HomeMy WebLinkAboutBLD2004-00812 MLA04-00710
QUILDING PERMIT APPLICAAN Review Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00812 Received Date: 12/22/2004
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: RANDI FOX PHONE: (360) 344-3699
841 TYLER ST
PORT TOWNSEND WA 98368
PROJECT DESCRIPTION SFR ADDITION/ALTERATION
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ADD MAIN:
VALUATION 15,000.00 ADD'L: HEAT TYPE: UH
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY: R-3 UNHEATED: # OF STORIES:
OCCUPANCY:
CONST TYPE: 5N OTHER: 145 SHORELINE:
CONST TYPE: GARAGE: SETBACK: 38
DECK: BANK HEIGHT: 55
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: 3 Flood Way Floodplain
Routing Date: F&W Landslide
.2 Q/0y- i Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $265.25 BAC 12/22/04 68832
Plan Check $172.42 BAC 12/22/04 68832
State Building Code $4.50 BAC 12/22/04 68832
Total: $442.17
•
JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT .;
REFUND REQUEST/POSTING MEMO
DATE: s Z ^ �^—CJ`'3
The amount of t ` , . LI I received from ' —To u...r i k alci
for(case#) 3 L () 2 _ is to be refunded to: 5 36 j go -,c 4 r Q4
\k).-Vkkirt..0 r . w , wA
as a'result of:
Date&number of original receipt: L�6 3 L._ 1 C� ( () l k
REVENUE
FUND CODE NO. REVENUE SOURCE NAME AMOUNT
143-000-010 322.10.00 BUILDING PERMIT APPLICATIONS BLD
143-000-010 322.40.20 ROAD APPROACH PERMIT APPLICATIONS RAP
143-000-010 322.40.30 UTILITY PERMIT APPLICATIONS
143-000-010 322.40.80 ADDRESS FEES 911
143-000-010 334.04.20.20 CTED GRANTS
143-000-010 341.50.00 SALE OF MAPS&PUBLICATIONS PUBS
143-000-010 341.60.00 DUPLICATING SERVICES COP/DUP
143-000-010 345.81.00 SUBDIVISION APPLICATIONS
143-000-010 345.81.10 CAMPER CLUB APPLICATIONS
143-000-010 345.81.20 SHORELINE SUBSTANTIAL DEV.PERMIT APPS
143-000-010 345.81.30 CURRENT USE TAX ASSESSMENT APPLICATIONS
143-000-010 345.81.40 ZONING APPROVAL APPLICATIONS
143-000-010 345.81.50 CRITICAL AREA REVIEW CAR
143-000-010 345.81.60 CONVERSION OPTION HARVEST PLAN COHP
143-000-010 345.83.00 PLAN CHECK FEES
143-000-010 345.83.10 FIRE MARSHALL PLAN REVIEW
143-000-010 345.89.00 ENVIRONMENTAL REVIEW/SEPA
143-000-010 346.22.30.40 DCD Water Review
143-000-010 359.90.60 SHORELINE VIOLATIONS
143-000-010 359.90.65 BUILDING CODE VIOLATIONS
001-250-000 369.90 MISC TREASURER REV-BAD CHECK FEE
127-000-010 346.22.30.10 HEH523 WATER AVAILABILITY FEES H2O
127-000-010 346.22.30.10 HEH541 LIQUID WASTE FEES SEPTIC
127-000-010 346.22.30.10 HEH545 EES 3RD Party Inspector Report Filing Fee
127-000-010 346.22.30.10 HEH582 SHORT/LONG PLAT FEES
180-000-010 322.40.50 RIGHT OF WAY APPLICATIONS
180-000-010 343.20.10 ROAD FUND
626-000-010 239.10 PLNG TRUST ACCT
650-511-000 386.00 STATE BLDG CODE FEES
659-003-030 367.13 FIRE DIST#3.MITIGATION FEES
685-049-030 300.00.00.2900 SCH DIST#49.MITIGATION FEES
TOTAL REFUND
( 1)rAuthorized person signature:
Treasurer's check# : Date:
Treasurer's signature:
G:/PermitCenter/DEPOSIT/Refund Form 10-2005.doc
yrillw
.¢,go1eJEFFERSON �1NTY •DEPARTMENT OVOMMUNITY DEVELOPMENTQE 2 2
C` � 621 Sheridan Street• Port Townsend •Washington 98368
4.• .y 360/379-4450 • 360/379-4451 Fax
.q O www.co.jefferson.wa.us/commdevelopment
2004
SONG'S
Master Permit Application MLA: 0 if 710
Project Descnp'on(include e��parate sheets ne ,,,,
.- sary): ,\ 1
,,,,,,,,
I)n fie ofed --NIT&
PFo r
�' ) \lCa tiG,
Tax P el ��1 perty
Number: 9773 Size: 1 .+ a.eip (acres/square feet)
Site Address and/or Directions to Property: 53C) / I h _4-' Road !O'd](Lj'/ k
Property Ow pet )of Record: 0 ,�
Telephone:(SW� 327S- LI'-1 y 7 Fax: email: a ''COM
Mailing Address: -S'3(3 Rai h)p'.v' : ,, o y-/ ti / W/ -r \�
Applicant/Agent(if differept from owner): i'yiy rrpd'� ;o f/0 t ` t , I l F x i .L1/
Telephone: :I/4 09ff Fax: email: r 6c�� - jlpt_ e_q/6
Mailing Address: Ty) -f, f.j,
What kind of Permit?(Check each box that applies)
*Building ❑Variance(Minor,Major or Reasonable Economic Use)
❑ Demolition Permit ❑ Conditional Use[C(a), C(d),or C]**
❑Single Family ❑ Discretionary"D"or Unnamed Use Classification
❑Garage Attached/Detached El Special Use(Essential Public Facilities)**
❑Manufactured Home ❑ Boundary Line Adjustment
❑ Modular 0 Short Plat**
❑Commercial* 0 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* ❑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 ' C/x to act as my agent in matters relating to this,applic/ation for permit(s).
t
OWNER SIGNATURE ' 'It' _„1C_ e, ! ,; ;/
'l' v(1 ) / ,(_, ((•#,1 l(� ,, ; 'By signing this application form,the owner/agent attests that the infom 1 �/ `t -1' -,'L' rrect to the best of
his,her or it's knowledge. Any material falsehood or any omission of a • PF y j', i )plication packet
may result in this permit being null and void. i}r, f�r, I , ( ,r.
I further agree to save,indemnify and hold harmless Jefferson County ney's fees and
expenses which may in any way accrue against Jefferson County as a , _ , ,. , ,
I further agree to provide access'and right of entry to Jefferson County I '
( 7 �� ll (� I i 1 I pose of application
review and any required later'rispections.Access �d `'ht of en to f I ` - ( '''/ I
hours. 1 '6 f,,{ agular business
ry)
Signature: i' i 1 f",i l L\\'1:^J'^-- 1TkL 1.)in
t('-:L j l 'X•_} () j / (-••(
l L
•
The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upta I t,l lC.,l I IIVIG"„aatened 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•pgt violate the ESA. 1,6,ny individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)even if you are i, compliance with the' rson County development code.The Applicant acknowledges that ,she or it holds individual
and non-trarerable res ibilyyi for/ dhering ng with the ESA. The Applicant has read this disclaimer and/si s n dates it below.
Signature: f` . r i1,L tat , Date: /� 0
G:\PernutCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
r— - I OWNER BUILDER STATEMENT •
The signe(of¢his;statehie t does hereby • 01 ; -I t ey are th0Owners of the parcel referenced herei ,that they are not licensed contractors and that
they will s8�irpin tide ''`'-ility of I -• p- Co r f the proposed project.
I /} p
Signature: , , , {, .V J Date:
(H
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: 3ONE: , N. FAX:
4(7 ) 11 ��� (-- `)
MAILING ADDRESS:
DEC z 2 2004 E
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER f
ARCHITECT/ENGINEER: 124,04,4...1 /iX. PHONE ( ) 3(i FP x-(-----._.)_
MAILING ADDRESS: Q• 1 Tyler Si'. / : T I .l )ityr,, 1 1� EMAIL r Cr Se Ni- ' (o�`.y,\
i LL �-t iSl '`
Project Type: 'Frame Type: Bathrooms: 4)----
Shoreline: Type of Sewage Disposal:
. New Vood Existing: CISewer
1 Addition 1-❑ Steel Proposed: Bank ❑ Community System '
Alteration/Remodel ❑ Concrete Total: Hight: ❑ Individual System
❑ Repair ❑ Masonry SEP Permit# p(��•�� t 1I 1F(W'p�r2�ILT
O Demolition ❑ Other: Bedrooms: Water Supply: ft7ll�
Existing: °�� Setback: Private well ❑ Two
j Type of Heat: • __ Proposed: -wilf. ❑ Public
Total: .9
( - �i- s.s!?•ia.;: �1.; 'is' Name of System.
YID 'tom► ih VlPICI kelli {
II ' If this is a Commercial Project you must answer the following:
11` Number of Parking Spaces: Current_ Proposed: Number of ADA Parking Spaces:
IIJJ 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'l D ❑ Underground Tank ❑ Above ground Tank Size of Propane Tank:
i ❑ Heat Stove ❑ Cook Stove ❑ Woodstove-"D Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove LI Other
Is this appliance being installed in alll tailifactured I Mobile Home? Yes / No
/10 When applying for a permit to tall 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.
d Square Footage For Office Use Only �
Current Proposed Amount
Main Floor Consistency Review:
--
214u Floor Base fee:
ao ) LlZ.oO
3"d Floor Additional Section:
Mezzanine: Plan Check fee: !ti t L 7 2.
Heated Basement State Surcharge fee: /
Unheated Basement Pot Water Review fee: c�� f g�/
Q it t:.11 fill) I .D oil--.5)g
Other Unheated 911/Rd Approach fee:
i;. 4-i'Sk 1,}(i
Garage/Carport TOTAL: $ C l It
'
Decks
Receipt Number: 6g(33Z. . ':,, 4'
Other 1 r w� Cash/Check Number O �t rr j� ,.‘ ice .t
eovt reS ,n'-r parr h � ,
ESTIMATED C ) 4 !`e J Date 'yl
•Fair mark e l r- and ma rials foundatio mish0
15- ti
� /'� Initials:
— V4-0-------
G:\PemritCenter\FORMS\DRD FORMS\Master Pemri lication 7-8-04
c 7c O afl Atc_.. 12cVD I /161 Joc
-,f)
1
y o �5 o -0, w x r I P.L.100.04
m
y E m C - mT O zyy I { 5'REAR •-1 0'. K
i Fs< .
mN z m v P. s m
m8 cn ,
J
o0 > zo 73
1 i 0 •o'm Z
o 03
q % � %n 0
m / o I
x r
j
i z 'rn
�'f z I-
, 9
•
C� I u
1V 1
l � J
\ d/j-Z- ,, :.
/ 7.1 1_. 1 ;0 m
,
- O` r
m it
-1 v L - 1
V
-1 0
i
m o 1
N p
I rill
pJ
l p :J1
1 Q' P.
T X ?�
C9--- Q ;P9
z `> p m oc
Km I--; , 2# m c 4A
N
//ily
. x
ID
.Th
11111 gi
I T�, \ go ,
•
I s�� � - )
gTLm wm Tmvm
n "y ! n
( \ .A5
> - .LW-� _ Inio
fAl
- --- - C E:BACK FROM
to m - .a..., 0 •
_ TOP.OPBANK
0 D
m z= 4
—I N '
II m I
g .0 b = TOP OF BANK
ZOQ — Z SHORELINE
(1173 _ e TOE OF BAN
0p ��
0A'
Site Plan Tour du Monde Residence RC Fox Design Studio
N 12.11.04 530 Rainier CD Nordland WA 98358 841 Tyler St.Port Townsend WA 98368
y
Tax Parcel Number 977700024 360.344.3699 rcfox@seanet.com
a a
„,530 REINIER RD BLD04-812 _
TOUR DE MONDE
Approvals Req'd Prior
to Final Inspection
SEP
Z 0 N
SIPz_
DPW