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Home My WebLink AboutBLD2013-00003 • BUILDING PERMIT APPLICION BLD13-00003 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD13-00003 Received Date: 1/7/2013 SITE ADDRESS: 161 RIDGE DR PORT TOWNSEND, 98368 OWNER: IRMA D NOEL PHONE: 360-385-0597 161 RIDGE DR PORT TOWNSEND WA 98368-9435 CAPE GEORGE VILLAGE DIV 4 SUBDIVISION: Block: Lot: 6 PARCEL NUMBER: 940800006 Section: 13 Township: 30 N Range: 02 W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2014 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI A/G 120 GAL PROP TANK SWAP OUT TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION 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: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Propane Tanks/Stoves $76.00 LYK 01/07/13 139870 APPROVED Total: $76.00 JAN - 72012 Jefferson County DCD \Hirlarn r4\rint,fnrmc\F RI in Ann RIA m} 1/7/9(4 CERTIFICATE OF OCCUPANCY Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 Carl Smith, Director/Building Official PERMIT#: BLD13-00003 SITE ADDRESS: 161 RIDGE DR Issue Date: 01/7/2013 PORT TOWNSEND, 98368 Final Date: 3/25/2013 APPLICANT: IRMA D NOEL PHONE: 360-385-0597 161 RIDGE DR PORT TOWNSEND WA 98368-9435 SUBDIVISION: CAPE GEORGE VILLAGE DIV 4 Block: Lot: 6 PARCEL NUMBER: 940800006 Section: 13 Township: 30 N Range: 02 W PROJECT DESCRIPTION:A/G 120 GAL PROP TANK SWAP OUT THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2009 EDITION. OCCUPANCY GROUP: TYPE OF CONSTRUCTION: SPRINKLER SYSTEM yes no THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 3/25/2013 \\tidemark\data\forms\F_BLD Occupancy.rpt 3/27/2013 • 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#: BLD13-00003 Received Date 1/7/2013 SITE ADDRESS: 161 RIDGE DR Issue Date 1/7/2013 PORT TOWNSEND, 98368 APPLICANT: IRMA D NOEL PHONE: 360-385-0597 161 RIDGE DR PORT TOWNSEND WA 98368-9435 6 SUBDIVISION: CAPE GEORGE VILLAGE DIV 4 Block: Lot: PARCEL NUMBER: 940800006 Section: 13 Township: 30N Range: 02W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2014 OWNER, IRMA D NOEL PHONE: 360-385-0597 if different: 161 RIDGE DR PORT TOWNSEND WA 98368-9435 PROJECT DESCRIPTION: A/G 120 GAL PROP TANK SWAP OUT 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 1/7/2014. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: 7.4.N 3 20 /3 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_Perm it_Propane.rpt 1/7/2013 �� oN cod JEFFERS§COUNTY • G7 IA DEPARTMENT OF COMMUNITY DEVELOPMENT ", ~C 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax 4.q 4,c5 www.co.jefferson.wa.us/commdevelopment c Master Permit Application MLA: id rncA Proje t Description(includ- -•- ,to sheets_as n`ece,sary): , q b � ( ( • OP I Otl uLJn)0 p E:>' SCE r7e lf; Jo' 'c-7 o Tax Parcel Numb r: -I Oa* Mme' ' • p • -. (acres/square feet) Site •ddress and/or Pi ections to •ro•-rty: 'fl C E IJ V _1_ .��.c�� /r/ 'L� , 4 Pro•-rty Owner(s)of R'-cord: i--;A AVM! " , , , 111111 Telephone: . , /— .38:-- I S Fax: i , :G email: 111 4I Mailing Address: �'/_ p__, - -. V 4 Applicant/Agent(if different fro` owner): J FFERSON COUNTY .,,.•____J - . , I, T t i ' t ► t•r Telephone: Fax: - Mailing Address: What kind of Permit?(Check each box that applies ❑Lot or Road Segregation Auilding ❑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 I ❑ 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** ❑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)* 0 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 ❑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 e• ired later inspections, Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the me of the ap, •n that he or shs--wan p• otice. i . ignature: pal iii ,.r+' —I® Ot Date: /— 7— Z d / The action • 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 i ed 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 • are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual nd non-trans • • - responsibility for adhering • • 'lying i h the ESA. The Applicant has read this disclaimer and signs and dates it below. f�AP//►/ `"r� ignature: �/t Date: /— 7— v/ G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc III 0 BUILDER STATEME The signer of this statement does hereby certify that they are the Owners of the parcel -ferenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed proj ct. Signature: Date: GENERAL ONTRA TOR IR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: 1 NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: C� EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: O New 0 Wood Existing: 0 Sewer O Addition 0 Steel Proposed: Bank ❑ Community System O Alteration/Remodel 0 Concrete Total: _ Height: ❑ Individual System O Repair ❑ Masonry SEP Permit# O 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 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 'I Proposed IBC Occupancy: IBC Type of construction: I Will you have Food Service? Yes / No If this is a Pro•ane T.nk and/or A••liance Installation •-rmit mark all -ms below that a l i Underground Tank • •ove ground Tank Size of Prop I'ne Tank: I, t Heat Stove ► Cook Stove i Woodstove i Fireplace Insert i Hot W er Tank i Pellet St i Other Is this appliance being installed in a Manufactured/Mobile Home? Y / No When applying for a permit to install a propane tank you must also su+'mit a site plan showing all of the buildings,all property lines,tank location and size,distances from the propane tank to all pr.petty lines,buildings and septic system components, including the reserve area. 1 Square Footage Current Proposed For Office Uwe*jt. ,• Amount. Revision Main Floor Heated 1. EH Bld A•p Review: 2nd Floor Heated Consiste:cy Review: 1 Other Heated Base fee Mezzanine Addition. Section: Heated Basement Plan Ch: fee: Unheated Basement 1 State Su(charge fee: Other Unheated Pot Wat r Review fee: Garage/Carport I SUBTOTAL r' Decks 911/Rd pproach fee: Other TOTAL: $ Receipt Number: D Cash/C eck Number: ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish Initials: G:\Peru itCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit App .bon 5-29-08.doc