HomeMy WebLinkAboutBLD2013-00163 es ON roe, DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street,Port Townsend,WA 98368
Tel:360.379.4450 Fax:360.379.4451
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Web:www.co.jefferson.wa.us/communitydevelopment
4f-sit f N-.cO` E-mail:dcd@co.jefferson.wa.us
CERTIFICATE OF OCCUPANCY
PERMIT#: BLD13-00163
APPLICANT: JEANNE STAUFFER PHONE: 360-437-9540
BARBARA CASE
1051 SHINE RD
PORT LUDLOW WA 98365-9287
SITE ADDRESS: 1051 SHINE RD Issue Date: 07/22/2013
PORT LUDLOW, 98365 Final Date: 5/5/2016
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 821343006 Section: 34 Township: 28 N Range: 1E
PROJECT DESCRIPTION:ADD BATHROOM AND SATELITE BEDROOM TO EXISTING GARAGE
THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2009
EDITION.
OCCUPANCY GROUP:
TYPE OF CONSTRUCTION:
SPRINKLER SYSTEM No
THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 5/5/2016
Interim Building Official,
David Goldsmith
\\tidemark\data\forms\F_BLD_Occupancy.rpt 5/23/2016
BUILDING PERMIT APPLICION BLD13-00162
Jefferson County Department of Community Development Review Type:
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD13-00163 Received Date: 5/28/2013
SITE ADDRESS: 1051 SHINE RD
PORT LUDLOW, 98365
OWNER: JEANNE STAUFFER
BARBARA CASE PHONE: 360-437-9540
1051 SHINE RD
PORT LUDLOW WA 98365-9287
SUBDIVISION:
PARCEL NUMBER: 821343006 Section: 34 Township: 28 Btock:N Range: 01 E t TX61�
CONTRACTOR: OWNER/BUILDER
PHONE:
REPRESENTATIVE:
PHONE:
PROJECT DESCRIPTIOf ADD BATHROOM AND SATELITE BEDROOM TO EXISTING GARAGE
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP ADD
VALUATION 59,490.00 MAIN: 440
CODE EDITION: 2009 ADD'L: HEAT TYPE: HTP
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: OTHER: 330
CONST TYPE: GARAGE: SHORELINE:
DECK: SETBACK:
SEWAGE DISPOSAL: BANK HEIGHT:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist: 0
Prop: 1 Prop: 1
Total: 1 Total: 1
Routing Date: L3-4
57//3
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $713.75 ZAL 05/23/13 142118
Plan Check $463.94 ZAL 05/23/13 142118 APPROVED
State Building Code $4.50 ZAL 05/23/13 142118 JUL 2 2 2013
Total: $1,182.19
Jefferson County DCD
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• BUILDING PERMIT •
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD13-00163 Received Date: 5/28/2013
SITE ADDRESS: 1051 SHINE RD Issue Date 7/22/2013
PORT LUDLOW, 98365 Expiration Date 7/22/2014
OWNER: JEANNE STAUFFER PHONE: 360-437-9540
BARBARA CASE
1051 SHINE RD
PORT LUDLOW WA 98365-9287
SUBDIVISION: Block: Lot: TX61-1
PARCEL NUMBER: 821343006 Section: 34 Township: 28 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
PROJECT DESCRIPTION: ADD BATHROOM AND SATELITE BEDROOM TO EXISTING GARAGE
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP ADD MAIN: 440
VALUATION 59,490.00 ADD'L: HEAT TYPE: HTP
CODE EDITION. 2009 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY:
CONST TYPE: OTHER: : 330 SHORELINE:
GARAGE
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM: Type Amount Paid By: Date: Receipt:
BEDROOMS: BATHROOMS: Permit $713.75 ZAL 05/23/13 142118
Exist: Exist: 0 Plan Check $463.94 ZAL 05/23/13 142118
Prop: 1 Prop: 1 State Building Code $4.50 ZAL 05/23/13 142118
Total: 1 Total: 1 Total: $1,182.19
Directions to Site:
HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION
THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED
BUILDING INSPECTION HOT-LINE 379-4455.
Request must be received by 3pm the day before the inspection is needed.
Office Hours 9:00 am -4:30 pm MONDAY - THURSDAY
HOT LINE AVAILABLE 24 HOURS A DAY
SPECIAL CONDITIONS APPLY-SEE ATTATCHED
Jefferson County Building tision Permit Niter: BLD13-00163
Applicant: STAUFFER
BUILDING PERMIT INSPECTION APPROVALS Applicable Code: 2009 International Building Codes
To schedule inspections, call (360)379-4455 no later than 3:00PM the day before the inspection is needed.
Requests received after 3:00 PM will not be scheduled for the next day's inspections.
ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries.
The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection
Inspection Item Date Approval Signature Notes
Setbacks
Erosion Control
Foundation Footing t( 13
Footing Drains
Foundation Stem Wall ti/A
Underground Plumbing 11.,,,
Under Floor Framing
Straps(hold downs)
12-i7t/13 3 c
Ext. Shear Wall Nailing { 1
Rough-in Plumbing
1/z14
Framing /
Blockin ' I d
g ` 27/14 it
Airseal 7/21 (4I 61/
Insulation:Walls :L) l! , ,
Insulation: Floors I)I
Insulation: Ceiling i/2-t/1 4
Int. Shear Wall Nailing y _/z.e/13 ,
Wallboard Nailing 13I,
Gas Line: Interior kVA*
Gas Line: Exterior N/A
Propane Tank N/A
Heat/Chimney Clearance IYA
Blower Airtight Test
Smoke&CO2 ,/Llil/ d 5
Drywell/Alt Drainage
Address Posted iziz4'/13 JC
FINAL INSPECTION FINAL I706
CTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
• •
CONDITIONS for Building Permit# :BLD13-00163
1.) The project shall adhere to the Best Management Practices (BMPs)to control stormwater,
erosion and sediment during construction. BMPs shall address permanent measures to
stabilize soil exposed during construction, and in the design and operation of stormwater
and drainage control systems.
2.) The site plan as submitted with the Building Permit application on May 28, 2013 has been
reviewed for consistency under the UDC, and has been approved by Jefferson County
Department of Community Development. Any modifications, changes, and/or additions to
the stamped, approved site plan dated May 29, 2013 shall be resubmitted for review and
approval by Jefferson County Department of Community Development.
\\tiriemark\data\fnrmc\F RI fl Permit Rlrin rnt 7/72/7f111
• D04910;ii� JEFFERS�COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT MAY 2 3 20
621 Sheridan Street• Port Townsend •Washington 98368 L
4• , . . 360/379- 450 • 360/379-4451 Fax JEFFERSON COUNTY{ 0O www.co.jefferson.wa.us/commdevelopment OMMUNITYDEYEtOPM
ENr
Master Permit Application MLA:
Project Description(include separate sheets as necessary):
s"-A-VrrEgiGhE 4 D Nictkbt At1U tI AT O
Tax Parcel Number: 0 7-1 4 300(0 Property Size: 1•IS AGE (acres/square feet)
Site Address and/or Directions to Property:
1091 SH i Nt; goteP
Property Owner(s)of Record: J PrNti • S17cVfl - hND $Priz.Bk1.A, C. S✓
Telephone: 3le0 437 94r2D Fax: email: XANI46045(0O MAIL.•GOIM
Mailing Address: f0SI SHINV- F.OPrb rr• LVtLOW wA 983(o5
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies
yuilding
T ❑Critical Areas Stewardship Plan
❑ Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use)
lit Single Family XGarage Attached/Detached 0 Conditional Use[C(a),C(d),or CI"
❑ Manufactured Home 0 Modular ❑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 ❑Binding Site Plan"
❑Propane 0 Long Plat"
❑Sign 0 Planned Rural Residential Development(PRRD)Amendments w"
❑Allowed'Yes'Use Consistency Analysis 0 Plat Vacation/Alteration'"`
❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions"
❑Site Plan Approval Advance Determination(SPAAD)" 0 Shoreline Management Substantial Development"
❑Temporary Use ❑Shoreline Management Variance
❑Wireless Telecommunication* ❑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 to act as my agent in matters relating to this application for permit(s).
OWNER 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 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 attomey'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 thez pi tion that he or she r�no
Signature: ?/Z�LY ze.- _ Date: S/2_3/t 3
The action dr ions Applicant will undertake as a uk 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-tra rable responsibility for to and plying with the ESA. The Applicant has read this disclaims and signs and dates it below.
Signature: _"'/�/ .c 4 - Date: - / L 3 // 2>
J'
G:\Peanitcenter\###FORMS###\DRD FORMS\Ma+ter Peanit Application 5-29-084oc
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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 uming the responsibility of the Tel Contractor for the proposed project.
Signature: ✓ _ ✓i (—A, Date: J /.',. 3/(-)
GENERAL CONTRACTOR OR MANUFACTUR 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:
U New A Wood Existing: 2- r I Sewer
Addition ❑ Steel Proposed: I Bank ❑ Community System
Alteration/Remodel ❑ Concrete Total: ,3 Height, X Individual System
i Repair 0 Masonry SEP Permit#
i.i Demolition 0 Other: Bedrooms: Water Supply:
Existing: 3 Setback: a Private well 0 Two Party
Type of Heat Proposed: .____r__—
k4B ?OW Total: 4- i 1301 N Public
ame of System: ,IEf1672A N
C1's(VBIrIG tr1 L tI At5(R1Ctft-I
If this is a Commercial Prolect 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 Propane Tank and/or Appliance Installation permit,mark all items below that apply:
1 Underground Tank I Above ground Tank Size of Propane Tank:
1 Heat Stove 1 Cook Stove I Woodstove Fireplace Insert 1 Hot Water Tank I Pellet Stove 1 Other
Is this appliance being installed in a Manufactured I 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+ era T k+r 1n r.. ' { ' .7 a! 17
S•uare Footes@ Current Pro, c,,n.' > i i' _n «l I ,,, r :> ,P n i ..:r«r:.r.vt a�,!". si
Main Floor Heated I 3 l;p EH Bld App Review:. v�
2n0 Floor Heated t r 7�j�
. Consistency Review: Os,
Heated ' Y {i Base fee: r
• 7(3 • -7S
Mezzanine =r ""' Additional Section:
,. fip.:
Heated Basement ,3 . a I : Plan Check fee:
Unheated Basement •s 1 State Surcharge fee:
Other Unheated j ` Pot Water Review fee:
ai,D 07-g9
Garage/Carport O -,
440 t
J�J? SUBTOTAL C��
I`T 6d ,/�
Decks
,,; 911/Rd Approach fee: a ,
g3(
Other LpNVq�(� (,k9.kbE a� 7 TOTAL: $ /�n /q
Rec)ript Number: /�a ///
Cash/Check Number: h a 9A2 00336
ESTIMATED COST(REQUIRED) Date: C�
.Fair market value of all labor and materials foundation to finish 5 43
�' 1'1 c.:� rho C. Initials:
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