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HomeMy WebLinkAboutBLD2013-00012 • BUILDING PERMIT APPLIAION BLD13-00012 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD13-00012 Received Date: 1/15/2013 SITE ADDRESS: 235 MEADOW RD PORT TOWNSEND, 98368 OWNER: MARK SABELLA PHONE: 360-385-3927 STACY SABELLA 235 MEADOW RD PORT TOWNSEND WA 98368-8919 RAVENS RIDGE SHORT PLAT SUBDIVISION: Block: Lot: 1 PARCEL NUMBER: 002124028 Section: 12 Township: 30 N Range: 02 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr WOODSTOVE INSTALLED IN SFR 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 $152.00 LYK 01/15/13 139898 APPROVED Total: $152.00 D JAN 15 2012 Jefferson County L CL Wir4nmor4lr4o4o1fnrmc\F RI n Ann 1:2Ir1 m4 1/1 F/9!11'2 is • 5labe/(A 23C Ae-61hv) 7 17-' _ v6- -R LI V -(0 v et 1 ,FE 0 1 JAN 1 5 2013 isj Oct- JEFFERSON COUNTY ... !C L DEPT.OF COMMUNITY DEVELOPMENT ii G 1,s P° ere fl6L' _____-- ..] 1 CiIY°1 eV 0'6(;\ 7,etir 1 Demito6t -••• , 44$ cod JEFFERlik COUNTY W ' $ DEPARTMENT OF COMMUNITY DEVELOPMENT 1.I"° ` 621 Sheridan Street• Port Townsend •Washington 98368 . ' ' 360/379-4450 • 360/379-4451 Fax .4 7N > www.co.jefferson.wa.us/commdevelopment G Master Permit Application MLA: C Project Description(include separate sheets as necessary): ,.. i stz l (/Vc'CJ 47( 5/0 Lie- Tax Parcel Number: c0-1"4© Property Size: S' (acres/square feet) Site Address and/or Directions to Property: 02 35 T1 eado&) 7c( 277 /lJ411YIsoNc 'Property Owner(s)of Record: ma/4- a Nom° Sfa(L ,Sa b// • Telephone: 3B-5 3CtZ/ Fax: email: / 99S cy skee/ 7 Mailing Address: 0�' ei ium pu s, pie C Applicant/Agent(if different from owner): y ✓ _J Telephone: y Fa,/ email: Mailing Address: / V hat kind of Permit?(Check each box that applies ❑Lot or -<.r. I�.l •� '. Building 0 Criti« �, �' '�.`v F 0 Demolition Permit 0 Varia :r1'' • , . . _ _ „ : T. ic Use) ❑Single Family ❑Garage Attached)Detached ❑Condi i• se[C(a),C(d),or C]** I ❑ Manufactured Home .❑ Modular ❑ Discr:t�n=ry"D"p� �nn r ed se Cl. .. "9. ion ❑ Commercial* 0 Speci sa;(Es s le I Public line D Change of Use D Boun : [4. e Adjustment ❑ Address 0 Road Approach ❑Sho Plat*+--�.� ❑Home Business ❑Cottage Industry ❑Bindi g Site Plan FERSON COUNNTTy O Propane ❑Long4Iat APT OF COMMUNITY DEilELOPMENT O Sign 0 Planned Rural Residential Deve opmen RD)/Amendments** O Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration ❑Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions** O Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development** O Temporary Use 0 Shoreline Management Variance O Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendment O Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference D 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 `ltime of the application that he or sh-w- is prior notice. J`4jgnature: 1 .-1 .. 6 Date: ///37/3 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-transferable responsibili or adhering to and complying with the ESA. The Applicant has read this disclaim r and signs and dates it below. %Signature: /l/t(1 Date: "57/7i G:\PennitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc �I BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel teferenced herein,that they are not licensed contractors and that they will be assuming the responsibili of the General Contractor for the proposed proct. gnature: C '��(�!` jaa Date: '/l �/3 GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: I ( ) ( ) MAILING ADDRESS: 1 EMAIL: CONTRACTOR'S LICENSE I WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: I PHONE ( ) FAX:( ) MAILING ADDRESS: j EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: • New ❑ Wood Existing: ❑ Sewer ❑ Addition 0 Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: _ Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well 0 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 I 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 Underground Tank i Above ground Tank Size of Propane Tank: I Heat Stove 1 Cook Stove )4llfoodstove i Fireplace Insert I Hot WEer Tank 1 Pellet Stove I Other Is this appliance being installed in a Manufactured/Mobile Home? Y /(.....,4 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. F Square Footage Current Proposed For Office Use Only, out :Revision Main Floor Heated EH Bld App Review: 2""Floor Heated Consistel'icy Review: Other Heated Base fee: Mezzanine Additiona Section: Heated Basement Plan Chek fee: Unheated Basement State Surlcharge fee: Other Unheated Pot Wat •Review fee: Garage/Carport SUBTOTAL Decks 911/Rd fi pproach fee: Other ..--TOTAL: $ I Receipt \lumber: iLlser3 Cash/Chieck Number: -4--7 ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish Initials: G:\PemutCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Appli ation 5-29-08.doc 1 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#: BLD13-00012 Received Date 1/15/2013 SITE ADDRESS: 235 MEADOW RD Issue Date 1/15/2013 PORT TOWNSEND, 98368 APPLICANT: MARK SABELLA PHONE: 360-385-3927 STACY SABELLA 235 MEADOW RD PORT TOWNSEND WA 98368-8919 1 SUBDIVISION: RAVENS RIDGE SHORT PLAT Block: Lot: PARCEL NUMBER: 002124028 Section: 12 Township: 30N Range: 02W CONTRACTOR: OWNER/BUILDER PHONE: OWNER, MARK SABELLA PHONE: 360-385-3927 if different: STACY SABELLA 235 MEADOW RD PORT TOWNSEND WA 98368-8919 PROJECT DESCRIPTION: WOODSTOVE INSTALLED IN SFR 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 1/15/2014. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: S-;,e,,( .)L 1—Z3-13 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 1/15/2013