HomeMy WebLinkAboutBLD2021-00294 - 01 Permit ApplicationPermit Application Page 1 of 2
DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street, Port Townsend, WA 98368
Tel: 360.379.4450 | Fax: 360.379.4451
Web: www.co.jefferson.wa.us/communitydevelopment
E-mail: dcd@co.jefferson.wa.us
PERMIT APPLICATION
Steps in the Permit Process:
-Review application checklist to ensure all information is completed prior to submitting application.
-Make sure septic has been applied for and water availability has been proven.
-Make an appointment to meet with the Permit Technician by calling 360-379-4450.
-This is not a standalone application; it must be accompanied by a project specific supplemental application.
-Fees will be collected at intake. Additional fees may apply after review and payment is required before permit is issued.
For Department Use Only Building Permit #
Related Application #s: MLA #
Site Information
Assessor Tax Parcel Number:
Site Address and/or Directions to Property:
Access (name of street(s)) from which access will be gained:
Present use of property:
Description of Work (include proposed uses):
Wastewater - Sewage Disposal
This property is served by Port Townsend or Port Ludlow sewer system? YES NO
If not served by sewer identified above, identify type of septic system below:
Type of Sewage System Serving Property:
Septic Septic Permit #:
Community Septic Name of System: Case #:
Are other residences connected to the septic system?
Additions or repairs to sewage system:
Is it a complete or partial system installation: Complete Partial
Has a reserve drainfield been designated? Yes No
Date of Last Operations & Maintenance check: Attach last report to application
Describe or attach any drainfield easements, covenants or notices on title, which may impact the property:
X
May 06 2021
Permit Application Page 2 of 2
The authorized agent/representative is the primary contact for all project-related questions and correspondence. The County will mail
/ e-mail requests and information about the application to the authorized agent/representative and will copy (cc) the owner noted
below. The authorized agent/representative is responsible for communicating the information to all parties involved with the
application. It is the responsibility of the authorized agent/representative and owner to ensure their mailbox accepts County email (i.e.,
Applicant/Property Owner Information
Property Owner:
Name:
Address:
Phone #: E-mail Address:
Please contact Authorized Agent/Representative with project info. (select only one).
Property Owner Signature: Date:
Note: For projects with multiple owners, attach a separate sheet with each owner(s) information and signatures.
Applicant: Authorized Agent/Representative (If other than owner)
Name:
Address:
Phone #: E-mail Address:
Professional: Is this an Authorized Agent/Representative for this project? NO YES
Engineer Architect Surveyor Contractor Consultant
Name: License #
Address:
Phone #: E-mail Address:
Professional: Is this an Authorized Agent/Representative for this project? NO YES
Engineer Architect Surveyor Contractor Consultant
Name: License #
Address:
Phone #: E-mail Address:
Professional: Is this an Authorized Agent/Representative for this project? NO YES
Engineer Architect Surveyor Contractor Consultant
Name: License #
Address:
Phone #: E-mail Address:
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 or her 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 making any issued permit null and void.
I further agree to that all activities I intend to undertake or complete associated with this permit will be performed in compliance with
all applicable federal, state and county laws and regulations and I 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. Applicant may
visits related to this application and subsequent permit issuance.
Signature: Print Name: Date: ______________
May 06 2021
May 06 2021
May 06 2021
Your jobsite for permit number 3510887P was inspected 2/3/2021 by Michael Friend.
The results of inspection are listed below:
Inspections:
Inspection Date Inspection Result Inspection Comment
2/3/2021 Circuit,New,Concealed,<=120V,<=1
00A
Approved Complete BATH HOUSE
2/3/2021 Feeder,New,Underground,240V,<=1
00A
Approved Complete SUB PANEL LOWER
FIELD
The following corrections were written on this inspection today.
The following corrections were marked completed on this inspection today.
Regulation Title Correction
NEC -210 .12 .(A) Dwelling Unit AFCI
Requirements
PLEASE INSTALL AFCI PROTECTION FOR LAUNDRY
CIRCUIT.-All 120-volt, single phase, 15- and 20-ampere
branch circuits supplying outlets or devices installed in
dwelling unit kitchens, family rooms, dining rooms, living
rooms, parlors, libraries, dens, bedrooms, sunrooms, recreation
rooms, closets, hallways, laundry areas, or similar rooms or
areas shall be protected by any of the means described in
210.12(A)(1) through (6). The AFCI shall be installed in a
readily accessible location.
NEC -406 .12 . Tamper-Resistant
Receptacles
All 15- and 20-ampere, 125- and 250-volt nonlocking-type
receptacles in the areas specified in 406.12(1) through (8) shall
be listed tamper resistant receptacles. (1) Dwelling units,
including attached and detached garages and accessory
buildings to dwelling units, and common areas of multifamily
dwellings specified in 210.52 and 550.13 (2) Guest rooms and
guest suites of hotels, motels, and their common areas (3)
Child care facilities (4) Preschools and education facilities (5)
Business offices, corridors, waiting rooms and the like in
clinics, medical and dental offices and outpatient facilities (6)
Subset of assembly occupancies described in 518.2 to include
places of awaiting transportation, gymnasiums, skating rinks,
and auditoriums (7) Dormitory units (8) Assisted living
facilities
NEC -250 .104
.(B)
Other Metal Piping PLEASE BOND PROPANE PIPE-If installed in or attached
to a building or structure, a metal piping system(s), including
gas piping, that is likely to become energized shall be bonded
to any of the following: (1) Equipment grounding conductor
for the circuit that is likely to energize the piping system (2)
The service equipment enclosure (3) Grounded conductor at
the service (4) Grounding electrode conductor if of sufficient
size (5) One or more grounding electrodes used if the
grounding electrode conductor or bonding jumper to the
May 06 2021
Regulation Title Correction
grounding electrode is of sufficient size. The bonding
conductor(s) or jumper(s) shall be sized in accordance with
Table 250.122, and equipment grounding conductors shall be
sized in accordance with Table 250.122 using the rating of the
circuit that is likely to energize the piping system(s). The
equipment grounding conductor for the circuit that is likely to
energize the piping system(s). The points of attachment of the
bonding jumper(s) shall be accessible.
NEC -210 .8 .(A) Dwelling Units PLEASE PROVIDE GFCI PROTECTION FOR FAN
ABOVE SHOWER.-All 125-volt through 250-volt receptacles
installed in the locations specified in 210.8(A)(1) through
(A)(11) and supplied by single-phase branch circuits rated 150
volts or less to ground shall have ground-fault circuit-
interrupter protection for personnel.
NEC -408 .36 .(D) Back-Fed Devices PLEASE PROVIDE BREAKER RETAINER FOR SUB-
PANEL-Plug-in-type overcurrent protection devices or plug-in
type main lug assemblies that are backfed and used to
terminate field-installed ungrounded supply conductors shall
be secured in place by an additional fastener that requires
other than a pull to release the device from the mounting
means on the panel.
You can view all inspection information on this permit online at Labor and Industries, electronic permit
and inspection system. Additional fees may be assessed and will not appear until they are processed by
our support team.
May 06 2021