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HomeMy WebLinkAboutBLD2010-00212 BLD10-00212 BUILDING PERMIT APPLI ION Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00212 Received Date: 6/15/2010 SITE ADDRESS: 150 MT CHRISTIE CT PORT LUDLOW, 98365 OWNER: EDWARD E COLBURN PHONE: 360-437-4199 GAIL S BOREN COLBURN PO BOX 65157 PORT LUDLOW WA 98365-0157 OLYMPIC TERRACE DIVISION 1 SUBDIVISION: Block: Lot: 28 PARCEL NUMBER: 978800028 Section: 21 Township: 28 N Range: 01 E CONTRACTOR: MEEKER CONSTRUCTION PHONE: 360-437-8188 161 W ALDER ST PORT LUDLOW WA 98365 Contractor's License MEEKEC*940DN Expires 5/21/2011 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI` ADD WINDOWS TO EXISTING COVERED DECK TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP DEK MAIN: VALUATION 6,500.00 ADD'L: HEAT TYPE: UH CODE EDITION: 2006 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: OCCUPANCY: OTHER: CONST TYPE: SHORELINE: GARA0 CONST TYPE: DECKLE 144 SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 0 Prop: 0 Total: 0 Total: 0 Routing Date: --� Ilam"10 Type Amount Paid By: Date: Receipt: Approved/Date Permit $139.25 LYK 06/15/10 117857 APpR ovEr Plan Check $90.51 LYK 06/15/10 117857 State Building Code $4.50 LYK 06/15/10 117857 JUN Z3 201U Total: $234.26 Jefferson County P!anninc & Building Department Jefferson County Buildingivision Permit Aker: BLD10-00212 Applicant: COLBURN 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 �_��,}r+j�= 1 �� 1!� ;�Sg tNJ>;'ll ► ���ttJ,.,„ Nt�i tNSrfY�.�> Wallboard Nailing S--Z- to FINAL INSPECTION •}L (4 FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR • px co JEFFERSON COUNTY W ' 4 DEPARTMENT OF COMMUNITY DEVELOPMENT 1-1 ` '4 621 Sheridan Str •Washington 98368 360/379 445 • 360/379 4451 Fax �qsp"� www.co.jefferson. . merit Master Permit Application MLA: ) f'�L.k el,. I Project Description(include separate sheets as necessary): -/V(1.•C6E _&C)Vet4:-') Po 2-CW-k- p �,� Tax Parcel Number: Lp.t 27 j-"l D �(�(-i---52 roperty Size: 33, '7.3Z — .77 f(acres/square feet) Site Address and/or Directions to Property: i50 illy ( 'I1( 15i1t Ck t_.Cv uciN_ 1 Property Owner(s)of Record: p IUD 7 67-Fi _E Q[ej[ L eA/ Telephone: 4/37-4/V l f Fax: email: Mailing Address: /T mT OP'/e/5Y/E eet„e7 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 lBuilding L_Ac..\os; C u-v-o-v & �‘C -R� h")7 Critical Areas Stewardship Plan ❑ Demolition Permit .� r,-s-- ,1- 0 Variance(Minor, Major or Reasonable Economic Use) Single Family 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 El Address 0 Road Approach 0 Short Plat** ❑ Home Business 0 Cottage Industry 0 Binding Site Plan** El Propane ❑Long Plat** • ❑ Sign . ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** El Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions** El 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 El 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 ) M/ to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE U� tt I (r !� 4�r, 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 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 late)inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applicztfon that he or she wants prior notice. Signature: i// 1',.� i r. �l, f /,/ Date: j / i 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 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 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-transferable responsibilitylfor a ring to and complying with the ESA. The Applicant has read this disci er and signs and dates it below. i Signature: '_, t f 1 � \ Date: �� �� G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc III 1110 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: (1i1 L�-1 -1C Cl alkj S1,ZCe:-f c co ld (36 ) 30(-75 (% ) V 37—PZ 7 3 MAILING ADDRESS: lb` ((1 t - p_. 5 r, EMAIL: CONTRACTOR'S LICENSE C QZT ut 0t,c _ my.'}_ 1 3vS WAINS NUMBER: )(.5 1S L3tI q k-foDt.k NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: //� Shoreline: Type of Sewage Disposal: ❑ New ffi Wood Existing: av " Sewer ❑ Addition ❑ Steel Proposed:Total: Bank 4 h`Community System Alteration/Remodel ❑ Concrete Total: _ Haig"' ❑ Individual System ❑ Repair ❑ Masonry �� SEP Permit# LI Demolition ❑ Other: Bedrooms: Water Supply: Existing: '" Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: t _ ' Public 911eNr 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 U• nderground Tank i Above ground Tank Size of Propane Tank: H• eat Stove I Cook Stove i Woodstove i Fireplace Insert I Hot Water Ta k i Pellet Stove i Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / > o 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: 2n°Floor Heated Consistency Review: Other Heated Base fee: / 3 cY Z — Mezzanine Additional Section: --_-- Heated Basement Plan Check fee: 'CIk)o5 Unheated Basement State Surcharge fee: "T• U Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL z' 2 Decks 911/Rd Approach fee: Other C'Nti.,CyG nC-0G(4 1q4 9ik TOTAL: $„23 (/ 2 �6 Receipt Number: i tiSr5 1 `_ _ Cash/Check Number: ��.1� E MATED COST(REQUIRED)' Date: �- •F market value of all labor and materials founds to finish - l Initials: - ---� s6� G:\PemutCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc N 0) N cil- • rvi —11 "F-T—c) ' CL___) -- I gt ti' D r-:. _ &. r — rat 1--r cr .1 i stl Ell ri — a El r) v cY c 1 J i .. , ..,-, s i . J r. ._ . f M. CLIT:13 i i ,E1.___. ° A in__ r e 767 adMd 11 ,___N, g3 11;i: ___ v E=,. 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