HomeMy WebLinkAboutBLD2011-00267 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 #: BLD11-00267
SITE ADDRESS: 4900 CENTER RD Issue Date: 10/4/2011
CHIMACUM, 98325 Final Date: 9/20/2013
APPLICANT: FLORA C MACE PHONE 206-545-2838
JOANN KIRKPATRICK JTWROS
4725 37TH AVE NE
SEATTLE WA 98105-3014
SUBDIVISION: Block: Lot
PARCEL NUMBER: 801033001 Section: 3 Township: 28 N Range: 01 W
PROJECT DESCRIPTION: REPAIR & REPLACE ROOF & 2ND STORY WALLS ON EXISTING BARN, &
CHANGE FROM UNHTD TO HTD SPACE - NO PLMB- NO ADD'L SQ FT &
WITHIN EXIST FOOTPRINT
THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2009
EDITION.
OCCUPANCY GROUP:
TYPE OF CONSTRUCTION:
SPRINKLER SYSTEM yes no
THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 9/20/2013
\\tidemark\data\forms\F_BLD_Occupancy.rpt 9/20/2013
•
Jefferson County Building Division Permit Nuh,,her: BLD11-00267
Applicant: MACE
BW DING 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
Framing .2-
16 I L
Airseal S-_ S-_/Z
Insulation: Walls 1/114/7 C
Insulation: Floors
Insulation: Ceiling 7 gol 12 J[
Wallboard Nailing 7130/ Z �-
0(14- > l0-1 ' // tZin
G64.a+ - g—Ib-IZ
..32.--
pes id0o9
FINAL INSPECTION cf I (611 I�
1 Il
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
ILDING PERMIT APPLICAO1 B ReviewType:
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD11-00267 Received Date: 9/29/2011
SITE ADDRESS: 4900 CENTER RD
CHIMACUM, 98325
OWNER: FLORA C MACE PHONE: 206-545-2838
JOANN KIRKPATRICK JTWROS
4725 37TH AVE NE
SEATTLE WA 981053014
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 801033001 Section: 3 Township: 28 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
VtS 11-1-11
PROJECT DESCRIPTION REPAIR & REPLACE ROOF & 2ND STORY WALLS ON EXISTING
BARN - NO ADD'L SQ FT & WITHIN EXIST FOOTPRINT - 1C44-9e_ h}d-F't
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP REP MAIN: gb�l
VALUATION 16,000.002, (p
CODE EDITION: 2009 ADD'L: $10'1 HEAT TYPE: Jj E.Ec rei.L
OCCUPANCY: HEAT BASE: HEAT TYPE: 1ATQoD
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL: Q Df
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 0 Prop: 0
Total: 0 Total` 0
1Rguting Date:
ipe Amount Paid By: Date: Receipt: �A�pgrpu��GQ�r r��
Irmit $265.25 LYK 09/29/11 128184 iV IV 1L.�1 V
n Check $172.41 LYK 09/29/11 128184 �u�1
e Building Code $4.50 LYK 09/29/11 128184 OCT
Total: $442.16 Jefferson County Planning
&Building Department
iszc,SON-c-:
°L, JEFFERSOIUNTY
T.; DEPARTMENT OF COMMUNITY DEVELOPMENT
w
`' ` ''•4 621 Sheridan Street • Port Townsend • Washington 98368
360/379-4450 • 360/379-4451 Fax
p� www.co.jefferson.wa.us/commdevelopment
kIN
Master Permit Application MLA: ) DILA
Ecr—
P- 'ect Description 'nclude separ sheets as necessary): CC) �k I St t9
aovZ Z �#�c COWS - C�C�c1 } - (�LA-{-tun al Sr
Tax Parcel Number: fin/ (1) CO I� Property Size: iin res/square feet) Pi-
Site Address and/or Directions to Property:
4700- ce,4 et,'elia cineAoc vo 6 038 3az cewi lowke204,4 Ack"7143
Property Owner(s)of Record: f L rcti (Mare .37tAnn ri rkpli (ch(
Telephone: 20(0 54 5.-- .2t;33te Fax: 2b(o S'4$APs\Z email:371e1,1 omek FicPake E\tk.1.
Mailing Address: t4725"-- ''7.4', NE SeA,Ke W Pt olRAoS
Applicant/Agent(if different from owner):
Telephone: Fax: mil
Mailing Address: I ;t C E a ,vJ i
What kind of Permit? (Check each box that applies 0 Lot or Road Segreg44q
❑Building Z.( a 'Rotor 'RelovAal 0 Critical Areas Stewidship'Plan
❑ Demolition Permit 0 Variance(Minor, MEjgr or Reasonable Economic Us 1
❑ Single Family 0 Garage Attached/Detached ❑ Conditional Use[C(a),• (d),or C]**
❑ Manufactured Home .0 Modular - 0 Discretionary"D"or U>;n ed Use Classification
❑ Commercial* 0 Special Use(Essential Public Nips OUNTY
❑ Change of Use 0 Boundary Line AdjustmerarpT.OF COMMUNITY DEVELOPMENT
❑ Address _ 0 Road Approach_ 0 Short Plat**
❑ Home Business ❑ Cottage Industry 0 Binding Site Plan**
O Propane ❑ Long Plat**
❑ sign 0 Planned Rural Residential Development(PRRD)/Amendments**
❑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 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 0 Tree Vegetation Request
**Requires a Pre-Application Conference
Please identify any other local,state or federal permits required for this proposal, if known:
wtes WAva 310 30t 4,' ESIGNATION OF AGENT
I hereby designate A LOT.% CoNA ex, to act as my agent in matters relating to this applicationio for permit(s).
!!l
OWNER SIGNATURE Date::S.e J- (Dot(
By signing this application form,the owner/a nt 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 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 County in writing at the
time of the application that wan tice. ((� .gyp
Signature: Date: Q" �"O D)
The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon Done 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 for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: Date:
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
BUILDER STATEMENT I.
The signer of this statement does hereby ce,.ify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be assuming the res . y f the Gen I Contractor for the proposed project.
nature: _ Date: _
GENERAL CONTRACTOR OR M UFACTURED HOME INSTALLER: PHONE: FAX:
( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: • ".' PHONE ( - •) ' • FAX:( )
MAILING ADDRESS: EMAIL
project Type: . . . Fr me Type: Bathrooms: Shoreline: Type of Sewage Disposal:
New X Wood . ' _Existing: ❑ Sewer
• ❑ Addition ❑ Steel ' Proposed: ' •` flank - ❑ Community System
.''• '514 Altt?ration/Remodel - " ' D. Concrete - Total: • _ Height: -• .: El Indivitiiial System
Repair ❑ Masonry ' .; • ' • SEP Permit# _
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type of Heat: Proposed: ❑ Public
eC L Total: Name of System:IlLaillo
(),t1DIb
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 Abov ground Tank Size of Propane Tank:
i Heat Stove i Cook Stove x oodstove i Fireplace Insert I Hot Water Tank i Pellet Stove I Other
Is this appliance being installed 1t11 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 sy e compone
including the reserve area. �QJy(m St c5-r (t�t It 1
Square Footage Current Proposed For Office Use Only Amount Revision
Main Floor Heated EH Bld App Review: �/�
2"tl Floor Heated Consistency Review: l
Other Heated Base fee: I uct 75 arm sell, so
Mezzanine Additional Section: '' • • , '
Heated Basement Plan Check e:S i 4• 1`7a 4\ Sg2 73
Unheated Basement' State •
Surchiarggee fee: ...4.
of C j
Other Unheated Pot Water Review fee
Garage/Carport SUBTOTAL
Decks 911/Rd Approach fee:
Other , . TOTAL: $ 2140 ( `o' 155223
Receipt Number: ►a s 1 O Li la3a95
— Cash/Check Number: da l91 c3 I
ESTIMATED COST(REQUIRED) Date: _)q- ' — — I
L .Fair ma et value of all labor and
--pmaterials foundation to finish
I mf Initials:
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
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