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HomeMy WebLinkAboutBLD2005-00743 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 #: BLD05-00743 SITE ADDRESS: 104 COOK AVE EXT Issue Date: 12/6/2005 PORT TOWNSEND, 98368 Final Date: 4/6/2006 APPLICANT: DALE R WURTSMITH PHONE: 360-385-6379 SANDRA WURTSMITH 1612 HASTINGS AVE W PORT TOWNSEND WA 983689213 SUBDIVISION: Block: Lot: + PARCEL NUMBER: 001043003 Section: 4 Township: 30 N Range: 01 W PROJECT DESCRIPTION: NEW MAN HOME/ADU 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 now, THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 4/6/2006 N 3ictfCt. -BO/ OW( 41/010Co Buil mg la ign ture Date I:\F_BLD_Occupancy.rpt 10/29/19 1 • • MANUFACTURED/MOBILE HOME INSTALLATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD05-00743 Received Date: 11/30/2005 SITE ADDRESS: 104 COOK AVE EXT Issue Date: 12/6/2005 PORT TOWNSEND, 98368 APPLICANT: DALE R WURTSMITH SANDRA WURTSMITH 1612 HASTINGS AVE W PORT TOWNSEND WA 983689213 SUBDIVISION: Block: Lot: + PARCEL#: 001043003 Section: 4 Township: 30 N Range: 01 W CONTRACTOR/ JAIME KOZELISKY PHONE: (360)385-3215 DEALER 1112 S JACOB MILLER RD PORT TOWNSEND WA 98368 Contractor's License KOZELHS027C3 Expires 1/6/2007 INSTALLER: PREFERRED HOME SERV Expires: 12/19/20( 26158 HWY 101 SEQUIM WA 98382 PROJECT DESCRIPTION: NEW MAN HOME/ADU MAKE: SKYLINE YEAR: 2005 SIZE: 44' x 27' THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 12/6/2006. CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. Setbacks/Footing (CONTINUOUS FOOTING SLAB r PADS USED): � �-- C. 7 — J Stormwater FINAL Approval:v1)) Blocking/Plumbing: 1..\2 C (0_ Propane Tank/Lines Zoning Final Approval: Septic System Final Approval (If not on sewer):____ Road Approach Final Approval: Final/Skirting/Vents/Porches/Steps: (Q 012_ HEALTH DEPARTMENT AND PUBL C WOR S 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 • MLA05-00691 Review Type: MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00743 Received Date: 11/30/2005 SITE ADDRESS: 104 COOK AVE EXT PORT TOWNSEND, 98368 APPLICANT: DALE R WURTSMITH PHONE: 360-385-6379 SANDRA WURTSMITH 1612 HASTINGS AVE W PORT TOWNSEND WA 983689213 SUBDIVISION: Block: Lot: T 58 PARCEL NUMBER: 001043003 Section: 4 Township: 30 N Range: 01 W CONTRACTOR/ JAIME KOZELISKY PHONE: 360-681-7559 DEALER: 1112 S JACOB MILLER RD PORT TOWNSEND WA 98368 /� Contractor's License KOZELHS027C3 Expires 1/ 0 71-7580 Contractor's License Expires 12/19/2006 INSTALLER: PREFERRED HOME SERV 12/19/2006 360-681-7559 26158 HWY 101 SEQUIM WA 98382 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION: NEW MAN HOME TYPE OF WORK RES MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW MAKE: SKYLINE SETBACK: VALUATION 52,110.00 YEAR: 2005 LABOR & INDUSTRIES APPROVAL? SIZE: 44' x 27' BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: CITY BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 2 Prop: 2 Total: 2 Total: 2 Routing Date: tt oWb31 Type Amount Paid By: Date: Receipt: A roved/Date Manufactured Homes $157.00 SLE 11/30/05 77464 APPROVED Potable Water Application $53.00 SLE 11/30/05 77464 DEC 2005 Total: $210.00 > Jefferson County Planning & Building Departme t --�,r ire JACK WESTERMAN III 0 Jefferson Coun�urthouse ASSESSOR PO Box 1220, on Townsend, WA 98368 (360)385-9105 MOHILE HOME INFORMATION FORM OWNER'S NAME/MAILING ADDRESS: ---) -- '\-'-„Ju-- Z-t='? d-/l,rr' NAME: �! ' -f 1.tYi d j , � ADDRESS: /(z/:Z7 'O iS J' Fle,, Gt. ', ) f GTt- T i)-e 17le`?, L, ,"7 X. :: -a PHONE NO. 3(. 6, C. 4''-:5= ' 9J 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. 10MOBILE HOME DATA: (A)MAKE 11."/i t-' (B)MODEL 1( -('/YI L)r 1 (C)YEAR cgd0 (D)LENGTH 7 � (E)WIDTH 7 ( SERIAL # /k 7et /OttrcIi k? V (G)YOUR PURCHASE PRICE(Do not include sales tax) //6 PURCHASE DATE "'� 2)PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE t TO QUESTION 3) (A)FROM WHOM DID YOU PURCHASE MOBILE I 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 ✓`7� Lot/Space# (C) IF NOT LOCATED IN MOBILE-)HOME PARK- NAME OF LAND OWNER: :_/-"- ' ,,.fir,/kL r . z >t,L.c-ESyl-c t/i LOCATION ADDRESS /6 t71 l"..,CX 4 t • . ,�: /___Arr l 14v2oei t 4 qe(36, REAL PROPERTY PARCEL#/DESCRIPTION CI)/c'(71 3 4 0 3 r - ; 1 1 1"7-,;\,:3 Signature of applicant THANK YOU FOR YOUR HEX:Pt U �3DNOV , X JO COSSELL. Property Technician ... -_._.,.,,,..,,,.., ..,.......,,wl„-aorIno-t.,AIHtUKALIHKU-UUI , , # � .' - L /. / AO '-/ / • '"`") r-', — ..- �� 2 f -' - - - _ _ r 'f '-s+ it 1!,r I(��i' im • -3 6 f NC)V 3 0 2005 e mu rm_—_ issommummommomes .- 1171111SE1111 1111 ■��.r UMNIMM wUM■ M g^ �u� �n�r s+■ ��o■ DINING IWNcw wnu ni . _ PA MY MM. �' MEEIE, Roots • in'cAea[la. '2 ��mimusomms 11' moon mammon t,. (: :::-1 \ N j/ i CAI}EORAL TWO OUT MASTER , BEDROOM No.1 LMNG ROOM 7 .1 BEDROOM 17'-q• No.2 9'4` iiilii 1111111101111 03uEn 6326CT14428 1,188 SQ.FT.)2BEDROOM-2BATHS-CATHEDRAL THRU-OUT • • QED 1 4 3 0 t %11T1 %t% 1 Ncv 30 05 02: 53p p. 2 r rz �; 4.. . . .' • !r �` 'mot ,. ii r � (' • • • . ?. 81 , . , , .. • . a et. ' ... i % v a w '� - 1 F4 N.--- T-- ^^ •1 ,fit• • o f d ' • .• '. . - • "► a . • h: _ .1 r . J ERFilligtig a. m IL 1; 43 w S,o A. ct a 1 ` s 1 9° i . i c x [ i , i Mi rill 1 X 11Q a BERM" # SAD i i 12a - - 0 MI D S0�1 t uU® • • SPECIAL CONDITIONS CASE # BLD05-00743 1.) The application was reviewed by the Jefferson County Department of Community Development staff on December 2, 2005 for the potential presence of Environmentally Sensitive Areas (ESAs) under the provisions of the Unified Development Code (UDC). After an initial Geographic Information Systems mapping review and an investigative site inspection, the following ESAs were confirmed to be present on the subject property: Susceptible Aquifer Recharge Areas. 2.) Aquifer Recharge Areas in Jefferson County are characterized by porous geological formations that allow percolation of the surface water into the soils and the underlying zone of saturation. Aquifers are geologic formations that contain sufficient saturated permeable material to yield significant quantities of water to wells and springs. Aquifers serve as the source of drinking water within most of the rural portions of Jefferson County. 3.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to groundwater aquifers. 4.) 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. 5.) The applicant is proposing to create or add 1764 square feet of impervious surface and 1892 square feet of land disturbing activities. Sections 6.6 and 6.7 of the Jefferson County Unified Development Code requires that your proposal shall adhere to Best Managment Practices (BMPs). 6.) 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. 7.) Jefferson County determined that this proposal is categorically exempt from review under the State Environmental Policy Act (SEPA) pursuant to WAC 197-11-800(1)(b)(i). 8.) The site plan as submitted with the building permit application on November 30, 2005 has been reviewed for consistency under the UDC, and has been approved by Jefferson County Department of Community Development. Any modifications, changes, and/or additions to the stamped, approved site plan dated December 2, 2005 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 9.) This approval is for a manafactured home installation and a garage only. Any future permits on this site are subject to review for consistency with applicable codes and ordinances and does not preclude review and conditions which may be placed on future permits. 10.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 11.) 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 113) 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). 12.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 13.) The building height is not to exceed 35 feet. 14.) Minimum setbacks from Cook Ave Ext and Hastings Ave W right-of-ways are 20 ft. Minimum side and rear setbacks are 5 ft. 15.) This parcel has been designated as Rural Residential 1:20 under the Jefferson County Comprehensive Plan Land Use Map effective August 28, 1998. 16.) A tank only septic permit (SEP05-00407) was approved on December 5, 2005 to connect to SEP02-00115, which is a system of 600 gallons per day. • 17.) Cook Ave Ext (C629317) is a county local access road. A road approac was reviewed under RAP05-00077, and an address of 104 Cook Ave Ext has been assigned to the parcel. 18.) A minimum of four(4) parking spaces are required for the single family residence and accessory dwelling unit (ADU). 19.) 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. 20.) This parcel is served by a public water system, City of Port Townsend. (c,,,---ON-6:86, JEFFEFAN COUNTY • r \u� - f I ! i l ,, DEPARTMENT OF COMMUNITY DEVELOPMENT *€` --- ` `� 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-445 Fax NOV 3 0 2005 q O www.co.jefferson.wa.us/commdevelopment SBIN�� Master Permit Application MLA: 0 5- b J . Project Description(include separate sheets as necessary): Tax Parcel ,/ Property --� Number: (X/0 T 30a j Size: ,_} Lt C(,E.., _,.,,f.-1 (acres/square feet) Site Address and/or Directions to Property: /t V Cccii /gte- C,tt, Property Owner(s)of Record:. / //a le, 'i' ( c)Gt,•fV1-12t, i . -t/d71fA k Telephone:,j G - i j--,,6//'3-y`�' Fax: 5tiyo- :3gl"--/�f y(: email: ,.7=S4.n t. ? 'v/q)eit:t.e, Mailing Address: / %/l Neiati/1 .s .AfyZ G� ,sTI �r�-r 7i 111e,i`i1 _J1 `1'�_7G7 Applicant/Agent(if different from owner):Telephone: Fax: /f69 email: Mailing Address: What kind of Permit?(Check each box that applies) X Building ❑Variance(Minor,Major or Reasonable Economic Use) ❑ Demolition Permit ❑Conditional Use[C(a),C(d),or C]** ❑ Single Fami� CI Discretionary"D"or Unnamed Use Classification ,Q4 Garage ttachedi/Detached ❑ Special Use(Essential Public Facilities)** ;IQ Manufactured Home ❑ Boundary Line Adjustment ❑ Modular ❑ Short Plat** ❑ Commercial* ❑ Binding Site Plan** ❑Change of Use ❑ 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.Across and right of entry to this property shall be requested and shall occur only during regular business hours. �ff ' U i{.. J Signature:`._../ l7Gi tet_ ,Ct-'t..t_—�- r ZCrt—/-) Date: /./ ,/::7/e 5--- 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 Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transr ruble respc/?,nsibility for/�dheri g to and complyin with the ESA. The Applicant has read this disci 'mer a d signs and dates it below. • Signature: ' v�[.t-/14%tc'✓" l,. LVLt1",lt-C-- Date: /{_`) /.3 L�.5—‘ G:\PeimitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc • OWNER BUILDER STATEMENT • The signer of this statement does hereby rtify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming theresponsibility o the Contractor for the proposed project. Signature: `�. j(i/'l�it-jt-mil G(Al024.-c_t4 Date: / 05 GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: lira/d n lit»ie_s 1 n�� ,Pi, r/ rr . . ri' (3 `') &,Y/- 7 541 (� t ) 41 753-� MAILING ADDRESS: ., l.`l //. c L EMAIL: i n �-e(�J''g%6 e 7 " .,5 • C.e=�,(e � flG it/} y t-t.1yl � li h hem 7y1 CONTRACTOR'S LICENSE S WAINS _ NUMBER: Pk e FE h'St j g k NUMBER li,4//ls /3 5.3 ARCHITECT/ENGINEER: j) ,/ I PHONE (3 G, ) 8 '-,75�j FAX::(-3416 )6% •7 5)11 MAILING ADDRESS: ='C.4%/r.}/ '� /C/ . eye -4'j EMAIL � il'-Y 1 Ce..t q o 1 he 1 es.,LG7t7 Ci tra-�Z ,r *a- : Kt,2e.liM ' ;s ,Write .l.Sar1/it� Project Type: Fran*Type: Bathrooms: Shore!' Type of Sewage Disposal: X New ,P,Wood Existing: f) 4 0 Sewer ❑ Addition ❑ Steel Proposed: Q Bank+"/f ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: A Individual Syst ❑ Repair 0 Masonry S P Permit# ( - I I J ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: O Private well ❑ Two Party Type of Heat: Proposed: A Public G/ems, Total: `'� Nape of System: cf f /i-rt TU-usLIe& 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 em loyees,etc) Current Proposed IBC Occupancy: IBC Type of i• s tion: Will you have Food Service? Yes / No If this is a Propane Tank and/or Applia + tion permit,mark all items below that apply: ❑ Underground Tank 0 Above ground a , Size of Propane Tank: ❑ Heat Stove ❑ Cook Stove ❑ W•••stov- ❑ Fireplace Insert ❑ Hot Water Tank ❑ 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 compon nts, including the reserve area. t=5k', lit Square Footage For Office Use Only Current Proposed Amount • Main Floor 1/S Y Consistency Review: 461,DU 2Nu Floor NIA Base fee: r n c 3rd Floor 4)//4 Additional Section: Mezzanine: Plan Check fee: Heated Basement 41/4 State Surcharge fee: T� Unheated Basement Pot Water Review fee: Other Unheated 911/Rd Approach fee: .APC I`] Garage/Carport 7t,. j TOTAL: $ d . ("3 ' Decks /�/ p 14 � Receipt Number: Other A Jk Cash/Check Number: 1 r ' ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish i t - , ) Initials: G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc 70 m _. ' C_? rnry :..►bore 1,1..,.?aito v. v r i ,_._ _ ,_ ......> : . , ,,,,... is._2,3 _,,,,,,,,,,,,.„ „t.,,,-, 'e, .r„ .., - ),.. .,„.: ' ..,1`,. if -4. A - 1t _L__54 eodli� Y IIIp f 1 I— R , *II j r/ . l � lOS+ �. ism � 7 i� t • —� I -.,_ 73 r I 1 . ____ 1iiii i. _ •: � 1 6OIY1 • 0 +*7)7, ,ff 1, aF_ • .,. 1.41,1p. 1 1 ... - — —— OOI l O__ (j sio,-ii _ , . r. ►r7 co ,._..4 _,,.:} _ _ —r_ + _ _(lr I— T a ! j j I I I I , j I I p �— — 1 — � i (F ! I I ! — j J i1rn a � b n _ ...,___ I , , , 1 , 1 , ____L__ : , , , . _ ..>\ . 4,.__ .._.. _I__- -_.-i I— I • I I 1 ; _-__ -•e.._4.,i_H' __.4L__. ____L,t'_'____1 .___,!____ - i.i l l . ..i t'.A1 r 1 1 1� o — . 9 ,„,,_ f,, , : : , .. . 1 r --- "--4-M ! 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