HomeMy WebLinkAboutBLD2012-00325 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 #: BLD12-00325
SITE ADDRESS: 474 BLUE MOUNTAIN RD Issue Date: 10/22/2012
CHIMACUM, 98325 Final Date: 2/21/2013
APPLICANT: MELVIN E MILLER PHONE: 360-732-0280
ROBERTA F MILLER
474 BLUE MOUNTAIN RD
CHIMACUM WA 98325-8790
SUBDIVISION: COUNTRY RIDGE Block: Lot: 19
PARCEL NUMBER: 801045019 Section: 4 Township: 28 N Range: 01 W
PROJECT DESCRIPTION: CONVERT 2ND FLOOR UNHTD STORAGE TO HEATED STORAGE
(SEE BLD12-83)
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 2/21/2013
\\tidemark\data\forms\F_BLD_Occupancy.rpt 3/20/2013
Jefferson County Building Division Permit Num! BLD12-00325
Applicant: MILLER
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 `!0-l t 1�
Blocking V
Airseal -l O lc
Insulation:Walls a_
Insulation: Floors 1 U�
Insulation: Ceiling 14-11-- /
Wallboard Nailing `_Iit 7II L,
Drywelle
Address Posted q _ I l 3
FINAL INSPECTION ,I9Ai
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
•UILDING PERMIT APPLICA�N BLDI2-00325
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD12-00325 Received Date: 10/11/2012
SITE ADDRESS: 474 BLUE MOUNTAIN RD
CHIMACUM, 98325
OWNER: MELVIN E MILLER PHONE: 360-732-0280
ROBERTA F MILLER
474 BLUE MOUNTAIN RD
CHIMACUM WA 98325-8790 COUNTRY RIDGE
SUBDIVISION: Block: Lot: 19
PARCEL NUMBER: 801045019 Section: 4 Township: 28 N Range: 01 W
CONTRACTOR: INTEGRITY HOMES & REMODELING PHONE: (360) 316-9472
124 SWANSON AVE
PORT TOWNSEND WA 98368
Contractor's License INTEGHR953PD Expires 10/4/2013
REPRESENTATIVE: DONALD CHARLTON PHONE: (360) 316-9472
124 SWANSON AVE
PORT TOWNSEND WA 98368
PROJECT DESCRIPTION CONVERT 2ND FLOOR UNHTD STORAGE TO HEATED STORAGE
(SEE BLD12-83)
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP ALT MAIN:
VALUATION 45,000.00 ADD'L: 576 HEAT TYPE: EEE
CODE EDITION: 2009 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 0 Prop: 0
Total: 0 Totah..._ _--
Routing Date:
Type Amount Paid Bv: Date: Receipt: Approved/Date
Permit $593.25 LYK 10/11/12 135293 APPHOVEr
Plan Check $385.61 LYK 10/11/12 135293
State Building Code $4.50 LYK 10/11/12 135293 CIL(Z2--2012
Total: $983.36
Jefferson County Planning
& Building Department
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oG JEFFERSOI.OUNTY •
' ' DEPARTMENT OF COMMUNITY DEVELOPMENT
~' '"C 621 Sheridan Street • Port Townsend • Washington 98368
360/379-4450 • 360/379-4451 Fax
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IN
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Master Permit Application t4-r---_ SPCkC� MLA: ND IL
Project Description (include separate sheets as necessary): All;it e_- G •-t /5,1, E,i- -F,ek,7 t 1
Retrofit existing pole barn garage level to finish space and retrofit upper level fo heated/finished space for storage/utility room.
Tax Parcel 801045019 Property 9 , 3 3 CI, �s
Number: Size: - 3', :-f C ) s i_ (acres/square feet)
Site Address and/or Directions to Property: 474 Blue Mountain Road, Chimacum, WA 98325
Property Owner(s)of Record: Melvin E Miller,Roberta F Miller
Telephone:360-732-0280 Fax: email:
Mailing Address: 474 Blue Mtn.Road,Chimacum,WA 98325
Applicant/Agent(if different from owner): Donald Charlton,Jr.
Telephone: 360-316-9472 Fax: email: integrityhomes@cfaith.com
Mailing Address: 124 Swanson Ave,Port Townsend,WA 98368 (' -• 4 V�n r, L --1
What kind of Permit?(Check each box that applies r I^� �-
0Building ❑Variance(Minor,Majo(or Reasonable Economic Us4)
❑ Demolition Permit 0 Conditional Use,[C(a),!C(d),or CI** 1l
❑ Single Family ❑ Garage Attached/Detached 0 Discretionary"Cr or Unnamed Use Classificatiorj
O Manufactured Home ❑ Modular ❑ Special Use(Essential Public Facilities)** 12
❑ Commercial* ❑ Boundary Line Adjustment
r I Change of Use 0 Short Plat** JEFF-ERSON COUNTY
El Address ❑ Road Approach ❑ Binding Site Plan** DEPT.Or COMMUNITY DEVELOPMENT
I ❑ Home Business El Cottagelndustry ❑ Long Plat**
❑ Propane ❑ Planned Rural Residential Development(PRRD)/Amendments**
❑ Sign 0 Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions**
❑ Stormwater Management ❑ Shoreline Management Substantial Development**
❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance
❑Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* 0 Jefferson County Shoreline Master Program Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium ❑Tree Vegetaion Request
*May require a Pre—Application Conference **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 Donald Charlton,Jr. to act as my agent in matters relating to this applicationa for permit(s).
/
OWNER SIGNATURE Dat . 'r) t,/C)
u
By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is tr e and correct to the best of
his,her or it's 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 ap�icatio hat h qr she wan prio otice. �!�� / /
Signature X � LL �SIJ� t/ Dat / E/"lt-' 1 l—
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-tr ra resp nsibility for a�dheri taarld lying with the ESA. The Applicant has read this dis i r and igns and dates it below.
ti
Signature e.,.ii - 2.. Date
r
C:\Documents and Settings\car l\Local Settings\'Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.doc
i-► . II/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 assumin the responsibility of the General Contractor for the proposed project.
Signature: / Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
Integrity Homes&Remodeling ( 360)316-9472 ( )
MAILING ADDRESS: integrityhomes@cfaith.com EMAIL: integrityhomes@cfaith.com
CONTRACTOR'S LICENSE WAINS
NUMBER: INTEGHR953PD NUMBER C11SG3504, NAIC#37206
ARCHITECT/ENGINEER: xx PHONE ( ) Fax:( )
MAILING ADDRESS: xx EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
r, New '✓Wood Existing: 0 t, Sewer
I I Addition Steel Proposed: 0 Bank ❑ Community System
1 Alteration/Remodel Concrete Total: 0 Height: ❑ Individual System
Repair Masonry NA SEP Permit# 14 -co i 5
Demolition Other: Bedrooms: W 0 ter Supply:
Existing: Setback: V Private well Two Party
Type of Heat: Proposed: 0 Public
Electric Forced Air Total: 0 NA Name of System:
If this is a Commercial Project you must answer the following:
Number of Parking Spaces: Current: Proposed: __Number of ADA Parking narp
Number of occupants(includes owners,tenants, employees,etc) Current r
IBC Occupancy: IBC Type of construction: Will youl� ooc
If this is a Propane Tank and/or Appliance Installation permit, mark all items below that apply:
0 Underground Tank °Above ground Tank Size of Propane Tank:
❑Heat Stove 0 Cook Stove 0 Woodstove 0 Fireplace Insert 0 Hot Water Tank 0 Pellet Stove ❑Otheri12
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 showi'rff}afl'ofthat buildings,a property
lines, tank location and size, distances from the propane tank to all property lines,buildings and septic system-corn onents,
including the reserve area.
Square Footage Current Proposed For Office Use Only Amount Revision
Main Floor Heated EH Bid App Review:
2"d Floor Heated ��
�(p Consistency Review:
Other Heated Base fee:
Mezzanine Additional Section:
Heated Basement Plan Check fee: 2 3. cot
Unheated Basement State Surcharge fee: �--
Other Unheated fj n Pot Water Review fee:
s�o 7 -( , - PII(Yt a
Garage/Carport J� SUBTOTAL
fl( (c 3�
Decks 911/Rd Approach fee: au
c�,
Other `� ' "t _
TOTAL: $ (D50! 3.D
Receipt Number: ( 3 q 3
Cash/Check Number: 30(U
_4
TIMATED COST(REQUIRED) Date: I
*Fair market va ue o materials foundation to finish I -t-1-
3,
--y -- i Initials: -
C:\Documents and Settings\carat\Local Settings\'Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.doc
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