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HomeMy WebLinkAboutBLD2013-00072 BUILDING PERMIT APPLICION BLD13-00072 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD13-00072 Received Date: 3/4/2013 SITE ADDRESS: 80 MARINER PL PORT LUDLOW, 98365 OWNER: JOHN A DIRKSEN PHONE: 360-215-4067 ELVA LEDESMA DIRKSEN 80 MARINER PL PORT LUDLOW WA 98365-9765 BAYVIEW VILLAGE DIV 2 SUBDIVISION: Block: Lot: PARCEL NUMBER: 931900005 Section: 16 Township: 28 N Range: 01 E 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 DESCRIPTIOP PROPANE TANK SWAMP OUT TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC VALUATION MAIN: CODE EDITION: 2009 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: 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 $76.00 JLA 03/04/13 140056 APPROVED Total: $76.00 MAR 0 4 2013 Jefferson County DCD \\+iricmnrk\rintn\fnrmc\G RI Il Ann PIA rn+ "2/Y1/0(11q 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 #: BLD13-00072 SITE ADDRESS: 80 MARINER PL Issue Date: 03/4/2013 PORT LUDLOW, 98365 Final Date: 5/1/2013 APPLICANT: JOHN A DIRKSEN PHONE: 360-215-4067 ELVA LEDESMA DIRKSEN 80 MARINER PL PORT LUDLOW WA 98365-9765 SUBDIVISION: BAYVIEW VILLAGE DIV 2 Block: Lot: PARCEL NUMBER: 931900005 Section: 16 Township: 28 N Range: 01 E PROJECT DESCRIPTION: PROPANE TANK SWAMP OUT THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2009 EDITION. OCCUPANCY GROUP: TYPE OF CONSTRUCTION: SPRINKLER SYSTEM yes n THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 5/1/2013 \\tidemark\data\forms\F_BLD_Occupancy.rpt 5/16/2013 � , 0N co JEFFERSON COUNTY • rz, �� DEPARTMENT OF COMMUNITY DEVELOPMENT '' ` ' 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax � .0 www.co.jefferson.wa.us/commdevelopment bTIN Master Permit Application MLA: Project Description(include separate sheets as necessary): D(zdpFINE -TfINv- - SWfP 0 bc—i- Tax Parcel Number: ¶3 j ? '0 no OS Property Size: (acres/square feet) Site Address and/or Directions to Property: o rna.rt'Ne -- PL) Y L.&W/-6(A) 1A)A g36S- Property Owner(s)of Record: �C 1-1 N 'f' ELV/ ,b( Telephone: �j to D`2/5--- 1-f©b7 1 Fax email: Mailing Address: g b 114& i iv`e C f 1.) ft rf LidlocAl' W/1 Cr g36S Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies El 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** ❑Sign ❑Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes" Use Consistency Analysis ❑ Plat Vacation/Alteration** El 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 ❑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 C EN e X 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. Staff's access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applicatii�gp that he or h wants prior notice. Signature: a����'v� C e - NY-K3114- Date: _7_4` 2d 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-transf le respon bi ity for adhering t and with the ESA. The Applicant has read this disclaimers and signs and dates it below. Signature: trl ,/,.._ Date: 3^T'- 2ô 13 . • 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 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: New ❑ Wood Existing: a Sewer E Addition S Steel Proposed: Bank ❑ Community System ✓ Alteration/Remodel ❑ Concrete Total: _ Height: ❑ Individual System • Repair ❑ Masonry SEP Permit# 10 Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: r 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 Pro•ane Tank and/or A••liance Installation •ermit mark all items below that a••1 : Underground Tank i Above ground Tank Size of Propane Tank: Heat Stove Cook Stove i Woodstove I Fireplace Insert Hot Water Tank Pellet Stove Other Is this appliance being installed in a Manufactured/Mobile Home? Yes I 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: 2ntl 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: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $ 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 #: BLD13-00072 Received Date 3/4/2013 SITE ADDRESS: 80 MARINER PL Issue Date 3/4/2013 PORT LUDLOW, 98365 APPLICANT: JOHN A DIRKSEN PHONE: 360-215-4067 ELVA LEDESMA DIRKSEN 80 MARINER PL PORT LUDLOW WA 98365-9765 SUBDIVISION: BAYVIEW VILLAGE DIV 2 Block: Lot: PARCEL NUMBER: 931900005 Section: 16 Township: 28N Range: 01E 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, JOHN A DIRKSEN PHONE: 360-215-4067 if different: ELVA LEDESMA DIRKSEN 80 MARINER PL PORT LUDLOW WA 98365-9765 PROJECT DESCRIPTION: PROPANE TANK SWAMP 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 3/4/2014. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: 4343 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 3/4/2013