HomeMy WebLinkAboutBLD2004-00528 . _ 0 0 ,.', -
BUILDING PERMIT "'"
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD04-00528 Received Date 08/16/2004
SITE ADDRESS: 530 REINIER RD Issue Date 09/2/2004
NORDLAND, 98358
APPLICANT: DEE TOUR DU MONDE PHONE: (360) 385-4448
530 REINIER RD
NORDLAND WA 98358-9621
SUBDIVISION: OLSON & HAMBLETON'S Block: 6-7 Lot: T32
PARCEL NUMBER: 977700024 Section: 4 Township: 29 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
PROJECT DESCRIPTION: ADDING 3/4 BATHROOM TO EXISTING GARAGE - NO MLA REQ'D
REQUIRED INSPECTIONS:
[ ] SETBACKS: /v/E
[ ] UFFER: /J`A
[ ] Footing: pd.
[ ] Foundation: N f�,
[ ] Stormwater FINAL Approval:. is) f
[ ] Underground Plumbing: e •/ e4 ,
[ ] Underground Insulation: WA
[ ] Shear Wall : A/A
( ] Framing: Oie ifc./�1/4''/ 17/
f 1 Plumbing: Ci /1/20
[ ] Propane Tank/ Lines. A A
[ ] Insulation: 0 //`.? of/ r
• i
( 1 Sheetrock: � // ffrifif
] Septic Sytem Final pal: •
1 Road Approach Final Approval:
[ ] Zoning Final Approval:
f 1 Final/Occupancy Approval: OK ..c - -ci,;td-i Iz/BAV
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. 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
I:\F_BLD_Permit_Buildng.rpt 10/29/1999
mJILDING PERMIT APPLICA"?TZN SREP04-00p161
e: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00528 Received Date: 8/16/2004
SITE ADDRESS: 530 REINIER RD
NORDLAND, 98358
OWNER: DEE TOUR DU MONDE PHONE: (360) 385-4448
530 REINIER RD
NORDLAND WA 98358-9621
SUBDIVISION: OLSON & HAMBLETON'S Block: 6-7 Lot: T32
PARCEL NUMBER: 977700024 Section: 4 Township: 29 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI ADDING 3/4 BATHROOM TO EXISTING GARAGE - NO MLA REQ'D
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP ALT MAIN:
VALUATION 1,000.00 ADD'L: HEAT TYPE: SEMI
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY:
CONST TYPE: OTHER: 88 SHORELINE:
CONST TYPE: GARAGE: SETBACK: 310
DECK: BANK HEIGHT: 47
SEWAGE DISPOSAL: ALT
WATER SYSTEM: PWELL PARCEL TAGS: YES NO
BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA
Exist: Exist: Wetland Erosion
Prop: Prop: 1 Seismic Streams
'Total: Total: 1 Flood Way Floodplain
Routing Date: F&W Landslide
1s/�isgl °2 Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid Bv: Date: Receipt: Approved/Date
Permit $38.75 KAS 08/16/04 67467 APPROVED
Plan Check $25.19 KAS 08/16/04 67467
State Building Code $4.50 KAS 08/16/04 67467 SEP - 2 2004
Potable Water Application $52.00 KAS 08/16/04 67467 Jefferson County Planning
Total: $120.44 & Building Dep�mart
Coin„� _�
��¢gO1V c0� JEFFERSONTY
W ' 'ice DEPARTMENT OF COMMUNITY DEVELOPMENT nn [ N. I:' I,+ CJ7 nr
`' '4 621 Sheridan Street • Port Townsend •Washington 98368 U. —__ !
9 n 1
360/379-4450 • 360/379-4451 Fax f : ,
1, 4,0 www.co.jefferson.wa.us/commdevelopment L AUG 1 6
Master Permit Application MLA:, /40. Mt- l a(rt I
/gDescription (include separate sheets as necessary):
I
Tax Parcel cp - -7 0-O C 2 Li Property /� ,'7 tC jr S
Number: / Size: 10 oj,/�C k. -`(,� (acres/square feet)
Site Address and/or Directions to Property: .j 30 In 'r R ,) Ntre J7i,41J , )4 yY s
Property ner(s)of Record: .L2e
Telephone: 3 ` Fax: email:
Mailing Address: . -3� `P !J'7 let-) / 1 - 1 `
t;iigiu
Applicant/Agent(iflifferent from owner): �{ /
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies)
ilding j 0 Variance(Minor,Major or Reasonable Economic Use)
❑ Demolition Permit / �„r.�1:
L�(J /y w(� h ❑ Conditional Use[C(a), C(d),or C]**
CI Single Family ❑ Discretionary"D"or Unnamed Use Classification
0 Garage Attached/Detached S;Zx.l S/!s ❑ Special Use(Essential Public Facilities)**
❑ Manufactured Home J JY0 Boundary Line Adjustment
0 Modular 0 Short Plat**
❑Commercial* CI Binding Site Plan**
❑ Change of Use ❑ Long Plat**
❑Address ❑ Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments**
❑ Propane ❑ Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions**
❑ Stormwater Management ❑ Shoreline Management Substantial Development**
❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance
❑Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* 0 Jefferson County Shoreline Master Program Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium
*May require a Pre—Application Conference **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 it's 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 Jeffron County as a result of or in consequence of the granting of this permit.
I further agree to provide acce and right of entry to,J e son County and its employees,representatives or agents for the sole purpose of application
review and any,required later(n ctions.Access and- of entry this property shall be requested and shall occur o ly during regular business
hours. ‘
Signature: Date: a _
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."Jeffers County makes no'assurances to the applicant that the actions that will be undertaken because this
permit has been issued will not • late the SA. Any individual, r up or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)even if you are in com is ce wi the Jefferso Coun v'lopment code.The Applicant acknowledges that he,she or it holds individual
and non-transferable responsibil r adh 'ng to and plyin the A. The Applicant has read this disdai'i
er a signs and dates it below.
Signature: $),}\ ( �Date: I l
G:\PemvtCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
41111 P OWNER BUILDER STATEMENT
The signer of is stat nt does hereb that thy are the Owners of the parcel referenced herein,that they not'ltcehsed contractors and that
they will be a '•g Vie r ponsibi of neral tractor for the proposed project. ;L.
Signature: l'� CST 1 j. I1ffi Date: •g//�1l 11 1I
/ .L
PHONE: 1_FAX:
1.11<Kr a 3� kG J D �t ( . Z.C)) �- fie )
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 lam'Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: 1Bank ❑ Community System
14.. Alteration/Remodel, '*Lett') ❑ Concrete Total: ! Height:' �. Individual System
❑ Repair ' Q,siin1 Masonry ILSEP Permit# ,-�2l- /6
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: 1 Setback: 1.1 Private well ❑ Two Party
Type of Heat: Proposed:Total: 3/0 / I I Public
Name of System: /)i i 1i221
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 Propane Tank and/or Appliance Installation permit,mark all items below that apply:
i 1 Underground Tank I I Above ground Tank Size of Propane Tank:
1 I I Heat Stove I I Cook Stove 1 1 Woodstove I Fireplace Insert 1 ! Hot Water Tank I Pellet Stove 1 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 For Office Use Only
Current Proposed Amount
...6_,..
Main Floor Consistency Review:
2Nu Floor Base fee: 3 i '-]S`
3t°Floor Additional Section:
Mezzanine: Plan Check fee: -3 I c\1
Heated Basement State Surcharge fee:
Q
Unheated Basement Pot Water Review fee:
Other U hea (J .i: .)L) 911/Rd Approach fee: {Garage/Carport c / TOTAL: $ 1 5 3,."'Vt
Decks 0 Receipt Number: 'r. `71(C-1
Other • Cash/Check Number:
5r.:)
ESTIMATED COST(REQUIRED) Date: p / `( /cCt
•Fair market value of all labor and mat foundation to finish O g- / t
Initials:
G:\PemmitCenter\FORMS\DRD FORMS\ Permit Appjicaner 7-8-04.doc
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