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HomeMy WebLinkAboutBLD2003-00316 • BUILDING PERMIT • Jefferson County Departmi 621 Sheridan Street, Portentof Townsend,Commun Wty AD 98368 Development (360)379-4450 FAX (360)379-4451 PERMIT #: BLD03-00316 Received Date 05/21/2003 SITE ADDRESS: 23 RAEBURN CT Issue Date 06/16/2003 PORT LUDLOW, 98365 APPLICANT: BRUCE D HENRICUS PHONE: 737-7711 MAGDALENA G HENRICUS 23 RAEBURN CT PORT LUDLOW WA 98365-9796 SUBDIVISION: SOUTH BAY#3 Block: Lot: 10 PARCEL NUMBER: 995700010 Section: 21 Township: 28 N Range: 01 E CONTRACTOR: OWNER/BUILDER PHONE: LOAN LENDER/ BOND HOLDER: PROJECT DESCRIPTION: ENCLOSE DECK- NO CHNG IN FTPRNT REQUIRED INSPECTIONS: [ ] SETBACKS /Footings: AS [ ] Foundation: N/A [ ] Underground Plumbing/Underground Insulation: N/A ( ] Shear Wall: A//A [ ] (Framin Plumbing: OK 20/ o3, 1 1 Propane Tank/Lines: [ ] Insulation: Die 07766 1 Sheetrock: )f + 02 a' I 1 Septic System Final Approval: [ ] Zoning Final Approval: n 1 1 Final/Occupancy Approval: es l�C 4 -t i h.a. fifiVOHEALTH DEPARTMENT APPOL QUIRED 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 is\F_BLD_ Permit_Bu ildng.rpt 10/29/19 � . ,sox c°t JEFFI SON COUNTY • 4 $4101 DEPARTMENT OF COMMUNITY DEVELOPMENT 14 . 'ti' 621 Sheridan Street• Port Townsend •Washington 98368 ls, (.40 360/379-4450. 800/831-2678 .360/379-4451 Fax www.co.jefferson.wa.us/commdevelopment Master Land Use Permit Application Form PROPERTY INFORMATION Tax Parcel Number: E EI E ® 0 ® ® Subdivision Name: ;' .J ki ; �Ay - 3 Lot Number: Property Size: (acres/square feet) Existing Use of Property: c._5- -N Y tiA 1- Site Address and/or Directions to Property: :)--: RF-,0 1' V x.rs. Cuvrl ?f,V-c Iv '•---) J "'S"3‘5 APPLICANT& OWNER NNFORMATION Y Applicant(if applicable): 1=' , , Telephone: Address: It lid- City: State: 1v Zip Code: Email Address Applicant's Signature: Property Owner(s)of Record: Telephone: Address: City: State: Zip Code: Email Address I acknowledge that the applicant above is applying for a building permit on my property. Owner's Signature: l� ,.,c,.T,-tip:. I hereby designate \ \ to act as my agent in matters relating to this application for permit(s). (PROPERTY OWNER SIGNATURE) (DATE) DESCRIPTION OF PROPOSED USE OR ACTIVITY(include separate sheets as necessary) [THIS SECTION FOR OFFICE USE ONLY] Refer to the specific sections of the UDC referenced below for more information and further requirements. An asterisk (*) indicates that a supplemental application or questionnaire may be required. Type I Permits Refer to: ❑ Septic Permit/Evaluation of Existing System(EES) UDC Section 6.4.1 and Chapter 8.15 JCC ❑ Building/Demolition Permit UDC Section 3.2.1 and Table 3-1 O Allowed"Yes"Use Consistency Analysis UDC Section 3.2.1 and Table 3-1 ❑ Home Business Table 3-1 and UDC Section 4.20 ❑ Stormwater Management* UDC Section 6.7 ❑ Road Access* UDC Section 6.8 ❑ Boundary Line Adjustment* UDC Section 7.2 ❑ Minor PRRD Amendments UDC Section 3.6.13.15 ❑ Sign Permit* UDC Section 6.15 ❑ Site Plan Approval Advance Determination(SPAAD) UDC Section 8.7 ❑ Shoreline Master Program Exemption/Permit Revisions UDC Section 5 O Temporary Use (based on use may be Type II or Type III)* UDC Sections 4.38 and 4.39 (OVER) O SON 0 ..illirilliilil, o JEFFERSON COUNTY ram, g < DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend • Washington 98368 '`45 ige`V- 360/379-4450 • 360/379-4451 Fax http://www.cojefferson.wa.us/commdevelopment/ Stormwater Calculation Sheet IAA- (4i12(770NA C. ROOF O1J LY) MLA# PROJECT/APPLICANT NAME: This stormwater calculation sheet should accompany stand-alone stormwater management permit applications, building permit applications,and other land use approval applications that involve stormwater review. STORMWATER CALULATIONS-IMPERVIOUS SURFACE NEW 1 144 EXISTING Structures(all roof area) 31,y4 sq/ft Structures(all roof area) frr 7 0 sq/ft Driveway sq/ft Driveway J' V sq/ft Sidewalks sq/ft Sidewalks `3'3 7 sq/ft Patios sq/ft Patios i sq/ft Solid Decks sq/ft Solid Decks / 16 sq/ft Other sq/ft Other ( sq/ft Total New " I; sq/ft Total 2 ':- 4/Existing ; 7 sq/ft TOTAL NEW+TOTAL EXISTING* 4 .J e sq/ft *This amount will be used to check total lot coverage Please also indicate the amount of land-disturbing activity, in addition to the creation of impervious surface, that will take place: LAND DISTURBING ACTIVITY Drainfield area cleared sq/ft Well, Structures, Utilities,etc. sq/ft Driveway sq/ft Other sq/ft Total Land Disturbance 0 sq/ft STORMWATER MGMT PERMIT.DOC REV.12/23/2002 • • �� ozv Jefferson County Department of Community Development .77 'O d. 621 Sheridan Street,Port Townsend WA 88368(3601378-4450 Kss.„.._. 0-= prmft a PpUc © 0 0 � 0 0 0 Project Description: Building Type: Project Type: Frame Type: ,L, Single Family ❑ New '(SZ: )4 Wood ❑ Garage Attached/Detached 1 JLi Addition � C 4 EC p (c - ❑ Steel ❑ Modular '❑ Alteration/Remodel 0 Concrete ❑ Commercial 0 Repair ❑ Masonry ❑ Multi-family/#of Units 0 Demolition ❑ Other: ❑ Industrial ❑ Other: Bathrooms: Bedrooms: Type of Sewage Disposal: Type of Heat: Choose one: Existing: Existing: ❑ Sewer ❑ Community System 0 Electricity 0 Oil Proposed: Q Proposed: G 0 Individual S stem Total: Total: Y 0 Woodstove 0 Propane If not sewer,fill out the following: `Heat Pump ❑ Conventional ❑ Alternative ❑ Other Permit# SEP Water Supply: 0 Private well ❑ Two Party Well Public:Name of water system: &et pC4uJ Square Footage: For Office Use Only Main Floor Consistency Review 41177013- 2ND Floor Base fee (aS,, '5 3rd Floor 65% i . U l Plan Check fee— Htd Basement State Surcharge fee L.b.SO Unhtd Basement --- --, Subtotal I ) • I �D Garage/Carport ) Pot Water Review fee Decks 911/Rd Approach fee Commercial TOTAL 4C7 " r 16 Industrial Receipt# ,5'(p ( l f g Other Cash/Check# / b g-3 Total Valuation: Initials Or Date /2( /o3 Estimated Cost: t If within 200' of the Shoreline, pp Distance to Bank or Ordinary High Water Mark N,A, ft. Bank Height ft. By signing the application form,the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. Any material falsehood or any omission of a material fact made by the applicant/owner 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 it's employees,representatives or agents for the purpose of application review and any required later inspections. Access and right of entry to the applicant's property or structure shall be requested and shall occur during regular business hours. Signature: ;V�,.�_ � �., > Date: _ Z P 0 '3 .OVER- - H:HOME\PLNCNTR\INFOBLDG\FOP IS\BLDpemutApplication 11-8-01 11, BUILDING PERMIT APPLI.TION BLD03-00316Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00316 Received Date: 5/21/2003 SITE ADDRESS: 23 RAEBURN CT PORT LUDLOW, 98365 OWNER: BRUCE D HENRICUS PHONE: 737-7711 MAGDALENA G HENRICUS 23 RAEBURN CT PORT LUDLOW WA 98365-9796 SUBDIVISION: SOUTH BAY#3 Block: Lot: 10 PARCEL NUMBER: 995700010 Section: 21 Township: 28 N Range: 01 E CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: ROGER LARSON PHONE: (360)437-0170 142 RESOLUTE LN PORT LUDLOW WA 98365 PROJECT DESCRIPTIOI ENCLOSE DECK - NO CHNG IN FTPRNT TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP ALT MAIN: VALUATION 5,875.00 ADD'L: HEAT TYPE: HTP CODE EDITION: 1997 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: 90 SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: SEW WATER SYSTEM: LUDLOW PARCEL TAGS: YES NO BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA Exist: Exist: Wetland Erosion Prop: Prop: Seismic Streams Total: Total: Flood Way Floodplain Routing Date: i F&W Landslide 3 alb Shoreline Aquifer Forest: Commercial J� (��RRural Type Amount Paid By: Date: Receipt: APpplov:.i� V E D Permit $125.25 MAM 05/21/03 56148 JUN 1 6 2003 Plan Check $81.41 MAM 05/21/03 56148 State Building Code $4.50 MAM 05/21/03 56148 Jefferson County Planning Total: $211.16 & Building Department cro( OS- be-c Z7 , d - _L (09E) f , . �1� 1 4 . 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