HomeMy WebLinkAboutBLD2005-00472 CERTIFICATE OF OCCUPANCY
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451 (800) 831-2678
PERMIT #: BLD05-00472
SITE ADDRESS: 304 SMITH RD Issue Date: 08/29/2005
NORDLAND, 98358 Final Date: 10/29/2007
APPLICANT: ROBERT G BOWEN PHONE: 205-807-2541
MELANIE J BARRY
PO BOX 43623
BIRMINGHAM AL 352430623
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 921051009 Section: 5 Township: 29 N Range: 01 E
PROJECT DESCRIPTION: NSFR W/AG PROPANE TANK
THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING
CODE 2003 EDITION.
OCCUPANCY GROUP: R-3
TYPE OF CONSTRUCTION: 5N
SPRINKLER SYSTEM yes no
THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON
10/29/2007
I:\F_BLD_Occupa ncy.rpt 10/29/19
1
IU ILDING PERMIT APPLICASN MRAOW00437
Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD05-00472 Received Date: 7/20/2005
SITE ADDRESS: 304 SMITH RD
NORDLAND, 98358
OWNER: ROBERT G BOWEN PHONE: 205-807-2541
MELANIE J BARRY
PO BOX 43623
BIRMINGHAM AL 352430623
SUBDIVISION: Block: Lot: T 9+
PARCEL NUMBER: 921051009 Section: 5 Township: 29 N Range: 01 E
CONTRACTOR: TBD PHONE: 205-807-2541
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr NSFR W/ AG PROPANE TANK
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 1,466
VALUATION 350,000.00 ADD'L: 1,380 HEAT TYPE: PRO
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY: R-3 UNHEATED: # OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: 5N GARAGE: SHORELINE:
CONST TYPE: SETBACK:
DECK: 114
BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: OTHER
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: 2 Prop: 3
Total: 2 Total: 3
Routing Date:
Type Amount Paid Bv: Date: Receipt: Approved/Date
Permit $2,393.75 SLE 07/19/05 73486 APPROVED
Plan Check $1,555.94 SLE 07/19/05 73486
State Building Code $4.50 SLE 07/19/05 73486 AUG 2 9 2005
Potable Water Application $53.00 SLE 07/19/05 73486
efferson County Planning
Total: $4,007.19 op Buil • artment
1O42_
JEFFERSON COUNTY ' .�1K
(1-":--g,ON
44006
,4 DEPARTMENT OF COMMUNITY DEVELOPMENT `621 Sheridan Street • Pat Townsend •Washington 98368 1-
JUL 1 9 2005 :
360/379-4450 • 360/379-4451 Fax _
c/11 3 www.co.jefferson.wa.us/commdevelopment JEFFERSON COUNTY
�S87NG,S DEPT. OF C 'UNITY ,^f 6V1ENT
Master Permit Application MLA: '...
Project Description(include separate sheets as necessary):
t'S (4etk41 4,1. d2 S,Jrovp., (tf,rAP
Tax Parcel Property 1
Number: �(2 t O S/ U 09 Size: O. 61 h-c (-.r,� k'f2) (acres/square feet)
Site Address and/or Directions to Property: 3 C' S n..I its, I-c' 0 o-t(A(AAA 4) tJ34 Cf ?3 Sg-
(2Gp ( W
Property Owner(s)of Record: 4r r " . 13 6 P+i M^1 a-tn 1•e Cr• (3 644-r
Telephone:abr W6 9 e2SY fo( Fax: ;Of.1 - I in email:
Mailing Address: (7ex 4942.3 (3(rM i-,nf lto,1 64(, .1132 ( '
Applican (if different from owner): T i t4 44 r4,- t-f w 0 L.'c4-*)
Telephone: 3 0 3k S- .6.2 k Fax: email:
Mailing Address: (3 YI tice 5-r. 12014 —Rrlwtse►,c Lb4- fi>3 b I
What kind of Permit?(Check each box that applies)
Building 0 Variance(Minor,Major or Reasonable Economic Use)
❑ Demolition Permit ❑ Conditional Use[C(a),C(d),or CI**
'Single Family ❑ Discretionary"D"or Unnamed Use Classification
'V(Garage Attached Detached 0 Special Use(Essential Public Facilities)'"
t Manufactured Home ❑ Boundary Line Adjustment
❑ Modular ❑ Short Plat**
❑ Commercial* [I Binding Site Plan"*
❑ Change of Use ❑ Long Plat**
,Address 4�t ❑ Road Approach 0 Planned Rural Residential Development(PRRD)/Amendments--
) Propane ❑ Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions**
❑ Stormwater Management [] Shoreline Management Substantial Development**
u 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, sta te or federal permits required for this proposal, if known:
5-011/ CJ► --F�r (IN kt-*c*.ea
-C ESIGNATION GENT
I hereby designate�kw-0-. (-, 0‘.I' 444 r act ff my in matters relating to this application for permit(s).
OWNER SIGNATUR / �tJL' t• ' ate: (.3"O}
By signing this application form,the owner/agent attests that the information provided herein,a 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 en to Jefferson County and; ployees,representatives or agents for the sole purpose of application
review and any required later Inspections.Acres a ght of entry to this 11 be requested and shall occur only during regular business
hours. 7 ;(y j
Signature -fit! Z-i t Date: 2—(5--0 S
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., 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 ltiffe County code.The Applicant acknowledges that he,she or it holds individual
and non-trans cable responsibility for adherir plyi, with th ESA. 'Applicant has read this disclaimer and signs and dates It below.
Signature: y� "161 Date: `l._- [3—6 5—
r'_•\,,..«..:.('....m.\FCIR AAC\r1R rl Fr1R MC\Mnetor P,.rrn;t A nnliratirx,7-A-114.rinc 1.
I
0. ,<_ • •
OWNER BUILDER STATEMENT
The signer of this statement does hereb9'( rtlfy that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be ming responsibUity of the proposed project —�
Signature: h•, ?—l 3 s .1�
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: f i Fell_ i 9 t r
fi� T�� (tor) S-o7 a s .t( tt ( ) 2005
MAILING ADDRESS: EMAIL: JEFFEf1 pN COUNTY
CONTRACTOR'S LICENSE WAINS DEPT. OF COMMUNITY DEVELOPMENT
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
liti New ithr Wood Existing: ❑ Sewer
❑ Addition 0 Steel Proposed: " . Bank ❑ Community System
❑ Atteration/Remodel ❑ Concrete Total: 3— Height: Irtdivldual System
❑ Repair ❑ Masonry 12' SEP Permit# o Y GU 2 ��
0 Demolition ❑ Other: Bedrooms: Water Supply:
Existing: — Setback: ❑ Private well ❑ Two Party
Type of Heat: Proposed Total: Z �.�' ❑ Public
Name of System:
Vc 3 r.(t...%.4-4iet4
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(indudes 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 XAbove ground Tank Size of Propane Tank: /SZ) it,
❑ Heat Stove 0 Cook Stove ❑ Woodstove ❑ Fireplace Insert ,P Hot Water Tank 0 Pe Stove ❑ Other
Is this appliance belnnjnstalled In a Manufactured 1 Mobile Home? Yes /(G)
When applying for a permit to Install a propane tank you must also submit a site plan showing all of the buildings,all property
Iines, tank location and size,distances from the propane tank to all property lines,buildings and septic system components,
including the reserve area.
Square Footage or dJti.OnlX n 5::, 7A: 7
Current , r
Main Floor i Proposed :ra.. p `� 1:"''i► 0, k feat,I r ,t;ia�
2 Floor �eie �, {rat d�• 1M,� +,�`� 1,�w
l 3�a i bBR. D 34t t 4. r , ;1 ,
3f°Floor kfdltbr�al•$ectkob :; ->r ,14.�x ,4„J 4 Ki r 2
Mezzanine: "PlartChpck a•' tSI5 lt*LIK t i '1 ,{
Heated Basement ' `'' t ` - ;
Unheated Basement Po�tittal�t( ' TM r ' ,rr.7 ; �cti Srr ,t
•
Other Unheated .41 " 4' z;‘;F',l4N,,),,,,A T r
.• t.. . • --*.T
Garage/Carport iotfiiiV 41 n ::'
, N PC
il _ .. .,r U �.+ M
'q' ^ _' Y�r ��[p} r J Y JC N'
Other --{/ / iumbort, ,•t R t1 At r r 7i4 �,u "
lai
tt uiK"f 1 1. 4 �Y 51T4✓n�,i
ESTIMATED COST(REQUIRED) Pate: 1 '� `fA"j;0-r 11, ;N: c L
*Fair market value of all labor and mat: .ur._,.-• r. ; . ' 1 ( rY' , ,ri. 3 t ; a� *:} j
initials• rr t F 4,: � j.�,r,
G:\PecmitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.4oc
0
BUILDING PERMIT III
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD05-00472 Received Date 07/20/2005
SITE ADDRESS: 304 SMITH RD Issue Date 08/29/2005
NORDLAND, 98358
APPLICANT: ROBERT G BOWEN PHONE: 205-807-2541
MELANIE J BARRY
PO BOX 43623
BIRMINGHAM AL 352430623
SUBDIVISION: Block: Lot: T 9+
PARCEL NUMBER: 921051009 Section: 5 Township: 29 N Range: 01 E
CONTRACTOR: TBD PHONE: 205-807-2541
PROJECT DESCRIPTION: NSFR W/AG PROPANE TANK
CALL IN FOR THE REQUIRED IN PECTI NS THAT APPLY TO YOUR PROJECT.
SETBACKS: Q/X /z, '► OG
UFFER: ,/,,K Vz5/oG,
Footing: OA //RS 44 Ai
Foundation: jfk z/OLA
Stormwater FINAL Approval:
Underground Plumbing:
Underground Insulation:
Shear Wall : 41-67216e SHEN2 OK 17//04,
Sheathing: L.
Framing:wire,.Ft.o.,-2._i/-i3- eVe, 2/4/C7`
. �
Plumbing: a( 6/4-7
Propane Tank/ Lines: /''vL in 7 "2w'o/✓:fs✓�/=/ha /O 42,R -c,7
Insulation: �ick_ '�t-,.Si- I'k_ z/it r.T 4AJ* t 4 ►, A.9, it) L-ii)'Wc-SIZ.410')
Sheetrock::,2, W' �
Septic Sytem Final Approval (If not on sewer):
Road Approach Final Approval:
Zoning Final Approval:
Final/Occupancy Approval: IC' -r2i -07
HEALTH DEPARTMENT D 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 A BLD05-00472 •
1.) Eastern edge of structure/greenhouse must be NO MORE THAN 118'from the top of the
bank to allow for placement of approved onsite sewage system.
2.) PRIOR TO FINAL OCCUPANCY
1. water sample results for bacteria, chloride and nitrate must be submitted.
2. Verification that the unit provides 400 gallon in a day using actual flow from the unit
after it is installed.
3. An as-built drawing of the system as installed.
4. An operation and maintenance manual for the system.
Please contact Susan Porto with Jefferson County Environmental Health at(360)
385-9404 to schelule the final inspection of the water system.
A Declaration of Restrictive Covenant Concerning the Drinking water supply was recorded
by Auditor file number 502271 on August 24, 2005.
3.) VOLUNTARY MEASURES OF COASTAL &AT RISK SIPZ:
Water conservation measures:
1. Roof and other intercepted precipitation shall be routed to on-site detention ponds
and/or other approved means and allowed to be released to the soil slowly.
2. Water collected from Storm water and roof catchments may be used for watering
lawns and gardens. Unless catchment water has been treated to meet drinking water
standards, there shall be no cross connections allowed between the potable supply and
impounded water.
3. Water withdrawn from wells on each property shall not be used for watering of lawns
and/or gardens.
4. Ground water withdrawn from each property shall be restricted to a rate of three (3)
gallons per minute.
5. Installation of water conserving fixtures such as low flow toilets, faucets and shower
restrictors and other water saving plumbing fixtures.
6. Landscaping plan (xeriscaping, native vegetation with minimal amounts of irrigation).
Please NOTE that the above listed measures are not intended to be exhaustive, but rather
is intended to be illustrative of the types of water conservation measures.
4.) VOLUNTARY MEASURES OF COASTAL &AT RISK SIPZ:
1. Installation of a flow meter.
2. On-going well monitoring for chloride concentration.
3. Submittal of monitoring data to County.
5.) MANDATORY MEASURES FOR COASTAL SIPZ:
1. For proof of potable water on a building permit application, applicant must utilize
DOH-approved public water system if available.
2. If public water is unavailable, a qualifying alternative system may be used as proof of
potable water or an individual well may be used as proof of potable water subject to the
following requirement:
a. Chloride concentration of a laboratory-certified well water sample submitted with
building permit application.
3. If public water is unavailable, a qualifying alternative system may be used as proof of
potable water.
• •
6.) MANDATORY MEASURES OF HIGH RISK SIPZ:
Water conservation measures:
1. Roof and other intercepted precipitation shall be routed to on-site detention ponds
and/or other approved means and allowed to be released to the soil slowly.
2. Water collected from Storm water and roof catchments may be used for watering
lawns and gardens. Unless catchment water has been treated to meet drinking water
standards, there shall be no cross connections allowed between the potable supply and
impounded water.
3. Water withdrawn from wells on each property shall not be used for watering of lawns
and/or gardens.
4. Ground water withdrawn from each property shall be restricted to a rate of three (3)
gallons per minute.
5. Installation of water conserving fixtures such as low flow toilets, faucets and shower
restrictors and other water saving plumbing fixtures.
6. Landscaping plan (xeriscaping, native vegetation with minimal amounts of irrigation).
Please NOTE that the above listed measures are not intended to be exhaustive, but rather
is intended to be illustrative of the types of water conservation measures.
7.) MANDATORY MEASURES FOR HIGH RISK SIPZ:
1. For proof of potable water on a building permit application, applicant must utilize
DOH-approved public water system if available.
2. If public water is unavailable, a qualifying alternative system may be used as proof of
potable water or an individual well may be used as proof of potable water subject to the
following requirements:
a. Variance from Chapter 173 WAC standards granted by Ecology per WAC 173-160-106
for a new groundwater well within 100 feet of a sea-salt water intrusion area per WAC
173-160-171 (i.e., within 100 feet of a groundwater source showing chloride
concentrations above 200mg/L or within 100 feet of the marine shoreline); or for an
existing or proposed groundwater well not subject to an Ecology variance, applicant must
provide evidence through a hydrogeologic assessment(relevant components of an
Aquifer Recharge Area Report per UDC 3.6.10.e) of a reasonable probability that the
subject aquifer will not be degraded by the proposed use of well.
Flo cko0 ft ? r 9e,�5 7
c. On-going well monitoring for chloride concentration.
d. Submittal of flow and chloride data to the County per monitoring program.
3. If public water is unavailable, a qualifying alternative system may be used as proof of
potable water.
8.) 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.
9.) A Stormwater Plan has been submitted and approved by the Department of Community
Development. Once the subject permit has been issued the applicant shall fully
implement the provisions of the submitted plan and contact the Jefferson County
Department of Community Development to arrange a schedule to inspect the property for
plan compliance. A Certificate of Occupancy will not be issued until the Department
verifies plan compliance. No clearing for roadways or utilities shall occur on the project
site until clearing necessary for the installation of temporary sedimentation and erosion
control measures have been completed.
10.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
11.) The building height is not to exceed 35 feet.
12.) There is a 20 foot setback from the edge of the right-of-way of Smith Road (p5089).
There are 5 foot side setbacks (north & south), of which eaves can enroach within up to 2
feet. the rear setback is 30 feet from the top of the shoreline bluff(west).
13.) Residential developers and individual builders shall be required to preserve shoreline
vegetation and reduce the associated risk of erosion during construction and any future
activity which may impact the stability of the shoreline.
I:\F_BLD_Permit_Buildng.rpt 10/29/19
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