HomeMy WebLinkAboutBLD2005-00509 ItUILDING PERMIT APPLICAN MLA05-467
Review Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD05-00509 Received Date: 8/2/2005
SITE ADDRESS: 745 VAN TROJAN RD
OWNER: MICHAEL W MADSEN PHONE: 801-465-1718
3996 W 12000 S
PAYSON UT 846519666
SUBDIVISION: Block: Lot: TX28
PARCEL NUMBER: 901153002 Section: Township: Range:
CONTRACTOR: CONSTRUCTION RESOURCE GROUP PHONE: 425-861-8130
7960 170TH AVE NE
REDMOND WA 98052
Contractor's License CONSTRGOO6KJ Expires 5/9/2006
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP MODULAR HOME W/ SITE BUILT ROOF STRUCTURE
TYPE OF WORK MOD SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 1,661
VALUATION 83,366.00 ADD'L: 1,431 HEAT TYPE: EEE
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY: R-3 UNHEATED: # OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: 5N GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: 4 Prop: 4
Total: 4 Total: 4
Routing Date: ?AV
Type Amount Paid By: Date: Receipt: Approved/Date
Potable Water Application $53.00 SLE 08/01/05 76415
State Building Code $4.50 SLE 08/01/05 76415
Plan Check $573.14 SLE 08/01/05 76415
Permit $881.75 SLE 08/01/05 76415
Total: $1,512.39
• _• I
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,contractods and t.
they will be assuming the responsibility of the General Contractor for the proposed project.
Signature: Date: i 1 _
I
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX
y� ( y f t ( 2.5) 2—
{IL�'C1JC`7lL U< �a i Z EMAI ) +' ! ` l ��i
MAILING ADDRESS: } ) i ( i� bi A.I.Id L r i t I-
CONTRACTORS LICENSE Cr().cd , C i7 C..- WAINS i
NUMBER: �t l v 7(yy C I . NUMBER
ARCHITECT/ENGINEER: 4 `I 4 t��.1D L evil /, � ) 6 FAx. ) _� �1 Ici
/� 1� Q ii �'�}t�c `u_ � r_,ry�i } � PHONE '47� �� �1� '�G7 �_{� �]
MAILING ADDRESS: I {i, Li) 4�1.��rtt"(( ,(11`iz / L� }J i,) EMAIL
Project -it,
Type: tt�� 9 XX�� . 2 t33`,
Frame Type: Bathrooms: I� Shoreline: Type of Sewage Disposal:
New
,,,Q Wood Existing: D Sewer
GI Addition 0 Steel Proposed: YL Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: , ` 2- Height: A Individual System
❑ Repair n Masonry SEP Permit# t5 2�'7 1
❑ Demolition L] Other: Bedrooms: Water Supply:
Existing: Setback: ,1 Private well ❑ Two Party
Typp of.lat: Proposed: ❑ Public
e r i ' Total: Name of System:
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:
X Underground Tank ,Vi Above ground Tank Size of Propane Tank: 1. CND
❑ Heat Stove X Cook Stove ❑ Woodstove j Fireplace Insert ,k1 Hot W er Tank ❑ Pellet Stove ❑ Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes / o
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 Per Office Use Only
Current Proposedgpnt
Main Floor t'r /ny5 1-3
, 11 C nsisterxy Review: 400
2 Floor ✓ Base felet
►,k3).5 {L (q3 a1- 1
3na Floor �+ 1 Secboli:°
Mezzanine: plan Bieck fee:
Heated Basement - State Surcharge fee:
Unheated Basement Pot Water Reidievi fee. t 0d
Other Unheated 9 e
fee, f,-.
Garage/Carport U-r'.car— TOTAL. $
I 5-1 Gm ,
Decks
ici �� r; Receipt Number 7/ •
OtherQeoc r�eF CashlChock Number v '
"1tGz :
ESTIMATED COST(REQUIRED) Date: t� I D
.Fair market value of all labor and materials ion to finish
1 3 Initials:
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DESIGNER PROJECT
DRAWN BY HNS CONSTRUCTION
'I Al 2 DATE o�il9ios a�Madsen Residence TRUE
•
REVISIONS PROJECT I� GROUP
ADDRESS Port '�,�lo�` ' to 7960 170.th avenue NE
REDMOND, 4/ASHINGTf7N' 9E
TITLE VODZEI 423-B61-B130
PROJECT NO. SITE PLAN (ENLARGED) FAX 425-eea-2693
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S1TE PLAN
SCALE: I"=150'-O"
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100' SETBACK
TYPE 3 STRAEM
PROPANE TANK i E'
PP-OP05ED II
RE51DENCE I �_
TANKS MIN. 5' FROM BUILDING Q1
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100' SETBACK FROM
DRAINFIELDS
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SETBACK
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SETBACK
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PLAN SHEET AI.2
NORT
LEG7AL DESGRI PTI ON
TAX PARCEL #: q01-153-002
SITE ADDRESS:
l45 VAN TROJAN ROAD
GHIMAGUM, HASHINGTON 98325
S 1 TE DATA
LOT SIZE.
3-744656.42 5F
BUILDING FOOTPRINTS
RE5IDENCE
1512.63
SF
6ARAGE
W 24
SF
TOTAL
263"-1
5F
ROOF AREA:
RESIDENCE
2I43.93
5F
6ARA6E:
828.00
5F
DRIVEWAY:
26856
5F
DECK/PORCK
1511.00
5F
PORCH:
BUILDING LOT COVERAEE.
0.0865%
ROOF, DRIVEWAY AtV 6ARA6E SLAB: 2Y7Ib4 SF
IMPERVIOUS DEVE4_OPI !TAL AREA:
?971A4 5F
BUILDING FLOOR
MAIN LE -NFL.
SF
LOPER LEVEL:
5F
6ARA66
SF
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-7 45 VAN TROJAN RD BLD 0 5—5 0 9 —
MADSEN
Approvals Req'd Prior
A dioftivaisliiii0dtgrior
t6 Final Inspection
sFP 167
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