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Home My WebLink AboutBLD2012-00290 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 #: BLD12-00290 SITE ADDRESS: 1291 IRONDALE RD Issue Date: 09/20/2012 PORT HADLOCK, 98339 Final Date: 3/11/2013 APPLICANT: CYNTHIA L GRAVES PHONE: 206-781-3225 HOWARD W PERKINS 9610 22ND CT NW SEATTLE WA 98117-2439 SUBDIVISION: HILLCRESTADDITION Block: Lot: 11-13 PARCEL NUMBER: 960000105 Section: 2 Township: 29 N Range: 01 W PROJECT DESCRIPTION: FIRE DAMAGE REPAIR TO KITCHEN-REPLACE SHEETROCK & INSULATION 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 3/11/2013 \\tidemark\data\forms\F_BLD_Occupancy.rpt 3/20/2013 Jefferson County Building Division Permit Num BLD12-00290 Applicant: GRAVES 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 Insulation: Walls (iJ 7, ( jf' ._rc Insulation: Ceiling < l `� � ) u/c1 /1 9 l rl-75 Wallboard Nailing Miscellaneous FINAL INSPECTION 2\y'�\-3 FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR I tILDING PERMIT APPLICA$N B Review 0290 Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD12-00290 Received Date: 9/20/2012 SITE ADDRESS: 1291 IRONDALE RD PORT HADLOCK, 98339 OWNER: CYNTHIA L GRAVES PHONE: 206-781-3225 HOWARD W PERKINS 9610 22ND CT NW SEATTLE WA 98117-2439 HILLCREST ADDITION SUBDIVISION: Block: Lot: 11-13 PARCEL NUMBER: 960000105 Section: 2 Township: 29 N Range: 01 W CONTRACTOR: WARREN ENTERPRISES PHONE: (360)732-7487 PO BOX 626 CHIMACUM WA 98325 Contractor's License WARREE*947BR Expires 2/13/2014 REPRESENTATIVE: MICHAEL WARREN PHONE: 360-981-9388 PO BOX 626 CHIMACUM WA 98325 PROJECT DESCRIPTION FIRE DAMAGE REPAIR TO KITCHEN-REPLACE SHEETROCK & INSULATION TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP REP MAIN: VALUATION 20,000.00 ADD'L: HEAT TYPE: CODE EDITION: 2009 HEAT BASE: HEAT TYPE: OCCUPANCY: R-3 UNHEATED: #OF STORIES: OCCUPANCY: CONST TYPE: 5N OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: 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 $321.25 LYK 09/20/12 135218 APPROVE Plan Check $208.81 LYK 09/20/12 135218 State Building Code $4.50 LYK 09/20/12 135218 SEF' D Total: $534.56 Jefferson County Plannini & Building Department \\firlomorlAtInfo\fnrmc\C RI n onn Rid rr,r onni,n1') 4./. �. ONco�, JEFFERSON LINTY. ' rr. DEPARTMENT OF COMMUNITY_ Mrif*I'I, — '' ` '4 621 Sheridan Stre t _ of his ,8368 360/379 4450 • 360/3 , qs �p www.co.jefferson.w o mmdevelopment B�rNO SEP ') 0 2012 1' JI Master Permit Application i L MLA: PC MLA Pr ' ct Description in lude separate sheet ece sfiry :jEFFERSON COUNTY — f l � TY DEVELOPMENT Tax Parcel Number. c� ins Property Size: 13 i!, .s..5 (acres/square feet) Site Address and/or Directions to Property: I otG 1 _ c_1(21.e._. cz R + ' ' \oC. < gj-63cr Property Owner(s)of Record: O:tK& (TrnVPs Telephone:/ADC) Z$l - 3?2-S 1 Fax: N/►k- email: tJ( r✓I�— G Mailing Address: ' ;+A-4 ic1 G-yo.JC� 1(FI0 z2v1c (fir OW 7,,,'k�ip c,,�� ,,).,L131 Applicant/Agent(if different from owner): 1 " 'l f./1 e_ r ar-rti N. Telephone:i 4 b ?2-1 -9 3 8 g, Fax: email:iv e li(hike\1.Zuv A, 5�l e�).r...• Cc i Mailing Address: Q , (r,Lb ('ln'�wrQ,ci�u \( g . What kind of Permit? (Check each box that applies 0 Lot or Road Segregation '"itwilding 0 Critical Areas Stewardship Plan Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]** ❑ Manufactured Home .0 Mcdula; 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* 0 Special Use(Essential Public Facilities)** Change of Use 0 Boundary Line Adjustment ❑ Address 0 Road Approach_ 0 Short Plat** 0 Home Business 0 Cottage Industry 0 Binding Site Plan** 0 Propane ❑ Long Plat** ❑ .iyn ❑ 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 ❑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: r DESIGNATION OF AGENT I hereby designate '1/ r to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE )� Date: ?A/40 e By signing this application form, he 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 ma erial 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' t ti n ffs access and right of entry will be assumed unless the applicant info the unty in writing at the time of the applica' t r sh s for notice.�� /Signature: Date: � 2// ii2,12____ The action r actions plicant 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 responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: Date: G.\P.,..,,:.rP.,r...\illiiiF(lP fCIiiitt\TIRTI F(1R T,fC\C,,...,,,,TIRTI F,,—„e\AG--Tle....,:♦ 4....1:,...,:,...S ')o nQ,L.,. • 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: L )A-f 1:7 _Kicy--v‘i _2AS-C-- S (3) '2 l-- cl2 V& ( ) MAILING ADDRESS: ( ' /'ii. ‘lMCLOAilel.i\AA EMAIL.: 1Aike.A. U,,fe y,L tC jb `')ire,Cool CONTRACTOR'S LICENSE WAINS NUMBER: (c.01 ---73 - ZC; NUMBER ARCHITECT/ENGINEER: l PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New ❑ Wood Existing: U Sewer ❑ Addition ❑ Steel Proposed: Bank E Community System • Alteration/Remodel ❑ Concrete Total: _ Height: ❑ Individual System -Xi Repair ❑ Masonry — SEP Permit# _ Bedrooms: Water Supply: El Demolition � Other: PP Y: 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: 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. 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: 3 2 I . aS Mezzanine Additional Section: Heated Basement Plan Check fee: 03 Si Unheated Basement State Surcharge fee: 0 Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $c931.,_5(0 Receipt Number: Cash/Check Number: I nzt __, ESTIMATED COST(REQUIRED) Date: -.Fair market value of all labor and -terials foundation to finish - - .i Initials: G\Permir('enter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc