HomeMy WebLinkAboutBLD2012-00304 IUILDING PERMIT APPLICA N B
Review
0304
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD12-00304 Received Date: 10/2/2012
SITE ADDRESS: 31 CENTER RD
CHIMACUM, 98325
OWNER: LOREN S TURNER PHONE:
5229 S ORCHARD TER
SEATTLE WA 98118-4232
CLARK'S 1ST TO CHIMACUM
SUBDIVISION: Block: 1 Lot: 7-8
PARCEL NUMBER: 943800105 Section: 14 Township: 29 N Range: 01 W
CONTRACTOR: TERSULI CONSTRUCTION SERVICES LLC PHONE: 206-853-8547
1416 NW 46TH ST SUITTE 105 PMB
#338
SEATTLE WA 98107
Contractor's License TERSUCS891DW Expires 3/16/2013
REPRESENTATIVE: JEFF GILLAND SE PHONE: 425-238-9137
608 STATE ST STE100-D
KIRKLAND WA 98033
PROJECT DESCRIPTIOr STRUCTURAL REPAIR TO DECK & PORCH FROM VEHICLE DAMAGE
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP REP
VALUATION 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: 0 Exist: 0
Prop: 0 Prop: 0
Total: 0 Total:_ - -0
Routing Date:
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $321.25 LYK 10/02/12 135259 s\ID P R('vy V E
Plan Check $208.81 LYK 10/02/12 135259
State Building Code $4.50 LYK 10/02/12 135259 MI 2 2012
Total: $534.56 Jefferson County Planning
& Building Department
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Jefferson County Building Division Permit Num BLD12-00304
Applicant: TURNER
BUILDING PERMIT INSPECTION APPROVALS Applicable Code: 2009 International Building Codes
To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection.
Requests received after 7:00 AM will not be scheduled for that day's inspections.
ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries.
The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection
Inspection Item Date Approval Signature Notes
Setbacks L--I;` IS
Foundation Footing + ,
Framing „ � �r�
FINAL INSPECTION l -( 7
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
,�w7N coo, JEFFERSON•UNTY
W r� DEPARTMENT OF COMMUNITY DEVELOPMENT
h ` '4 621 Sheridan Street • Port Townsend • A/ashington 98368
360/379-4450 • 360/379-445 f l V �1
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v.co.jefferson.wa.us/commde Eor.T.
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Master Permit Application I it ,,,;, - _',;2 M4 • I<Ob
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Project Description(include separate sheets as necessary):Li Li
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DEPT.OF CMPF-E MTY DE .L0 6F pack vv. r c� �
Tax Parcel Number: 91.1S j ?)0
��T�. ,Q,�/iQ�pkZ�Y (acres/square feet)
Site Address and/or Directions to Property: I
3( r. c1ae.. 1?Q/ e r�► _. ,s 3z5--
Property Owner(s)of Record: �DI.M.I `G
Telephone: Fax: email:
Mailing Address: 5ZD3 5 c J 1J ? 7-E12., jrL e 4t� �gl i$ ,
Applicant/Agent(if different from owner): .1T &ILL4.A,.jb,SE
Telephone: Lea-- ---2,3f,—,(3' Fax: email: t4 s'�ljuc., 'cw1
Mailing Address: �47� �i'C ST 5 ATE /Car9-c J4,C�C( �1(�,I99476133
Wha kind of Permit? (Check each box that applies 0 Lot or Road Segregation
uildin9 0 Critical Areas Stewardship Plan
Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use)
Single Family- ..04 -D 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_ 0 Short Plat**
o Home Business ❑Cottage Industry 0 Binding Site Plan**
❑ Propane ❑ Long Plat**
u^ Ciyn 0 Planned kurai 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/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 0 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 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 rovide accea
Al . right of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application
review and any r uired I. 'ens. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the appli do `I •- s prior notice.
Signature: i..r_ Date:-__ 2�It,
The act' t �� j" nt will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or
endangered s•'"1's -nd ould 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 bee• 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 J you are in comprance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-trans' ra•l: respo -i..-ity or -dhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: i�1%/II 11 Date: vow!:•\A......:•r' itttFrlR\.f/tiff\7lp Tl F(lR\,4C\!'.,..P.,,TIR TI F.....,.\\if,.�ro.Re._.,:. d,...1:,-,,,:,..,C')O r14,7,.,-
• 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:
MAILING ADDRESS: py`(p gy(GJ Sr/ !O * 3 8 EMAIL:
CONTRACTOR'S LICENSE r fail WAr 9&id4 WAINS
NUMBER: !1G"$LIC'S ell 'D Vi NUMBER
ARCHITECT/ENGINEER: aK 5tv,,e,rogoic, w t,i,„;yit,(,,c, PHONE (Liarz , FAX:( )
9T
MAILING ADDRESS: 5rr C ica,.�/� �, EMAIL it � C,tho� t
Project Type: Frame Type: Bathrooms: 3 �J Shorell e: Type of Sewage Disposal:
L, New Wood Existing: E Sewer
Li Addition ❑ Steel Proposed: 0 Bank ❑ Community System
Total: Height: ❑ Individual System
Iteration/Remodel `Concrete — —
Repair--0E4kIr 0 Masonry SEP Permit#
D Demolition 4 , ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type of.Heat:, Proposed: 0 ❑ 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 i Above ground Tank Size of Propane Tank:
I Heat Stove I Cook Stove 1 Woodstove i Fireplace Insert i Hot Water Tank i Pellet Stove i 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 EH BId App Review: --_
2nd Floor Heated Consistency Review: —_____
Other Heated Base fee: , 95
Mezzanine Additional Section: �( .
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee: /
•
Other Unheated• Pot Water Review fee:
Garage/Carport SUBTOTAL
Decks 911/Rd Approach fee:
Other (FE-14411t) TOTAL: $`5, L- ,Stp
Receipt Number: 15D251
Cash/Check Number: I Lo 43
ESTIMATED COST(REQUIRED) Date: t � --
.Fair market value of all labor and materials foundation to finish i
itei�990 Initials:
GAPermitCenter\###FORMS###\DRD FORMS\Current DAD Forms\Master Permit Application 5-29-08.doc