HomeMy WebLinkAboutBLD2005-00084 •
Jefferson Count BUILDING PERMIT •
621 Sherid n Street, Port Townsend,epartment of ity �evelo
WA 983Gp8 ent
UPAZILS: (360)379-4450 FAX (360)379-4451
BLD05-00084
334A COUNTRY MEADOW RD
CHIMACUM Received Date 02/11/2005
APPLICANT: 98325 Issue Date
MARY DEAN, KATHERINE DEAN 04/4/2005
WILL O'DONNELL
PO BOX 1499 PHONE:
PORT TOWNSEND WA 98368 360 301 1977
SUBDIVISION:
PARCEL NUMBER:
901263024
p 29 N
CONTRACTOR: Section: 26 Township: Block:
Range: 01 Lot: TX 27
STAPF CONSTRUCTION W
PO BOX 212
PORT HADLOCK WA 98339 PHONE:
(360)385-6540
Contractor's License: STA AFC*249J8 Expires:
4/25/2005
PROJECT DESCRIPTION: REMODEL/ADDTION TO EXISTING qpU
SETBACKS: REQUIRED INSPECTIONS THAT APPLY TO YOUR1,245 sq. ft.)
PROJECT.
IN FOR THE RE
UFFER:
Footing: _
Foundation:
Stormwater FINAL A
Underground Plumbing:
val: LZ
Os—
Underground Insulatio
Shear Wall : Lz
Sheathing:
Framing: 4/ G
Plumbin : G-2
Propane Tank/Lines:
Insulation:
Sheetrock:
Septic Sytem Final Approval (If not on sewer):
Road Approach Final Approval:
Zoning Final Approval:
Final/Occupancy Approval.
HEALTH DEPARTMENT -1� 0
ND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL
THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE
BUILDING INSPECTION HOT-LINE LID-4455. INSPECTION
CALL 24 HOURS IN PROPERLY RENEWED
Office Hours 9:00 a. ADVANCE TO SCHEDULE INSPECTIONS.
HOT LINE AVAILABLE 24 HOURS A DAY ECTIONS.
SPECIAL CONDITIONS APPLY -SEE REVERSE
16ILDING PERMIT APPLICATION MLA05-00087
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD05-00084 Received Date: 2/11/2005
SITE ADDRESS: 334A COUNTRY MEADOW RD
CHIMACUM, 98325
OWNER: MARY DEAN, KATHERINE DEAN PHONE:
WILL O'DONNELL
781 OLD TARBOO LAKE RD
QUILCENE WA 98376
SUBDIVISION: Block: Lot: TX 27
PARCEL NUMBER: 901263024 Section: 26 Township: 29 N Range: 01 W
CONTRACTOR: STAPF CONSTRUCTION PHONE: (360)385-6540
PO BOX 212
PORT HADLOCK WA 98339
Contractor's License STAPFC*249J8 Expires 4/25/2005
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI` REMODEL! ADDTION TO EXISTING ADU
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ALT MAIN: 300
VALUATION 30,000.00 ADD'L: HEAT TYPE: EEE
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: # OF STORIES:
OCCUPANCY: OTHER: 135
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM: PWELL PARCEL TAGS: YES NO
BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA
Exist: 1 Exist: 1 Wetland Erosion
Prop: Prop: Seismic Streams
Total: 1 Total: 1 Flood Way Floodplain
Routing Date: ------. F&W Landslide
I \,)V)3 (C4-t/. Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: ��f�p�ye�ate�
Permit $441.75 BAC 02/11/05 71392 fU�EUUll \\11//11
Plan Check $287.14 BAC 02/11/05 71392
State Building Code $4.50 BAC 02/11/05 71392 APR - k 2005
Total: $733.39 Jefferson County Planning
&Building Department
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*JEFFERSON COUNTY BUILDING PERMIT APPLICATION
BUILDINGUI TYPE IMPROVEMENT TYPE
L�J SINGLE FAMILY ❑ NEW BUILDING
❑ MOBILE Of/ ADDITION 500+/ 00-
❑ MODULAR 0 ALTERATION
❑ GARAGE ATTACHED/DETACHED 0 REPAIR
❑ WOODSTOVE ❑ DEMOLITION
❑ MULTI-FAMILY/UNITS 0 RELOCATION
❑ COMMERCIAL
❑ INDUSTRIAL
❑ HOTEL/MOTEL/DORM/UNITS
❑ OTHER UBC OCCUPANCY GROUP
DESCRIPTION OF IMPROVEMENT: An►ar Owe Z Afo4LA In-1hr s d Ap KI64fml,
Pri
SQUARE FOOTAGE PRINCIPLE TYPE OF HEATING FUEL
MAIN FLOOR 96 lie" ELECTRICITY 0 OIL
2ND FLOOR 0 WOODSTOVE 0 GAS
3RD FLOOR 0 HEAT PUMP 0 OTHER
HTD BASEMENT
UNHTD BASEMENT
CARPORT PRINCIPLE TYPE OF FRAME
GARAGE —/
DECKS II! WOOD 0 MASONRY
COMMERCIAL ❑ MANUFACTURED ❑ OTHER
INDUSTRIAL 0 STRUCTURAL STEEL
OTHER
TOTAL VALUATION OR ESTIMATED COST
��� O INSTALLED 19�0
TYPE OF SEWAGE DISPOSAL: 0 SEWER Q'SEPTIC SYSTEM
0 NOT INSTALLED
TYPE OF WATER SUPPLY: PRIVATE DRILLED WELL OTHER
PUBLIC 0 CITY OTHER: NAME
❑ PUD E(9K..tf` STATE I.D.iivi--k rim kr_t Uls41t
NUMBER OF EXISTING BEDROOMS ►i$ ( 3 NUMBER OF EXISTING BATHROOMS I
NUMBER OF PROPOSED BEDROOMS It 0 O NUMBER OF PROPOSED BATHROOMS 0 V
TOTAL NUMBER OF BEDROOMS I 1 47T,TO NUMBER OF BATHROOMS 1 I- / I x ,ram
IF WATERFRONT PROPERTY NAME OF ADJACENT BODY OF WATER
BANK HEIGHT SETBACK
c-----`
SIGNATURE ...8 '' DATE )3/43/9.474
APPLICANT NAME (PLEASE PRINT) el,.1 -4 G4.(fstrwr►
rJ 0 *s-t vvie R r ecy-e i h 7,l-f ti 4 bed R frames roc 4 a R rriwil .
SPECIAL CONDITIONS FOR CASE # BLD05-00084
1.) NO BUILDING FINAL APPROVAL UNTIL DESIGNATION OF RESERVE AND
LOCATION OF EXISTING DRAINFIELD COMPLETED BY A LICENSED SEPTIC
DESIGNER OR PROFESSIONAL ENGINEER.
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.) 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.
4.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
5.) 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).
6.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
7.) The building height is not to exceed 35 feet.
8.) Setback from private easement 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.
9.) A minimum of two (2) on-site parking spaces is required for the single-family residence.
I:\F_B LD_Perm it_Bu ildng.rpt 10/29/19
��ggON cow JEFFERSOhUNTY
4'4... 0.t .,". 410
,�.� DEPARTMENT OF COMMUNITY DEVELOPMENT
`'d 621 Sheridan Street• Port Townsend •Washington 98368~o,
360/379-4450 • 360/379-4451 F I
q`S$ING�0 www.co.jefferson.wa.us/corrlmdegelopment ---_.______
ii
I
Master Permit Application F' : FEB 1 1 i. c _
Project Description(include separate sheets as necessary):
/eE1)10.46-4/, ,,7 / ee/s274i0- ii.., I l.L,
Tax Parcel Property
Number: 9912 63 dZ y Size: 3 46gEs
(acres/square feet)
Site Address and/or Directions to Property: 27,2o etT-/T-12 RQA.D/.3.3y 4 (60, '9' / �/ J
Property Owner(s)of Record: NIA'V ! -i f 1 �g77lc mik- 4e- w/LL. O lOem7NgLL Pt Telephone:(i,O) 37 9 - 452 77 Fax: email:
Mailing Address: Pa. Lox /S199 Po,eT TDnJi,/S�f4 W/] _ 9Q368
Applicant/Agent(if different fro owner): STAFF Co,IS7RUC77�!/R/Chi' `/'F.J.
Telephone: 379-5355 p/- (�/8y Fax: ;3(, 3 s L~722 email: Sfa�f � aides P,(,,(,. ' 0?
Mailing Address: Z 74 7 //AST/4/6S 4i/ . A. T; /;t/4 9$3e.q P
What kind of Permit?(Check each box that applies)
Building ❑Variance(Minor,Major or Reasonable Economic Use)
❑ Demolition Permit 0 Conditional Use[C(a),C(d),or C]**
Single Family 0 Discretionary"D"or Unnamed Use Classification
❑Garage Attached/Detached 0 Special Use(Essential Public Facilities)**
❑Manufactured Home ❑ Boundary Line Adjustment
0 Modular 0 Short Plat**
❑Commercial* ❑ Binding Site Plan**
0 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)* 0 Shoreline Management Variance
0 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:
I herebydesignate STgPF DESIGNATION OF AGENT
g CONST CU c.no,f to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE ' 4-fA-cci ) -£��,w� Date: - / // /"3
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 resuit 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: / i'tiA . AQ—.-er------
_. Date: / I i 74 S
t.
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-transfera le responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: ,4:.,- 4 t Date: , /Q j
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
410 OWNER BUILDER STATEMENT411
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 responsibilityof the General Contractor for the proposed project.
Signature: /irk/ Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
.STAPF C9A1S7P/C77O,J (360 ) 379-53,55 ( )
MAILING ADDRESS: 2 7Z 7 HIAST1,f(a,S Avg. EMAIL: SfQtf5 czt6/CS?E'ed•w?om
CONTRACTORS LICENSE d� WAINS
NUMBER: STAPFC �r Zy9TD NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New (i Wood Existing: / ❑ Sewer
O Addition ❑ Steel Proposed: Bank ❑ Community System
X Alteration/Remodel ❑ Concrete Total: / Height: X Individual System
❑ Repair ❑ Masonry SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: / Setback: Private well ❑ Two Party
Type of Heat: Proposed: ❑ Public
ELE.C /::- 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:
❑ Heat Stove ❑ Cook Stove ❑ Woodstove ❑ Fireplace Insert ❑ 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 •ForOffice'UselDnly '` °.;,`
e
Current Proposed Amount
Main Floor Consistency Review:
888 3ot� w5 :�0
2ND Floor Base fee: t
3T0 Floor Additional Section:
Mezzanine: Plan Check fee: •
Heated Basement State Surcharge fee:
Unheated Basement Pot Water Review fee: fr ---
Other Unheated .AN> 911/Rd Approach fee:
Garage/Carport _ . $ i i' y
- ' ot j6\
Decks Receipt Number: i‘k:-- '''il a a
Other CasfClClt ' t it er �_' '
ESTIMATED COST(REQUIRED) �5 Date:
•Fair ri alue of allJakor and materials foundation to ash �`�
� / Initials. ^"
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
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