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HomeMy WebLinkAboutBLD2013-00246 •BUILDING PERMIT APPLICA N B 0246 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD13-00246 Received Date: 8/12/2013 SITE ADDRESS: 883 WALKER WAY PORT LUDLOW, 98365 OWNER: JAMES I FULTZ PHONE: 360-437-0989 DEBORAH K FULTZ 883 WALKER WAYILL RD PORT LUDLOW WA 98365 PORT LUDLOW NO. 4 SUBDIVISION: Block: Lot: PARCEL NUMBER: 990500075 Section: 8 Township: 28 N Range: 01 E CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTION INSTALL STOVE AND TANK INSTALL (INSERT) TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION 4,600.00 ADD'L: HEAT TYPE: EEE 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 08/12/13 142372 APPROVED Total: $228.00 AUG 12 2013 Jefferson County DCD \\}irlcmnrIArlofo\fnrme\G RI n Ann PIA rnf pm-nom-4 of gsoN o ■ ► (? - 2 q J RSQN COUNT Y � °� ti DTPARTMENT OF COMM i ITY DEVELOPMENT off 621 Sheridan Street I Port Townsend,WA 98368 I Web:www.co.Jefferson.wa.us/communitydevelopment �sXING� Tel:360.379.4450(Fax:360.379.4451 I Email:dcd @co.jefferson.wa.us Building Permits&Inspections J Development Consistency Review J Long Range Planning I Watershed Stewardship Resource Center Master Permit Application MLA: Project Description(include separate sheets as nec�esss�a�ry):a d 7 ..�F-a x�- ( s)�yt,C ) Tax Parcel Number: 1 05-0 0(Y1 Property Size: (acres/square feet) Site Address and/or Directions t r : 803 ° r Property Owner(s)of Record: J Q e S vs ,'e.L An A,.. /f 2- Telephone: ,360 �1J. Fax: email: , = ,, Mailing Address: 8�'J r t,J4— ,°4 /-u d/ di../' , (�� SI 7' 5 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 ❑ 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** j2.Propane ❑ Long Plat** ❑Sign ❑ Planned 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** O Temporary Use ❑Shoreline Management Variance O 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. 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-••lication that he or she want.nor notice. 0.2A5 Signature:Vi, , _.• �4( . ,L Date: The action or actions Applicant will underta e 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-tran rabl responsibility for adhering to and complying with the ESA. The Applicant has read this discclplai er an signs and dates it below. Signature: Jam' lA'r Date: f1/2 an (( 07/24/2013 • 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 res.•nsibility of the eral Contractor for the proposed project. Signature: 'A-L i i4�J Date: 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: Shoreline: Type of Sewage Disposal: New Wood Existing: Sewer Addition Steel Proposed: Bank Community System Alteration/Remodel Concrete Total: Height: Individual System Repair Masonry SEP Permit# Demolition Other: Bedrooms: Water Supply: Existing: Setback: Private well 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 Above ground Tank Size of Propane Tank: Heat Stove Cook Stove i Woodstove 1 Fireplace Insert i Hot Water Tank 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. T Square Footage Current Proposed or ti se vi l5 Main Floor Heated t t 7 EH Bid App Review: 2m Floor Heated -, Consistency Review: 8 4a Other Heated r Base fee: AZT Mezzanine Additional Section: Heated Basement 6 .,, Plan Check fee: att- Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 1 911/Rd Approach fee: Other 001AChit TOTAL: $ -3:14**= Receipt Number: Cash/Check Number: ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish Initials: 07/24/2013 a - I X fi m co -I -b x -I -I co o) -- -- 0) V Cl) m x Q n r+ x o C) -, v co o — V -, -s C) o) < Q CD 0) O CD 3 -n cc -- co CC co co C CD rF O CD - 7 7C r -5 E -3 •• CD -I O 7 # C Ca) - N CD C) O - CO -3 Q O O O - -' 0 O O O Cn TI Co 4 C CO r o -I 0 0 CO O 0 0 0 -.I < Cl) o Cl) o rF - 0) -n V co Co L C7 -. 1+ c r no Ci) O CO MI D O -0 C r O O CD 33 CO 00 X 3 0) U) -I -I 0 -I O m -o 0 NI -I X 33 CO r CD -I - -.4 n 73 I- a a m x cn r Q In CD c r x I-I -I C c a C ) 7C In a O CO I- r m 7C -71 -I 3 r co o O c 3] a m O N rn X T r o x CO f - 73 -- X c -I o a 0 0 a r N 73 03 I-I Z CO rn -< -I m I- o -P m X I-♦ N CO rn • o M o_ a r CO -4 -1 r 4 N -C X X Ca) -- Co zi H -r 3 D CO v z 3> o_ CO o n r- Cl) o O o m -i E Cn X c o m Q :ID CI O C Q CO CD CD O O -I -1 C-) 3 V V r o no o z rn n n c) CT n -.1 Cf) 3 3 3 C -- I CO CD I-I 0. rl- Cn o 0 In I-I c C7 n Z co r+ Q 33 3 0. Ci) -5 0 0 I- Ca] - D- O m CO N CO - CD -b CO •- CO •• •• o cn C_ ^.I O I-i O • 1l Z O" N -n so O c -+ I-♦ N 33 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#: BLD13-00246 Received Date 8/12/2013 SITE ADDRESS: 883 WALKER WAY Issue Date 8/12/2013 PORT LUDLOW, 98365 APPLICANT: JAMES I FULTZ PHONE: 360-437-0989 DEBORAH K FULTZ 883 WALKER WAYILL RD PORT LUDLOW WA 98365 SUBDIVISION: PORT LUDLOW NO. 4 Block: Lot: PARCEL NUMBER: 990500075 Section: 8 Township: 28N Range: 01E CONTRACTOR: OWNER/BUILDER PHONE: OWNER, JAMES I FULTZ PHONE: 360-437-0989 if different: DEBORAH K FULTZ 883 WALKER WAYILL RD PORT LUDLOW WA 98365 PROJECT DESCRIPTION: INSTALL STOVE AND TANK INSTALL(INSERT) 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 8/12/2014. REQUIRED INSPECTIONS: # 1 a V 13 Tank/Line/Appliance: '<Lot Og 1.41,AL*41.144-4. FinalApproval: aA' $/Z7/13 G� 1 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 8/12/2013 {. .k 4,j="„�i<4.- L Date 8 am/z-6 time received If ” !pm Mon. 41, Wed: Thur. -Sri. BLD: 13 244, Date: B/2 7 OWNER: fttiztZ. Contact Name: ADDRESS: e83 •W LK 1) Pi.- �[ Contact Number:360 l37' ©159 °jam �� . Notes: T •Z©P,4 b Ten i145+�'�C f A UY_ 286 /6 _I ' r` Foundation Plumbing - Framing . Propane Tank . - ' Mechanical Setbacks _ Under-ground Framing _____ Under ground Furnace Footing Rough In Air seal — Stemwalt _ Hydronic Above ground Gas il Exterior shear Exterior lines Oil Straps interior shear Interior lines •Post Hole Ventilation Ducts Underfloor Appliance Man-Homes Gas/wood stove Setbacks insulation. - Foundation — Final Inspection Block&Tie ' s, — floor _wall ceiling- . tb Address Posted • C V l • "'N \ W •