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HomeMy WebLinkAboutBLD2005-00107 IUILDING PERMITMLA05-00113 APPLICATT�N Review T . Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00107 Received Date: 2/24/2005 SITE ADDRESS: 500 SAND RD PORT TOWNSEND, 98368 OWNER: JUDITH C FRENCH-SCOTT PHONE: 385-3510 500 SAND ROAD PORT TOWNSEND WA 98368 SUBDIVISION: Block: Lot: T26+ PARCEL NUMBER: 001184026 Section: 18 Township: 30 N Range: 01 W CONTRACTOR: JERRY LINDSEY EXCAVATING PHONE: 360-385-1076 1865 W UNCAS RD PORT TOWNSEND WA 98368 Contractor's License JERRYL962QR Expires 11/19/2006 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI` DEMO OF RESIDENCE DESTROYED BY FIRE TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP DEM VALUATION MAIN: CODE EDITION: 2003 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: PWELL PARCEL TAGS: YES NO BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA Exist: 2 Exist: 1 Wetland Erosion Prop: Prop: Seismic Streams Total: 2 Total: 1 Flood Way Floodplain Routing Date: F&W Landslide a 7/05 t D�-� Shoreline Aquifer Forest: Commercial Rural Type Amount Paid By: Date: Receipt: Approved/Date Permit $49.00 BAC 02/24/05 71523 State Building Code $4.50 BAC 02/24/05 71523 APPROVED Total: $53.50 MAR 3 1 2005 c Jefferson County Planning p{ e. Idi artr$pt, • BUILDING PERMIT • Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD05-00107 Received Date 02/24/2005 SITE ADDRESS: 500 SAND RD Issue Date 03/31/2005 PORT TOWNSEND, 98368 APPLICANT: JUDITH C FRENCH-SCOTT PHONE: 385-3510 500 SAND ROAD PORT TOWNSEND WA 98368 SUBDIVISION: Block: Lot: T26+ PARCEL NUMBER: 001184026 Section: 18 Township: 30 N Range: 01 W CONTRACTOR: JERRY LINDSEY EXCAVATING PHONE: 360-385-1076 1865 W UNCAS RD PORT TOWNSEND WA 98368 Contractor's License: JERRYL962QR Expires: 11/19/2006 PROJECT DESCRIPTION: DEMO OF RESIDENCE DESTROYED BY FIRE CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. SETBACKS: UFFER: Footing: Foundation: Stormwater FINAL Approval: Underground Plumbing: Underground Insulation: Shear Wall : Sheathing: Framing: Plumbing: Propane Tank/ Lines: Insulation: Sheetrock: Septic Sytem Final Approval (If not on sewer): Road Approach Final Approval: Zoning Final Approval: /J Final/Occupancy Approval: li g//QI 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 BLD05-00107 • 1.) PROTECT SEPTIC DRAINFIELD (INCLUDING RESERVE) AND TANK FROM ANY COMPACTION OR HEAVY EQUIPMENT TRAFFIC. 2.) All land disturbing activity shall take place within the immediate area of the burned residence. No land disturbing activity, clearing or grading shall take place any further north or east than the existing structures shown on the approved site plan dated March 29, 2005. All land disturbing activity, clearing and grading outside the immediate area of the burned residence may require a stormwater management permit from the Jefferson County, Dept. of Community Development. 3.) 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. 4.) 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. 5.) Setback from Sand 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. 6.) The building height is not to exceed 35 feet. 7.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. • I:\F_BLD_Permit_Buildng.rpt 10/29/19 JEFFERSON COUNTY BUILDING DEPARTMENT \- � 379-4450 0°S` RAPID EVALUATION SAFETY ASSESSMENT FORM BUILDING DESCRIPTION OVERALL RATING: (Check One) Owner's Name: Juan tH Fi4ENCH SCOTT Mailing Addr : P.O. 80X 3.2. 3 INSPECTED (Green) ❑ Phone _ Exterior only Site Addr p ii Q _ 72o44D _ Exterior & Interior Pirr rip I /Jb U14- Qd33d8 No. of Stories : LIMITED ENTRY (Yellow) ❑ Basement: Yes 0 No Unk ❑ UNSAFE (Red) A Section /5 Township 3h- Range j K" Parcel No. :OD//S go .26 INSPECTOR: Inspector ID ,,.)vrl, _,01 J a Primary Occupancy: Dwelling >f Affiliation j6 cso l Go gi.oL b P r Other Residential ❑ Commercial ❑ Office ❑ Industrial ❑ Public Assembly 0 School ❑ INSPECTION DATE;/))03/05' Government ❑ Emer. Serv. ❑ Historic ❑ Mo/day/year 021o, Other Time Z,'S-O amZ-n) Instructions: Review structure for the conditions listed below. A "yes" answer to 1, 2, 3 or 5 is grounds for posting entire structure UNSAFE. If more review is needed, post LIMITED ENTRY. A "yes" answer to 4 requires posting AREA UNSAFE and/or barricading around the hazard. Hazards such as a toxic spill or an asbestos release are covered by 6 and are to be posted and/or barricaded to indicate AREA UNSAFE. More Review Condition Yes No Needed 1 . Collapse, partial collapse, or buiding off foundation 'A ❑ Cl 2. Building or story noticably leaning ❑ n ❑ 3. Severe racking of walls, obvious severe damage & distress ❑ ❑ 4. Chimney, parapet or other falling hazard ❑ ❑ 5. Severe ground or slope movement resent ❑ 1 ❑ 6. Other hazard present bof EcooL i 1%0.141�l�v o�T Pam P, ❑ ❑ Recommendations: No further action required ❑ Detailed Evaluation required (circle one) Structural Geotechnical Other ❑ Barricades needed in the following areas: ❑ Other: Posted at this Assessment: Yes ❑ No Comments: TO T4 L LOSS H:\home\pincntr\forms\safety.frm 07/04/2002 07:52 -360-3 5-3510 BRASS 1 - PAGE 02 - A . pB1 83 os.zsi2oos ao:1S F pc fpv17� ' O M i .i.yvr t '�-cL, APPROVED— • GONDtT10NAllY AP 0 r"" • 7: joii.• , FOR COMPLIANCE W TH " `-`,,.' .1,--le OPCA I. Jr'AD .i,,� I e" "'"RIII! ••- �""; ; on of Demolition Permit 05gem001c,5 ,;�...:_w.:,.„ i , ,'a4: of trey structure ottkas sett sic.--� , . ,-. . n '• eatrsIe er e{l�nw the d.atolttion(or oar reaovstius) containing ttta/arwlls have been removed Sheaves to**demobbed Work approval from OR CAA. e."an asbestos project of demolition unlessthe o or�tO toss obtained w$tts>w a depmttdon doll ludo s candle:Woo that there it no known eeb.etnr-coatatateg mortal remaining in the area of the structure. Prgject Sitc,A V° Alt ' M Crory 'F.r Qb1 City:170Ki OW1✓Si.t�1Dss State:,,. �aHIAkS Zip: "t�3GK S n$Date: I Completion Date: *ahem is t 10 wo4bg8 day edvavcs intif.. oo period from receipt of permit application) (3 D) 385--35ID �tYo"� SU0 I� -R aor Telepttte: c-) 37►'154. Faa('760) 311-)6-16 Ma!ing Addresa: ► '1 ,. 5 ili rai as 10 mze i rticor,P... 5 City: g iD6 f a,gf`)L..--_ -- State: CA gyp:5 5 '7 ' y Lr`o tt 1 etc,wt rm) �L 9� Demolition Ca or ----• "--- - --" tare License": ,-Xle.e,Y� Q&- Mailing Add1'e S: _-- - _ ..a - _ a CA City._ P-0RT - -- sl�� ,zi>�: ' [ ' Contact Person:,_,It R 1Ry L,&P y Telepit.' yr:6_36-3%05'-Sot-•l07 fr03i2 .Fact: YES SQ )e--_ Demolition by ' :, • cc Dismantling.? ($250O fee)check# Z&Q 3 Training]File I -,,cation? (If yes,attach fire department request for training fire) "4_ Renc+wsttSran,AU g nation.Remodeling,Maintt��,or other Ceml ctrnn? Asbestos. , or s+�pnrtede�srNsa�a ISJQ �ICR *An ORCAA of Intent w Iteniove • En.apa�le rye 6e tree prior iihesws wawa! writ. sawing projects -• ,vial demotinno muss b4 prefcenost by a Canniest Asbestos CAutractor and all friable or potentially friable beets must be r[eltwed"taftevt ivy dimiaiitfam beg*, Refer to °RCAA Regulation 1 Article 14 ko additional requirement'ram May apply. Asbs+ates SnrveyCompteted by = A 1 D A.CPERA GirOfied Inspector Z'444, Certification# /0// 71 , Gc.; 47L77 a d . ©D.�,L �'� This crow pt anitwarI Enclose 31215 Certification of t3raAaAetttoe Survey meat ba,�>,rtrlablp evadable*the jab sett Processingp ee accompany die form 294613 I-mat ei Lent Nw,olytepa,Weinuegine 91602 t 1044 * 800•422•.56Z3 * fax360.491-fi3OR Rao tlf11102 pitgm Www_orore evg • e ond4 - — i FMAR - 32005 , I ��g„goN cbo. JEFFERSONNUNTY �� __ ,� DEPARTMENT OF COMMUNITY DEVELOPMENT `- `4 621 Sheridan Street • Port Townsend •Washington 98368 FEBZ �} L005 360/379-4450 • 360/379-4451 Fax ��QS, ,oO� www.cojefferson.wa.us/commdevelopment - 87NG Master Permit Application MLA: 05 - 113 Project Description(include separate sheets as necessary): �2C1,/ 77oA) c R.gstiocrUci 7R D9 p By F/i2_., Tax Parcel Property Number: 00/ I gq 0 Z(p Size: /O kf.S (acres/square feet) Site Address and/or Directions to Property: Coo ' 6 AJ 7�?o D Property Owner(s)of Record: J'UD 1-i-H FRc►x.rj- O.7- '- Telephone: 76Q$37/-361 "�- Fax: #�o email:Mailing Address: 3x 32-3 ) R-521"To ce p t 41g r-Yg3Ge olJ .cc«_ Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What 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]** Ll 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 ❑ Long Plat** ❑Address 0 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 0 Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment I]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 uired later inspections.Access and right of entry to this property shall be requested and shall occur only during regular business hours. Signature: a ,,(.{(.�?..cks /ii_- �Ll 3(6."[ 1 Date: 2- -``>/- C<— 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-trans ble responsibility for adhering to an plying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature:CA 1,4 lA-,1 _ <c Date: _ - Z - (7)Z / G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc 0 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: i-ke, L.r/0D.5 -Y/K(v ji7)A1c (";('o )" 55- Io'7(0 ( ) MAILING ADDRESS: l // L`It Ufvc 15 Pr UJ. E • CONTRACTOR'S LICENSE WA1NS NUMBER: -Xi itia y L It,Z k' NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL 1 Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New Ilif, Wood Existing: I ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: I Height: X,Individual System ❑ Repair ❑ Masonry SEP Permit# i& Demolition ❑ Other: Bedrooms: Water Supply: Existing: 2- Setback: X Private well ❑ Two Party Type of Heat: Proposed: ❑ Public ooD Si'ov� � £L£C"i'(ZI L Total: Z Name of System: c t30AIeU 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: U Underground Tank ❑ Above ground Tank Size of Propane Tank: ❑ Heat Stove ❑ Cook Stove ❑ Woodstove El Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove ❑ Other Is this appliance being installed in a Manufactured/Mobile Home? Yes I 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: 4q, (�l� 2""Floor Base fee: 49 ` CO 3t0 Floor Additional Section: Mezzanine: Plan Check fee: Heated Basement State Surcharge fee: 4 cj0 Unheated Basement Pot Water Review fee: Other Unheated 1 — 9i",URdApproach fee: Garage/Carport I f_ .. 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