HomeMy WebLinkAboutBLD2005-00611 • BLD05-00611
Review Type:
MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD05-00611 Received Date: 9/22/2005
SITE ADDRESS: 295293 HWY 101
QUILCENE, 98376
APPLICANT: RICHARD W BANCROFT PHONE: 360-765-3418
JENNIFER L BANCROFT
PO BOX 231
QUILCENE WA 983760231
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 702242006 Section: 24 Township: 27 N Range: 02 W
CONTRACTOR/ WASHINGTON HOME CENTER INC PHONE: (800)648-1113
DEALER: PO BOX 176
CHEHALIS WA 98532
Contractor's License WASHIHC07 70A Expires 1/2/1975
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION: NEW MANUFACTURED HOME WITH COVERED PORCH
TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE:
TYPE OF IMP NEW MAKE: ID. CHAMPION SETBACK:
VALUATION 130,663.00 YEAR: 2000
LABOR & INDUSTRIES APPROVAL?
SIZE: 71 X 26.8 BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 2 Prop: 2
Total: 2 Total: 2
Routing Date: _`1, 705l
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $157.00 SLE 77002 ,A P P R O V E
Potable Water Application $53.00 SLE 77002
Total: $210.00 — 2005
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BUILDING PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD05-00611
SITE ADDRESS: 295293 HWY 101 Received Date 09/22/2005
QUILCENE, 98376 Issue Date 11/2/2005
APPLICANT: RICHARD W BANCROFT
JENNIFER L BANCROFT PHONE: 360 765 3418
PO BOX 231
QUILCENE WA 983760231
SUBDIVISION:
PARCEL NUMBER: 702242006 Block: Lot:
Section: 24 Township: 27 N Range: 02 W
CONTRACTOR: WASHINGTON HOME CENTER INC
PO BOX 176 PHONE: (800)648-1113
CHEHALIS WA 98532
Contractor's License: WASHIHC0770A Expires: 3/19/2007
PROJECT DESCRIPTION: NEW COVERED PORCH MANUFACTURED HOME (ALL ONE UNIT
FROM
CALL IN FOR THE REQUIRED INS EC QNS THAT APPLY TO YOUR PROJECT.
SETBACKS: O 3 zz vL
UFFER:
Footing: "x
pN rilbd at 3 �Z oL
Foundation: ,$ ,A/A)4 , -7� ` p&zeitys e24 3,%/
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: ,t �f `7.—!��r�
HEALTH DEPARTMENT Ah1D 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 At A BLD05-00611 •
1.) Critical Aquifer Recharge Areas may require special protection measures to mitigate water
quality degradation. The submitted proposal does not require additional aquifer
protection measures. However, during construction the project shall follow the Best
Management Practices (BMPs) and facility design standards as identified and defined in
the Stormwater Management Manual for the Puget Sound Basin.
2.) The identified Fish and Wildlife Habitat Area (Type I 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 residence&associated improvements.
3.) An additional setback of five (5) feet is required from the edge of the buffer area to the
proposed residence.
4.) No trees are authorize to be removed as part of this application. The applicant shall fully
adhere to all conditions and requirements of the eagle habitat management plan that will
be developed by the WA State Department of Fish &Wildlife for this property.
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.) 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.
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 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).
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.) The setback from Highway 101 is 50 feet from the edge of the right-of-way. The side
setbacks are 5 feet from the property lines. The rear setback is a minimum of 155 feet
from the edge of the Big Quilcene River, wetland, and associated floodplain.
12.) The applicant shall contact the WA State Department of Transportation at(360) 357-2725
to ensure that the access to HWY 101 may be utilized and meets DOT requirements. You
should refer to access permit number 45275.
13.) A minimum of two off-street parking spaces are required.
I:\F_BLD_Permit_Buildng.rpt 10/29/19
JACK WESTERMAN 110 Jefferson Courthouse
ASSESSOR PO Ilox 1220. Port Tri-nsend. WW.% 98360
, (360) 385-91115 -- _
MOBILE HOME INFORMATIOI, ` ►
OWNER'S NAME/MAILING ADDRESS: 2 2 fir';
NAME: 11/414 Y41c NO L , r
ADDRESS: t' C 15 c=k (G_.> /3 '/ iNCAl
PHONE NO.(34-;c-) 76/C — c C
The purpose of this questionnaire is to obtain information regarding either the
current location of a mobile home or the previous ownership and location of a mobile
home. This will help our office determine whether the.mobile home is already on the
tax rolls in Jefferson County or if it has been moved to this county from another area.
',MOBILE HOME DATA: ( C/Jok55LçRy
N J
(A) MAKE IDA() CND a'/0Air.
(B►MODEL (C) YEAR goo 6
(D) LENGTH 7/ /L T (E)WIDTH L7c(h 3 (F)SERIAL # -`c6 C, f O3‘3f
(G)YOUR PURCHASE PRICE (Do not include sales tax) ,, K :3 PURCHASE DATE< S& rj.
20 PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3)
(A) FROM WHOM DID YOU PURCHASE MOBILE
ADDRESS
(B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR?Yes No
If Yes, Previous address of mobile.
If No, What County was Mobile assessed in last year.
3►WHERE MOBILE HOME IS TO BE LOCATED:
(A) WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes No
(B)IF LOCATED IN MOBILE HOME PARK: �--�
NAME &ADDRESS OF PARK Lot/Space #
(C) IF NOT LOCATED IN MOBILE HOME PA K:
NAME OF LAND OWNER: J'/ C/i' k/) L) , 4-it;C A()7-
LOCATION ADDRESS 5.• ! 3 /!/G-//L/m y /O/ S c u pt 0 C- 9L 1 L(L/P
REAL PROPERTY PARCEL #/DESCRIPTION S 7/4r /�,� IL,6. 7GjlUJ
42
Signature of applicant
THANK YOU FOR YOUR HELP!
4JO COSSELL, Property Technician
"CC7rr co�� O OTY 1 .
1 DEPARTMENTJEFFERS OF COUNMMUNITY DEVELOPMENT
~' 4\ d '4 621 Sheridan Street• Port Townsend •Washin bpi'9
Z 360/379-4450 • 360/379-4451 Fax 2)�a
�q s , .0 www.co.jefferson.wa.us/commdevelopment
I
Master Permit Application _ ----- -MLA:-�/ _ 5_ 59a'
Project Description(include separate sheets as necessary):
V-w ' /L'UMCir)2 ) /1O41L Cov6RED Pc/- I/
Tax Parcel !
Number: 746, a 4,2 00 4 Size: ' 0 ,35
A C.,gc,$' (acres/square feet)
Site Address and/or Directions to Property: a ?S a 9 3 /4 /6v-fly AY to/ CSavfh o7 Pt,/Cfir�ye J
Property Owner(s)of Record: R/C/MR.) W, ,g 4/0 �-'E NN/FED L, B�4iv�F T
Telephone: l�6 v) 76$ -34.e/8 Fax: email:
Mailing Address: // r:U' fj'X.23/ Q c,t c.c eiv&.l w/. 5..e.3 7
Applicant/Agent(if different from owner): RA yMOND L,, I Ro j'& se,N
Telephone: (36a) 7 9•(, —00)2, Fax: email:
Mailing Address: r 0, BOX 6 O3 BRIN NO N, Go/4 9 Q3.2O
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)**
❑ Single Family ❑ Discretionary"D"or Unnamed Use Classification
❑Garage Attached/Detached C] Special Use(Essential Public Facilities)**
Manufactured Home [] Boundary Line Adjustment
❑ Modular ❑ Short Plat**
❑ Commercial* El Binding Site Plan**
❑Change of Use [] Long Plat**
❑Address 404- 0 Road Approach [l Planned Rural Residential Development(PRRD)/Amendments**
❑Propane 0 Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisions**
Cl Stormwater Management ❑ Shoreline Management Substantial Development**
❑ Site Plan Approval Advance Determination(SPAAD)* C]Shoreline Management Variance
❑Temporary Use El Comprehensive Plan/UDC/Land Use District Map Amendment
0 Wireless Telecommunication* C]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 /no 4 A/ to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE Date: %- 3- S
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 inspectio .Access and right of entry to this property shall be requested and shall occur only during regular business
hours.
Signature:
Date: 9- CAS
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-transferable respo�.. o dherin and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: GCrt > „
Date: 1 ' (,,:-,>
G:\Pem \ \ \
vtCenterFORMSDRD FORMS Permit Application 7-8-04.doc
AOWNER 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:
taA6Ii//.1G-7O/t) /fort CEN 71 (WO) qfC -9q2 ( )
MAILING ADDRESS: 4/ 5E RYAa RD. $yk�re Jzt/JAI y ?S9gEMAIL: j e e/ J R.s'c4l @war�'�i{)ome .CA.1
CONTRACTOR'S LICENSE WAINS Iy as .. CE450 4.4A4AS
NUMBER: S / C.O7 O NUMBER
ARCHITECT/ENGINEER: N OA PHONE ( ) FAX:( )
_MAILING ADDRESS: s' ' '-7 N'N 85$4 EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
Ie'New S-"Wood Existing: _-__ _ ❑ Sewer
❑ Addition ❑ Steel Proposed: a. Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: ,2 Height: 0 Individual System
❑ Repair ❑ Masonry SEP Permit# _$ID 8 $
O Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: Private well -t±S Two Party
T�p e of Heat: Proposed: ___ __ ❑ Public
zR'". Fi 0 Aid Total: 2 Name of System:
15/(W �vP./Vi4Cf
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:
O Underground Tank 0 Above ground Tank Size of Propane Tank:
O Heat Stove ❑ Cook Stove ❑ Woodstove 0 Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove 0 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. c7 51.. i 2_
Square Foo „Eo lce Use Only
Current P pose :Amount
Main Floor l/a3 -Consistency /j;,Review: .q.b�
2""Floor (� `Base fee:
`-�
15-1 . oa
3`d Floor -Additional Section:
Mezzanine: Plan Check fee:
Heated Basement State Surcharge fee:
i
Unheated Basement Pot Water Review fee: p O Q
Other Unheated / 911/Rd Approach fee: ..---- ; ,
p
Garage/Carport TOTAL: $
Decks
/ rR l a-iceipt Number: l
Other f Check Number 5 3
ESTIMATED COST Q D) Dabs: I
cl�� ,�
.Fair market valu /r�,.I1 labor and 'als foundation to finish _Inifilals: 2 2 204 5 11J
O SEP
G:\P tCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
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