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Home My WebLink AboutBLD2009-00307 WILDING PERMIT APPLICA N BLD09-00307 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD09-00307 Received Date: 9/16/2009 SITE ADDRESS: 100 OLYMPIC PL PORT LUDLOW, 98365 OWNER: ANNA GOTTLIEB PHONE: CHARLES SCHMIDT 3609 SILVER MAPLE CT SE LACEY WA 98503-2167 THE ADMIRALTY SUBDIVISION: Block: Lot: 12 PARCEL NUMBER: 990300112 Section: 9 Township: 28 N Range: 01 E CONTRACTOR: B PARKER ENTERPRISES PHONE: 206-818-4184 70 MERIDETH STREET PORT LUDLOW WA 98365 Contractor's License BPARKPE925BG Expires 1/7/2010 REPRESENTATIVE: MICHAEL DERRIG PHONE: 360-437-0520 PO BOX 65323 PORT LUDLOW WA 98365 PROJECT DESCRIPTION RE-ROOF 100 OLYMPIC PL TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 16,750.00 ADD'L: HEAT TYPE CODE EDITION: 2006 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: SETBACK: DECK: 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 $279.25 LYK 09/16/09 110916 Plan Check $181.51 LYK 09/16/09 110916 State Building Code $4.50 LYK 09/16/09 110916 Total: $465.26 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 Al Scalf, Building Official PERMIT #: BLD09-00307 SITE ADDRESS: 100 OLYMPIC PL Issue Date: 09/16/2009 PORT LUDLOW, 98365 Final Date: 8/16/2010 APPLICANT: ANNA GOTTLIEB PHONE: CHARLES SCHMIDT 3609 SILVER MAPLE CT SE LACEY WA 98503-2167 SUBDIVISION: THE ADMIRALTY Block: Lot: 12 PARCEL NUMBER: 990300112 Section: 9 Township: 28 N Range: 01 E PROJECT DESCRIPTION: RE-ROOF 100 OLYMPIC PL 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 8/16/2010 I:\F_BLD_Occupancy.rpt 10/29/19 Jefferson County Building Dion Permit Numb Applicant: BUILDING PERMIT INSPECTION APPROVALS %pplicable Code: 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 FINAL INSPECTION -1 b.I o FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR _ON • . Ci 0,, JEFFERSON COUNTY k al ' ` a DEPARTMENT OF COMMUNITY DEVELOPMENT i� 621 Sheridan Street • Port Townsend •Washington 98368 �� 360/379-4450 • 360/379-4451 Fax www.co.jefferson.wa.us/commdevelopment BINS Master Permit Application MLA: ► fl `YjJ CR9 Pr t D cription(include sep rate sheets as necessary : t \ o. _ I Vitlf Tax Parcel Number: CL.OI4 7jp b \ ( `Z_ Property Size: (acres/square feet) Site Address and/or Directions to Property: Property Owner(s)of Record: Telephone ax: email: Mailing Address: L0 4. 5 om' Lc , lv Applicant/Agent(if different from owner): Telephone: Fax: email: _ Mailing Address: What kind of rmit? heck eac box that applie 0 Lot or Road Segregation nilding a'e,) 0 Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family ❑Garage Attached/Detached ❑Conditional Use[C(a), C(d),or C]*" ❑ Manufactured Home .0 Modular - 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* 0 Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment ❑ Address 0 Road Approach ❑Short Plat** ❑ Home Business ❑Cottage Industry 0 Binding Site Plan** ❑ Propane 0 Long Plat** ❑ Sign -- 0 Planned Rural Residential Development(PRRD)/Amendments** 0 Allowed"Yes" Use Consistency Analysis 0 Plat Vacation/Alteration** ❑ Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions'"" ❑ Site Plan Approval Advance Determination (SPAAD)* 0 Shoreline Management Substantial Development** 0 Temporary Use 0 Shoreline Management Variance ❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference ❑Tree Vegetation Request **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 �.t, k to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and rrect to the best of his,her or its 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. Staffs access and right of entry will be assumed unless the applicant informs the C unty in writing at the time of the applicatio at he or an once. Signature: Date: The action or actions Applicant will undertake as a result of the'ssuance 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 tederal 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 the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferable res sibility f heri d mplying with the E . he Applicant has read this disclaims and sig an i ates it below. Signature: Date: ,Q �) ,n .f \+4u4+c-IDT C4444 \1 D cnD 1C\ T1D a c ^111no 4_ 1 • 0 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: G RAL TRACTOR OR MANUF CTURED HOW INSTALLER: PHONE: FAX: :;s: TIti? >tai MAILING ADDRESS: , Ar,�` `:1 " - CONTRACTOR'S LICENSE "L WAINS NUMBER: tie iQ.,Ni•, P Eev-J. cbsti. NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New 0 Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel 0 Concrete Total: _ Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: ❑ Public Total: 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 EH BId App Review: 2nd Floor Heated Consistency Review: _ Other Heated Base fee: !_I 35 Mezzanine Additional Section: Heated Basement Plan Check fee: I p ( 3 Unheated Basement State Surcharge fee: r1 Other Unheated Pot Water Review fee: _ Garage/Carport SUBTOTAL ,, 5 �i U • Decks 911/Rd Approach fee: ,._-{_ —— - � Other TOTAL: $z L( 5 2 Receipt Number: 0q ( c Cash/Check Number: /173B-7 ESTIMATED COST(REQUIRED) Date: ,IG •Fair arket value of all labor and materials foundation to finish 1 l_1- �kOs`�� '� Initials: — iI G:\PemutCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc