HomeMy WebLinkAboutBLD2012-00146 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 #: BLD12-00146
SITE ADDRESS: 1812 BEAVER VALLEY RD Issue Date: 06/11/2012
PORT LUDLOW, 98365 Final Date: 5/14/2013
APPLICANT: CARL D LOPEMAN PHONE: 360-732-7107
CAROLYN LOPEMAN
1864 BEAVER VALLEY RD
PORT LUDLOW WA 98365-9211
SUBDIVISION: C&C LOPEMAN SHORT PLAT Block: Lot: 2
PARCEL NUMBER: 821183022 Section: 18 Township: 28 N Range: 01 E
PROJECT DESCRIPTION: DEMO EXISTING SFR & SHED
THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2009
EDITION.
OCCUPANCY GROUP:
TYPE OF CONSTRUCTION:
SPRINKLER SYSTEM yes ho
THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 5/14/2013
\\tidemark\data\forms\F_BLD_Occupancy.rpt 5/16/2013
•
DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD12-00146 Received Date 5/8/2012
SITE ADDRESS: 1812 BEAVER VALLEY RD Issue Date 6/11/2012
PORT LUDLOW, 98365
APPLICANT: CARL D LOPEMAN PHONE: 360-732-7107
CAROLYN LOPEMAN
1864 BEAVER VALLEY RD
PORT LUDLOW WA 98365-9211 2
SUBDIVISION: C&C LOPEMAN SHORT PLAT Block: Lot:
PARCEL NUMBER: 821183022 Section: 18 Township: 28N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
OWNER, CARL D LOPEMAN PHONE: 360-732-7107
if different: CAROLYN LOPEMAN
1864 BEAVER VALLEY RD
PORT LUDLOW WA 98365-9211
PROJECT DESCRIPTION: DEMO EXISTING SFR& SHED
Directions
To Site:
THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE.
THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR.
THE EXPIRATION DATE IS 6/11/2013.
REQUIRED INSPECTION:
FinalApproval: -J/5 /
BUILDING INSPECTION HOT-LINE 379-4455. Request must be received by 7am the day the inspection is needed
Office Hours 9:00 a.m. -4:30 p.m. MONDAY-THURSDAY
SPECIAL CONDITIONS APPLY-SEE REVERSE
HOT LINE AVAILABLE 24 HOURS A DAY
SPECIAL CONDITIONS FOR CASE# BLD12-00146:
1.) Demo permit approved based conversation w/owner and the understanding that the
existing septic system may NOT be used for new construction. OK to keep existing septic
for occasional RV use.
I:\F_BLD_Perm it_Propane.rpt 10/29/19
OUILDING PERMIT APPLICA•N BLD12-00146
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD12-00146 Received Date: 5/8/2012
SITE ADDRESS: 1812 BEAVER VALLEY RD
PORT LUDLOW, 98365
OWNER: CARL D LOPEMAN PHONE: 360-732-7107
CAROLYN LOPEMAN
1864 BEAVER VALLEY RD
PORT LUDLOW WA 98365-9211 C&C LOPEMAN SHORT PLAT
SUBDIVISION: Block: Lot: 2
PARCEL NUMBER: 821183022 Section: 18 Township: 28 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOD DEMO EXISTING SFR & SHED
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP DEM
VALUATION MAIN:
CODE EDITION: 2009 ADD'L: HEAT TYPE:
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total:
Routing Date:
Type Amount Paid Bv: Date: Receipt: APPROVED
Permit $74.00 LYK 05/08/12 131708
State Building Code $4.50 LYK 05/08/12 131708
Total: $78.50 JUG ( 2012
Jefferson County Planning
& Building Department
•
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t-f-,,~' coGGION 0Z:$&V Olympic Region Clean Air.Agency
. "v.4::2;' /'�,� 2940-B Limited Lane NW
.',<. "` ``r ' - 1 q Olympia,WA 98502 •
ti, s'5 c;l (360)539-7610•FAX(360)491-6308
l Demolition Permit
:� :,.., ,. Port Angeles office(360)417-1466
�'=''''��r. • 'e�; OttCAA, `�°r Raymond Office(360)942-2137
}.. ''ti:r,a i\� fe;IFHots09•W�4j www.ORCAA.org
Owner occupied residential dwelling-Permit fee: $35.00-Prior Notice-Nonrefundable
[ ] Other Structures-Permit fee: $60.00-10 working day wait period-Nonrefundable
PROPERTY OWNER • • •
Name:�ii 1 Phc:e: (.�6.4 7-3, 71 07 I Email:
(:AR L L ° 11-) a n FAX: ( ) Mobile:( )
Mailing Addres • State: Zi
/6, eGltielZ Ln//c�r i�r - f-� 0 ��t ��k3loS-
Site Address: --Ci': State: Zip:
/S,'/Z r. buere (/aIkci-..(. -W \-12i- Lvir[_)Otit) t&,, - gg. 6.
DEMOLITION CONTRACTOR•K Check if same as property owner information
Business Name: Phone: ( ) Email:
FAX: ( )
Onsite Contact: • Phone: ( ) Mobile: ( )
FAX:' ( )
Mailing Address: City: State: Zip:
DEMOLITION INFORMATION
#of Structures being demolished: Start Date: 1',, ff r Completion Date: . 16 2e f}� (/ 1 _ /g(J/f_
Asbestos present Yes X(No Survey attached" Ax cs No Has all identified asoestos been I'
removed Yes _No I
DEMOLITION PROJECT CATEGORY
[ ] Complete Demolition -� y _ 1
Training Fire-Fire Agency ~f nr2 4- 1....t. 1-]nyJ 5l rt:.e_ a > ,i- n 1�,
' : 'Re o:ztior,Airradon,Remodeling,Maintenance,or other Construction . .
, . : Emergence-Additional Fee of$30.00(must be accompanied by Government Ordered Declaration-Commercial only)
I have read and will abide by the conditions set forth in this permit and any addendum thereto. I do hereby certify
that all identified asbestos has been removed and the information in this application and supplemental data
described herein is,to the best of my knowledge,accurate and complete. .
,..7 7-7/
et4-11?"-L L OP-e 1-3-1 a cn (--,---74,i,,„- .,_,....______ 2_
Applicant Name Signature Date
D o e Payment Info. -4 Approved Asbestos Permit
U [ ] C35Ji n [ ] Disapproved Permit# ASBOO
heck: # f o44`( f Demolition Permit
MAY 0'9 2012 [ ] Credit Card Review date:(OJ.J /1 Permit#Je DEM00 fi
t.
Receive date: '...-/?/f - Reviewed by
ilAt .' _4 o/ A Agency Use Only Agency Use Only Agency Use Ony ,
08110141 lit• itlar4t OVER
(":4: 0N c° JEFFERSO UNTY
W„iii • 4� A DEPARTMENT OF COMMUNITY DEVELOPMENT
`' -\ 621 Sheridan Street • Port Townsend • Washington 98368
_AO; 360/379-4450 • 360/379-4451 Fax
.1 pP. www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: (lO (V1c/
Pro ect Description (include separate sheets as necessary):
� 0 e k ST- fi
Tax Parcel Number: gitaffic. i(2,/ /g3 022_Property Size: l• .3 (acres/square feet)
Site Address and/or Directions to Property:
/�
Property Owner(s)of Record: l a - I <1- Ca ro I J k) L n e .-4 cl '
Telephone: ....-3(,,,p 73.. ' �v Fax: _ 1 email:
Mailing Address: /07# f3e«14-c re, /6/1/477 ,i9 (.r ,e£, t.t,dbw) t.c tea. ej 8- 6 S—
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
(a z i ilding 0 Critical Areas Stewardship Plan
jr' Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
❑ Single Family ❑ Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]**
O Manufactured Home .0 Modular 0 Discretionary"D"or Unnamed Use Classification
❑ Commercial* 0 Special Use(Essegt I
Change of Use ' ❑ Boundary Line Adjdst n 0 V 1
O Address 0 Road Approach_ 0 Short Plat**
❑ Home Business 0 Cottage Industry 0 Binding Site Plan*
❑ Propane 0 Long Plat** i M Ay — g 2n17
❑ sign 0 Planned Rural Res n i I DeveTb meht(PRRb)/Am: . nts**
❑Allowed"Yes" Use Consistency Analysis 0 Plat Vacation/Alters tgnL
❑ Stormwater Management 0 Shoreline Master P-ogra ,. - 'ens**
❑ Site Plan Approval Advance Determination (SPAAD)* 0 Shoreline Management Substa a-• V::Irh,- • irlvf
❑Temporary Use ❑ Shoreline Manage • (1MA9U 'I .y
❑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:
DESIGNATION OF AGENT
I hereby designate 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 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 h,e or she-wants prior notice.
►a( Signature: L'I_1L i 'Z./6,_, ----'---- _ Date: ..5' - 3 - j 2.
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 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 r spor sibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
X, Signature: a_,c. - ;z= ' �. — Date:Date: -7 - 3 -/ ---..
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
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