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HomeMy WebLinkAboutBLD2012-00319 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 #: BLD12-00319 SITE ADDRESS: 120 SYCAMORE ST# Issue Date: 10/11/2012 PORT HADLOCK, 98339 Final Date: 9/30/2013 APPLICANT: STEVEN M OMODT PHONE: 360-302-0392 120 SYCAMORE ST PORT HADLOCK WA 98339-9558 SUBDIVISION: BISHOP ACRES Block: Lot: 28 PARCEL NUMBER: 932300028 Section: 2 Township: 29 N Range: 01 W PROJECT DESCRIPTION:A/G 120 GAL PROP TANK, PIPING & HEAT STOVE 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 9/30/2013 \\tidemark\data\forms\F_BLD_Occupancy.rpt 10/8/2013 0 0 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#: BLD12-00319 Received Date 10/11/2012 SITE ADDRESS: 120 SYCAMORE ST Issue Date 10/11/2012 PORT HADLOCK, 98339 APPLICANT: STEVEN M OMODT PHONE: 360-302-0392 120 SYCAMORE ST PORT HADLOCK WA 98339-9558 28 SUBDIVISION: BISHOP ACRES Block: Lot: PARCEL NUMBER: 932300028 Section: 2 Township: 29N Range: 01W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 1 V1602012-5875 OWNER, STEVEN M OMODT PHONE: 360-302-0392 if different: 120 SYCAMORE ST PORT HADLOCK WA 98339-9558 PROJECT DESCRIPTION: A/G 120 GAL PROP TANK, PIPING & HEAT STOVE 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 10/11/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: F (? FinalApproval: R)56 I; BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:00 a.m. -4:30 p.m. HOT LINE AVAILABLE 24 HOURS A DAY \\tidemark\data\forms\F_BLD_Permit_Propane.rpt 10/11/2012 ILDING PERMIT APPLICATIN BLD12-00319 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD12-00319 Received Date: 10/11/2012 SITE ADDRESS: 120 SYCAMORE ST PORT HADLOCK, 98339 OWNER: STEVEN M OMODT PHONE: 360-302-0392 120 SYCAMORE ST PORT HADLOCK WA 98339-9558 BISHOP ACRES SUBDIVISION: Block: Lot: 28 PARCEL NUMBER: 932300028 Section: 2 Township: 29 N Range: 01 W CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/17/2012 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP A/G 120 GAL PROP TANK, PIPING & HEAT STOVE TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: CODE EDITION: 2009 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: �0151e-rdvPropane Tanks/Stoves $222.00 LYK 10/11/12 135285 Total: $222.00 OC 1k 2012 Jefferson County Planninc & Building Department \\4ir4omorL\rlota\fnrmc\C RI Il Ann PH rn4 1(1/11/9(119 SITE VISIT REPORT (PLOT PLAN) JOB (3v 6a�T� DATE: 11 7 12. CONTACT: ADDRESS L 2 0 6•C.AcW uu`( 4• PHONE #:_ . DIRECTIONS FAX #: Email , PLANNER )),.4-Q... L.. . . . s Include all street names adjacent to property,property lines,talks,appliance&`piping locations,distances of tank to property lines and buildings,Septic,wells,wetland areas,distance to water bodies. 2a' CID �IL r-, Jf1 _\ ocT 1 .i 2012 J JEFFERSON COUNTY V�.t- ,q, DEPT.OF COMMUNITY DEVFLO'AGENT ' of ,0 • le 1-. v1N� r t tiler r \J e ' (-) F-0 V lL.aslz. 'c o\ �. c "t„`p 't'o 'Poi. O1\ , Q-e on=2 _ 5 n V' k' U l A"c'i�-�(J f 4 ,\ l t� Gbt Ise e.Z' 4.'a :U-CNA "4 Q2tT-Aow2:l .c 1-14 aka, \\Sunshinel\E\BUSINESS\FORMS\PROJECT PLANNING\SITE VISIT REPORT-PLOT PLAN.doc iocvsoN'Od JEFFERSON COUNTY trikk‘ DEPARTMENT OF COMMUNITY DEVELOPMENT i \ 621 Sheridan Street• Port Townsend•Washington 98368 360/379-4450.• 360/379-445.1 Fax p' ` www.cojefferson.wa.us/commdevelopment Master Permit Application MLA: . n() (Y)C44- Project Description(include separate sheets as necessary): I a,t441 if I egur..-.4-cirtr,i_wweil,_ Tax Parcel Number: UC1 3 a3 d Q C7 / Property Size: (acres/square feet), Site Address and/or Directions to Property: ] 'D-O t3\i C. Mt4 C p.,. lcstzx -P W U2,t W PI- q$ b9 Property Owner(s)of Record; N(E2 Q H. 0.0y Telephone:3i0 0`-3 D - p Fax: - Mailing Address: I3,0 t 1 c tT12 �7+I ( ,i L o 3I email: Applicant/Agent(if different from owner): �� �, 9 _ �� co ' Telephone: 385 57`l7 Fax: 38 5 -..875 email: ' s`44~dl+-‘,..g-, "-r't ,c-,)',- Mailing Address: . /O 853. k/I 0.2 y 6P. ' Pi.,f/R-0l-0 c% i,,,)// . What kind of Permit?(Check each box that applies. 0 Lot or load Segregation QBuilding 0 Critical Areas Stewardship Plan 0 Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family 0 Garage Attached./Detached .Q Conditional Use[C(a), CO),or C]** ❑ Manufactured Home. .0 Modular - 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* 0 Special Use(Essential Public Facilities)** 0 Change of Use 0 Boundary Line A Ju 0 Address . . .O Road Approach O Short Plat** ❑ Home Business ❑ Cottage!Industry GIBinding Site Plan,,1 " V LE ropane CI Long Plat; ** 1, ' ❑Sign 0 Planned Rural Residential Development(PRRD)/ ments** . ❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration** I 0 Stormwater Managementi. g 0Shoreline Master Prc�ram.Exemption/Permit Rel%,/ i "* ❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Managertle S ,b�t�,ntia_I pev_elopmer' ©Temporary Use_ 0 Shoreline Management Vartsftte:ON COIJNMY 0 Wireless Telecommunication* 0 Compr hensive,Planl�l nefti i g er p aip76 Am dment ❑ Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master rogr nt May require a Pre-Application Conference CI 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 ereby designate to act as my agent in matters relating to this application for permit(s). 5 '0 IVVNER SIGNATURE 1 i Z Dater /0/5 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. Stafrs access and right of entry will be assumed unless the applicant informs:the County in writing at the t : time of the application that he or she wants prior notice, ' ..nature: ,l t� Date: /II,cS �Z The action or actions Applicant will undertake as a result of the issuance of this permitmay 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 res sibility for adhering to and complying with the ESA. The Applicant has read this Signature: discla' er.and signs and dates it below. � Date: /DLZ t r:•\pi-,--4('rnre.\euttprrahrso##\DM-1 PrRM.C1r11,-..,r 11Rrl F,,..,.r\T.f..•.-..,n_...,:,A....i:,..,.;,,,,c on no A..... 0 • 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 ass Ming the esponsibility of the General Contractor for the proposed prof I Signature: d°""" Date: , [-,b tit,1 GENERAL CONTRACTOR ER: PHONE: FAX: St,�I„ S if I n e t°2 t° ()66 ) 3 Fs- s 717 ( 344 3 a'S-S a9 75 MAILING ADDRESS: Q,,,""(I 0E sC? 0 .,�/1 pt p. �./ EMAIL: CONTRACTOR'S LICENSE °" WAINS NUMBER: 5 LA ►il S > T 7 7 Q 0 NUMBER ARCHITECT/ENGINEER; ` PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: 0 New 0 Wood Existing: 0 Sewer 0 Addition 0 Steel Proposed: _ Bank 0 Community System 0 Alteration/Remodel 0 Concrete Total: Height: 0 Individual System 0 Repair 0 Masonry SEP Permit# 0 Demolition 0 Other: . Bedrooms: Water Supply: Existing: Setback: Type of Heat: Proposed: Cb Private well U Two Party ❑ 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 /4--jf this is,a Propane Tan and/or Appliance Installation permit,mark all items below that apply: 1 Underground Tank = . . nd T ,a Size of Propane Tank:)2(7 <- Heat Stogy I Cook Stove 1 Woodstove 1 Fireplace.Insert 1 Hot Water Tank 1: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 propertylines, buildings and septic system components, including the reserve area. {G I4 F� f-R �r Y M -.? 4 '-0 S•uareFoote•a Current Proposed y" - sdi , ,�I %u','/K ley,. Ii A ir. M VW j� a 0.e0'-„ aL ,9,;.4(.i, .,t4z iiir,;� , Main Floor Heated P M,w :'.EH Bld App Review: 2na Floor Heated ". r }' ; �5. K u Consistency Review: gar �, , , Other Heated .' $ A ar?�;,1,;, Base.fee: ,, Mezzanine ,Q_a __ p ,7, }1` 3' Additional:Section: Heated Basementre. .'.r x Plan Check fee: t Unheated Basement ,0 1 State Surcharge fee: f , 1 ' Other Unheated' ' �0t1, '0 Pot Water ' Review fee: t Garage/Carport .t... ft',F IVO Al .j SUBTOTAL Decks t {4� '', `" 911/Rd Approach fee: Other ,l , Ia {> i,..,IA `VP; TOTAL: $ � i. c, a f,*l,: Receipt Number 1' ✓ j 4,,x*'too` s Cash/Check Number:. ,;ass. r.. b' ��2 ESTIMATED COST(REQUIRED) Date: 'Fair market value of all labor and materials foundation to finish [d (1 t' Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-24-08.doc