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Home My WebLink AboutBLD2013-00023 • BUILDING PERMIT APPLIiION BLD13-00023 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD13-00023 Received Date: 1/22/2013 SITE ADDRESS: 477 N JACOB MILLER RD PORT TOWNSEND, 98368 OWNER: PAUL D SAASTAD PHONE: 360-379-1804 NINA E SAASTAD 477 N JACOB MILLER RD PORT TOWNSEND WA 98368-9807 RHOADES/CARROLL SHORT PLAT SUBDIVISION: Block: Lot: 1 PARCEL NUMBER: 001051021 Section: 5 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 9/17/2014 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOII PELLET STOVE 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 01/22/13 9617885 Total: $152.00 APPROVED JAN 2 2 2013 Jefferson County DCD \\+irin.n rlArh+.\inrme\F RI rl Ann Rlrl rn+ q/99/9MZ 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#: BLD13-00023 SITE ADDRESS: 477 N JACOB MILLER RD Issue Date: 01/22/2013 PORT TOWNSEND, 98368 Final Date: 2/21/2013 APPLICANT: PAUL D SAASTAD PHONE: 360-379-1804 NINA E SAASTAD 477 N JACOB MILLER RD PORT TOWNSEND WA 98368-9807 SUBDIVISION: RHOADES/CARROLL SHORT PLAT Block: Lot: 1 PARCEL NUMBER: 001051021 Section: 5 Township: 30 N Range: 01 W PROJECT DESCRIPTION: PELLET STOVE 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 2/21/2013 \\tidemark\data\forms\F_BLD_Occupancy.rpt 3/20/2013 4 fr . v cO JEFFERSON COUNTY • DEPARTMENT OF COMMUNITY DEVELOPMENT "' ` '� 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax pY www.co.jefferson.wa.us/commdevelopment 81N Master Permit Application MLA: (1()(x, Project Description(in ude s par to sheet as necessary): f e///t s76ve Tax Parcel Number. CO I0 1 d7( Property Size: (acres/square feet) Site Address and/or Directions to Property: z/17 Al- Sfi ca_ p'I L L��. R . P1 7"6 ui nl 501,6 , (j) 9'7 3 L 7 Property Owner(s)of Record: / //L p . SJ9A 5 n'9 6 Telephone: 360 :37q f y i O W Fax: j Q /12 email:f AUL 51;i .5-- 7W G- `/ n /1 Mailing Address: '7 77 At �7 C i, 1 C -1-1 /C 1, P' T (,q - m A/L • Co I") Applicant/Agent(if different from owner): Telephone: Fax: email: 1� ( F L Mailing Address: at kind of Permit?(Check each box that applies ❑Lot or Road Segregation , jiliAlBuilding ❑Critical Areas Stewardship Plan `r, � ?(�13 ;r ❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) ❑Single Family ❑Garage Attached/Detached ❑Conditional Use[C(a),C(d),or Cl'" ---3 i ❑ 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' ❑Sign .... ❑Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration** ❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions** O 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 ❑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 a lue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to •..vide access •nd right of entry to J-. erson County and its employees,representatives or agents for the sole purpose of application review and any, uir.,•e er in,pec i• -�-wnv ss an•right of entry will be assumed unless the applicant informs the County in writing at the time of the a�,• tion he r she wa prior n�r�-. t Signature• ■. _ .�1■7 - Date:/ Z 2 — , Pr The action or actions A•plicant 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 S•ecies Act"or"ESA"Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit ha- •een rued will not v' ate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s eveh if yo are in co •liance with t'a Jefferson County development code.The Applicant acknowledges that he,she or it holds individual Viand no -tra s - ••le r .•• • •T ng • :nd complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. 1Signa re j".. ' . i, ■s Date: / — Z 2 — 7.- • • BUILDER STATEME T • The signer of this statement does hereby certify that they are the Owners of the parcel eferenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed pro, ct. Signature: Date: GENE L CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: AreA \ ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: I PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: O New ❑ Wood Existing: 0 Sewer ❑ Addition 0 Steel Proposed: Bank ❑ Community System O Alteration/Remodel 0 Concrete Total: Height: 0 Individual System ❑ Repair 0 Masonry SEP Permit U Bedrooms: Water Supply: ❑ Demolition ❑ Other: pp y: Existing: Setback: ❑ Private well ❑ 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 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 irb..ellet Stove 1 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, including the reserve area. F M C Square Footage _ Current Proposed Office Use`Only Amount, vision Main Floor Heated f EH Bld App Review: 2"°Floor Heated Consistency Review: Other Heated Base fee: i Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated- - Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $ t Receipt Number: Cash/Check Number: ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish Initials; 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#: BLD13-00023 Received Date 1/22/2013 SITE ADDRESS: 477 N JACOB MILLER RD Issue Date 1/22/2013 PORT TOWNSEND, 98368 APPLICANT: PAUL D SAASTAD PHONE: 360-379-1804 NINA E SAASTAD 477 N JACOB MILLER RD PORT TOWNSEND WA 98368-9807 1 SUBDIVISION: RHOADES/CARROLL SHORT PLAT Block: Lot: PARCEL NUMBER: 001051021 Section: 5 Township: 30N Range: 01W CONTRACTOR: EVERWARM INC PHONE: (360)452-3366 257151 HWY 101 PORT ANGELES WA 98362 Contractor's License EVERWI*088NL Expires 9/17/2014 OWNER, PAUL D SAASTAD PHONE: 360-379-1804 if different: NINA E SAASTAD 477 N JACOB MILLER RD PORT TOWNSEND WA 98368-9807 PROJECT DESCRIPTION: PELLET STOVE 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 1/22/2014. REQUIRED INSPECTIONS: Tank/Line/Appliance: 2 Zt - 13 (3 FinalApproval: 2--.2c - 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_Permit_Propane.rpt 1/22/2013