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Home My WebLink AboutBLD2005-00061 IIIIA ILDING PERMIT APPLICATIr'�1 05-00057 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00061 Received Date: 1/31/2005 SITE ADDRESS: 294 FAIRBREEZE DR PORT TOWNSEND, 98368 OWNER: RICHARD C VAN GALDER PHONE: 360-385-0667 NANCY L VAN GALDER 294 FAIRBREEZE DR PORT TOWNSEND WA 983689583 SUBDIVISION: KALA POINT#6 Block: Lot: 299 PARCEL NUMBER: 965000202 Section: 27 Township: 30 N Range: 01 W CONTRACTOR: O'REILLY FINE HOMES PHONE: 360-301-3103 PO BOX 1383 PORT TOWNSEND WA 98368 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP ADDITION TO EXISTING BEDROOM & A/G 120 GALLON PROPANE TANK TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP ADD MAIN: 234 VALUATION 15,000.00 ADD'L: HEAT TYPE: PRO CODE EDITION: 2003 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: 400 SHORELINE: CONST TYPE: DECK: 238 SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: PARCEL TAGS: YES NO BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA Exist: 2 Exist: 3 Wetland Erosion Prop: Prop: Seismic Streams Total: 2 Total: 3 Flood Way Floodplain Routing Date: cqcyor...) F&W Landslide Shoreline Aquifer Forest: Commercial Rural Type Amount Paid By: Date: Receipt: Approved/Date`/c Permit $265.25 BAC 01/31/05 71319 A,PPRO V ED Plan Check $172.41 BAC 01/31/05 71319 State Building Code $4.50 BAC 01/31/05 71319 APR - 1 2005 Total: $442.16 Jefferson County Planning &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 #: BLD05-00061 Received Date 01/31/2005 SITE ADDRESS: 294 FAIRBREEZE DR Issue Date 04/1/2005 PORT TOWNSEND, 98368 APPLICANT: RICHARD C VAN GALDER PHONE: 360-385-0667 NANCY L VAN GALDER 294 FAIRBREEZE DR PORT TOWNSEND WA 983689583 SUBDIVISION: KALA POINT#6 Block: Lot: 299 PARCEL NUMBER: 965000202 Section: 27 Township: 30 N Range: 01 W CONTRACTOR: VAN VAN BEUZEKOM PHONE: 161 CENTER ROAD CHIMACUM WA 98325 Contractor's License: VANBEBC964QS Expires: 11/10/2006 PROJECT DESCRIPTION: ADDITION TO EXISTING BEDROOM & A/G 120 GALLON PROPANE TANK CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. SETBACKS: UFFER: Footing: yam, (o [o-cP Foundation i,&' .6 O ' Stormwater FINAL Approval: Underground Plumbing: Underground Insulation: Shear Wall : >lL P 5" Sheathing: Framing: Plumbing: Propane Tank/ Lines: 49, c.ir�rr j /` D Insulation: fq, Y 4 At , ?•`jC'c ' . °!: Sheetrock: Septic Sytem Final Approval (If not on sewer): Road Approach Final Approval: Zoning Final Approval: Final/Occupancy Approval: lit t 1`"l�S-n‹.(rrr7 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 CASE t BLD05-00061• 1.) Critical Aquifer Recharge Areas may require special protection measures to mitigate water quality degradation. The submitted proposal does not require additional aquifer protection measures. However, during construction the project shall follow the Best Management Practices (BMPs) and facility design standards as identified and defined in the Stormwater Management Manual for the Puget.Sound Basin. 2.) 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. 3.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 4.) 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). 5.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 6.) The building height is not to exceed 35 feet. 7.) Minimum setback from Fairbreeze Dr right-of-way is 20 ft. Minimum setback from Pinecrest Dr right-of-way is 20 ft. Minimum side and rear setbacks are 5 ft. 8.) A minimum of two (2) on-site parking spaces are required for the single family residence. 9.) 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_B LD_Perm it_Bu ildng.rpt 10/29/1999 IIIOWNER 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: AX! 1 L G t2E(LL''r' 1 t r-(.Fa 40 tit gS (3(to ) ( ) MAILING ADDRESS: P O l3.50 EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: 0 r2-01 L—F I-F q$ 3 t¢ U NUMBER ARCHITECT/ENGINEER: Ut.. 1/tQ IL Y�uetc_ > tc��G,2voP/Csolltt- PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: O New X Wood Existing: 5 ❑ Sewer 'Addition ❑ Steel Proposed: -O Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: z Height: ❑ Individual System ❑ Repair IIMasonry t./..4 SEP Permit# '„ti- .3/ t ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: ;4- Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: _ i? ❑ Public 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: ❑ Underground Tank `,Above ground Tank Size of Propane Tank: /ZO 54//Oj Heat Stove ❑ Cook Stove 0 Woodstove ❑ Fireplace Insert ❑ Hot W. er Tank ❑ Pellet Stove ❑ Other s this appliance being installed in a Manufactured/Mobile Home? Yes / U16 IL 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`Offi : -'-Ohl L _ Current Proposed Y Amotr R z � `�� `, TANG Main Floor J?Co sistency •Review: r. z' " 2'' Floor :ase fee: R ac 3n0 Floor Additional Saction: ''.' Mezzanine: Plan Check fee: Heated Basement State Surcharge fee: `; Unheated Basement Pot Water Review fee: r Other Unheated 911/Rd 'r,,'P 5�w , '° Approach fee: 4 '�r Garage/Carport �;`, TOTAL: �' } ` x Decks w.$ 3 ' d Receipt Number . ;41--;,•::.4,-- :'l 3 ', Other Cash/Check Number: 1 - x;N , r a3: ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish= /3/ �� /:� a � ` Initials: t G:\PemritCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc • �¢goly cow JEFFERSON*UNTY 0� �' DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax Is, www.co.jefferson.wa.us/commdevelopment JAN 3 1 2005 Master Permit Application MLA: No - jd "Project Description(include separate sheets as necessary): ...:. -- //pDi I ioe- To /jhl r,k si/14 eLI)1?004i✓1 Tax Parcel r� Property Number: q(," j /C/ i 'c� . Size: /a ) (acres/square feet) Site Address and/or Directions to Property: -tj? ,1 ,4 l/= /.-' ,? /�Z-2 - ,7' Property Owner(s)of Record: - /(.,/c ;i Ai4di:C . v/11 Ad 7 K%(0=,r4 Telephone: :4- : ; z) is 6 / Fax: email: _ Mailing Address: ,2 L/ ;=.=1-//z r`s 2-1-E- z= 7)(= Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: at 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]** El 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** ❑ Change of Use El 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 ❑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 (� �� [�p to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE `- , 1 "�""- "-µ^'✓ Date: /` 3/ "05f 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 ifs 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. �. , //// Cl � 3 Signature: _PA-PA t 1, • (7a.v Date: / — i "0 5 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 respo sibiii for adherring_to and 9om II 'rig with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: /a/ t C • V,>v- .L i L& Date: i —3 / -a G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc