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HomeMy WebLinkAboutBLD2005-00054 GILDING PERMIT APPLICASN NONE REQRD ew Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00054 Received Date: 1/27/2005 SITE ADDRESS: 24 BLUEBERRY HILL RD PORT LUDLOW, 98365 OWNER: JAMES M FOSTER PHONE: 360-437-0412 SHARON L FOSTER 24 BLUEBERRY HILL RD PORT LUDLOW WA 983658765 SUBDIVISION: Block: Lot: 58 PARCEL NUMBER: 821334060 Section: 33 Township: 28 N Range: 01 E CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr NO MLA REQRD - FINISH UNFINISHED BEDRM#4 IN BASEMENT NO CHG IN FOOTPRINT TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP ALT MAIN: 1,410 VALUATION 4,500.00 ADD'L: HEAT TYPE: CODE EDITION: 2003 HEAT BASE: 1,305 HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: SHORELINE: GARAGE: 507 CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: PUD PARCEL TAGS: YES NO BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA Exist: 3 Exist: 3 Wetland _ Erosion Prop: 1 Prop: Seismic Streams Total: 4 Total: 3 Flood Way Floodplain Routing Date: F&W Landslide \\())\\ J \c C) c', Shoreline Aquifer Forest: Commercial Rural Type Amount Paid By: Date: Receipt: proved/Date Permit $111.25 BAC 01/27/05 69144 APPROVE D Plan Check $72.32 BAC 01/27/05 69144 �% State Building Code $4.50 BAC 01/27/05 69144 FEB - 3 2005 Total: $188.07 Jefferson County Planning & Building Department A S fy pap BUILDING PERMIT• Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD05-00054 Received Date 01/27/2005 SITE ADDRESS: 24 BLUEBERRY HILL RD Issue Date 02/3/2005 PORT LUDLOW, 98365 APPLICANT: JAMES M FOSTER PHONE: 360-437-0412 SHARON L FOSTER 24 BLUEBERRY HILL RD PORT LUDLOW WA 983658755 SUBDIVISION: Block: Lot: 58 PARCEL NUMBER: 821334060 Section: 33 Township: 28 N Range: 01 E CONTRACTOR: OWNER/BUILDER PHONE: PROJECT DESCRIPTION: NO MLA REQRD - FINISH UNFINISHED BEDRM #4 IN BASEMENT NO CHG IN FOOTPRINT CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. SETBACKS: UFFER: Footing: Foundation: Stormwater FINAL Approval: Underground Plumbing: Underground Insulation: Shear Wall : X Framing: OK L)�Cenifle.rPf 3/3/t Plumbing: Propane Tank/ Lines: Insulation: X Sheetrock: dk 3fD,S Septic Sytem Finaf Approva (I not on sewer): Road Approach Final Approval: Zoning Final Approval: )( Final/Occupancy Approval: O+C car- G fo 5/5/o5 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 10/29/19 e.,3, 0N c06 JEFFERSO1WUNTY ` DEPARTMENT OF COMMUNITY DEVELOPMENT _ '' 621 Sheridan Street• Port Townsend •Washington 98368 l fl i` • 360/379-4450 • 360/379-4451 Fax I / �O� www.co.jefferson.wa.us/commdevelopment JAN 2 � 2005 RING Master Permit Application ; MLA: Project Description(include separate sheets as necessary): ' I �Fjfi4rc%i F#J/3 th' f,(ti1F�ii/5W �7EDlEeL )1i-J 46C6/A ?{�F?ie 5c:1T3fcGrkt,l_'9 Tax Parcel t .,/� �f-f Property �j�,�, Number: Z f ' i 7 fCi S • ize:��/`s"'X° /L�C, (acres/square feet) � C NTF�L &.ff- wE/�j Site Address and/or Directions to Property: %� c t l�l3G/ � er%�.E / , ���fj� Property Owner(s)of Record: -TietafES . I=6/40S ed1/4)/C •�h fse� Telephone:3t4--V-3 7-4%2._ Fax: email: Mailing Address: Z , LI-1E/? y/f(' A, /1/C' -it, t:1/, WA yc36 Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) 0 Building ❑ Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use[C(a), C(d),or C]** 13'Single Family ❑ Discretionary"D"or Unnamed Use Classification ❑ Garage Attached/Detached 0 Special Use(Essential Public Facilities)** ❑ Manufactured Home ❑ Boundary Line Adjustment O Modular ❑ Short Plat** 0 Commercial* ❑ Binding Site Plan** El Change of Use ❑ Long Plat** ❑Address (1 Road Approach 0 Planned Rural Residential Development(PRRD)/Amendments** ❑ Propane ❑ Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis 0 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 'SC/g to act as my agent in matters relating to this application for permit(s). OWNER SIGNATUR /� �' ja/7)/( 47 ,/a' 1�- Date: /.. _1c. 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 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 a re uired later inspections.Access and right of entry to this property shall be requested and shall occur only during regular business hours. /j /�/� �,� 956e/VL, / / Signature: l41 if �"l �fuw/i(6;e- py4r- Date: / 2 4 . r/ 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)eve if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non- ansfe e responsibilit'(/ adherin and co lying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature �- 4 Date: rr-Z�j— (r�5" G:\PermitCcnter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc • OWNER 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 ads ing the r n ' . of the General Contractor for the proposed project. Signatur ,l/�� fJ <_- Date: g:13 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 H-Wood Existing: 'r CI Sewer ❑ Addition ❑ Steel Proposed: --- Bank ❑community System tY Alteration/Remodel ❑ Concrete Total: .) Height: f1 Individual Sys♦{sm �j Li Repair ❑ Masonry SEP Permit# Lit—'3/O ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: .- Setback: t1 Private well ❑ Two Party Type of Heat: Proposed: __.1_ U Public Total: tt- Name of System: P«P{,4/ ti L)E. f� ,._ Effligy 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: r1 Underground Tank t.1 Above ground Tank Size of Propane Tank: Ill Heat Stove I.1 Cook Stove a Woodstove t.i Fireplace Insert LI Hot Water Tank I 1 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 ail property lines,buildings and septic system components, including the reserve area. Square Footage For Office Use Only Current Proposed Amount Main Floor rr Consistency Review: 2NU Floor Base fee: . 2 - 3t0 Floor Additional Section: Mezzanine: Plan Check fee: 1 Heated Basement ',? I - A �; State Surcharge fee: 4 Unheated Basement Pot Water Review fee: JAN Other Unheated 911/Rd Approach fee: g TOTAL: $ r S +J Garaa/Ca rt 6e7 /G �r Decks / Receipt Number: 1 / ¢ Other Cash/Check Number: ESTIMATED COST(REQUIRED) Date: jpe!r ma et-Value.of ails bor and materials foundation to finish Q - 11- KInitials: G:\PemritCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc • N ❑ • ❑ ❑.❑: ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ o a d 0 ❑ ❑ 0 ° a E H O F' �P W N F-' 0 Cl ti H .0. N hi H F•' o w 0� --1 01 Ul • hi (-I- 0 II 0 ' ' W (D . . 0 H 0 td a m mi rt rid P" n r} H. N• (II hi n0N• o (ooy� t�ro (nbrau~imalm �roo (Donahano amm cnt-I) F0 H mo � 0Nrl, FirrancDl( rr ol� F' E000b ¢ au. �• gon b N 0 o ff 0 (D 'i a H H' H II° a (D (D n N• N 0 rr ° t i c H ' O r rare a (n � N0 ((DDaona.H) inn (NDorar � c�D •� na � rroD �' Md '>srr N (n (nNo (n � In IA 0 O 0 (D td n 0 H 0 H. hi ►-1 H. 0 1 i a rt H F i N Fitt (D 11 0 (wD r N m o a F-' ft (D o a F' rt a o oP o 0-. 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