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HomeMy WebLinkAboutBLD2006-00171 ItILDING PERMIT APPLICATION M Review T0165 Type: I Jefferson County Department of Community Development 621 Sheridan Street Pori Townsend, WA 98368 PERMIT #: BLD06-00171 Received Date: 4/10/2006 SITE ADDRESS: 133 GLACIER RIDGE RD QUILCENE, 98376 OWNER: HANS M GLITSCH PHONE: 360-680-9016 CATHERINE E GLITSCH 6650 OAK BAY RD PORT LUDLOW WA 98365 GLACIER RIDGE DIVISION ONE SUBDIVISION: Block: Lot: 6+ PARCEL NUMBER: 601225006 Section: 22 Township: 26 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTION NEW SFR ALSO A/G 500 GAL PROPANE TANK TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION 94,003.00 MAIN: 1,440 CODE EDITION: 2003 ADD'L: HEAT TYPE: OCCUPANCY: R_3 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: CONST TYPE: 5N OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: PWELL BEDROOMS: BATHROOMS: Exist: Exist: Prop: 2 Prop: 1 Total: 2 Total: 1 Routing Date: Type Amount Paid By: Date: Receipt: /� Pprav�edttiVi E r Permit $958.75 KAS 04/10/06 81055 /�-1 r� l �„� Plan Check $623.19 KAS 04/10/06 81055 MAY 1 '1 2006 State Building Code $4.50 KAS 04/10/06 81055 Potable Water Application $55.00 KAS 04/10/06 81055 Jefferson County Planning Total: $1,641.44 & Building Department eoluitsvr •- )N i • BUILDING PERMIT Jeffe County pm o 621rson SheridanDe Streetart, Portent Tf ownsendCommunity, WA 98368 Development (360)379-4450 FAX (360)379-4451 PERMIT #: BLD06-00171 Received Date 04/10/2006 SITE ADDRESS: 133 GLACIER RIDGE RD Issue Date 05/17/2006 QUILCENE, 98376 APPLICANT: HANS M GLITSCH PHONE: 360-680-9016 CATHERINE E GLITSCH 6650 OAK BAY RD PORT LUDLOW WA 98365 SUBDIVISION: GLACIER RIDGE DIVISION ONE Block: Lot: 6+ PARCEL NUMBER: 601225006 Section: 22 Township: 26 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: PROJECT DESCRIPTION: NEW SFR ALSO A/G 500 GAL PROPANE TANK CALL IN FOR THE REQUIR D IN PE TIONS THAT APPLY TO YOUR PROJECT. SETBACKS: .7 };0 UFFER: '7 rt• Q Footing: 2t{f o(p mow _ Foundatio : Stormwater FINAL Appr val: Underground Plumbing: 7 ti. ,- -t--/1,pt 7 71fQ& Underground Insulation: 7 _ _f Shear Wall : Sheathin • Framing: 7 o7 Plumbin . Propane nk i es: 1)s—"t t_(.el Insulation: '3 q 7 / Sheetrock: (1407 Septic Sytem Final Approval MUST be obtained before final of structure can be attempted. Road Approach Final Approval: Zoning Final Approval: Final/Occupancy Approval: 1/21 f a" 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 • •SPECIAL CONDITIONS FOR CASE A BLD06-00171 • 1.) A vegetative buffer of 30-feet shall be permanently maintained from the top or edge of the Landslide Hazard Area. All buffers shall be measured perpendicularly from the top of the Landslide Hazard Area. 2.) Landslide Hazard Areas and their associated buffers shall remain naturally vegetated. Should buffer disturbance occur during construction, the Unified Development Code (UDC)Administrator shall require replanting with native vegetation. No alterations shall be made to the Landslide Hazard Area or its associated buffer without prior authorization by the UDC Administrator. 3.) Prior to and during approved construction activities, the perimeter of the landslide hazard area buffer shall be marked with a temporary sign. The sign shall be placed in such a manner that it can be directly observed from the construction area. The sign shall contain the following statement: "Landslide Hazard Area and Buffer- Do not Remove or Alter Existing Vegetation." 4.) All construction activities shall not encroach upon the buffer. This includes the storage or preparation of materials. 5.) The applicant shall permanently separate the boundary of the Landslide Hazard Area Buffer from the remainder of the subject property through installing logs, trees, a hedge row, or any other prominent physical marking approved by the UDC Administrator. 6.) The identified Fish and Wildlife Habitat Area (Type 5 Stream), shall maintain a vegetative buffer setback of 50 feet. The setback shall be measured horizontally from the Ordinary High Water Mark (OHWM) to the Single Family Residence. 7.) An additional setback of five (5) feet is required from the edge of the buffer area to the proposed Single Family Residence. 8.) 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. 9.) The building height is not to exceed 35 feet. 10.) Minimum front yard building setback is 20 feet. Side building setbacks are 5 feet. Rear setback is 250 feet. 11.) A minimum of two (2) on-site parking spaces is required for the single family residence. I:\F_BLD_Permit_Buildng.rpt 10/29/1999 ' .�ON C �4� o�� JEFFERS COUNTY i�♦ V, , `'ice ,� DEPARTMENT OF COMMUNITY DLOPMENT 1" v , ` 621 Sheridan Street • Port Townsend •Washington e 360/379-4450 • 360/379-4451 Fax �1�41)��►► �gS, NO2p� www.co.jefferson.wa.us/commdevelopment Master Permit Application JEFFERSON COUNTY ACM Project Description (include separate sheets as necessary): G.lac�4' IR,t'ci.v1e ©Use s� �► l� Pro erty Tax Parcel Number: 60 1 2 Z S©O6 Size: 5 GiC=G es (acres/square feet) Site Address and/or Directions to Property: 133 I c o to N i Icdt , 6 Rol QU t"(Ce✓t,. • (VA 993 76 Property Owner(s)of Record: y�y G f � v- L. ,� Telephone: Fax: email: Mailing Address: rx ( uy ., POO 1 L I.•,'Cow, k/if GIg3 6,> Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: WFlat kind of Permit?(Check each box that applies) Building ❑ Variance(Minor, Major or Reasonable Economic Use) ❑ Qemolition Permit ❑ Conditional Use[C(a), C(d),or C]** Single Family ❑ Discretionary"D"or Unnamed Use Classification ❑ Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** ❑ Manufactured Home ❑ Boundary Line Adjustment ❑ Modular ❑ Short Plat** ❑ Commercial* ❑ Binding Site Plan** ❑ Change of Use ❑ Long Plat** ❑Address [1 Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** lOropane ❑ 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 an right of entry to this property shall be requested and shall occur only during regular business hours. J�� � Signature: — Date: f O S/a,006 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 rile a lawsuit on behalf of an endangered species regarding your action(s) even if you are in compliance with the Jefferson Count development code.The Applicant acknowledges that he,she or it holds individual and non- transferable res ibility for adherin o nd ompl i g with the ESA. The Applicant has read this disclaimer and sign,s an tes i below. Signature: �l _ Date: el z ,0 G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc • 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 responsibi ty of the eneral ontractor for the proposed project. Signature: fi�Avt/k.4 - Date: 1/ 7 ZOO ,, Eli �IL�4 I E4e(� E ) GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) , ( i, Witt MAILING ADDRESS: EMAIL: i tt I J 'i"'W CONTRACTOR'S LICENSE WAINS NUMBER: ARCHITECT/ENGINEER: NUMBER PHONE ( ) JEEt EllSUN Vi ,Q:01Q MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New ❑ Wood Existing: 0 ❑ Sewer ❑ Addition V Steel Proposed: I Bank Height: ri Community System ❑ Alteration/Remodel ❑ Concrete Total: I Individual Syilep i ❑ Repair i-I Masonry Npc SEP Permit# b_ ❑ Demolition 1 i Other: Bedrooms: Water Supply: Existing: 0 Setback: A/Private well !I Two Party Type of IHeat: I Proposed: 2 ❑ Public e(ec-f Irj c- 'hyd o61t(; Total: Z r—v Nae fS 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 I\1AAbove ground Tank Size of Propane Tank: .500 q 0,I I ;1 I 1 Heat Stove ❑ Cook Stove ❑ Woodstove I I Fireplace Insert ❑ Hot Water Tank i] Pellet Stove P',l/Other 9etile IP-af0✓' Is this appliance being installed in a Manufactured/Mobile Home? Yes /to 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 Proposed Fo icg Use pnly Amount Revision Main Floor Heated j © �0 H BId App Review: j0c3 0� 2"°Floor Heated 1 Consistency Review: l 5 3 a 4 Other Heated Base fee: 9 (6-, 15 Mezzanine Additional Section: Heated Basement Plan Check fee: ( 3• Unheated Basement State Surcharge fee: Li.5—'0 Other Unheated Pot Water Review fee: ()‘h . O Garage/Carport SUBTOTAL atili' �Ii Decks 911/Rd Approach fee: 94 t' Other TOTAL: $ ` 8 Oikt,lA u Receipt Number: 10 J 1 Cash/Check Number: toJc1 ESTIMATED COST(REQUIRED) Date: LA ' •Fair market value of all labor and materials foundation to finish Initials: 4 4 0,000 G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc II ,4 • V •N t O OD Sit knW Aft iL'MG 3 m .. Uvv N g N e _‘1;3 -L .fa) m Sir y H /W cep K %* i,K L> vfD 6 ch ,. W0. 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