HomeMy WebLinkAboutBLD2004-00788 UILDING PERMIT APPLICA1N MLA04N-00671 Review
Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00788 Received Date: 12/13/2004
SITE ADDRESS: 230 OLD FERRY RD
PORT HADLOCK, 98339
OWNER: DANA A STOCKS PHONE: (425) 891-4048
RICHARD A STOCKS
9550 172ND AVE NE
REDMOND WA 98052-3229
SUBDIVISION: PORTAGE BAY PARK Block: Lot: 12-14
PARCEL NUMBER: 989100011 Section: 1 Township: 29 N Range: 01 W
CONTRACTOR: MV BUILDERS PHONE: (360) 661-1721
3395 OLD HWY 99 N
BURLINGTON WA 98233
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP NEW DECK
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP DEK MAIN:
VALUATION 16,912.00 ADD'L: HEAT TYPE:
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: SHORELINE:
CONST TYPE: GARAGE: ('3 Y( 9r SETBACK:
95
DECK: 1,216 BANK HEIGHT: 50
SEWAGE DISPOSAL: ALT
WATER SYSTEM: PUD 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: F&W Landslide
al ii 10/ Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid Bv: Date: Receipt: Approved/Date
Permit $431.65 BAC 12/13/04 68852 APPROVED
Plan Check $280.57 BAC 12/13/04 68852
State Building Code $4.50 BAC 12/13/04 68852
Total: $716.72 JAN 1 3 2005
Jefferson County Planning
4 & Building
De artmenp
! 7----
• 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 assuming the responsibility of the General Contractor for the proposed project.
Signature: Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
/IV 136.i lcei'S (34,c ) 1iilp1 -/ 79..1 ( )
MAILING ADDRESS: 3 3 rl'5 I!/ll Mt,y °J W. /J / in. EMAIL:
CONTRACTOR'S LICENSE iv/9 9,y,z.3 WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
IV New CV yi' Wood Existing: p r 0 Sewer
❑ Addition 0 Steel Proposed: Bank 0 Community System,�l f
I
❑ Alteration/Remodel 0 Concrete Total./ Height 0 Individual System /�
❑ Repair 0 Masonry 5-0 SEP Permit#
❑ Demolition 0 Other: Bedrooms: Water Supply:
Existing: ,y4Setback: ❑ Private well 0 Two Party
Proposed: --i
Type of Heat* Total:i� J� Name Public /vof System: 1'
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:
❑ Underground Tank ❑ Above ground Tank Size of Propane Tank:
El Heat Stove ❑ Cook Stove 0 Woodstove 0 Fireplace Insert 0 Hot Water Tank ❑ Pellet Stove 0 Other
Is this appliance being installed in a Manufactured I 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 4,.tfpiteppee Use Only "' " 6 M1 .f,}
Current Proposed {k `` + r� '
Main Floor � it on:cistenc Review 'c ��^ ,e ,: > 'r
NU �.4.� `3 d �' At.46H,,,,,...i.-4;
s
2 Floor Base fee,:
3 Floor Addi on. s '' °� q, c i
Mezzanine: M. , M r r
Plan Check a :': -„,4,p f r .,w z ,-0
Heated Basement * ; _1, � a~
State- rcharge fee '� ,'� `'�r `,. .• ;e�g
Unheated Basement �, ,T j -„, 4,
�. Pot 1'Vater Review fa¢�,, .� !,
}'A n.. # .�E. C -`Pau�YG Zn " S ?tias a' ...t �' t.
Other Unheated App ` ,� t 4i '�z ' • -� ,z.' '''
Garage/Carport '` ` °. �` �. ,. t s �..
TOTAL: t r_i 4 'ar�=
Decks - x, ' R "
Y' D � ar Receipt ', E }p¢ � a n'
Other ..:.:F.../.1,','.:;,,:',:!: Q( _; A . " a
ESTIMATED CAST(REQUIRED) Date �` s y f A', ;?`'i"
*Fair market value of all labor and materials foundation to finish DEC 1 3 2004 Y� k;'�U.,: L
.15."� .initials:
1
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G:\PermitCenter\FORMS\D13D FORMS\Master Permit Application 7-8-04.doc _..'.. ,..... ,�
, °IsT coe\ JEFFERSS COUNTY • '
DEPARTMENT OF COMMUNITY DEVELOPMENT t
''
malli
621 Sheridan Street• Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
vY`SbiINe,„p www.co.jefferson.wa.us/commdevelopment DEC 1 3 2004
Master Permit Application MLA:
Projectec Description(include separate sheets as necessary):
a� CK 1 / 230 o i Fir.~y lid 1? .L li-�`•1 `
Tax Parcel °j^ A , w.4 r r R.7J•St y�I
Property
Number: 9g9 ® C� 0 /
Size: -/l.A8
�"14i' (acres/square feet)
Site Address and/or Directions to Property: 43o vid lecty /7d , Rv-t Net d/0ck . coA
Property Owner(s)of Record: /?-,di ar d ri"t),gnrq 5 -0c_KS
Telephone: iSra y) 3 9/-lie v g Fax
Mailing Address: a 3 b email: 144A.Ske A s emSi1,c 0 in
old Feer�y A'd, for /ladiecit , UR 5773d/-c74,..7 Applicant/Agent(if different from owner):
Telephone: Fax:
Mailing Address: email:
What kind of Permit?(Check each box that applies)
❑ Building ❑Variance(Minor,Major or Reasonable Economic Use)
n Demolition Permit ❑Conditional Use[C(a),C(d),or C]**
Single-Family ❑ Discretionary"D"or Unnamed Use Classification
❑Garage Attached/Detached
Manufactured Home ❑Special Use(Essential Public Facilities)**
❑Modular * 0 Sma Plat Line Adjustment
0 0 Commercial —De el( 0 Binding Site Plan**
❑Change of Use ❑ Long Plat**
0 Address 0 Road Approach ❑ Planned Rural Residential Development(PRRDYAmendments**
❑Propane ❑ Plat Vacation/Alteration**
❑Mowed"Yes"Use Consistency Analysis ❑ Shoreline Master P 0 Stormwater ManagementProgram Exemption/Permit Revisions*'
❑Site Plan ❑ Shoreline Management Substantial Development**
Approval Advance Determination(SPAAD)* ❑Shoreline Management Variance
❑Temporary Use 0 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:
I hereby designate DESIGNATION OF AGENT
to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE
Date:
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,expenses which may in any way accrue a inst Jeffersonuencoft court costs,ts,reasonable permit
ble attorney's fees and
9a County as a result of or in consequence of the granting of this pe
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 " t of entryto this property
hours. P Perb shall be requested and shall occur only during regular business
Signature: / l i v i ,J l/./li!
!i h�-
Date: 1/ /x 4co51
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 f you are in compliance with the Jeffe
and non f yol County development code.The Applicant acknowledges that he,she or it holds individual
ponsibility for adhering to a complying with the SA. The Applicant has read this disciai er and.signs and dates it below.
Signature: / �--.4.- ,S).el,/ ,- `fUt //
/1-/ /Cy Date: f ?-fz �Y
_
G:\Per itCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
4.
BUILDING PERMIT •
Jefferson County Department of Community, Development
621 Sheridan Street, Port Townsend WA 98368
(360)379-4450 FAX (360)3 79-4451
PERMIT #: BLD04-00788 Received Date 12/13/2004
SITE ADDRESS: 230 OLD FERRY RD Issue Date 01/13/2005
PORT HADLOCK, 98339
APPLICANT: DANA A STOCKS PHONE: (425) 891-4048
RICHARD A STOCKS
230 OLD FERRY RD
PORT HADLOCK WA 98339
SUBDIVISION: PORTAGE BAY PARK Block: Lot 12-14
PARCEL NUMBER: 989100011 Section: 1 Township: 29 N Range: 01 W
CONTRACTOR: MV BUILDERS PHONE: (360) 661-1721
3395 OLD HWY 99 N
BURLINGTON WA 98233
PROJECT DESCRIPTION: NEW DECK
CALL IN FOR THE REQUIRED INS'ECTIO S THAT APPLY TO YOUR PROJECT.
SETBACKS: d/K 3/.4/.5
UFFER: go
Footing: /)K 3/ D5 (265-r) Ø
Foundation:
Stormwater FINAL Approval:
Underground Plumbing:
Underground Insulation:
Shear Wall :
Framing: 44' ,2>%f 56/
Plumbing:
Propane Tank/ Lines:
Insulation:
Sheetrock:
Septic Sytem Final Approval (If not on sewer):
Road Approach Final Approval:
Zoning Final Approval:
Final/Occupancy Approval: ove -Ay - ', I 05,
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
SPECIAL CONDITIONS APPLY -SEE REVERSE
SPECIAL CONDITIONS FOR CA A BLD04-00788 •
1.) The road approach permit (RAP04-00307) must be inspected and finalled by the Jefferson
County Department of Public Works prior to the final inspection/certificate of occupancy of
this residence. Contact Terry Duff at 360-385-9159 for the road approach inspection.
2.) Setback from Old Ferry Rd. right-of-way is no less than 20 ft., setback from Laurel St.
right-of-way is no less than 20 ft., side and rear setbacks are no less than 5 ft. If an
environmentally sensitive area (ESA) is present, then the more restrictive setback shall
apply.
3.) To help prevent seawater from intruding landward into underground aquifers, all new
development activity on Marrowstone Island, Indian Island and within 1/4 mile of any
marine shoreline shall be required to infiltrate all stormwater runoff onsite.
4.) MANDATORY MEASURES FOR COASTAL SIPZ:
1. For proof of potable water on a building permit application, applicant must utilize
DOH-approved public water system if available.
2. If public water is unavailable, a qualifying alternative system may be used as proof of
potable water or an individual well may be used as proof of potable water subject to the
following requirement:
a. Chloride concentration of a laboratory-certified well water sample submitted with
building permit application.
3. If public water is unavailable, a qualifying alternative system may be used as proof of
potable water.
5.) The project shall adhere to the Best Management Practices (BMPs) to control stormwater,
erosion and sediment during construction. BMPs shall address permanent measures to
stabilize soil exposed during construction, and in the design and operation of stormwater
and drainage control systems.
6.) Stormwater shall be retained and infiltrated on site. The owner shall control all
sedimentation and erosion on the property.
7.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
8.) Not more than two (2) unlicensed or inoperable vehicles shall be stored on any lot less
than one-half acre unless totally screened from view of neighboring dwellings and
rights-of-way. Such screening shall meet all applicable performance and development
standards specific to the district in which the storage is kept, and shall be in keeping with
the character of the area. Screening shall meet the requirements of Unified Development
Code (UDC) Section 6. Outdoor storage of thirteen (13) or more unlicensed or inoperable
vehicles is prohibited except in those districts where specified as an automobile wrecking
yard or junk (or salvage) yard and allowed as a Permitted Use in Table 3-1 of the UDC,
and such storage shall meet the requirements of UDC Section 4.10. In no case, shall any
such unlicensed or inoperable vehiclesbe stored in an Environmentally Sensitive Area
(ESA).
9.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
10.) The building height is not to exceed 35 feet.
11.) Exterior lighting for residential uses shall not exceed twenty feet (20') in height from the
finished grade, excepting when such lighting is an integral part of a building or structure.
Ground level lighting is encouraged.
12.) Lighting fixtures shall be designed and hooded to prevent the light source from being
directly visible from outside the boundaries of the property. The intensity or brightness of
all lighting, during construction and after project completion shall not adversely affect the
use of surrounding properties or adjoining rights-of-way.
13.) A medium stormwater plan has been submitted and approved by the Department of
Community Development. Once the subject permit has been issued the applicant shall
fully implement the provisions of the submitted plan and contact the Jefferson County
Department of Community Development to arrange a schedule to inspect the property for
plan compliance. A Certificate of Occupancy will not be issued until the Department
verifies plan compliance. No clearing for roadways or utilities shall occur on the project
site until clearing necessary for the installation of temporary sedimentation and erosion
control measures have been completed.
I:\F_BLD_Permit_Buildng.rpt 10/29/19
li °� JEFFERSON COUNTY
`► DEPARTMENT OF COMMUNITY DEVELOPMENT DEC - 2 2004
621 Sheridan Street • Port Townsend • Washington 98368
A.07 360/379-4450 • 360/379-4451 Fax
http://www.co.jefferson.wa.us/commdevelopment/
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# PROJECT/APPLICANT NAME:
Please answer all of the following questions to the best of your ability. Where the question calls for depiction on a site map, the
applicant may choose to either incorporate the elements into the general plot plan for the Master Land Use Application or to submit a
separate stormwater site plan map.
Project Overview
1. Describe the proposed developed conditions of the site. Indicate position and relative size of proposed improvements on the
site map. /
•
Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map.
d • /
3. Describe the existing vegetation. Indicate native vegetation areas on the site map.
3„y//71/ a SP>&"/
4. Describee/ the existing soils. Indicate soil type on the site map.
C!l
5. Describe the existing site hydrology(i.e., drainage;behavior of water on the site—above,below,and on the ground). Indicate
existing stormwater drainage to and from the site on the site map. Depict separate drainage basins on the site map, if
applicable,and indicate acreage of each.
APp a
SrOR •
6. Describe any excess levels of noise generated by the proposed use or activity: A N
105
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stormwater site plan template-rev.10/1/2003
7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams,
steep slopes,etc.)on the site. Indicate location on the site map.
8. Describe the general vicinity of the site,including adjacent land uses and structures, utilities, roads,and sensitive/critical areas
(streams,wetlands,lakes,steep slopes,l etc.). j Cj�—/
0 0 i'Y�' +y iYi ../r ..//'47iJr ♦ ri ,F,, ,rfry. 144aIf! ` .
Permanent Stormwater Control Plan
This portion of the Stormwater Site Plan consists of the selection and installation of the appropriate stormwater control BMPs
and facilities to remain in place after construction of the project is completed.
"Medium" size projects are required to have the totals calculated of all impervious surfaces, pollution-generating impervious
surfaces, and pollution-generating pervious surfaces to verify that the thresholds for treatment facilities and flow control
facilities are not exceeded.
g. Describe the developed site hydrology,as proposed. Indicate whether stormwater will be fully dispersed(i.e., per BMP T5.30
in the Manual)or, if not, what types of stormwater flow control will be utilized for the site or specific threshold discharge areas
within the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities.
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•
10. If the project requires the use of stormwater treatment facilities, describe the types of stormwater treatment facilities proposed
for use on the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. [This is
normally for large"projects or projects that involve the potential for dispersion of contaminants.]
11. Describe the performance goals and standards applicable to the project. // LL__
41,,4-re ot— de' Lw ,'Jr' A- `�t y Zr'e-// t"" 4Ar N�Ariv
12. Describe the flow control system.
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�.__..sti.nnwater site pan template—rev.10/1/2003 6
•
13. Describe the water quality system.
14. Describe the conveyance system analysis and design.
15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material.
16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
UniVf9rm Building Code.
17. Describe the proposed surfacing material.
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18. Describe methods for restoration of the site.
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19. An Operation and Maintenance Manual is required for each flow control and treatment facility. [This is normally required for
large'projects only and only those for which facilities are required to control flow or treat runoff.] If included,list the Manuals
here.
20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
21. List other necessary permits and approvals as required by other regulatory agencies. If those permits or approvals include
conditions that affect the drainage plan or contain more restrictive drainage-related requirements,describe those conditions or
restrictions here.
stormwater site plan template-rev.10/1/2003 7
•
CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN(SWPPP)
The Construction SWPPP addresses sediment and erosion control during construction. The BMPs indicated by the applicant in the
template that follows must be installed on the ground during all construction phases of the project. The proponent is responsible for
preventing sediment and erosion impacts to environmentally sensitive areas and off-site areas. Consult the Construction Stormwater
Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet for guidance, particularly with rural residential
development.
SECTION I—CONSTRUCTION SWPPP NARRATIVE
1. Construction Stormwater Pollution Plan Elements. Describe how each of the Construction SWPPP elements has been or
will be addressed. Identify the type and location of BMPs used to satisfy the required element. If an element is not applicable
to the proposal,justify in writing. Descriptions of the 12 Elements are found at section 2.5.2 of the Manual(beginning on page
2-15).
12 Required Elements—Construction SWPPP
1. Mark Clearing Limits. / j
•
2. Establish Construction Access. / per,/
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3. Control Flow Rates.
4. Install Sediment Controls.
�/� • >le // .5;/�- Ferree — A7p 7 to 06%1?fir v� As LW/
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5. Stabilize Soils.
Af_Se,ed
6. Protect Slopes.
7. Protect Drain Inlets.
stormwater site plan template—rev.10/1/2003 8
12 Required Elements—Construction SWPPP(continued) E
8. Stabilize Channels and Outlets.
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9. Control Pollutants.
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10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
11. Maintain Best Management Practices(BMPs).
12. Manage the Project. /
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2. Adjacent Areas.
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential
areas,roads).
,ice
b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
yards).
fin
3. Environmentally Sensitive Areas.
a. Description of environmentally sensitive areas that are on or adjacent to the site.
y
stormwater site plan template—rev.1(Y1/2003 9
b. Description of special requirements for working in or near environmentally sensitive areas.
4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site
soils(e.g.,erodibility,settleability,permeability,depth,texture,soil structure).
5. Construction Phasing.
a. Construction sequence
b. Construction phasing(if proposed)
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
I. Provide a proposed construction schedule.
II. Wet Season Construction Activities.
a. Proposed wet season construction activities.
b. Proposed wet season construction activities for environmentally sensitive areas.
7. Financial/Ownership Responsibilities.
a. Identify the property owner responsible for the initiation of bonds and/or other financial securities.
b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation
impacts.
8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable.
a. Sediment Ponds/Traps.
b. Diversions.
c. Waterways.
d. Runoff/Stormwater Detention Calculations
stormwater site plan template—rev.10/12003 10
Stormwater Site Plan Changes
If the designer wishes to make changes or revisions to the originally approved Stormwater Site Plan, the proposed revisions shall be
submitted to DCD prior to construction. The submittal shall include substitute pages that include all proposed changes, revised
drawings showing any structural changes,and any other supporting information that explains and supports the reason for the change.
Final Corrected Plan Submittal
If the project included construction of conveyance systems,treatment facilities,flow control facilities, or structural source control BMPs
(not standard on-site stormwater management BMPs), the applicant shall submit a final corrected plan ("as-builts")when the project is
completed. These should be engineering drawings (stamped by a licensed civil engineer) that accurately represent the project as
constructed.
APPLICANT SIGNATURE
By signing the Construction SWPPP 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.
4;:: S6J /z AY
(LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DAT
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
DFC - 2 2004
12 stormwater site plan template—rev.10r1/2003
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