HomeMy WebLinkAboutBLD2014-00175 BUILDING PERMIT APPLI ION BLDI4-00175
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD14-00175 Received Date: 5/20/2014
SITE ADDRESS: 11 N PALMER DR
PORT TOWNSEND, 98368
OWNER: JOYCE A CARDINAL PHONE: 360-460-3001
11 N PALMER DR
PORT TOWNSEND WA 98368-9489
CRESTHAVEN SUBDIVISION
SUBDIVISION: Block: Lot: 1
PARCEL NUMBER: 946100001 Section: 12 Township: 30 N Range: 02 W
CONTRACTOR: PHONE:
PHONE:
REPRESENTATIVE: BORDEN FARNELL PHONE: 360-808-3833
294 HERON HILL RD
SEQUIM WA 98382
PROJECT DESCRIPTIOt Add gable roof over existing front entry of exsiting sfr.
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ADD MAIN:
VALUATION 12,000.00 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: OSS
WATER SYSTEM: 11050
BEDROOMS: BATHROOMS:
Exist: Exist: 0
Prop: Prop:
Total: Total: 0
Routing Date:
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $179.00 MEB 05/20/14 148646
Plan Check $116.35 MEB 05/20/14 148646
State Building Code $4.50 MEB 05/20/14 148646 MAY 2 0 2014
Total: $299.85
Jefferson County DCD
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N.N.N. JEFFERSON COUNYDCD
BUILDING PLAN REVIEW
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ar
FFER COUNTY
�w� .`',- �} DEPARTMENT OF COMMUNITY DEVELOP_
elb ( (1-)-c--- .
MENT
l' '' . " 621 Sheridan Street • Port Townsend •Washington 98368
\ ,$� 360/379-4450 • 360/379-4451 Fax
<yS, N� www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA:
Project Description(include separate sheets as necessary):
Tax Parcel Number: q , j 00 06 1 Property Size:
—.� • (acres/square feet)
Site Address and/or Directions to Property:
1/ A\ /, 9 (1; 1 — . Vr . a,)0/0
Property Owner(s)of Record: ...3c)y e r r ci r`r1Ck( /
Telephone: ?LW')- LU( O- SC7i 1 1 Fax: email:
Mailing Address:
Applicant/Agent(if different from owner): �r a r " -
Telephone:, .--e - '3P,33 Fax:
email:
Mailing Address:
What kind of Permit?(Check each box that applies ❑Lot or Road Segregation
(Building ❑Critical
Areas Stewardship Plan Demolition Permit
pD ❑Variance(Minor, Major or Reasonable Economic Use)
Single Family ❑Garage Attached ached/Detached ❑ **
Conditional Use
Ca
❑ Manufactured Home .❑ Modular D[ r ),Cad),or C]
,* ❑ Discretionary or Unnamed Use Classification
0 Commercial ❑Special Use(Essential Public Facilities)**
0 Change of Use ❑Boundary Line Adjustment
❑ Address_ ❑Road Approach ❑Short Plat**
o Home Business ❑Cottage Industry ❑Binding Site Plan**
❑Propane ❑Long Plat**
❑.,'yn ❑Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration**
❑Stormwater Management ❑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 Plan/UDC/Land Use District Map Amendment
0 Forest Practices Act/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
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 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 applicAon that 09 or she wan
rior notice.
Signature: “-)• / ('� 'l (L G./te P
Q.-
Date: -S'c)a - /
Y
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. 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 rponsibility f�adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: fit:..,. f3c'I�Gz l/r 4_0 Date: ,j—,2O -1
BUILDER STATEMENT
al
i
The signer of tnis statement does hereoy 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: c/1,14,,,_ C?t4".,,,..2_p Date: _.=J. `' a0-/y
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: P ':".`!_: FAX:
( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) Fax:( )
MAILING ADDRESS: EMAIL
Project Type: i Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
r: New : Wood Existing: = Sewer
Addition = Steel Proposed: Bank 3 Community System
_. Alteration/Remodel 2 Concrete Total: Height: i D Individual System
• Repair D Masonry I — SEP Permit# _
Bedrooms: Water Supply:
Demolition =_i Other: pp Y:
Existing: _ II Setback: 0 Private well 0 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 I Woodstove I Fireplace Insert i Hot Water Tank I Pellet Stove ► 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 Bld App Review: .
-
2 Floor Heated Consistency Review:
Other Heated - Base fee:
Mezzanine • Additional Section:
Heated Basement Plan Check fee: b r '.,
Unheated Basement I State Surcharge fee: 11, S-0. •
•
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL 5S-5 I
Decks 911/Rd Approach fee: I
Other I I TOTAL: $ k<6,t.5'"
r I
Receipt Number: 1 14 lr}ilk)
Cash/Check Number:
ESTIMATED COST(REQUIRED) Date: /
•Fair market v lue of all labor and materials foundation to finish 1 .'" . .e._>/
Initials: ✓1 t
•
,,w4SAN F,?°i JEFFERSON COUP*
�° DEPARTMENT OF COMMUNITY DEVELOPMENT
NSKIN&SO
Date: I 1 14Time Received: am/pm Mon. 0 Wed. Thur. Fri.
t-` Date:
BLD: 1 4 m ' I �'� Contact Name: il�
Owner: ,.TD V CI-- Caerlifice, Contact Number: 360 or _
Address:v Lea ) J /J, a /arum- Or, -2@CL ropc -A ,,e),,.-/--- mhy
)( %'S cr(griada
--Pieter. i 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
�sON coei JEFFERSON COUN
•
Igo{ DEPARTMENT OF COMMUNITY DEVELOPMENT
Date: to-lc Time Received: am/pm o. Tue. Wed. Thur. Fri.
Date:
BLD: f q - 1 1 S" Contact Name:
Owner: Contact Number: 360 k'68 3255
Address: I PA1 ttiti, 206
Notes:
Foundation Plumbing Framing Propane Tank Mechanical
Setbacks Under-ground Framing V 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
�ON 1
•
• Inspections are required to be called in by 3:00 pm to receive an inspection the next day. Do to
staffing issues, at this time, we cannot guarantee that you will receive an inspection the next day.
day. Unless you receive a call from us, assume we will arrive on your requested inspection day.
• You may leave an inspection request 24 hours a day, and Inspections are available from
Monday through Friday.
• We cannot determine the time we will arrive in advance. However, if you call our office the
morning of your inspection, around 9:00 a.m., we can give an estimate of when the inspector will
arrive. Our general office phone number is 360 379-4450.
• An approved set of plans are to be on site with building permit for all inspections. If permit and
plans are not on site at time of inspection, a re-inspection fee must be paid prior to re-scheduling
another inspection.
If no access, no inspections will be performed, and a re-inspection fee must be paid prior to
re-scheduling another inspection.
• Inspectors will not access a home that has personal affects inside when the owner is not present.
• Commercial projects require 24 hour notice for inspection.
• •
Jefferson County Building Division Permit Number: BLD14-00175
Applicant: CARDINAL
BUILDING PERMIT INSPECTION APPROVALS Applicable Code: 2012 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
Foundation Footing 5/20/2014 (o-1 b-1,f
Framing 5/20/2014 w
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 £H
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 5/20/2014
• BUILDING PERMIT •
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT#: BLD14-00175 Received Date: 5/20/2014
SITE ADDRESS: 11 N PALMER DR Issue Date 5/20/2014
PORT TOWNSEND, 98368 Expiration Date 5/20/2015
OWNER: JOYCE A CARDINAL PHONE: 360-460-3001
11 N PALMER DR
PORT TOWNSEND WA 98368-9489
CRESTHAVEN SUBDIVISION
SUBDIVISION: Block: Lot: 1
PARCEL NUMBER: 946100001 Section: 12 Township: 30 N Range: 02 W
CONTRACTOR: PHONE:
PHONE:
PROJECT DESCRIPTION: Add gable roof over existing front entry of exsiting sfr.
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ADD MAIN:
VALUATION 12,000.00 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: OSS
WATER SYSTEM: 11050 Type Amount Paid By: Date: Receipt:
BEDROOMS: BATHROOMS: Permit $179.00 MEB 05/20/14 148646
Exist: Exist: 0 Plan Check $116.35 MEB 05/20/14 148646
Prop: Prop: State Building Code $4.50 MEB 05/20/14 148646
Total: Total: 0 Total: $299.85
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