HomeMy WebLinkAboutBLD2002-00277 0
BUILDING PERMIT
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451 (800) 831-2678
PERMIT #: BLD02-00277 Received Date 05/10/2002
SITE ADDRESS: 475 N JACOB MILLER RD Issue Date 06/12/2002
PORT TOWNSEND, 98368
APPLICANT: THOMAS D CARROLL PHONE: (360)385-4539
ELLEN HEINEMANN
475 N JACOB MILLER RD
PORT TOWNSEND WA 98368-9649
SUBDIVISION: RHOADES/CARROLL SHORT PLAT Block: Lot:
PARCEL NUMBER: 001051022 Section: 5 Township: 30 N Range: 01 W
CONTRACTOR: OWNER PHONE:
LOAN LENDER/
BOND HOLDER:
PROJECT DESCRIPTION REPLACE CHIMNEY
REQUIRED INSPECTIONS:
[ ] SETBACKS / Footings:
[ ] Foundation:
[ ] Underground Plumbing/Underground Insulation:
[ ] Shear Wall:
[ ] Framing/Plumbing:
[ ] Propane Tank/Lines:
[ ] Insulation:
[ ] Sheetrock:
[ ] Septic System Final Approval:
[ ] Zoning Final Approval:
[ ] Final/Occupancy Approval:
HEALTH DEPARTMENT APPROVAL REQUIRED PRIOR TO FINAL INSPECTION
THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED
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
•
BLD02-00277
O BUILDING PERMIT APPLICATION Review T
ype.
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00277 Received Date: 5/10/2002
SITE ADDRESS: 475 N JACOB MILLER RD
PORT TOWNSEND, 98368
OWNER: THOMAS D CARROLL PHONE: (360)385-4539
ELLEN HEINEMANN
475 N JACOB MILLER RD
PORT TOWNSEND WA 98368-9649
SUBDIVISION: RHOADES/CARROLL SHORT PLAT Block: Lot:
PARCEL NUMBER: 001051022 Section: 5 Township: 30 N Range: 01 W
CONTRACTOR: OWNER PHONE:
REPRESENTATIVE(S):
PROJECT DESCRIPTION REPLACE CHIMNEY
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ALT MAIN:
VALUATION 3,200.00 ADD'L: HEAT TYPE: EEE
CODE EDITION: 1997 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: OSS
WATER SYSTEM: CITY PARCEL TAGS: YES NO
BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA
Exist: 2 Exist: 1 Wetland Erosion
Prop: Prop: Seismic Streams
Total: 2 Total: 1 Flood Way Floodplain
F&W Landslide
Routing Date:
/(. i 02-- Ce i2C9 Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $97.25 MAM 05/10/02 47548
Plan Check $63.21 MAM 05/10/02 47548 ® �/ t,
State Building Code $4.50 MAM 05/10/02 47548 JUN 12 2002
Total: $164.96
Jefferson County Plc.. ,
& Building Depart,1.
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64, JEFFERSON COUNTY D ._,T1
ti 2 DEPARTMENT OF COMMUNITY DEVELOPMENT
MAY 10 2002
O. 621 Sheridan Street • Port Townsend • Washington 98368
..
`S'1tj-1\10 360/379-4450 • 800/831-2678 • 360/379-4451 Fax Y
DEPT. OF CO.' ,_',, LOPMENT
BUILDING PERMIT APPLICATION
Project Description:
Building Type: Project Type: Frame Type:
X Single Family x New X Wood
Garage Attached/Detached Addition Steel
Modular - Alteration/Remodel Concrete
_ Commercial Repair . Masonry
Multi-family/#of Units Demolition Other:
Industrial f-- p/q c-c c in ; ►_v_s c j
Other: /05+ ; In Egi—f /✓qk-e Z-v/
Bedrooms: Bathrooms: Type of Sewage Disposal: Type of Heat:
Choose one:
Existing: 5 Existing: / Sewer Community System X Electricity Oil
Proposed: Proposed: x Individual System
Total: Total: Woodstove Propane
If not sewer,fill out the following: Heat Pump
Conventional X Alternative 11 Other
I Permit# SEP 9 O -• 6.2$
Water Supply:
: Private well _ Two Party Well_X Public:Name of water system: C.'.h t r Ol Po Y. fi- T W n S e,y,
Square Footage: For Office Use Only N O nit LA- II2-0
Main Floor - 1:5-' UBC OCCUPANCY GROUP �+
2ND Floor Base fee -l/7.2.5"
3rd Floor Plan Check fee 63 .Z(
Htd Basement State Surcharge fee ` c 1 •ma7
t
Unhtd Basement Subtotal f.`i4
Garage/Carport - Pot Water Review fee
lari
Decks -a` $1,—"'• 911/Rd Approach fee
Commercial TOTAL t 6, Lt-.
Industrial Receipt ; 4"7574-
•
Other Cash/ 6 C4 S-S
Total Valuation: r"L".i el"r,C.h r 131Rc4.61•41.i Initials �.Paa
/
Or Date S / 1O(TS.2---i,
Estimated ' os .s
> ..) 2 0 o• o o b
If within 200' of the Shoreline,
Distance to Bank or Ordinary High Water Mark ft. Bank Height ft.
liv signing the application form,the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. Any material falsehood or any
omission of a material fact made by the applicant/owner 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 it's employees,representatives or agents for the purpose of application review and any required later inspections.
Access and right of entry to the applicant's property or structure shall be requested and shall occur during regular business hours.
Signature: Date: �_ /�
I-I:f-TOME\PLNCN'I'R\IN FOBLDG\FORMS\BI,DpermitApplication l/2000
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