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Home My WebLink AboutBLD2011-00212 - RE ROOF UILDING PERMIT APPLICAT!N BLD11-00212 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD11-00212 Received Date: 8/2/2011 SITE ADDRESS: 1891 S JACOB MILLER RD PORT TOWNSEND, 98368 OWNER: MADELEINE C HOUSTON PHONE: 360-385-1489 PO BOX 751 PORT TOWNSEND WA 98368-0751 IRVING PARK ADDITION SUBDIVISION: Block: 13 Lot: 1-10 PARCEL NUMBER: 963301301 Section: 16 Township: 30 N Range: 01 W CONTRACTOR: INTERLOCK INDUSTRIES INC PHONE: 425-438-8585 1420 80TH ST SW SUITE E EVERETT WA 98203 Contractor's License INTERII020LC Expires 2/6/2013 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI RE-ROOF SFR TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 44,140.00 ADD'L: HEAT TYPE: CODE EDITION: 2009 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total:_._._. Routing Date: <' 8 z[ 1 Type Amount Paid By: Date: Receipt: Approved/Date Permit $593.25 LYK 08/02/11 127969 APPf \j Plan Check $385.61 LYK 08/02/11 127969 State Building Code $4.50 LYK 08/02/11 127969 AL'S 3 21111 Total: $983.36 Jefferson County Planning &Building Department S . i' CsN JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 1 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax �'° (' www.co.jefferson.wa.us/commdevelopment vl, r Master Permit Application MLA: IN- ) MLA e€ Project Description(include separate sheets as necessary): HD M E Tear off existing Comp/Cedar roofing,replace all plywood&Reroof to New Interlock Aluminum Shingles in our Slate design Tax Parcel �� Property Number: q(0,5--L ) I Size: (acres/square feet) Site Address and/or Directions to Property: 1891 South Jacob Miller Road, Port Townsend, WA 98368 Property Owner(s)of Record: Madeleine Houston&Daniel Hauptman Telephone:360-385-1489&/or 503-507-3571 Fax: email: Mailing Address: P.O.Box 751,Port Townsend,WA 98368 Applicant/Agent(if different from owner): Interlock Industries,Inc. Telephone:425-438-8585 Fax: 425-438-8577 email: RBLAOK@ALROOF.COM Mailing Address: 1420 80th Street SW Suite E,Everett,WA 98203 Whit t kind of Permit?(Check each box that applies uilding ❑Variance(Minor, Major or Reasonable Economic Use) Demolition Permit ❑Conditional Use[C(a),C(d), or C]** ❑Single Family ❑Garage Attached/Detached ❑Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home ❑ Modular ❑Special Use(Essential Public Facilities)** ❑ Commercial* ❑ Boundary Line Adjustment ❑ Change of Use ❑Short Plat** ❑ Address ❑Road Approach ❑Binding Site Plan** ❑ Home Business ❑Cottagelndustry ❑Long Plat** ❑ Propane ❑Planned Rural Residential Development(PRRD)/Amendments** ❑Sign ❑Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisions** ❑Stormwater Management ❑Shoreline Management Substantial Development** ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Variance ❑Temporary Use ❑Comprehensive Plan/U I -•• - - • as• ,•• e t ❑Wireless Telecommunication* ❑Jefferson County S n a�tvfe is t ❑ Forest Practices Act/Release of Six-Year Moratorium ❑Tree Vegetaion Re,i V *May require a Pre—Application Conference **Re•uires a P -`' •. ibation Conference Please identify any other local,state or federal permits required for this pr• •o, �l, if known: 2 2011 I DESIG'A 'N OF 'GENT ! Ii U hereby designate Interlock Industries,Inc. to • as t agent in mattes relat •• - -'- - •-•••2=i or permit(s). JEFFE'•�( �r v, OWNER SIGNATURE A I i- -%.I:. ." _,tip A.1'14 �b.! .�.y .. ate: D . '+ !I' M'll a), DEVELOPMENT By signing this application form,the owner•gent attests that the information pr. •.d herein,and in any attachment,is true and correct to the best of his,her or it's knowledge. Any material falsehood or any omission of a material - ade 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 Jeffers.• Coun and its employees,representatives or agents for the sole purpose of application review and any required later inspections. St="'s access a d right.f:ntry will be assumed unless the applicant informs the County in writing at the time of the appli ion a i e or sh- ants , for • 'ce. n Signature: t i-.�l_!_ f,l(�i. .•fat. ` '_ `,>( 4_.,t Date: oL 2.011 The action or actions Applicant will u dertake as a result of the issuance of thi- •e it may negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered specs= s 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 r agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in compliance with the Jefferson Cou de I ment c•.l-.The Applicant acknowledges that he,she or it holds individual and non-trans'e able re o sibility f r adh ring nd complyi g it th ESA. I e Applicant has read this discla' er and signs and dates it below. Signature: a \ �� L li to-- Date: �� C:\Documents and Settings\caral\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.doc • • BUILDER STATEMENT The signer of this statement does hereby certify that t -y,r-th. • ners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility of - enera Co ,eta t r the proposed proje . Signature: it A . I.1 If. '�.r A.IT t c:.. .J._ _ _I ��',__ ,mate: GENERAL CONTRACTOR OR MAVUFACTURED HOME INSTALLEI PHONE: FM: Interlock Industries,Inc. ii ( 425)438-8585 (425 )438-y5-11 MAILING ADDRESS: ft�••Both Si 3ytr ,�+, e l IN1E q8 3 EMAIL: ° le eAL Roo F. Co�y1 CONTRACTOR'S LICENSE WAINS �t NUMBER: UBI:601 828 920 NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAx:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System 4/ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: ❑ Public Total: Name of System: If this is a Commercial Proiect you must answer the following: Number of Parking Spaces: Current: Proposed: Number of occupants(includes owners,tenants,employees,etc) Current ,■, t-' . e• IBC Occupancy: IBC Type of construction: RR ave Food Service? Yes / o If this is a Pro•ane Tank and/or A. •Hance Installation •ermit mark all items . hat . ! '0, : 2 2011 in Underground Tank °Above ground Tank Size of Propane Ta I 1 ❑Heat Stove ❑Cook Stove ❑Woodstove ❑ Fireplace Insert ❑Hot Water Tan ';jC pellet Stove ❑Other, Is this appliance being installed in a Manufactured/Mobile Home? Yes / No JEFFERSON COUNTY When applying for a permit to install a propane tank you must also submit a 'e plan sh r, 1, .,∎I. ',- •1.>j_ T. , . property lines,tank location and size,distances from the propane tank to all property I - , •rI •rags and septic system components, including the reserve area. Square Footage Current Proposed For Office Useb ..".,. nly . ', ,;' Amount a Revision Main Floor Heated y EH Bld App Review: 2 n a Floor Heated - Consistency Review: Other Heated . Base fee: 1--5C)3 9j Mezzanine Additional Section: Heated Basement Plan Check fee: 3a3. u 1 Unheated Basement , State Surcharge fee: Other Unheated ' '" ; Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: sC Receipt Number: !7-C _t�' Cash/Check Number: i 24�� 1 , ESTIMATED COST(REQUIRED) Date: ��'� .Fair market value of 1l labor and materials foundation to finish yy of Initials: C:\Documents and Settings\caral\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.doc Jefferson County Building Division Permit Num . BLD11-00212 Applicant: HOUSTON BUILDING PERMIT INSPECTION APPROVALS kpplicable 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 Insulation:Ceiling FINAL INSPECTION 7_ D- /Z gip FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR