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Home My WebLink AboutBLD2008-00372 i IbILDING PERMIT APPLICA N RLevDOew-00372 : I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD08-00372 Received Date: 8/14/2008 SITE ADDRESS: 21 KELLY RD BRINNON, 98320 OWNER: ROWLAND C DENNIS PHONE: 360-554-8054 KATHRYN M DENNIS PO BOX 829 BRINNON WA 983200829 OLYMPIC CANAL ADDITION 4 SUBDIVISION: Block: Lot: PARCEL NUMBER: 981002302 Section: 16 Township: 25 N Range: 02 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP ROOF REPAIR AND ADD BEAM-NO MLA REQ'D TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP REP MAIN: 1,050 VALUATION 2,500.00 ADD'L: HEAT TYPE: CODE EDITION: 2006 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: r Z A I L Type Amount Paid By: Date: Receipt: rd/Date APF5R '/EED Permit $83.25 AMS 08/14/08 100778 Plan Check $54.11 AMS 08/14/08 100778 State Building Code $4.50 AMS 08/14/08 100778 AUG i O 2008 Total: $141.86 Jefferson County Planning &Building Department • Jefferson County Building Division Permit Num, BLD08-00372 Applicant: DENNIS BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2006 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 Noted 1 ` Framing ��/7 po t«.Q . �� „ tti:s.; Insulation: Ceiling c `�'2 7- 'G SLR -e CPt C/la ) 7/'V I354— FINAL INSPECTION -11.7.,q 1N FINAL INSPECTION/MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR .. R�� ( ,,F',it `' 1 i ,�gON C, ,- 4� OG JEFFERSC.OUNTY 1111 k �L, j DEPARTMENT OF COMMUNITY DEVELOPMENT AUG 1 2Q49 cr.) - "< 621 Sheridan Street • Port Townsend • Washington 98368 U & i'.`� > • • 360/379-4450 • 360/379-4451 Fax [[ ppp COUNTY n n s, ,,p www.co.jefferson.wa.us/commdevelopment JEFfEf1JQN t,llUt�11 PH �`II N �� y' e c�( 0( MLA: n - Master Permit Application � t Project Description(include separate sheets as necessary): f2EC".l= asvul!e PI Property Tax Number: 9r,' OO�—,3O -- Size: -.��/4C � (acres/square feet) Site Address and/or Directions to Property: l I4..e-I. • P-D -1nnc - upPr 4�3.5-e� Property Owner(s)of Record: l.JldM '- 441:V-Ili e3 D 'v s Telephone: c. (y '4,5� ` in'S `t Fax: - - email: ai Mailing Address: Po t )c; f3 -9 -544ftns+-..-- wis 14'3 ` - Sk , Cc46"—. Applicant/Agent(if different from owner): el is Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies 14Building ❑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** 0 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/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium 0 Tree Vegetaion Request *May require a Pre-Application Conference **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 P)A 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 it's 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 applic tion th t he or she wants pri n tice. p 12 Signature: /l�� Date: O /c d The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon ne 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- ansf=rable esponsibility for ering to and complying with the ESA. The Applicant has read this disclai er an igns and dates it below. Signature. ' / �. Date: .6 1C a C:\Documents and Settings\carat\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.doc i • BUILDER STATEMENT 4110 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 Ge I Contractor for the proposed project. Signature: , ( Date: /$4" ipi GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE I 1 WAINS NUMBER: 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 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 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: ❑Underground Tank []Above ground Tank Size of Propane Tank: ❑Heat Stove 0 Cook Stove 0 Woodstove ❑ Fireplace Insert 0 Hot Water Tank 0 Pellet Stove 0 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 /ds?) EH Bld App Review: 2na Floor Heated Consistency Review: \ Other Heated Base fee: .NCj Mezzanine Additional Section: \ Heated Basement Plan Check fee: 511- ' I 1 Unheated Basement ,� State Surcharge fee: 9 Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL t , ( , Decks 911/Rd Approach fee: e � ,t t Other TOTAL: $ (H 1 , Receipt Number: 1 on--)- ] v� Cash/Check Number: 3 y l- ESTIMATED COST(REQUIRED) Date: G )c--)Fi.Fair market value of all labor and materials foundation to finish O11 IL. S-Z c-C) Initials: lir C:\Documents and Settings\caral\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.doc Map Output • • Page 1 of 1 Site Plan Map __ _.. 502163005 }, 502tel008 : zoia,2 \'\\---' — s 98100220, `�.. Legend 4' 981002301 0 Selected Features `.. JC Roads �, �,�,> 7C I \v Parcels H 1 d :,, � I �,v 4h4 Boundaries ' 49 C6� ..kA4sso,carry. Wars )' i i� ..r.;_k.. 1 �� 9111002305 MICr.2 i�6 i I 981.002203Y.. 981002303 • :, , ''.,,,\ UIJ.0 i2n v. ...,_'/ tr 14 98100230 7 Yl 48'CO22O5 \' ,r 481002206 1 YYYI'1 ti!�1Y.'f C.iSC'if.]?l'.:.L-R � 9:810023 s :� f:�:ij yey^tiX1Z207 v =s"r®Ym,ii l FOR INFORMATIONAL PURPOSES ONLY- Jefferson County does not attest to the accuracy of the data contained herein and ma_ kes no warranty with respect to its correctness or validity. Data contained in this map is limited by the method and accuracy of its collection. Thu Aug 14 14:38:43 2008 1,,(point p -4- --,Rct,,x_..,.at.)U. "- c-fiv-kt'_s c k l (Z-b /Po 8 5 ---bpnncn, C 9 r 3 -c 1 (1)Nt-C.e.(2_ ' I ( C_Dc). -3 e. I11,' ECEWED AUG 1 4 2008 JEffERSON COUNTY DCD http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientVersion=4.... 8/14/2008