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HomeMy WebLinkAboutBLD2010-00362 itILDING PERMIT APPLICA•N B RDI w00p362 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00362 Received Date: 10/13/2010 SITE ADDRESS: 51 MAPLE ST PORT HADLOCK, 98339 OWNER: CHRISTINE R LEAF TRUSTEE PHONE: 360-452-3492 CHRISTINE LEAF REV LIV TR 181 FINN HALL RD PORT ANGELES WA 98362-8114 SUBDIVISION: Block: Lot: T 154 PARCEL NUMBER: 901022008 Section: 2 Township: 29 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: DARRAGH BYRNE PHONE: 323-244-0409 PO BOX 1163 PORT HADLOCK WA 98339 PROJECT DESCRIPTIOF RE-ROOF TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 3,950.00 ADD'L: HEAT TYPE: CODE EDITION: 2009 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 Bv: Date: Receipt: Approved/Date Permit $97.25 LYK 10/13/10 120200 Plan Check $63.21 LYK 10/13/10 120200 State Building Code $4.50 LYK 10/13/10 120200 Total: $164.96 Jefferson County Building Dion Permit Nun.: Applicant: BUILDING PERMIT INSPECTION APPROVALS \pplicable 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 'scz,f Oco i3 FINAL INSPECTION '_ .1 0 FINAL INSPECTIO MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR co (i-iiiilliklJEFFERSON COUNTY• •�4' DEPARTMENT OF COMMUNITY DEVELOPMENT '-3 621 Sheridan Street • Port Townsend •Washington 98368 �� 360/379-4450 • 360/379-4451 Fax www.co.jefferson.wa.us/commdevelopment 87Na n Master Permit Application MLA: (Y u L�'6 Project caption(Jude sarate sheets as necessary): KAI ©O �- h ;v o Tax Parcel Number: 1 0 22 %s C(P‹ Property Size: ii fit;v-Q ,S (acres/square feet) Site Address and/or Directions to Property: Property Owner(s)of Record: L‘• 4 c VI.0-- Telephone. it 3 I. .72 Fax: email: Mailing Address: / 1. i / n n r;Ad f Applicant/Agent(if dill nt from owner): a v" r�J' Ji r/1‘0Telephone: (S"` -'�214 f o 4-a? Fax: a ail: • Mailing Address: o �fi 1 i ID 8 or 1 G _ 1 j3a - -� 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) ,ISingle Family ❑ Garage Attached/Detached 0 Conditional Use[C(a), C(d),or CI** ❑ 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 ❑Short Plat** ❑ Home Business 0 Cottage Industry 0 Binding Site Plan** 0 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 0 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 **R••uires a Pre-A..licafion Conference Please identify any other local,state or federal permits required for this proposal, if known: DESIGNATION OF AGENT I hereby designate +'ci. ►^ to act as my agent in matters relating to this appli tion for permit(s). t p OWNER SIGNATURE PA ___/Date: a1J/ 2- /b 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 er inspections. Staffs access and right of entry will be assumed unless the applicant informs the Co my in writing at the time of the application at e or shemiaqayarior oti Signature: ��= Date: 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 y%` :re in compliance with the Jefferson County development code.The Applicant acknowledges that h ,she or it holds individual and non-transfer.• espotnsi j ity fo erin o a c plying with the ESA. The Applicant has read this disc imer rl sig and dates it below. Signature: A ./- Date: G:\PemiitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc • • BUILDER STATEMENT The signer of this stat,mept does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assumin the responsi ility o he Gener ontractor for the proposed project. // ) Signature: `Date: �0/ ( 2 GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New 0 Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: _ Height: 0 Individual System ❑ Repair ❑ Masonry SEP Permit# O Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: 0 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: 1 Underground Tank 1 Above ground Tank Size of Propane Tank: 1 Heat Stove 1 Cook Stove 1 Woodstove 1 Fireplace Insert 1 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 UseOlaly Amount _ Revision Main Floor Heated EH Bld App Review: 2 Floor Heated Consistency Review: Other Heated Base fee: oll ,a5 Mezzanine Additional Section: Heated Basement Plan Check fee: _ ( v 3. Unheated Basement State Surcharge fee: 5-) Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL- $ (Lii�i .9, Receipt Number: Cash/Check Number: IMATED COST(REQUIRED) Date: • it market value of all labor and materials foundation to finish 4)- 3c1 50 . Initrals: G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc m1G n- I,-- _ .---.- 1..� _, - ...--_ .._ a .. , • • . , f - - r- ' r N. ,, , , -1, 00 . .N, ' L 1 - ... ' ' • i up 1 ; • , . . .. c:` . . m 4 ( , s _t 1 73 m --g-: ' il-f: --v ,, , .. 1 . , .,. . ) , 1 j , , , , . . \, : , t ilk * . . .-. , , . . , . i , m . Q.V bjJ Fill) OCR • 1 m m y . A.) ;F Z 73 v Z. i eN i2. E W E. 0 R ir Z . .. ......; rt; c 1 .7\ t 1- rn m eg , a) t z 1 73 to rn _ 0 r . CJ -cil. .---. Z r N� ) 4