HomeMy WebLinkAboutBLD2012-00042 THIS BUILDING IS
NOT FINALED .
PERMIT WAS CANCELLED
PRIOR TO RECEIVING ALL
INSPECTIONS AND HAS NOT
BEEN ISSUED A CERTIFICATE
OF OCCUPANCY .
IJ ILDING PERMIT APPLICA' N MLA
IN e: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD12-00042 Received Date: 2/13/2012
SITE ADDRESS: 1219 CENTER RD
CHIMACUM, 98325
OWNER: AT&T PHONE: 206-818-9995
760 ALOHA ST
SEATTLE WA 98109
SUBDIVISION: Block: Lot: T 4+
PARCEL NUMBER: 901231004 Section: 23 Township: 29 N Range: 01 W
CONTRACTOR: TBD PHONE: 205-807-2541
REPRESENTATIVE: CATHERINE FUNTANILLA PHONE: 206-818-9995
760 ALOHA ST
SEATTLE WA 98109
PROJECT DESCRIPTION ADD 4' MICORWAVE DISH ON EXISTING TOWER & NEW CABINET
ON EXISTING SLAB
TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL:
TYPE OF IMP NEW MAIN: INDUSTRIAL:
VALUATION 10,000.00 ADD'L: HEAT TYPE:
CODE EDITION: 2009 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: NUMBER OF EMPLOYEES:
WATER SYSTEM:
BATHROOMS:
Exist:
Prop:
T. - :
Routing Date:
Type Amount Paid--Bp:---I ate: Receipt: Approved/Date
Permit $181.50 LYK 02/13/12 181442 APPROVEr
Plan Check $117.81 LYK 02/13/12 181442
State Building Code $4.50 LYK 02/13/12 181442 NJ1' 1
Total: $303.81 Jefferson County Paanninr.
& Building Department 4
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�+,
r i„,41,,� JEFFERSON COUNTY
` DEP ARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street• Port Townsend•Washington 98368
360/379-4450 • 360/379-4451 Fax
www.co.jefferson.wa.us/commdevelopment
1.3 Master Permit Application MLA: k -c 5
Project Description(include separate sheets as necessary): C-' i►'1
PO6l ph of a 4° microwave a t on -exith n - R--1t4fitm of r cab`re on si�6
Tax Parcel Number: 9O122,l 004 Property Size: (1000 -c4 (acres/square feet)
Site Address and/or Directions to Property:
i -1Ci (cv 9c\ ,OilifraCt,m I W R ganc
Property Owner(s)of Record: Kayo h tf v C)2- -i 12 ,a)ih C_ ('S
Telephone: 3(O()-X33°1001 CJ Fax: email:
Mailing Address: ?JO3'2 iflC)Y(t:itn Si 1j/iG�VV) ; t1vPj q SO --
Applicant/Agent(if different from owner): W,-h�iePirte ci rtl i IR-
Telephone: 20(o_0(6 `q q a Fax: at-,2G--cl i email: Gftjt}tiit kW-QVi i'1C-t4h.mS Cern
Mailing Address: 100 PMMoi1& S* Se&i+te, vv Pt x Sty')
What kind of Permit?(Check each box that applies
21'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
Commercial* ❑Special Use(Essential Public Facilities)*"
❑ Change of Use ❑Boundary Line Adjustment
❑ Address ❑Road Approach 0 Short Plat
.*
❑Home Business ❑Cottage Industry ❑Binding Site Plan**
❑Propane ❑Long Plat**
❑Sign 0 Planned Rural Residential Development(PRRD)/Amendments
❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/After-00h*"
❑Stormwater Management 0 Shoreline Master Progtarcmgtion/Pemi = '
❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management SubstantialOevettop -
ID Temporary Use ❑Shoreline Managerr►ent Variance
21 Wireless Telecommunication* ❑Comprehensive Pla DC/Lapp 1Ase I rioCt� p • ant
❑Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Sh r line ME 1&Pr arxi end i
*May require a Pre-Application Conference ❑Tree Vegetation Re
It
**Requires a Pre-AnrJliu_ntien Can ice -_.
Please identify any other local,state or federal permits required for this proposal ff &hill CO11P
DEPT.OF COQ OD: r' ;
G DESIGNATION OF AGENT
I hereby designate C(� I" Ztflci . li-ai(1i) to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE i T mobile crime let , OttlACC' Date: 9-la 119-
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 application that he or she wants nrinr nn - .- f
2
Signature: �LLLLA , IeYT>(Date: )I to•
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 responsi lity for ad ring to complyin with th ESA. The Applicant has read this disclaimer nd signs and dates it below.
Signature: r - y ?T4 r Date: " - le I ta-
r
G:\PemmitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
• •
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: PIS SC. 0.-1A0 A T Mo`r e C UC1/4/W '. Dare: C k r INTeT-S pori,o-iti4i.g
-r-F3-4-Thecessacls II svppoizir onrt\nC trIS ikcrravt YFest tS.
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
1"-W' ( ) ( )
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: ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank 0 Community System
❑ Alteration/Remodel 0 Concrete Total: Height: ❑ Individual System
❑ Repair ❑ Masonry SEP Permit#
C Demolition 0 Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well 0 Two Party
Type of Heat: Proposed: 0 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 andlor Appliance Installation permit,mark all items below that apply:
1 Underground Tank I Above ground Tank Size of Propane Tank:
1 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 I 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,
includin• the reserve area.
S•uare Foote t e Current Pro••sed =' --`-'.4, } ` s. ...4,` €-?t,
Main Floor Heated _ : `� EH Bid App Review:
Floor Heated r ,- Consistency Review:
Other Heated 1
- j _ - -e: 'q 5-
....�� r '
Mezzanine + x ••NM= al Section: _____---
Heated Basement / � eck fee: 1 11 -81
I
Unheated Basement : . E E Q t. ` rcharge fee:
141 & z
Other Unheated a i W*' Yr of Wa er Review fee:
7EFF: , �
Garage/Carport DEPT OF CO . �
• -11,1411t SUBTOTAL (35 31
Decks �-, 911/Rd Approach fee: _.----•
Other { , TOTAL: $ 335. g I
Receipt Number: 13 2
Cash/Check Number: I
ESTIMATED COST(REQUIRED) Date: —1 3,l Z
•Fair market value of all labor and materials foundation to finish
A 101000 Initials:_
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
•
m
1
National Development Team—Tower Asset Management
T-Mobile 12920 SE 38"'Street, Bellevue,WA 98008
January 12, 2012
RE: Letter of Authorization—Co-Location on T-Mobile tower.
Property address: 1219 Center Rd., Chimacum, WA 98325
Latitude: 47° 59' 11.50" Longitude: 122° 45'41.10"
T-Mobile Site: SE06101A
To Whom It May Concern:
New Cingular Wireless PCS, LLC ("AT&T") is currently in negotiations with T-Mobile West
Corporation, a subsidiary of T-Mobile USA, Inc ("T-Mobile"), to co-locate its communications
equipment on the T-Mobile tower located 1219 Center Rd., Chimacum, WA 98325 .
AT&T shall be required by the terms of the agreement to seek and obtain all necessary local
permits and approvals. As a duly authorized representative of T-Mobile, permission is hereby
granted to AT&T, and agents thereof, for the purpose of consummating any applications
necessary to gain the required approvals from the Chimacum/Jefferson County/Washington.
Any fees or charges associated with all applications or permits and any conditions placed on the
applicant shall be the sole responsibility of AT&T.
Yours truly,
Lisa Boyer
Tower Asset Management, West
T-Mobile USA, Inc.
425-383-3074
Lisa.Boyer @T-Mobile.com
CSI . 0
[a copy of this document shall have the same effect a t original]
'-Thl FEB 1 3 2012
dl
JEFFERSON COUNTY
DEPT.OF COMMUNITY DEVELOPMENT
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JEFFERSON COUNTY
�► ARTIVIENT OF 0,• mumrt DEWLMNIENT mum
621 Sheridan Street,Pat Townsend,WA98368 I Web:www.co.iefferson.wa.us/conmunitydevelooment
Tel:360.379.4450 I Fax:360.379.4451 I Emai:dud(axo.iefferson.waus
SquareONE Resource Center I Building Permits& Inspections( Development Review I Long Range Planning
March 13, 2014
AT&T
760 ALOHA ST
SEATTLE WA 98109
RE: SUBJECT: FAILURE TO RENEW
SITE ADDRESS: 1219 CENTER RD
PERMIT#: BLD12-00042 PARCEL: 901231004
LEGAL DESCRIPTION: BLOCK: LOT: T 4+
PROJECT DESCRIPTION: ADD 4' MICROWAVE DISH ON EXISTING TOWER & NEW
CABINET ON EXISTING SLAB
DEAR AT&T
The Community Development Office sent you a renewal notice indicating the need to either renew or
schedule a final inspection on your building permit. To date, a final inspection has not been successfully
passed nor has a renewal fee been paid.
An annual renewal fee is due unless a final inspection is passed and a certificate of occupancy is issued.
Please submit payment of$228.00 to renew your permit to 621 Sheridan St. Port Townsend, WA 98368.
If you have any questions you can contact our office at 379-4450 between 9:00 a.m. and 4:00 p.m.
Monday through Thursday.
If we do not receive payment or hear from you within thirty (30) days from the date of this notice, we will
proceed with cancelling the building permit. If the structure has not passed a final inspection we will begin
the process of placing a notice to title on your property. Once cancelled, a new permit will need to be
applied for, new fees paid, and the structure built to current building codes.
Sincer-
r .
Permit Technician
cc: file
Jefferson County Building Dion Permit Num. BLD12-00042
Applicant: AT&T
BUILDING PERMIT INSPECTION APPROVALS Applicable Code: 2009 International Building Codes
To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection.
Requests received after 7:00 AM will not be scheduled for that 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
Miscellaneous Microwave dish
Miscellaneous Equipment cabinet
Miscellaneous second party verification of instalation
FINAL INSPECTION
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
• BUILDING PERMIT S
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT#: BLD12-00042 Received Date: 2/13/2012
SITE ADDRESS: 1219 CENTER RD Issue Date 11/21/2012
CHIMACUM, 98325 Expiration Date 11/21/2013
OWNER: AT&T PHONE: 206-523-1941
760 ALOHA ST
SEATTLE WA 98109
SUBDIVISION: Block: Lot: T 4+
PARCEL NUMBER: 901231004 Section: 23 Township: 29 N Range: 01 W
CONTRACTOR: TBD PHONE: 205-807-2541
PROJECT DESCRIPTION: ADD 4' MICROWAVE DISH ON EXISTING TOWER & NEW CABINET ON
EXISTING SLAB
TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL:
TYPE OF IMP NEW MAIN: INDUSTRIAL:
VALUATION 10,000.00 ADD'L: HEAT TYPE:
CODE EDITION: 2009 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM: Type Amount Paid By: Date: Receipt:
BATHROOMS: Permit $181.50 LYK 02/13/12 131442
Exist: Plan Check $117.81 LYK 02/13/12 131442
Prop: State Building Code $4.50 LYK 02/13/12 131442
Total: Total: $303.81
NUMBER OF EMPLOYEES:
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 7 am the day 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
• •
CONDITIONS for Building Permit# :BLD12-00042
1.) The existing wireless facility received review under ZON99-00057 and ZONO2-00073.
2.) The project shall adhere to the Best Management Practices(BMPs)to control stormwater,
erosion and sediment during construction. BMPs shall address permanent measures to
stabilize soil exposed during construction, and in the design and operation of stormwater
and drainage control systems.
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