HomeMy WebLinkAboutBLD2011-00299 IllU
ILDING PERMIT APPLICA•N B 0299
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Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD11-00299 Received Date: 10/27/2011
SITE ADDRESS: 4900 CENTER RD
CHIMACUM, 98325
OWNER: FLORA C MACE PHONE: 206-545-2838
JOANN KIRKPATRICK JTWROS
4725 37TH AVE NE
SEATTLE WA 981053014
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 801033001 Section: 3 Township: 28 N Range: 01 W
CONTRACTOR: ADVANCED HEATING & COOLING PHONE: (360)415-9335
1211 IVY RD
BREMERTON WA 98310
Contractor's License ADVANHCO22NF Expires 8/21/2013
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr CONVERT UNHTD GARAGE/SHOP #2 TO HTD STORAGE SPACE - NO
PLMB
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP ALT MAIN: 1,344
VALUATION 100,867.00 ADD'L: HEAT TYPE: PRO
CODE EDITION: 2009 HEAT BASE: HEAT TYPE:
OCCUPANCY:
OCCUPANCY: UNHEATED: #OF STORIES:
OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 0 Prop: 0
Total: 0 Total: 0
Routing Date:
(O��1
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $999.35 LYK 10/27/11 128288 p p p R J
Plan Check $649.58 LYK 10/27/11 128288
State Building Code $4.50 LYK 10/27/11 128288 DEC IZ YIA
Total: $1,653.43
Jefferson County Plannint_
&Building Department
Jefferson County Building Dillon Permit Num. BLD11-00299
Applicant: MACE
BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2009 International Building Codes
To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection.
Requests received after 7:00 AM will not be scheduled for that day's inspections.
ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries.
The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection
Inspection Item Date Approval Signature Notes
Mechanical Systems
I"I p l`) /d .0 /7773
ex/. FAvs ie p
FINAL INSPECTION , /L. I
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
44i-•S"N co& JEFFERSON•UNTY •
w • ' \� DEPARTMENT OF COMMUNITY DEVELOPMENT
"' 'N ' 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
,q p'� www.co.jefferson.wa.us/commdevelopment
BINc
Master Permit Application MLA: IJOuq f& ' t\
Project Description(include separate sheets as necessary):
CGvtuZ'7410 Ov,kc..4 Q. 4e VI(.%•f_<<(i. Stu« I t 1 '<...�C,e/ S}cI..jc
Tax Parcel Number: Ve 103 s 601 Property Size: (acres/square feet)
Site Address and/or Directions to P perty:
'moo CaA-k-r a4
Property Owner(s)of Record: "-HO V C.MC.& t -� - ■t K1 r<p tot,
Telephone: 2Q - 9ci9- 71O3 Fax: 2.O0-$IS-c3,2,t a.. email: Mgcp . -ripe C' cirn0,11•(a.1
Mailing Address: 1-1.'72 S- 3744A 1:\E. Sect* . 1A1 I - G21O,47
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
1Building 0 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 C]**
❑ 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❑ pp 0 Short Plat**
❑ Home Business 0 Cottage Industry ❑ Binding Site Plan**
❑ Propane 0 Long Plat**
❑ Sign 0 Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes" Use Consistency Analysis 0 Plat Vacation/Alteration'"
❑ Stormwater Management ❑ 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[UD `t R dment
0 Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shpretif s AA nt
*May require a Pre—Application Conference 0 Tree Vegetation RegUetf —1
**Requires a Pre-Application Conference !I
PI>edbe identify any other local,slate ur fAteial penrrita required fur this'pIO sal, if known: !
,
DESIGNATION OF AGENT `
I hereby designa to act as my agent in matters relating to this aI{ijtlkiation for pe it(s).
l
Ilr i ill`!I I nr'^^ NT
— OWNER SIGNATURE e Z�� Date: �, D.O I 1
By signing this application form,the o ner/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 inspe . . Staff access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the application tha ants prio
Signature: Date: D a 7 02O 8
The a ion 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 'th the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transferable respo adheri 2q, an omplying with the ESA. The Applicant has read this disclai ran gns and dates it bel w.
Signature: Date: r ?, e�0f>
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
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• 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:
ActJ«:«<< 4te,..41 .,, t Cc.,07.1 :=i,.. (36) 'tIS-;635 (3( )yts -�,tre-,l
MAILING ADDRESS: I2 t( 3-1 0)e S .k )03 &e.,..V.e4 rr, 0.4 EMAIL: I v re ( c,(0c,.,,,..V 1'1Je Lc .C
CONTRACTORS LICENSE 'i C-3/0 WAINS
NUMBER: Ab'Jpry H c. 022„OF NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
• New ❑ Wood Existing: G Sewer
❑ Addition ❑ Steel Proposed: Bank ❑ Community System
✓ Alteration/Remodel ❑ Concrete Total: _ Height: ❑ Individual System
❑ Repair ❑ Masonry SEP Permit# _
Ei Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
TyRe of Heat: Proposed: ❑ Public
L-- e-7 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 Tan or Appliance Installation permit,mark all items below that apply:
-- i Underground Tank Above ground Tangy Size of Propane Tank:
t Heat Stove 1 Cook Stove I Woodstove 1 Fireplace Insert I Hot Water Tank I Pellet Stove i Other )'t,+"... t2-LI ►-tt- '
Is this appliance being installed in a Manufactured/Mobile Home? Yes / Nco
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 {A •-{4 (4
06b1 EH Bid App Review: � —— —
id Floor Heated 1� Consistency Review: ��
Other HeaTed Base tee: j�,qq •
Mezzanine Additional Section: ` ____
Heated Basement Plan Check fee: to' I,g 55
Unheated Basement State Surcharge fee: 4,
Other Unheated Pot Water Review fee: looW P n
Garage/Carport SUBTOTAL j�
1 tia3.43
Decks 911/Rd Approach fee:
,t
Other TOTAL: $I (0 • 4(
15
Receipt Number: 'a a o is
��� Cash/Check Number: aal
C
air market value of all labor and materials foundation to finish
. Initials:
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