HomeMy WebLinkAboutBLD2011-00105 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 #: BLD11-00105
SITE ADDRESS: 40 LIBBY CT Issue Date: 05/3/2011
PORT LUDLOW, 98365 Final Date: 3/5/2012
APPLICANT: DEAN D RIENSTRA PHONE: (541) 829-9284
KATHLEEN J GAGER
40 LIBBY CT
PORT LUDLOW WA 983659639
SUBDIVISION: PORT LUDLOW NO. 2 Block: Lot: 44
PARCEL NUMBER: 990600144 Section: 9 Township: 28 N Range: 01 E
PROJECT DESCRIPTION: INTERIOR REMODEL
THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING
CODE 2009 EDITION.
OCCUPANCY GROUP: R-3
TYPE OF CONSTRUCTION: 5N
SPRINKLER SYSTEM yes no
THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 3/5/2012
I:\F_BLD_Occupancy.rpt 10/29/19
Jefferson County Building Dielion Permit Num. BLD11-00105
Applicant: RIENSTRA
BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2009 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 (l_ ( —(l
Foundation Stem Wall
Under Floor Framing
Straps(hold downs)
Ext. Shear Wall Nailing
Rough-in Plumbing �._ , (1 ,,
Shower Pan �p
Framing L (
Blocking
Airseal
Insulation:Walls
�1—� I 'i� OA IAA's( . S
Insulation: Floors
Insulation: Ceiling
Wallboard Nailing S_ )/ , 2 10
FINAL INSPECTION
- - S
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
•UILDING PERMIT APPLICAC BL ReviewTy 105
Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD11-00105 Received Date: 4/27/2011
SITE ADDRESS: 40 LIBBY CT
PORT LUDLOW, 98365
OWNER: DEAN D RIENSTRA PHONE: (541) 829-9284
KATHLEEN J GAGER
40 LIBBY CT
PORT LUDLOW WA 983659639 PORT LUDLOW NO. 2
SUBDIVISION: Block: Lot: 44
PARCEL NUMBER: 990600144 Section: 9 Township: 28 N Range: 01 E
CONTRACTOR: CRAFTSMAN BUILDING LLC PHONE: (206)855-9465
10549 MANDUS OLSON RD NE
BAINBRIDGE ISLAND WA 98110
Contractor's License CRAFTB*135PH Expires 9/15/2001
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP INTERIOR REMODEL
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ALT MAIN:
VALUATION 30,000.00 ADD'L: HEAT TYPE:
CODE EDITION: 2009 HEAT BASE: HEAT TYPE:
OCCUPANCY: R-3 UNHEATED: #OF STORIES:
OCCUPANCY:
CONST TYPE: 5N OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL: SEW
WATER SYSTEM: 68700
BEDROOMS: BATHROOMS:
Exist: 3 Exist: 2
Prop: 0 Prop: 0
Total: 3 Total:
Routing Date:)
Type Amount Paid Bv: Date: Receipt: Approved/Date
Permit $441.75 LYK 04/27/11 123450 APPROVED
Plan Check $287.14 LYK 04/27/11 123450
State Building Code $4.50 LYK 04/27/11 123450 z01
Total: $733.39 ('•A'
Jefferson County Planning
& Building Department
¢SON C0 •
,� JEFFERSOh�OUNTY
k a DEPARTMENT OF COMMUNITY DEVELOPMENT
I' i� 621 Sheridan Street • Port Townsend •Washington 98368
�� 360/379-4450 • 360/379-4451 Fax
G www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: :, m( (if ,), b
Project Description(include separate sheets as necessary):
S,n'1 e -cc..,..,:.1 y \nr,..,,.o ,vr.,,s�a.'r 1x 1-1 n CX ry..1 \C;4s-c,Lo n ve ,,,,b k,
Tax Parcel Number. I o C„oo\LA t Property Size: I' 80o SF• (acres/square feet)
Site Address and/or Directions to Property: A.`' ,,-..."�Mc kc
14o L bey Cou< NE. Poc-sr- tx...a.`o w , v-J A l83(i)S
Property Owner(s)of Record: l pan R,e rN.sk,ra _,IA_ 1 .c.li4nt,-e (-1 C--)c,St Nr
Telephone: 5 4 1 • 8Z9 • 1 2.S 4 Fax: email: Kc-1r\r,y CeacJese P yca‘,00.cry rv+
Mailing Address: 4c L;bU../ C.oc-,c-A en c-11- L'—cx 4 c W A TA �C.,c,r�
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies 0 Lot or Road Segregation
®Building 0 Critical Areas Stewardship Plan
❑ Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
RI Single Family Garage - 0 Conditional Use[C(a),C(d),or C]"*
❑ Manufactured Home .0 Modular - ❑Discretionary"D"or Unna 1Jse Cass v./❑ Commercial* ❑Special Use(Essential P • i
fet❑ Change of Use ❑Boundary Line Adjustme t'D
❑ Address 0 Road Approach 0 Short Plat**
❑ Home Business 0 Cottage Industry 0 Binding Site Plan**
❑ Propane ❑Long Plat** APR 2 7 2011
❑Sign - 0 Planned Rural Residentia pment(PRRD)Amendme
❑Allowed"Yes'Use Consistency Analysis 0 Plat Vacation/Alteration**
❑Stormwater Management ❑Shoreline Master Pr
ogram Exemption/)F (Al£ as**
❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management S bs•tarltia [Ae dlaftt�Wti El OPMENT
❑Temporary Use 0 Shoreline Management Va"ai
❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment
❑Forest Practices Act/Release of Six Year Moratorium ❑Jefferson County Shoreline Master Program Amendment
*May require a Pre—Application Conference 0 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 A(t Q I<<� ',t, to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE K << „ ! v' `� Date: ei .2 7 //
Bysigning this application form,the owner/agent atf is that the
9 9 PP 9 t e information provided herein,and in any attachments,is true and correct 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 withbe assumed unless the applicant informs the County in writing at the
time of the application that he or she wan prior notice.
Signature: K.,,.t. i.., ' ai i ,c, -.-- c % Date: 'y - 7_ //
The action or 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 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 responsibility f r dhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: ,��:, �� - Date: l/- c2 7- //
1.
• •
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: .'w-Zt r r� Date: ,j:;! 7.
l �
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
L.-C. (2cxo)25-S'•o517 (2c..)6)2542• -I\
MAILING ADDRESS: (c s q h(qn y O\won 2.A. . NE EMAIL' _y3�1n C«cieS MGM�c):.ld.:r\ .v,o-�
CONTRACTOR'S LICENSE rba,‘n\Or;�c,e ‘...0 is, \\O WAINS J
NUMBER: C. R A C K a L. S c_.c. M R NUMBER Z t-.X cD l:::t Co O 7 se a t 2. , .
ARCHITECT/ENGINEER: I I i k f i e J 1 PHONE ( ) FAX:( )
MAILING ADDRESS: 'j9./ r4,ICI q, b:. vac, i,KQ ll%L. 7/ 2 ZU :.. Lo AMAIL ,J:,u.� t Ic.r'i �aL1.� c,cc(A.if P:.t.l. ('u r•-,
Project Type: Frame Type: Bathrooms: Shoreline: 4ype of Sewage Disposal: —
❑ New 9' Wood Existing: _ Sewer
❑ Addition 0 Steel Proposed: _0_ Bank 0 Community System
i Alteration/Remodel 0 Concrete Total: 2 Height: 0 Individual System
O Repair 0 Masonry SEP Permit#
❑ Demolition 0 Other. Bedrooms: Water Supply:
Existing: _3 Setback: 0 Private well ❑ Two Party
Type of Heat: Proposed: —G— S,Public
Total: 3 Name of System:
OtTy.P'c., L C i 31-Se.F-.4Q-v
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:
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 / t®
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.
£s ,--.^ ' --..-
Square
Footage Current Proposed ,�`cr „rMain Floor Heated
\�S EH BId App Review:
•
2"Q Floor Heated Consistency Review: lJ� r
Other Heated Base fee: LA ��` r- � ��
41
Mezzanine Additional Section: 1 0 IL v
' Ii \\J' I F
Heated Basement - Plan Check fee: ! 1
Unheated Basement Stater;='Surcharge fee: ,71I r
•L I„
Other Unheated _. Pot Water Review fee: �a • figr
Garage/Carport SUBTOTAL k_I DP is•
•JC( UNl COUNTY .T , _
q C(MMl1NITY DEVFL
Decks E:��r l y o 911/Rd Approach fee:
Other pc�K I\bl TOTAL: $ r7 -:-
_
Receipt Number: 03 LC: ,
Cash/Check Number: .3440
ESTIMATED COST(REQUIRED) Date:
•Fair market value of all labor and materials foundation to finish
A, � JlY-11 Initials:
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