HomeMy WebLinkAboutBLD2009-00414 •BUILDING PERMIT APPLICO•ON BL Revviewiew T Tyy414
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Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD09-00414 Received Date: 12/17/2009
SITE ADDRESS: 91 CANAL LN
BRINNON, 98320
OWNER: ROBERT W MARSHALL PHONE: 360-249-5534
SUSAN MARSHALL
120 WYNOOCHE RD W
MONTESANO WA 985639643 OLYMPIC CANAL ADDITION 1
SUBDIVISION: Block: 3 Lot 17+
PARCEL NUMBER: 980100314 Section: 21 Township: 25 N Range: 02 W
CONTRACTOR: OWNER/BUILDER PHONE
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI REPAIR POST & BLOCK FOUNDATION, ADDING FLOOR JOISTS TO
EXSITING SFR
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP REP MAIN:
VALUATION 6,000.00 ADD'L: HEAT TYPE:
CODE EDITION: 2006 HEAT BASE: HEAT TYPE:
OCCUPANCY:
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total:
Routing Date:
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $125.25
APPROVED
Plan Check $81.41 LYK 12/17/09 113577
State Building Code $4.50 LYK 12/17/09 113577 DEC 11 2009
Total: $211.16
Jefferson County Planning
& Building Department
Jefferson County Building �ision Permit NO:
Applicant:
BUILDING PERMIT INSPECTION APPROVALS \pplicable Code: 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 day's 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
FINAL INSPECTION
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
A,,4eN cbe, JEFFERSLOUNTY 0
ft ``� DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street• Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
�.qS, N0,t0� www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: kb (rA1l_A ED I,b
Project Description(include separate sheets as necessary): +
ie •ir` .c ?„,4 c1 () to c_l, -aav,4,.'F\o.� i �Aa 11ti� / to ``c1 SAS,v1 •
Tax Parcel Number: 960 _ tap _3 i'f(L 'C `18o-too-3 k Property Size: O , Z(o A c r-eS (acres/square feet)
Site Address and/or CQ Directions to Property: , ►^ k /4
t ( i1ec/ -Ct...1e S,- h i0,1r ,W' A 14 €3 i o1 W� ,1 4J -A L /c 31t ; 'urt-. LttA U `4 v ,.'a.
Property Owner(s)of Record: oar=+ lir S 4 s o,,.. Ma r-s 1 k x
Telephone: a,,a--2_49 -Ss 3 q_ Fax: 3rap •-7_4-�j - 6 l " t
n `� email:yVlu-r's Ina ik�'i f;.0 C.) CAC,vt4U ryle
Mailing Address: 12.0 w .l y V�c(c.wk Q —.)_.Aa;,�'�
� tAe e N c ci`-t, m W A 9 3 . e t !
Applicant/Agent(if different from owner):
Telephone: Fax:
email:
Mailing Address:
What kind of Permit?(Check each box that applies
Ilding ❑Critical Areas Stewardship Plan
Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use)
,a-Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a),C(d),or C]**
❑ Manufactured Home 0 Modular 0 Discretionary"D"or Unnamed Use Classification
❑ Commercial* 0 Special Use(Essential Public Facilities)**
❑ Change of Use ❑Boundary Line Adjustment
❑ Address ❑ Road Approach 0 Short Plat**
❑Home Business ❑ Cottage Industry 0 Binding Site Plan**
❑ Propane 0 Long Plat**
❑Sign 0 Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration**
0 Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions**
❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development**
❑Temporary Use 0 Shoreline Management Variance
❑Wireless Telecommunication* 0 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 0 Tree Vegetation Request
**Requires a Pre-Application Conference
Please/��7 identify any
any other local,state or federal permits required for this proposal,if known:
3,it, & 4 if t✓i,,ei e.,Y+P c1" ?/4,..,1 �,,.., tO,(.�
/ 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 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 ri h of entry will be assumed unless the applicant informs the County in writing at the
time of the app' i n the r she wants prtice.
Signature: (,(J 6 Date: (Z/ —7 AU j
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-transfer r onsi city for adhering
�to d co plyirith the ESA. The Applicant has read this disclai er and "gns and dates it below.
Signature: "'r ) •-/%'Cu i�v Date: I Z /-�ct j
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.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 as �ing the respoonsi ili f the G era C2ntractor for the proposed project.
Signature: '�a l 1�- Date: ('Z(/J/'7 D 9
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTORS LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
O New ❑ Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank ❑ Community System
❑ Alteration/Remodel 0 Concrete Total: Height: ❑ Individual System
Repair ❑ Masonry SEP Permit#
O Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: 0 Private well ❑ Two Party
Type of Heat: Proposed: ❑ 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 i Above ground Tank Size of Propane Tank:
1 Heat Stove 1 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.
S.uareFootage Current Proposed Fir-OfficeUseQ Amount Revision
Main Floor Heated EH Bld App Review: w
2nd Floor Heated Consistency Review: ______`
Other Heated Base fee:
Mezzanine Additional Section:
Heated Basement Plan Check fee: r3 1 ( i I
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee:
G- arage/Carport SUBTOTAL -\ i I I
D-ecks 911/Rd Approach fee: �/`____
Other TOTAL: $ ( ( 1 , I
Receipt Number: l [ 7 7
Cash/Check Number:
ESTIMATED COST(REQUIRED) Date: Jl 3�
.Fair market value of all labor and materials foundation to finish 12 t r , 1
• .y .� Urn `"f Initials: -___..,__----<)_
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
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WASHINGTON DEPARTMENT OF FISH AND WILDLIFE
BALD EAGLE MANAGEMENT PLAN
RCW 77.12.655, WAC 232-12-292
EAGLE TERRITORY: Duckabush 1022 1 Jefferson
Occurrence# Nest# County
The following conditions apply to the entire parcel if any portion falls within the distance guidelines.
0 Any construction or vegetation removal on a lot within 400 feet of a nest tree or roost site will require a
bald eagle management plan tailored for the specific land use and landowners goals. The landowner will
need to contact and consult with the Washington Department of Fish and Wildlife(WDFW)prior to any
clearing or construction. Please contact the WDFW at (360) 681-4276.
❑ Any lot located between 400 and 800 feet of a nest tree site: retain all known perch trees and all conifers
>24 inches diameter at breast height(d.b.h). Also retain>50%of pre-clearing or pre-construction conifer
stand with diameter distributions representative of the original stand (>6 feet tall). Windowing and low
limbing of trees is acceptable provided no more than 30%of the live crown is removed.
® Any lot located>800 feet but within 1/2 mile from a nest and within 250 horizontal feet of the shoreline or
top of high bank bordering a shoreline: Retain all known perch trees and conifers>24 inches diameter at
breast height (d.b.h.). Also retain>50% of pre-clearing or pre-construction conifer stand with diameter
distributions representative of the original stand (>6 feet tall). Windowing and low limbing of trees is
acceptable provided no more than 30%of the live crown is removed.
I have read and understand the above condition(s)placed on Parcels# 980-100-314 located in the
NW Quarter of SE Quarter of Section 21, Township 25N , Range 2W (East/West meridian) with actual street
address of 91 Canal Lane (Brinnon) . If the landowner(s)feel these conditions are too restrictive,a site
specific plan may be developed with the Washington Department of Fish and Wildlife. If the conditions set forth
above are acceptable,please sign below and this will serve as your Bald Eagle Management Plan. Activities will be
periodically monitored and failure to comply with this Plan constitutes a misdemeanor as set forth in RCW
77.15.130. However,compliance with this plan does not ensure compliance with the Endangered Species Act or
other federal, state, or local laws.
Z,l0 8 Robert and Susan Marshall
Landowners(s) Si ture (s) (Da e) Landowner(s) Name (s) (Print)
' 7/0$ 120 Wynooche Rd. W.
eg � isional Program Manager (Date) Address
// 0 7-1'1-Q$ Montesano, WA 98563-9643
Wildlife B'•logist (Date) City, State, Zip
Send Original To: WDFW (360)249-5534
Region 6 Office Phone
48 Devonshire Road
Montesano, WA 98563-9618
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