HomeMy WebLinkAboutBLD2009-00223 IUILDING PERMIT APPLICA•N M�LA09-00Typ235
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD09-00223 Received Date: 7/15/2009
SITE ADDRESS: 201 OLD FERRY RD
e: I
PORT HADLOCK, 98339
OWNER: DANA A STOCKS PHONE: 425-891-4048
RICHARD A STOCKS
230 OLD FERRY RD
PORT HADLOCK WA 983399762 PORTAGE BAY PARK
SUBDIVISION: Block: Lot: 12+
PARCEL NUMBER: 989100011 Section: 1 Township: 29 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: JASON STOCKS PHONE: 206-683-65201
230 OLD FERRY RD
PORT HADLOCK WA 98339
PROJECT DESCRIPTION NEW ADU
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ADU MAIN: 1,008
VALUATION 96,677.00 ADD'L: 228 HEAT TYPE:
CODE EDITION: 2006 HEAT BASE: HEAT TYPE:
OCCUPANCY: R-3 UNHEATED: #OF STORIES:
OCCUPANCY:
CONST TYPE: 5N OTHER: SHORELINE:
GARA
CONST TYPE: DECKLE 180 SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: OTHER
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 2 Prop: 3
Total: 2 __Total: - a- __...
Routing Date: l
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $972.75 LYK 07/15/09 108805
Plan Check $632.29 LYK 07/15/09 108805
State Building Code $4.50 LYK 07/15/09 108805
Potable Water Application $62.00 LYK 07/15/09 108805
Total: $1,671.54
III •
�IsON ke, JEFFERSON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street• Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
Gft° www.co.jefferson.wa.us/commdevelopment JUL 1 5 2009 '3 j
Master Permit Application MLA: - 04 _a ")�
Project Description(include separate sheets as necessary):
Atces5t,ry 1�wc//:N5 go';/' (, )u )
Tax Parcel Number. '89/00 0// Property Size: 35;
/oo O (acre square feet)
Site Address and/or Directions to Property:
got otd Keely "Rd, /moo,! NA.d/oek , t,JR 51'331
Property Owner(s)of Record: }�;c.b.4 rd t- 1)A,vA Sfiocxs
Telephone: (4'2S ) $9/- 'fa' 8 Fax: email�Aiid S1.As e MS/y.C Doi
Mailing Address: .230 01 c/ /'e'r y fed eort ,4%J/oe k s0A- 9,ki 35'
,. ....., Applicant/Agent(if different from owner): -�a.ci r` 51 o c,K ,
Telephone: �O (,:c� l„S 0email:Fax:
/ �yr0k: ks_ 00e r41/ao.04'
Mailing Address: v 1- h P ey. /� PCY` tin ark ,=N1✓t `I G'..5 3 S`
What kind of Permit?(Check each box that applies
building 0 Critical Areas Stewardship Plan
171 Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use)
71 Single Family/i DU, 0 Garage Attached/Detached ❑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 ❑Boundary Line Adjustment
❑ Address 0 Road Approach ❑Short Plat**
❑Home Business ❑Cottage industry ❑Binding Site Plan'"`
❑Propane 0 Long Plat**
❑Sign
❑Allowed'Yes'Use ConsistencyAnalysis 0 Planned Rural Residential Development(PRRD)/Amendments•*
Y 0 Plat Vacation/Alteration**
j Stormwater Management $.,shoreline Master Program Exemption/Permit Revisions**
❑Site Plan Approval Advance Determination(SPAAD)* a horeline Management Substantial Development*•❑Temporary Use U Shoreline Management Variance
❑Wireless Telecommunication• ❑Comprehensive Plan/UDC/Land Use District Map Amendment
❑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 Conference
Please identify any other local,state or federal permits required for this proposal, if known:
fI S op/ ,Sf"p�kS DESIGNATION OF AGENT
I hereby designate J
to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE �?4 ,) /1 �7✓e-4, Date: 77ffil S
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 required later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the application hat he or he wants prior notice.
Signature: ,Ntn, , �f,,a.
Date: 7/9/o
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-transferabl pons ility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: -t�„e� / 9
Date: ��
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doe
IIMIIIIIIM
• •
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 assume the responsibility of the General Contractor for the proposed project.
. JC
Signature: /44.4. ✓1....51-ii.at Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: Fax:
( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
�, Wood Existing: 0 n Sewer
ri New fr (� Proposed: X.-� 3 Bank ❑ Community System
D Addition ❑ Steelonp Total: A� 3 Height: v 4 Individual System
i i Alteration/Remodel 0 Concrete jy-i y 5Ep Permit#
❑ Repair 0 MasonryBedrooms: Water Supply:
M. Demolition 0 Other: Existing: 0 Setback: ❑ Private well D Two Party
Type of Heat Proposed: _Ad._ x Public
e/e.lei c.. Total: a, Name of System:
If this is a Commercial Protect 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
Tsrnk and/or Appliance Installation permit,mark all items below that apply:
i Underground Tank i Above ground Tank Size of Propane Tank: A G I c c.4-v;c.
i Heat Stove X Cook Stove i Woodstove X Fireplace Insert XHot Water Tank i Pellet Stove i Other
Is this appliance being installed in a Manufactured I Mobile Home? Yes I e
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. t
Square Footage f Current Proposed wit tom_ 4yl:''r,, '' _.. Ai'hount 4:5_ I ice: .... 4
Main Floor Heated 14 = , EH Bld App Review: ��
/Dog
t Asa sa „: Consistency Review: '�f
2 Floor Heated aa8 C1,
Other Heated r' . Be y q r 7-5
Mezzanine I-, 'li-_I7
Heated Basement 7. Plan Check fee: rr ,,�
Y� �•
Unheated Basement 4 State Surcharge fee:
r
Other Unheated Pot Water Review fee: I c
Garage/Carport SUBTOTAL t[
•
Decks } U �rosch fee:
go . UT1UT9 a► 3_
Other TOTAL a---ic,
Receipt Number. I bg gp�
C44:0•;4:1..,.,.:-.... Cash/Check Number:
ESTIMATED COST(REQUIRED) Date: —(<j—
.Fair marks!value of alland materials foundation to finish Initials: �)
f¢1! op('/O
G:\PennitCcnter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
f+l p
t
rn Z N mm,'p {. , i�oam2a���
Z y -yio :::::(2,-,:;):8:-.0,v � � 2
O O �fv 2m,00nc,n2
'11 n Rl CO m.y ��m OOc)2
v --MI 2 r n
v Cc)NI
c �o�;2y� 2�� �
1� � �� 0 m�22m2 ��y0��
— � r00 0 2n��O�ap�
2 a 2
m n'I O c m o Z 2 0 2
2 c2� o ; k� �cr,1o�� 02z n
p �k tn0 n-00 22 '2
2.
V D 1vm cn� 2 ypa�cb��2a ��
o v a om no��c2jo 2�0�a
c r01 am0 �C. •
a��~�ZmO
w
�CO r m m � �� k01
�gz2v'Oc)2 i,,m
O 16
(n � 20 y i Opm�=O� O
�� �� �� O ��2200p �2p
fl
m In m 'ta m2pon 2 mho cp
O� o �o �m ma��0O2mnm
�r O� �1 �O �2r(ny �m�C��
O _NBld17' �� m Ck 20-.-.—< 2' _
30"W n2 O 2 2`1 rrl cn2v)� r_-<
• T Co
m 7? 9j� •
2� rn i �oaca�oaz�
�O m Za c ` J Oo�oro��"'�
ni
r pox ' yo (J ,r0Z�Oa� y
14
�� 0 0 ��YEEk:
sa____..........1 c.))"21. r'/) (.0 Ui.0c)
320' �2 ?��� 2mO�y
rri
J O q , r 1d7,3p W
r 87.76
I.
O � _, . � �
O `t` VIII c 1.
1111:
CO-
� r�
o
:0 \
i
/ - ) 1
cts
' .i i
f Dia
, i
L•
`'off st .{a A
0).... ir7 `lo
`'o
01
sod' a�
P/ S tl�77;3��.,J
zo
IA''1 c:
1601
71
�� _...__�._._.._
m2 4
0, 0,u, CO # IN
•
...4
A •
•
�o k
c:3
�+d =0 2
v jTwlaV Sld17T , •-\ II 6.---c.i wm
P La
1 0
r ' O y Il
•
•
;31
� 20
Qo\ / A _ _
�Q... Jm J7
( SA
O .
Zli
71
'' � / A y �': 2
• �� - aIf S,,D;
I2
t -1 i t ill 1
r I • a � 1
v 111/
I ( Ii'� I Ci
I I Ok
co
try
I
t ill
I ! t
01
0 ir
' ' n I L -!-Jtt L- ___-1 ....1
al.i9Z!
/ — — �� — 3 gj*Zpre N .._.
I\i
I►-
n w
m
Do
0
w m m
a .�r� •1S ��� tf1
v � mo
� �` t o �$
v wC �� ���, � m !:Zr
.) mA 20
H
O
Cri
wy m ii/ � m O
a a : tit �O a O
cn m a
a O p o O O
� =v ••en
�'°1
vm cl o„i
A Co �-► —
O N A
Z
CD
, . , .
A
O.
v' - �1
lI' V' W i' W
'° o \ w w
As
20-30
I I
(2. o
11111
11,
m m m
am/ ��— 71 --'�i �__�
40 68id 40 68id ��
N
m D 71
p n5
W
A ? �I Q 01 U N . N
w �I Q I w cn Do mm —+ O w m -,-i Q --+
-n =Lin I o
i
--
`° K 40-68i• ew — j I on
S I
® ._ I
N
o inw
I "' 30-68id
THHF
1:1 z I m
t L 14 I' I� L a o 0 W
` a v,
N —1 cn >OD I illi:
m O rlN
Li-, 70 '-1
° fl
n 3 N
W � CJ1
�0 COCO
-`1 0
C
N
(I m -
N cn ---A N
Q n
- ND
<
c-
' :.2--\i, •
AP
OD V' h- m I
-5 3 21 --a
_ p f l6 \ N
11
w cn Z
m
G) fTl Z rr-1 al
N Z O
Cn 0 W
I I
' 30 50 0 30 Sed 2�4-� 2-B
co N N. V' N 01 ti--
.s-- I 1 I� - - I -
m 01 0' W
-
i.
4 m
7u 0
n --1-- /\ \
6 6cr.' \l
1 \ n
O u)
�' /
v D
> a
C
CI'
1\)
C>
C-D
N r ' . A
N .A
J ,- i -
m
N N lir
26740 26 40
I I Ill I L
4
vl
N
D D-I -1 N
N (-72 m -I -I .i
:O 4L n (---)CD =
(21 •
CO
�1 U
gcr,2.(
b -I i
airai
N IiiP o ) ciy\-b'
m - N
_,N
\ / I a __, ,,D «i �. wN
N
N m
ro w =
rn
o `D
7 73
p 7D 0_ `D x
o 0
N —
n 000
rt
8- m -v
m O c. 0
w :rnQ O
cfl
m g0 ° D
a-
0 2 o 0
N , c
U
I O O
LIJ 1 N
-P o S.
1 C
Ni.
U
CT 3
Wi
N
O.
-h
m
i__ I III I
26-40 26-40
N
- N
-14
-------]
N N
Up Up
n 0
0 n
c / /\
D
O
N 0 `—'
Ii\ 70 /
J
D
cp
N D C
.
201 OLD FERRY RD / BLD09
STOCKS MLA09-235
te —/---hc(vez a)4
Approvals Req'd Prior
to Final Inspection
SEP
RAP
ZON
stPz
DPW
FEES OWED