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Home My WebLink AboutBLD2010-00206 • BUILDING PERMIT APPLI•ION BL 206 Revv iewiew T Tyype: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00206 Received Date: 6/10/2010 SITE ADDRESS: 831 THORNDYKE RD PORT LUDLOW, 98365 OWNER: PETER V CIANI PHONE: 360-437-9195 DEBORAH P CIANI 193 MAXVIEW DR PORT LUDLOW WA 98365-9577 BRIDGEHAVEN DIV 5 SUBDIVISION: Block: Lot: PARCEL NUMBER: 935100009 Section: 9 Township: 27 N Range: 01 E CONTRACTOR: PENINSULA TANK SERVICES INC PHONE: 360-613-5866 PO BOX 2596 SILVERDALE WA 98383 Contractor's License PENINTSO44KZ Expires 5/8/2011 REPRESENTATIVE: PHONE PROJECT DESCRIPTIOt DECOMISSION & REPLACE U/G OIL TANK TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP ALT VALUATION MAIN: CODE EDITION: 2003 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: OTHER: SHORELINE CONST TYPE: GARAGE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total Routing Date: L_ (--(c Type Amount Paid By: Date: Receipt: Approved/Date Permit $213.00 LYK 06/10/10 117841 Total: $213.00 APPROVEr JUN j2010 Jefferson County Plannin &Building Department • • Jefferson County Building Division Permit Number: BLD10-00206 Applicant: CIANI BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2003 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 Mechanical Systems - Verify Tank Empty Of Fuel Oil Mechanical Systems Verify All Piping Removed and Capped Mechanical Systems Verify Tank Is Filled With Concrete Slurry, Mechanical Systems New Oil Tank FINAL INSPECTION / I\'� , FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR I �v Gfi°//e) 14 ti'-et. ,i,c 4-o a <<'('h `f ('1„ CwY b (Jc •2 Ore..-\ fc-l�. - 1< O Q._. ski • ..-- \(\_0 • ' J4 e KS 111111 ferigii-eillc� JEFFERS"COUNTY ' pA DEPARTMENT OF COMMUNITY DEVELOPMENT ` 621 Sheridan Street• Port Townsend • Washington 98368 �0' 360/379-4450 • 360/379-4451 Fax www.co.jefferson.wa.us/commdevelopment hi7Na Master Permit Application MLA: N o fV l L 4- , Project Description(include separate sheets as necessary): �} /� �y '" L Cw1.c,St.--, Y714t c ec.424-ti- s r�)r=-*-.' h - ,, I . IC/ HTax Parcel Number: f�l '�'S - u'C>5N Property Size: 70 Y r 9 c+1 (acres/square feet) Site Address and/or Directions to Property: �j of I `r L J� Lc . / r,z•-r- [mil , / Cc)c� Ci,5s 365 Property Owner(s)of Record: Pr `tom c Telephone: 3 G 0• `'f'3 ' `r I ei )r Fax: /�7 email: c'Y yr ' 6, 0 ,'ti 5.?., c , , Mailing Address: /�1�l /24.4 A"{/< Fo0 4-- Pe 2T Lam " u.)ca `j q-3G c Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies 0 Lot or Road Segregation ❑Building— 0 Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) ❑Single Family ❑Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]** ❑ Manufactured Home . ❑ Modular - • - 0 Discretionary"D"or Unnamed Use Classification I 0 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* 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 n to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE v Date: 6 •/o'/v 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 requir later i pections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applicaf r she wants prior notice. Signature: 4.4.1 Date: " f° '/.0 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 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 a in comp; nce with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transfers s ns" ityfor adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: etw' Date: h • /O t /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: GENERAL CONTRACTOR OR MANUFACTURED�7 HOME INSTALLER: PHONE: FAX: cr 4 ' 1Gt 1 41/4-* (t 5"erVice5 (3“) 439613 - 5Y(v(: ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: Q z-r c N-' 5 0 4 Y K Z NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: _ Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# • Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private 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 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 Fqr Office Use Only, Amount ,<Revision Main Floor Heated EH Bld App Review: 2nd Floor Heated Consistency Review: Other Heated Base fee: Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL 71,, 0 U • Receipt Number: // 70 7 ` Cash/Check Number: � ESTIMATED COST(REQUIRED) Date: j j� /l/, 'Fair market value of all labor and materials foundation to finish r Initials: / —X)4 G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc