HomeMy WebLinkAboutBLD2011-00052 GILDING PERMIT APPLICATOlk Review 0052
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Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD11-00052 Received Date: 3/8/2011
SITE ADDRESS: 290 COLMAN DR
PORT TOWNSEND, 98368
OWNER: JACK D SALMON PHONE: 360-379-9392
CAROLYN W SALMON
290 COLMAN DR
PORT TOWNSEND WA 983689477 CAPE GEORGE COLONY DIV 7
SUBDIVISION: Block: 14 Lot: 26
PARCEL NUMBER. 939601425 Section: 13 Township: 30 N Range: 02 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI` ENLARGE EXISTING SHOWER & REPLACE TUB IN 2ND BATHROOM
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ALT
VALUATION 12,000.00 MAIN:
CODE EDITION: 2009 ADD'L: HEAT TYPE: EEE
OCCUPANCY: R-3 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: 5N OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: 11050
BEDROOMS: BATHROOMS:
Exist: 3 Exist: 3
Prop: 0 Prop: 0
Total: 3 Total: 3
Routing Date:
Type Amount Paid_$.v.:_--Date: Receipt: Approved/Date
Permit $209.25 LYK 03/08/11 123269 APPROVED
P R O,V/ D
Plan Check $136.01 LYK 03/08/11 123269 /"1
State Building Code $4.50 LYK 03/08/11 123269 MAR (0 !U11
Total: $349.76
Jefferson County Planning
& Building Department
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F �, ,o I NOTE: 5/6/86 Duke Shold of Shold Ex.
called and reported this system has
•again failed. They want to repair as
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per 1984 permit. It is the only spot
' �tik S C to attempt repair. He wants to instal
L 1 4 system tomorrow. I approved to instal
4 (\ and ok to cover tomorrow as this is a
' I ' i t repair and there is no place else to
-I design. R.M.D.
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Jefferson County Building Dion Permit Num, BLD11-00052
Applicant: SALMON
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
Underground Plumbing
Rough-in Plumbing ,I Icj/t� ),,
Pressure Test ✓
FINAL INSPECTION
2 9/
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
1:sON„. C% JEFFERSONWUNTY •
al
' .4 DEPARTMENT OF COMMUNITY DEVELOPMENT
1-3 `
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: k.�O ( 1L1A Fif G b,
Project Description(include separate sheets as necessary):
16J4e. E-Y I -n �t-,51'1tb ut.� 1c ,�": +:r,,
Tax Parcel Number: Cf j() J1LI o5 Property Size:
p y (acres/square feet)
Site Address and/or Directions to Pro _
)(_, Cldaia l- be g_f-r. 1._ct.� n Lk`,'►&, c1 k�.(�
Property Owner(s)of Record: n r ire r.��. �✓9�&Ai / �c
Telephone: 6 IN 3?`I-4/,j'I- Fax: l �`-- email:. S;41i-"rz ve40444,,/
Mailing Address: . qU (,,/,y,,p v A_,,,,r t "/ /4:y,,,,t,<,_,,, -L)/-f e/5 6.S
- Applicant/Agent(if different from owner):
Telephone: Fax:
email:
Mailing Address:
What kind of Permit?(Check each box that applies ❑Lot or Road Segregation
^G Building 0 Critical Areas Stewardship Plan
J 0 Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
IilSingle Family ❑ 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
❑ Address 0 Road Approach ❑Short Plat**
❑ Home Business 0 Cottage Industry ❑Binding Site Plan**
0 Propane 0 Long Plat**
0 Sign 0 Planned Rural Residential Development(PRRD)/Amendments**❑Allowed"Yes"Use Consistency Analysis ❑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
0 Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment
*May require a Pre—Application Conference ❑Tree Vegetation Request
**Requires a Pre-Application Conference
Please identify any other local, state or federal permits required for this proposal, if known: Y/l
DESIGNATION OF AGENT
I hereby designate to act as my agent in matters relating to this application for permit(s).
/OWNER SIGNATURE Date: ]//47
By signing this appli on 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 attorneys 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 atio�2at�r she wants prior notice.
,rrry Signature: -z1Zy,_
Date: 1/a'
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 are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transfers e res onsibility for adhering to and complying with the ESA. The Applicant has read this dis la' er and signs and dates it below.
/Signature i Date: •// //
G:\PemutCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
III
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 re pgnsibility of the General Contractor for the proposed project.0711/
?
Signature: Date:
FAX:
/GENE ONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: ( )
( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER:
PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Type:
Frame Bathrooms: Shoreline: Type of Sewage Disposal:❑ Sewer
❑ New Wood Existing:
Altera
tion ❑ Steel Proposed: Bank ,Community System
❑ AlteratiAlteration/RemodeloRemodel ❑ Concrete Total: Height: ❑ Individual System
SEP Permit#
❑ Repair ❑ Masonry
❑ Other: Bedrooms: Water Supply:
• Demolition Existing: Setback: ❑ Private well ❑ Two Party
Type f Heat: Proposed: v 0Public
Eel &_ Total: Name of System( e 6ec je
If this is a Commercial Project You must answer the following: /VI/ Number of ADA Parking Spaces:
Number of Parking Spaces: Current: Proposed: Proposed
Number of occupants(includes owners,tenants,employees,etc) Current p
Type Occupancy:
IBC T e 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: /Jj9
i Underground Tank i Above ground Tank Size of Propane Tank:
1 Heat Stove i Cook Stove i Woodstove 1 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 site plan showing all of the buildings,all property
property
lines, tank location and size,distances from the propane tank to alllines,buildings and septic system components,
including the reserve area. r
' o� evision
Square Footage 1 Current Proposed �f ��q�'��#�Y �"��-� •, � -
Main Floor Heated I EH Bld App Review: n `�
/U.-y
2— Floor Heated Consistency Review: ___�_
J OS'q . �'y�
Other Heated Base fee:
J(1 • a5
Mezzanine Additional Section:
-Heated Basement Plan Check fee: l a O I
Unheated Basement State Surcharge fee: 4=-Jc)
Other Unheated Pot Water Review fee: CO 1111
SUBTOTAL
Garage/Carport lit° 31-1
Decks 911/Rd Approach fee:
Other TOTAL: $3-11. 7(D
Receipt Number: I
_ 23Z
_ Cash/Check Number:
M 000
TIM D COST(REQUIRED) Date: .--
.Fai of all labor and materials fo ation to finish Initials: -J
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.d
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