HomeMy WebLinkAboutBLD2005-00296 •
BUILDING PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD05-00296 Received Date 05/9/2005
SITE ADDRESS: 3903 DUCKABUSH RD Issue Date 06/16/2005
BRINNON, 98320
APPLICANT: VONDA N MC INTYRE PHONE: 206-633-3493
GLENN A HACKNEY
4121 INTERLAKE AVE N
SEATTLE WA 98103-8151
SUBDIVISION: Block: Lot: +
PARCEL NUMBER: 503014004 Section: 1 Township: 25 N Range: 03 W
CONTRACTOR: MITCHELL CONSTRUCTION PHONE: (360)796-2060
4246 DUCKABUSH RD
BRINNON WA 98320
360-796-4379
Contractor's License: MITCHC*1010E Expires: 4/9/2007
PROJECT DESCRIPTION: HEATED BATHHOUSE W/PLUMBING - 120sq ft
CALL IN FOR THE EQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT.
SETBACKS: /
UFFER: , 7/j p
Footing: 1?/'7OS' �r, z._3/Z�
Foundation:2,T/
Stormwater FINAL Approval:
Underground Plumbing:
Underground Insulation:
Shear Wall : OV , 4 rtPrb
Sheathing: dg. ej q f 1,f)L-
Framing: d22.G/'C�, L7//4-
Plumbing: 012-12 4..)-03'
Propane Tank/Lines: /A/%.6----,��sa 2'7-05-
Insulation: FLee).s OK 7/ /LaC•
Sheetrock:
Septic Sytem Final Approval (If not on sewer):
Road Approach Final Approval:
Zoning Final Approval:
Final/.occupancy Approval: U r `(—((—r)b 4
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
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SPECIAL CONDITIONS APPLY -SEE REVERSE
UILDING PERMIT APPLICSDN MLA05-00287
Review Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD05-00296 Received Date: 5/9/2005
SITE ADDRESS: 3903 DUCKABUSH RD
BRINNON, 98320
OWNER: VONDA N MC INTYRE PHONE: 206-633-3493
GLENN A HACKNEY
4121 INTERLAKE AVE N
SEATTLE WA 98103-8151
SUBDIVISION: Block: Lot: +
PARCEL NUMBER: 503014004 Section: 1 Township: 25 N Range: 03 W
CONTRACTOR: MITCHELL CONSTRUCTION PHONE: (360)796-2060
4246 DUCKABUSH RD
BRINNON WA 98320
Contractor's License MITCHC*1010E Expires 4/9/2007
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI' HEATED BATHHOUSE W/ PLUMBING - 120sq ft
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW a0 5�MAIN: 120
VALUATION 18;4Q9e6~ ADD'L: HEAT TYPE: EEE
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY:
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: �O SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: 0 Prop: 1
Total: 0 Total: 1 /7 //`.6
Routing Date: �/ic/
K A5
Type Amount Paid Bv: Date: Receipt: �� Ap�ro�/Dat
Permit $293.25 BAC 05/09/05 73064 P R VE
Plan Check $190.62 BAC 05/09/05 73064
State Building Code $4.50 BAC 05/09/05 73064 JUN 1 6 2005
Potable Water Application $53.00 BAC 05/09/05 73064 Jefferson County Planning
Total: $541.37 & Department
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• •
SPECIAL CONDITIONS FOR CASE A BLD05-00296
1.) The identified Fish and Wildlife Habitat Area (Type 1 Stream), shall maintain a vegetative
buffer setback of 150 feet. The setback shall be measured horizontally from the Ordinary
High Water Mark (OHWM) to the proposed bath house.
2.) An additional setback of five (5) feet is required from the edge of the buffer area to the
proposed bath house.
3.) 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.
4.) 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."
5.) 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.
6.) 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.
7.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
8.) 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 of 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).
9.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
10.) The building height is not to exceed 35 feet.
11.) Setback from Duckabush 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.
•
I:\F_BLD_Permit_Buildng.rpt 10/29/19
�4SON ?N JEFFERSON RUNTY •
j ,�..3 DEPARTMENT OF COMMUNITY DEV PMENT .�_
'Q 621 Sheridan Street • Port Townsend ;Washin ton 98368
360/379-4450 •• 360/379-4451 Fax Washington 144';
�,4 O� www.co.jefferson.wa.us/commdevelopment Ii I i
�3ING - c. �
Master Permit Application MLA: 05 -(-7 , s'7
Project Description(include separate sheets as necessary): ?�1
Tax Parcel
Number: s'L°�(�'� ) 4�C7(� 1 Property
7J Size: .Zg "RCS 40.. (acres/square feet)
Site Address and/or Directions to Property: s'963 i)de 1,s5-(-) e_e? Ao(j�ijto`f e,..41. epics&O
Property Owner(s)of Record: /7•!Je,_ 22,7/ re -&' -r c�f s 7c
Telephone:02.0e, 62•5 3 y y3 tax: /
email:
Mailing Address: Y/ •L I 1 n1`-Pv.E.r 1 a 4✓t' - 4i. -CE4J7 i -• ..Li/9 22r`Ao 3
Applicant/Agent(if different from owner): Mt.(eJ// e: 4✓3{-/e C,e- /(irk - A f2r, ,I
Telephone: 3&•c) Seib "2 ' 6 Ci Fax: lam!`, i'7 '/ ?i, email:
Mailing Address: Yam. vU 0 (JY_`tom•/( 4e(iS,' A7� ' (20'ti,,o2wt' irt447 q)r4 2-.d
Igh,Kind of Permit?(Check each box that applies)
wilding ❑Variance(Minor, Major or Reasonable Economic Use)
o 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)**
❑ Manufactured Home ❑ Boundary Line Adjustment
❑ Modular ❑ Short Plat**
❑Commercial* ❑ Binding Site Plan**
Change of Use ❑ Long Plat**
0 Address ❑ Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments*"
IErPropane ❑ Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis 0 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
❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment
0 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 f'E' L LE//EPA L.-3P +I ��3E.Stc.1;96'.'
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 an ' t of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any re ired later in s.Across and right of entry to this property shall be requested and shall occur only during regular business
hours.
i
Signature: - Date: -S- '-U5—
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 complian - with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transferabl esponsib" Zi:dhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: ���. --
Date: . 7- Q 4`
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 assuming the responsibility of the General Contractor for the proposed project.
Signature: Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
/4 1 T4/ i( 9ncrp_ Lk.ii tA-/ (36o) ?di 6 L C a e) (-- oel �9b-Y../7
MAILING ADDRESS: 4,2 _, .b. /)cC,Cf) t.?,. q A - izo/ivo tci EMAIL:616t C? ,z 7
CONTRACTOR'S LICENSE - WAINS
NUMBER: /1 / •?c!4 A ii, r-01' /C NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
New Wood Existing: ❑ Sewer
❑ Addition 0 Steel Proposed: I Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System
❑ Repair 0 Masonry SEP Permit# qZ._
Bedrooms: Water Supply:
❑ Demolition ❑ Other. C
Existing: Setback: trivate well ❑ Two Party
Type of Heat: Proposed: ❑ Public
T ,l C Total: Name of System:AP J`/
AEC; s C
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 VrAbove ground Tank Size of Propane Tank: 2- ec ih . 2- - 2d &41- 7I4n'l 5
❑ Heat Stove ❑ Cook Stove ❑ Woodstove ❑ Fireplace Insert t 'c of Water Tank ❑ Pellet Stove ❑ 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 For Office Use Only
Current Proposed Amount
Main Floor t0 Consistency Review: {/,�t
2Nu Floor Base fee:
3`0 Floor A�( 7i s ipl 3c..6"tom; r ,. 1
Menanine: P141.: P++eclr4ee: V}
j`fi t i V �. , SAP J„J. .
Heated Basement St?1 t*jSurc r fee9 2005 r
Unheated Basement ot Water Review fee:
Other Unheated 3' f!pcb1t ,
Garage/Carport TOTAL: $ ` _..I :1,
Decks 4 I /I 11 ''II Receipt Number: '..f 2,44 i
(p0 �i�'t. p i ‘_....t.ti• "i
Other 1' Cash/Check Number:
ESTIMATED COST(REQUIRED) Date: ,
•Fair market value of all labor and material ( "�
•.-- 5o0 Initials
J 1
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
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