HomeMy WebLinkAboutBLD2005-00151 tILDING PERMIT APPLICATIN B RDOe 00w p1e51
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD05-00151 Received Date: 3/15/2005
SITE ADDRESS: 4250 S DISCOVERY RD
PORT TOWNSEND, 98368
OWNER: KARL JON JACOBSEN PHONE: 360-385-2758
SANDRA J JACOBSEN
4250 S DISCOVERY RD
PORT TOWNSEND WA 98368-9676
SUBDIVISION: Block: Lot: B
PARCEL NUMBER: 001322036 Section: 32 Township: 30 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOD DECK REPAIR - NO MLA RQRD, NO CHG IN FOOTPRINT
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP REP MAIN:
VALUATION 6,000.00 ADD'L: HEAT TYPE:
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: # OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS: APPROVED
Exist: Exist: APPROVED
Prop: Prop: APR - 4 2005
Total: Total:
Routing Date: Jefferson County Planning
i 'k & Building Department
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $125.25 BAC 03/15/05 71716 /` P P R O\E r
Plan Check $81.42 BAC 03/15/05 71716 /"�
State Building Code $4.50 BAC 03/15/05 71716 APR - 4 20
Total: $211.17
Jefferson County Planning
�& Building flepartna�r,:
BUILDING PERMIT•
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD05-00151 Received Date 03/15/2005
SITE ADDRESS: 4250 S DISCOVERY RD Issue Date 04/4/2005
PORT TOWNSEND, 98368
APPLICANT: KARL JON JACOBSEN PHONE: 360-385-2758
SANDRA J JACOBSEN
4250 S DISCOVERY RD
PORT TOWNSEND WA 98368-9676
SUBDIVISION: Block: Lot: T93+
PARCEL NUMBER: 001322036 Section: 32 Township: 30 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
PROJECT DESCRIPTION: DECK REPAIR - NO MLA RQRD, NO CHG IN FOOTPRINT
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: .)
Final/Occupancy Approval:kr /(Y 0--C?(c
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
•
I:\F_BLD_Permit_Buildng.rpt 10/29/19
• 0
Impervious surface is a hard surface that either prevents or retards the entry of water into the soil mantle as under natural conditions
prior to development. A hard surface area which causes water to run off the surface in greater quantities or at an increased rate of flow
from the flow present under natural conditions prior to development. Common impervious surfaces include, but are not limited to roof
tops, walkways, patios, driveways, parking lots or storage areas, concrete or asphalt paving, gravel roads, packed earthen materials,
and oiled, macadam or other surfaces which similarly impede the natural infiltration of stormwater.
4 irke, e i ., STORMWATER CALULATIONS-IMPERVIOUS SURFACE
NEW \.)O i.) t.u.r f;re.,1n , QNc5 t'1 tifl EXISTING
I
Structures(all roof area) sq/ft Structures(all roof area) _ 2,457.00 sq/ft
Sidewalks sq/ft Sidewalks � t�I D , sq/ft
Patios sq/ft Patios Gz 4• O sq/ft
Solid Decks sq/ft Solid Decks —$' sq/ft
(without infiltration below) (without infiltration below)
Driveway sq/ft Driveway 9 8(p sq/ft
Other sq/ft Other -®- sq/ft
Total New sq/ft Total Existing 4 ]87.D sq/ft
TOTAL NEW+TOTAL EXISTING* 418). 0_ sq/ft 'This amount will be used to check total lot coverage.
The following questions will help determine whether the proposed project is considered development or redevelopment.
DEVELOPMENT v.REDEVELOPMENT
Divide the total existing impervious surface above by the size of the parcel and convert to a percentage: 26•5_52.
Does the site have 35%or more of existing impervious surface? Circle: Yes No
FURTHER INSTRUCTIONS: If the answer is yes, the proposal is considered redevelopment and the attached Figure 2 should be
used to determine the applicable Minimum Requirements. If the answer is no, the proposal is considered new development and the
, attached Figure 1 should be used. At this juncture, the applicant should refer to the applicable Flow Chart to determine the Minimum
Requirements for stormwater management. DCD staff will help verify the classification of the project and the application requirements.
For proponents of "small" projects who must comply only with Minimum Requirement #2—Construction Stormwater Pollution
Prevention—an additional submittal is not required. The proponent is responsible for employing the 12 Elements to control erosion and
prevent sediment and other pollutants from leaving the site during the construction phase of the project. Pick up the Construction
Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet. Proponents of "medium"projects—those
that must meet only Minimum Requirements #1 through #5—and for "large" projects—those that must meet all 10 Minimum
Requirements—are required to submit a Stormwater Site Plan. DCD has prepared a submittal template of a Stormwater Site Plan,
principally for rural residential projects. Complete the template in the Stormwater Site Plan Instructions and Submittal Template or
prepare a Stormwater Site Plan using the step-by-step guidance in the Stormwater Management Manual.
APPLICANT SIGNATURE
By signing the Stormwater Calculation Worksheet, I a8 the applicant/owner attest that tithe 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. MAR 1 5 2005
>t,,t,t\ .. t&scwL„,,, 'D — 1 e - v5
(LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) i (DATE)
t .-_,.J
stormwater calc worksheet—REV.10/1/2003 2
/ ON 0�. JEFFERSOJ RUNTY _
rftlf:; DEPARTMENT OF COMMUNITY DEVELOP�1ENTJ?� ;; f-: fl V E „1~
... ..,
621 Sheridan Street • Port Townsend •Washin I
. . 360/379-4450 . 360/379-4451 Fax I 11
qS, ,SO www.co.jefferson.wa.us/commdevelopmerlt , I 15 l._
hilN� -
Master Permit Application - MtA.
Project Description(include separate sheets as necessary): - _ _ .. __- .._
Re ,?w►ra, Q.X. 3ti(.49 d4�k
Tax Parcel Property
Number: 00 i 3 La 0 3 Co Size:
O 3foZA1'S,1&�8r.�72 s}{ (acres/square feet)
Site Address and/or Directions to Property: 4z50 Seu�1 Ds SCove.{ty R.cy,i a.* I;w,S.Q,uat WA, 5636,8
Property Owner(s)of Record: k fvfa A $qNd Q,p J R,c-o10 S Q,.,
Telephone: 3G0-385 -Z 75S Fax: "VA email: KAL1` (.C}b193P • Caw1
Mailing Address:4Z58 S.$41A CA D'iseov y R.4. ?...1` T a a5 sti.�, WA, 9 , �J S 3c
Applicant/Agent(if different from owner): 5 A vAll 45 O.e.t.t,
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies)
building LI Variance(Minor,Major or Reasonable Economic Use)
❑ Demolition Permit ❑ Conditional Use[C(a),C(d), or C]**
❑ Single Family ❑ Discretionary"D"or Unnamed Use Classification
❑ Garage Attached/Detached ❑ Special Use(Essential Public Facilities)**
CI Manufactured Home ❑ Boundary Line Adjustment
❑ Modular ❑ Short Plat**
❑Commercial* ❑ Binding Site Plan**
❑ Change of Use ❑ Long Plat**
❑Address t I 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:
N/pt
OF AGENT
I hereby designate N( pt 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 attorney'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.Signature: �\4K\ ,pt,0 S Q/h � �- ‘ � — !%
Date:
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-tra_rtsferat?le repo sibility or adhering to and complying with the ESA. The Applicant has read this disdaimer and signs and dates it below.
Signature:*p'& J J Date: _ —. I &
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
• 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 a u ng res sibility of the General Contractor for the proposed project.
Signature: (,
. ' \ t-) — it r')
tb QM Date:
a�,
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:
O New a Wood Existing: /f Li Sewer
❑ Addition ❑ Steel Proposed: Bank ❑ community System
❑ Alteration/Remodel ❑ Concrete Total: Height: [H'Individual S Stem
' Repair ❑ Masonry SEP Permit# : `
❑ Demolition ❑ Other: Bedrooms: Is/R Water Supply:
Existing: Setback: [i Private well 11 Two Party
Type of Heat: Proposed: tB'Public
Total: Name of System:
If this is a Commercial Project you must answer the following: VA
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:
i i Underground Tank t_i Above ground Tank Size of Propane Tank:
i i Heat Stove i i Cook Stove [i Woodstove LI Fireplace Insert Ll Hot Water Tank I:1 Pellet Stove I i 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.
/t-Square Fobt'age For Office Use Only
Current Proposed Amount
Main Floor Consistency Review:
"Itt:tfr- . '2
2Nu Floor Base fee:
3rd Floor Additional Section:
•
Mezzanine: -L.),"
' Plant Check fee: 1 L I
�
Heated Basement I r1 , State Surcharge fee: -
ifIR Y 55 �� L
Unheated Basement `` Pot Water Review fee:
Other Unheated 911/Rd Approach fee: . ,
Garage/Carport TOTAL: $ ( .
Decks Receipt Number: r') I I CO
Other Cash/Check Number: 0 it -4
ESTIMATED COST(REQUIRED) Date:•Fair market value of all labor and materials foundation to finish Itc7•31I,(1`j
6,o 0 0. o� Initials: (�` ; 2
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
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