HomeMy WebLinkAboutBLD2012-00196 •
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#: BLD12-00196
SITE ADDRESS: 650 MONTGOMERY LN Issue Date: 06/26/2012
PORT LUDLOW, 98365 Final Date: 11/8/2012
APPLICANT: DAVID J MC LEOD PHONE: 360-437-9276
650 MONTGOMERY LN
PORT LUDLOW WA 98365-9618
SUBDIVISION: PORT LUDLOW NO 1 Block: Lot: 55
PARCEL NUMBER: 990400255 Section: 9 Township: 28 N Range: 01 E
PROJECT DESCRIPTION: INTERIOR ALTERATION & UPGRADES
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 11/8/2012
\\tidemark\data\forms\F_BLD_Occupancy.rpt 11/21/2012
1
Jefferson County Building Dieion Permit Num. BLD12-00196
Applicant: MC LEOD
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
Framing p (Nft6)
110k, ?toe N;'e' nvi-i/Ft.omi0 oit 44'
Insulation:Walls
Wallboard Nailing , f v,
FINAL INSPECTION '1 ,--�) L,� (r71/5
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
•ILDING PERMIT APPLICATJ BLD12-00196
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD12-00196 Received Date: 6/25/2012
SITE ADDRESS: 650 MONTGOMERY LN
PORT LUDLOW, 98365
OWNER: DAVID J MC LEOD PHONE: 360-437-9276
650 MONTGOMERY LN
PORT LUDLOW WA 98365-9618
PORT LUDLOW NO 1 AREA 2
SUBDIVISION: Block: Lot: 55
PARCEL NUMBER: 990400255 Section: 9 Township: 28 N Range: 01 E
CONTRACTOR: WHITEY JOHNSON GENERAL CONTR PHONE: (360)779-9884
PO BOX 1110
SUQUAMISH WA 98392
Contractor's License WHITEJG952DN Expires 3/15/2013
REPRESENTATIVE: WHITEY JOHNSON PHONE: (360) 779-9884
PO BOX 1110 (360) 598-3308
SUQUAMISH WA 98392
PROJECT DESCRIPTIOI INTERIOR ALTERATION & UPGRADES
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ALT MAIN:
VALUATION 18,500.00 ADD'L: HEAT TYPE: HTP
CODE EDITION: 2009 HEAT BASE: HEAT TYPE:
OCCUPANCY: R-3 UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: 5N GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: SEW
WATER SYSTEM: 68700
BEDROOMS: BATHROOMS:
Exist: 3 Exist: 3
Prop: 0 Pro
Total: 3 Total: 3
Routing Date:
(o Zs-t2
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $307.25 LYK 06/25/12 134941 ^^��� � �`
Plan Check $199.71 LYK 06/25/12 134941 A PP
State Building Code $4.50 LYK 06/25/12 134941 ,,.
Total: $511.46 '�UN '�
Jefferson County Planning
& Building Departmen+
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Braced Wall Panels (2009 IRC1 1JEFFERSON COUNTY
nr- of r'''\ l'INIIN CrVELOPMENT
1n Plywood braced wall panel at 1 &2 story buildings. 1/2" CDX plywood one
side (block all plywood panel edges) nailed with
nails
12at c„ .c.inteat all rmediate el
edges, 6"o.c. into sole plates, 6 o.c into top plate and o
studs. No holdowns required. Maximum wall height is 10'-0", u.n.o..
4�,�w4'S°N c°t, JEFFERSOf\WUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
"' 4\ 1-4 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
4111111 0- www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: j b rfic k
Project Description (include separate sheets as�� necessary):
r<�c-c �- �r k-1 r) l:.�t=1 N 't-'S '-'(;/tvl I tuo ra.. 1 ti TEL i e,a., /kL"1Z�2 F�TI a
Tax Parcel Number: qv 400 2' ' Property Size: 15t9e / (acres/square feet)
Site Address and/or Directions to Property:
5 5 jvlc7,..)-,--e.-a rat c-r2.-; L.A PC.)12- - I—+hr)t...b .)
Property Owner(s)of Record: l7A-u if) 1 JU ID Y M C.( --00
Telephone: a fmo• `t'S 7 1.%& Fax: email:
Mailing Address: �S 1VLOr.D i -e,r✓tr_-2-`r' (...PtI•Jr= ( �-v" kAt,l_c7(,.) L 0-2,e, C(?..)�(.,,s'
Applicant/Agent(if different from owner): WI*r-rE-tr-' r-{- . ,SQL , c1-2 , How
Telephone: Cob 2h 5 °(:,C1- Fax: email:c.oh r r; ` r,�1 ri o1-(�
Mailing Address: 17 G F��k l i ►a A O t.t r n�l r� �1 e>3c-(2.-- Cvwi e- -4 i, t-t- ;
What kind of Permit? (Check each box that applies 0 Lot or Road Segregation
3 t ilding 0 Critical Areas Stewardship Plan
❑ Demolition Permit 0 Variance(Minor,Maior Qr Reasonable Economic Use)
❑ Single Family 0 Garage Attached/Detached 0 Conditional Use- C(ap G] r
❑ Manufactured Home .0 Modular 0 Discretionary"�''olr'_#4r e s 0l s ibrj 1 I
❑ Commercial* 0 Special Use,(Essential Public Facilities)** .l
❑ Change of Use 0 Boundary Line Adjustment
❑ Address 0 Road Approach 0 Short Plat** ' J U N 2 5 2012
o Home Business 0 Cottage Industry 0 Binding Site Plan** J
❑ Propane 0 Long Plat** , L f
❑ ,ign 0 Harmedkyrai Rerdent� li �RIp� tt(ri'RD)/A endments**
❑Allowed"Yes" Use Consistency Analysis 0 Plat Vacation/Alt9rAtiq ,,,,,,,,,rNiTy v PR r
❑ Stormwater Management 0 Shoreline MasterPoyuanr ' ions**
0 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:
DESIGNATION OF AGENT
I hereby designate LA?(4r--g-r" 40 k-t(---,4yaJ r� to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE -`e/- -�/ `;!'f Date: 1_• /Z 2e, L.
By signing this application form,the wner/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 ri entry will be assumed unless the applicant informs the County in writing at the
time of the application that he or ants rior notice.
i 'Ci
Signature:�i� .-- • �� Date: , �I 1 /�'
The action or actions Applica tfiwill undertake as a result of the issuance of thispermit maynegatively impact g y p ct 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 Co my development code.The Applicant acknowledges that he,she or it holds individual
and non-transferable esponsibi' for adherin nd c ying with the ESA. The Applicant has read this dilai r and gns and dates it below.
Signature: "-- 'j Date: 2/ O j e
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• 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: Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: rr��
l/01 i I DC' CeDv-IT2. \tJ U (3 ') 2(..5 ci'c — ( ) ✓ls J 3 3O8
MAILING ADDRESS: " t _ CZ EMAIL.:
CONTRACTORS LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) Fax:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
E New e3'Wood Existing: 2. lWewer
❑ Addition ❑ Steel Proposed: Bank G' ommunity System
Le-Alteration/Remodel ❑ Concrete Total: j Height: ❑ Individual System
❑ Repair ❑ Masonry SEP Permit#
Li Demolition ❑ Other: Bedrooms: Water Supply:
Existing: 3 Setback: ❑ Private well 0 Two Party
Type of Heat: Proposed: V ublic
Her Rin wtP Total: ? Name of System:, 7
/ /," /L - //L.
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:
1 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 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.
Square Footage Current Proposed For Office Use Only Amount Revision
Main Floor Heated EH Bld App Review:
•
2nd Floor Heated Consistency Review:
Other Heated Base fee: SO y
Mezzanine Additional Section:
Heated Basement Plan Check fee: t- l t . r7 ,
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL
Decks 911/Rd Approach fee:
Other TOTAL: $51 Lice
Receipt Number: 3L19 14 I
Cash/Check Number: ' I
ESTIMATED COST(REQUIRED) Date: _
Fair market value of all labor and materials foundation to finish
Initials:
•
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