HomeMy WebLinkAboutBLD2006-00143 itILDING PERMIT APPLICATal MLA06-00142
Review Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD06-00143 Received Date: 3/29/2006
SITE ADDRESS: 31 N DUQUESNE AVE
PORT TOWNSEND, 98368
OWNER: JASCHA KOZELISKY PHONE: 360-344-3269
912 S JACOB MILLER RD
PORT TOWNSEND WA 983689253
IRONDALE
SUBDIVISION: Block: 123 Lot: 15-19
PARCEL NUMBER: 962112307 Section: 34 Township: 30 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP NEW MFH ADU SER#19435 WOODRIDGE
TYPE OF WORK MOB SQUARE FOOTAGE:
TYPE OF IMP NEW
VALUATION MAIN:
CODE EDITION: 2003 ADD'L: HEAT TYPE:
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: # OF STORIES:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK. BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: PUD
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 2 Prop: 2
Total: 2 Total: 2
Routing Date: V k
Type Amount Paid By: Date: Receipt: C
PPOV r P
Permit $163.00 LYK 03/29/06 80951 v V
Potable Water Application $55.00 LYK 03/29/06 80951 APR ►8 2006
Total: $218.00
Jefferson County Planning
&Building Department
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JASCHA KOZELISKY
KOZELISKY
912 S. JACOB MILLER RD.
PORT TOWNSEND, WA 98368
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MAR 2 9 20O6
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___.... ELOPMENT
JACMi WESTERMAN If Jefferson C t.-Courthouse
ASSESSOR PO ilex 12 Port Townsend, W.% 98368
(360)305-9105
MOBILE HOME INFORMATION FORM fi
OWNER'S NAME/MAILING ADDRESS: MAR 2 9 2006
NAME: J0-SCIAc. Atc
ADDRESS: 912 yh tnes
PHONE NO. 3‘-Iq 32�, C}� a� f
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 1 HOME DATA:
(A)MAKE i-r i - A (B)MODEL In C O 1 (C)YEAR l 9 8
(D) LENGTH _! Lr Q v Q
(E)WIDTH Z Q (F)SERIAL # 1 T
(G)YOUR PURCHASE PRICE(Do not include sales tax) 7, 00 0 PURCHASE DATE!0'70`2bO.S
2)PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3)
(A) FROM WHOM DID YOU PURCHASE MOBILE PS
ci
ADDRESS , 0 . LAX ��
IP O� / P l l Z',C /t,^ (,.�/4 9G'"3�!
(B)WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST Y AR?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 To
(B)IF LOCATED IN MOBILE HOME PARK:
NAME &ADDRESS OF PARK Lot/Space#
(C) IF NOT LOCATED IN MOBILE HOME PARK:
NAME OF LAND OWNER:
LOCATION ADDRESS 7 1 N U U, u e3('.e__- -4 fou,, S e14,G,
REAL PROPERTY PARCEL #/DESCRIPTION 9 ('2 1I7_ 307
Signature f appli nt
THANK YOU FOR YOUR HELP!
;`�ssFQ Q
JOIN COSSELL, Property Technician -
• •
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#: BLD06-00143 Received Date: 3/29/2006
SITE ADDRESS: 4J &4-1k N DUQUESNE AVE Issue Date: 4/18/2006
PORT TOWNSEND, 98368
APPLICANT: JASCHA KOZELISKY
912 S JACOB MILLER RD
PORT TOWNSEND WA 983689253
SUBDIVISION: IRONDALE Block: 123 Lot: 15-19
PARCEL#: 962112307 Section: 34 Township: 30 N Range: 01 W
CONTRACTOR/ OWNER/BUILDER PHONE:
DEALER
PROJECT DESCRIPTION: NEW MFH ADU SER#19435 WOODRIDGE
MAKE: FLEETWOOD
YEAR: 1988
SIZE: 44X28
THIS PERMIT IS VALID FOR ONE YEAR.
THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR.
THE EXPIRATION DATE IS 4/18/2007.
CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT.
Setbacks/Footing (CONTINUOUS FOOTING, SLAB or PADS USED):t»L VtA 13c t•I'VVao
>c—t3 Cabil> ttfvb vF674-
Stormwater FINAL Approval:
Blockin Plumbing: mJit,Ats W Tlk I hiNtD it r4-rdt> `p- 'i2
Propane Tank/Lines
Zoning Final Approval:
Septic System Final Approval (If not on sewer):
Road Approach Final Approval:
Final/Skirting/Vents/Porches/Steps: --3O--0
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
ID •
SPECIAL CONDITIONS CASE # BLD06-00143
1.) The application was reviewed by the Jefferson County Department of Community
Development staff on April 5, 2006 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:
SARPA aquifer recharge area; coastal SIPZ, airport noise.
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 are defined as Seawater Intrusion Areas, and Special
Aquifer Recharge Protection Areas and the following land uses located within Susceptible
Aquifer Recharge Areas (1)All Industrial Land Uses (2)All Commercial Uses (3)All Rural
Residential Land Uses requiring a Discretionary Use or Conditional Use Permit (4)All
Rural Residential Land Uses with nonconforming uses that would otherwise require a
Discretionary Use or Conditional Use Permit (5) Unsewered Planned Rural Residential
Developments (6) Unsewered residential development with gross densities greater than
one unit per acre. All of the above listed uses shall be subject to the applicable
requirements and standards of the Jefferson County Unified Development Code.
5.) Marine shorelines and islands are susceptible to a condition that is known as seawater
intrusion. Seawater intrusion is a condition in which the saltwater/freshwater interface in
an aquifer moves inland so that wells drilled on upland areas cannot obtain freshwater
suitable for public consumption without significant additional treatment and cost.
Maintaining a stable balance in the saltwater/freshwater interface is primarily a function of
the rate of aquifer recharge (primarily through rainfall) and the rate of groundwater
withdrawals (primarily through wells). The Washington Department of Ecology is the
agency with statutory authority to regulate groundwater withdrawal for individual wells in
Jefferson County. New development, redevelopment, and land use activities on islands
and in close proximity to marine shorelines in particular should be developed in such a
manner to maximize aquifer recharge and maintain the saltwater/freshwater balance to
the maximum extent possible by infiltrating stormwater runoff so that it recharges the
aquifer.
6.) The parcel is located within a coastal SIPZ (seawater intrusion protection zone) according
to the County GIS map. There are voluntary and mandatory measures identified in the
Jefferson County Seawater Intrusion Policy(Resolution 44-22, effective September 23,
2002) that apply to well drilling proposals and building permit applications on existing lots
of record.
A Coastal SIPZ is defined as: all islands and area within one-quarter mile of marine
shoreline, but no history of chloride concentration above 100 mg/L in groundwater sources
within 1000 feet.
7.) 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.
8.) 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.
9.) VOLUNTARY MEASURES O"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.
10.) 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.
11.) 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.
12.) The property owner shall comply with Water Conservation Measures (per list maintained
by the UDC Administrator).
13.) The applicant is proposing to create or add 1962 square feet of impervious surface and
2092 square feet of land disturbing activities.
14.) 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.
15.) 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).
16.) The site plan as submitted with the manufactured home installation application on March
29, 2006 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 April 5, 2006 shall be
resubmitted for review and approval by Jefferson County Department of Community
Development.
17.) This approval is for a manufactured home installation with attached 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.
18.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
•
19.) 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).
20.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
21.) The building height is not to exceed 35 feet.
22.) 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.
23.) 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.
24.) Minimum setback from North Duquesne Avenue right-of-way and portion of unvacated
alley right-of-way(south boundary) shall be 20 feet. Minimum side and rear yard setbacks
shall be 5 feet.
25.) A minimum of two (2) on-site parking spaces shall be provided for the manufactured
home.
26.) The parcel is served by PUD water.
27.) The parcel has been designated as RR 1:5 under the Jefferson County Comprehensive
Land Use Map effective August 28, 1998.
28.) The lot was created through the Irondale#5 Subdivision on April 2, 1910 under AFN
29795.
29.) A building permit (BLD03-0686) for a manufactured home installation was finaled on
March 15, 2004. A road approach permit (RAP03-0246) was finaled on March 31, 2004.
A building permit(BLD04-0013) for an attached garage was finaled on March 5, 2004. A
septic permit (SEP03-0266) was finaled on March 12, 2004. A building permit
(BLD06-0144) for an attached garage will be issued with the manufactured home permit
(BLD06-0143) which is considered an ADU on this parcel.
30.) A Restrictive Covenant was recorded on March 29, 2006 under AFN 509629 for the
purpose of consolidating Lots 13-19, Block 123, Irondale Division 5 for installation of
septic and manufactured home installation only.
31.) JCIA is a community airport for civil aviation and has been designated an Essential Public
Facility by Jefferson County in accordance with the provisions of the Washington State
Growth Management Act and the Jefferson County Comprehensive Plan. Properties in
the vicinity of the airport may be subject to potential discomforts or inconveniences from
noise and vibration associated with aircraft takeoff, landing, over-flight, and normal ground
operations at the JCIA site. The County does not consider these inconveniences and/or
discomforts arising from such operations to be a nuisance as long as they are consistent
with Federal Aviation Administration regulations and standards. It is acknowledged that
areas lying outside the fixed boundary of the Airport Overlay I may also be subject to low
level noise and vibration. This information is intended only as a disclosure to property
owners and potential property owners of their proximity to the JCIA, and the potential for
low-level noise associated with airport activities.
32.) An address of 31A North Duquesne Avenue, Port Townsend has been assigned to the
parcel. North Duquesne Avenue is a county local access (C678509).
BUILDER STATEMENT 410
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 assumin
the res nsibility of the General Contractor for the proposed project.
Signature: j:'/ ' Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) I
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
k New Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed Bank Height: ❑ Community System
0 Alteration/Remodel 0 Concrete Total: r' Individual System
0 Repair El Masonry
S P Permit# 'L, (G r�
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: Ii Private well Cl Two Party
Type of Heat: Proposed: c 'Public
Total: ? 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:
[I Underground Tank ❑ Above ground Tank Size of Propane Tank:
❑ Heat Stove ❑ Cook Stove ❑ Woodstove n Fireplace Insert ❑ Hot Water Tank 11 Pellet Stove n 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 Current Propoaed For Office Use Only Amount Revision
Main Floor Heated R EH Bid App Review:
2"a Floor Heated Consistency Review: 1 3
Other Heated Base fee:
\., tO 3
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee:
Garage/Carport _ SUBTOTAL
Decks Of 1) ' 'r5cf `J ? oO
Other
TOTAL: $ . (e ,
Receipt Number: Q 9 1
Cash/Check Number: CPI
ESTIMATED COST(REQUIRED) Date: o)1 ��/
.Fair market value of all labor and materials foundation to finish
Initials:
ei5"/
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc
II
I
ioriV. JEFFER�COUNTY � -
A DEPARTMENT OF COMMUNITY DEVELOPMENT 4,1'
` '.4 621 Sheridan Street • Port Townsend •Washington 98368-
360/379-4450 • 360/379-4451 Fax
kq ' p� www.co.jefferson.wa.us/commdevelopm ,,
Master Permit Application MLA: lJ� AD
Project Description(include separate sheets as necessary): -_ J
f ) 1.✓ i 4i--(V /4✓iA-E , .'J L 1 .,e 5 9 •
Property
Tax Parcel Number: f?(. 7 // a. ',o 7 Size: / Z Ltd (acres/square feet)
Site Address and/or Directions to Property: / /�` 4 J c>0,(✓\vi c
Property Owner(s)of Record: mil-, Sc C,« /c-r-• ? /, Sky
•
-f
Telephone: ��c/4f- 3'z 9 Fax: email: J o_.>c� c:,iceZ..0 Ac 1-il,,,c,.' I,con
Mailing Address: 9/7 S ),;c r-i-, /"(, I( 1'7
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit? (Check each box that applies)
0 Building ❑ Variance(Minor, Major or Reasonable Economic Use)
❑ Demolition Permit ❑ Conditional Use[C(a), C(d),or Cl"
r, Single Fr-' " - 0 Discretionary"D"or Unnamed Use Classification
Garage (8Ytached%Detached ❑ Special Use(Essential Public Facilities)**
9,'Manufactured Home ❑ Boundary Line Adjustment
❑ Modular ❑ Short Plat**
❑ Commercial* ❑ Binding Site Plan**
❑ Change of Use ❑ Long Plat**
❑Address Li 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 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 inspections.Access and right of entry to this property shall be requested and shall occur only during regular business
hours. % r,
Signature: Date:^ C `
1
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 response ity r a ering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: ./ ,\ Date: --- : 7-'
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc
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