HomeMy WebLinkAboutBLD2010-00118 Jefferson County Buildingivision Permit Ater: BLD10-00118
Applicant: POPE RESOURCES
BUILDING PERMIT INSPECTION APPROVALS \pplicable 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
Miscellaneous
FINAL INSPECTION
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
MLA10-00145
ilkUILDING PERMIT APPLICAPON Review Type: 1
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD10-00118 Received Date: 4/20/2010
SITE ADDRESS: 1442 SHINE RIDGE RD
PORT LUDLOW, 98365
OWNER: POPE RESOURCES PHONE: 360-297-0570
C/O OLYMPIC RESOURCE MGMT
19245 10TH AVE NE
POULSBO WA 98370-7456
SUBDIVISION: Block: Lot: +
PARCEL NUMBER: 821312001 Section: 31 Township: 28 N Range: 01 E
CONTRACTOR: BARAN TELECOM INC PHONE: 678-455-1174
2355 INDUSTRIAL PARK BLVD
CUMMING GA 30041
Contractor's License BARANTI942L8 Expires 4/5/2011
REPRESENTATIVE: AT&T MOBILITY/GOODMAN NETWORKS PHONE: 460-865-6082
GERALD PRIOR 425-636-3601
8815 122ND AVE NE
PROJECT DESCRIPTIOP ADD (3) PANEL ANTENNAS-1 PER SECTOR, (3) TMA's, (6) RUNS OF
COAX & (3) DIPLEXERS
TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL:
TYPE OF IMP NEW MAIN: INDUSTRIAL:
VALUATION 15,000.00 ADD'L: HEAT TYPE
CODE EDITION: 2006 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: NUMBER OF EMPLOYEES:
WATER SYSTEM:
BATHROOMS:
Exist:
Prop:
To
Routing Date: 1110
Type Amount Paid Bv: Date: Receipt: /,pp ved/Date
Permit $251.25 LYK 04/20/10 117560 p R O V E
Plan Check $163.31 LYK 04/20/10 117560
State Building Code $4.50 LYK 04/20/10 117560 JUN 0 2010
Total: $419.06 Jefferson County Planning
& Building Department
a
CONDITIONS for Building Permit# :BLD10-00118
1.) SEE BLD04-00664 for conditions that apply to this property and project.
2.) 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.
. SON
JEFFERSON COUNTY
En% DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street• Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
� p� ww.co.jefferson.wa.us/commdevelopment
t I
Master Permit Application MLA: I 0 " I k- S
Project Description(include separate sheets as necessary):RN10 Twin Lakes:
Modify an existing telecommunications facility by adding(3)panel antennas(1 per sector),(3)TMA's(6)runs of 1-5/8"coax(2 per sector)and the addition of(3)diplexers.
Tax Parcel 821312001 Property , 500 sf
Number: Size: (acres/square feet)
Site Address and/or Directions to Property: 1442 Shine Ridge Rd., Port Ludlow.
See driving directions on Cover Sheet of Plans
Property Owner(s)of Record: Pope Industries-contact Tim Rush
Telephone:(360)297-0570 ext.23 Fax: email:
Mailing Address: P.O.Box 7,Port Gamble,WA 98364
Applicant/Agent(if different from owner): AT&T Mobility/Goodman Networks by Gerry Prior
Telephone: (460)865-6082 Fax: (425)636-3601 email: 9P'p'o°°°°m°^^°'"°"'—
Mailing Address: 8815 122nd Ave.NE,Kirkland,WA 98033
What kind of Permit?(Check each box that applies
❑Building 0 Variance(Minor, Major or Reasonable Economic Use)
❑ Demolition Permit ❑Conditional Use[C(a),C(d),or C]**
❑Single Family 0 Garage Attached/Detached ❑ Discretionary"D"or Unnamed Use Classification
❑ Manufactured Home ❑ Modular 0 Special Use(Essential Public Facilities)**
❑ Commercial* ❑ Boundary Line Adjustment
❑ Change of Use ❑Short Plat**
❑ Address ❑Road Approach 0 Binding Site Plan**
❑Home Business 0 Cottagelndustry 0 Long Plat"""
❑Propane 0 Planned Rural Residential Development(PRRD)/Amendments*"`
❑ Sign ❑ Plat Vacation/Alteration**
❑Allowed"Yes" Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisions**
❑Stormwater Management 0 Shoreline Management Substantial Development**
0 Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Variance
❑Temporary Use ❑Comprehensive Plan/UDC/Land Use District Map Amendment
in Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium ❑Tree Vegetaion Request
*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 G""P"°"G°°°'"°""°""°"° to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE Date: 25 March 2010
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 it's 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 ac ss-gnd right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any t insp ctions. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the appcation t_ she wants prior notice.
Signature: ?r ITE. C'*WM'ZALtFS-AT+-•r Wtc, a -r' Date: I Z— \S .s I— I CD
The action or actions App(cant 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 indiv al,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)even if you are incompliance with t rson ty development code.The Applicant acknowledges that he,she or it holds individual
and non-transferable re oasibilittr ad ng to I g with the ESA. The Applicant has read this disclaims and signs and dates it below.
Signature:-- - , / Date: I.2. 7?1Z I t.- ' I t7
DTT•-Mc , -r5'
C:\Documents and Settings\caral\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.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:
Baran Telecommunications,Inc.-Joe Gonzalez,Project Manager ( 206)575-0250 (206 )2301
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: BARANT1942L8 NUMBER
ARCHITECT/ENGINEER: Pacific Telecom Services-Richard Leighton PHONE (206 ) 464-4402 FAX:(206 )
MAILING ADDRESS: 568 First Ave.S.,Seattle,WA 98104 EMAIL rleighton@ptswa.com
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New ❑ Wood Existing: II Sewer
Li Addition ❑ Steel Proposed: Bank Li Community System
IA Alteration/Remodel ❑ Concrete Total: Height: U. Individual System
❑ Repair ❑ Masonry SEP Permit#
Li Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: Li 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: _umbe� DA •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:
❑Underground Tank 0Above ground Tank Size of Propane Tank:
❑Heat Stove 0 Cook Stove ❑Woodstove ❑ Fireplace Insert 0 Hot Water Tank 0 Pellet Stove 0 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:
2fa Floor Heated Consistency Review: -
Other Heated Base fee: `
15
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 15.000 TOTAL: $ [ E �
0
Receipt Number: 11,
Cash/Check Number:
7331-7
ESTIMATED COST(REQUIRED) Date: . �
.Fair market value of all labor and materials foundation to finish '1- , IC
Initials: _
C:\Documents and Settings\caral\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.doc
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