HomeMy WebLinkAboutBLD2008-00350 •UILDING PERMIT APPLIC•ON MRLAOB-OOpe374
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD08-00350 Received Date: 8/4/2008
SITE ADDRESS: 5131 DOSEWALLIPS RIVER RD
BRINNON, 98320
OWNER: MILLY V NORWOOD PHONE: 360-387-9611
N STEPHEN NORWOOD
298 ROCKY MTN HIGH RD
CAMANO ISLAND WA 982826527
SUBDIVISION: Block: Lot: TX 5
PARCEL NUMBER: 602302001 Section: 30 Township: 26 N Range: 02 W
CONTRACTOR: ALL PURPOSE STRUCTURES PHONE: 800-678-7761
P 0 BOX 367
SUMNER WA 98390
Contractor's License ALLPUS1110NH Expires 8/5/2010
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI NEW DETACHED POLE BLDG - UNHTD, NO PLMB
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION 30,000.00 ADD'L: HEAT TYPE: UH
CODE EDITION: 2006 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY:
OTHER:
CONST TYPE: GARAGE: 720 SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: OTHER
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 0 Prop: 0
Total: 0 Total: 0
Routing Date:
Type Amount Paid By: Date: Receipt: Approved/Date
APPROVED
Permit $441.75 LYK 08/04/08 100720
Plan Check $287.14 LYK 08/04/08 100720
State Building Code $4.50 LYK 08/04/08 100720 SEP a ? 2008
Total: $733.39 Jefferson County Planning
& Building Department
Jefferson County Building Dion Permit Num. BLD08-00350
Applicant: NORWOOD
BUILDING PERMIT INSPECTION APPROVALS \pplicable Code: 2006 International Building Codes
To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection.
Requests received after 7:00 AM will not be scheduled for that days inspections.
ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries.
The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection
Inspection Item Date Approval Signature Notes
Setbacks )D... _tX
�}
Post Holes
I0._20_K `7cr W t�
Footing Drains
Framing h/21>IG:1 i
Blocking
Drywell/Alt Drainage
- Address Posted
vL saiLbacic. S4-42- cor,Dot-.or f 1
FINAL INSPECTION //A/D r -ice'
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
•
CONDITIONS for Building Permit# :BLD00350
1.) A MINIMUM OF 50' MUST BE MAINTAINED BETWEEN THE PROPOSED WELL AND
EDGE OF SEPTIC TANK. SEPTIC TANK MUST BE A MINIMUM OF 5' FROM THE
FOUNDATION.
2.) Residential developers and individual builders shall be required to preserve shoreline
vegetation and reduce the associated risk of erosion during construction and any future
activity which may impact the stability of the shoreline.
3.) 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.
4.) Per the"Notice to Public": The identified Fish and Wildlife Habitat Area (Type 1 Stream),
shall maintain a vegetative buffer setback of 150-feet. The setback shall be measured
horizontally from the Ordinary High Water Mark (OHWM) to any future proposed
development.
5.) Per the"Notice to Public": An additional setback of five (5) feet is required from the edge
of the buffer area to any future proposed development.
6.) Per the"Notice to Public": A permanent physical separation along the boundary of the
buffer area shall be installed and permanently maintained. Such separation can include
installing logs, trees, a hedgerow, or any other prominent physical marking approved by
the UDC Administrator.
7.) Per the "Notice to Public": Buffer perimeters shall be marked with temporary signs at an
interval of one per parcel or every one hundred (100) feet, whichever is less. Signs shall
be in place prior to and during construction activities. The signs shall contain the following
statement: "Buffer- Do Not Remove or Alter Existing Vegetation."
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.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
10.) The building height is not to exceed 35 feet.
11.) Minimum setback from Dosewallips River Road is 20 feet. Minimum side and rear
setbacks are 5 feet. Shoreline and Critical Areas may further affect setbacks.
12.) Work within the jurisdiction of the Shoreline Master Program other than as described
above shall receive separate review from this Department.
13.) No fill or other material may be placed in the waters or intertidal areas of Jefferson
County.
�4�¢go1V c�b� JEFFERSOOUNTY S
,. DEPARTMENT OF COMMUNITY DEVELOPMENT
`4 621 Sheridan Street • Port Townsend • Washington 98368
360/379-4450 • 360/379-4451 Fax
�q�, �K,p', www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: (. J
ci
Project Description(include separate sheets as necessary):
CDC)Sk-• nth Cd Di{ x s-tarc`6cj
Tax Parcel Number: LD 0 L C 0(7 , Property Size: e 0 g . .D g (acre)quare feet)
Site Address and/or Directions to Property: 5 .-J` - 7ip�. \&\\\ (JS R._6c-ir-in Rar)i 0,3,4
Property Owner(s)of Record:-_`fit OCK-U3OZDA
Telephone: '(oO - 387 q(al Fax: email:
Mailing Address: 5131- 'ju,ctza,\1ieS Z3, (104:31n l9-1Pt. 9 Zf)
Applicant/Agent(if different from owner): Ot'ei[k•l Qpl,I40 �
Telephone: o Z ig Fax: ZS&S(o ! i 3 email: 5mp r-m`-c (,t(�
Mailing Address: Po �3(c mt-uf- W1- Ct� y] 0l MCA
What kind of Permit?(Check each box that applies
❑Building 0 Critical Areas Stewardship Plan
❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use)
❑Single Family Garage Attached Detached 0 Conditional Use[C(a),C(d),or C]**
❑ Manufactured Home 0 Modular ❑ Discretionary"D"or Unnamed Use Classification
❑ Commercial* 0 Special Use(Essential Public Facilities)**
❑ Change of Use 0 Boundary Line Adjustment
❑ Address 0 Road Approach 0 Short Plat**
❑Home Business 0 Cottage Industry ❑ Binding Site Plan**
❑ Propane 0 Long Plat**
❑Sign 0 Planned Rural Residential Development(PRRD)/Amendments**
0 Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration**
❑ Stormwater Management 0 Shcreline Master Program Exemption/Permit Revisions**
❑Site Plan Approval Advance Determination(SPAAD)* 0 Shcreline Management Substantial Development** . _ ___
❑Temporary Use 0 Shoreline Management Variahce .
❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment 1
❑ Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment
*May require a Pre—Application Conference ❑Tree Vegetation Request
**Requires a Pre-Application Conferer{W G - 4 2008
Please identify any other local,state or federal permits required for this proposal, if known: 1
DESIGNATION OF AGENT
I hereby designate ` `_.._ ( r )
g � P OK,Y ZS _ to act as my agent in matters relating'to this application for'pet"rrilt(s)�-
OWNER SIGNATURE IC
--II I
C--
By Date: Vl l�
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 its 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 9aquired 1 er inspections. Staff' ccess and right of entry will be assumed unless the applicant informs the County in writing at the
time of the ap a;a the or e nts r notice.
Signature: ��
r
Date:
The action or action 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 no violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)even if y are in pliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transf res �iibbiillity or eri nd complying with the ESA. The Applicant has read this dis laimer n signs and dates it below.
Signature: LLLLLL`.� �v " Date: �2 r
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
• BUILDER STATEMENT •
The signer of thi st to t does h e certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be a u n t spo y of the ',era/Contractor for the proposed project. �/—,'— C/
Sign ure: Date:
GENERAL CONTRACTOR OR MANU CTURED HOME INSTALLER: PHONE: FAX:
tit R - �sr(nc- (ems(0Z, Vp�--- 5-'s(-ter(' voz(44-3
MAILING ADDRESS: �JC c J07 !.�' rY1,- ,- (J, EMAIL:V(}�I�L Hsi'. n-&r r(
CONTRACTOR'S LICENSE r WAIN n
NUMBER: A'L L 7t&'S3 I�D K4- NUMBER `4
ARCHITECT/ENGINEER: -n S 1 PHONE ( T(Q u- X:( ) 02 7 j Li 0 3
MAILING ADDRESS: `Pp rO -3 (a.1 • EMAIL
Pr9joct Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
New iood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank I] Community System
❑ Alteration/Remodel ❑ Concrete Total: Height: Individual System
❑ Repair ❑ Mason SEP Permit#
❑ Demolition IIth :f'0- Bedrooms: Water Supply:
Existing: \ Setback: Private well ❑ Two Party
Type of Heat: Proposed: ❑ Public
n I a' Total: Name of System:
If this is a Commercial Project you must answer the following:
Number of Parking Spaces: Current: a.- Proposed: ate- Number of ADA Parking Spaces-..----__
Number of occupants(includes owners,tenants,employees,etc) Current Proposed
IBC Occupancy: J" I'-12 IBC Type of construction: \/'v Will you have Food Service? Yes / 'lo
If this is a Propane Tank and/or Appliance Installation permit, mark all items below that apply: Iv fe
1 Underground Tank i Above ground Tank Size of Propane Tank:
i Heat Stove i Cook Stove i Woodstove i Fireplace Insert i Hot Water Tank 1 Pellet Stove i 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 Proposed For Office Use Only, twx,,.. y 1. ,:o le. 1.. : h
Main Floor Heated EH Bld App Review: /-JJ
l�
2nd Floor Heated Consistency Review:
. 1 5:---1
Other Heated Base fee: '12-1 1 7�7
Mezzanine d tt 7ectiort;_.
Heated Basement Plan Check fee: „0-N g 1 t 1
•
Unheated Basement State Surcharge fee: 1
Other Unheated Pot Water Review fee: .
KID A HPD
Garage/Carport -1W 1 C'gCT`) {, SUBTOTAL 3�.
f, 77 1
Decks 911/Rd Approach fee:
Other TOTAL: $
Receipt Number: ICI`-12---c
Cash/Check Number: LC
ESTIMATED COST(REQUIRED) Date:
•Fa' aet value of all labor and materials foundation to finish _
f, �"I L� Initials: �— r�j
rk
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— ALL-PURPOSE P.O.BOX 367-1408 HUBBARD-SUMNER,WA 98390
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