HomeMy WebLinkAboutBLD2010-00239 5
43UILDING PERMIT APPLIC/OON MR v e0 Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD10-00239 Received Date: 7/6/2010
SITE ADDRESS: 925 FOUR CORNERS RD
OWNER: JAMES B HAY JR PHONE: 360-385-1748
PATRICIA L HAY
925 4 CORNERS RD
PORT TOWNSEND WA 98368-9373
SUBDIVISION: Block: Lot: T 65+
PARCEL NUMBER: 001334030 Section: 33 Township: 30 N Range: 01 W
CONTRACTOR: BERKSETH ENTERPRISES PHONE: 360-452-8355
21 LADYBUG LN
PORT ANGELES WA 98362
Contractor's License BERKSE*224BJ Expires 1/14/2012
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP NEW DETACHED GARAGE - UNHTD, NO PLMB
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION 35,000.00 ADD'L: HEAT TYPE: UH
CODE EDITION: 2009 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: SHORELINE:
GARAGE: 1,320
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 0 Prop
Total: 0 Tota: 0
Routing Date:
r1-71_10
Type Amoun v: Date: Receipt: Approved/Date
Permit $492.25 LYK 07/06/10 117948 AppfJtrEIJ
Plan Check $319.96 LYK 07/06/10 117948V
State Building Code $4.50 LYK 07/06/10 117948 AUGS 2010
Total: $816.71 Jefferson County Planning
& Building Department
Jefferson County Building •sion Permit Nu•r: BLD10-00239
Applicant: HAY JR
BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2009 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 )�
45-(7 to
Erosion Control
Post Holes i7 _I V
Underground Plumbing
Straps(hold downs)
Ext. Shear Wall Nailing
Framing
I0-1 5.- IC (71-1
Blocking
Drywell/Alt Drainage
Address Posted
FINAL INSPECTION 0.12 ._fC; c66,-15
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
• •
CONDITIONS for Building Permit# :BLD10-00239
1.) See BLD06-00646 for conditions that apply to this property and project.
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.
r44
4 �\
� JEFFERSOSOUNTY 0
DEPARTMENT OF COMMUNITY DEVELOPMENT
`w " `4 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
�o www.co.jefferson.wa.us/commdevelopment
8IN
Master Permit Application MLA: 1 L Q(05
Project Description (include separate sheets as necessary):
TO C D IJ S TiLuC I" & 3d'S 4%4 ' IN G'"TIP•C to Et GA 2AG C:. - (2n K Kb Tax Parcel Number: n _,,,e)
Op I� �o 3o Property Size: S P�.,II.t;-r (acres/square feet)
Site Address and/or Directions to Property:
Ct 2 S Fo u A- Con t.l�v.t R.p Pott.•r p k,,^1 S t N6 i __
Property Owner(s)of Record: SAA-lcs PAT",fi t C.LA I- rky
Telephone: 3Coc7 38S 1"1`4$ � Fax:
email:.)l01 E}A y 91 lip MS p-I•do.".
Mailing Address: $ t4 G
Applicant/Agent(if different from owner):
Telephone: Fax: a l:
Mailing Address: `' - 6 2010 —
hat kind of Permit?(Check each box that applies
ilding 0 Critical Areas Stewardship Plan
0 Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
❑ Single Family lii arage Attached(6etached) ❑Conditional Use[C(a), C(d),or C]**
❑ Manufactured Home ❑ Modular 0 Discretionary"D"or Unnamed Use Classification
O Commercial* ❑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 ❑ Shoreline Master Program Exemption/Permit Revisions**
❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development**
❑Temporary Use 0 Shoreline Management Variance
0 Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment
0 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 to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE 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 later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the appli ation that he or she wants prior notice.
Signature: f Date: SUL 20 I.
The action or a ions 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-transferable responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
.Signature: Date: 'JVL�/ 7� 2 Of 0
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
• IIIBUILDER 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:
i3t QC-cen-E Cj►wSTri-WCTLOKI ()Go) tk L 835-s ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: 1`�En_KS t JE 2 2`-1 t.j\ NUMBER
ARCHITECT/ENGINEER: G—Et (f OPGt'.. eNc. PHONE ( ) FAx:( )
MAILING ADDRESS: 14ot W. 1 fl YC,to skti1661, 3 EMAIL up ai dec MSN•GOpein.
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
V New Al/Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank ❑ Community System
System
Total: Height: ❑ Individual S s
❑ Alteration/Remodel ❑ Concrete Y ,
❑ Repair ❑ Masonry SEP Permit# t j
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type of Heat: Proposed: =i CI Public
et )I-).�l 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:
1 Heat Stove 1 Cook Stove i Woodstove i Fireplace Insert i Hot Water Tank 1 Pellet Stove 1 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: r7 '
2nd Floor Heated Consistency Review: c9 (3 —
-Other Heated Base fee: ��n a 5
Mezzanine Additional Section: �'►_______--0{
Heated Basement Plan Check fee: 3 )(1 .(1(0
Unheated Basement State Surcharge fee: ..4. r-c.:
Other Unheated Pot Water Review fee: �� P > ,
Garage/Carport `32D 3-iii., SUBTOTAL (0 I
•
Decks 911/Rd Approach fee:
Other TOTAL: $ I (t o l
T)
Receipt Number: 1 1 7() 43
- Cash/Check Number: e 15
ESTIMATED COST(REQUIRED) Date: "� �10
•Fair market value of all labor and materials foundation to finish
., ` �xM t� Initials:
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
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