HomeMy WebLinkAboutBLD2013-00324 " UILDING PERMIT APPLICA ON BLDI3-00324
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD13-00324 Received Date: 10/17/2013
SITE ADDRESS: 44 GAMBLE LN#
PORT LUDLOW, 98365
OWNER: MARY GITTS TRSTEE PHONE:
LOREN GITTS TRUSTEE
44 GAMBLE LN
PORT LUDLOW WA 983659726 PORT LUDLOW NO 1
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 990400109 Section: 9 Township: 28 N Range: 01 E
CONTRACTOR: EVERWARM INC PHONE: 425-219-9972
257151 HWY 101
PORT ANGELES WA 98362
Contractor's License EVERWI*088NL Expires 8/17/2014
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOII INSTALL 120 GAL PROPANE TANK, GAS FIREPLACE INSERT,
GAS/ELECTRIC KIT/RANGE
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP MEC MAIN:
VALUATION 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 $228.00 MEB 10/17/13 145469
Total: $228.00 APPROVED
OCT 182013
Jefferson County DCD
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DEPARTMENT OF COMMUNITY DEVELOPMENT
I-5 '4 621 Sheridan Street • Port Townsend • Washington 98368
360/379-4450 . 360/379-4451 Fax
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4. ww.co.jefferson.wa.us/commdevelopment
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Master Permit Application MLA:
Project Description (include separate sheets as necessary): IPAJ,0p
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Tax Parcel Num er: 7 yD $ 26/41 . Property Size: (acres/square feet)
Site Address and/or Directions to Property:
A/-5/ *et. 1.-a n.2 jPilt-q- ∎°rc /env„_t o9 365
Property Owner(s)of Record:
Telephone: X06 �*13/ 2 ,7/;6 Fax: email: 9?,bCgrnai/• tOriZ
Mailing Address: '/'T .a6P''�i� 4 LD, 9(3 6,3
Applicant/Agent(if different from owner):
Telephone: Fax: email: _
Mailing Address:
What kind of Permit? (Check each box that applies ❑ Lot or Road Segregation
❑Building ❑ Critical Areas Stewardship Plan
❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use)
❑ Single Family ❑ Garage Attached/Detached ❑ Conditional Use[C(a), C(d),or C]**
❑ Manufactured Home .❑ Modular • ❑ Discretionary"D”or Unnamed Use Classification
I ❑ Commercial* ❑ Special Use (Essential Public Facilities)**
O Change of Use ❑ Boundary Line Adjustment
❑ Address ❑ Road Approach ❑ Short Plat**
❑ Home Business ❑ Cottage Industry ❑ Binding Site Plan**
❑ Propane ❑ Long Plat**
• ❑ Sign ❑ Plarinea 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**
❑ Temporary Use ❑ Shoreline Management Variance
❑Wireless Telecommunication* ❑ Comprehensive Plan/UDC/Land Use District Map Amendment
❑ 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.
t 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 application that •r she wants prior n• ;,-.
/a _/ 7 /.3
Signature: �/' —oat ` ,,r Date:
The action or actions Applicant • undertake as a r: ult 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 for dhe• to and comp • g wi the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: Date: /6 —/ 7 /3'
•
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 the responsibility of the General Contractor for the proposed project.
Signature: Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME
INSTALbo •yS - 3G HONE: FAX:
ux 7144/1i,
MAILING ADDRESS:SWO S QJ? 1 is VtQ / h
CONTRACTOR'S LICENSE rf ,i'ttdldolckl,LgP3,3F. WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
El New Wood Existing: a Sewer
Addition U Steel Proposed: Bank r Community System
0 Alteration/Remodel G Concrete Total: _ Height: 0 Individual System
C Repair 2 Masonry SEP Permit# _
Demolition 11 Other: Bedrooms: Water Supply:
Existing: Setback: U Private well G 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 i• ob ve ground Tank ) Size of Propane Tank: /.C5 9d-e
Heat Stove i Cook Stove l Woodstove 4 Fireplace Insert Hot Water Tank I Pellet Stove I 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: I —
Other Heated Base fee: 2 f7 c(� —
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: $ 2 r
Receipt Number: I(,(S 1.(bq
Cash/Check Number:
ESTIMATED COST(REQUIRED) Date:
•Fairmarket value of all labor and materials foundation to finish it)/ �y�(
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^kw¢SON t% JEFFERSON COON
PARTMEN F COMMUNITY DEVELOPMT
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Date: Pii'ef Time Received: _ a ,��'�' Mon. Tue. /e+.1l,L
Date:e9)*OD Contact Name: U 0 A.01
Contact Number: 360 4 ._ .,•
Owner: �- �6
Address: i �'�
Notes: (ic,79Q /704-- �''f �
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Framing Foundation Plumbing g Propane Tank Mechanical
round Furance
Setbacks Under-ground Framing Under g
Footing In Rough Gas
Rou h Air Seal Above ground H dronic Exterior shear Exterior lines
Oil
Stemwall Y Interior lines Ducts
Straps Hot Water Htr Interior shear Appliance
Post Hole Ventilation
Underfloor i i Gas/Wood sf
Insulation Fr6)00,-(-
Man-Homes Final Inspection A,,
Setbacks Floor
Foundation
Wall Address Posted
Block&Tile Ceiling
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Date • 'time received am / pm Mon. co,Wed: Thur. --Fri.
BLD: L3-5z-� Date: ®('�<_ - .
OWNER: • - - • Contact Narnec //��2
ADDRESS: / �etasi4� Contact Number.36.0 T 7 7 6
206 r -
Notes:
.Foundation 'Plumbinq - Framing - - Propane Tank - Mechanical
Setbacks Under-ground Framing Underground K Furnace -
Footing Rough in Alrseal Above ground Gas
Stemwall __ Hydronic Exterior shear Exterior lines Oil
Straps Interior shear Interior lines •Ot Ducts .
. Post Hole Ventilation . . . Appliance •
Underfloor _ Gasfwood stove
Man=Horn es -
Setbacks V Insulation. • Final Inspection = -
Foundation
Block&Tiie floor _wall ceiling. . Address Posted •
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Jefferson County DCD Building Division
Correction Notice
PERMIT NUMBER a - 003z4
OWNER C I T`T'S
JOB LOCATION 4-4 CI ii me Le 0v
Inspection of this structure has found the following violations:
tlxreztc,r-
.rru2 DYLL)t. Ta 2.3 - 1.-6siK5
1/4N K° /) M
-_________,Ji
You are hereby notified that no more work shall be done upon these premises until
the above violations are corrected, unless noted otherwise. When corrections have
been made, call for inspection. (�
Date /0Z /5 Inspecto — -4'
BUILDING DIVISION(360)379-4450 INSPECTION HOTLINE(360)379-4455
I THIS NOTICE MUST BE KEPT WITH APPROVED PLANS ON SITE I
0 I
MECHANICAL AND DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT#: BLD13-00324 Received Date 10/17/2013
SITE ADDRESS: 44 GAMBLE LN# Issue Date 10/17/2013
PORT LUDLOW, 98365
APPLICANT: MARY GITTS TRSTEE PHONE:
LOREN GITTS TRUSTEE
44 GAMBLE LN
PORT LUDLOW WA 983659726
SUBDIVISION: PORT LUDLOW NO 1 Block: Lot:
PARCEL NUMBER: 990400109 Section: 9 Township: 28N Range: 01E
CONTRACTOR: EVERWARM INC PHONE: 425-219-9972
257151 HWY 101
PORT ANGELES WA 98362
Contractor's License EVERWI*088NL Expires 8/17/2014
OWNER, MARY GITTS TRSTEE PHONE:
if different: LOREN GITTS TRUSTEE
44 GAMBLE LN
PORT LUDLOW WA 983659726
PROJECT DESCRIPTION: INSTALL 120 GAL PROPANE TANK, GAS FIREPLACE INSERT,
Directions GAS/ELECTRIC KIT/RANGE
To Site:
oS
THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE.
THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR.
THE EXPIRATION DATE IS 10/17/2014.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: l.)4. Q J i L '- 6V-, I I�Iz/- f 3 it
ov, 11/0104 0-'„, .
FinalApproval: (/A irci4c4cli OA,
BUILDING INSPECTION HOT-LINE 379-4455.
REQUESTS MUST BE RECEIVED BY 3 PM THE DAY BEFORE THE INSPECTION IS NEEDED.
Office Hours 9:00 a.m. -4:30 p.m. Monday-Thursday
HOT LINE AVAILABLE 24 HOURS A DAY
\\tidemark\data\forms\F_BLD_Permit_Propane.rpt 10/17/2013