HomeMy WebLinkAboutBLD2013-00385 BLD13-00385
BUILDING PERMIT APPLIC ifil ON Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD13-00385 Received Date: 12/11/2013
SITE ADDRESS: 70 COLE AVE
PORT TOWNSEND, 98368
OWNER: SUSANNA BAIR TRUSTEE PHONE: 714-412-0621
BAIR FAMILY TRUST
PO BOX 437
SUNSET BEACH CA 90742-0437 CAPE GEORGE VILLAGE DIV 7
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 941500020 Section: 19 Township: 30 N Range: 01 W
CONTRACTOR: EVERWARM INC PHONE: (360)452-3366
257151 HWY 101
PORT ANGELES WA 98362
Contractor's License EVERWI*088NL Expires 8/17/2014
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION Install Woodstove in front of existing fireplace
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP MEC MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 2012 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: SHORELINE:
GARAGE: SETBACK:
CONST TYPE: DECK:
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 12/11/13 145615 PP
p ROVED
Total: $152.00 APPROVED
DEC 1 1 2013
Jefferson County DCD
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4, at, JEFFERSOOUNTY
-s_ ' `'h4 DEPARTMENT OF COMMUNITY DEVELOPMENT
1-3 621 Sheridan Street • Port Townsend •Washington 98368
4. 360/379-4450 • 360/379-4451 Fax
IrsAIN www.co.jefferson.wa.us/commdevelopment
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Master Permit Application MLA:
Project Description(include separate sheets as necessary):
Tax Parcel Number: 9 1 5 e 0e0 2 .
O Property Size: . . 5 ai.quare feet)
Site Address and/or Directions to Property:
_ ( )-4______P-----2- .
Property Owner(s)of Record: ,,W c ..*. r .S c ■g, .:' v e . t ,cQ r+,
Telephone: I ?i y `il 2_ c 1,1-- i Fax: email: `�
Mailing Address: ?.l0. . jSy `-1-3 7 5- ,,,Se*"& -& C 41 ) `) 3
Applicant/Agent(if different from owner): tI\ r. .Yr�
Telephone: 3k '3$ C '17 1) Fax: email: .. s c �. .C�
Mailing Address: Z 0 ' I . A 1 - -
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 ❑Short Plat**
❑ Home Business ❑Cottage Industry ❑Binding Site Plan**
❑ Propane ❑Long Plat**
o 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**
❑Temporary Use ❑Shoreline Management Variance
❑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 El 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 application thai he or s e wa s prior notice.
Signature: 1 t - 4",.— Date: i -1...../1 J ) 3
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(able res nsibili or adhering to and complying with the ESA. The Applicant has read this disclaim and si ns and dates it below.
Signature: t Q N-- Date: I Z ) si
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
• BUILDER STATEMENT II
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: Fax:
( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTORS LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE
( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
O New 0 Wood Existing: ❑ Sewer
O Addition 0 Steel Proposed: Bank 0 Community System
O Alteration/Remodel ❑ Concrete Total: _ Height: ❑ Individual System
O Repair ❑ Masonry — SEP Permit#
O Demolition ❑ 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 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:
I U ound Tank I Above gro I. k Size of Propane Tank:
I eat Stov' I Cook Stove I ••dstove I Fireplace Insert I Hot Water Tank I Pellet Stove I Other .
Is this appliance being instal e. 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 BId App Review:
2�Floor Heated Consistency Review: —
Other Heated Base fee:
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee:
Other Unheated .. Pot Water Review fee: y
Garage/Carport SUBTOTAL
Decks 911/Rd Approach fee:
Other TOTAL: $
Receipt Number: I'f. f'(c.
Cash/Check Number:
(2_((9 3 r/ � —
ESTIMATED COST(REQUIRED) Date: 11 t t�
•Fair market value of all labor and materials foundation to finish l 2 (( /S
Initials: ( y
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
Jefferson Co Dept of Comm Li WA- Online Payments • Page 1 of 1
-C. Jefferson County
Step 1:Select Payments Step 2:Review and Submit Step 3:Confirmation and Receipt
Step 3: Confirmation and Receipt
Result: Payment Authorized
Confirmation Number: 12163162
Your payment has been authorized successfully and payment will be processed.
Jefferson County Department of Community Development thanks you for your payment.For questions about your account,please call 360-379-4452 Thank you for using
our bill payment services.
Please save or print a copy of this receipt for record keeping purposes.
My Bills
'Description Amount Due
$152.00
Due
Residential Applications payment of$152.00 on Parcel Number 941500020 $152.00
Subtotal:
Customer Information Convenience Fee: $5.00
Total Payment: $157.00
First Name: Michael G
Last Name: Bair
Address Line 1: 201 Pond Rd
Address Line 2:
City: Port Townsend
State: Washington
Zip Code: 98368
Phone Number: 360-385-7716
Email Address: mgbair @gmail.com
Payment Information
Card Number: ************3731
Expiration Date:**/**
Print
https://client.pointandpay.net/web/JeffersonCoDeptofCommDevWA 12/11/2013
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SON co JEFFERSON JEFFERSON COUN•
•
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DEPARTMENT OF COMMUNITY DEVELOPMENT
Date: ? Time Received: 94x9 co/pm Mon. Tue. der. Thur. Fri.
Date: ` O
BLD: l 3 — 3.3c Contact Name:
Owner: Contact Number: 360 SC( f
Address: —10 C.--0 Le A,,JO. 206
Notes: UODeb .
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
- -- - - --
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#: BLD13-00385 Received Date 12/11/2013
SITE ADDRESS: 70 COLE AVE Issue Date 12/11/2013
PORT TOWNSEND, 98368
APPLICANT: SUSANNA BAIR TRUSTEE PHONE: 714-412-0621
BAIR FAMILY TRUST
PO BOX 437
SUNSET BEACH CA 90742-0437
SUBDIVISION: CAPE GEORGE VILLAGE DIV 7 Block: Lot:
PARCEL NUMBER: 941500020 Section: 19 Township: 30N Range: 01W
CONTRACTOR: EVERWARM INC PHONE: (360)452-3366
257151 HWY 101
PORT ANGELES WA 98362
Contractor's License EVERWI*088NL Expires 8/17/2014
OWNER, SUSANNA BAIR TRUSTEE PHONE: 714-412-0621
if different: BAIR FAMILY TRUST
PO BOX 437
SUNSET BEACH CA 90742-0437
PROJECT DESCRIPTION: Install Woodstove in front of existing fireplace
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 12/11/2014.
REQUIRED INSPECTIONS:
Tank/Line/Appliance:
FinalApproval: `f 0 V25-15—
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 12/11/2013