HomeMy WebLinkAboutBLD2004-00531 •
BUILDING PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD04-00531 Received Date 08/18/2004
SITE ADDRESS: 20 FAIRWIND CT Issue Date 08/24/2004
PORT LUDLOW, 98365
APPLICANT: ANTHONY S HERNANDEZ PHONE:
EVELYN BOYCE
20 FAIR WIND CT
PORT LUDLOW WA 983659551
SUBDIVISION: LUDLOW POINT VILLAGE DIV 1 Block: Lot:
PARCEL NUMBER: 969400001 Section: 16 Township: 28 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
PROJECT DESCRIPTION: MASONRY FACING WALL REPLACEMENT-NO MLA REQ'D
REQUIRED INSPECTIONS:
[ ] SETBACKS: 2k' 9/k41c4
[ ] UFFER: N�
[ ] Footing: esk q/Zohy
[ ] Foundation:
[ ] Stormwater FINAL Approval:
[ ] Underground Plumbing:
[ ] Underground Insulation:
[ ] Shear Wall :
[ ] Framing:
1 1 Plumbing:
[ ] Propane Tank/ Lines:
[ ] Insulation:
[ 1 Sheetrock:
[ 1 Septic Sytem Final Approval:
Road Approach Final Approval:
[ ] Zoning Final Approval:
I 1 Final/Occupancy Approval: 0k •c►tia,t ?�/i7/Db
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
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F.U'c S 2004
JEFFERSON COUNTY
DEPT. OF COMMUNITY DEVELOPMENT
[
GILDING PERMIT APPLICATA/ BLD04-00531
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00531 Received Date: 8/18/2004
SITE ADDRESS: 20 FAIRWIND CT
PORT LUDLOW, 98365
OWNER: ANTHONY S HERNANDEZ PHONE:
EVELYN BOYCE
20 FAIR WIND CT
PORT LUDLOW WA 983659551
SUBDIVISION: LUDLOW POINT VILLAGE DIV 1 Block: Lot:
PARCEL NUMBER: 969400001 Section: 16 Township: 28 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION MASONRY FACING WALL REPLACEMENT- NO MLA REQ'D
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION 3,000.00 ADD'L: HEAT TYPE:
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: # OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: 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: / ,) n F&W Landslide
��I� Q�f � Shoreline _Aquifer
Forest: Commercial Rural
Type Amount Paid Bv: Date: Receipt: 1 Apwroved/Date
Permit $97.25 ZAN 08/18/04 66727 APPROVED
Plan Check $63.21 ZAN 08/18/04 66727
State Building Code $4.50 ZAN 08/18/04 66727 AUG 2 4 2004
Total: $164.96 Jefferson County Planning
nn & Building Department
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k��gozv �o� JEFFER COUNTY II
' '-i DEPARTMENT OF COMMUNITY DEVELOPMENT
rc 621 Sheridan Street • Port Townsend •Washington 98368
4. ' ' 360/379-4450 . 360/379-4451 Fax _ AUG 1 8 2004 .:....)/
�p www.co.jefferson.wa.us/commdevelopment
`Y`g�.I.NQ'S
JEFFERSON COUNTY
Master Permit Application MiEA:OF COMMUNITY DEVELOPMENT
Project Description(include separate sheets as necessary):
1 Tax Parcel / 9/ / Property
Number: / 0�(P / Size: /I (acres/square feet)
Site Address and/or Directions to Property: 0-00 `-itizec17,4e) GT/ , 3 r— L 4,--4c Cr,-. )
Property Owner(s)of Record: o.Jy/ i-z'�s e y—,) h/e-,c-..."-"v,0,?z--
Telephone:/3G c1) V T 2 --9-5 V 7 Fax: email:
Mailing Address: a-0 i. 'h' '-'O c T i ,( t 1✓ 'L�,Oc'—e,"-.)
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
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 ❑ Special Use(Essential Public Facilities)**
Manufactured Home ❑ Boundary Line Adjustment
❑ Modular ❑ Short Plat**
❑ Commercial* ❑ Binding Site Plan**
U Change of Use U 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 U 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 / 'e-'74- •oc"—e— to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE • /�'s�.�/t►..r��` L Date: 2// /Oc/
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 attomey'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 any required later inspections.Access and right of entry to this property shall be requested and shall occur only during regular business
hours.
Signature: /c-'�.✓.q--- ' — Date: g// /CX�
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 compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transferable resonsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer ar)d signs and dates it below.
Signature: 7 /27e-,, ,:>i Date: I1/S" Oy
\\Permitserver\Home\permit\Peterb\Draft forms\Master Permit Application 6-30-2004.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 assumin the r sponsibility of the General Contractor for the proposed project. V Signature: • c.rG-•/�ti7>�-�Z� Date: 0y
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 Wood Existing: `- Sewer
Addition Steel Proposed: Bank Community System
Alteration/Remodel Concrete Total: Height: Individual System
Repair Masonry
Demolition Other: Bedrooms: Water Supply:
Existing: Setback: Private well Two Party
Type of Heat: Proposed: ublic
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:
CI Underground Tank I] Above ground Tank Size of Propane Tank:
I Heat Stove I I Cook Stove I l Woodstove I Fireplace Insert I Hot Water Tank I I Pellet Stove ❑ 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,
including the reserve area.
Square Footage For Office Use Only
Current Proposed Amount
Main Floor Consistency Review: C/
2"u Floor Base fee: q • 1 c
31°Floor Additional Section: I
Mezzanine: Plan Check fee:
Heated Basement State Surcharge fee:
Unheated Basement Pot Water Review fee:
Other Unheated 911/Rd Approach fee: ,
Garage/Carport i
TOTAL: $ ; 6.LI • (( L.
Decks Receipt Number: 4 C72-1
Other Cash/Check Number: I t r
ESTIMATED COST(REQUIRED) Date: � l b A -
.Fair market value of all,labor and materials foundation to finish U l' O�
-n ( _) Initials:
\\Pemutserver\Home\permit\Peterb\Draft forms\Master Permit Application 6-30-2004.doc
• •
" uod. JEFFERSON COUNTY E C E EI
WE nillkiii41 DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street •• Port Townsend ••Washington 98368 _ AUG 1 5 IsZti-Nec °
360/379-4450 • 360/379-4451 Fax
http://www.co.jefferson.wa.us/commdevelopment/ JEFFERSON COUNTY
DEPT. OF COMMUNITY DEVELOPMENT
Stormwater Calculation Worksheet
-
MLA# PROJECT/APPUCANT NAME: Per V AIN D Z+
DETERMINING STORMWATER MANAGEMENT REQUIREMENTS:This stormwater calculation worksheet should be completed first
to classify the proposal as"small,""medium,"or`large." The size determines whether a Stormwater Site Plan is required in conjunction
with a stand-alone stormwater management permit application, building permit application, or other land use approval application that
involves stormwater review. The basic information will also be helpful for completing a Stormwater Site Plan,if required.
PARCEL SIZE(I.E.,SITEI
Size of parcel acres An acre contains 43,560 square feet. Multiply the acreage by this figure.
Size of parcel in square feet sq/ft
Land-disturbing activity is any activity that results in movement of earth, or a change in the existing soil cover(both vegetative and
non-vegetative) and/or the existing soil topography. Land disturbing activities include, but are not limited to clearing, grading, filling,
excavation,and compaction associated with stabilization of structures and road construction.
Native vegetation is vegetation comprised on plant species,other than noxious weeds,that are indigenous to the coastal region of the
Pacific Northwest and which reasonably could have been expected to naturally occur on the site. Examples include species such as
Douglas fir,western hemlock,western red cedar,alder,big-leaf maple,and vine maple;shrubs such as willow,elderberry,salmonbeny,
and salal;herbaceous plants such as sword fern,foam flower,and fireweed.
LAND DISTURBING ACTIVITY,CONVERSION OF NATIVE VEGETATION,AND VOLUME OF CUT/FILL
Calculate the total area to be cleared,graded,filled, Answer the following two questions related to
excavated,and/or compacted for proposed development conversion of native vegetation:
project. Include in this calculation the area to be cleared for:
{ Does the project convert%acres or more of
Construction site for structures c sq/ft native vegetation to lawn or landscaped areas?
Drainfield,septic tank,etc. sq/ft Circle: Yes No
Well,utilities,etc. sq/ft Does the project convert 2 34 acres or more of
native vegetation to pasture?
Driveway,parking,etc. sq/ft
Circle: Yes No
Lawn,landscaping,etc. sq/ft
Other compacted surface,etc. sq/ft Indicate Total Volumes of Proposed:
/ /b c
Total Land Disturbance /(.' j sq/ft Cut Fill (cu/yd)
[over)
stormwater calc wortrsheet—REV.10/12003 1
•
Impervious surface is a hard surface that either prevents or retards the entry of water into the soil mantle as under natural conditions
prior to development. A hard surface area which causes water to run off the surface in greater quantities or at an increased rate of flow
from the flow present under natural conditions prior to development. Common impervious surfaces include, but are not limited to roof
tops, walkways, patios, driveways, parking lots or storage areas, concrete or asphalt paving, gravel roads, packed earthen materials,
and oiled,macadam or other surfaces which similarly impede the natural infiltration of stormwater.
STORMWATER CALULATIONS—IMPERVIOUS SURFACE
NEW EXISTING
Structures(all roof area) sq/ft Structures(all roof area) .� '49 sq/ft
Sidewalks
sgfft Sidewalks sq/ft
Patios — y Patios sq/ft
Solid Decks s Solid Decks sq/ft
(without infiltration (without infiltration below)
Driveway AUG Driveway F y c sgfft
Other ___...SON rn tirsq/ft Other sq/ft
Total New DEPT.OF COMMUNITY : cvELOPMENT Total Existing � 2(, sq/ft
TOTAL NEW+TOTAL EXISTING* 1 7 7-0 sgfft *This amount will be used to check total lot coverage.
The following questions will help determine whether the proposed project is considered development or redevelopment.
DEVELOPMENT v.REDEVELOPMENT
Divide the total existing impervious surface above by the size of the parcel and convert to a percentage:
Does the site have 35%or more of existing impervious surface? Circle: Yes No
FURTHER INSTRUCTIONS: If the answer is yes, the proposal is considered redevelopment and the attached Figure 2 should be
used to determine the applicable Minimum Requirements. If the answer is no, the proposal is considered new development and the
attached Figure 1 should be used. At this juncture,the applicant should refer to the applicable Flow Chart to determine the Minimum
Requirements for stormwater management. DCD staff will help verify the classification of the project and the application requirements.
For proponents of "small" projects who must comply only with Minimum Requirement #2—Construction Stormwater Pollution
Prevention—an additional submittal is not required. The proponent is responsible for employing the 12 Elements to control erosion and
prevent sediment and other pollutants from leaving the site during the construction phase of the project. Pick up the Construction
Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet. Proponents of"medium"projects—those
that must meet only Minimum Requirements #1 through #5—and for "large" projects—those that must meet all 10 Minimum
Requirements—are required to submit a Stormwater Site Plan. DCD has prepared a submittal template of a Stormwater Site Plan,
principally for rural residential projects. Complete the template in the Stormwater Site Plan Instructions and Submittal Template or
prepare a Stormwater Site Plan using the step-by-step guidance in the Stormwater Management Manual.
APPLICANT SIGNATURE
By signing the Stormwater Calculation Worksheet, I as the applicant/owner attest that the information provided herein is true and
correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all
owners of the affected property.
S e'4.
(LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE)
stormwater calc worksheet—REV.10/1/2003 2