HomeMy WebLinkAboutBLD2011-00061 IJ ILDING PERMIT APPLICAT!N BL 061
Revv iew iew T Tyype:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD11-00061 Received Date: 3/21/2011
SITE ADDRESS: 261 QUINAULT LOOP
PORT TOWNSEND, 98368
OWNER: RUDY H THEOBALD TRSTE PHONE: 619-804-7839
PAMELA A THEOBALD TRUSTEE
5112 VIA MINDANAO
OCEANSIDE CA 92057-2618 CAPE GEORGE COLONY DIV 4
SUBDIVISION: Block: 10 Lot: 26
PARCEL NUMBER: 938701038 Section: 13 Township: 30 N Range: 02 W
CONTRACTOR: MILLENNIUM ONE HOMES INC PHONE: (360)385-4141
40 VANCOUVER AVE
PORT TOWNSEND WA 98368
Contractor's License MILLEOH010MM Expires 7/27/2011
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION ADD BATHROOM IN EXISTING BASEMENT
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ALT
VALUATION 11,000.00 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: 2 Exist: 2
Prop: 0 Prop: 1
Total: 2 ,.Total:-
Routinq Date: <I__ _ �—
II
Type Amount Bv: Date: Receipt: PAbVEDPermit $195.25 LYK 03/21/11 123306 AP
Plan Check $126.91 LYK 03/21/11 123306
State Building Code $4.50 LYK 03/21/11 123306 MAC ZtJil
Total: $326.66 Jefferson County Plannine
& Building Department
Jefferson County Building Desion Permit Nun,: BLD11-00061
Applicant: TRSTE
BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2009 IInBternDational 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
Rough-in Plumbing
Framing j
Airseal 4.
Insulation: Walls ��y
Irrstrtattep. A/A/A
FINAL INSPECTION si'' - ( l�
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
411 Oct 29 09 02: 48p
include the following Items on your plot plan:
L Property boundaries
a Names of adjacent stools t3 Septic tank
0 Driveways and parking spa..s.eti 0 Drainfield(enter NN if unknown)
o Surface water(ponde.creeks. otc) Zn
0 North Arrow
C3-, BullclIngs(reeldence,sheds,garages,etc) o Wells
/ . .
•
N. .
PLOT PLAN-date prepared k onS
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ENVIROvtifECK, L.L.C.
1612 Hastings Ave.W. -
NOT TO SCALE Port Townsend,WA 98368
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gkation of art_Existing site Sewage System.,_07:30/04_odi—
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ON C' •
r 6,.. JEFFERSON C�UNTY
' DEPARTMENT OF COMMUNITY DEVELOPMENT
` ►�C 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
tipwww.co.jefferson.wa.us/commdevelopment
Master Permit Application
MLA: NO MCA -p w I
Project Description(include separate sheets as necessary):
1A \ 1i a + 14 ( oa , ( \ Si e 'c Q- `-p+r,
) _
Tax Parcel Number: 4 p ' a 3
Property Size: /to+3 t 3 (acres/square feet)
Site Address and/or Directions to Property:
2 b t c .tA.► vka l t'I -} ‘....0 0 p
Property Owner(s)of Record: R u a.y .i na H,y T M e
Telephone: (p t Q t Ott ` 7$3 4 Fax:
email:
Mailing Address: POI ea.DX 1_2-4 0 Lar s 1' S 11�.i S t...0 4 y Paw 1 k y 1.64 ri ed
Applicant/Agent(if different from owner): T on t Vw \e k w ihr.c S
taw. O��
Telephone: ';t — 10 j'" aj ei t 3 Fax: 3ti S-- to /te teo
Mailing Address: 14'e\ V\ S+ c),T email: 4
What kind of Permit?(Check each box that applies 0 Lot or Road Segregation
EiBuilding 0 Critical Areas Stewardship Plan
❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use)
❑Single 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* !]Special Use(Essential Public Fa Idles *-C�1 Change of Use 0 Boundary Line Adjustment )
0 Address 0 Road Approach 0 Short Plat**
0 Home Business 0 Cottage Industry 0 Binding Site Plan**
0 Propane ❑Long Plat**
❑Sign 0 Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration**
•
0 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 ❑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 forpermit(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 de 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 agat st 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 application that h or sh prior notice.
Signature: 0
/ ,/ /
Date: ;r' 2 /
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 spades 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 responsiblity for dhering to and complying with the ESA. The Applicant has read this disclaimer an signs and dates it below.
Signature: l:
Date: 7/2/ //
•".\T_ :✓".._....-\444444C YID A$04#444\TDT CrID1,,C\r \
-_____-Tn- ,_..___%•r._.. I
.
BUILDER STATEMENT
The signer of this statement does hereby certify that they are the
rOwners
for the of
parcel
j referenced
renced herein,that they are not licensed contractors and that
9
they will be assuming the res sibildy f the neral Contra Signature: 3/f Z�I f
Date:
PHONE: FAX:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: O fro)3-0 1— et 4` ? (3(00) yyS---xlvte
O EMAIL: e5 ke � to 05 L O"WI
MAILING ADDRESS: 30� V. $* `', • WAINS
CONTRACTOR'S LICENSE A' I` E.O o Ia tij W1 NUMBER
NUMBER: PHONE FAX:( )
ARCHITECT/ENGINEER: EMAIL
MAILING ADDRESS:Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
Wood Existing: �7��...er System
❑ New ' ❑ Steel Proposed: ___I___ Bank ❑ Community • y
-. Alte Alteration/Remodel
o d i'" Total: __ Height: Er(dividual System
❑ Repair r�k ❑ Concrete SEP Permit#
❑ Masonry Water Supply:
❑ m ❑ Other: Bedrooms:
❑ Demolition Existing: Z Setback: p-ovate well ❑ Two Party
Proposed: ❑ Public
Type of Heat: Total: m. Name of System:
ELrLE�.t,✓gtl t(l� C,r
If this is a Commercial Project ou must answer the f Proposed: Number of ADA Parking Spaces:
Number of Parking Spaces: Current: s
Number of occupants(includes owners,tenants,employees,etc) Current Proposed
Will you have Foo posed Yes f No ,
IBC Occupancy:
IBC Type of construction:
if this is a Pro ne Tank and/or A liance Installation rrif
Size of Propane Tank'ow that awl
1 Underground Tank T Above ground Tank
1 Heat Stove I Cook Stove 1 Woodstove 1 Fireplace.Insert 1 Hot Water Tank 1 Pellet Stove I Other
is this a liance bein installed in a Manufactured/Mobile Home? Yes / No
n for a permit to install a propane tank you must also submit a site plan showing all of the buildigs,all property
When applying tank to all property lines,buildings and septic systemp
lines,tank location and size,distances from the propane �� � ���� �� k �
the.reserve area. �>,F. w x } :. x'art' b
includin' 3
3 .a c i_ r E 3 ,t^' i s Y, r tw f �9 �•�, w�5
�� �����l��r� '�:q$,,.�� t c' ��"t t'. e i�, .. ,�, � ��t+p,�sb,�."�`nw+±'.,N:n:�!c
S uare Foots•e Current Pro osed EH Bid App Review:
Main Floor Heated 1 1 f,0 - ,
2' Floor Heated , hpt
Consistency Review:
A ,
,� �` Base fee'• •
Other Heated S• - �`` €
'l'!< 7,, • ' Additional Section:
6e f Plan Check fee: t cAD' (4) MIN
Heated Basement T 1� , •, 1.;
: :, 4 State Surcharge fee:
Unheated Basement y,,
lN.ie
Pot Water Review fee:
Other Unheated• •4 , '
g% SUBTOTAL
KM
Garage/Carport b i' k`t
�! tr-, ,, 911/Rd Approach fee:
Decks f_
TOTAL: $ f�C,FINEWII.
(r k'
Other ,, ,
w '' 4 Receipt Number:
a
1111111111111111111111111111
Cash/Check Number: L.( C 20
ESTIMATED COST
(REQUIRED) Date: MEM
•Fair market value of all labor and materials foundation to finish Initials:
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