The URL can be used to link to this page

Home My WebLink AboutBLD2012-00398 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 #: BLD12-00398 SITE ADDRESS: 670 ADELMA BEACH RD Issue Date: 12/10/2012 PORT TOWNSEND, 98368 Final Date: 4/10/2013 APPLICANT: STEPHEN J CHAPPUIS PHONE: JANICE L CHAPPUIS 829 NE IMPERIAL AVE PORTLAND OR 97232-2637 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901051013 Section: 5 Township: 29 N Range: 01 W PROJECT DESCRIPTION: re-roof 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 4/10/2013 \\tidemark\data\forms\F_BLD_Occupancy.rpt 4/11/2013 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#: BLD12-00398 Received Date 12/10/2012 SITE ADDRESS: 670 ADELMA BEACH RD Issue Date 12/10/2012 PORT TOWNSEND, 98368 APPLICANT: STEPHEN J CHAPPUIS PHONE: JANICE L CHAPPUIS 829 NE IMPERIALAVE PORTLAND OR 97232-2637 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901051013 Section: 5 Township: 29N Range: 01W CONTRACTOR: OWNER/BUILDER PHONE: OWNER, STEPHEN J CHAPPUIS PHONE: if different: JANICE L CHAPPUIS 829 NE IMPERIALAVE PORTLAND OR 97232-2637 PROJECT DESCRIPTION: re-roof 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 12/10/2013. REQUIRED INSPECTIONS: T2hklLine/Appliance: " teefr---6,-D--( FinalApproval: .- 4 —q -- 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 12/10/2012 I WILDING PERMIT APPLICA N B Review 0398 Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD12-00398 Received Date: 12/10/2012 SITE ADDRESS: 670 ADELMA BEACH RD PORT TOWNSEND, 98368 OWNER: STEPHEN J CHAPPUIS PHONE: JANICE L CHAPPUIS 829 NE IMPERIAL AVE PORTLAND OR 97232-2637 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901051013 Section: 5 Township: 29 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP re-roof TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 29,000.00 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 Permit $421.55 JLA 12/10/12 139815 Plan Check $276.61 JLA 12/10/12 139815 State Building Code $4.50 JLA 12/10/12 139815 Total: $702.66 DEC 10 2012 Jefferson County Planninr & Building Department \\4i, rlArla4o\fnr,v \C RI n nnn Rid rnf i iin/ n17 lercill codJEFFERSOI*IJNTY r i DEPARTMENT OF COMMUNITY DEVELOPMENT in " '� 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax .qS N�4,0 www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Project Description (include separate sheets as necessary): • Tax Parcel Number: I D+ 0 I D) Property Size: (acres/square feet) Site Address and/or Directions�to Pr arty: { 124 lia316,$n `� 2+1-4,04 Property Owner(s)of Record: , Telephone: 130 3- c1`7 b—I 1S v // Fax:,. email: feihe'f's �Mailing Address: Gt-VYIe el S C r-',(P_ G-011'1 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 Mt uilding 1r`C'—'CO Cf. 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 C]** ❑ 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_ ❑Short Plat** ❑ Home Business 0 Cottage Industry 0 Binding Site Plan** ❑ Propane 0 Long Plat** 0 Sign 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** ❑ Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions** 0 Site Plan Approval Advance Determination (SPAAD)* 0 Shoreline Management Substantial Development** ❑Temporary Use 0 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 AGENT I hereby designate nate to act as my agent in matters relating to this application for permit(s). ---k--- • OWNER SIGNATURE 0�1 Ct�(� Date: 0-- 06 l )--- 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. Sta access and right of entry will be assumed unless the applicant informs the County in writing at the time of the a licatio he or he wants r r otice. PP �_/' P Signature: !\ -V"� / �"—1 Date: I L (v I t 2_ 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 t fferson County development code.The Applicant acknowledges that he, he or it holds individual and non-transferabl ponsibility for adhe ng to and complying with the ESA. The Applicant has read this disclaim r an signs and dates it below. Signature: �� ___ l✓to p(\ Date: tY [d ( C, G:\PermitCenter\###FORMES###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc 0 BUILDER STATEMENT 4111 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 OR MANUFACTURED HOME INSTALLER: PHONE: FAx: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAx:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New C. Wood Existing: 1 Sewer E Addition C Steel Proposed: Bank ❑ Community System C Alteration/Remodel a Concrete Total: _ Height: ❑ Individual System Li Repair C Masonry — SEP Permit# _ C Demolition C Other: Bedrooms: Water Supply: Existing: - Setback: C Private well ❑ Two Party Type of Heat: Proposed: E 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 FoodService? 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 Heat Stove i Cook Stove i Woodstove i Fireplace Insert i Hot Water Tank i 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 property lines,buildings and septic system components, including the reserve area. Square Footage Current Proposed For Office Use Only Amount Revision Main Floor Heated EH BId App Review: 2nd Floor Heated Consistency Review: Other Heated Base fee: 8il /; `>L1/ 5 Mezzanine Additional Section: 7 7 Heated Basement Plan Check fee: n/ (7/- 1 /_ I Unheated Basement State Surcharge fee: — S • 1/.lv Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $ 72-(o`P riv2.(p le Receipt Number: ,i / gj Cash/Check Number: yy(a te ESTIMATED COST(REQUIRED) Date: / 2��O•/ Z .Fair market value of all labor and materials foundation to finish Initials: (;.\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc