The URL can be used to link to this page

Home My WebLink AboutBLD2012-00357 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 #: BLD12-00357 SITE ADDRESS: 30 GOLDFINCH LN Issue Date: 11/1/2012 PORT LUDLOW, 98365 Final Date: 2/25/2013 APPLICANT: ROBERT E COMMANDER PHONE: SHARON L COMMANDER 30 GOLDFINCH LN PORT LUDLOW WA 98365-9764 SUBDIVISION: PORT LUDLOW NO. 4 Block: Lot: 26 PARCEL NUMBER: 990500026 Section: 17 Township: 28 N Range: 01 E PROJECT DESCRIPTION: A/G 120 GAL PROP TANK 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 2/25/2013 \\tidemark\data\forms\F_BLD_Occupancy.rpt 3/20/2013 • • 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 #: BLD12-00357 Received Date 11/1/2012 SITE ADDRESS: 30 GOLDFINCH LN Issue Date 11/1/2012 PORT LUDLOW, 98365 APPLICANT: ROBERT E COMMANDER PHONE: SHARON L COMMANDER 30 GOLDFINCH LN PORT LUDLOW WA 98365-9764 26 SUBDIVISION: PORT LUDLOW NO. 4 Block: Lot PARCEL NUMBER: 990500026 Section: 17 Township: 28N Range: 01 E CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797 10853 RHODY DR PORT HADLOCK WA 98339 Contractor's License SUNSHP*077QP Expires 11/1602012-5875 OWNER, ROBERT E COMMANDER PHONE: if different: SHARON L COMMANDER 30 GOLDFINCH LN PORT LUDLOW WA 98365-9764 PROJECT DESCRIPTION: A/G 120 GAL PROP TANK 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 11/1/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval: 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 11/1/2012 BLD12-00357 litUILDING PERMIT APPLICATION Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD12-00357 Received Date: 11/1/2012 SITE ADDRESS: 30 GOLDFINCH LN PORT LUDLOW, 98365 OWNER: ROBERT E COMMANDER PHONE: SHARON L COMMANDER 30 GOLDFINCH LN PORT LUDLOW WA 98365-9764 PORT LUDLOW NO. 4 SUBDIVISION: Block: Lot: 26 PARCEL NUMBER: 990500026 Section: 17 Township: 28 N Range: 01 E 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 DESCRIPTION A/G 120 GAL PROP TANK TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: 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: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid Bv: Date: Receipt: Approved/Date Propane Tanks/Stoves $74.00 LYK 11/01/12 135374 p Lei f•rt j r I Total: $74.00 t u hOa Zui[ County Plennin,„ F Building Denartrieni \\firlcmorlr\rInfn\fnrmc\C RI f1 Ann PIA rnf 11/1 PJr 1, M Orr �a JEFFERSON COUNTY , IIP I • ' \,% DEPARTMENT OF COMMUNITY DEVELOPMENT 4\ .fsi 621 Sheridan Street• Port Townsend •Washington 98368 d 360/379-4450 • 360/379-4451 Fax www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA; RIP Project Description(include se sheets necessary): • Tax ParoelNumber: q c1&5 0 C .02.(p _ Property.Size: (acres/square feet) Site Add ss and/grlDirections to Property: I Property ner(s)of Recordr #O(t2T£ 12 p-0 eb(Y)' ICkii: (Z. Telephone: Fax: ` � email: Mailing Address: 30 .6Dt-Or in1 C-f^t i-�l) '-&�T • C_ZSt.,3 Applicant/Agent(if different from owner): _mac .,_ /L./lwi,.. .-- Telephone: ge5 57 7 Fax: 38 5--.�875: email: Gy s �d4...-,--i-P-ayJa-,-e ,cA,,,, Mailing Address: /d ' 3 ,i?f•/o"v 60. Pi //R-0c-0 ck ,i,;)A. What kind of Permit?(Check each box that applies 0 Lot or Road Segregation oBuilding 0 Critical Areas , ❑ Demolition Permit 0 Variance(Minor,M • e itte o usi ❑ Single Family 0 Garage Attached./Detached El Conditional Use(Crr )„- ❑ Manufactured Home ; -0 Modular - ❑.Discretionary"0"or, nnamed Use Classificati ❑ Commercial* p Special Use.(:Essential Public Facilities ** ❑ Change of Use 0 Boundary Line Adjustment ❑ Address . . 0 Road Approach 0 Short l,lat** ❑ Home Business 0 Cottage Industry . ❑Binding Site Plan'*"uI Propane 0 Long Plat** JEFFERSON COUNTY o Sign •. , .. • 0 Planned Rural Residtrffal V r dments** ' 0 Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration*" 0 Stormwater Management 0 Shoreline Master Program.Exemption/Permit Revisions** 0 Site•Plan Approval Advance Determination(SPAAD)* 0 Shorelihe Management Substantial Development** -❑Temporary Use , ❑Shoreline Management Variance ❑Wireless Telecommunication* 0 Comprghensive 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 D Tree Vegetation.Request **Regpfres:a Pre-Application Conference Please identify any other local, state orfederal 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). Si' •WNER SIGNATURE t J- \f it (1 . J Le-r-vt,,,,m-G` Date: "_ %Z I 7---- 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. Staffs access and right of entry will be assumed unless the applicant informs:the County in writing at the t time of the ap I' lion that he She wants prior notice. '` +Al . •natur • ts+'l t��1� �•�L�� ✓l -C.!t Date: /I- 1/ The action or actions Applicant will undertake as a result of the issuance of this pemtitjmay negatively impact upon one or mote 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. Ahy 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-trap a able responsibili t for adhering to and o�p�m� plyi�ng.with the ESA. The Applicant has read this discla er and signs and dates it below. ` Signature? �..er ,,tom nlit4Y?/t.44. 'h-� Date: J0 ZS -. �� // `W (--:•\Pr...,;r(enter\###FORM.C###\fRTl FnRmg\C,....nrr pn F.....,-\rT..,....o..-rn:.4««1:..,.1:,.«F on no A.... • 0 • ,Otv ea JEFFERSON COUNTY ernoi \,k DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fix d" www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Project Description(include separate sheets as necessary): Tax Parcel Number: Property.Size: (acres/square feet) Site Address.and/or Directions to Property: Property Owner(s)of Record: Telephone: Fax: email: Mailing Address: Applicant/Agent(if different from owner): .cam pA..4->o,,..)^ Telephone: Y85 S7 5 7 Fax: -38 S- e 75; email: Uy s',44.4A-•-,•.Lipirr.va-,-e ,es,,,. Mailing Address: . /O&53 k.1-/02)y 612. Pi. //A-O -0c% r..JA" What kind of Permit?(Check each•box that applies • 0 Lot or Road Segregation 0Building 0 Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family 0 Garage .Attached./Detached ❑Conditional Use(C(a), C(d),or C]** ❑ Manufactured Home •0 Modular 0 Discretionary"D"or Unnamed Use Classification O Commercial* 0 Special Use(Essential Public Facilities)** ❑ Change of Use ❑Boundary Line Adjustment Address 0 Road Approach . ❑Short plat** ❑ Home Business 0 Cottage Industry 0 Binding Site Plan** 'ropane 0 Long;Plat** ❑ Sign ❑Planned Rural Residential.Development(PRRD)/Amendments** 0 Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** O Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions"* 0 Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development** .0 Temporary Use, , .❑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 AGgNT I hereby designate to act as my agent in matters relating to this application for permit(s). 516, •WNER SIGNATURE Date: 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 falsehoodor 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 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 application that he or she wants prior notice, , g . .nature: Date: The action or actions Applicant will undertake as a result of the issuance of this permitmay negatively Impact upon one or mote 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: •\Pprrnit inter\###FORMRii##\T?RTn Pr RMC\r',,,,-..,r npn Pnrrr,r\114..or.,r n.....:.A.,..1:.....4,.,,s no no a,... 0 . BUILDER STATEMENT The signor of this statement does hereby certify that they are the Owners of the parcel referenced her In,th they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed project Signature: date. � / 3/,1 / GENERAL CONTRACTOR ER: PHONE: FAX: St t..a„ s.ii t n e rP(2 PA-v . (?6 ) 3 Fs- -r- 7 f 7 (3 64 3 es-5-a 75 MAILING ADDRESS: '0g 5C 5� 4 3 „ pl P. (.t EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: S'C' 5. „"177 Q h . :'NUM)3ER . 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 MasonrySEP'Permit# o Demolition 0 Other: . Bedrooms: Water Supply: Existing: Setback: Type'of-Neat: Proposed: 0 Private well 0 Two Party Total: t. -- 1 Or/ N-----7 . 1 If this.is a Commercial Prolecc you must answer the following: I Number of parking Spaces: Current: Proposed: Number of ADA Rar1§612Spa Number of occupants(includes owners,tenants,employees,etc) Current. Proposed • IBC Occupancy:. IBC Type of construction: .. . • Will yell haua Fodeftervlce' Yes ' No Jf this is,a Propane Tank and/orA pliance Installation permit,mark all items below that i r�$ON COUNTY - I(�U I Underground Tank 1 e nd k Size of Propane Tan : N F C� NITY DEVELOPMENT ro I Heat Stove I Cook Stove I Woodstove t Fireplace insert I'Hot Water Tank ...1,Pellet Stove 1 Other Is this appliance being installed in a Manufactured'/Mobile Home? Yes / No When applying fora permit to install a propane tank you must also submit a site plan showing all of the buildings,all'property - >linos, tank location and size,distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. Yl`7 "�' }t.b '`tisr Y '�1 7 .fE^�'lL"� "�+' __{�v�nv y "�+ �.S � � l S, 3n•orb wY a �`rri� G' 4f, '' w �+,.p o„ k ,1 ` p S 7 eu (te r n �" 7� Rl Pitt: Square Footage Current Proposed v ,e) t Y s� ,� , Main Floor Heated a , " .„ ,..P 5� t ., �T ok.„ /..,,EH Bid App Review: „� 2"°Floor Heated ":, Consistency Review: 1 �� Other Heated , f Base fee: 5a,, Mezzanine ,-, ,i '4, Additional.Section: l,�,�a tP,t-t`' Heated Basement r , °: a y Plan Check fee: Unheated Basement „., 4` ; State Surcharge fee: Other Unheated:.... . ..: .... . P �� 11 VW r' 5 Pot Water Review fee: ellt, �S Garage/Carport rl7a ` �,, 3 , , f, SUBTOTAL Decks , t)R �if'J 1 ' ��{b��ryx�rtr .� • 911/Rd Approach fee: Other a ), ,, 94P 9 G .4- TOTAL _ ,,,v.,:tr� .., �7x.4 1 Receipt Number : . .�. r,, •seeCash/Check Number.: ,. ` , , AN, Y i ESTIMATED COST(REQUIRED) : - Date: •Fair market value of all laborand materials foundation to finish: — I- Initials: Sr G;\PetmitCenter\###FORMS###\DRD FORtvMS\Current DRD Foriiis1/4Master Prank Application 5-24-08.cloc