HomeMy WebLinkAboutBLD2010-00014 'BUILDING PERMIT APPLICA•N MA e0 000 14
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #:
SITE ADDRESS: BLD10-00014
20 APPALOOSA PL Received Date: 1/13/2010
BRINNON, 98320
OWNER: TODD K PETERSON PHONE: 360-796-2947
JACKI V STRATTON
PO BOX 430
BRINNON WA 983200430 LAZY C RANCH DIV 1
SUBDIVISION: Block: Lot: 4
PARCEL NUMBER: 966900004 Section: 34 Township: 26 N Range: 02 W
CONTRACTOR: TIMBER IRON ERECTORS PHONE: 360-670-6227
DAVID RICHARDSON
PO BOX 516
CARLSBORG WA 98324
Contractor's License TIMBEI952QC Expires 11/3/2009
REPRESENTATIVE: DAVID RICHARDSON PHONE: 360-670-6227
TIMBER IRON ERECTORS
PO BOX 516
PROJECT DESCRIPTIOI■ NSFR REPLACEMENT ON EXISTING FOUNDATION
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 784
VALUATION 95,621.00 ADD'L: 392 HEAT TYPE: WOD
CODE EDITION: 2006 HEAT BASE: HEAT TYPE:
OCCUPANCY: R-3 UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: 5N GARAGE: SHORELINE:
CONST TYPE: DECK: 308 SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: OTHER
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 1 Prop: 1
Total: 1 TotalY :---�
Routing Date: -
- t3-Ib
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $965.75 LYK 01/13/10 113642 AP®®®�, `Et
Plan Check $627.74 LYK 01/13/10 113642 1� ( � V
State Building Code $4.50 LYK 01/13/10 113642 AP? 5 2QWU
Potable Water Application $98.00 LYK 01/13/10 113642
Total: $1,695.99 Jefferson County Plannin g
&Building Department
�,ON c ,, DEPARTMENT OF COMMUNITY DEVELOPMENT
a 621 Sheridan Street,Port Townsend,\X'?r 98368
Tel:360.379.4450 I Fax:360.379.4451
Web:www.co.jefferson.wa.us/communitydevelopment
�-q Ok E-mail: dcdaco.jefferson.wa.us
SfI1 NCI'
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CERTIFICATE OF OCCUPANCY
PERMIT#: BLD10-00014
APPLICANT: JACKI V STRATTON PHONE: 360-796-2947
20 APPALOOSA PL
BRINNON WA 98320-0430
SITE ADDRESS: 20 APPALOOSA PL Issue Date: 04/5/2010
BRINNON, 98320 Final Date: 9/23/2015
SUBDIVISION: 9669- LAZY C RANCH Block: Lot:
PARCEL NUMBER: 966900004 Section: 34 Township: 26 N Range: 2W
PROJECT DESCRIPTION: NSFR REPLACEMENT ON EXISTING FOUNDATION
THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2006
EDITION.
OCCUPANCY GROUP: R-3
TYPE OF CONSTRUCTION: 5N
SPRINKLER SYSTEM yes
THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 9/23/2015
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k+.30&. . JEFFERSOI)UNTY I
'IAA DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street • Port Townsend •Washington 98368 •
360/379-4450 • 360/379-4451 Fax i Zinc
/- ' „p wow.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: iO 4
Pro De tion(include separate sheets as necessary):
Tax Parcel Number. q 6( ( ((,j')(`/ r________ Property Size: (acres/square feet)
Site Address and/or Directions to Property: _
p i�1- Se co ej
A ' rK�St Nlac�- i2,r, t,npf l� ( ryC,7l4 C i �� r t`}
om4�0
Property Ownsr(a)of Record: far kA S1ra 0'- -4 Toc Pe-E-E.re‹hn _t 1
Telephone: '`.-2):1--.CS lo ()iJ 1 Fax email: i y nA 024 CC P �{!lt h(Q.0-fir R'`,J”"
Mailing Address: Per L•13t t')et(\nc.. ,✓ 4 '"iEE3aO
ApplicantlAgent(if different from owner): �)• '" {-mkt ac)Ccnra
Telephone: (01C)40CL1 Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies
❑Building ❑Critical Areas Stewardship Plan
Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use)
Ccit Ingle 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"
❑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:
R I G DESIGNATION OF AGENT
I hereby designate l�4 tie IC&Y J n to act as my agent in matters relating to this application for permit(s).
r'
OWNER SIGNATURE -,;,Le .-------3 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 apps cati h
'- she wants prior notice.
Signature: .r- ' � Date:, -/ /.0
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 adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: ,44,-,k tc o __�- Date: ,
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• BUILDER STATEMENT 0
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: ',7(-'444,-�ltaCZ, Date. -
GENERAL CONTRACTOR OR MANUFACTURED HOME IN TALLER: PHONE: FAX:
7/1 E 140 N -X r /0/1's (3(0) O C'.0 7 (340) 6(3— ?NI
MAILING ADDR of Po do y.,_ sip G R l S jjpµ tai, EMAIL: 'l`ERE C (o J 'M)-,:c. t COIN{
CONTRACTOR'e LICENSE TT „ ,,,� WAINS
NUMBER: ` +�+/16 t� S. Q ( NUMBER c�
ARCHITECT/ENGINEER: f^ l ' PHONE (40S) ycl�-/.t FAX:(6—) I/7 W. !,l/
MAILING ADDRESS: P o 3 0 X 30 K l 4 4 spi 5 'o/ 'f EMAIL
Project Type: Frame Type: Bathrooms: rP Shoreline: Type of Sewage Disposal:
M New p Wood Existing: -10-Sewer
El Addition ❑ Steel Proposed: 7 Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: 1 v,� Height: V Individual System
❑ Repair ❑ Masonry SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type of Heat: Proposed: t! ❑ Public
Total: l Name of System:
v/off E�Y
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: _
I Heat Stove I Cook Stove I Woodstove I Fireplace Insert I Hot Water Tank I Pellet Stove 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 properly
lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system components,
includin• the reserve area.
S• are Foo- !e .: _. x 4,a 4:0 "0 : `T r
Main Floor Heated 76fti EH Bid App Review:•
Ze Floor Heated 3 (eats. ,R- q+tax1 x t 5 Consistency Review. I 5.00
Other Heated • , Base fee: 1 .i
—
Mezzanine '([ ' - Additional Section:
Heated Basement -1 Plan Check fee: to3r1 14
Unheated Basement a,' : State Surcharge fee:
- 0Re 4-Sd
Other Unheated Pot Water Review fee: cx')
Garage/Carport SUBTOTAL �a�i— n^
-u ' �`1
Decks 11/Rd Approach fee:
D D.:
Other ,t , .
a�a TOTAL $POI•
i:17, Receipt Number. ` l3(c42
Cash/Check Number �A.{4
l 11 I
ESTIMATED COST(REQUIRED) Date:
.Fair -rket value of all labor and materials . . . --r, o`�s_�_
•
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Jefferson County Building Divi. Permit NumberiLD10-00014
Applicant: PETERSON
BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2006 International Building Codes
To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection.
Requests received after 7:00 AM will not be scheduled for that day's inspections.
ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries.
The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection
Inspection Item Date Approval Signature Notes
Setbacks TZ-k
Erosion Control
Foundation Footing �QZr0-e(12_,) fl
Footing Drains
Foundation Stem Wall
Underground Plumbing
Under Floor Framing
Straps(hold downs)
Ext. Shear Wall Nailing f 47-70
Rough-in Plumbing 0
Framing 7 l.■q 11D FAN
Blocking Y
FL( iro Airseal I t �o ,,t /_%
Insulation:Walls -
_Z A O
Insulation: Floors
Insulation: Ceiling
Int. Shear Wall Nailing
Wallboard Nailing Ci --"1„0-10
Gas Line: Interior 0 ✓/1
Gas Line: Exterior
Propane Tank
Heat/Chimney Clearance
Drywell/Alt Drainage
Address Posted g ra is-
FINAL INSPECTION (41.-31(y 1)3._
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
• •
CONDITIONS for Building Permit# :BLD10-00014
1.) THE WATER LINE MUST BE RE-ROUTED 10 OR MORE FEET FROM THE EXISTING
SEPTIC TANK AS SHOWN ON PLOT PLAN..
VERIFICATION REQUIRED... call 360-385-9444 48hr in advance to arrange inspection.
2.) NEW HOME MUST BE 10 FEET FROM DRAINFIELD EDGE OR 11.5 FEET FROM THE
4" LATER PIPE THAT HAS BEEN LOCATED
3.) The project shall adhere to the Best Management Practices (BMPs) to control stormwater,
erosion and sediment during construction. BMPs shall address permanent measures to
stabilize soil exposed during construction, and in the design and operation of stormwater
and drainage control systems.
4.) The project shall comply with Construction Stormwater Pollution Prevention (SWPP)
Elements#1 through#12 of the Department of Ecology's Stormwater Management
Manual for Western Washington to control stormwater, erosion and sediment during
construction. BMPs shall address permanent measures to stabilize soil exposed during
construction, and in the design and operation of stormwater and drainage control systems.