HomeMy WebLinkAboutBLD2014-00010 B•
UILDING PERMIT APPLICAN BLD1.4-00010
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD14-00010 Received Date: 1/10/2014
SITE ADDRESS: 55 QUEETS PL
PORT TOWNSEND, 98368
OWNER: ELLEN L HARGIS PHONE:
RICHARD C HARGIS JR
55 QUEETS PL
PORT TOWNSEND WA 983689430 CAPE GEORGE COLONY DIV 4
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 938701029 Section: 13 Township: 30 N Range: 02 W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2014
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION Gas Pipe to Cook Stove
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW 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 $152.00 MEB 01/09/14 145701
Total: $152.00 APPROVED
JAN I U 21
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06 , JEFFERSON COUNTY
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el DEPARTMENT OF COMMUNITY DEVELOPMENT JAN 0 8 c'' 'c 1.
144-: "4 621 Sheridan Street• Port Townsend •Washington 98368
• . . 360/379-4450 • 360/379-4451 Fax
-4:0 www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA:
Project Description(include separate sheets as necessary):
D -(o c.o o L.i' p
U
Tax Parcel Number: 9 j 8 - 7 o I - o ' Property Size: (acres/square feet)
Site Address and/or Directions to Property:
SS- Q u. -r:TS Mel e . * P l • v r,h sue? , CJ q K���
Property Owner(s)of Record: ELL - . s _' : -
Telephone: Fax: email:
Mailing Address: . %-r
Applicant/Agent(if different from owner):
Telephone: � Fax: .0-..- .
Mailing Address:
What kind of Permit?(Check each box that applies
OBuilding ❑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 0 Modular ❑Discretionary'D"or Unnamed Use Classification
O Commercial* ❑Special Use(Essential Public Facilities)**
O Change of Use ❑Boundary Line Adjustment
❑ Address ❑ Road Approach ❑Short Plat**
0 Home Business ❑Cottage Industry ❑Binding Site Plan**
,Propane ❑Long Plat**
❑Sign ❑Planned Rural Residential Development(PRRD)/Amendments**
O Allowed"Yes Use Consistency Analysis ❑Plat Vacation/Alteration**
❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions**
O Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development*-
O Temporary Use ❑Shoreline Management Variance
O Wireless Telecommunication* 0 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).
sir OWNER SIGNATURE J. .1 '�c Date: //6/:=.2-c)/tre By signing this application form,the o =r/-•ent 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
C t(� time of the application th �e orr e^wan prior noti
\U Signature: � .rte! [ ` ry 1-(2_o_.-v✓ 4.--t---; Date: //6'/6?-c--3/ Cr
The action or actions Applicant will undert a a8 a result of the Issuance of this permit may negatively impact upon one or more threatened or
endangered species and could lead to a otential"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 --on •illy fo-adhering o and coma ing with the E • The Applicant has read this discia' r and,signs and dates it below.
(41C11 Signature: A _ � ` _! �._ _ Date: / 6 / c -o/ L-1
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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 assuming the responsibility of the General Contractor for the proposed project.
Signature: Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: r -7 FAX:
J -e t , ( ) 3 <? ...7 l ( )
MAILING ADDRESS: /O C5 j 1 , y/ Y�o EMAIL:
CONTRACTOR'S LICENSE / WAINS
NUMBER: Jtlt?Sr/P 8 ' 7 GL. r NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: ' EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New ❑ Wood Existing:. ❑ Sewer
❑ Addition 0 Steel Proposed: Bank ❑ Community System
0 Alteration/Remodel 0 Concrete Total: Height: ❑ Individual System
0 .Repair 0 Masonry SEP Permit#
0 Demolition 0 Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well 0 Two Party
yp e . -..--ry-...,.:._..r_.,, - mp '
,,. ❑ Public
Total: Name of System:
If this is a Commercial Protect 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: EX-/J 77 rvC7-
i Heat Stove 1 ook Sto i Woodstove i Fireplace Insert i Hot Water Tank i Pellet Stove i Other
Is this appliance be ng nstalled 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.
S•uare Foota•e Current Pro•osed l 4®4 1. t� x rl pe • ' ' 4 "4' m �1 '" t I9 to I -
F y5�
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Main Floor Heated ,� ` ! EH Bid App Review:
2"0 Floor Heated r„ �`4� Consistency Review:
Other Heated ET 1, 3t,7, ,: Base fee:
-
Mezzanine " 1 Additional Section:
Heated Basement '1' ', Plan Check fee:
4. �1 U ?
Unheated Basement ,1 r ,. 4,j State Surcharge fee:-
Other Unheated r.-.1'1,,','`.''x-. ' t
��# Pot Water Review fee:
lip_, "
Garage/Carport i; ��, 1 i . SUBTOTAL
u �t=.,.w}tssci
Decks a 911/Rd Approach fee:
Other ' TOTAL: $
i'-i ,l I Receipt Number:
�t ,r.,4 " Cash/Check Number:
ESTIMATED COST(REQUIRED) Date:
.Fair market value of all labor and materials foundation to finish
Initials:
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9
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#: BLD14-00010 Received Date 1/10/2014
SITE ADDRESS: 55 QUEETS PL Issue Date 1/10/2014
PORT TOWNSEND, 98368
APPLICANT: ELLEN L HARGIS PHONE:
RICHARD C HARGIS JR
55 QUEETS PL
PORT TOWNSEND WA 983689430
SUBDIVISION: CAPE GEORGE COLONY DIV 4 Block: Lot:
PARCEL NUMBER: 938701029 Section: 13 Township: 30N Range: 02W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339 ((33 l 3g
Contractor's License SUNSHP*077QP Expires 1T/167�/2014-5875
OWNER, ELLEN L HARGIS PHONE:
if different: RICHARD C HARGIS JR
55 QUEETS PL
PORT TOWNSEND WA 983689430
PROJECT DESCRIPTION: Gas Pipe to Cook Stove
Directions
To Site:
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 1/10/2015.
REQUIRED INSPECTIONS:
Tank/Line/Appliance: L !,Jr£ .3-1 I
FinalApproval: l .-`�.1'l
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
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OWNER: _ ," i-je...91./c . - •. Contact Narne.
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ADDRESS: c5 $— .6stie,ers- . . Contact Number:36.0
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Notes: - .
" -
. ' • • . .
' . .
Foundatio.n Plumbing - FFamind' . MechaniCal
. Propane Tank • - V
... __ ..
. Underground. .
Setbacks . Under-g round. Framing _. Furnace
Footing Rough in Air seal Above ground - Gas
. —
Stemwall _ Hydronic Exterior shear Exterior lines Oil
Straps -- Interior shear Interior lines A Ducts A
l'• •
—
Post Hole • Ventilation Appliance•
"
• Underfloor _ Gas/wood stove•
Man,Honies .
.
. •
. .
Setba •cks Insulation. , , Final Inspecti.on
Foundation-- . . • • •1....r:i. :,,,i
0
Block&Tie floor wall ceiling. . Address Poslid
. ;