HomeMy WebLinkAboutBLD2005-00691 OUILDING PERMIT APPLICA1SN MLA05-00646
Review Type:I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD05-00691 Received Date: 11/2/2005
SITE ADDRESS: 860 ROBBINS RD
NORDLAND, 98358
OWNER: MARY JO BOUSHIE PHONE: 360-379-9188
FRANK A BOUSHIE
PO BOX 123
NORDLAND WA 98358 LOIS TWELVES SHORT PLAT
SUBDIVISION: Block: Lot: 1
PARCEL NUMBER: 921093015 Section: 9 Township: 29 N Range: 01 E
CONTRACTOR: OWNER BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI NEW DETACHED GARAGE UNHEATED & NO PLUMBING
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP NEW � IIAIN:
VALUATION 6i ADD'L: HEAT TYPE: UH
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: 5N GARAGE: 720 SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 0 Prop: 0
Total: 0 Total: 0
Routing Date: 1
.1N05
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $279.25 SLE 11/02/05 77317 APPROVED
Plan Check $181.51 SLE 11/02/05 77317
State Building Code $4.50 SLE 11/02/05 77317 DEC a . `Orr
Total: $465.26 l�
Jefferson County Planning
� & Building Department
C— N
Col Fr e S fop
•
BUILDING PERMIT •
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD05-00691 Received Date 11/2/2005
SITE ADDRESS: 860 ROBBINS RD Issue Date 12/28/2005
NORDLAND, 98358
APPLICANT: MARY JO BOUSHIE PHONE: 360-379-9188
FRANK A BOUSHIE
PO BOX 123
NORDLAND WA 98358
SUBDIVISION: LOIS TWELVES SHORT PLAT Block: Lot: 1
PARCEL NUMBER: 921093015 Section: 9 Township: 29 N Range: 01 E
CONTRACTOR: OWNER BUILDER PHONE:
PROJECT DESCRIPTION: NEW DETACHED GARAGE UNHEATED & NO PLUMBING
CALL IN FOR THE REQUIRED I}VSP,E1 TIONS THAT APPLY TO YOUR PROJECT.
SETBACKS: ////D/04
UFFER: /V/�
Footing: D z,/e.e i Mons 004,
Foundation: //j
Stormwater FINAL Approval:
Underground Plumbing:
Underground Insulation:
Shear Wall :
Sheathing:
Framing: 2.161"6
PlumbingV
Propane Tank/ Lines:
Insulation:
Sheetrock:
Septic Sytem Final Approval (If not on sewer):
Road Approach Final Approval:
Zoning Final Approval:
Final/Occupancy Approva . a kj f,Q
HEALTH DEPARTMENT ND I ULIC WORKS APPROVAL REQUIRED
QU RED 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 BLD05-00691
1.) There has been no approval or review by the Health Department for plumbing for this
structure. Further review is required if plumbing is proposed.
2.) There is no plumbing proposed for this project. If the proposal changes to include
plumbing the applicant shall meet all of the Aquifer Recharge and SIPZ conditions.
3.) 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.
4.) To help prevent seawater from intruding landward into underground aquifers, all new
development activity on Marrowstone Island, Indian Island and within 1/4 mile of any
marine shoreline shall be required to infiltrate all stormwater runoff onsite.
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 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.) Exterior lighting for residential uses shall not exceed twenty feet (20') in height from the
finished grade, excepting when such lighting is an integral part of a building or structure.
Ground level lighting is encouraged.
12.) Lighting fixtures shall be designed and hooded to prevent the light source from being
directly visible from outside the boundaries of the property. The intensity or brightness of
all lighting, during construction and after project completion shall not adversely affect the
use of surrounding properties or adjoining rights-of-way.
13.) Setback from Robbins Rd. right-of-way is no less than 20 ft., setback from Baldwin 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 10/29/1999
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JEFFERSOOUNTY S
F DEF T.OF C COt�MUNITY DEVELOPMENT
�,,we`soly cor,, JEFFERSOI OUNTY •
W
,� DEPARTMENT OF COMMUNITY DEVELOPMENT
I-, ` ' 621 Sheridan Street• ••� . c-wish
. . 360/379-4450 • 360/37 a ", .'life Try
!'L 1 "' _
Is NG ° www.co.jefferson.wa.0 * deVe opment ;
NOV 2005 'F h'
Master Permit Application ' MLA: ;1 S -
Project Description(include separate sheets as necessary): I-foil-C:1
Tax Parcel _ Property - .- e
Number: � f,.•' Ci9'-j v(/ Size: ,< -/. ,, ( 5 (acres/square feet)
Site Address and/or Directions to Property: ,'2) �i: r) c.,h/„'//v.., A--,�/2/..) ��ie_z!3G/9A/z)
Property Owner(s)of Record: riCl A/i re /->/94.7y �U z'k%z-i.`s•h/1. —
Telephone: % �'/y � Fax: email:/ ,'A//-C-/c-',/ ,.S'/›) "--
Mailing Address: /C-' /2 .9 /I,-(-"//)L JJ.oYZ) / 1 j, F, C --
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]**
❑ Single Family ---- _ ❑ Discretionary"D"or Unnamed Use Classification
K Garage Attached/e eta shed ❑ Special Use(Essential Public Facilities)**
❑Manufactured Hom ❑ Boundary Line Adjustment
❑ Modular Cl Short Plat*''
❑ Commercial* ❑ Binding Site Plan**
❑ Change of Use Cl Long Plat**
❑Address _ ❑ 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:
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 required later inspections.Access and right of entry to this property shall be requested and shall occur only during regular business
hours. /
Signature: � ,y,T/ .;/% -—",— ", 7- Date: t/- `-/
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 responsibility for hering to a�complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: rs -/�� .'' it Date: %s�- / ,j
�iif
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: F 7;Y,>� ,;% r y - Date: / 1
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:
New : Wood Existing: ❑ Sewer
❑ Addition 0 Steel Proposed: ---0—
Bank 0 Community System
❑ Alteration/Remodel ❑ Concrete Total: -0— He' t: ❑ Individual Syste
❑ Repair ❑ Masonry , /,_ SEP Permit# q/=�j/7
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type of Heat: Proposed: A/AEll Public
A/t. - A,'e- Total: ----7.-- Name of System:
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 ❑ Above ground Tank Size of Propane Tank:
0 Heat Stove ❑ Cook Stove 0 Woodstove 0 Fireplace Insert 0 Hot Water Tank Li Pellet Stove ❑ 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.
Square Footage For Office Use Only
Current Proposed Amount
Main Floor - isteeview: 4 CI
CI
2rvu Floor I.' r 'T Base fe :' E, a 19 a,5
In,3rd Floor NOV - 2 itionalr.d 'on:
Mezzanine: Plan_Check fee: i 2' 5 j.
Heated Basement State,:Surcharge fee: I 0
t
Unheated Basement Pot Water Review fee: s
Other Unheated 911/Rd Approach fee:
I,/
- Garage/Carport r 4. TOTAL: $ o�,
.5
Decks `� ..------1- Receipt Number ry
1 )1 "..1
Other Cash/Check Number: J ,
OciESTIMATED COST(REQUIRED) Date: a
*Fair market value of all labor and materials foundation to finish
Initials: . 1
• -t
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
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JEFFERSON COUNTY DCD •