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Home My WebLink AboutBLD2010-00198 • BUILDING PERMIT APPLIC 'ION BRD e0 Typ198 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00198 Received Date: 6/7/2010 SITE ADDRESS: 204 OLYMPUS BLVD PORT LUDLOW, 98365 OWNER: DONALD KOLMAN PHONE: 360-274-6825 MILDRED KOLMAN 240 GEORGE TAYLOR RD SILVERLAKE WA 98645-9710 OLYMPUS BEACH SUBDIVISION: Block: Lot: 52-53 PARCEL NUMBER: 978900031 Section: 4 Township: 28 N Range: 01 E CONTRACTOR: HOPE INC PHONE: (360)385-5653 DBA HOPE ROOFING PO BOX 1199/105 LOUISA AVE PORT TOWNSEND WA 98368 Contractor's License HOPER**043N7 Expires 2/16/2011 REPRESENTATIVE: ZACH EADES PHONE: 360-381-0342 PO BOX 1199 PORT TOWNSEND WA 98368 PROJECT DESCRIPTIOI ROOF PITCH CHANGE TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 15,000.00 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: Total: . Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $251.25 LYK 06/07/10 117810 Plan Check $163.31 LYK 06/07/10 117810 APPROVED State Building Code $4.50 LYK 06/07/10 117810 Total: $419.06 JUN a\ 201U Jefferson County Plannin! & Building Department Jefferson County Building vision Permit Ober: BLD10-00198 Applicant: KOLMAN BUILDING PERMIT INSPECTION APPROVALS Npplicable 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 Foundation Footing Framing Blocking Insulation: Ceiling Address Posted FINAL INSPECTION 5 ��l2-16 �A, i FINAL INSPECTION MUST B1 PPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR . ' 7.01.,s0N cod, JEFFER COUNTY W ,o� ,,j DEPARTMENT OF COMMUNITY DEVELOPMENT I' '. i 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax 4- ,,d. www.co.jefferson.wa.us/commdevelopment '11 -1-il/s1W.Master Permit Application MLA: IN. U ifl I__ A Project Description(include separate eparate sheets as necessary): tttivi 1?e,ia.. f jj /G .44✓ `�*a ..L Aee tt t.rrw r / i G€144d, CA.y ases, Tax Parcel Property Number: 9?o ! a 003/ Size: (acres/square feet) Site Address and/or Directions to Property: Property Owner( of ecord: Telephone: - Fax: email: Mailing Address: 02--L1O ibe S ,4, 4 Ge//f}- 5g q S Applicant/Agent(if diffe ent fr owne . 1 ray. Telephone: 36 0—3 B/- 03 Li,Z aP x: email: Mailing Address: PO L3 o)/ //Q9 What kind of Permit?(Check each box that applies HIBuilding ►\ c• e,,4_ Dust_. ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit fon e' ❑Conditional Use[C(a), C(d),or C]** kSifigle'Family C,11 y.h`\ 0 Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification ❑ Manufactured Hom- 0 Modular 0 Special Use(Essential Public Facilities)** ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use ❑Short Plat** ❑ Address 0 Road Approach 0 Binding Site Plan** 0 Home Business 0 Cottagelndustry ❑Long Plat** ❑ Propane ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑Sign ❑ Plat Vacation/Alteration** 0 Allowed"Yes" Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** 0 Stormwater Management 0 Shoreline Management Substantial Development** ❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Variance ❑Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment 0 Wireless Telecommunication* 0 Jefferson County Shoreline Master Program Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium 0 Tree Vegetaion Request *May require a Pre—Application Conference **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 ea=gtel Date: By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct.)the best of his,her or it's knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respeotfe 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 to Writing at the time of the application th t he or s wan prior notice. Signature: / Date: 6p —c/ " (2 The actio r 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 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-transf le resp i ility for adhering to and complying with the ESA. The Applicant has read this dis imer and sin and dates it below. Signature: Date: L'l " � a/ C:ADocuments and Settings\carat\Local Settings\Temporary Internet Files\OLKM\Master Permit Application 12-19-2006.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: ( ) ( ) MAILING ADDRESS: 120 COX 1/99 P. 7 EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: h/012601_ "40 t/ 'l IV 2 NUMBER / ARCHITECT/ENGINEER: JL /�- Eujl!�S PHONE (Jeo 36l`.03ca FAX:( ) MAILING ADDRESS: EMAIL EMAIL T Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New t( Wood Existing: 2. Sewer Addition Steel Proposed: Bank Community System X. Alteration/Remodel Concrete Total: 2.._ Height: IX. Individual System ( Repair Masonry SEP Permit# Demolition Other: Bedrooms: Water Supply: y Existing: 2... Setback: i Private well Two Party Type of Heat: Proposed: 1 Public crte._.t 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: ❑Underground Tank °Above ground Tank Size of Propane Tank: ❑Heat Stove 0 Cook Stove 0 Woodstove 0 Fireplace Insert 0 Hot Water Tank 0 Pellet Stove 0 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: • 2"°Floor Heated Consistency Review: Other Heated Base fee: a . l Z' Mezzanine Additional Section: Heated Basement Plan Check fee: , I (o � Unheated Basement State Surcharge fee: )1 Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $ h.l ( 9 0 b Receipt Number: l l 1 0 t 0 Cash/Check Number: 2`- 19 3 ESTIMATED COST( UIRED) Date: r _ -, "�U.Fair market value of a labor and mat a/s foundation to&lnh f�O0v ) Initials: R—"----, C:\Documents and Settings\carat\Local. s\Temporary Int t Riles\OLK86\Master Permit Application 12-19-2(X)6.doc • Page 1 of 1 • 0 . 978900036 • ._. 9789300,-.. / / 978900030 ,..,..._..._..... / . ...., — 978900032 97890:031 / U . t 978900234 I/1 : 9/890:033 : . 978900110 4 978900038 I , Naas wooded rry/dIersan Cowry Coma Serecas GIS 0 •081 http://maps.co.jefferson.wa.us/output/parcels_gisserver4540310419656.jpg 6/6/2010 ! • A...---44 1- 1 SV—A.....,1 ki 4 1 s. 1 I II , li 1 1 1 1 1 It 1 1 I II 1 1 I 1 L i I:1 6, 1 I ca I iki 11 A II A I I r k I is N , I { .1 . i -4 I A 1 , Z I 1 j. 0 I �, I C.� r a D D co1 _ I I o N.)I A I I A = C. 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