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Home My WebLink AboutBLD2012-00169 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#: BLD12-00169 SITE ADDRESS: 81 JACKSON LN Issue Date: 06/5/2012 PORT LUDLOW, 98365 Final Date: 6/5/2013 APPLICANT: JAMES T GOODE PHONE: 360-437-2529 TERESA E GOODE 81 JACKSON LN PORT LUDLOW WA 98365-9668 SUBDIVISION: PORT LUDLOW NO 2 AREA 3 Block: Lot: 48 PARCEL NUMBER: 990600348 Section: 9 Township: 28 N Range: 01 E PROJECT DESCRIPTION: REPLACEMENT HEAT PUMP 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 6/5/2013 \\tidemark\data\forms\F_BLD_Occupancy.rpt 6/5/2013 • PROPANE/PELLET/WOOD STOVE & TANK INSTALLATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD12-00169 Received Date 6/5/2012 SITE ADDRESS: 81 JACKSON LN Issue Date 6/5/2012 PORT LUDLOW, 98365 APPLICANT: JAMES T GOODE PHONE: 360-437-2529 TERESA E GOODE 81 JACKSON LN PORT LUDLOW WA 98365-9668 48 SUBDIVISION: PORT LUDLOW NO 2 AREA 3 Block: Lot: PARCEL NUMBER: 990600348 Section: 9 Township: 28N Range: 01 E CONTRACTOR: BRENNAN HTG &A/C LLC PHONE: 206-248-7900 4601 S 134TH PL SEATTLE WA 98168 Contractor's License BRENNHA971R9 Expires 12/29/2013 OWNER, JAMES T GOODE PHONE: 360-437-2529 if different: TERESA E GOODE 81 JACKSON LN PORT LUDLOW WA 98365-9668 PROJECT DESCRIPTION: REPLACEMENT HEAT PUMP 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 6/5/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: u .i.„„c — FinalApproval: 7 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 HOT LINE AVAILABLE 24 HOURS A DAY I:\F_BLD_Permit_Propane.rpt 10/29/19 0169 MILDING PERMIT APPLICATIONB Review Type: Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD12-00169 Received Date: 6/5/2012 SITE ADDRESS: 81 JACKSON LN PORT LUDLOW, 98365 OWNER: JAMES T GOODE PHONE: 360-437-2529 TERESA E GOODE 81 JACKSON LN PORT LUDLOW WA 98365-9668 PORT LUDLOW NO 2 AREA 3 SUBDIVISION: Block: Lot: 48 PARCEL NUMBER: 990600348 Section: 9 Township: 28 N Range: 01 E CONTRACTOR: BRENNAN HTG &NC LLC PHONE: 206-248-7900 4601 S 134TH PL SEATTLE WA 98168 Contractor's License BRENNHA971R9 Expires 12/29/2013 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr REPLACEMENT HEAT PUMP TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP MEC MAIN: VALUATION 3,500.00 ADD'L: HEAT TYPE: CODE EDITION: 2009 OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: DECK: SETBACK: 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 $97.25 LYK 06/05/12 131775 Plan Check $63.21 LYK 06/05/12 131775 State Building Code $4.50 LYK 06/05/12 131775 Total: $164.96 t �ygON • , I q 4t % JEFFERSON C!NTY51 Li `t ` `A. DEPARTMENT OF COMMUNITY DEVELOPMENT' 621 Sheridan Street • Port Townsend •Washington 98368 &+ ,§�'�` 360/379-4450 • 360/379-4451 Fax A y www.co.jefferson.wa.us/commdevelopment a Master Permit Application MLA: i : m( I 12.0 )11� Proj c Description(include separate she is as neces ry): YAAP VA-e..-( -E, \I( I cS---h ft.‘t 0 nk-f_) , Li )2i, --cf.,- , V( . Tax Parcel Number: ropt;rtl,Size: (acres/square feet) Site Address and/or Directions to Property: Eck.c 4 sc L Vof L 0 , \ok Property Owner(s)of Record: \ Telephone: ' (-0() • `I. Fax: email: Mailing Address: Applicant/A ent(if different from owner): 0 . & .& .. . AL li. e _ t- Telephone; M) a �, ��, Fa : .• •6 % , T email:, Vk.t t'f\.t e(�Cif-(.,\..YN.a-n --1=1-mQ . Mailing Address: C' ¶ I? V S & , -L Ck c&i+ r CC T\r- What kind of Permit?(Check each box that applies ❑Building 0 Critical Arai s Stewardship Plan ❑ Demolition Permit 0 Variance ;N inor,Major or Reasonable Economic Use) ,,IRAingle Family ❑Garage Attached/Detached ❑Conditional Use[C, ❑ Manufactured Home 0 Modular ❑Discretion ai 5 "D"o s f4911 ,1 t ❑ Commercial* 0 Special Use ;Essenti I • ❑ Change of Use ❑Boundary L ne Adju4 ❑ Address ❑ Road Approach 0 Short Pla *' ❑Home Business ❑Cottage Industry ❑Binding Site Plan**I J U N — 5 202 ❑Propane ❑ Long Plai ' I ❑Sign ❑Planned Rural Resident' Development(PRRD)/Am eats** ❑Allowed"Yes'Use Consistency Analysis 0 Plat Vacalic n/Alteration EF ER ❑Stormwater Management 0 Shoreline N aster Progra - •* ❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline N anagement ❑Temporary Use 0 Shoreline N anagement Variance ❑Wireless Telecommunication* ❑Compreh arsive Plan/UDC/Land Use District Map Amendment ❑Forest Practices Act/Release of Six-Year Moratorium 0 Jeffersorl C:runty Shoreline Master Program Amendment *May require a Pre—Application Conference 0 Tree Veg at-ation Request **Re 71.,fres a Pre-Application Conference Please identify any other local,state or federal permits required fc r this proposal, if known: DE GNATION OF AGED fT I hereby designate C 't�h, ' �ct as my agent In matters relating to this application for permit(s). OWNER SIGNATURE —(F1 r. `/1 o /`� _ Date: 3130 /j Z I By signing this application form,the owner/agent attests that the information provided here re,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 mad a I ty 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 liabilitit;s,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 employee representatives or agents for the sole purpose of application review and any required later inspections. Staffs access and nght of entry will be assuwr a t: unless the applicant in 3J /forms the County in writing at the time of the application th he or she wants prior•notice. / Signature: C t 2 v M Date. 1— The action or actions Applicant will undertake as a result of the issuance of this permit n a negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered species as th Ise terms are defined in the federal law known as the "Endangered Species Act"or"ESA."Jefferson County makes no assurances to the app!ci 'tt 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.Th s applicant acknowledges that he,she or it holds individual and non-transferable res sibility for adhering to and complying with the ESA. The Ap)li:ant has read this disclaimer and signs and dates it below. Signature: Q!p 14 L. It., L .. Date. 6114 2 G:\PeimitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc • • _.. BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel rehire ced 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: ENERAL CONTRACTOR ORMANUFACTURED HOME INSTALLER: Pt IG- IE: FAX: ( it U-J 1 L -AI y � (c C I�O )q c �oc, (�R O4, Q'3 0 q )'J MAILING ADDRESS:y� , c� 44 -c E9+q.l:. rna�, Q%r({_,CONTRACTOR'S LICENSE �'(,� �� `�}a C\ 4( pit iS ct,rYl NUMBER: NI 1ME ER ARCHITECT/ENGINEER: PeI0.4E ( ) Fax:( ) MAILING ADDRESS: EMM Project Type: Frame Type: Bathrooms: - Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: Ci Sewer ❑ Addition Li Steel Proposed: _ Bank 0 Community System ❑ Alteration/Remodel ❑ 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: VJill you have Food Service? Yes / No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: 1 Underground Tank I Above ground Tank Size of Propane mink: 1 Heat Stove I Cook Stove I Woodstove 1 Fireplace Insert I Hot Water'`'e+rk 1 Pellet Stove 1 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. bola tfs 4 C.'i i , a f�� .t k,sa . .a'; Square Footage Current Proposed • ) ,� '.. Amount.._.; sit iY_ ' x Main Floor Heated ` ' EH Bld App re/ew: Floor Heated , , Consistency RE view: i,„ z. f. Other Heated ,.I.i. #.,s m ' Base fee: H. Mezzanine �r �*4 Additional Sect�nn: N,r,,,,Wf yAla: .sE Y„:-.Heated Basement Basement ry" d r Plan Chock f>p --� ' Unheated Basement *4 State Surchargg--r fee: ' l 1, ET.q — Other Unheated { "n,a-• Pot Water Review fee: Garage/Carport tY SIZE TOTAL a Decks ' n �,t 1 911/Rd ApprJac:h fee; , 411 Other TOTAL:"�- Li;r f,,, _ $ , 1 Ci(G ��4 1 ion ESTIMATED COST(REQUIRED) Date: i '.Fair market value of all labor and materials foundation to finish %Nv 2nu,IntWaTs: � �� _- _ JEFFERSON COUN1Y G:\PermitCentcr\###FORMS###\DRD FORMS\Master Permit Application'sr =O84dIPMENT • S ______ ....47„,... s;/„...„..4 \acrect Iv c-j 6-1.4.i,t, � Z. /q /--- , -v--__.2 , f'/ ,, ,i-,- ... -ell , _ , _ . , , , , .. . '„, J UN ' 5 2012 1, 7'! ,`i/ '• irF� L, ; ^err FR.Ir fir-,! rr � +, r ;rrDncr,