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HomeMy WebLinkAboutBLD2004-00562 •UILDING PERMIT APPLICASN BRD04-00p562 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD04-00562 Received Date: 9/7/2004 SITE ADDRESS: 1700 HAZEL POINT RD QUILCENE, 98376 OWNER: LARON WILLIAMS PHONE: (360) 765-3929 KATHERINE WILLIAMS 1700 HAZEL POINT RD QUILCENE WA 98376 SUBDIVISION: Block: Lot: T2+ PARCEL NUMBER: 601344001 Section: 34 Township: 26 N Range: 01 W CONTRACTOR: PACIFIC NW DEVELOPMENT INC PHONE: (425) 773-5362 BILL BISSELL 17217 11TH AVE NE SHORLINE WA 98155 Contractor's License PACIFND973KK Expires 5/12/2005 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION REMODEL STAYING W/EXISTING FOOTPRINT TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP ALT MAIN: VALUATION 25,000.00 ADD'L: 200 HEAT TYPE: EEE CODE EDITION: 2003 HEAT BASE: HEAT TYPE: PRO OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: 60 BANK HEIGHT: 75 SEWAGE DISPOSAL: WATER SYSTEM: PARCEL TAGS: YES NO BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA Exist: 4 Exist: 2 Wetland Erosion Prop: Prop: Seismic Streams Total: 4 Total: 2 Flood Way Floodplain Routing Date: F&W Landslide 'f/ o� Shoreline Aquifer ( �l Forest: Commercial Rural Type Amount Paid By: Date: Receipt: A PP R D�tV E D Permit $401.35 KAS 09/07/04 67615 Plan Check $260.88 KAS 09/07/04 67615 OCT 1 2 2004 State Building Code $4.50 KAS 09/07/04 67615 Jefferson County Planning Total: $666.73 & Building Department CsoQ� • BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD04-00562 Received Date 09/7/2004 SITE ADDRESS: 1700 HAZEL POINT RD Issue Date 10/12/2004 QUILCENE, 98376 APPLICANT: LARON WILLIAMS PHONE: (360) 765-3929 KATHERINE WILLIAMS 1700 HAZEL POINT RD QUILCENE WA 98376 SUBDIVISION: Block: Lot: T2+ PARCEL NUMBER: 601344001 Section: 34 Township: 26 N Range: 01 W CONTRACTOR: PACIFIC NW DEVELOPMENT INC PHONE: (425) 773-5362 BILL BISSELL 17217 11TH AVE NE SHORLINE WA 98155 Contractor's License: PACIFND973KK Expires: 05/12/2005 PROJECT DESCRIPTION: REMODEL STAYING W/EXISTING 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 : / Framing: `-f 2/GS Plumbin . • t— Propane k/ Lin s: //0914- 47(165? v�(y < ��,,�ti /0/ Insulation: y i- / Sheetrock: Septic Sytem Final Approval (If not on sewer): Road Approach Final Approval: Zoning Final Approval: Final/Occupancy Approval: 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 10/29/1999 Jefferson Cook,Department of Community Development 4,z,S° °° • 621 Shoid n Bu rt Townsend WA A 88368 060131 -4450` �� a �W � 0 r 1 iY permcfi=, ,.......: 0 ," • , , , , A ,_, � ,. , p_ ca00nSrINO�° B 'lding Type: Project Type: ' Frame Type: Single Family ❑ New i't. Cr K.Wood ❑ Garage Attached/Detached LI Addition ❑ Steel ❑ Modular .Alteration/Remodel ❑ Concrete ❑ Commercial ❑ Repair ❑ Masonry ❑ Multi-family/#of Units ❑ Demolition ❑ Other: ❑ Industrial ❑ Other: Bathrooms: Bedrooms: Type of Sewage Disposal: Type of Heat: Choose one: Existing: Existing: ❑ Sewer ❑ Community System i$Electricity ❑ Oil Proposed: — Proposed: 44 Individual System ❑ Woodstove /Propane Total: Total: If not sewer,fill out the following: ❑ Heat Pump I] Conventional ❑ Alternative [I Other Permit# SEP Water Supply: U Private well U Two Party Well❑ Public:Name of water system: '5 PI' `^ Square Footi ge: Office Use For Office Use Only ,lts --Mainfloor � I �A I' Consistency Review 2ND Floor S� • l L'). O� Base fee ' t'0_1 • 55 3rd Floor 836 S' t Plan Check fee Q 620, 2Y Htd BasemetR �)-' State Surcharge fee l ,,', Unhtd Basement (' Subtotal (Q(Q(-7 3 ge Garage/Carport t f �'C~' Pot Water Review fee -0 . Decks ei,S-k — I , O(X) 911/Rd Approach fee -f" ��est,,r1,8 • Commercial I TOTAL (I b‘P•,3 t• r _ Industrial 1 Receipt# 1.�-1 CO t_C Other ' �'� Cash/Check# (o' t—14\ ^, � r�„( �>rr.'� — Initials C.25 '� •f( v t3 ��O ` Date q I -(J/D f Estimated Cof If within 200' o ' e, / , Distance to Bank or Ordinary High Water Mark ft.Bank Height ef' L 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 provid access and ri entry to Jefferson Co my and it's employees,representatives or agents for the purpose of application review and any required later inspections. Access and right of en to the app" nt' roperty or structure sh be requested and shall occur during regular business hours. Signature: „ Date: OVER ► G:\PermitCenter\FORMS\BLDG FORMS\BLDPermit Application.doc 01/08/2004 JEFF RSON COUNTY •444 ', DEP ENT OF COMMUNITY DEVELOP NT 41, �O� 621 Sheridan Street • Port Townsend • Washington 98368 ((`L 87Nd 360/379-4450 . 800/831-2678 • 360/379-4451 Fax ) BUILDING PERMIT SUPPLEMENTAL CONTACT INFORMATION 3�u la tic Pelmets.,&cue& eta cor to as poeelile: Project Description: 9 Digit Parcel Identification Number(from your tax statement): Site Address 911#: r?ob O c,z ( J Road Name: � z l ' p. - a-43 Zip Code: -3--) Legal Description Subdivision Name: 0 Block: Lot(s): Parcel Size (acres or square footage): 1 1 4-'Jr Property Owner: LaAA Kkkcor--- Phone: Mailing Address: Applicant/Occupant: Phone: (if different from owner) L-rng- Mailing Address: Authorized Rep: Phone: Mailing Address: General Contractor: Or Manufactured Home Installer: S1 k1 W‘•NS Phone<( ) -73 -S'3(0 Mailing Address: , . r►� �c f�vcil O,p •h r� t�c I -1 a i-) t l 4^-` P C--T N D I -13 K or /o Contractor's State License Number: Expiration Date: Architect:/Engineer: �x�L t-i Phon [ 1 � s c+� 2 cr __zit," %30 S Mailing Address: 10 E1 k— PA— 3-Or.nd,. C A4 G:\PermitCenter\FORMS\BLDG FORMS\BLDPermit Application.doc 01/08/2004 • • VI ti; cob JEFFERSON COUNTY t — , 6.:, ,, / -''*N\ DEPARTMENT OF COMMUNITY DEVELOPMENT )��`� 4, 140,-) 621 Sheridan Street • Port Townsend • Washington 98368 rqS360/379-4450 • 360/379-4451 Fax • http://www.co.jefferson.wa.us/commdevelopment/ .P1. 0 L , Stormwater Calculation Worksheet MLA# PROJECT/APPLICANT NAME: 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.,SITE) Size of parcel acres An acre contains 43,560 square feet. Multiply the acreage by this figure. Size of parcel in square feet I L"I Li S�'3 `' 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,salmonberry, 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 3/a acres or more of Construction site for structures V sq/ft native vegetation to lawn or landscaped areas? Drainfield,septic tank,etc. sq/ft Circle: Yes No Well,utilities,etc. Ve sq/ft Does the project convert 2 Y2 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: Total Land Disturbance sq/ft Cut Fill (cu/yd) [over] stormwater calc worksheet—REV.10/1/2003 1 45----- Impervious surface is a hard surface feat 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 N 0 V' tU C. EXISTING G Structures(all roof area) sq/ft Structures(all roof area) �4 ��� sq/ft Sidewalks sq/ft Sidewalks . ° sq/ft Patios sq/ft Patios sq/ft Solid Decks sq/ft Solid Decks sq/ft (without infiltration below) (without infiltration below) Driveway sq/ft Driveway )1 — sq/ft Other sq/ft Other �-, "— sq/ft Total New sq/ft Total Existing /a/ - / S sq/ft TOTAL NEW+TOTAL EXISTING* sq/ft *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 Sto er Calculation Worksheet, I as the applicant/owner attest that the information provided herein is true and correct to the b of y knowledge. I also certify that this application is being made with the full knowledge and consent of all own rs of the ec d property. _a _U—/- ( WNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) ti a.1 d , i .._.y ash..;+, a r_ _.,. m'^�" per ,.,.�....t i__._..�.,i ss.,.,1 .- a ^>. A.,.. kTsl-,...tc'.. ..»..,� stormwater calc worksheet—REV.1D/1/2003 2 .3..solve III i`-lo vnL-A " , , % JEFF!RSON COUNTY I-, Q DEPARTMENT OF COMMUNITY DEVELOPMENT V) 4• .. . 621 Sheridan Street•Port Townsend•Washington 98368 !r vl G 360/379-4450•800/831-2678 •360/379-4451 Fax L IN www.co.jefferson.wa.us/commdevelopment Master Land Use Permit Application Form PROPERTY INFORMATION Tax Parcel Number: 1 E1 © 1I I�I I ] k5 0 Subdivision Name: Lot Number: nJ Property Size: 1 9 (acres/square feet) Existing Use of Property: �1n,3\C • A.zs t-•L _�„ Site Address anddr Directions to Property: `-7 CC: H C`z c A l '� f (Dur`C_o , (Arli- e-al ` c APPLICANT&0 ER INFORMATION 1 Applicant(if pplicable): l-elrrO y• w 1�,`4w%! Telephone: '(QO --)(p$ - 39 aci Address: 1 b zj Pa re. City: State: Zip Code: � 6 7(G Email Address Applicant's Signature: ote Property Owner(s)of Record: _ I(y V1M14, Telephone: Address: City: State: Zip Code: Email Address I acknowledge that the plican e is applying for a building permit on my property. Owner's Signature: I hereby designate to act as my agent in matters relating to this application for permit(s). Agent's Contact Telephone: Address: (PROPERTY OWNER SIGNATURE) (DATE) DES RIPTION OF PROPOS�USE OR ACTIVITY(include separate sheets as necessary) �k .. W`-k t.\\ ► QeC•� i,v,gic Q'. ?MKT raA,,- Ncr.1(. - k\e-..Nfe 4 ,w . }-)G}C LJ s WAG \(Cm (L,,, 'f Owe- -V /‘ `j,�Nl [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 0 Building/Demolition Permit UDC Section 3.2.1 and Table 3-1 ❑ 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 0 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 0 Shoreline Master Program Exemption/Permit Revisions UDC Section 5 ❑ Temporary Use(based on use may be Type II or Type III)* UDC Sections 4.38 and 4.39 (OVER) MASTER LAND USE PERMIT.DOC REV.11/18/2003 Type II Permits Refer to: ❑ Discretionary"D"or Unnamed LWlassification UDC SectiW.2.1, 3.2.2 and Table 3-1 ❑ Cottage Industry UDC Section 7.3 and Table 3-1 ❑ Short Plat, Preliminary and Final* UDC Section 7.3 ❑ Binding Site Plan* UDC Section 7.5 ❑ Conditional(Administrative)"C(a)"Use UDC Table 3-1 and Section 8.8 ❑ Conditional(Discretionary)"C(d)"Use UDC Table 3-1 and Section 8.8 (Discretionary Permit Review Process Determined by Administrator) ❑ Variance, Minor* UDC Section 8.9 ❑ Wireless Telecommunication Ordinance 06-0712-99(UDC Appendix C) ❑ Shoreline Substantial Development(Primary Use) UDC Section 5 ❑ Forest Practices Act/Release of Six-Year Moratorium for Single- UDC Section 4.16.5(c) Family Residence ❑ Appeal UDC Section 8.4.2 SEPA 8.10.12(b) Type III Permits ❑ Conditional"C"Use UDC Section 8.8 ❑ Long Plat, Preliminary* UDC Section 7.4 ❑ Planned Rural Residential Development Preliminary Approval UDC Section 3.6:13(must be in conjunction with an (PRRD)and Major Amendments* underlying land division application) ❑ Plat Vacation/Alteration UDC Section 7.1.3(d) ❑ Variance, Major* UDC Section 8.9 ❑ Reasonable Economic Use Variance* UDC Section 3.6.4(h) ❑ Wireless Telecommunication Ordinance 06-0712-99 UDC Appendix C ❑ Shoreline Management Substantial Development, Secondary Use* UDC Section 5 ❑ Shoreline Management Conditional Use* UDC Section 5 ❑ Shoreline Management Variance* UDC Section 5 ❑ Appeal UDC Section 8.4.3 SEPA 8.10.12 (c) Type IV Permits ❑ Long Plat, Final UDC Section 7.4 ❑ PRRD, Final UDC Section 3.6.13 Type V Permits ❑ Special Use(Essential Public Facilities) UDC Section 3.3.5 ❑ Jefferson County Comprehensive Plan/UDC/Land Use District Map UDC Section 9 Amendment* ❑ Jefferson County Shoreline Master Program Amendment* UDC Section 5 ❑ Appeal of SEPA UDC Section 8.10.12(d) Other Local,State or Federal Permits ❑ Please identify any other local,state or federal permits required for this proposal,if known: ACKNOWLEDGEMENTS [PLEASE NOTE THAT TWO SIGNATURES ARE REQUIRED] By signing the application form, the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. I also certify that this application is being made with the full knowledge and consent of all owners of the affected property. 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 its employees, representatives or agents for the sole purpose of application review and any required later inspections. This right of entry shall expire when the County (through the Administrator or the Administrator's representatives)concludes the application has complied with all applicable laws and regulations.Access and right of entry to the applicant's property shall be requested and shall occur only during regular business hours. 1. 14CEms. ✓ C �) / C. Z/1 PROPERTY OW DATENER ) 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 responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. 2. PROPERTY OWNER (DATE)