HomeMy WebLinkAboutBLD2011-00242 RILDING PERMIT APPLICAT BLD11-00242Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD11-00242 Received Date: 8/30/2011
SITE ADDRESS: 1370 IRONDALE RD
PORT HADLOCK, 98339
OWNER: JAMES P MICHELSON PHONE: 360-385-3910
1370 IRONDALE RD
PORT HADLOCK WA 98339-9529
SOUTH PORT TOWNSEND
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 996400104 Section: 2 Township: 29 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: RANDY MOORE PHONE: 360-461-0142
2524 RYAN DR
PORT ANGELES WA 98362
PROJECT DESCRIPTIOP RE-ROOF
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW
VALUATION 5,200.00 MAIN:
CODE EDITION: 2009 ADD'L: HEAT TYPE:
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: 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 By: Date: Receipt: Approved/Date
Permit $125.25 LYK 08/30/11 128066
Plan Check $81.41 LYK 08/30/11 128066 APPF?Ovpr
State Building Code $4.50 LYK 08/30/11 128066
Total: $211.16 AUK' 5O
Jefferson County
&Building P .
Jefferson County Building Di lion Permit Null":
Applicant:
BUILDING PERMIT INSPECTION APPROVALS applicable Code: 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
FINAL INSPECTION f •
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
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FOR INFORMATIONAL PURPOSES ONLY-
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in this map is limited by the method and accuracy of its collection.Tue Aug 30 13:38:49 2011
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. N coL JEFFERSOFUNTY 410
4 ' 1j DEPARTMENT OF COMMUNITY DEVELOPMENT
.3 ` '4 621 Sheridan Street • Port Townsend • Washington 98368
360/379-4450 • 360/379-4451 Fax
gsp0. www.co.jefferson.wa.us/commdevelopment
HIN
, Master Permit Application MLA: Po Noe-t P ')
Project
tt7Description(include separate sheets as necessary): "
/CeA-fa 1L c�nv) Rt k.c� ex.15T7hq Ae'OF
Tax Parcel Number: ,9 to`7 1 ✓ Property Size: (acres/square feet)
—.Site Address and/or Directions to Property:
�l 1370 I&el. ,.. � . Pryr r ki l i,c(( fs 339
/Property Owner(s)of Record: -„rn,+►�.; P /I r. /- l3o.I I r
E i
r, Telephone: 36,0 3 $,S- 31 /0 Fax: i 1 r gill
v
j Mailing Address: /3-70 I ron/Jc.h IZ,) i
Applicant/Agent(if different from owner): ga..4 xe !, !I.
Telephone: 560-wg;1-o I rI Z Fax: I • email:
Mailing Address: Ltc Ly RyRnl Dr, FOrr A-y eie s 4 c 36, L L-----_.
What kind of Permit? (Checkeachthatapplies 0 Lot or oad r � ON COUNTY
box
ppt9 ntiom
1NI DEVELOPMENT
Building 0 Critical Areas tewar s
❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use)
❑ Single Family 0 Garage Attached/Detached ❑ Conditional Use[C(a), C(d),or CI**
❑ 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 0 Short Plat**
❑ Home Business ❑ Cottage Industry 0 Binding Site Plan**
❑ Propane 0 Long Plat**
0 Sign ❑ Planned kurai Residential Development(PRRD)/Amendments**
❑Allowed"Yes" Use Consistency Analysis 0 Plat Vacation/Alteration**
❑ Stormwater Management El 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 0 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:
I / DESIGNATION OF AGENT
I hereby designate Ai)c) Of ao r c_ /, to act as my agent in matters relating to this application for permit(s).
>CSWNER SIGNATURE C 412 A 277 1 4 YL Date: 3 d D
//��By signing this applijn 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
jrne of the application that he or she wants prior ti .
nature: Q1.)�*- Date: ' 3 Q ,,2 Q 1(
The action or tions 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
d non-transferable responsibility for adheri to nd complyin ith the ESA. The Applicant has read this disclaimer and signs and dates it below.
/`Signature: C Gt,m� p '21'j Date: p .30 6a1 r
Q i
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 as uming the responsibility of the General Contractor for the proposed project.
ignature: e.•,c< Date: _ isf 3O /Lai t
GENERAL CON RACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
C New ❑ Wood Existing: ❑ Sewer
• Addition ❑ Steel Proposed: Bank C Community System
❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System
❑ Repair ❑ Masonry SEP Permit# _
E Demolition C Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ 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: 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 1 Above ground Tank Size of Propane Tank:
i Heat Stove i Cook Stove i Woodstove i 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 Footage [urrent Proposed For Office Use Only Amount Revision
Main Floor Heated EH Bld App Review:
2nd Floor Heated Consistency Review:
Other Heated Base fee:
Mezzanine Additional Section:
Heated Basement Plan Check fee: Li
I
Unheated Basement State Surcharge fee: LI
,
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL 311 .
Decks 911/Rd Approach fee: I
Other TOTAL: $c..) I I I ,
Receipt Number: I a (P
Cash/Check Number: IQ+ f
ESTIMATED COST(REQUIRED) Date: . Q`I
•Fair market value of all�labor and materials foundation to finish
p_ Initials:
SZ 0 O�` t Tex
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc'