HomeMy WebLinkAboutBLD2012-00291 •UILDING PERMIT APPLICAN BLD12-00291
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD12-00291 Received Date: 9/25/2012
SITE ADDRESS: 80 RANDOLPH ST
PORT HADLOCK, 98339
OWNER: LUCIANNE PUGH PHONE: 360-621-4642
PO BOX 731
PORT HADLOCK WA 98339-0731
PORT HADLOCK
SUBDIVISION: Block: 5 Lot: 5-6
PARCEL NUMBER: 989400503 Section: 2 Township: 29 N Range: 01 W
CONTRACTOR: NORDIC SERVICES INC PHONE: 206-522-9570
9618 MIDVALE AVE N
SEATTLE WA 98103
Contractor's License NORDISI180QA Expires 1/1/2014
REPRESENTATIVE: NORDIC SERVICES INC PHONE: 360-792-2565
PO BOX 1492
BREMERTON WA 98337
PROJECT DESCRIPTION INTERIOR REPAIR & RE-ROOF FROM FIRE DAMAGE
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP REP MAIN:
VALUATION 43,457.00 ADD'L: HEAT TYPE: EEE
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: 2 Exist: 2
Prop: 0 Prop: 0
Total: 2 Total: 2
Routing Date:
Type Amount Paid Bv: Date: Receipt: Approved/Date
Permit $583.15 LYK 09/25/12 135230 APPROVEE
Plan Check $379.05 LYK 09/25/12 135230
State Building Code $4.50 LYK 09/25/12 135230
Total: $966.70 SEA 25 .j l
Jefferson County Planninc
& Building Department
\f irlcmor4\rInfn\forme\F RI n Ann PIA rnf p/7l,r7(117
Jefferson County Building Dillon Permit Num. BLD12-00291
Applicant: PUGH
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
Rough-in Plumbing
Framing 1l '13- r L �2 /A O F �•��Y/�c `
Airseal
Insulation:Walls
Insulation: Floors
Insulation: Ceiling
Wallboard Nailing
Mechanical Systems
Smoke&CO2
FINAL INSPECTION
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
C/2
I CD
} 13'8' �I l 5'4'
I m t.`
T I 9'10' m \ N
.._..i
t 1
13'6'
n n \ / i -it
55 4..
N
/A 4 5' 8 .,/ 3 10 • 8 9 e-r5' 15 8'
1 44'2' 1
yf Imre
8'10' MIII
!P1!JiI1 .1
I
00
NJ
N
O_
NJ
'17
CO a
aq w
CD
n
J it,
• •
e
CD
to
N C
CD
11'2" . 13'11•
A
m � m
V T
I
44.
g•1
5'11• I `
11
5'7' q
1 2 --
f.
—3• �--. 1 Igo
I q.
1
00
O
N
7y Y
CD
•.
=J
00 n
• •
1
rtiA,,
. NO cb , JEFFERSON SUNTY •DEPARTMENT OF COMMUNITY DEVELOPMENT
''d 621 Sheridan Street• Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
��q�, 0 www.co.jefferson.wa.us/commdevelopment
.011‘10.
Master Permit Application MLA: k_C 11. 1(_l
Project Description(include separate sheets as necessary): c' ^
f n-bil lid ' I( •ft)OC- Pt �z c � V�C[T
Tax Parcel Number:67 p, /1of� (-)'�j Property Si±e: (acres/square feet)
Site Address)nd/or Directions to Property:
Property Owner(s)of Rebord•
Telephone: -(o 2 1- 4 tp t-I-z Fax: email:
Mailing Address:% e X r-r I , I-ZJ( cd (A`)A
Applicant/Agent(if different from owner): gin,e1( ( t.) I C_PS r Li I
Telephone:'I P 17 le -- 2-S L/D Fax: .i P C)'.7d 12 DI 4 q email:f✓Prr,ev-k /vt-Fn
MMailing Address: ;)r //'Z, 6,•(irn e7fi„? i,,,A Gj k i 7 VI bvcir t S e v V i c e i. ( Ole--
What kind of Permit?(Check each box that applies
❑Buildi - El Critical Areas Stewardship Plan
❑ De nr:Permit/7 [i �f El Variance(Minor,Major or Reasonable Economic Use)
❑Sin Emily --'O GBtage a /Detached ❑Conditional Use[C(a),C(d),or CI**
❑ Manufactured Home 0 Modular El Discretionary"D"or Unnamed Use Classification
❑ Coj'nmercial* ❑Special Use(Essential Public Facilities)**
❑ Cha►vge of Use Lu 1L ❑Boundary Line Adjustment
❑ Address 0 Road A a El Short Plat--
❑Home Business f1CQttageltldustry 0 Binding Site Plan**
❑Propane JEFFERSON COUNTY 1 0 Long Plat**
❑Sign "FPT.OF CO.'''' '' '''"'''''r ❑Planned Rural Residential Development(PRRD)Amendments**
❑Allowed"Yes'Use Consistency Analysis ❑Plat Vacation/Alteration**
El Stormwater Management El Shoreline Master Program Exemption/Permit Revisions**
0 Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development**
❑Temporary Use ❑Shoreline Management Variance
El 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 ❑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 , : ..�0, I,0-2.:I to act as my agent in matters relating to this application for permit(s).
',OWNER SIGNATURE_( ' /, 1, I: t 1. Date: ' "
ay 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 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 res.,. bil" for'adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
j.Signature: N Date: '\ )
f .
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-O8.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:
xL.IENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
0( L 5 rv ,cg_s L Nc, (3Ga) 19l- 2SGC (*(i) 9-4-Oit/9
MAILING ADDRESS: \ V. p)dx I l I G, gic',^t. . „ W ik EMAIL:
CONTRACTORS LICENSE 9 ce 3 41. WAINS
NUMBER: Ncg'OS iSI c Ca k NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: r Shoreline: Type of Sewage Disposal:
I New V Wood Existing: ❑ Sewer
-1 Addition ❑ Steel Proposed: Bank ❑ Community System
I Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System
#.' ' Repair C Masonry SEP Permit#
Demolition 0 Other: Bedrooms: Water Supply:
tiisten ,
Existing: Setback: I I Prfy 0 Two Party
Type of Heat Proposed: 'b
Total: ai t
If this is a Commercial Project you must answer the following: II1� r r '% 5 2012
Number of Parking Spaces: Current: Proposed: Number of AbA Parking Spaces: J
Number of occupants(includes owners,tenants,employees,etc) Current I i Proposed _
IBC Occupancy: IBC Type of construction: Will you hale Food Senii1F R
If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: nE COMMUNITY DEVELOPMENT
i Underground Tank i Above ground Tank Size of Propane Tank:
l Heat Stove 1 Cook Stove l Woodstove i Fireplace Insert i Hot Water Tank 1 Pellet Stove l Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes I 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 ,o,, Amount ;Revision
Main Floor Heated EH Bld App Review:
2na Floor Heated — Consistency Review:
Other Heated Base fee: 3J r3
Mezzanine Additional Section:
Heated Basement Plan Check fee: 379. 05
Unheated Basement State Surcharge fee: ._L5D
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL
~
Decks ��` 911/Rd Approach fee:
Other
TOTAL: S C)C C , 0
_ Receipt Number: 13E Z' o
Cash/Check Number:
.2_530
ESTIMATED COST(REQUIRED) Date: g �C _l�
.Fair--- -' --`-"' -- rd Taterials foundation to finish _J�
J 1--) St / Initials:
GAPemvtCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc