HomeMy WebLinkAboutBLD2009-00268 BUILDING PERMIT APPLICA•N B Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD09-00268 Received Date: 8/11/2009
SITE ADDRESS: 150 ADELMA BEACH RD
PORT TOWNSEND, 98368
OWNER: STIG KJELL OSTERBERG PHONE: 360-385-1121
HEIDE MARIE C BRANDT
1119 LAWRENCE ST
PORT TOWNSEND WA 98368-6525
SUBDIVISION: Block: Lot: TX F+
PARCEL NUMBER: 001324031 Section: 32 Township: 30 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: RICHARD BERG ARCHITECTS PHONE: 360-379-8090
719 TAYLOR ST (360) 379-8324
PORT TOWNSEND WA 98368
PROJECT DESCRIPTIOI' RE-ROOF & PITCH CHANGE
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION 15,000.00 ADD'L: HEAT TYPE:
CODE EDITION: 2006 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 0 Prop: 0
Total: 0
Routing Date: Cr-
3-I t-o°1
Type Amount Paid By: Date: Receipt: APFRcVEP
Permit $251.25 LYK 08/11/09 110717 AUG a 42009
Plan Check $163.31 LYK 08/11/09 110717
State Building Code $4.50 LYK 08/11/09 110717 Jefferson County Planning
&Building Department
Total: $419.06
• 411
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JEFFERSON COUNTY
W 144 DEPARTMENT OF COMMUNITY DEVELOPMENT
` `4) 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
4 p'$ www.co.jefferson.wa.us/commdevelopment
'Is.
Master Permit Application MLA: 00 n 1( A. fkr.01
Project Description(include separate sheets as necessary):
I,LEW igeof .RAt— WC, MID Rd,>F(Wes DV'VR CAR.9oR.T at OFFICE
Tax Parcel Number: 040 (-- 37.4 • D',S( Property Size: (acres/square feet)
Site Address and/or Directions to Property: (SO APEL'MA PW Co RC.
PORT Toww$ mot), WA 96348
Property Owner(s)of Record: 'Sf 16 C TeR.E.Cs * l41;C D t latex NI'1)1
Telephone: 3 85 kV?...t Fax: email: kith a a t p J s.net
Mailing Address: (56 ADEL-I AA 13EicC1& R.D. PoRa'710 0 61VeNQ, wA 9 8 Sb&
Applicant/Agent(if different from owner): R(CHARRD BE5126 A44RCO (TrcT3 PC-
Telephone: 31 q-eto9 o Fax: S 7'4' e 3 Z.cf email: r•I'e,kard.el
Mailing Address: r[ckardloe Arch siCctS.Co
What kind of Permit?(Check each box that applies 0 Lot or Road Segregation J m
Building 0 Critical Areas Stewardship Plan
❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use)
Single Family ❑ Garage Attached/Detached El Conditional Use[C(a), C(d),or C]**
❑ Manufactured Home .❑ Modular 0 Discretionary"D"or Unnamed Use Classification
El Commercial* ❑Special Use(Essential Public Facilities)**
❑ Change of Use ❑ Boundary Line Adjustment •
❑ Address ❑ Road Approach_ _ ❑ Short Plat**
❑ Home Business ❑ Cottage Industry ❑ Binding Site Plan**
❑ Propane ❑ Long Plat**
❑ Sign ❑ Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes" Use Consistency Analysis ❑ Plat Vacation/Alteration**
❑ Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions**
❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development**
❑Temporary Use ❑ Shoreline Management Variance
❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment
*May require a Pre—Application Conference ❑Tree Vegetation Request
**Re•uires a Pre-A•.lication Conference
Please identify any other local, state or federal permits required for this proposal, if known:
NONE
DESIGNATION OF AGENT
I hereby designate
tAR.D AZl. A2.0 11iSt,TS to act as my agent in matters relating
to this application� for permit(s).
t��✓f Date: ! `/
OWNER SIGNATURE / /
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 applicption or she wants prior notice.
Signature: " ' 1 i' Date: 7 2— 176N/
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 . 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 ompliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-trarislqrable resp sibility for adhering to and complying with the ESA. The Applicant has read this dise)a r and dates it below.
Signature: ✓/ a Date: l ((tLy
Jefferson County Building lesion Permit Null:
Applicant:
BUILDING PERMIT INSPECTION APPROVALS \pplicable Code: International Building Codes
To schedule inspections, call (360)379-4455
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
F-V.L. /12111W (0 —cxe
FINAL INSPECTION\ r; r,S/
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
0 •
BUILDER STATEMENT
The signer of thi$state s hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be ass) 'hg t e respo ibility of the General Contractor for the proposed project. /'
Signature: - Date: 7 2- -/-
GENERAL CONTRACTOR OR MANUFACTURED YIOME INSTALLER: PHONE: FAX:
( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: 'k4AZ se-R.Giod2,04 mm15 Pc PHONE ( ) 379. $ietp FAX:( )t3?. .S3211
MAILING ADDRESS: 711 TAYLoR ST.. PORT'T1W145041)Ih►A EMAIL reakelrft C redAct riot be,ova.i4e.c i.Gil n.
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New I/Wood Existing: 2 ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank ❑ Community System
'Alteration/Remodel 0 Concrete Total: _ HP6ht.r Le Individual System
❑ Repair ❑ Masonry SEP Permit#
❑ Demolition 0 Other: Bedrooms: Water Supply:
Existing: 2 Setback: 0 Private well ❑ Two Party
Type of Heat: Proposed: I ePublic Sag Gh.
Total: ADO Name of System: ,"PUP.
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 t Above ground Tank Size of Propane Tank:
i Heat Stove I Cook Stove i Woodstove i Fireplace Insert i Hot Water Tank i 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 Amount Revision
Main Floor Heated 4073 EH Bld App Review: __ __
2nd Floor Heated 7 2 Consistency Review:
Other Heated Base fee:
I c�5
Mezzanine Additional Section: --
U'
Heated Basement Plan Check fee: I (45' 3/
Unheated Basement State Surcharge fee: ,51- y —
,oe'l--
Other Unheated Pot Water Review fee:
Garage/Carport 340 SUBTOTAL ,r
Decks 62 O ........ 911/Rd Approach fee: ----
Other TOTAL: $4 lg. O(.40
Receipt Number: ICY—t -1
Cash/Check Number: !
ESTIMATED COST(REQUIRED) Date: ,,cam
'Fair mark t value of all labor and materials foundation to finish — v�
S, 0 � Initials: -—
r;\P irrrnrrr\###FORMS###\ORF)FORMS\Current ORD Fnrmc\Master Peimir Annlirarinn S-99-OR rinr.
! l
it-i SON co& JEFFERSON COUNTY
W \g A DEPARTMENT OF COMMUNITY DEVELOPMENT
, . 621 Sheridan Street • Port Townsend • Washington 98368
qs, �O 360/379-4450 . 360/379-4451 Fax
�7NG` http://www.co.jefferson.wa.us/commdevelopment/
Stormwater Calculation Worksheet
MLA# C niAL` 2e6) 'J PROJECT/APPLICANT NAME: G OVE1?J 2C, + i eit t 13'Rp T
DETERMINING STORMWATER MANAGEMENT REQUIREMENTS: This stormwater calculation worksheet should be completed first
to classify the proposal as"small,""medium," or"large." The size determines whether a Stormwater Site Plan is required in conjunction
with a stand-alone stormwater management permit application, building permit application, or other land use approval application that
involves stormwater review. The basic information will also be helpful for completing a Stormwater Site Plan, if required.
QQ
PARCEL SIZE(I.E., SITE)
Size of parcel d• 88 acres An acre contains 43 560 square feet. Multiply the acreage by this figure.
Size of parcel in square feet 343 1 2.30 sq/ft
Land-disturbing activity is any activity that results in movement of earth, or a change in the existing soil cover (both vegetative and
non-vegetative) and/or the existing soil topography. Land disturbing activities include, but are not limited to clearing, grading, filling,
excavation, and compaction associated with stabilization of structures and road construction.
Native vegetation is vegetation comprised on plant species, other than noxious weeds, that are indigenous to the coastal region of the
Pacific Northwest and which reasonably could have been expected to naturally occur on the site. Examples include species such as
Douglas fir,western hemlock,western red cedar, alder, big-leaf maple, and vine maple; shrubs such as willow, elderberry, salmonberry,
and salal; herbaceous plants such as sword fern, foam flower, and fireweed.
LAND DISTURBING ACTIVITY, CONVERSION OF NATIVE VEGETATION, AND VOLUME OF CUT/FILL
Calculate the total area to be cleared, graded,filled, Answer the following two questions related to
excavated, and/or compacted for proposed development conversion of native vegetation:
project. Include in this calculation the area to be cleared for:
Does the project convert'/<acres or more of
Construction site for structures O sq/ft native vegetation to lawn or landscaped areas?
Drainfield, septic tank,etc. D sq/ft Circle: Yes No
Well, utilities, etc. 0 sq/ft Does the project convert 2 1/2 acres or more of
native vegetation to pasture?
Driveway, parking, roads, etc. 0 sq/ft
Circle: Yes No
Lawn, landscaping, etc. 0 sq/ft
Other compacted surface, etc. 0 sq/ft Indicate Total Volumes of Proposed:
Total Land Disturbance 0 sq/ft Cut d Fill O (cu/yd)
[over]
• •
Impervious surface is a hard surface that either prevents or retards the entry of water into the soil mantle as under natural conditions
prior to development. A hard surface area which causes water to run off the surface in greater quantities or at an increased rate of flow
from the flow present under natural conditions prior to development. Common impervious surfaces include, but are not limited to roof
tops, walkways, patios, driveways, parking lots or storage areas, concrete or asphalt paving, gravel roads, packed earthen materials,
and oiled, macadam or other surfaces which similarly impede the natural infiltration of stormwater.
STORMWATER CALULATIONS—IMPERVIOUS SURFACE
NEW EXISTING
Structures (all roof area) 536 sq/ft Structures(all roof area) 231? sq/ft
Sidewalks (UVldtr 110,4 60 sq/ft Sidewalks '620 sq/ft
roof)
Patios sq/ft Patios sq/ft
Solid Decks sq/ft Solid Decks b zo sq/ft
(without infiltration below) (without infiltration below)
Driveway, parking, roads,etc sq/ft Driveway, parking, roads, etc 417 JO sq/ft
Other sq/ft Other sq/ft
Total New 318 sq/ft Total Existing 5 25 sq/ft
TOTAL NEW+TOTAL EXISTING* V 5Q 3 sq/ft *This amount will be used to check total lot coverage.
The following questions will help determine whether the proposed project is considered development or redevelopment.
DEVELOPMENT v. REDEVELOPMENT
Divide the total existing impervious surface above by the size of the parcel and convert to a percentage: 2 1
Does the site have 35%or more of existing impervious surface? Circle: Yes C
FURTHER INSTRUCTIONS: If the answer is yes, the proposal is considered redevelopment and the attached Figure 2 should be
used to determine the applicable Minimum Requirements. If the answer is no, the proposal is considered new development and the
attached Figure 1 should be used. At this juncture, the applicant should refer to the applicable Flow Chart to determine the Minimum
Requirements for stormwater management. DCD staff will help verify the classification of the project and the application requirements.
For proponents of "small" projects who must comply only with Minimum Requirement #2—Construction Stormwater Pollution
Prevention—an additional submittal is not required. The proponent is responsible for employing the 12 Elements to control erosion and
prevent sediment and other pollutants from leaving the site during the construction phase of the project. Pick up the Construction
Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet. Proponents of"medium" projects—those
that must meet only Minimum Requirements #1 through #5—and for "large" projects—those that must meet all 10 Minimum
Requirements—are required to submit a Stormwater Site Plan. DCD has prepared a submittal template of a Stormwater Site Plan,
principally for rural residential projects. Complete the template in the Stormwater Site Plan Instructions and Submittal Template or
prepare a Stormwater Site Plan using the step-by-step guidance in the Stormwater Management Manual.
APPLICANT SIGNATURE
By signing the Stormwater Calculation Worksheet, I as the applicant/owner attest that the information provided herein is true and
corr ct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all
owr rs of theeaffected property.
(LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DAT7/215
!l
FOR OFFICE USE ONL'Y ' °`
SMALL MEDIUM LARGE REDEVELOPMENT Stormwater Site Plan: Yes No
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PORT TOWNSEND,WA 4,3368 "
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150 ADELMA BEACH ROAD qe
FAX: (360)314-8324 ►,�
PORT TOWNSEND, HA a8368 Ncharclerlchardbergarchitects.coon