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HomeMy WebLinkAboutBLD2006-00239 • BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD06-00239 Received Date 05/5/2006 SITE ADDRESS: 1031 LUDLOW BAY RD Issue Date 06/2/2006 PORT LUDLOW, 98365 APPLICANT: STEVEN R ROGEL PHONE: (360) 437-0371 CONNIE R ROGEL 12020 NYANZA RD SW LAKEWOOD WA 98499-1440 SUBDIVISION: LUDLOW BEACH TRS 2 Block: Lot: 21+ PARCEL NUMBER: 969000022 Section: 16 Township: 28 N Range: 01 E CONTRACTOR: NORCO FIRE PROTECTION INC PHONE: (425) 432-7250 PO BOX 363 RAVENSDALE WA 98051 (425) 413-2230 Contractor's License: NORCOFP015J0 Expires: 4/12/2007 PROJECT DESCRIPTION: INSTALLATION OF FIRE SPRINKLER SYSTEM IN SFR - NO MLA REQ'D CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. SETBAC KS: UFFER: Footing: Foundation: Stormwater FINAL Approval: Underground Plumbing: Underground Insulation: Shear Wall : Sheathing: Framing: Plumbing: 011 'JPP SP4f25 Ghee tcrL. 2 r+1 DS ss"CS/'Iv/i1-oLc di°37:4i/RS i4016Zt Zlf ;G-144PP—/17A Propane Tank/ Lines: Insulation: Sheetrock: Septic Sytem Final Approval MUST be obtained before final of structure can be attempted. Road Approach Final Approval: Zoning Final Approval: Final/Occupancy Approval: HEALTH DEPARTMENT AND PUBLIC WORKS 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 I:\F_BLD_Permit_Buildng.rpt 10/29/1999 ICILDING PERMIT APPLICAN BLD06-00239 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00239 Received Date: 5/5/2006 SITE ADDRESS: 1031 LUDLOW BAY RD PORT LUDLOW, 98365 OWNER: STEVEN R ROGEL PHONE: (360)437-0371 CONNIE R ROGEL 12020 NYANZA RD SW LAKEWOOD WA 98499-1440 LUDLOW BEACH TRS 2 SUBDIVISION. Block: Lot: 21+ PARCEL NUMBER: 969000022 Section: 16 Township: 28 N Range: 01 E CONTRACTOR: NORCO FIRE PROTECTION INC PHONE: (425) 432-7250 PO BOX 363 RAVENSDALE WA 98051 Contractor's License NORCOFP015JO Expires 04/06/2006 REPRESENTATIVE: NORCO FIRE PROTECTION INC PHONE: (425)432-7250 PO BOX 100 (425) 413-2230 CHIMACUM WA 98325 PROJECT DESCRIPTIOP INSTALLATION OF FIRE SPRINKLER SYSTEM IN SFR - NO MLA REQ'D TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 4,500.00 ADD'L: HEAT TYPE: CODE EDITION: 2003 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: SHORELINE: GARAGE: SETBACK: CONST TYPE: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: 5 1 ‘i lati67-) Type Amount Paid By: Date: Receipt: Af'PRO V E r Permit $111.25 KAS 05/05/06 81168 Plan Check $72.32 KAS 05/05/06 81168 JJ v2 2006 State Building Code $4.50 KAS 05/05/06 81168 Jefferson County Planning Total: $188.07 &Building C k 'tg \ rk`T-- ep 44, oG JEFFERSON COUNTY' `s DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 MAY -g 2nnr 360/379-4450 • 360/379-4451 Fax �qs gip'$ www.co.jefferson.wa.us/commdevelopment FANG Master Permit Application NO fill,A Project Description(indude separate sheets as necessary): yr, .'A,:5ThLv7T7L V 6/- Fer.SPRln1Kr s /Jf ,n/die j 'NtpA/ Tax Parcel �1 Property Number: /&If� Size: f� / (acres/square feet) Site Address and/or Directions to Property: , rCIN Property Owner(s)of Record: 677,t1 >!C" � I'(+="r 4-IJ r L r> Telephone: r 11 V) 03-7I Fax:,210 1- email: Mailing Address: Bc)c iiX Ch t rfl(0.3, ( 1 ll r r)ki /I✓� Applicant/Agent(if different from owner): ,'�{h(�ll� �/�'E PjP I� � Telephone: - Fax: - email: I'Yfrr�)11'7/rY_ _aaCorr, Mailing Address: p bJX .��/2 /1 e 11 4 t 7 What kind of Permit?(Check each box that applies) Variance(Minor,Major or Reasonable Economic Use) Building Demolition Permit I Conditional Use[C(a),C(d),or Cj*" Single Family tit' Si 6-.'`� `� �f�NF('t}t'✓D I Discretionary"D"or Unnamed Use Classification Garage Attached/Detached Special Use(Essential Public Facilities)** Manufactured Home I Boundary Line Adjustment Modular Short Plat** Commercial* Binding Site Plan** Change of Use i Long Plat** Address i Road Approach L Planned Rural Residential Development(PRRD)/Amendments** I I Propane 1 Plat Vacation/Alteration** Allowed"Yes"Use Consistency Analysis ! Shoreline Master Program Exemption/Permit Revisions** Stormwater Management i Shoreline Management Substantial Development** Site Plan Approval Advance Determination(SPAAD)* r Shoreline Management Variance I Temporary Use I Comprehensive Plan/UDC/Land Use District Map Amendment Wireless Telecommunication* i, Jefferson County Shoreline Master Program Amendment Forest Practices Act/Release of Six-Year Moratorium **Requires aPre-Application Conference *May require a Pre—Application Conference Please identify any other local,state or federal permits required for this proposal, if known: �� �, D SIGNATION OF AGENT I hereby designate / (C) -//l)/rClf /1' •to act as my agent in matters relating to hisa lication for permit(s). OWNER SIGNATURE Date: -3'/Old 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 , o ide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and an es -fired I er ins,,-di. S.Access and right of entry to this property shall be requested and shall occu only during regular business hours. , -2� Signature: _�i :A A _ , Date: The actio . 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 Spe . ct"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has befissu d wil not v olate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)ev if yo are. co Ii ce with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non- ansf e s fib" ring to and complying with the ESA. The Applicant has read this (c er.n Igns and dates it below. Date: f (,p Signature: C:\Documents and Settings\mochil\Desktop\Master Permit Application 7-8-04.doc OWNER BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of a erenced herein,that they are not licensed conpctors and that they will be assuming the responsibility of the General C e proposed project. C� Signature: Date: 1 L r GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: Ake() 'Or fieeircyvAi //(i (/2c)c'&i,-73, (we- tii3 a3 3' MAILINGADDRESS: �/�� �/�� �� `/ EMAIL: horLD l .jia)/ (z?- j CONTRACTOR'S LICENSE WAINS ' LCC 1 J' 1 NUMBER: ^ l`, l 0 NUMBER�/ ARCHITECT/ENGINEER: ' / r (,,J��` VVV Vji/ PHONE l w ) c f.„7_63 71 FAX: (300)a) _ 3, MAILING ADDRESS: r)C.Jc/ �' �rx) (J,/M�` b� ^nzS--EMAIL Project Type: Fra a Type: „/ Bathrooms: Shoreline: Type of Sewage Disposal: ,;,'New I4'Wood Existing: Sewer H Addition f', Steel Proposed: Bank Community System Alteration/Remodel 1 Concrete Total: Height: 1 1 Individual System Repair H! Masonry SEP Permit# Demolition i Other: Bedrooms: Water Supply: Existing: Setback: 1 i Private well Two Party Type of Heat: Proposed: aj1 Public Total: AD_ Name of System: If this is a Commercial Protect 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: 1 Underground Tank 1 Above ground Tank Size of Propane Tank: I Heat Stove I Cook Stove 1 Woodstove I Fireplace Insert 1 Hot Water Tank 1 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 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 For Office Use Only Current Proposed Amount Main Floor Consistency Review. 2""Floor .7n7 Base fee: 1 t I , C, 3fd Floor Additional Section: Mezzanine: Plan Check fee: —1: 3a Heated Basement 773 State Surcharge fee: 41 Unheated Basement Pot Water Review fee: Other Unheated 911/Rd Approach fee: Garage/Carport TOTAL: $ D ,V11 Decks /„l/ Receipt Number: % '` b ili Other UJ/^ I�/.^ Cash/Check Number: ESTIMATER_COST(REQUIRED) d/ �-/� Date: air m rket value of all W3or and als foundation to finish <� l J �/�O 1c Initials: . C:\Documents and Settings\mochil\Desktop\Master Permit Application 7-8-04.doc PROCEDURE,: • • Upon completion of work,inspection and tests shall be made by the contractor's representative and witnessed by an owner's , representative. All defects shall be corrected and system left in service before contractor's personnel finally leave the job. A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities,owners,and contractor. It is understood the owner's representative's signature in now way prejudices any claim against contractor for faulty material, poor workmanship,or failure to comply with approving authority's requirements or local ord7nces. PROPERTY NAME: C'c GA— ,5� .,_)C 1,6,rNswr I DATE: 4- t 1 - 01 PROPERTY ADDRESS: 1 C t t lnvt- ,k_� --v??i> r s� ACCEYIbI)BY APPROVING AUTHORITIES(NAMES) J ct CIS.r» 1 1 C£^1 C ADDRESS t0CL ot.N,J• 7 i O_C 't 0,4,--) u- L�La, Malta Tzs PLANS ��t ��l� -= � ' INSTALLATION CONFORMS TO ACCEPTED PLANS YES NO EQUIPMENT USED IS APPROVED „•,.) YES NO IF NO.EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED ',J YES I I NO ASTO LOCATION OF CONTROL VALVES AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? IF NO,EXPLAIN INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: ./ YES NO YES NO 1_SYSTEM COMPONENTS INSTRUCTIONS .. YES NO 2.CARE AND MAINTENANCE INSTRUCTIONS _ , YES NO 3.NFPA-�3- C,v.,�,“0� t-'I A...-,-:n� LOCATION SUPPI: S BUILDINGS OF SYSTEM Asz.AN,(_,t- MAKE MODEL YEAR OF ORIFICE QUANTITY TEMPERATURE MANUFACTURER G SPRINKLERS PIPE AND TYPE OF PIPING C-C)\J c- F.72-?:-i c)i-_y.,+,<..- .,\.- FITTINGS TYPE OF FITTINGS C 4 C-C'x z_n,„`-'�o-'ti MAXIMUM TIME TO OPERATE ALARM DEVICE THROUGH TEST CONNECTION ALARM TYPE MAKE MODEL MIN. SEC. VALVE OR c FLOW ( ," Pc)\\<t, . 1 iD >)2L, CT - c, INDICATOR DRY VALVE Q.O.D. MAKE I MODEL SERIAL NO. MAKE MODEL SERIAL NO. TRIP TIME WAllrlt ALARM TIME TO TRIP WA MR AIR THROUGH PRESSURE PRESSURE POINT UAIRR 1 REACHED TEST OPERATED DRY PIPE TEST LET PROPERLY OPERATING CONNECTION TEST MIN SEC PSI ' PSI PSI NoN. SEC. YES NO W/O Q_OD. WITH Q.O.D. IF NO,EXPLAIN • 11111 OPERATION I PNEUMATIC I f ELECTRIC I I HYDRAULIC PIPING SUPERVISED I I YES I NO J DETECTING MEDIA SUPERVISED YES NO DOES VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE CONTROL STATION YES NO IS THERE ACCESSIBLE YES NO IF NO,EXPLAIN DELUGE& FACILITY IN EACH CIRCUIT PREACTION MAKE MODEL DOES EACH CIRCUIT DOES EACH CIRCUIT MAXIMUM TIME TO OPERATE VALVES OPERATE SUPERVISION OPERATE VALVE RELEASE RELEASE LOSS ALARM? YES NO YES NO MIN. SEC. LOCATION MAKE&MODEL SETTING STATIC PRESSURE RESIDUAL PRESSURE FLOW PRSURE &FLOOR (FLOWING) RATE REDUIG INLET(PSI) OUTLET(PSI) INLET(PSI) OUTLET(PSI) FLOW VALVE'1'h 'T (GPM) HYDROSTATIC Hydrostatic tests shall be made at not less than 200 psi(13.6 bats)for two hours or 50 psi(3.4 bars)above static pressure in excess TEST of 150 psi(10.2 bars)for two hours. Differential dry-pipe valve clappers shall be left open during test to prevent damage. All aboveground piping DECRIPTION leakage shall be stopped. PNEUMATIC Establish 40 psi(2.7 bars)air pressure and measure drop,which shall not exceed 114 psi(0.1 bars)in 24 hours. Test pressure tanks at normal water level and air pressure and measure air pressure drop,which shall not exceed 1 54 psi(0.1 bars)in 24 hours. ALL PIPING HYDROSTATICALLY TESTED AT Z or) PSI `' HRS IF NO STATE REASON D £IGALL-Y TESTED YES `, NO Lin ,L\FP v L 4 EQUIPMENT OPERATES PROPERLY v YES No DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS SODIUM SILICATE OR DERIVATIVES OR SODIUM SILICA RIME,OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TESTING SYSTEMS OR STOPPING LEAKS?, 'E NO TESTS DRAIN READING OF GAGE LOCAIEll NEAR WATER RESIDUAL PRESSURE WITH VAVLE IN TEST TEST SUPPLY TEST CONNECTION: PSI CONNECTION OPEN WIDE PSI UNDERGROUND MAINS AN DLEAD IN CONI CTIONS TO SYSTEM RISER FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING �(t: (:)) VERIFIED BY COPY OF THE U FORM NO.85B YES NO OTHER EXPLAIN FLUSHED BY INSTALLER OF U/G PIPING 1 YES NO IF POWDER DRIVEN FASTENERS ARE USED IN CONCRETE, YES NO IF NO,EXPLAIN HAS REPRESENTATIVE SAMPLE TESTING BEEN J /�., SATISFACTORILY COMPLETED? / _ BLANK _NUMBER USED LOCATIONS NUMBER REMOVED �. GAS ` ___ DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH YES NO THE REQUIREMENTS OF AT LEAST AWS D10.9,LEVEL AR-3? DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN COMPLIANCE YES NO WELDING WITH THE REQUIREMENTS OF AT LEAST AWS D10.9,LEVEL AR-3 DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A DOCUMENTED YES NO QUALITY CONTROL PROCEDURE TO INSURE THAT ALL DISCS ARE RETRIEVED,THAT OPENINGS IN PIPING ARE SMOOTH,THAT SLAG AND OTHER WELDING RESIDUE ARE REMOVED,AND THAT THE -' INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED? CUTOUTS DO YOU VERIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL CUTOUTS(DISCS) (DISCS)._., ARE RETREIVED? YES NO HYDRAULIC NAME PLATE PROVIDED( YE6) NO IF NO,EXPLAIN DATA NAMEPLATE q9 REMARKS DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN 4.1 '4/ NAME OF SPRINKLER CONTRACTOR: \-1 c.)2cam; r,st✓c �-r..c ,t-, ., \+J c_. STS WITNESSED BY: SIGNATURES PROPERTY O ER: TLTLE .JEPP cc. CD,tlse/LT DATE / i, //, J' C©oE a ic%gL 09 °7' ' FOR RACTOR: ,// V67 / TITLE ,fit��A r DATE `y / ADDITIONAL EXPLANATION. NOTES: /�P ,v U✓ 'Ci" /,- e--T ,e-"ist/Ar09 0111/!4Y&I)6 O f/44_ -forte �.itearrie GE , i7-cxe✓ 1