HomeMy WebLinkAboutBLD2014-00226 OBUILDING PERMIT APPLIC•ON BLD14-00226
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD14-00226 Received Date: 6/26/2014
SITE ADDRESS: 703 OLD GARDINER HWY
SEQUIM, 98382
OWNER: ANDREW SWARTZBACKER PHONE: 360-417-1844
CATHARINE SWARTZBACKER
703 OLD GARDINER RD
SEQUIM WA 98382 CARYL SHORT PLAT
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 002331043 Section: 33 Township: 30 N Range: 02 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP ENCLOSING UNDERNEATH THE EXISTING HOUSE, HOME IS A POLE
STRUCTURE - NO HEAT OR INSULATION WILL BE ADDED
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ALT MAIN:
VALUATION 20,484.00 ADD'L: HEAT TYPE:
CODE EDITION: 2012 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: 720 #OF STORIES:
OCCUPANCY:
CONST TYPE: OTHER: 0 SHORELINE:
CONST TYPE: GARAGE: 0 SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop: 0
Total: Total:
Routing Date:
II
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $278.00 JLA 06/24/14 148811
Plan Check $180.70 JLA 06/24/14 148811 APPROVED
State Building Code $4.50 JLA 06/24/14 148811 JUL � '
Total: $463.20 2014
Jefferson County DOD
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' DEPARTMENT OF COMMUNITY DEVELOPMENT •
621 Sheridan Street• Port Townsend •Vltashington 98368
4:1-4„ 360/379-4450 . 360/379-4451 Fax
`S$ www.co.jefferson.wa.us/commdevelopment
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Master Permit Application MLA:
Project Description(include separate sheets as necessary): . Pi c--/-(-4
A �S lh 6..... v cc, -- (-R- le (' vim " A L 6 t
•Tax.Parcel Number 0 0 2. 3 3 /07 Property Size: /24/04.00 (acres/square feet)
Site Address and/or Directions to Property:
703 0t,1 C,c.,rd n.er A"' .1,
Property Owners)of Record:
Telephone: .340 Li,7- / .sit` Fax: email:
Mailing Address: 11-0 c i;n e- P a, 5.��a rr» '/. 9
Applicant/Agent(if different from owner):
Telephone: Fax: email: •
Mailing Address:
What kind of Permit?(Check each box that applies ❑Lot or Road Segregation
/1Building ❑Critical Areas Stewardship Plan
❑ Demolition Permit ❑Variance(Minor, Major or z easonable Economic Use)
❑ Single Family ❑Garage Attached/Detached ❑Conditional Use[C(a),C(• ,
.❑ Manufactured Home .❑ Modula . - ❑Discretiona "D"or Unn. t , c"-- ••
G Commercial* ❑Special Use(Essential ' • , :ar -
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❑ Change of Use ❑Boundary Line Adjustm , 1/ �/C�
❑ Address ❑Road Approach ❑Short Plat** C�
❑Home Business ❑Cottage Industry ❑Binding Site Plan** // "JU/j�r
❑ Propane ❑Long Plat** • 2 4 1,
o Sign ❑Planned Rural Resi ntial u- -lopmeht(PRRb)Ainen•r - • **
❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Altera on** JEF F
❑Stormwater Management ❑Shoreline Master Prog - d ate 1%le i i 1`1 •
❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substan '4 4.etg nt**
❑Temporary Use ❑Shoreline Management Variance PMEM
❑Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map • - :• ent
❑ 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 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. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the appli ' n that he or she w s pri .
Signature: Date: C°— 2(717W
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-transfe responsibility f dher d complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: r Date: e'r 'Y"7}
G.\PrrmitCenter\###FORMS###\T)RT)FORMS\C.,irrrnt'DR f Pnrmc\Macre.?Permir A,-,ni inn 5-99-f)Arinr
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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 assum•• he responsibili • the -ra` 'ontractor for the proposed project.
•
Signature: ,i •-•epr' Date: -2 z11'/4
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: 3 Shoreline: Type of Sewage Disposal:
r New 1Ec Wood Existing: / ?A ❑ Sewer
0 Addition 0 Steel Proposed: Bank 0 Community System •
jg Alteration/Remodel 0 Concrete Total: / ,/y Height: ❑ Individual System
❑ Repair 0 Masonry SEP Permit# 9/.At 6•
0 Demolition ❑ Other: Bedrooms: Water Supply:
Existing: I Setback: ❑ Private well 0 Two Party
Type of Heat Proposed: St 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'Ser lice? 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 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 Foie Office 40 44 • _ Amokint ,Region
Main Floor Heated EH Bld App Review:
2nd Floor Heated Consistency Review:
Other Heated Base fee:
-1 g DO 1
Mezzanine Additional Section:
Heated Basement Plan Check fee:
/ EM• 1•
X Unheated Basement 72 t� � State Surcharge fee: II S0
Other Unheated' .3 lit y Pot Water Review fee:
•
Garage/Carport SUBTOTAL
Decks 911/Rd Approach fee:
4.
Other
TOTAL: $ 5' 1.. 100 C V Receipt Number: �r-) _�_ VC `/ �1
Cash/Check Number: i I-1/r ESTIMATED COST(REQUIRED) Date: 1
I �
•Fair market value of labor and materials foundation to finish I` J1
'7 e> O. Initials: ----r�--o t"'�
1_FFERSON COUNTY
DEPT.OF COMMUNITY DEVELOPMENT
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ENvIlIONMENTAL HEALTH DIVISION w
SEPTIC SYSTEM INSTALLATION CERTIFICATION. AND "AS BUILT"
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' ;c. vy NAME MAttg cp 2Yz a SEP t°t/ra$ Installer LARRY
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° ?s ird fade location of septic tank, pump chamber, draini"cld, and other system compone is in relation to the house,.
- cc rl,lines.or other permanent objects. Note any charge from the approved plans here or on the beck of this form.
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Borrower/Ctent ANDREW SWARTZBACKER
Property Address 703 Old Gardiner Rd
City Sequim County JEFFERSON State WA Zip Code 98382
Lender KITSAP BANK/VA
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DEPT.OF COMMUNITY DEVELOPMENT
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Parcel # 000002331043 1eo Cd 300233105751 Auto Roll : OFF
CARYL SHORT PLAT Nbhd Cd 5720
LOT 1
Loc ID
* Taxpayer Cd SCHI 2750 SCHIFFERS, BARBARA C T/P Chg Dt 7/13/1993
* Title Owner T/P Chg Usr KELL
Tax Code 0781 Status TX TAXABLE Land Use 1100 RES-SINGLE
Affidavit 86049 Vol/Page / C/U Code
COMPLETE ADDRESS WINDOW
Taxpayer
SCHI2750 BARBARA C SCHIFFERS
703 OLD GARDINER RD
SEQUIM WA 98382-8701
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Borrower/Client ANDREW SWARTZBACKER
Property Address 703 Old Gardiner Rd
City Sequim County JEFFERSON . State WA Zip Code 98382
Lender KITSAP BANK/VA
Subject Front
703 Old Gardiner Rd �
A,� - . L �� Sales Price 235,000
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Gross Living Are�1,296
, �,,, _ � . � : f � Total Rooms 4
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Borrower/Client ANDREW SWARTZBACKER
Pro Address
party 703 OId Gardiner Rd
City Sequim County JEFFERSON . State WA Lp Code 98382
Lender KITSAP BANK/VA
Subject Street West
703 Old Gardiner Rd
Sales PnCe 235 000
Gross Living Are�1,2s6
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DEPARTME OF COMMUNITY DEVELOP NT
Date: -25 Time Received: 2 4pm Mon. 461 ed Thur. Fri.
Date: g- i■ yZ7
BLD: I°1— nac Contact Name:
Owner: Contact Number: 360
Address: 1o3 OLD C.. ArLaktual R A 206 ?q," /s 9'
Notes: &C.LA. C-00/0Sr-
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 Division Permit Number: BLD14-00226
Applicant: SWARTZBACKER
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
Framing
Add'Septic Inspect Req'c a ty verify water line setback met,see conditions of approval,fees may be
assessed.
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_9..
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
• •
CONDITIONS for Building Permit# :BLD14-00226
1.) This system as designed and approved is sized for only one single family residence. It is
not sized for an Accessory Dwelling Unit(ADU). The minimum daily design flow per
residence is 240 GPD.
2.) Prior to final occupancy the owner will uncover the water line and either confirm it meets
the required 10'setback or will move the line to meet the requirment.
\\tidemark\data\forms\F_BLD_Perm it_BIdg.rpt 7/21/2014
BUILDING PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT#: BLD14-00226 Received Date: 6/26/2014
SITE ADDRESS: 703 OLD GARDINER HWY Issue Date 7/21/2014
SEQUIM, 98382 Expiration Date 7/21/2015
OWNER: ANDREW SWARTZBACKER PHONE: 360-417-1844
CATHARINE SWARTZBACKER
703 OLD GARDINER RD
SEQUIM WA 98382
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 002331043 Section: 33 Township: 30 N Range: 2■1
CONTRACTOR: OWNER/BUILDER PHONE:
PROJECT DESCRIPTION: ENCLOSING UNDERNEATH THE EXISTING HOUSE,
HOME IS A POLE STRUCTURE - NO HEAT OR INSULATION WILL BE
ADDED
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ALT MAIN:
VALUATION 20,484.00 ADD'L: HEAT TYPE:
CODE EDITION: 2012 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: 720 #OF STORIES:
OCCUPANCY:
CONST TYPE: OTHER: 0 SHORELINE:
CONST TYPE: GARAGE: 0 SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: Type Amount Paid By: Date: Receipt:
BEDROOMS: BATHROOMS: Permit $278.00 JLA 06/24/14 148811
Exist: 1 Exist: 2 Plan Check $180.70 JLA 06/24/14 148811
Prop: 0 Prop: 0 State Building Code $4.50 JLA 06/24/14 148811
Total: 1 Total: 2 Total: $463.20
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
SPECIAL CONDITIONS APPLY-SEE ATTATCHED