HomeMy WebLinkAboutBLD2011-00250 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#: BLD11-00250
SITE ADDRESS: 33 STATION PRAIRIE RD Issue Date: 11/21/2011
PORT TOWNSEND, 98368 Final Date: 11/26/2012
APPLICANT: KARINE FISHER TRSTEE PHONE: 360-385-4193
K& M FISHER LIVING TRUST
PO BOX 266
PORT TOWNSEND WA 98368-0266
SUBDIVISION: WOODLAND HILLS NO 1 Block: Lot: 19
PARCEL NUMBER: 001275011 Section: 27 Township: 30 N Range: 01 W
PROJECT DESCRIPTION:ADD BATHROOM TO EXISTING BASEMENT
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 6' >
THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 11/26/2012
\\tidemark\data\forms\F_BLD_Occupancy.rpt 11/26/2012
Jefferson County Building DSion Permit Null: BLD11-00250
Applicant: FISHER TRSTEE
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
Underground Plumbing / -/, ,lZ KIPRough-in Plumbing , 3
Framing ��9 � /
Pressure Test S ���_(Z del lam.r,% S 4 c ;.,,��— Ct
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FINAL INSPECTION
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
eILDING PERMIT APPLICA1N BLD11-00250
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD11-00250 Received Date: 9/13/2011
SITE ADDRESS: 33 STATION PRAIRIE RD
PORT TOWNSEND, 98368
OWNER: KARINE FISHER TRSTEE PHONE: 360-385-4193
K& M FISHER LIVING TRUST
PO BOX 266
PORT TOWNSEND WA 98368-0266 WOODLAND HILLS NO 1
SUBDIVISION: . Block: Lot: 19
PARCEL NUMBER: 001275011 Section: 27 Township: 30 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr ADD BATHROOM TO EXISTING BASEMENT
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ALT MAIN:
VALUATION 10,032.00 ADD'L: HEAT TYPE: EEE
CODE EDITION: 2009 HEAT BASE: 135 HEAT TYPE:
OCCUPANCY: R-3 UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: 5N GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: 05783
BEDROOMS: BATHROOMS:
Exist: 2 Exist: 3
Prop: 0 Prop: 1
Total: 2 Totem -
Ro inq Date:
131 (
Type Amount-P-aid--Bv:' Date: Receipt: Approved/Date
Permit $195.25 LYK 09/13/11 128113 �����`
V Plan Check $126.91 LYK 09/13/11 128113
Er
State Building Code $4.50 LYK 09/13/11 128113 NOV 9 1 11111
Total: $326.66
Jefferson County Planning
& Building Department
•
CONDITIONS for Building Permit# :BLD11-00250
1.) FINAL approval of SEP11-28 is required prior to final of this building permit.
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cJJEFFERSON COUNTY•' �� DEPARTMENT OF COMMUNITY DEVELOPMENT` 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 t i
�qs y www.co.jeffersOr(. i • �.1,�;
HIN ;, 1
Master Permit Application SEP 1 MLA: NL n e-Er !,
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1
Project Description (include separate sheets as necessary): Z�,
P� t .; i • e- r- , -
. �c�rl_i�SO� coolly
Tax parcel Number: I d/ -I't OF CO 0111Ni pFt,Fl(?PMEi4r Prop•rty Size: 4r Y 1—5 a c (acres/square feet)
Site Address and/or Directions to Property:
3:,3 _;7; //O%✓ A/ii X/E At
Property Owner(s)of Record: A-/)r/NE 5, 1 S c5C;,
Telephone: ._ v - A. .1/4'c . Fax: email:
Mailing Address: /f,O - O,,%/ flie T 7 ,uiN.c,- h--.,, f
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies ❑Lot or Road Segregation
❑Building 4I[)iN G 4 8'47 '''P,i O/11 /4' ❑Critical Areas Stewardship Plan
❑ Demolition Permit 7,k' - ,/../ 0 Variance(Minor, Major or Reasonable Economic Use)
0 Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]**
❑ Manufactured Home .0 Modular 0 Discretionary"D"or Unnamed Use Classification
0 Commercial* 0 Special Use(Essential Public Facilities)**
O Change of Use 0 Boundary Line Adjustment
❑ Address 0 Road Approach 0 Short Plat**
O Home Business 0 Cottage Industry 0 Binding Site Plan**
❑ Propane 0 Long Plat**
❑ Sign - 0 Planned Fturai 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**
❑Temporary Use ❑Shoreline Management Variance
❑Wireless Telecommunication* ❑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 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 21 Zri...o �_.-/= to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE /(,f41 f , 'T""'Y`\-s''—) Date: 9••- /_ - //
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 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 attorneys 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 County in writing at the
time of the application that he or she wants prior notice.,.Signature:� qn��— �� Date: 1 — % ' /(I
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 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-transferab e responsibility for a ring to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
_/
Signature:_ lLv, g1 . �-�>.4"k—, Date: /
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G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
• 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 o e General Contractor for the proposed project.
Signature:
GZ.t<i!/!�D ..._ Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PFIONE: FAX:
( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New Wood Existing: 3 0 Sewer
O Addition ❑ Steel Proposed: _ _ Bank ❑ Community System
IIAlteration/Remodel 0 Concrete Total: 4 _ Height: ❑ Individual System
O Repair 0 Masonry SEP Permit#
O Demolition 0 Other: Bedrooms: Water Supply:
Existing: Setback: 0 Private well 0 Two Party
Typg of Heat: Proposed: 0 Public
0()f.- AC 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 1 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. ;
se
Square Footage Current Proposed Office U " t 4- 0`" F 'c'`,z ' 50.t
Main Floor Heated EH Bld App Review: ,.
13
2�Floor Heated - Consistency Review:
; 1C�5
Other Heated Base fee:
Mezzanine Additional Section:
Heated Basement Plan Check fee:
_ 1h -t 1 I a(o -q
Unheated Basement State Surcharge fee: 451D
Other Unheated Pot Water Review fee: ---------
3,i" ., SUBTOTAL
Garage/Carport 3c6,, (A,
DecksK"� 911/Rd Approach fee:
Other TOTAL: $ 3co,44,
Receipt Number: 1 ag 1 13
'Fl " Cash/Check Number: 2q
ESTIMATED COST(REQUIRED) ,' Date: (^) I ,
'Fair market v lue of all labor and materials foundation to finish
] Initials: C ,z
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