HomeMy WebLinkAboutBLD2011-00204 BLD11-00204
RILDING PERMIT APPLICATPN Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD11-00204 Received Date: 7/27/2011
SITE ADDRESS: 21 E BOAT DR
PORT LUDLOW, 98365
OWNER: GERALDINE A SUTHERLAND PHONE: 206-755-8197
42 E BOAT DR
PORT LUDLOW WA 98365-9227
PARADISE BAY ESTATES
SUBDIVISION: Block: 11 Lot: 6
PARCEL NUMBER: 983401104 Section: 22 Township: 28 N Range: 01 E
CONTRACTOR: HOPE ROOFING PHONE: (360)385-5653
PO BOX 1199
PORT TOWNSEND WA 98368
Contractor's License HOPER**043N7 Expires 2/28/2013
REPRESENTATIVE: HOPE ROOFING PHONE: 360-385-5653
ZACK EADES 360-379-8456
PO BOX 1199
PROJECT DESCRIPTIOP RE-ROOF & ROOF PITCH CHANGE - NO ADDED SQ FT
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP ALT MAIN:
VALUATION 17,000.00 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: ,
7 ( i,_
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $279.25 LYK 07/27/11 127952
Plan Check $181.51 LYK 07/27/11 127952 APPROVED
State Building Code $4.50 LYK 07/27/11 127952
Total: $465.26 JUL* 2011
Jefferson County Planning
Building Department
•
Jefferson County Building Division Permit Num. BLD11-00204
Applicant: SUTHERLAND
BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2009 International Building Codes
To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection.
Requests received after 7:00 AM will not be scheduled for that day's inspections.
ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries.
The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection
Inspection Item Date Approval Signature Notes
Framing ,)/,/2_ Pri5 new trusses
Framing /; _-0_/2 PC. roof sheathing nailing
FINAL INSPECTION / 2 //IP
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
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IEFFERSON COUNTY
,___I)7.0T.OF COMMUNITY DEVELOPMENT
:ten‘ON III
JEFFERSOOUNTY
DEPARTMEN F COMMUNITY DEVELOPMENT
621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
ZrIN 6Q www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: 60 Mc Q /
Project Description pnclude separate sheets as necessary);
Tax Parcel j
Number: ! 6) 0// G y Pros Size: ',V OO (acres quare fee
Site Address and/or Directions to Property:
142 'E acet.-E- �r., Por-- Lu.oti u w A- ci 2 1P 5-
-Property Owner(s)of Record: t r-ry Su ilieXiew
(X(D Telephone: 2 . -7S S a "� Fax: email:
Mailing Address: '-42 E. Par+ LuSJ ow IA.4%. 9(2)3(oS
Applicant/Agent(if different from owner): 1-Fp . I, T" ar-1 o NJ Telephone: yFaxl V email:
Mailing Address: I
What kind of Permit?(Check each box that applie$ \
❑Buildin
9 I'1 I 0 Variance(Mi , Major or Reasonable Economic Use)
❑ Demolition Permit L, 0 Conditional U (a), C(d),or C]**
❑ Single Family 0 Garage Attached/DetacheciEFFE nary D"or Unnamed Use Classification
❑ Manufactured Home 0 Modular ssen.ial Public Facilities)**
❑ Commercial* DE.T.OF coM I tment
❑ Change of Use ❑Short Plat**
O Address 0 Road Approach 0 Binding Site Plan**
❑ Home Business 0 Cottagelndustry 0 Long Plat**
❑ Propane 0 Planned Rural Residential Development(PRRD)/Amendments**
❑ Sign 0 Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions'"
❑ Stormwater Management 0 Shoreline Management Substantial Development**
0 Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Variance
❑Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment
0 Wireless Telecommunication* 0 Jefferson County Shoreline Master Program Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium 0 Tree Vegetation Request
*May require a Pre—Application Conference **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 le.44n c /d to act as my agent in matters relating to this applicationp for permit(s).
OWNER SIGNATURE (//J�Z !+�5�2 �Z�'G� Date: 7--/ it-
By 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 3 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 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 he or she wants prior notice.
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 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 responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: Date:
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc
• BUILDER STATEMENT
The signer of this statement does hereby certify that they are the Owners of the par need herein,that they are not licensed contractors and that
they will be assuming the responsibility of the General Contractor for the pr project.
Signature: Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
HOW Rr ftlit, c CoNstlQctc-ri of i I- _J (� —3s5-5vS3 Glom 3 . 8 s0
MAILING ADDRESS: �� � +�.whsend EMAIL: 111r-19 rt
CONTRACTOR'S LICENSE WAINS
NUMBER: NOPER44 6143 N} NUMBER
ARCHITECT/ENGINEER: NA PHONE ( ) FAx:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New 0 Wood Existing: ❑ Sewer
❑ Addition 0 Steel Proposed: Bank 0 Community System
❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System
❑ Repair 0 Masonry SEP Permit#
❑ Demolition 0 Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well 0 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: Pro Number of ADA Parking Spaces:
Number of occupants(includes owners,tenants,empl s,etc) Current Proposed
IBC Occupancy: IBC Type of co ction: Will you have Food Service? Yes / No
If this is a Propane Tank and/or Appliance nstallation permit,mark all items below that apply:
1 Underground Tc.nk I Above ground Tank Size of Propane lank:
I Heat Stove 1 Cuok Stove I 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. yy
a 1 rb T �"d9, !"�- PAS t ka�itier .r, 0.11K a.11ii: .4:0 .'� 15� "!` ir`4'hi'�.C-�.na'S• "�;; �..,
S•uare Foota•e Current Pro•osed ®t4 of u 1 . 1,60, ..01.82T i , :;, "• 0,`Ilii A, a tp �lsj 4 # ,eV
Main Floor Heated ,, EH Bld App Review.
2"0 Floor Heated ,;,a," i' F+ Consistency Review:
Other Heated 1 - ". - Base fee:
Mezzanine ;t`, ' ' Additional Section:Ap
11 +2,t iitAt •
Heated Basement 4,. .,- , } ..F` Plan Check fee: -
Unheated Basement .A.ty .,1:f;l State Surcharge fee: ? '
Age
Other Unheated 4 s o"h'. Pot Water Review fee:
Y
Garage/Carport ,e f ? SUBTOTAL
Decks t ;1F1 sth., 911/Rd Approach fee:
Other ,O ' �TOTAL: $ (05 2L
iPi i Receipt Number: 1 r9—it-3
,-J
.,v, `•s ' Cash/Check Number: ,� , ,
• ESTIMATED COST(REQUIRED) Date: r7, —1
•Fair market value o lab and materials foundation to finish , I
�j f 0( 0 Initials: ----2-
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc