HomeMy WebLinkAboutBLD2005-00042 IILDING PERMIT APPLICATC MLA05-00036
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD05-00042 Received Date: 1/21/2005
SITE ADDRESS: 705 LINDSEY HILL RD
QUILCENE, 98376
OWNER: GEORGE L MILLER PHONE: 360-765-3190
RETA W MILLER
PO BOX 448
QUILCENE WA 983760448
SUBDIVISION: QUILCENE BAY VISTA Block: Lot: 8+
PARCEL NUMBER: 701205008 Section: 20 Township: 27 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION NEW CONSTRUCTION OF PARTIAL SECOND STORY
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION 22,274.00 ADD'L: 342 HEAT TYPE:
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY:
OCCUPANCY: UNHEATED: # OF STORIES:
OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM: 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
0A O ( j Shoreline Aquifer
Forest: Commercial Rural
r
Type Amount Paid By: Date: Receipt: AFsi5AOVED
d/ te
Permit $363.25 BAC 01/21/05 69126
Plan Check $236.12 BAC 01/21/05 69126
State Building Code $4.50 BAC 01/21/05 69126 FEB 2 4 2005
Total: $603.87 Jefferson County Panning
& Building Department
•
BUILDING PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD05-00042 Received Date 01/21/2005
SITE ADDRESS: 705 LINDSEY HILL RD Issue Date 02/24/2005
QUILCENE, 98376
APPLICANT: GEORGE L MILLER PHONE: 360-765-3190
RETA W MILLER
PO BOX 448
QUILCENE WA 98376-0448
SUBDIVISION: QUILCENE BAY VISTA Block: Lot: 8+
PARCEL NUMBER: 701205008 Section: 20 Township: 27 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
PROJECT DESCRIPTION: NEW CONSTRUCTION OF PARTIAL SECOND STORY
CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT.
SETBACKS:
UFFER:
Footing: Zr,..r ' / - '/V0;%
Foundation:
Stormwater FINAL Approval:
Underground Plumbing:
Underground Insulation:
Shear Wall :
Framing: y Ai
:
Plumbing:
Propane Tank( Line
Insulation:LA-C C6 OpC
Sheetrock:
Septic Sytem Final Approval (If not on sewer):
Road Approach Final Approval:
Zoning Final Approval:
Final/Occupancy Approval: [_ -Zi-pS
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 CAI A BLD05-00042
1.) A vegetative buffer of 30-feet shall be permanently maintained from the top or edge of the
Landslide Hazard Area. All buffers shall be measured perpendicularly from the top of the
Landslide Hazard Area.
2.) Landslide Hazard Areas and their associated buffers shall remain naturally vegetated.
Should buffer disturbance occur during construction, the Unified Development Code
(UDC)Administrator shall require replanting with native vegetation. No alterations shall be
made to the Landslide Hazard Area or its associated buffer without prior authorization by
the UDC Administrator.
3.) Prior to and during approved construction activities, the perimeter of the landslide hazard
area buffer shall be marked with a temporary sign. The sign shall be placed in such a
manner that it can be directly observed from the construction area. The sign shall contain
the following statement: "Landslide Hazard Area and Buffer- Do not Remove or Alter
Existing Vegetation."
4.) All construction activities shall not encroach upon the buffer. This includes the storage or
preparation of materials.
5.) The applicant shall permanently separate the boundary of the Landslide Hazard Area
Buffer from the remainder of the subject property through installing logs, trees, a hedge
row, or any other prominent physical marking approved by the UDC Administrator.
6.) The identified Fish and Wildlife Habitat Area (Type 5 Stream), shall maintain a vegetative
buffer setback of 50 feet. The setback shall be measured horizontally from the Ordinary
High Water Mark (OHWM) to the proposed addition.
7.) An additional setback of five (5) feet is required from the edge of the buffer area to the
proposed addition.
8.) A permanent physical separation along the boundary of the buffer area shall be installed
and permanently maintained. Such separation can include installing logs, trees, a
hedgerow, or any other prominent physical marking approved by the UDC Administrator.
9.) Buffer perimeters shall be marked with temporary signs at an interval of one per parcel or
every one hundred (100) feet, whichever is less. Signs shall be in place prior to and
during construction activities. The signs shall contain the following statement: "Buffer- Do
Not Remove or Alter Existing Vegetation."
10.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
11.) 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).
12.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
13.) The building height is not to exceed 35 feet.
14.) Setback from the ingress/egress easement right-of-way is no less than 20 ft., Setback
from the Lindsey Hill Rd. 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.
15.) 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.
16.) 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.
17.) A minimum of two (2) on-site parking spaces is required for the single-family residence.
411
18.) The project shall adhere to thelest 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.
19.) The project shall comply with Construction Stormwater Pollution Prevention (SWPP)
Elements#1 through #12 of the Department of Ecology's Stormwater Management
Manual for Western Washington 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.
I:\F_BLD_Permit_Buildng.rpt 10/29/19
��gSON cod JEFFERSON 411UNTYIII
,a DEPARTMENT OF COMMUNIfW•� EL PsME '"7.----"-----------
;
'
i ff�621 Sheridan Street • Port To1 se�d-- ahngtdn 9836R `�I
360/379-4450 • 360/379-445 'Fax
www.cojefferson.wa.us/commdev Ioprf2 `y� O 1 ,Master Permit Application
ML 05 -3t'r
Project Description(include separate sheets as necessary):
ci,i•-.> i—. 1ti4 C.1- ?Ai,t el /tL• 2"-=" Si l'p,'y i) U1.> r rIc`A.!• }
Tax Parcel Property
Number: l U j` 1 cS S
cs-- c G Size: A, / 7 (acres/square feet)
•
Site Address and/or Directions to Property: '7 0.S L_ /A I J S'i '= /'I i%.1- i C!/{-U
Property Owner(s)of Record: 6 VC R(f / $ Kt; TA %9 i t-I-(`-?-
Telephone: -34,0 76)S 3/f 0 Fax: , -
Mailing Address: F- 0, 0ex `f-18 C; a 1 LLe AlE, tt. i-} emailI.:i2 1"/} Ail�i a /C�,0t.y;tit �15.^ 'e l
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies)
dBuilding ❑Variance(Minor,Major or Reasonable Economic Use)
❑ Demolition Permit ❑ Conditional Use[C(a),C(d),or Cj**
[ ingle 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**
❑ Change of Use ❑ 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 ❑ Shoreline Management Substantial Development**
❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance
❑Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment
El 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 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,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. 1- 1) �'j1tSignature: c !C "C
Date: /� IAA Z.ricS'
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-transf le respons ility4-forpdhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: ,yrL., k L�
;' Date: /L.' TWA/ Z-C C'.S:
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
40 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.
;44
Signature:''-'- '�L t4'C )14,t,�;.-t�- Date: j0% •�itN -__ C_'
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:
24, New Wood Existing: - �„ ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank ❑ Community System \('
El Alteration/Remodel ❑ Concrete Total: Height: El Individual System \'' -`
CIRepair ❑ Masonry SEP Permit# 'il' �--2'
El Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type of Heat: Proposed: CI Public
Total: Name of 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: _
[1 Heat Stove ❑ Cook Stove ❑ Woodstove ❑ Fireplace Insert ❑ Hot Water Tank ❑ 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:
:8o
2""Floor Ill j /- )3��13 54Base fee: 363. 25
3rd Floor Additional Section:
Mezzanine: Plan Check fee:
:,3Ca. 12.
Heated Basement I State Sur a e ,: 'i --I i
Unheated Basement I tterl'WaRe: -: -�f
I t . t I 1 '1
Other Unheated !d 911VRd,Mi+t fee�5 1
Garage/Carport TOTAL. .:$ ,' t 7 6,2 g1
Decks .';
Receipt Number, 10 4) J
Other _ Cash/Check Number: �7
ESTIMATED COST(REQUIRED) ;4 2. 21 3 5'4 j
.Fair market value of all labor and materials founda to finish 1 I 1 135
� (r)()() (Y() Initials: )
G:\Pecrnit-Center\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc