HomeMy WebLinkAboutBLD2010-00231 THIS BUILDING IS
NOT FINALED .
THIS IS AN INCOMPLETE
BUILDING APPLICATION . THE
PERMIT WAS NEVER ISSUED .
BUILDING PERMIT APPLIION MLA e0 00p256
Revw Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD10-00231 Received Date: 6/29/2010
SITE ADDRESS: 2 N BAY WAY
PORT LUDLOW, 98365
OWNER: CAROLE L DANDRIDGE TRSTE PHONE: 415-898-7011
J B DANDRIDGE GSTT TRUST
30 DRY CREEK LN
NOVATO CA 949453459 OAK BAY WATERFRONT
SUBDIVISION: Block: Lot: 39+
PARCEL NUMBER: 976800022 Section: 29 Township: 29 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: HENRY M SOUZA PHONE: (360) 379-8338
DESIGNS BY SOUZA INC (360) 379-9136
164 SWANSON
PROJECT DESCRIPTION NEW DETACHED GARAGE W/ 2ND FLOOR HTD REC ROOM & BATH
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION 142,850.00 ADD'L: 814 HEAT TYPE: EEE
CODE EDITION: 2006 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: SHORELINE:
GARAGE: 1,040
CONST TYPE: SETBACK:
DECK: 108
BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 0 Prop: 2
Total: 0 Total: 2.__..._....__......._._..._._.
Routing Date:
.r
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $1,234.55 LYK 06/29/10 117918
Plan Check $802.46 LYK 06/29/10 117918
State Building Code $4.50 LYK 06/29/10 117918
Potable Water Application $98.00 LYK 06/29/10 117918
Total: $2,139.51
,SON t •
zo 06 JEFFERSON COUNTY
7 A DEPARTMENT OF COMMUNITY DEVELOPMENT
n 'N ,;- `4 : 621 Sheridan Street• Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
O" www.co.jefferson.wa.us/commdevelopment
ING
Master Permit Application MLA: 10 "J
Project Description(include separate sheets as necessary):
_ _ constuction of garage and rec room
Tax Parcel 976800022 Property 1.13 acres/49,167 SF
Number: Size: (acres/square feet)
Site Address and/or Directions to Property: East on Oak Bay Road. Turn left onto Alderview Lane. Turn
left at North Bay Way. Site is on right
Property Owner(s)of Record: Carole Dandridge TRSTE,JB Dandridge GSTT Trust
Telephone:415 898 7011 Fax: email:
Mailing Address: 30 Dry Creek Lane,Novato,CA 94945
Applicant/Agent(if different from owner): Designs by Souza,Inc.
Telephone: 360-379-8338 Fax: email: henry @designsbysouza.com
Mailing Address: 164 Swanson Ave,Port Townsend,WA 98368
at kind of Permit?(Check each box that applies
1/4uilding ❑Variance(Minor, Major or Reasonable Economic Use)
Demolition Permit _. _ ❑Conditional Use[C(a),C(d),or C]**
a Single Family ( l Garage Attached etached .)❑ Discretionary"D"or Unnamed Use Classification
U Manufactured Home ❑ Modular � � ="" f ❑Special Use(Essential Public Facilities)**
❑ Commercial* ❑ Boundary Line Adjustment
❑ Change of Use ❑Short Plat**
❑ Address ❑ Road Approach ❑ Binding Site Plan*"
❑ Home Business ❑Cottagelndustry ❑ Long Plat**
❑ Propane ❑Planned Rural Residential Development(PRRD)/Amendments**
❑Sign ❑ Plat Vacation/Alteration*"
❑Allowed"Yes" Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisions*"
❑Stormwater Management ❑Shoreline Management.Substantial,Development**
❑ Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Variance
❑Temporary Use ❑Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium ❑Tree Vegetaion Request
*May require a Pre—Application Conference **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 He .sou to act as my agent in matters relating to t is application for permit(s).
f / Q
OWNER SIGNATURE Date: 2` &
A
By signing this applicat'n 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 it's 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 acce - ,d right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any eq ired lat insp.ctions. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the appl, at in 'a e or. e want prior otice. // /*�
Signature: ,.` Date: tit l 2- !v
The action or ions A':licant will undertake a 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 iced will not 'ala the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)even itfyoulare i cy plia;ce with the Jefferson County development code.The Applicant acknowledges that he,she it holds individual
and non-transfelabl. re a' ibil' for ad ri,ig o and complying with the ESA. The Applicant has read this discJairryLran�si Gan dates it below.
Signature: .. Date: ((�Q[[// 2. G
C:\Documents and Settings\caral\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.doc
•
BUILDER STATEMENT
The signer of state'ent d'es hereby certify that they are the Owners of the parcel referen d herein,that they are not licensed contractors and that
they will be : in;//,'e re a. sibili of t,'• General Contractor for the proposed projeFt.b Zr /0
Si nature: Date:
int w
GENERAL J 'R•CTOR OR MANUFAf RED 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: Shoreline: Type of Sewage Disposal:
✓ New ® Wood Existing: 16 ❑ Sewer
❑ Addition ❑ Steel Proposed: 2 _ Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: ' Height: V Individual Syst
❑ Repair ❑ Masonry 15 SEP Permit# CA
: 1
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: ( Setback: V Private well ❑ Two Party
Type of Heat: Proposed: 0f 150 ❑ Public
Electric Total: Y� Name of System:
If this is a Commercial Proiectyou 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:
0 Underground Tank 0 Above ground Tank Size of Propane Tank:
❑Heat Stove ❑Cook Stove ❑Woodstove ❑ Fireplace Insert ❑Hot Water Tank ❑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:
20°Floor Heated ,,71 c-..671-7,,c),24 gConsistency Review: .
Other Heated ' Base fee:
Mezzanine Additional Section:
Heated Basement Plan Check fee: g` '' C
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee: ,i
Garage/Carport SUBTOTAL
1040 C(ii2 .�)
Decks 911/Rd Approach fee:
10e) Z 3 4C e,u -1
Other TOTAL: $c914-6,3_,
Receipt Number: i (-79 1
Cash/Check Number:
(.C5 <
ESTIMATED COST(REQUIRED) Date:
r
.Fair market-value"of alklabor and materials foundation to finish ----24-f "
Q142 , 850 . 00 ,} Initials: ( •„ rte_
C:\Documents and Settings\carat\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.doc
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