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Home My WebLink AboutBLD2012-00394 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 #: BLD12-00394 SITE ADDRESS: 1291 CHIMACUM RD Issue Date: 12/5/2012 PORT HADLOCK, 98339 Final Date: 3/4/2013 APPLICANT: MATTHEW H BAKER PHONE: 360-301-3998 YVONNE A BAKER PO BOX 1014 CHIMACUM WA 98325-1014 SUBDIVISION: Block: Lot: T 8+ PARCEL NUMBER: 901113011 Section: 11 Township: 29 N Range: 01 W PROJECT DESCRIPTION: PELLET 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 3/4/2013 \\tidemark\data\forms\F_BLD_Occupancy.rpt 3/20/2013 • • O PRPANE/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#: BLD12-00394 Received Date 12/5/2012 SITE ADDRESS: 1291 CHIMACUM RD Issue Date 12/5/2012 PORT HADLOCK, 98339 APPLICANT: MATTHEW H BAKER PHONE: 360-301-3998 YVONNE A BAKER PO BOX 1014 CHIMACUM WA 98325-1014 T 8+ SUBDIVISION: Block: Lot: PARCEL NUMBER: 901113011 Section: 11 Township: 29N Range: 01W CONTRACTOR: OWNER/BUILDER PHONE: OWNER, MATTHEW H BAKER PHONE: 360-301-3998 if different: YVONNE A BAKER PO BOX 1014 CHIMACUM WA 98325-1014 PROJECT DESCRIPTION: PELLET 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 12/5/2013. REQUIRED INSPECTIONS: Tank/Line/Appliance: FinalApproval:9(„,(9114)3 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 BLD12-00394 tUILDING PERMIT APPLICAT N Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD12-00394 Received Date: 12/5/2012 SITE ADDRESS: 1291 CHIMACUM RD PORT HADLOCK, 98339 OWNER: MATTHEW H BAKER PHONE: 360-301-3998 YVONNE A BAKER PO BOX 1014 CHIMACUM WA 98325-1014 SUBDIVISION: Block: Lot: T 8+ PARCEL NUMBER: 901113011 Section: 11 Township: 29 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP PELLET STOVE 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 SHORELINE: GARAGE: SETBACK: CONST TYPE: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: it Approved/Date Propane Tanks/Stoves $148.00 LYK 12/05/12 139807 r t.) Total: $148.00 [;�, J012 Jefferson County Planninc & Building Department \\FirlemorlAr4n+n fnrmc\F RI f1 Ann Rlrl rn+ 19/F/9f119 4��,SON c0� JEFFERSONUNTY • y ' `ram DEPARTMENT OF COMMUNITY DEVELOPMENT ' 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax kIs O www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: MLA. Projecty escription(include separate sheets as necessary): ir Tax Parcel Number:£1O (lab t l Property Size: (acres/square feet) Site Address and/or Directions to Property: / 2- `3 ( C4A i✓vt (AL 6->---k 244 P4- /4-- -‘�., ( d c--(L Property Owner(s)of Record: f Yl a 4- i- I, tL u,),-7 n C 6<,Vie,— Telephone: 3l9 v 3O`- `• 5 V Fax: email: \7 4,V-,er-Cc.r1-.. .,‘t 2_,0��c-.►.,.J.-e a..-, Mailing Address: O ? cx l O\L-1 C(\\P"r^Lt.\ tti. \,..i 1 3 A 5 Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies 0 Lot or Road Segregation Mtuilding 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 Cl** 0 Manufactured Home ❑ Modular 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** ❑ Home Business 0 Cottage Industry 0 Bind Site Wan** ❑ Propane ❑ Lon P *# ❑ Siyn IDPlanne(i • RD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** ❑ Stormwater Management ❑Shoreline!Master Program Exemptio , " t Revisions** ❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial DjT - I. ent** ❑ Temporary Use 0 Shoreliri Management Variance ❑Wireless Telecommunication* 0 Compfeh- ' - • -a I -.. - u ric Map Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson CountyiBlfififttaIlh&M1tf3tter Progra Amendment *May require a Pre-Application Conference 0 Tree;VegetatlOri) re tTY DEVELOPMENT **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 to act as my agent in matters relating to this application for permit(s). , OWNER SIGNATURE � i ^ Date: l2 / S7 / 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 I 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 time of the appl' ti hat he or she w prior no'ee. Signature: /v/S/l Date: 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 yo are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-tran fer a responsibility for adh ' g to and omplying with the ESA. The Applicant has read this disclaimer and signs artd,dates it below. Signature: �-._ /� /S —// ,,,_,� Date: G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc .mom • • 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 ing the responsibility o he Gene I Contractor for the proposed project. 6tjr)e✓ bcr rld«Date: _7o7-7.3 // Signature: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE FAX:( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTORS LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Type:T e: Bathrooms: Shoreline: Type of Sewage Disposal:. New E Wood Existing: = Sewer E Addition i Steel Proposed: Bank L Community System Alteration/Remodel 1: Concrete Total: _ Height: C Individual System Li SEP Permit# _ Repair E Masonry Other: Bedrooms: Water Supply: C Demolition Existing: _ Setback: C Private well ❑ Two Party T pe of Heat: Proposed: ❑ Public Total: Name of System: If this is a Commercial Project you must answer the following: ADA Parking Spaces: Number of Parking Spaces: Current: Proposed: Number of Proposed Number of occupants(includes owners,tenants,employees, etc) Current p . 13C Occupancy: IBC Type of construction: you- - - - - - _-_- -_ Will 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 Other i Heat Stove i Cook Stove I Woodstove i Fireplace Insert I Hot Water Tank `Ilet Stov 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 App Review: Main Floor Heated EH -2nd Floor Heated Consistency Review: Other Heated Base fee: i; (t2 -- Mezzanine Additional Section: `�1 c� Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $ l `T Receipt Number: I: q Stcl - Cash/Check Number: &-1 31(�) ESTIMATED COST(REQUIRED) Date: I�_Y�7+�C .Fair market value of all labor and materials foundation to finish Initials: __. i (::\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc