HomeMy WebLinkAboutBLD2013-00287 .UILDING PERMIT APPLICOON BLD13-00287
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD13-00287 Received Date: 9/17/2013
SITE ADDRESS: 161 DUNSMUIR RD
PORT LUDLOW, 98365
OWNER: EDOUARD GALFRE PHONE:
MARGUERITE GALFRE
161 DUNSMUIR RD
PORT LUDLOW WA 983658736 SOUTH BAY#3
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 995700019 Section: 21 Township: 28 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION Wood burning pizza oven
TYPE OF WORK STV SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION 2,700.00 ADD'L: HEAT TYPE:
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 $69.00 MEB 09/17/13 142498 APPROVED
Plan Check $44.85 MEB 09/17/13 142498
State Building Code $4.50 MEB 09/17/13 142498 SEP 17 2013
Total: $118.35
Jefferson County DCD
\\tidemark\data\forms\F_BLD_App_Bld.rpt 9/17/2013
f4/b1 ii r-4----
IsONc
(9,6 JEFFERSONOUNTY
° DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street• Port Townsend •Washington 98368
, 360/379-4450 • 360/379-4451 Fax
0n www.co.jefferson.wa.usfcommdevelopment
Master Permit Application MLA:
Project Description(include separate sheets as necessary):
.uvodi kU rtAL 0 vt.-o
Tax Parcel Number q 1 S 4000Iq Property Size: (acres/square feet)
Site Address and/or Directions to Property:
t &l -DtAx s tvvA,v- P-o a� r - IAA-a°w 414" 411).3-6.
Property Owner(s)of Record: • eA out wr'rA ti M a vu am-eTe- ..'41.L—ft
Telephone: 3 60 4 3"7 9,3Z h Fax: email:
Mailing Address: 16 C ,jet ttnswtt t%r (Z i iA T.L. W A-9 e3 Gs-
Applicant/Agent(if different from owner): G4•c.c42.
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies 0 Lot or Road Segregation
uilding WM) I ftitmet OVet.t ❑Critical Areas Stewardshi s PI_
❑ Demolition Permit V ❑Variance(Minor,Major • ^ q
❑Single Family CJ Garage Attached/Detached 0 Conditional Use[C(a), , • i... 1
0 Manufactured Home 0 Modular - 0 Discretionary"D"or Un : -• se assification
❑ Commercial* ❑Special Use(Essential ° •Tc Facilities)**
II'
❑ Change of Use ❑Boundary Line Adjust - S E P 1 6 2013
❑ Address ❑ Road Approach ❑Short Plat**
❑ Home Business ❑Cottage Industry ❑Binding Site Plan** I IA
❑ Propane ❑Long Plat**
❑Sign - ❑Planned Rural Reside 'al DtvolI 1N , ',r ' ;.-,r, "ents
❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteratio
0 Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions--
❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development--
Temporary Use ❑Shoreline Management Variance
❑Wireless Telecommunication* ❑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 ❑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 forpermit(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. Staff's access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the applicati n that he or sh rior no'ce.
Signature: Date: 1.6
The action orractions 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-transferabl responsibility forgnng to and complying with the ESA. The Applicant has read this disclaim and signs and dates ft below.
Signature: y Cl ..4-,�T�� Date: Ell `l ZO l 3
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.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 assumin the respon ibility of the General Contractor for the proposed project.QQ
Signature: �' r+ i Date: -l (l,( I 2 F 91
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER'
ARCHITECT/ENGINEER: PHONE ( ) 'AX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New ❑ Wood Existing: "❑ Sewer
O Addition ❑ Steel Proposed:, Bank " ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: Height: 0 Individual System
O Repair ❑ Masonry SEP Permit#
❑ Demolition o Other: Bedrooms: Water Supply:
Existing: Setback: 0 Private well 0 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:
1 Underground Tank 1 Above ground Tank Size of Propane Tank:
1 Heat Stove 1 Cook Stove 1 Woodstove 1 Fireplace Insert 1 Hot Water Tank 1 Pellet Stove 1 Other
Is this appliance being installed in 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 properly
lines,-tank location and size,distances from the propane tank to all property lines,buildings and septic system components,
including the reserve area.
q., wi
S
S.uare Foota•e Current Pro••sect E. : �
Main Floor Heated EH BId App Review:
2- Floor Heated Consistency Review:
Other Heated Base fee: /0 co
19-l•
Mezzanine Additional Section:
Heated Basement Plan Check fee: /y e.C,
Unheated Basement ' State Surcharge fee:
Other Unheated ; Pot Water Review fee:
Garage/Carport SUBTOTAL
tiK..
Decks 911/Rd Approach fee:
Other TOTAL: $ � J"
Receipt Number: 1 H2 t:{ag
Cash/Check Number:
C
ESTI` TED COST(REQUIRED) Date: , //(3•Fairmarket value of all labor and materials foundation to finish q(( A- l
4 9. --e2 Initials:
G:\PennitCenter\###FORMS#WATTRITFORMS\Current DRD Forms\Master Perrot Application 5-29-08.doc
■
BUILDING PERMIT ID
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT#: BLD13-00287 Received Date: 9/17/2013
SITE ADDRESS: 161 DUNSMUIR RD Issue Date 9/17/2013
PORT LUDLOW, 98365 Expiration Date 9/17/2014
OWNER: EDOUARD GALFRE PHONE:
MARGUERITE GALFRE
161 DUNSMUIR RD
PORT LUDLOW WA 983658736 SOUTH BAY#3
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 995700019 Section: 21 Township: 28 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
PROJECT DESCRIPTION: Wood burning pizza oven
TYPE OF WORK STV SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION 2,700.00 ADD'L: HEAT TYPE:
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 $69.00 MEB 09/17/13 142498
Exist: Exist: Plan Check $44.85 MEB 09/17/13 142498
Prop: Prop: State Building Code $4.50 MEB 09/17/13 142498
Total: Total: Total: $118.35
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
Jefferson County Building Divisisn 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
FINAL INSPECTION
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 9/17/2013
l • c�°1. JEFFERSON COUNTY
DEPARTMENT COMMUNITY DEVELOPM�t'
~.,`s,,[NO,0� �toioat pg. 0-51 g
Date: .9- Time Received: -3407_, am/pm Mon. Tue. Wed. Thu . Fri.
Date:
BLD: ,3'' 2-.1 Contact Name:
Owner: 0 kyc-„� Contact Number: 360 �7 7
Address: w��
206
Notes: ?1r2)3c, oo -e-t- ___
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
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Jefferson County Building Vision Permit Nuer:
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
201/4_ fr /'4 (lick
FINAL INSPECTION
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 9/17/2013
• BUILDING PERMIT •
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT#: BLD13-00287 Received Date: 9/17/2013
SITE ADDRESS: 161 DUNSMUIR RD Issue Date 9/17/2013
PORT LUDLOW, 98365 Expiration Date 9/17/2014
OWNER: EDOUARD GALFRE PHONE:
MARGUERITE GALFRE
161 DUNSMUIR RD
PORT LUDLOW WA 983658736 SOUTH BAY#3
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 995700019 Section: 21 Township: 28 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
PROJECT DESCRIPTION: Wood burning pizza oven
TYPE OF WORK STV SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION 2,700.00 ADD'L: HEAT TYPE:
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 $69.00 MEB 09/17/13 142498
Exist: Exist: Plan Check $44.85 MEB 09/17/13 142498
Prop: Prop: State Building Code $4.50 MEB 09/17/13 142498
Total: Total: Total: $118.35
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