HomeMy WebLinkAboutBLD2012-00392 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 #: BLD12-00392
SITE ADDRESS: 992 FOUR CORNERS RD Issue Date: 12/5/2012
PORT TOWNSEND, 98368 Final Date: 2/21/2013
APPLICANT: SANDRA M RAE PHONE: 360-379-1884
THOMAS C RAE
992 4 CORNERS RD
PORT TOWNSEND WA 9836-89373
SUBDIVISION: MICRAELUND SHORT PLAT Block: Lot: 1
PARCEL NUMBER: 001334037 Section: 33 Township: 30 N Range: 01 W
PROJECT DESCRIPTION: SWAP OUT A/G 250 GAL PROP TANK - SAME SIZE & LOCATION
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
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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 #: BLD12-00392 Received Date 12/5/2012
SITE ADDRESS: 992 FOUR CORNERS RD Issue Date 12/5/2012
PORT TOWNSEND, 98368
APPLICANT: SANDRA M RAE PHONE: 360-379-1884
THOMAS C RAE
992 4 CORNERS RD
PORT TOWNSEND WA 9836-89373 1
SUBDIVISION: MICRAELUND SHORT PLAT Block: Lot:
PARCEL NUMBER: 001334037 Section: 33 Township: 30N Range: 01W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP"077QP Expires 1//1602013 5875
OWNER, SANDRA M RAE PHONE: 360-379-1884
if different: THOMAS C RAE
992 4 CORNERS RD
PORT TOWNSEND WA 9836-89373
PROJECT DESCRIPTION: SWAP OUT A/G 250 GAL PROP TANK-SAME SIZE & LOCATION
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 12/5/2013.
REQUIRED INSPECTIONS:
Tank/Line/Appliance:
FinalApproval: ' . b t3
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 12/5/2012
BUILDING PERMIT APPLICATII BLD12-00392
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD12-00392 Received Date: 12/5/2012
SITE ADDRESS: 992 FOUR CORNERS RD
PORT TOWNSEND, 98368
OWNER: SANDRA M RAE PHONE: 360-379-1884
THOMAS C RAE
992 4 CORNERS RD
PORT TOWNSEND WA 9836-89373 MICRAELUND SHORT PLAT
SUBDIVISION: Block: Lot: 1
PARCEL NUMBER: 001334037 Section: 33 Township: 30 N Range: 01 W
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2013
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION SWAP OUT A/G 250 GAL PROP TANK - SAME SIZE & LOCATION
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: Approved/Date
Propane Tanks/Stoves $74.00 LYK 12/05/12 139804 A P P R O V E r
Total: $74.00
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Jefferson County Planninr
& Building Department
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• SITE VISIT REPORT
(PLOT PLAN)
JOB DJ SO,•V� �'e-- DATE: I t iz-7/-2. ,
CONTACT:
ADDRESS PHONE #:
DIRECTIONS •FAX #:
Email
PLANNER: vim- L• .
Include all street names adjacent to property,property lines,tank,appliance&piping locations,distances of tank to property lines and
buildings,septic,wells,wetland areas,distance to water bodies.
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. ON r, JEFFERSON COUNTY
i . '%iiiiit
4 DEPARTMENT OF COMMUNITY DEVELOPMENT
s 621 Sheridan Street • Port Townsend • Washington 98368
360/379-4450 • 360/379-4451 Fax
,q �p www.co.jefferson,wa.us/commdevelopment
`4WINc
Master Permit Application MLA: MCA
Projefct Description (include separate sleets as necessary):
,S ,51ye . ' iz -a50 - !&; /c- ca, 04
Tax Parcel Number: 0 0 1 33 V - 0 3 7 Property Size:
(acres/square feet)
Site Address and/or Directions to Property: _
ei .,D._ - zi C__0-r ria..trf ifeL4 _ r i
. claiu,-,,,,,,,,Q 630, ',Fic.)
Property Owner(s)of Record: , 5 > 0 2/'7 �/'an ��
-) r
Telephone: ,3 7 c /J7 'V Fax: n e ail:�,
Mailing Address: P c� 6 3 73 - I p 0/2$7 j O n o � - d 331
Applicant/Agent(if different from owner): iGt.--c�,.. 'r✓ A-11>d Al—A
Telephone: g@5 - '7 7 Fax: -31E 5--_5 87 S email: fy"' S"'y`dA-..�fO,r.ayJex,-e ,c__,,.,,,_
Mailing Address: /O d'..,�3 ./-/ o y CP• PT . ////-9 L o c,' L,)/j
What kind of Permit?(Check each box that applies ❑Lot or Road Segregation
❑Building ❑ Critical Areas Stewardship Plan
❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use)
❑ Single Family ❑ Garage Attached/Detached 0 Conditional Use tC(a.); d}t of :4\4',,
❑ Manufactured Home 0 Modular 0 Discretionary Q1 laf t r 4 L sk_l s ication,
❑ Commercial* ❑ Special Use (Essential Public Facttitteb ' 'f i
❑ Change of Use ❑ Boundary,Line Adjustment ,I
❑ Address 0 Road Approach 0 Short Plat** -; _ P. ,;,J12 it
❑ Home Business 0 Cottage Industry 0 Binding Site Plan
*propane 0 Long Plat**; 'L,, ,I
o Sign 0 Planned kural RRD) •mendments**
❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteratid f i` C''�'O nFY
❑ Stormwater Management ❑Shoreline Mast Ft ;;' ' !.;s a 4...1 ui' l;: isions**
❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Substantial Development**
❑ 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-Applicatipn Conference
Please identify an other local, state or federal permits required for this proposal, if known:
�'J%jam L'-
DESIGNATION OF AGENT
, I ereby designate to act as my agent in matters relating to this application for permit(s).
5J1'0 OWNER SIGNATURE, 'Y� Date: /2 - 3 / 2'
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 attorneys 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
r time of the app.ljcalion that he or e w nts prior notice.
/'t 11 l"" it, /nature: \1 ' �— Date: /Z - 3 -- / Z—"
�j 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-transfer ,b responsibility for a ring to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
` Signature: ✓ ZrykG �C e ye Date: /? - 3- /Z.
9 t
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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 ER: PHONE: FAX:
St,�r�, S ff t n e pc)(W 10r--v--- (2 d ) 3 eS- -I- 7 17 ( 3 G4 3eS-S P 75
MAILING ADDRESS: / j E 5 3tat-L.„44.1_ j r I' P (/ EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: 5toKIS Y > 2l77Qi2 NUMBER
ARCHITECT/ENGINEER: } PHONE ( ) FAX: ( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New 0 Wood Existing: _ ❑ Sewer
❑ Addition 0 Steel Proposed: Bank 0 Community System
O Alteration/Remodel 0 Concrete Total: Height: 0 Individual System
O Repair 0 Masonry SEP Permit#
❑ Demolition 0 Other: Bedrooms: Water Supply:
Existing: - Setback: 0Private well i Two Party
Type of Heat: Proposed: ij Public
Total: Name of System:
I
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 Pro.ane Tank - •:- Installation permit,mark all items below that appl :
I Underground Tan Above ground Ta Size of Propane Tank: 2SO
I Heat Stove I Cook .,- ••.•..s ove I Fireplace Insert I Hot Water Tank I Pellet Stove M 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.
1 9,A v. ori yr. +'T 6tm' i ti n ,;'. 4,,,Y W It i
g ¢ a� µ °7 S �fSquare Footage Current Proposed > n .; ,e'. b :n0F ,,,j .n ,. 1 c
Main Floor Heated EH Bld App Review:
• Y �
2nd Floor Heated t }' Consistency Review:
aM�a
Other Heated F�
fir f�` k Base fee: rJ
/��
Mezzanine i ' : ' , '• Additional Section:
4
Heated Basement fe, s Plan Check fee:
r* s, a
Unheated Basement , ' �f' State Surcharge fee:
' �
Other Unheated :* -��
��'�� ;, ` Pot Water Review fee:
Garage/Carport 041
40 , SUBTOTAL
Pik*
Decks
911/Rd Approach fee:
Other �Rr" r
a y 't�' TOTAL $ ' i•-t.
,i• i f ` Receipt Number:
r
-',:ii;
'' ' Cash/Check Number J'�11n7`(�r
ESTIMATED COST(REQUIRED) Date: „-
•Fair market value of all labor and materials foundation to finish ` _
Initials: --------) ,
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G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
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