HomeMy WebLinkAboutBLD2010-00060 E LDING PERMIT APPLICATA MLA 79
Review ew T Typype: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD10-00060 Received Date: 3/8/2010
SITE ADDRESS: 341 VERNER AVE
PORT LUDLOW, 98365
OWNER: HEATHER A DOSCH PHONE: 360-385-0480
KEVIN M DOSCH
7841 NE 21ST ST
MEDINA WA 980392313 OLYMPUS BEACH
SUBDIVISION: Block: Lot: 87+
PARCEL NUMBER: 978900093 Section: 4 Township: 28 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: MARIE PETERSON PHONE: 360-437-8148
107 LUDLOW BAY RD
PORT LUDLOW WA 98365
PROJECT DESCRIPTION RE-LOCATE EXISTING GREENHOUSE(FOUNDATION ONLY)-UNHTD
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 308
VALUATION 8,023.00 ADD'L: HEAT TYPE: UH
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: ALT
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 0 Prop: 0
Total: 0 Total: _0
Routing Date: /
Type Amount Paid-- Bv:---" 15ate: Receipt: Approved/Date
Permit $167.25 LYK 03/08/10 113974 APPROVED
Plan Check $108.71 LYK 03/08/10 113974
State Building Code $4.50 LYK 03/08/10 113974 DEC t 3,2U10
Potable Water Application $98.00 LYK 03/08/10 113974
Total: $378.46 iefferson County Planning
Building Department
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FF[HSUt UUUNIY U�U
Jefferson County Building r sion Permit Nu•r: BLD10-0r)060
Applicant: DOSCH
BUILDING PERMIT INSPECTION APPROVALS Npplicable 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 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
Setbacks
Foundation Footing
Rough-in Plumbing
FINAL INSPECTION -frc.).._ It fp
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
•
CONDITIONS for Building Permit# :BLD10-00060
1.) 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.
2.) The project shall adhere to the Best Management Practices (BMPs) 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.
3.) To help prevent seawater from intruding landward into underground aquifers, all new
development activity on Marrowstone Island, Indian Island and within 1/4 mile of any
marine shoreline shall be required to infiltrate all stormwater runoff onsite.
4.) VOLUNTARY MEASURES OF COASTAL &AT RISK SIPZ:
Water conservation measures:
1. Roof and other intercepted precipitation shall be routed to on-site detention ponds
and/or other approved means and allowed to be released to the soil slowly.
2. Water collected from Storm water and roof catchments may be used for watering
lawns and gardens. Unless catchment water has been treated to meet drinking water
standards, there shall be no cross connections allowed between the potable supply and
impounded water.
3. Water withdrawn from wells on each property shall not be used for watering of lawns
and/or gardens.
4. Ground water withdrawn from each property shall be restricted to a rate of three (3)
gallons per minute.
5. Installation of water conserving fixtures such as low flow toilets, faucets and shower
restrictors and other water saving plumbing fixtures.
6. Landscaping plan (xeriscaping, native vegetation with minimal amounts of irrigation).
Please NOTE that the above listed measures are not intended to be exhaustive, but rather
is intended to be illustrative of the types of water conservation measures.
5.) VOLUNTARY MEASURES OF COASTAL &AT RISK SIPZ:
1. Installation of a flow meter.
2. On-going well monitoring for chloride concentration.
3. Submittal of monitoring data to County.
6.) MANDATORY MEASURES FOR COASTAL SIPZ:
1. For proof of potable water on a building permit application, applicant must utilize
DOH-approved public water system if available.
2. If public water is unavailable, a qualifying alternative system may be used as proof of
potable water or an individual well may be used as proof of potable water subject to the
following requirement:
a. Chloride concentration of a laboratory-certified well water sample submitted with
building permit application.
3. If public water is unavailable, a qualifying alternative system may be used as proof of
potable water.
7.) The property owner shall comply with Water Conservation Measures (per list maintained
by the UDC Administrator).
/ ONc- • •
.i 6, JEFFERSON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
r4 621 Sheridan Street • Port Townsend •Washington 98368
�• '�' 360/379-4450 • 360/379-4451 Fax
\ NC/
www.co.jefferson.wa.us/commdevelopment
aster Permit Application MLA: U�1 JI
ject Description(include separate sheets as necessary):
3 yr(-tAl'J CreenirnuQ, `Fe--1 O ith vC L;( ;'I ))-ck.
Tax Parcel Number: 9 r7g9Dl q 3 Property Size: &el.;QDO ` 1 (acres/square feet)
Address and/or Directions to Property:
` / /� Cl__•11 (tCVCS
34) V G%rneA-- .Ave 'Port Lo tb�� )& 1 1 )3(40
,perry Owner(s)of Record: 'I-te R ;(' t-.)`-,C,1�
:phone: I')-4)1-5c 71 Fax: email:
ling Address: -314 ) Ve.r neAr Ave-1 ?-27c - [-&)tfl J 'von- 0 G,E
►licant/Agent(if different from owner): M air I e. P'-t e s 1 r)
phone: 3(L ) 437 81 LF? Fax:2,'OU C,033 42-3 3 email:'',G r i n n(t',ac t .P 1.c-OrY'1
ing Address: 1O`7 Ludic)vj --3....) x.A.a ?OctLt.AIC)V.1 L4Jf q 93
rt kind of Permit?(Check each box that applies ❑Lot or Road Segregation
uilding 0 Critical Areas Stewardship Plan
Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
Single Family El Garage Attached/Detached ❑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 0 Road Approach 0 Short Plat**
come Business ❑Cottage Industry ❑Binding Site Plan**
'ropane 0 Long Plat**
;iyn -• ❑Planned Rural Residential Development(PRRD)/Amendments**
,flowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration**
tormwater Management IRShoreline Master Program Exemption/Permit Revisions**
ite Plan Approval Advance Determination(SPAAD)* OShoreline Management Substantial Development**
emporary Use 0 Shoreline Management Variance
'ireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment
wrest 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
e identify any other local, state or federal permits required for this proposal, if known:
• DESIGNATION OF AGENT
i designate Mar 11. A. f e �1�701n to act as my agent in matters relating to this application for permit(s).
SIGNATURE Date: 3- 2. j O
g this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of
r its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet
t in this permit being null and void.
3ree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and
which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit.
Tree to provide access and right of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application
i any required later inspecttions. affs access and right of entry will be assumed unless the applicant informs the County in writing at the
do that he or shet wa s pr r o
3,-A 2�-6
Date:
Dr actions Applicant will undertake as a result of the issuance of this permit may negatively impact-upon one or more threatened or
I species and could lead to a potential"take"of an endangered species as those terms are defined in the tederal law known as the
d Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this
Teen issued will not violate the ESA. Any individual, group or agency can file a lawsuit on behalf of an endangered species regarding your
I ?.n if you are in compliance ' e Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
responsibility for a h n and complying with the ESA. The Applicant has read this disclaimer andte signs and dates it below.
• _— _ Date: is J` l 0
nter\###FORMS###\DRD FORMS\Current DRD Form;,Ovfacter ne...:.A,,.,r.,...«:...,con no.L
S
BUILDER STATEMENT
The signer of this statement does hereby certify tiltiy are the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be ssu1" 242J_
• g responsibility of the eneral ��ntractor for the proposed jei ��
Signature: ' Date: d
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:
❑ New ❑ Wood Existing: t ❑ Sewer
❑ Addition ❑ Steel Proposed: ( % Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: - Height: . .Uadividual System
O Repair 0 Masonry ' SEP Permit#
❑ Demolition Other: Bedrooms: Water Supply:
Existing: i Setback: 'rivate well ❑ Two Party
Proposed: ( ❑ Public
Tyke of Hats Total: Name of System:
If this is a Commercial Project you must answer the following: l
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 Above ground Tank Size of Propane Tank:
I Heat Stove I Cook Stove t Woodstove I Fireplace Insert 1 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 Fair mace Use-oAmount Revision
Main Floor Heated • EH Bld App Review:
2nd Floor Heated • Consistency Review:
Other Heated Base fee: -
Mezzanine Mdt on t Se Ort
Heated Basement Plan Check fee: I r 71
Unheated Basement State Surcharge fee:
Other Unheated - Pot Water Review fee: 1
00 cA-,
r� ip SUBTOTAL l(i_
Garage/Carport I I(4 4.L
Decks 911/Rd Approach fee:
Other TOTAL: $ fiCi, tt' .
Receipt Number: , l 74
Cash/Check Number:
ESTIMATED COST(REQUIRED) Date:
•Fair market value of all labor and materials foundation to finish 3 ___1 U,
'7� Initials: — t __
_ _
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