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HomeMy WebLinkAboutBLD2006-00708 ibILDING PERMIT APPLICATION BLD06 00708 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00708 Received Date: 12/20/2006 SITE ADDRESS: 10635 RHODY DR PORT HADLOCK, 98339 OWNER: DAN YOURA PHONE: 379-8800 CAROLYN ALLEN PO BOX 1169 PORT HADLOCK WA 983391169 CHALMER'S 2ND ADDITION SUBDIVISION: Block: Lot: PARCEL NUMBER: 942903704 Section: 3 Township: 29 N Range: 01 W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2008 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI NO MLA REQ'D PROPANE TANK SWAPOUT SAME SIZE SAME LOCATION 250 GAL TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION CODE EDITION: 2003 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: 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 Permit $51.00 DJK 12/20/06 87052 APPROVED Total: $51.00 APPROVED DEC 20Z Jefferson County DCD 1 R+-11k411 vED � �ygON �'G JEFFERSOID'JUNTY f(✓1) N 3_ 70% / - 'Y}' DEPARTMENT OF COMMUNITY DEVELOPMENT DEC W Kt 621 Sheridan Street • Port Townsend • Washington 98368 '� $ 360/379-4450 •• 3601379-4451 Fax i lL H `�r�,+u�11��D eq www.co.jefferson.wa.us/commdevelopment J(�'Y un r 137N j, Master Permit Application a MLA: Iv C1 \L4 V2-EQ.D Project Description(include separate sheets as necessary): fR© r. !ye_ -r79A/K sw, : Dtir S7 'Me zac4-0 roN Tax Parcel r ) # Q 1� Property / Number: 1-°1-'a C C I'j I lY c) E- I "1 ''903—7Qy Size: �,0 6 0(/x /,a/6 (acres/square feet) Site Address and/or Directions to Property: / d 6 3 leJ QJ,y D f o i / 77c9 I04 ' 9 33 r Property Owner(s)of Record" b R N `)0IA2 A- 4 Cr4 ra o f J 'S L L E& Telephone: 3 —2 q �O O Q Fax: © email: Ga il/La/)w F-~C,[241 Mailing Address: P co .P N ,y pi DZ'r( 1/1/ 7, ,-T3 9 Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: 4hat kind of Permit?(Check each box that applies) uilding 1 Variance(Minor, Major or Reasonable Economic Use) I Demolition Permit 1 Conditional Use[C(a), C(d), or C]** 1 Single Family 1 Discretionary"D"or Unnamed Use Classification 1 Garage Attached/Detached I Special Use(Essential Public Facilities)** I Manufactured Home I Boundary Line Adjustment I Modular • 1 Short Plat** I Commercial* I Binding Site Plan** I Change of Use 1 Long Plat** 1 Address 1 Road Approach 1 Planned Rural Residential Development(PRRD)/Amendments** Propane 1 Plat Vacation/Alteration** 1 !lowed"Yes"Use Consistency Analysis 1 Shoreline Master Program Exemption/Permit Revisions** 1 Stormwater Management 1 Shoreline Management Substantial Development** 1 Site Plan Approval Advance Determination(SPAAD)* 1 Shoreline Management Variance 1 Temporary Use 1 Comprehensive Plan/UDC/Land Use District Map Amendment 1 Wireless Telecommunication* 1 Jefferson County Shoreline Master Program Amendment I Forest Practices Act/Release of Six-Year Moratorium *May require a Pre—Application Conference **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 attorneys 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 that he or she wants prior notice. JZ _2 1) - Signature: U 1-14 Date: 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-transfera a responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates lt below. Signature: .,,A 1 to 2` Date: / 2-� — 06 1 G:\PemtitCenter\FORMS\DRD FORMS\Master Permit Application 07-14-2006.doc 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: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition CI Other: Bedrooms: Water Supply: Existing: Setback: a Private well G Two Party Type of Heat: Proposed: Total: Public 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)(Above ground Tank Size of Propane Tank: a,\ 1 1 Heat Stove i Cook Stove i Woodstove i Fireplace Insert i Hot Water T-4 i Pellet Stob i Other Is this appliance being installed 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 Bld App Review: 2"0 Floor Heated Consistency Review: Other Heated Base fee: 151 . b0 Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL 51 . 00 Decks 911/Rd Approach fee: Other TOTAL: $5 1 . 10 Receipt Number: % QS ' - Cash/Check Number: d _6 2 ESTIMATED COST(REQUIRED) Date: I •Fair market value of all labor and materials foundation to finish I a-ab Initials: \-.....' G:\PemutCenter\FORMS\DRD FORMS\Master Permit Application 07-14-2006.doc a•■ ••Y••••, VnV WY•• ‘• •bV - ■I Borrower/Client Dan Youra Property_Address 10635 Rhody Drive -_ . City Port Hadlock County Jefferson State Wa Zip Code 98339 Lender American Marine Bank REVIVED DEC 2 0 20 16e • FFF 1Ol OMR tlrll E UTILITY PATIO b ° cc l Cl MULTI-PURPOSE COVERED PORCH ,, 51-0' 16.0' , Ljj.JJ -Hi : _I 1 18.0' CLOSET BEDROOM I BATH KITCHEN b I FURN ,....:_i ` I LIVING ROOM o b N. 0, N GARAGE N ° BEDROOM CLOSET DEN DINING N o z_.t/`r'Q�/ 05).0. 18.0' G� rn COVERED PORCH 'PRO PAN -�- 1 1 —rArJ, I IUuJ Sketch by Apex IV° Comments: AREA CALCULATIONS SUMMARY LIVING AREA BREAKDOWN Code Description Size Net Totals Breakdown Subtotals GLAl First Floor 1020.00 1020.00 First floor GAR Garage 320.00 320.00 10.0 x 51.0 510.00 OTH Storage 384.00 384.00 10.0 x 51.0 510.00 1 • • PROPANE/PELLET/WOOD STOVE & TANK INSTALLATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD06-00708 Received Date 12/20/2006 SITE ADDRESS: 10635 RHODY DR Issue Date 12/20/2006 PORT HADLOCK, 98339 APPLICANT: DAN YOURA PHONE: 379-8800 CAROLYN ALLEN PO BOX 1169 PORT HADLOCK WA 983391169 SUBDIVISION: CHALMER'S 2ND ADDITION Block: Lot: PARCEL NUMBER: 942903704 Section: 3 Township: 29N Range: 01W CONTRACTOR: C H S INC PHONE: (360)732-4585 PO BOX 518 AUBURN WA 98071-0518 Contractor's License CHSIN**9790Z Expires 9/7/2008 OWNER, DAN YOURA PHONE: 379-8800 if different: CAROLYN ALLEN PO BOX 1169 PORT HADLOCK WA 983391169 PROJECT DESCRIPTION: NO MLA REQ'D PROPANE TANK SWAPOUT SAME SIZE SAME LOCATION 250 GAL 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 12/20/2007. REQUIRED INSPECTIONS: Tank/Line/Appliance: A),� /10s7-4".0611.) 06/1)8 - FinalApproval: O -SOY ti?tail th(let 4" BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:00 a.m. -4:30 p.m. HOT LINE AVAILABLE 24 HOURS A DAY I 1F_BLD_Permit_Propane.rpt 10/29/19