HomeMy WebLinkAboutBLD2011-00077 JILDING •PERMIT APPLICAN BLD11-00077
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD11-00077 Received Date: 4/5/2011
SITE ADDRESS: 691 WAWA POINT RD
BRINNON, 98320
OWNER: CHELANN/TO VORHIES 1/2 INT PHONE: 280-610-1066
MARIE K MENTOR 1/2 INT
801 2ND AVE STE 1600
SEATTLE WA 98104-1564
SUBDIVISION: Block: Lot: T 13+
PARCEL NUMBER: 602242015 Section: 24 Township: 26 N Range: 02 W
CONTRACTOR: SMALLWOOD DESIGN & CONSTRUCTION PHONE: 206-842-5443
PO BOX 11308
MAINBRIDGE ISLAND WA 98110
Contractor's License SMALLDC101DA Expires 1/9/2012
REPRESENTATIVE: ROB SMALLWOOD PHONE: 206-842-5443
PO BOX 11308
BAINBRIDGE ISLAND WA 98110
PROJECT DESCRIPTIOP EMERGENCY STRUCTURAL REPAIR FROM TREE DAMAGE TO SFR
400SF
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP REP MAIN: 400
VALUATION 120,000.00 ADD'L: HEAT TYPE:
CODE EDITION: 2009 HEAT BASE: HEAT TYPE:
OCCUPANCY: R-3 UNHEATED: #OF STORIES:
OCCUPANCY:
CONST TYPE: 5N OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: 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 $1,105.75 LYK 04/05/11 123363 APpROvEL
Plan Check $718.74 LYK 04/05/11 123363State Building Code $4.50 LYK 04/05/11 123363
Total: $1,828.99 APR r] 2011
Jefferson County Plannim.
& Building Departm,
Jefyerson County Building Dillon Permit Nu, BLD11-00077
Applicant: VORHIES 1/2 INT
BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2009 International Building Codes
To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection.
Requests received after 7:00 AM will not be scheduled for that day's inspections.
ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries.
The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection
Inspection Item Date Approval Signature Notes
Erosion Control
Footing Drains
Under Floor Framing
Straps(hold downs)
Ext. Shear Wall Nailing cj_ l<
•
Rough-in Plumbing
+0 -Zt
Framing �Z
Blocking
Airseal
Insulation:Walls k ( _ t
Insulation: Floors f
Insulation: Ceiling
Int. Shear Wall Nailing 2?_/I
Wallboard Nailing CO—Z7_I
Gas Line: Interior
Gas Line: Exterior
Propane Tank
Heat/Chimney Clearance
Drywell/Alt Drainage
Address Posted .-1 __ ‘1
FINAL INSPECTION _ki I (1
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
foriiii,el":'.°11
JEFFERS.OUNTY •
DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
szTh�.q G gyp$ www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: L, ! ► ► I t b
Project Description(include separate sheets as necessary):
Tax Parcel Number: (D0aP1a) ('3 Property Size: (acres/square feet)
Site Address and/or Directions to Property:
6Q t Injt04,J0. 17- -. ( a. 43rf Anon, UN . _ 11
Property Owner(s)of Record: t\ y j>a t_ (77✓ S Tdc�a `���w t
Telephone:,Z06-{c,(O "(O(o± Fax: - -cj3;?� email: -{ .cia;-}-vorh;•es ,L,t�w,l
Mailing Address: )'.D-(Z 1 y r'1 t . I". , ,net tytf• 614 '8 6r.1
Applicant/Agent(if different from owner): I ow A Sjyto H i wed / Srt xzil(uo� 2S/ in
Telephone:AN,— 8't2_-5443 Fax: t{Z-S /0 email:
Mailing Address: Po. P10JC j(3dg Al;ri ref e. Ts. W,/4 '8//0 $n'Ylbvtood(oo V iat.cwry
What kind of Permit?(Check each box that applies
iliguilding ❑Critical Areas Stewardship Plan
Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use):}
Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a),C(d),or Cj**
Manufactured Home 0 Modular ❑ Discretionary"D"or Unnamed Use Classification
❑ Commercial• ❑Special Use(Essential Public Facilities)**
❑ Change of Use 0 Boundary Line Adjustment
0 Address ❑ Road Approach 0 Short Plat"
❑Home Business ❑Cottage Industry 0 Binding Site Plan"
❑Propane 0 Long Plat'"
O Sign 0 Planned Rural Residential Development(PRRD)JAmendments•"
❑Allowed'Yes'Use Consistency Analysis 0 Plat Vacation/Alteration"
❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions"
❑Site Plan Approval Advance Determination(SPAAD)" ❑Shoreline Management Substantial Development"
Cl Temporary Use - 0 Shoreline Management Variance
❑Wireless Telecommunication" ❑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 Rob C l(L'V c/ to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE \ � �.' 1�.�" 1��� Y. Date: f20(//
By signing this application fo ,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 require IF er inspections. Sta s access and right of entry will be assumed unless the applicant informs t e County in writing at the
time of the app=�(.1���. he or a ants pri notice. t
Signature: At-is:� Date S-+ ii
ass
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 yo e in.,mpliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-trans ;. sibilir/'.r dhering o and complying with the ESA. The Applicant has read this di�Lola� er nd signs and dates it Mow,
Signature ` / - Date: T ,r 1/
c i.',Prrm;rt:enter\ti##FORMS##u\DRD FORMS\Master Permit Application 5-29-08.doc
• •
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 responsibility of the General Contractor for the proposed project.
Signature: ' Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
5('&Ai-4-..w00 W,t&IJ CO0STP.v -floiJ4, IIJC-. ( ) 5'(2,- ti3 (eta gi-f.E-rL10
MAILING ADDRESS: 1',p, 50 Y, 1 1 3 0,9 r I vIA . -lei )p EMAIL: tb SJ 4 SIN,ai J )o 1 Co.,35Tp'. rl bpl.C4frl
CONTRACTOR'S LICENSE WAINS
NUMBER: J k1AC� 6 <� (o i bA ?. t/4( - NUMBER
ARCHITECT/ENGINEER: c-r'Et..`G i►J ca..J t�4 / c_.Nvc& Htioy/A1 IS 1 PHONE (ZpG.)i 5-41-7 Z FAX:( )
MAILING ADDRESS: i So 4 is jL J l.j #3 o Z. $ 1 t WA 181 a9 EMAIL C In61141.45gCT6t" &i6 /pJ6j ,(icniA
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
O New X Wood Existing: N4 0 Sewer
❑ Addition ❑ Steel Proposed: Bank 0 Community System
❑ Alteration/Remodel 0 Concrete Total: Height: 0 Individual System
X. Repair 0 Masonry SEP Permit#
O Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well 0 Two Party
Ty��Hea • Proposed: 0 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 FoodService? 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 1.Fireplace Insert 1 Hot Water Tank I 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 Foota.e Current Proposed s 1Ce+ 143 €en A is44.. -`. ?W '' .
Heated „ �` EH Bld Review:
Main Floor 4.0 0 / T1, 7. .. App
26'Floor Heated ;f% {�-; Consistency Review:
Other Heated ftt "` _ Base fee: +"
Mezzanine '� r; ,{,ty r Additional Section:
g.
—Heated Basement `r rid, Plan Check fee: r
Unheated Basement ;•t , b' State Surcharge fee: /I S
,.K �� :i
Other Unheated• r ft{' Pot Water Review fee:
ut�
Garage/Carport ' I {` ', i�s SUBTOTAL
y a
Decks " iny,`:'\,; + 911/Rd Approach fee: --_
Other '
f f 0 TOTAL $ 3g ,co
r � . Receipt Number:
`At CashlCheck Number.
t, #... . ., ;3L1-7g 1 ,
rE:1"-MATED COST(REQUIRED) Date:
"1/4-eFairmark t value-of alliabg and : era/s foundation to finish `
000 Initials:
-- G:\Permit-Center\###FORMS###\DRD FORMS\Current DRD Fours\Master Permit Application 5-29-08.doc
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