HomeMy WebLinkAboutBLD2005-00774 I3UILDING PERMIT APPLIC ON MLA05-00729
Review Type:I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD05-00774 Received Date: 12/16/2005
SITE ADDRESS: 871 BLACK BEAR RD
PORT TOWNSEND, 98368
OWNER: MICHAEL J ANDERSON PHONE: 360 379-4115
ANNE M PRESTON
PO BOX 446
PORT HADLOCK WA 98339
SUBDIVISION: Block: Lot: T30+
PARCEL NUMBER: 001294013 Section: 29 Township: 30 N Range: 01 W
CONTRACTOR: `(y n 034\"\ PHONE:
PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP NSFR w/Attached Garage
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW
VALUATION 242,501.00 MAIN: 1,120
CODE EDITION: 2003 ADD'L: 1,290 HEAT TYPE: EEE
OCCUPANCY: R_3 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: # OF STORIES:
CONST TYPE: 5N OTHER:
GARAGE: 484 SHORELINE:
CONST TYPE: SETBACK:
DECK: 640
BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: PUD
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 3 Prop: 3
Total: 3 Total: 3
IRouting Date7")..A.
ype Amount Paid By: Date: Receipt: pprlderif=rmit $1,794.55 INT 12/16/05 77600
3n Check $1,166.46 INT 12/16/05 77600
ite Building Code $4.50 INT 12/16/05 77600 JAN 4 2006
able Water Application $53.00 INT 12/16/05 77600 Jefferson County
Total: $3,018.51 et � Plenn���
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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 #: BLD05-00774 Received Date 12/16/2005
SITE ADDRESS: 871 BLACK BEAR RD Issue Date 01/6/2006
PORT TOWNSEND, 98368
APPLICANT: MICHAEL J ANDERSON PHONE: 360 379-4115
ANNE M PRESTON
PO BOX 446
PORT HADLOCK WA 98339
SUBDIVISION: Block: Lot: T30+
PARCEL NUMBER: 001294013 Section: 29 Township: 30 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
PROJECT DESCRIPTION: NSFR w/Attached Garage
CALL IN FOR THE REQUIRD INSPEC *NS THAT APPLY TO YOUR PROJECT.
SETBACKS: OR /�/Gx
UFFER: Ok OA 6,41
Footing: ek / //e24 j
Foundation: /-A3-46
Stormwater FINAL Approval:
Underground Plumbing:
Underground A sulatp n:Shear Wall : 'J Z%S Cl--- FINKIt. KO-4u"_<:i -- 0 SIZ Vb6
Sheathing:
Framing:/ Et. la0--40
Plumbing: O 114 `D1i,
Propane Tank/ Lines:
Insulation: a r-Lky 6V-- VWJk `'I.2S-o to
Sheetrock:
Septic Sytem Final Approval (If not on sewer):
Road Approach Final Approval:
Zoning Final Approval:
Final/Occupancy Approval: ('2.,-.-U(o
HEALTH DEPARTMENT ND 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 CE A BLD05-00774 •
1.) A Medium 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.
2.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
3.) 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).
4.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
5.) The building height is not to exceed 35 feet.
6.) Minimum building setback from Black Bear Road is twenty(20) feet. Minimum side and
rear yard setbacks are five (5) feet.
7.) A minimum of two (2) on-site parking spaces are required for the single family residence.
I:\F_BLD_Permit_Buildng.rpt 10/29/1999
‘--)ertAs°14
, JEFFERSI. _ tilIJNTY •
fDEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax q O/ www.co.jefferson.wa.us/commdevelopment
NINrS.
Master Permit Application MLA:
Project Description(include separate sheets as necessary):
N' Cr: i- ^,tr ,�u t 7/-" .5* l"rJ Cr:- '. 1 - �l tI
Tax Parcel "`�- Property
Number: DO }Zo(t l 0 I L Size: �. ,=-E �e3square feet)
Site Address and/or Directions to Property: e"f i E L A«Ir ;f A,k: la<)A-, ,pro! -
Property Owner(s)of Record: U tea A'4. k^j/;s p.!,, 4) ;' q,J,JE PPE 5^6n!
Telephone: (3(.0 f 37 — t i J c Fax: email:
Mailing Address: 4R e. 3J;( q a po gr- I-A :_.Lt.d..- i WA `- .3 a
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies)
(Building 0 Variance(Minor, Major or Reasonable Economic Use)
❑ Demolition Permit [i Conditional Use[C(a),C(d),or C]**
Single Fami�l Li Discretionary"D"or Unnamed Use Classification
Garage '/Detached ❑ Special Use(Essential Public Facilities)**
❑ Manufactured Home ❑ Boundary Line Adjustment
0 Modular U Short Plat**
❑ Commercial* fl Binding Site Plan**
❑ Change of Use [1 Long Plat**
❑Address H Road Approach U Planned Rural Residential Development(PRRD)/Amendments**
❑ Propane U Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis [i Shoreline Master Program Exemption/Permit Revisions*"
❑ Stormwater Management ❑ Shoreline Management Substantial Development**
❑ Site Plan Approval Advance Determination(SPAAD)* [1 Shoreline Management Variance
❑Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* [J 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 hery designate j to act as my agent in matters relating to this application for permit(s).
........--
WINNER SIGNAT ? Date: /'�Jc 7
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 iabilities,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 pdtmit.
I further dgree to provide access and right of entry to Jefferson County and its ernaloyees,representatives or agents for the sole purpose of application
review and any/required later jsrsp ions.Access and right of entry to this properly shall be requested and shall occur only during regular business
hours. ��/
Signature: -- �.
7 _ Date: l J
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 haste been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
acti94s)even if you are in co pf nce with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
a9d non-transferable i 'ity for adhering to and complying with the ESA. The Applicant has read this disci • er/ signs and dates it below.
ignature` �' '�`_�——_-_ Date: i? !L/z,
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 resRonsibility of the General Contractor for the proposed project.
Signature: ( L c-',A ‘ L‘ ('(- v" Date: ITJ. (10
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
LAIL:
) ( )
MAILING ADDRESS: ,J\
CONTRACTOR'S LICENSE y-� WAINS
NUMBER: \te V /it tt NUMBER
ARCHITECT/ENGINEER: V` ,`` "j PHONE ( ) FAX: ( )
MAILING ADDRESS: j EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
New .® Wood Existing: ❑ Sewer
'0 Addition CI Steel Proposed: Z•5 Bank ❑ Community System
0 Alteration/Remodel ❑ Concrete Total: 2.• Height: ' Individual System
CI Repair Repair Masonry EP Permit# • •-- ,:,) A0vg,
❑ Demolition 0 Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type of Heat: Proposed: 3 E Public
,_r-c-j-_r,— Total: 3 `Name of System: tt• •
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:
C I Heat Stove El Cook Stove [i Woodstove ❑ 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 components,
including the reserve area.
Square Footage For Office Use Only
Current Proposed •Y' Amount
Main Floor �� \ ConsistencyReview:
A Y'i 1L3
154
2Nu Floor ` 11:' Base fee: , -�1 Ci c ��'
•
3`0 Floor r Additional Section:
Mezzanine: Plan Check fee: b Li
Heated Basement State Surcharge fee: U
�\ 2,,..,b
Unheated Basement Pot Water Review fee: 1 (.;O
- s.ccL__
Other Unheated st 911/Rd Approach f
Garage/Carport � r� J`�
\0 ul -,, TOTAL: $ I CN 1 c'
Decks `�Y6 ° ceipt Number: —77 OO
Other ;,, .,��- ash/Check Number: 3,
,tv.;,, ' ' . 1.=op� Nr ',� \ sb7 tcz•
ESTIMATED COST(REQUIRED)
•Fair market value of all labor and materials founftaticii to f iiish \, /2-_/6,-O,3
4, ,, 1,9 r � )nitials:
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