HomeMy WebLinkAboutBLD2005-00271 BLD05-00271
WILDING PERMIT APPLICAT vN Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD05-00271 Received Date: 5/2/2005
SITE ADDRESS: 7534 FLAGLER RD
NORDLAND, 98358
OWNER: MARTIN H LOKEN PHONE: 360-385-5038
MARJIANN K MOSS
PO BOX 211
NORDLAND WA 98358
SUBDIVISION: Block: Lot: T 32
PARCEL NUMBER: 021333007 Section: 33 Township: 30 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION REMODEL: EXPAND MASTERBDRM CLOSET, ADD UTILITY SINK &
SHOWER IN UTILITY RM ADD DISHWASHER IN KIT., ADD HEATERS
IN 2 BATHRMS
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ALT MAIN: 0
VALUATION 1,900.00 ADD'L: HEAT TYPE: EEE
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY: R-3 UNHEATED: # OF STORIES:
OCCUPANCY:
CONST TYPE: 5N OTHER: 0 SHORELINE:
GARA0
CONST TYPE: DECKLE' 0 SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS:
Exist: 3 Exist: 2
Prop: Prop:
Total: 3 Total: 2
Routing Date: 5 ( .1 \06-
Type Amount Paid Bv: Date: Receipt: Approved/Date
Permit $66.20 BAC 05/02/05 73054 �.�/�
Plan Check $43.03 BAC 05/02/05 73054 C�i
State Building Code $4.50 BAC 05/02/05 73054
Total: $113.73 AP etA Ca/0—r 7Y )%'
•
Mo Moss and Marty Loken
PO Box 211 g
101-(1
Nordland,WA 98358 r 5
May 23, 2005
To: Peter Bonyun
Jefferson County Dept. of Community Development it l���621 Sheridan Street rt
Port Townsend,WA 98368
RE: Withdrawal of Building Permit Application # 021 333 007
Dear Peter,
This is a followup to our telephone conversation last week regarding our application for a
building permit for our existing log home at 6534 Flagler Road, Nordland, on Marrowstone Island.
-i -46-ir",i•
Since making the application our realization of the costs involved in making any serious
revisions has made us rethink our approach. Our conclusion at this time is that we will expand the
closet (a non-permit-requiring change) and dress up the rest of the house with some paint,plaster,
and new cabinetry,and move in.
Therefore,we are withdrawing our application for a building permit for a remodel,
referenced above.
Since we had already started the process of creating a Reserve Drainfield Designation,we
will complete that undertaking and will have the paperwork in your office shortly. That way,when
we are ready to proceed with any other modifications, that will already be in place.
Thank you for your time and assistance in learning about the process and helping us focus
on our project.
Best Regards,
%. //6614/".-
nn Moss
• 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 wig ssu in e responsibility of the General Contractor for the proposed project.
Signature am.A 'U./ ' tt. La-5SY Date:
GENERAL CONTRACT OR MANUFACTURED HOME STALLER: 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 g Wood Existing: Z ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank ❑ Community System
Ti. Alteration/Remodel ❑ Concrete Total: Z. Height: ;N.Jndividual System
❑ Repair ❑ Masonry SEP Permit# . 7—16 S
❑ Demolition jir Other: Bedrooms: Water Supply:
Existing: 3 Setback: Lr. Private well is Two Party
Type of Heat: fume -, di Proposed: �fd C1 Public
Ell c Total: 3 Name of System:
roc f 34 i It4 cr
Wail S,
If this is a Commercial Protect 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 Ty .e'of construction: Will you have Food Service? Yes / No
If this is a Propane Tank and/orliance Installation permit,mark all items below that apply:
I 1 Underground Tank L 1 Above ground Tank Size of Propane Tank:
I I Heat Stove [.I Cook Stove LI Woodstove I i Fireplace Insert 1Ii Hot Water Tank I I Pellet Stove 11 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,
includin the reserve area.
Square Footage For Office Use Only
Current Proposed Amount
Main Floor ill) Consistency Review:
2Nu Floor Base fee: WC't 11
3rd Floor Additional Section: flo
�`..
Mezzanine: Plan Check fee:
Heated Basement State Surcharge fee: 450
Unheated Basement Pot Water Review fee:
Other Unheated ul i/Rd Approach fee:
Garage/Carport qz.2 TOTAL: $ 1 l'r
Decks � ��-
c`'7.57) Receipt etiber: 1 O5 4
Other Cash/Check Number: 0001
ESTIMATED COST(REQUIRED) i i,, 7a0t CO Date: c
•Fair market value of all labor and materials foundation to finish _ .__.__._ -.__,_ 5 /0 J
Initials: l
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
JEFFERSON UNTY •
tk� � DEPARTMENT OF COMMUNITY DEVELOPMENT
r1 621 Sheridan Street • Port Townsend •Washington 98368 64(4.V.
' , 360/379-4450 • 360/379-4451 Fax f\ D C 1Q_ l�'\
IN
O O www.co.jefferson.wa.us/commdevelopment
r )`-l(- A `R� D
Master Permit Application MLA: �,--�._if
Project Description(include separate sheets as necessary): EX ligd4 • �dwA ` t"s t f cAt t t `', '�;
rest (I I-th-fy ��t�d- s oave{- f� e,�jS t tY►(�Z/ roow� rn.s �� rare fer drsltwa�l , >
3.4rft./ ir\ Ki t,S rvrSfalfrk eler-tri* Bear['-r In twn PZ r011"S;
Tax Parcel Property
Number: OZ.j{ 333 66 7 Size: �r 5—3 0acre (acres/square feet)
Site Address and/or Directions to Property: 753�-- F(ag�e.r R,,- ,�J o rci/ate /S3S ►`Iar��` a J�h k 4"
V�r N ( cla.�.d— �ys�6su�-7yt11S�
Property Owner(s)of Record: Mar'&� Lo .
a.." Mari r ahr. iMOSS
Telephone:: c ) 3vSr503 Fax: C 360) 36,5 53g1 email• Marty C.. is/art1 ' t vp, am
Mailing Address: i X Z/I (r141ad I d ki•t. pr I? >4- 216 (Marty) / (v 64 QB-c
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies)
jJ 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 ❑ Special Use(Essential Public Facilities)**
❑ Manufactured Home ❑ Boundary Line Adjustment
❑ Modular ❑ Short Plat**
❑ Commercial* ❑ Binding Site Plan**
❑ Change of Use ❑ Long Plat**
❑Address I 1 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 federej permits required for this proposal, if known:
CC ,
OEM
I hereby designate - ' to act as my agent in ma-lters plating to this application for permit(s).
OWNER SIGNATURE irk • 2 2005 . tie:
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 rovide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any ie uired I r ins. ons.Access and right of entry to this property shall be requested and shall occur only during regular business
hours.
Signature:, a `�" r�1 Date: ` r 4
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)even if you are in mpliance with the Jefferson County,development code.The Applicant acknowledges that he,she or it holds individual
and non-tr ra sibility for adhering to.and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: ' l{ aid-"� nutt-S'K Date: ����'v� I I
G:\PermitCcnter\FORMS\DIM FORMS\Master Permi_ pplication 7-8-04.doc
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