HomeMy WebLinkAboutBLD2012-00410 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 #: BLD12-00410
SITE ADDRESS: 200 BEACH DR Issue Date: 12/26/2012
NORDLAND, 98358 Final Date: 3/4/2013
APPLICANT: TIMOTHY P TIBBALS PHONE: 360-301-1631
ALICE M TIBBALS
200 BEACH DR
NORDLAND WA 98358-9603
SUBDIVISION: FULLER'S ACRES Block: Lot: 5+
PARCEL NUMBER: 952200005 Section: 8 Township: 29 N Range: 01 E
PROJECT DESCRIPTION: HOT WATER HEATER & PIPING
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
• •
MECHANICAL AND DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT#: BLD12-00410 Received Date 12/26/2012
SITE ADDRESS: 200 BEACH DR Issue Date 12/26/2012
NORDLAND, 98358
APPLICANT: TIMOTHY P TIBBALS PHONE: 360-301-1631
ALICE M TIBBALS
200 BEACH DR
NORDLAND WA 98358-9603 5+
SUBDIVISION: FULLER'S ACRES Block: Lot:
PARCEL NUMBER: 952200005 Section: 8 Township: 29N Range: 01 E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/1602013-5875
OWNER, TIMOTHY P TIBBALS PHONE: 360-301-1631
if different: ALICE M TIBBALS
200 BEACH DR
NORDLAND WA 98358-9603
PROJECT DESCRIPTION: HOT WATER HEATER& PIPING
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 12/26/2013.
REQUIRED INSPECTIONS: Q (2Tank/Line/Appliance: V) (3ale
FinalApproval:
BUILDING INSPECTION HOT-LINE 379-4455.
REQUESTS MUST BE RECEIVED BY 3 PM THE DAY BEFORE THE INSPECTION IS NEEDED.
Office Hours 9:00 a.m. -4:30 p.m. Monday-Thursday
HOT LINE AVAILABLE 24 HOURS A DAY
\\tidemark\data\forms\F_BLD_Permit_Propane.rpt 12/26/2012
BLD12-00410
illtUILDING PERMIT APPLICA N Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD12-00410 Received Date: 12/26/2012
SITE ADDRESS: 200 BEACH DR
NORDLAND, 98358
OWNER: TIMOTHY P TIBBALS PHONE: 360-301-1631
ALICE M TIBBALS
200 BEACH DR
NORDLAND WA 98358-9603 FULLER'S ACRES
SUBDIVISION: Block: Lot: 5+
PARCEL NUMBER: 952200005 Section: 8 Township: 29 N Range: 01 E
CONTRACTOR: SUNSHINE PROPANE PHONE: 385-5797
10853 RHODY DR
PORT HADLOCK WA 98339
Contractor's License SUNSHP*077QP Expires 11/17/2013
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOF HOT WATER HEATER & PIPING
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:
r
Type Amount Paid By: Date: Receipt: Approved/Date
Propane Tanks/Stoves $152.00 LYK 12/26/12 139840 +� '` �j'-" �`"� d V ,'
.,
Total: $152.00
D",, c, 1 12
Jefferson County Plan
iw Luildina Department
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� JEFFERSO
N COUNTY
';A,� DEPARTMENT OF COMMUNITY DEVELOPMENT
'% 621 Sheridan Street • Port Townsend•Washington b836
360/379-4450 • 360/379-4461 Falx
' www.co.jefferson.wa.usicomrndeveiopment
Master Permit Application MLA: . f 1L�
Project Description(include separate sheets as necessary): •
�e ( o-, d e.r4L) C�J,f z.€,4' ? f . /, - Talc 14 e y of(e)
Tax Parcel Number:. Q 5.2 a. o • ooS
/ Property Size:_ (acres/square feet)
Site Address and/or Directions to Property:
c -Oo - I Q62 D r . ` ?a if e ,•...J GJc,_ f d'35cY
Property Owner(s)of Record; _ �l tYt , l CP T//.�/3 4i=S'
Telephone:__ .2 O� 3 a / /<0,3 Fax: v __.
Mailing Address: am" ---1 s
Applicant/Agent(If different from owner): i � IM —
Telephone: 385 ' 7, 7 • Fax: 38 5-S 8 7 5;
email: YS � ,�c ,
Mailing Address: . /d 8 3 ;E?f-/o dy ,QR. i . /l f/94-a c% �R 1 l
What kind of Permit?(Check each-box that applies 0 Lot or Road 4 g Urea
II 9 �
❑Building 0 Critical Arad to erdsh
O Demolition Permit 'f1NCt)ilf,
0 Variance(Mi r. '�"r!tirt��,gq I;e��nomic U e)
❑ Single Family ❑ Garage Attached./Detached 0 Conditional U e[C a), C( ,o SENT
0 Manufactured Home ❑ Modular Tad
0 Discretionary�4"o 1Jnnamed Use Classification
Commercial* - 0 Special Use•( ssential Public
❑ Change of Use 0 Boundary Lin Adjustment , : ` 1 0 V E
❑ Address . .... 0 Road Approach 0 Short Plat**
❑ Home Business 0 Cottage'Indust y 0 Binding Site P an*' ,' i L , i
, 'ropane 0 Long-Plat** _ ' I
❑Sign •. 0 Planned Rural Res dential,Development(PRRD)/Amei'tdmen
❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/ Iteration"* i
❑ Stormwater Management 0 Shoreline Ma er P o Yam Eire
� g r�ticD/Permit Revisions'"' t
❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Manage rent Substantial DaveF p eritfll/Ty
0 Temporary Use 0 Shoreli a Management Vanande iII
0 Wireless Telecommunication* . if SIN DEVELOPMENT
• 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
**Regglres:a Pre.Application Conference
Please identify any other local,state or federal permits required;for this proposal, if known:
•
DESIGNATION OF AGENT
I ereby designate to act as my agent in'natters relating to till application for permit(s).
•
9, •WNER SIGNATURE . Date: h2./
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 byte 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,Jud mens,court costs, reasonable attorney's fees and
expenses which may in any accrue against Jefferson County as a result of or in cpnsegU rice df the granting of this permit.
I further agree to provide access and right of entry to Jefferson County and its employees,rep ;sent!atives or agents for the sole purpose of application
review and any re it ater ins ions S a access and right of entry will be assumed unless the applicant Info s the County in writing at the t time of the appll o t t e; w pri oboe. 1
t + •nature:
dt Date: vL / 1�
gi
The action or actions Applicant will undertake as a result of the issuance of this permitray negatively impact upon one or more threatened or
endangered species and could lead to a potential."take"of an endangered species as those terms aye 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 law uit:on behalf of an endangered species regarding your
action(s)even if y a in corn • ce w Jefferson County development code:The Appii nt-acknowledges that he,she or it holds individual
and non-transfer I pons' iii or Bring 'and complying with the ESA. The Applicant has read this disc aim rand�igns and dates t below.
Signature: �___,_ �oz.//`r
Date;
31 1
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I
0
BUILDER STATEMENT
The signor 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 proje4ti,
Signature: bate:', 1
GENERAL CONTRACTOR ER: pHONE: FAX:
.Sl t_e, S fl i in e 2.0 ti e (96d ) 3 S- .r 7 17 (3 G4 3 eS-s a 75
MAILING ADDRESS: 'O 8 5 3 a i W p r P. ('( EtvtAIL:
CONTRACTOR'S LICENSE AINS
NUMBER: S L.l l�1 S * q ! Q e I�IUMRER
ARCHITECT/ENGINEER: • PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shorelin : Type of Sewage Disposal:
0 New ❑ Wood Existing: I 0 Sewer
❑ Addition ❑ Steel Proposed: I Bank d Community System
0 Alteration/Remodel ❑ Concrete Total: Height: 0 Individual System
❑ Repair ❑ Masonry i SEP Permit#
O Demolition 0 Other: . Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party.
Type'of-Heat: Proposed: i ❑ Public
Total: 1 Name of System:. •
If this is a Commercial Project you must answer the following:
Number of Parking Spaces: Current: Proposed: I Number of ADA Parking Spaces:
Number of occupants(includes owners,tenants,employees,etc) Current. Proposed
IBC Occupancy: IBC Type of construction: • 1/Vill you have Food'St rvice? Yes / No
4....Jf this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply:
1 Underground Tank I Above ground Tank Size of Propane Tank:
I Heat Stove I Cook Stove 11Noodstove 1 Fireplace Insert I Hot W e 1 Other 0 tt
is this appliance being installed in" a Manufactured/Mobile Home Yes / No P ICLeJ'S'
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.
4 Fk, r> uis:s. '1' ish `, ,x, ek,r ,1h-N, fi tAe d,0 , xF 5 .� f.
�r;.� 24 �f. �rp+f , �S 3j4 �;� I f"�"-a'�c.h'�C Yam`'' �n t "�,a.Y"� �'�� r �,
Square Footage Current Proposed ,, , j),7 elii; a ,`� `r r�4P, 4 ,:ai a�th�s'4 4P .Ig:N1-6141: ,�„iFe:16. t',F '' V? !',
Main Floor Heated r 1�� ��� '�,';; EH Bid A.pp Review:
2 Floor Heated u)' y �`,1A b` Consistency Review:
Other Heated + �Y4 ;�, _
a , Base fee:
Mezzanine gs'iw i ; , *4 . Additional Section:
' Heated Basement )..i 3.. ' �, ,i Plan Check fee:
Unheated Basement ' ,, 4,,:`` State Surcharge fee:
• .1� !e-'?'' 4
Other'Unheateit 1 y,,,,t;y ,, y Pot Water Review fee:
Garage/Carport ....dd , ',.' f.. 4. ,, SU OT.
h.
T AL
Oi L R 3•-
Decks ,'° ��`;474 r,, 911/Rd.Approa' h fee: '
I
Other " z H i 1
�1�;�; y�, TOTAL $ 1
r '
,,IA , ,4,I Receipt Number.: (, M
,i ? ;' Cash/Check Number:. ���,,
ESTIMATED COST(REQUIRED) Date: l
•Felr martcet value of all labor and materials foundation to finish 1 -i --_ 1
Initials: _
G:\PermitCenteA###FORMS###\DRD FORMS\Current DRD Porno\Master Permit Anr Pee:.,.,c_,n_na,t,,,.