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HomeMy WebLinkAboutBLD2011-00221 IZILDING PERMIT APPLICATTN Review00221 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD11-00221 Received Date: 8/8/2011 SITE ADDRESS: 160 PIONEER DR PORT LUDLOW, 98365 OWNER: CHASE W GRUSZEWSKI PHONE: 360-865-0634 ALISHA E GRUSZEWSKI 160 PIONEER DR PORT LUDLOW WA 98365-9620 PORT LUDLOW NO. 2 AREA 3 SUBDIVISION: Block: Lot: 116 PARCEL NUMBER: 990603116 Section: 9 Township: 28 N Range: 01 E CONTRACTOR: J L HOMES PHONE: 360-598-3839 20930 SEAPORT PL POULSBO WA 98370 Contractor's License JLHOM**026JA Expires 3/25/2012 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION REPLACE DECK BEAM TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP DEK MAIN: VALUATION 1,500.00 ADD'L: HEAT TYPE: CODE EDITION: 2009 OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: SEW WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 0 Prop: 0 Total: 0 Total: 0 Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $54.00 LYK 08/08/11 1279941 Plan Check $35.10 LYK 08/08/11 1279941 APPROVED State Building Code $4.50 LYK 08/08/11 1279941 Total: $93.60 AUG 15 2011 Jefferson County Planning & Building Department • Jefferson County Building Division Permit Num. BLD11-00221 Applicant: GRUSZEWSKI BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2009 International Building Codes To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection. Requests received after 7:00 AM will not be scheduled for that day's inspections. ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries. The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection Inspection Item Date Approval Signature Notes Framing V..3t/t FINAL INSPECTION to /c, j 016 FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR • • 160 1?IcN E 5_. R NO RTj h-)• ; r i (tST D Ec'.K �. A A 3 4.�2► 1, LA�D t, o W D ► AUG 8 2011 ; J JEFFERSON COUNTY DEPT OE_C IMMUNITY DEVELOPMENT ic:;, ,.soiv c0� JEFFERSONNTY • 1j DEPARTMENT OF COMMUNITY DEVELOPMENT '� ''� 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax kqs 0�p'$ www.co.jefferson.wa.us/commdevelopment bI7N r,----- (Master Permit Application MLA: V11im-) (TY A 3 /N Project Description(include separate sheets as necessary): Pep,'c,.,, roi*' decx beam. Tax Parcel Number: qq 6O3 He Property Size: 11 ,7 53 5'1,1" (acres/square feet) Site Address and/or Directions to Property: /60 PI oN EE 2 DR. Fb,2T LuOLOW wit %3& gEAVEg Macy(i4)6,0 c. 5141M3onlV11-1 e,0 c^1 plo1J EJe, tau56 bn1O Property Owner(s)of Record: C/lf15E 'AG/5M 61214.5 iS Telephone:34,0 a 5-0(o3g Fax: email: Qc°Walla. °)qi 1a'/(_pri i Mailing Address: / PIDPJt E►Z D2 ('Di2T LupLOIV VIA `'6365 �J Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit? (Check each box that applies 0 Lot or Road Segregation I:Building 0 Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) ©Single Family ❑ Garage Attached/Detached ❑Conditional Use[C(a),C(d),or C]** ❑ Manufactured Home .❑ Modular ❑Discretionary"D"or Unnamed Use Classification ❑ Commercial* 0 Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment ❑ Address 0 Road Approach 0 Short Plat** ❑ Home Business ❑ Cottage Industry ❑ Binding Site Plan** ❑ Propane ❑Long Plat** ❑ Sign - 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis ❑ Plat Vacation/Alteration** ❑ Stormwater Management ❑Shoreline Master Progra xem tion/Permit Revisions** ❑ Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management 5 a l t mErl ❑Temporary Use 0 Shoreline Management ail E ❑Wireless Telecommunication* 0 Comprehensive Plan/U I cp se is n ❑ Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shorel 9 -,, aster Program Amendment *May require a Pre—Application Conference ❑Tree Vegetation Reque•ti AUG 8 2011 **R•.uires a Pre-A y.! ation Conference Please identify any other local,state or federal permits required for this prop.- I, gown: JEFFERSON COUNTY DESIGNATION OF AGENT DEPT.Of COMMUNITY Dt:V LdPMEN I hereby designate to act as my agent in matters relating to this application for permit(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 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 applicat9n that he or she wants prior notice. / Signature: �/. f -L Date: 0 / 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 you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transfers fesp nsibilit or adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: Date: O // G:\PermitCenter\###FORMS###\DRD FORMS\Current 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: ./0/1 d Lg/k p ( /oo) 731 .749L1 (1k0)598:3839 MAILING ADDRESS: 2O"/p 3O 5c 1P -r pi. POuL550 WA- EMAIL: Bohr teal e @ome_a s+.net' CONTRACTOR'S LICENSE IJ ��1 18370 WAINS NUMBER: --n—HO'l x02 &J,4 NUMBER -17N PPLI�S630Z4 ARCHITECT/ENGINEER: M1 kE• DULL PHONE (60)275- 5906 FAX:( 6) 275 STDL MAILING ADDRESS: 2z 1 NE IAA/ RD 86L041e,INA 9852j EMAIL mi Kedul(y a' WAvecctble .'c rrr Project Type: ' Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New V Wood Existing: I /2-- B'Sewer ❑ Addition 0 Steel Proposed: O Bank n Community System ❑ Alteration/Remodel C>." Concrete Total: I.S Height: ❑ Individual System lit' Repair 0 Masonry SEP Permit# Water Supply: ❑ Demolition ❑ Other: Bedrooms: PP Y: Existing: I Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: o Public eyEG"T,/c,Wo&. rovE Total: 1 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: i Underground Tank i 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 Use Only Amount Revision _ Main Floor Heated 60L.1.'1I 9 ,f+r i EH Bld App Review: 2nd Floor Heated Consistency Review: LO PI 11-1 _. - - Other Heated Base fee: 5 i (` - Mezzanine Additional Section: ` ' Heated Basement 31 Plan Check fee: 311) Unheated Basement i1 i <� State Surcharge fee: Other Unheated " . 0 — Pot Water Review fee: Garage/Carport SUBTOTAL q 3 LI 0 Decks .-- ') 911/Rd Approach fee: .-- .- "J Other TOTAL: $ 0.3 c0c Receipt Number: I CX l 1 ) I . Cash/Check Number: rt 5 5 ESTIMATED COST(REQUIRED) Date: • air mark value of all labor and materials foundation to finish Initials: / G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc J. I j M 1 n Z ) 4? , DECK 'REA : a r" i m � a D¢ST.J05T5:2a 2 I r O.C.wrtn mu$WATER -•.. MD.ERANE-TW. �' e7� r-, 1 1 ♦ �� 1 li fp I I CI I I rn �, ; rn LJ Z� rn Z I o D D l u 4 -o f, D -o i> CI � W N A N` � to ��r aH CPS N l: tTCI Oo cn - A,t f • m Co-NJ N x -- g rn �n''' `. 6p 6> N D (eaZ11 n>� iw m ^T W . N n 2 W cp Co — rn N rn O U p 4�O rn rn D p= rn K 0 CO 0 aa I-- 0 I oa I N Ir2r rn L_ D Q rn O rn CI D rn -� -,a�o N V a3 QD zo p ?I }- O*+c 6) 0 N � � rn Z �- r Co0CD -nn 6l n x ` 0UT -0rnWO �rn W CO - rn �` - 57,N 0ig G Z • w � m ' "< y iv ,a fY p Fri70 < a) a , t7 4rKriT �C" co_ 0 0iill D O ix) VI VT J 9 CI 'Q ❑ ❑ rn � O `Z O m at y a) Q= [9. j a a 17 2 Ca � ` moos m � � CL)—, n ". n a o . . < < Z0 ^ I II 0z . . QL) .a � 3a� C v c v =r ? 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