HomeMy WebLinkAboutBLD2014-00182 BUILDING PERMIT APPLICION BRLD1e4 001p82
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD14-001.82 Received Date: 5/21/2014
SITE ADDRESS: 6350 CAPE GEORGE RD
PORT TOWNSEND, 98368
OWNER: DAVID A PARISSE PHONE: 415-215-5998
LUCIE DUCLOS
6350 CAPE GEORGE ROAD
PORT TOWNSEND WA 98368
SUBDIVISION: Block: Lot: TX 8
PARCEL NUMBER: 001302013 Section: 30 Township: 30 N Range: 01 W
CONTRACTOR: PHONE:
PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPT1014 REPLACEMENT OF WOODSTOVE IN EXISTING OUT BUILDING
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP MEC MAIN:
VALUATION ADD'L: HEAT TYPE: WOD
CODE EDITION: 2012 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:
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $152.00 MEB 05/21/14 148650
Total: $152.00
APPROVED
MAY 21 2014
. elierson County DCD
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(."-, JEFFERSON COUNTY`.- • DEPARTMENT OF COMMUN DEVELOPMENT
4A
,, 621 Sheridan Street(Port Townsend,WA 98368 I Web:www.co .son.wa.us/eommunitydevelooment
Tel:360.379.4450(Fax:360.379.4451 I Email:dcdt co.iefferson.wa.us
Building Permits&inspections I Development Consistency Review I Long Range Planning I Watershed Stewardship Resource Center
Master Permit Application MLA:
Project Description(include separate sheets as necessary):
R91 4(( snob; 1" Q td1-11,r1 t`01 NI
Tax ParcelNumbert'Yf. Iii% Ate60130Z013 Property Size: ti S cre square feet)
Site Address and/or Directions to Property:
(r7 So GRPC" C,Eo46E r2b , eb-r1-'T i„,h,s _.1 yjA. 9$3(91
Property Owner(e)of Record: D ftvt D /t. (At m\SSt, 1.-t) -i E tbi.X.Lo S 1
Telephone: 4($ 21.r-57 fl' Lail Fax: email: dear.5'S.e SLCy/oI1.Aid-
Mailing Address: L3 Sa Litre- 6E-o( : 1 b i• Po4r "ro 3 , j..)4- ' g'9(eg
Applicant/Agent(if different from owner): ^—
C/ Telephone: Fax email:
]��,1 Mailing Address:
OD What kind of Permit?(Check each box that applies ❑Lot or Road Segregation
❑Building ❑Critical Areas Stewardship Plan
Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use)
8 ❑Single Family
❑ Manufactured Home
❑Garage Attached/Detached ❑Conditional Use[C(a),C(d),or C]""
0
0 Discretionary"D or Unnamed Use Classification
❑ Commercial" ❑Special Use(Essential Public Facilities)**
❑ Change of Use 0 Boundary Line Adjustment
❑ Address ❑Road Approach ❑Short Plat""
Q Home Business 0 Cottage Industry ❑Binding Site Plan""
----y ❑Propane ❑Long Plat"'
.J ❑Sign ❑Planned Rural Residential Development(PRRD)/Amendments""
," ❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration""
0 Stormwater Management
0 Shoreline Master Program Exemption/Permit Revisions""
❑Site Plan Approval Advance Determination(SPAAD)• ❑Shoreline Management Substantial Development""
0 Temporary Use ❑Shoreline Management Variance
❑Wireless Telecommunication ❑Comprehensive PIaMUDC/Land Use District Map Amendment
.
0 Forest Practices Ad/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
1 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 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 th he or wants/ notice.
Signature: Date: ,1t /
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. My individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)even if you are' compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds Individual
and non-transferable r i forr using to and complying with the ESA. The Applicant has read this disclaimer and signs and dates It below.
Signature: ✓-_• Date: Mil I T 21,/c/
/ 07/24/2013
1T
BUILDER STATEMENT
The signer of this statement d reby certify that they are the Owners of the parcel referenced herein ey are not licensed contractors and that
they will be assuming a of ear,eral Contactor for the proposed project. 3/
Signature: 1 Date: sliTizoi l
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE( ) FAX( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: -Type of Sewage Disposal:
New , Existing: gi Sewer
Addition tee Proposed: Bank Community System
Alteration/Remodel Concrete Total: , Height: Individual System
Repair Masonry SEP Permit#
Demolition Other. Bedrooms: Water Supply:
Existing: 16' Setback: Private well Two Party
Type of Heat: / Proposed: Public
Once t)'ffD J L Total: _04..._ Name of System:
If this is a Commercial Project you must answer the foilowif a;
Number of Parking Spaces: Current: , Number of 8Q9 Parking Spaces:
Number of occupants(includes owners,tenants,eployees,etc) Current Proposed
IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes I No
if this is a Protmne Tank and/or Annliance installation permit mark all items below that aDOly:
Underground Tank Above nd tank Size of Propane Tank:
Heat Stove Cook Stove oodstove Fireplace.nsert rent° 1 evotS telleP I knaT retaW toH 1
Is this accidence being installed in a Manufactured/Mobile Home? Yes /Co
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 Bld App Review
2"0 Floor Heated Consistency Review:
Other Heated Base fee: 152-4)
Mezzanine Additional Section: 1q . CC)
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 TOTAL: $
Receipt Number: 1 Li(atio 7._f
CashlCheck Number:
ESTIMATED COST(REQUIRED) Date: ,) 0
•Fair market value of all labor and materials foundation to finish
Initials: .
_1)7/24/2113
I
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91344
JEFFERSON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street I Port Townsend,WA 98368 l Web:www.co.iefferson,wa.usicommttnitydevelooment
NO Tel:360.379.4450 I Fax:360.379.4451 I Email:dcd&o.iefferson,waus
Building Permits&Inspections I Development Consistency Review I Long Range Planning I Watershed Stewardship Resource Center
Master Permit Application MLA:
Project Description(include separate sheets as necessary):
P--9-fL4C.S. CA ' I^.1 0 Li1-11,0 L 01 4‘
Tax Parcel Number:N() h % meoolsozola Properly Size: "" square feet)
Site Address and/or Directions to Property:
6;35-0 cAfse-- GE04 .6.6 ga) i 106* 7744...ist...,0 kjA. 9noi
J .
Property Owner(*)of Record: prom b A. P Prrt‘SSC', Li-k-1 F bi.,CLD 4
Telephone: Lits 2Jr57 9 SI Let i Fax: email: dear;S'SC.Q51,C,44114.Aie
Mailing Address: L3 5 e (ACE- 6E06 e- 'Kb i. P01-1— "I'Dvatl„,TEP4D4 tvl 4.. I le -„Elf
Applicant/Agent(If different from owner): --
Telephone: Fax email:
Matting Address:
What kind of Permit?(Check each box that applies 0 Lot or Road Segregation
EIBuilding 0 Critical Areas Stewardship Plan
O Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use)
0 Single Family 0 Garage Attached!Detached 0 Conditional Use[C(a),C(d),or C]**
O Manufactured Home 0 Modular 0 Discretionary V'or Unnamed Use Classification
0 Commercial* 0 Special Use(Essential Public Facilities)**
O Change of Use 0 Boundary Line Adjustment
O Address 0 Road Approach 0 Short Plat**
0 Home Business 0 Cottage Industry 0 Binding Site Plan**
0 Propane 0 Long Plat**
0 Sign 0 Planned Rural Residential Development(PRRD)/Amendments**
0 Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration'"'
0 Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions**
0 Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development**
0 Temporary Use 0 Shoreline Management Variance
0 Wireless Telecommunication" ' 0 Comprehensive PIarVUDC/Land Use District Map Amendment
0 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
""Fleauffes a Pre-APPlication Conference
Please Identify any other local,state or federal permits required for this proposal,if known:
....0-
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 tees and
expenses which may in any way MMUS 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 tit he or a wants notice.
Signature: Date: alg1__j0/
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 spades 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 rePonsibJjlly forpring to and complying with the ESA. The Applicant has read this disclaimer and signs end dates It below.
Signature: CI .47-----..... 4 Date: Ago, IT, zoi 4/
07/24/2013
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 res of e�neral-Ccntractor for the proposed project. kf
Signature: (A A„,...4161-(;) Date: C/7%b!
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
( ) ( )
MAILING ADDRESS: EMAIL
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE( ) FAX( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
New CL10., Existing: 41— Sewer
Addition .tee Proposed: Bank Community System
Alteration/Remodel Concrete Total: Ig Height: Individual System
Repair Masonry SEP Permit#
Demolition Other. Bedrooms: Water Supply:
Existing: lirl Setback: Private well Two Party
Type of Heat: / Proposed: Public
1.xiaJ>rYl b t!iii Total: -- Name of System:
If this is a CommerclslProlect you must answer the following;
Number of Parking Spaces: Current: Prod: Number of WA 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
jf this is a Propane Tank and/or Aooilance Installation permit.mark all Items below that,aooly;
Underground Tank Above a • nd tank Size of Propane Tank:
Heat Stove Cook Stove r ood .+ve Fireplace.nsert rehtO I evotS telleP 1 knaT retaWtoH 1
Is this aopllance belna Installed In a Manufactured/Mobile Home? Yes /E)
When applying fore permit to install a propane tank you must also submit a site plan showing all of the buildings,all property
lines,tank location and sire,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
2n0 Floor Heated Consistency Review:
Other Heated Base fee:
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 TOTAL: $
Receipt Number:
Cash/Check Number:
ESTIMATED COST(REQUIRED) Date:
.Fair market value of all labor and materials foundation to finish
Initials:
07/24/2013
cOety.rritiL
ISper) 5ra t
60 CS licou-
rivkt‘BoiC
X SO CA PC-
6-One.GE
_CNre CIF:COE fkatt:. KIS
/ibt 7340(1
•
Jefferson County Building Division Permit Number:
Applicant:
BUILDING PERMIT INSPECTION APPROVALS Applicable Code: International Building Codes
To schedule inspections, call (360)379-4455 no later than 3:00PM the day before the inspection is needed.
Requests received after 3:00 PM will not be scheduled for the next 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
A final inspection will not be scheduled until all of the
following are completed and signed off by the applicable
Department:
• Building Permit Conditions are met
• Septic Permit Final/Complete for any building
containing plumbing
• Land Use Conditions met and signed off
• Public Works Permit Final(where applicable)
FINAL INSPECTION 1
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
• •
CONDITIONS for Building Permit# :
\\tidemark\data\forms\F_BLD_Permit_BIdg.rpt 5/21/2014
• BUILDING PERMIT •
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT#: BLD14-00182 Received Date: 5/21/2014
SITE ADDRESS: 6350 CAPE GEORGE RD Issue Date 5/21/2014
PORT TOWNSEND, 98368 Expiration Date 5/21/2015
OWNER: DAVID A PARISSE PHONE: 415-215-5998
LUCIE DUCLOS,.
6350 CAPE GEORGE ROAD
PORT TOWNSEND WA 98368
SUBDIVISION: Block: Lot: TX 8
PARCEL NUMBER: 001302013 Section: 30 Township: 30 N Range: 01 W
CONTRACTOR: PHONE:
PHONE:
PROJECT DESCRIPTION: REPLACEMENT OF WOODSTOVE IN EXISTING OUT BUILDING
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP MEC MAIN:
VALUATION ADD'L: HEAT TYPE: WOD
CODE EDITION: 2012 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM: Type Amount Paid By: Date: Receipt:
BEDROOMS: BATHROOMS: Permit $152.00 MEB 05/21/14 148650
Exist: Exist: Total: $152.00
Prop: Prop:
Total: Total:
Directions to Site:
HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION
THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED
BUILDING INSPECTION HOT-LINE 379-4455.
Request must be received by 3pm the day before the inspection is needed.
Office Hours 9:00 am-4:30 pm MONDAY - THURSDAY
HOT LINE AVAILABLE 24 HOURS A DAY
'1sy
DEPARTMET OF COMMUNITY DEVELOWENT
Date: '?M Time Received: rj l g arr)2 on Tue. Wed. Thur. Fri.
Date:
BLD: . l ' /8 Z Contact Name:
Owner: Contact Number: 360 4--P/5 /5 5-9 9 g
Address: (v.3 i`"C) (dye 7-e-o • 206
Notes: /A20o05 if.
Foundation Plumbing Framing Propane Tank Mechanical
Setbacks Under-ground Framing Under ground Furance
Footing Rough In Air Seal Above ground Gas
Stemwall Hydronic Exterior shear Exterior lines Oil
Straps Hot Water Htr Interior shear Interior lines Ducts
Post Hole Ventilation Appliance
Underfloor Gas/Wood stove
Man-Homes Insulation
Final Inspection
• Setbacks Floor
Foundation Wall Address Posted
Block&Tile Ceiling