HomeMy WebLinkAboutBLD2007-00558 • •
CERTIFICATE OF OCCUPANCY
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451 (800) 831-2678
PERMIT #: BLD07-00558
SITE ADDRESS: 21 S 5TH ST Issue Date: 11/8/2007
PORT TOWNSEND, 98368 Final Date: 11/30/2007
APPLICANT: CHRISTINE F BROMLEY PHONE:
GEORGE H BROMLEY
21 S 5TH ST
PORT TOWNSEND WA 983689782
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 001164011 Section: 16 Township: 30 N Range: 01 W
PROJECT DESCRIPTION: CONVERTING EXISTING SHOP & CARPORT TO LIVING SPACE -NO MLA
REQ'D
THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING
CODE 2006 EDITION.
OCCUPANCY GROUP:
TYPE OF CONSTRUCTION:
SPRINKLER SYSTEM yes no
THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON
11/30/2007
I:1F_BLD_Occu pa ncy.rpt 10/29/19c
ItUILDING PERMIT APPLICAS)N B RD p Review
ve:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD07-00558 Received Date: 10/25/2007
SITE ADDRESS: 21 S 5TH ST
PORT TOWNSEND, 98368
OWNER: CHRISTINE F BROMLEY PHONE:
GEORGE H BROMLEY
21 S 5TH ST
PORT TOWNSEND WA 983689782
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 001164011 Section: 16 Township: 30 N Range: 01 W
CONTRACTOR: PHONE:
PHONE:
REPRESENTATIVE: GEORGE BROMLEY JR. PHONE: 360-379-0427
21 S 5TH ST
PORT TOWNSEND WA 98368
PROJECT DESCRIPTIOr CONVERTING EXISTING SHOP & CARPORT TO LIVING SPACE -NO
MLA REQ'D
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ALT MAIN: 894
VALUATION 61,846.00 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:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: 3 Exist: 2
Prop: Prop:
Total: 3 Total: 2
Routing Date:
01 C2
Type Amount Paid Bv: Date: Receipt: �ed/Date
��Permit $0.00 CJZ 10/25/07 f O V E
Plan Check $0.00 CJZ 10/25/07
State Building Code $0.00 CJZ 10/25/07 NOV8 2007
Total: $0.00 Jefferson County planning
&Building Department
Jefferson County Building Di•s ision Permit Numb': BLD07-00558
Applicant: BROMLEY
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
Foundation Footing
Foundation Stem Wall
, w/
Under Floor Framing
Straps(hold downs)
Ext. Shear Wall Nailing
Rough-in Plumbing
�k l SkTrAci
Framing u- 3 0'CI M it c s
Blocking
Insulation:Walls
Insulation: Floors 11-36-•in INA Fertz. s
Insulation: Ceiling
Drywell/Alt Drainage ff
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(1.),s fis " CL, f A,t&"_c�
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FINAL INSPECTION IMA r S
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
k�w4"sQN cot, JEFFERSOOUNTY
(.
W A DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
NotCp� www.co.jefferson.wa.us/commdevelopment OCT 2 5 2007
Master Permit Application MLA: N o W\L `Ol
Project Description (include separate sheets as necessary): I
r\c-, x�`� �L :eaci S Svc 40 L-ccc ( .=J"6-,spc.2 -
Tax Parcel Property
Number: Inc ( Q \ 1 Size: (acres/square feet)
Site Address and/or Directions to Property:
I s 5 sk- .
Property Owner(e)of Record: —r rr r c `i C r,S f
Telephone: 3G 0 3 ) 1 • C'y xi Fax: email:
Mailing Address: So„ cs-- S part GP
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies
.gilding ❑Variance(Minor, Major or Reasonable Economic Use)
❑ Demolition Permit ❑ Conditional Use[C(a), C(d),or C]**
❑ Single Family 0 Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification
❑ Manufactured Home 0 Modular 0 Special Use(Essential Public Facilities)**
❑ Commercial* 0 Boundary Line Adjustment
❑ Change of Use ❑ Short Plat**
❑ Address 0 Road Approach 0 Binding Site Plan**
❑ Home Business 0 Cottagelndustry 0 Long Plat**
❑ Propane 0 Planned Rural Residential Development(PRRD)/Amendments**
❑ Sign 0 Plat Vacation/Alteration**
❑Allowed "Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions**
❑ Stormwater Management 0 Shoreline Management Substantial Development**
❑ Site Plan Approval Advance Determination (SPAAD)* 0 Shoreline Management Variance
❑ Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* 0 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 -�y -( �3r c1rn /-(7 S,Qa, to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE ��. , Date: l C) S ' a j
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 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. Sta&access and right entry will be assumed unless the applicant informs the County in writing at the
time of the appli tion that he she wants pr r•n .:'
Signature: ia' � G Date: /(J ^
The action or action‘Applicant will undert e 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 a Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transf ble respo ib" for ad ng and comp) yng with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: j � �4s � f`/ t>.tiv�' Oa)
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc
• BUILDER STATEMENT e
The signer of this tatement does hereby certify,that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be ass mg the respolbility of th ene I Contractor for the proposed project.
was: x % ,e 717 Date: / —/ - 0a
GENERAL CONTRA TOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: '��/►(��►
MAILING ADDRESS: EMAIL: ) ( 0dT 2 5 2007 ,_.i
CONTRACTOR'S LICENSE WAINS l
NUMBER: NUMBER ,Y
ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) -_J
MAILING ADDRESS: EMAIL
P!•oject Type: Femme Type: I Bathrooms: Shoreline: Type of Sewage Disposal:
ew /LI Wood Existing: _a_ ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: a, Height: 0 Individual System
❑ Repair ❑ Masonry SEP Permit# 7.1-1EX
❑ Demolition ❑ Other: Bedrooms: , Water Supply:
Existing: Setback: 'q-ivate well 0 Two Party
Type of Heat: Proposed: ❑ Public
Total: 3 • Name of System:
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 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 CovnuQ4nS-{o , - a( EH Bld App Review:
Cass pock IJQ.0., ?a a� lig
2 Floor Heatedoat` 64.- -Ika-c,( 24 Consistency Review: /v PC'
t� J J . - , l t`'`).3b
-43ther-l-tVfited Base fee:
Mezzanine Additional Section: „ F
Heated Basement , '` Plan Check fee: "A-13 O4
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee: , / /V
Garage/Carport /• SUBTOTAL /v ��Iacl
,a05
Decks 911/Rd Approach fee: n
Other IF/dl G7 VT`i\CI
*a(D°
Receipt Number:
Cash/Check Number:
ESTIMATED COST(REQUIRED) Date:
'Fair market value of all labor and materials foundation to finish
1CD v Initials:
_i
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc
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