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HomeMy WebLinkAboutBLD2009-00281 CERTIFICATE OF OCCUPANCY Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 Carl Smith, Director/Building Official PERMIT#: BLD09-00281 SITE ADDRESS: 941 SHINE RD Issue Date: 08/24/2009 PORT LUDLOW, 98365 Final Date: 12/11/2013 APPLICANT: JOHN SIMPSON PHONE: KATHERINE SIMPSON 941 SHINE RD PORT LUDLOW WA 98365-9286 SUBDIVISION: HOUSE SHORT PLAT Block: Lot: 1 PARCEL NUMBER: 821343026 Section: 34 Township: 28 N Range: 01 E PROJECT DESCRIPTION: INTERIOR REMOVAL OF WALLS 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 12/11/2013 \\tidemark\data\forms\F_BLD_Occupancy.rpt 12/17/2013 Jefferson County Building Dion Permit Nur.: BLD09-00281 Applicant: NANTUCKET MANOR LLC 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 clay'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 Rough-in Plumbing q t In f Framing -d 1 ) Airseal Insulation: Walls c� t 2 rc.'- )T' Insulation: Floors Insulation: Ceiling Wallboard Nailing D_ ori Address Posted Miscellaneous FINAL INSPECTION 12 _/0—/3 FINAL INSPECTIO i UST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR BLD09-00281 •UILDING PERMIT APPLICAAN Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD09-00281 Received Date: 8/24/2009 SITE ADDRESS: 941 SHINE RD PORT LUDLOW, 98365 OWNER: NANTUCKET MANOR LLC PHONE: 360-437-2676 PETER CONRARDY 941 SHINE RD PORT LUDLOW WA 98365-9286 HOUSE SHORT PLAT SUBDIVISION: Block: Lot: 1 PARCEL NUMBER: 821343026 Section: 34 Township: 28 N Range: 01 E CONTRACTOR: MADERA WOODWORKING LLC PHONE: 253-858-7934 PO BOX 202 GIG HARBOR WA 98335 Contractor's License MADERWL012CA Expires 2/4/2011 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION INTERIOR REMOVAL OF WALLS TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP ALT MAIN: VALUATION 29,891.00 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: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By Date: Receipt: Approved/Date Permit $441.75 LYK 08/24/09 110813 \1DIDRcVE[Plan Check $287.14 LYK 08/24/09 110813 State Building Code $4.50 LYK 08/24/09 110813 AUG 2009 Total: $733.39 Jefferson County Plannint: &Building Department NcpG • JEFFERSO OU TY �' DEPARTMENT OF C IAMUNITY DEVELO 621 Sheridan Street• ort Townsend •WashingPMENTton 98388,�� 360/379-4450. 360/ 9-4451 Fax .rgs� ps www,co,jefferson.wa. commdevelopment Master Permit ApplicationLI MLA: ,11C � .�,; �� Protect Description(include separate sheets as ssary): - 1-t )irj for ( ( wails Tax Parcel Number: W IC) Property Size: (acres/square feet) Site Addna sa end/or Directions to Property: :• `f I S'„,i e ,'_d? tif-. , -f- ):./4 Lt.), /l ctJ !/1// ?''l3 6 S r Property Owners of Record: t r ('n i r-c, ,r'd. Telephone:('3C° Y3 - Z(o. -( II Fax:(3&0) y3'•7-Z / email: Mailing Address: 'iY f S L.i.n e `irj P., L ..i ,d d ti 14/e r� 'i?� ' C '� Applicant/Agent(if different from owner): I Telephone: li Fax: email: Mailing Address: `.1 What kind of Permit?(Check each box that appi4s O8uilding I 0 Critical Areas Stewardship Plan ❑ Demolition Permit II 0 Variance(Minor,Major or Reasonable Economic Use) 0 Single Family ❑Garage Attache /Detached 0 Conditional Use[C(a),C(d),or C]" 0 Manufactured Home 0 Modular I ❑Discretionary"D"or Unnamed Use Classification 0 Commercial• 0 Special Use(Essential Public Facilities)** 0 Change of Use 0 Boundary Line Adjustment ❑ Address 0 Road Approach 0 Short Plat•• ❑Home Business 0 Cottage Industry ' 0 Binding Site Plan'• O Propane I 0 Long Plat•• ❑Sign 0 Planned Rural Residential Development(PRRo)/Amendments•' 0 Allowed"Yes"Use Consistency Analysis ❑Plat'Vacation/Alteration'•' 0 Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions'- 0 Site Plan Approval Advance Determination(S AAD)• ❑Shoreline Management Substantial Development`" d Temporary Use 0 Shoreline Management Variance O Wireless Telecommunication• I ❑Comprehensive Plan/UDC/Land Use District Map Amendment ❑Forest Practices Act/Release of Six-Year Mora"orlum 0 Jefferson County Shoreline Master Program Amendment •May require a Pre_Application Conference ; 0 Tree Vegetation Request II **Requires a Pre"Appl/cetion Conference . Please Identify any other local,state or feJYeral permits required for this proposal,if known: u DESIGNATION OF AGENT I hereby designate r%.-a �i3OQa/er,( _—/ L.LC to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE ' -'?-GO— Date: e/it.,,f CS, By signing this application form,the owner/agent attests that the Info ion provided herein,and in any attachments,is true and correct to the best of his,her or its knowledge, Any material falsehood or any'bmssion 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 I further agree to save,Indemnify and hold harmless rson County against all liabilities,Judgments,court costs,reasonable attomey's fees and expenses which may in any way accrue against Jefferso 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 J rson County and Its employees,representatives or agents for the sole purpose of application review and any required later Inspections. Staff a a and right of entry Will be assumed unless the applicant infornls the County In writing at the time of the sppl' that he or she wants r notice. Signature:_ n _ ,- �.c-,-• Date: d The action or actions Applicant will undertake as a result',for 'tlr auence of this permit may negatively Impact upon one or more threatened or endangered species and could lead to a potential"take"r"f ar(endangorad species as those terms are defined in the federal law known as the "Endangered Species Act"or'ESA,'Jefferson County mikes 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 actions)even If you are In compliance with the Jefferson'County development code.The Applicant acknowledges that ha,she or It holds Individual and non-trans le sponsibility for ad ' to and cafnprying with the ESA. The Applicant has read this disde' r end s and dates it below. Signature: 1 GAPennirCcnecr\ FORMS###\DRp rORMS\M".tcrPayne Applic,tion 5-29.08.doc ii AUG 2 4 2009 G i; it • • 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: L 4 LtJ J GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: X/act e ru /N©0d we.,einn , L-G. _ (X3) SS-�S -7 35i (253) e$2--USSZ MAILING ADDRESS: 7 EMAIL: r1,....1-y-;C l�� f u-3•:,r,1�e°rut ast.N.p f' 1?d ZOZ Gr �1�z�6v. �Ss j T' CONTRACTOR'S LICENSE WAINS NUMBER: /i/I/j/ P J o,1•7 G A NUMBER ARCHITECT/ENGINEER: /r / PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: Li New y Wood Existing: 71 Sewer n Addition L I Steel Proposed: Bank ❑ Community System ix. Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System 7 Repair ❑ Masonry SEP Permit# 7 Demolition L Other: Bedrooms: Water Supply: Existing: Setback: 1 Private well ❑ Two Party Type of Heat: Proposed: 7 Public ' 'd r e N..)- Total: Name of System: If this is a Commercial Prolect 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: 1 Heat Stove 1 Cook Stove 1 Woodstove 1 Fireplace Insert 1 Hot Water Tank 1 Pellet Stove 1 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,Qlficb"U_seeOnly Amount 4'Revision - Main Floor Heated EH Bld App Review: 2na Floor Heated % Consistency Review: Other Heated Base fee: 5 Mezzanine i is :. Additional Section: Heated Basement Plan Check fee: ' '-i 1 lii Unheated Basement State Surcharge fee: -2-I Other Unheated Pot Water Review fee: ft.-c Garage/Carport - SUBTOTAL -7 53 31 Decks 911/Rd Approach fee: Other -733 TOTAL: $ Receipt Number: O Cash/Check Number ( q 5-_7 ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish 2(.I 1--e11 Fge, , Initials: ----) G\PcrrnitCcntcr\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc .2, tO C71 Q. ! • FILE COPY: 0 4 6 r 4 > t., (i4,-, <, T)45 1...1 1) ..0., 4.! . To; n A. NNN .r. a / A": ..,.. t..: / ... '.. 111111111111111 11111111111111111111I `., *I I TAC /I r ... \ . ,..., • i .$:. • \ • \ t I*** *1 • 110111") * t, . V. • r, . . * $ ,.,r.............., '51 .....14 Fi '.Z ) 51) U./ 4:::)' C : ..'1 \ ....„ :..: .. 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