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HomeMy WebLinkAboutBLD2010-00308 •UILDING PERMIT APPLICA•N BL 308 Revviewiew T Tyype: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00308 Received Date: 8/26/2010 SITE ADDRESS: 70 TRAFALGAR DR PORT TOWNSEND, 98368 OWNER: WILLIAM S T MAYHALL PHONE: 360-531-3053 CHERON T MAYHALL 39645 S HORSE RUN DR TUCSON AZ 85739-2309 KALA POINT#4 SUBDIVISION: Block: Lot: 145 PARCEL NUMBER: 965000124 Section: 27 Township: 30 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr REPLACE POSTS ON EXISTING DECK ''QY SrOr1 l2]0o 10-02. EX sTT, ()IN:05dt, haard. TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP DEK MAIN: VALUATION 2,106.00 161 ADD'L: HEAT TYPE CODE EDITION: 2009 OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: 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_--1a . ate: Receipt: APP m - ,V E Permit $83.25 LYK 08/26/10 119998 Plan Check $54.11 LYK 08/26/10 119998 SEP 14 2010 State Building Code $4.50 LYK 08/26/10 119998 Jefferson County Planning Total: $141.86 &Building Department Jefferson County Building lision Permit Ntr: Applicant: E'JILDING PERMIT INSPECTION APPROVALS applicable Code: 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 ✓`ih ✓1.`t mo ��t.) ''; /��� ((_ I r) FINAL INSPECTION r/ L FINAL INSP CTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR • • N IF f--- -------- " ): - 2 °� (� � 1 4 : \ e; J i Ogg' ' V J =1 \ k', - • .--.7-------- Li '' Cam _ `—__...„, F X • • ,s - . tXJ �\ \ - il -4 ..---- c A t L, < Pr < '1' lb r f. 0 . � 1 0 1 I j 74 i C.b.-- . ., .z. Contact the Building (Department at (360) - 37 -450 prior to makinL changes or revisions to -he approved plans. N .FILE COPY "SON c0A JEFFERSOI OUNTY • ,, • ' A DEPARTMENT OF COMMUNITY DEVELOPMENT i' ` ''4 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax �qs p/ www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: 00 I YILA eEJ 1 Project Description(include separate sheets as necessary): I o1 - -CR- V V► r �p��L ' G j e X�e ( 6� (ter Y %y"' Tax Parcel Number: u f4 00o / 2-r Property Size: (acres/square feet) Site Address and/or Directions to Property: 7o 1 Np 4 ! S d ' � J �d G�4--�1g. rJ , Willa gct-t4iit ff�,//rr yy�� //� -T Property Owner(s)of Record: h t/ S' T �//cGZj A a / E </terolN eJ, fJ/GAL fj G' Telephone: 3 6 d.5-3 1.3 Q Fax: Ain email: /5 n a Mailing Address: /' Applicant/Agent(if different from owner): Telephone: Ad Fax: email: Mailing Address: Whit kind of Permit?(Check each box that applies 0 Lot or Road Segregation ' Juilding appal r 0Di/I RoAeileteiz fit,/ CO 0 Critical Areas Stewardship Plan O Demolition P rmit .e U k 6 (.� >�a.i 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family 0 Garage Attadtied[Detac ed 0 Conditional Use[C(a), C(d),or C]** O 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 ❑ Address 0 Road Approach_ 0 Short Plat** D Home Business 0 Cottage Industry ❑ Binding Site Plan** ❑ Propane 0 Long Plat** ❑ Sign - ❑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: ii)/Ji DESIGNATION OF AGENT I hereby designate 5 % I to act as my agent in matters relating to thi application for permit(s). MA OWNER SIGNATURE .1 / i i ,t ,�I Date: t/ZS�742/0 By signing this application form,the owner/agent attester:t 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 unty - d its employees,representatives or agents for the sole purpose of application review and any required later inspections. Staffs access an. '•h f -ntry will be assumed unless the applicant informs the County in writing at the time of the application t at fj- or she want pr•r - -. Signature: i,I d, Y. I /7", Date: The action or actions Applicant will undertake as - -s t oft - issuance of this permit may negatively impact upon one or more threatened or endangered species and Could lead to a potenti- "ta -"of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act"or"ESA."Jefferson Co 1 makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate he ESA. • i ,1 idual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)everyif u are in co pl. 1 th the ,_ e/:� County development code.The Applicant acknowledges that he,she or it holds individual and non-tra f' ble re i t :.hern. g. (. plying with the ESA. The Applicant has read this disclaimer and sign and dates it below. /Signature: �1 , Date: G:\PermitCenter\###FORMS###\D' Vim:' S\Current DRD Forms\Master Permit Application 5-29-08.doe • BUILDER STATEMENT • The signer of this statement does hereby certify that they are the Oiners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibilit f the General Contract for t yroposed project. 7 Signature: Date: b J C.ip J '721/0 GENERAL CONTRACTOR OR MANUFACTUR HOME TAL R: PHONE: FAX: �� 16d610 ( 0cD/3a).�>3 MAILING ADDRESS: PC11°( .Q EMAIL: /',�Sjai /jy7D© E��f � /CONTRACTOR'S LICENSE WAINS W ,/,sNUMBER: `P1 NUMBER ARCHITECT/ENGINEER: (� PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frapt Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ood Existing: 41,,Lj ❑ Sewer ❑ Addition CI Steel Proposed: Ban ��/ ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: _ Height: ❑ Individual System i/epair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: ❑ Public Total: Name of System: i 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 For Office Use Only Amount Revision Main Floor Heated EH Bid App Review: 2t'd Floor Heated Consistency Review: Other Heated Base fee: (C1s,i Mezzanine Additional Section: Heated Basement Plan Check fee: „ C., 5, ( i I 12 a Unheated Basement State Surcharge fee: / . . .. .. . . . Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL y : Decks 1 0OU Sc C 911/Rd Approach fee: Other TOTAL: $ I LI I _ 0 tp Receipt Number: I WIVE Cash/Check Number: 1 1 2 ESTIMATED COST(REQUIRED) Date: E� •Fair market value of all laborradm and materialsfoundation to finish 4 ,— "z V I0) ` 3 Initials: L G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc