� �j fir'=: �Ci i&c o '«h Meer CF' t�X�e>ii!c-' C_ Vh2/.c'e' 1 juitixij C10ik'S'. Tax Parcel Number: % C. 3C C COG Property Size::5'7"IC `t r=T (acres/square feet) Site Address and/or Directions to Property: tC. 1 rI i`Lc. .rJ C it-' , !: -- [- -oLoci< Property Owner(s)of Record: .T C i 1= 'ttf'%tt P S0^1 Telephone:36tC .ve; -C%F Fax: email: Mailing Address: f(I ( H- /St'1. 0if? - -'2-1 - }JtLrtC'r t C`t/ -- `7 -i-3 cs Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies 'building 0 Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use) TirSingle Family 0 Garage Attached I Detached 0 Conditional Use[C(a),C(d),or C)** D Manufactured Home 0 Modular 0 Discretionary"D"or Unnamed Use Classification O 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** ❑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* ❑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 �-f to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE (, •� I Ii..L'1it.-/),.:‘.+..� Date: By signing this application'onn,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 requir later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applicati at he or s e wants prior notice. Date: Signature: The action or action Applicant will unde ake 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-transfe le responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. w/ ^ Date: Signature: 1 CG:\PermitCenter\###FORMS###\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: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: 'TIC 14•11PSo I C STIZ (--'LT LIf k ) �`k[� MAILING ADDRESS: y /� �"'J �� l ( > �('1 2 hi LL_ed� 0Rs,promicic EMAIL. CONTRACTOR'S LICENSE r WAINS NUMBER: .!-tit(ZI/it ip �iC"'.70c) NUMBER ARCHITECT/ENGINEER: /�l �tI' PHONE ( FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: J New X Wood Existing: I Sewer El Addition ❑ Steel Proposed: Bank I] Community System Xr Alteration/Remodel Li Concrete Total: 2 Height: ,3('Individual System ❑ Repair C Masonry `f. SEP Permit# El Demolition C Other: Bedrooms: Water Supply: Existing: Setback: Private well C Two Party Type of Heat: Proposed: Public Total: l Name of System:t1I) a, If this is a Commercial Proiect 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 For Office Use Only Amount Revision Main Floor Heated rl�2 ` 'S 2. EH Bld App Review: 2fa Floor Heated Consistency Review: 6f ,Yoh Other Heated Base fee: Mezzanine ��' 195 Additional Section: --__, Heated Basement Plan Check fee: (n Unheated Basement I`40?)'3) State Surcharge fee: ,4 ' SI D Other Unheated Pot Water Review fee: Garage/Carport 2 4/ Z6 u Decks ( SUBTOTAL 7 4 19 No 0 I o `/ 911/Rd Approach fee: Other j� 0 TOTAL: $ I q_ Ob Receipt Number: I I-1—1 I O Cash/Check Number: ?q ESTIMATED COST(REQUIRED) Date: CD .Fair market value of all labor and materials foundation to finish ___' -e-:, _______ g /2,o—oc, _`2`" Initials: G:\PermitCcnter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc \,......),----- k .. NI _.....,,,, -......., C O LIU Liz (:)... r------ _. ___._____--_-____ ________ .-.__._._ ' -- En 1„ , , Cir) v, , , w , 0 i 3 v 1 Q c I o I , i z - •Z 1i ..1 I 1w.. t --............ 1 r Ao ), , CCCb 1 ri LJ z Ca ij .) 1 , � CY- 03 r P9HejQiS N 0 c._. _ �1 V1 •