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HomeMy WebLinkAboutBLD2005-00781 •ILDING PERMIT APPLICATON MLLA05-00738 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00781 Received Date: 12/21/2005 SITE ADDRESS: 604 ROBBINS RD NORDLAND, 98358 OWNER: MICHAEL PONGONIS PHONE: 360-379-5260 CAROL PONGONIS 604 ROBBINS RD NORDLAND WA 98358 SUBDIVISION: Block: Lot: T 58+ PARCEL NUMBER: 921093012 Section: 9 Township: 29 N Range: 01 E CONTRACTOR: APEX CONSTRUCTION PHONE: (360)765-4374 PO BOX 807 PORT HADLOCK WA 98339 Contractor's License APEXC**000CZ Expires 1/16/2006 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP NEW POLEBARN - NO PLMBG -NO HEAT TYPE OF WORK GAR SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 30,000.00 ADD'L: HEAT TYPE: UH CODE EDITION: 2003 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: 1,080 SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: PWELL BEDROOMS: BATHROOMS: Exist: Exist: Prop: 0 Prop: 0 Total: Total: Routing Date: `aa0s Type Amount Paid By: Date: Receipt: Ap�prr+oved/Date. , Permit $441.75 INT 12/21/05 78779 A l HI U V E i Plan Check $287.14 INT 12/21/05 78779 FEB 2006 State Building Code $4.50 INT 12/21/05 78779 Total: $733.39 Jefferson County Plannim & Building Department • BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD05-00781 Received Date 12/21/2005 SITE ADDRESS: 604 ROBBINS RD Issue Date 02/6/2006 NORDLAND, 98358 APPLICANT: MICHAEL PONGONIS PHONE: 360-379-5260 CAROL PONGONIS 604 ROBBINS RD NORDLAND WA 98358 SUBDIVISION: Block: Lot: T 58+ PARCEL NUMBER: 921093012 Section: 9 Township: 29 N Range: 01 E CONTRACTOR: CHERRY STREET BUILDERS PHONE: (360) 379-5595 1002 CASS ST PORT TOWNSEND WA 98368 Contractor's License: CHERRSB975KZ Expires: 5/9/2007 PROJECT DESCRIPTION: NEW POLEBARN - NO PLMBG -NO HEAT CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. SETBACKS: * .z/9/Z, UFFER: �o Footing: D!(td/ird-/usf.f L4 pBwo .A 1 - Foundation: S,E AWE (Maw awe. Stormwater FINAL Approval: Underground Plumbing: N,,4 Underground Insulation: Shear Wall : Sheathing: Framing: Oa( 4/7-5/e .gV Plumbing: N/q Propane Tank/Lines: Insulation: Sheetrock: Septic Sytem Final Approval (If not on sewer): Road Approach Final Approval: Zoning Final Approval: Final/Occupancy Approval: 1€' CeyttuScr+or)c a 4)/Nk, HEALTH DEPARTMENT AND 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 rye•' "u .JEFFER COUNTY _ ` DEPARTMENT OF COMMUNI t _.. LQPME NT ` 't fr I , e gg f 621 Sheridan Street•Port Town ' g&3fi i , 360/379-4450- 360/379-4451 Fax �it � www.ca.je#erson.wa.usJc f ' 2 1 2005 Master Permit Application ... MLA:' 0 �.�-- 11-' g Protect Description(include separate sheets as necessary): ''X3t! F'oLl 4, ArRrU D• �iKrb�Q; /tj'�+ QiA.4 Tax Pam! Number: (7 / — 0 e 3 P/A- Size: /O fie:eC5 (acres/square feet) Site Address artdtflrDirections to Property: lvg Rd/3/3,kis K.t, NeRr-,I it!;, it,Pi i$ .3 S j Property Ownerf$of Rem: /t t K F' o iv c} ill j 5 ' Telephone: :3 60--.3 7 7-._� 6 0 Fax: email: Mailing Address: F'€st. RO i9//V3, pimp , I o R D L A N p / U/4 : 0 9 3:s�' - 9‘ 2;z.. Applicant/Agent tit different from owner): ,9- PFX l'c427,s a c ire A) _Tijc., Telephone: 3i-iO -.33-4/3'7S1 Fax: 3 6 c, -73.2— 3 7,5 email: Mailing Address: PC C ' o t> J�nt'T t/ DR i-cam' What kind of Permit?(Check each box that applies) Buddi#ie oCriiorr Pemhit ng u Variance(Minor.Major or Reasonable Economic Use) u Dg ton u Conditional Use[C(s),C(d),or q•*, Discretionary"D"or Unnamed Use Classification )C Garage Attached 1 Detache. _ Special Use(Essential Public Facilities)** L Manufactured Home BoundaryLme Adjustment _ Modular C Short Plot Commercial* Site Plan*. L. Change of Use _ Long Plat** • Address i Road Approach i; Planned Rural Residential Development(PRRD}lArnendments** L. Propane u Plat Vacation/Alteration** Alloned"Yes'Use Consistency Analysis L. Shoreline Master Program Exemption&Pei hit Revisions'* _ Stomwwater 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 Tell' L. Jefferson County Shoreline Master Program Amendment . Forest Practices Act/Release of Six-Year Moratorium 'May require a Pre-Appliicaiion Conference Requites a Pre-Aptcation Conference Please identify any other local,state or federal permits required for this proposal,if known: ( DESIGNATION OF AGENT l hereby designate to act as my agent in matters relating to this applicationti for permit(s). DER SIGNATURE f7 belt G*-7 Date: r/Z //� 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. 1 further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorneys 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 orfor the sole agents purpose of alrpiiwtitn l review and any required later inspections.Access and right of entry to this property shall be requested and shall occur only during regular business ltrrs. � /J Signature. S ///!�" " L -1 r d-rule'... Date: I Z/Z i /L/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. My 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-ts to iafel.tAe T`espo ty to and complying with the ESA. The Signature: .i?l4( Z Applicant has read this disclaimer and signs and dates st below. Date: / 2/'7 / /b S— i I C:\Documents and Settings\wochil\Desktop\Master Permit Application 7-8-04,doc I i ' I IIIOWNER 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: GENE2g C_ r.:v5-kvLCA10ry CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: ° /i L 4 31 4 FAx:3 7 3 Z. .Z S ,7 � Imo`/ L {( , - ., � MAILING ADDRESS: f o 13 e g- q0-7 A-4- R K'1 OCk A l5 ? 7 CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage age Disposal: X.New Li Wood Existing: a Sewer ❑ Addition >r Steel Proposed: Bank ❑ Community System • Alteration/Remodel E Concrete Total: Heigh: , U Individual System -7 • Repair 0 Masonry Bedrooms: __// SEP Permit# 2 Demolition C Other. Water Supply: Existing: Setback: Type of Heat: Proposed: Private well _ Two Party Public £, Total: Name of System: If this is a Commercial Protect you must answer the following: 2/ Number of Parking Spaces: Current Proposed: �� Number of ADA Parking Spaces: Number of occupants(includes owners,t n ts,employees,etc) Cu ent 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: ' 7///// I Underground Tank I Above ground Tank r2 / Size of Propane Tank: I Heat Stove I Cook Stove I Woodstove r F' ace Insert I Hot Water Tank I Pellet Stove 1 Other Is this appliance being installed in a Manufa ured I Mobile Home? Yes I 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 _ado nt Main Floor co 241'Floor Base fee: ':: .l; d 1 3f°Floor Additiociibn1 2005 ,.,s M �� Mezzanine: Plan Check fee: I an fLl ,`1 State Surcharge fee: Heated Basement i 4.50 Unheated Basement Pot Water Review fee: Other Unheated 911/Rd Approach fee: Garage/Carport c y 36 //`8() TOTAL: $ S ' /� Decks Receipt Number: t 8 Tic( Other Cash/Check Number: 9‘(P' vg EST* et a of al Date: i 0(1 165 au et value of all la and mat " Is foundation to finish Y� © g ci} Initials: C:\Ducuments and Settings\mochil\Desktop\Master Permit Application 7-8-04.doc SPECIAL CONDITIONS FOR CM A BLD05-00781 • 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.) 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. 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.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 7.) 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). 8.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 9.) The building height is not to exceed 35 feet. • 10.) Minimum setback from Robbins Rd right-f-way is 20 ft. Minimum side and rear setbacks are 5 ft. 11.) 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. 12.) The applicant shall fully adhere to all conditions and requirements of the eagle habitat management plan dated February 2, 2006.. I:\F_BLD_Permit_Buildng.rpt 10/29/1999 N Zd Zm a y x Cl) mrA �.� �! m ovrn C !�t CX .D CD W V O CD -- o o � C -33d` 6 Ra�B�ti� �O/kD $rs 33 0 I