HomeMy WebLinkAboutBLD2011-00201 MLA11-00166
WILDING PERMIT APPLICATION Review Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD11-00201 Received Date: 7/26/2011
SITE ADDRESS: 104 RHODODENDRON LN
BRINNON, 98320
OWNER: TERENCE M GERMAINE PHONE: 360-796-4564
CYNTHIA P GERMAINE
104 RHODODENDRON LN
BRINNON WA 983209736
SUBDIVISION: Block: Lot: TX 44
PARCEL NUMBER: 502154007 Section: 15 Township: 25 N Range: 02 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION ADDITION & REMODEL TO EXISTING SFR
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ADD MAIN: 768
VALUATION 78,298.00 ADD'L: HEAT TYPE: HTP
CODE EDITION: 2009 HEAT BASE: HEAT TYPE:
OCCUPANCY: R-3
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: 5N OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: 1PWELL
BEDROOMS: BATHROOMS:
Exist: 2 Exist: 2
Prop: 0 Prop: 1
Total: 2 Total: 3-
Routing Date:
7-2(r--
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $846.75 LYK 07/26/11 127947 APPROVED
Plan Check $550.39 LYK 07/26/11 127947
State Building Code $4.50 LYK 07/26/11 127947 SEPon 2011
Total: $1,401.64 Jefferson County Planning
& Building Department
Jefferson County Building Division Permit Number: BLD11-00201
Applicant: GERMAINE
BUILDING PERMIT INSPECTION APPROVALS Nppiicable Code: 2009 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 9/ /01111
ii
Erosion Control
Foundation Footing 9/J2011 I
21 U VI4-'rb S
Footing Drains t2- t
� c
Foundation Stem Wall 9, .L,T ll
Underground Plumbing 9
Under Floor Framing k-/\`ti
Straps(hold downs)
Ext. Shear Wall Nailing 17_71
\I
Rough-in Plumbing CON (( l
Framing `61l7(u
Airseal (,0(fileft "P"
Insulation:Walls ((
Insulation: Floors 7, 2-6 l e- f
Insulation: Ceiling _ �-/( C t ,/Wallboard Nailing Q, / - 3
was Line• Exterior-.
Pron anlc--
Heat/Chimney Clearance
Drywell/Alt Drainage - ; _( z 1
Address Posted
FINAL INSPECTION 7,,26. (2- YIP
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
• •
CONDITIONS for Building Permit# :BLD11-00201
1.) FINAL APPROVAL OF SEP11-66 REQUIRED PRIOR TO FINAL OF THIS BLD.
2.) VOLUNTARY MEASURES OF COASTAL SIPZ:
Water conservation measures are encouraged. Ongoing well monitoring for chloride
concentrations is encouraged. Submitting well monitoring data to Jefferson County is
encouraged.
3.) 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.
4.) 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.
5.) This parcel is within a no shooting area per JCC 8.50.
6.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
7.) The building height is not to exceed 35 feet.
8.) Building setbacks from Rhododendron Lane and Black Point Road rights of way is no less
than 20 feet. Side and rear setbacks are no less than 5 feet.
4110
�..g,SoN cod, JEFFERSON RUNTY
t4� DEPARTMENT OF COMMUNITY DEVELOPMENT
h '4
621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
p"� www.co.jefferson.wa.us/commdevelopment
BINa
Master Permit Application MLA: __ I (4(rl
Project Descr ttion(include separate sheets as necessary):
//C 0 n7 t'JC 9C7 1_,/l,) it r
Tax Parcel Number: S 22 /j' ,/ OD 7 Property Size: S
P a c.Pr..— (acres/square feet)
Site Address and/or Directions to/JPropertt :
„2:_,,,_, 4 6
Property Owner(s)of Record: /r,,,,„... G C�,,,-7/,L 6-r,,,in,,„
Telephone: ?C 0 ..226 -Y S e y Fax: email: 7'�✓c•,l`i/,y , Cc'h>.e,,7, .,.J`
Mailing Address: /0 11 /?4e,,to_�e.,A-c.,_ Zri.,," i �>?i./ /Jr,,,,, ZCJ/J ,t' 1)
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address: .
What kind of Permit?(Check each box that applies 0 Lot or Road Segregation
building 0 Critical Areas Stewardship Plan
0 Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
❑ Single Family 0 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 0 Binding Site Plan**
❑ Propane ❑Long Plat**
❑Sign - • ' 0 Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes"Use Consistency Analysis ❑Plat VacatioNAlteration**
❑Stormwater Management ❑Shoreline Master Program ExemptioNPermit Revisions**
❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development**
❑Temporary Use ❑Shoreline Management Variance
❑Wireless Telecommunication* 0 ComprehensivePlan/IU /L d i +,, `;ut- ent
❑ Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Sholre i� r A••et •'
*May require a Pre—Application Conference 0 Tree Vegetation Request I
**Requires a Pre-Appl nation Conference
Please identify any other local,state or federal permits required for this propa's f;if kntdltvn2. 6 2011
DESIGNATION OF AGENT JEFFERSON.COUNTY
I hereby designate to act as my agent in matter relatgrt9FtimN~ ftpwimit(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 right of entry will be assumed unless the applicant informs the County in writing at the
time of the applica• ti that he or she ants prior notice.
Signature:.7/'r- 111 c'e.g.rr•,- Date: Z,./ l ,%ZG//
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 detined 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-transferable responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: "/2"7 . . ✓`7 l ei,—.,, Date:,/44 7(
0 •
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 assuming� the responsibility of the General Contractor for the proposed project.
Signature: / 'mil w /1/' •',G--,�„; Date: ,,,, "g'G, //
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 It"Wood Existing: 0 Sewer
Addition ❑ Steel Proposed: " Bank ❑ Community System 'r
O Alteration/Remodel 0 Concrete Total: ? _ Height: 0 Individual System`1`t-0/'/-1
❑ Repair 0 Masonry SEP Permit# ,:'6 f3
O Demolition 0 Other: Bedrooms: Water Supply:
Existing: 2. Setback: a- Private well 0 Two Party
Typeof Heat: Proposed: , 0 Public
fe4 f 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 FoodSeniice? Yes / No '
If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: •
1 Underground Tank 1 Above ground Tank Size of Propane Tank:
I Heat Stove 1 Cook Stove 1 Woodstove 1 Fireplace Insert 1 Hot Water Tank 1 Pellet Stove 1 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 %rDffice Use` ?nly, .t; ,r. . Amount Revision •
Main Floor Heated
'''1c�' . EH Bld App Review: 115
2�Floor Heated ; ,,�` Consistency Review:
Other Heated Base fee: 4 ."��
Mezzanine . Additional Section: y
4,,
Heated Basement--` ... ._ Plan Check fee: lam•
It`
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Reviewfee: _
k l S i 1K-C-� -
Garage/Carport f SUBTOTAL 1(0'37.CoL
- Decks 911/Rd Approach fee:
_ ()k5ntJ;
Other f,. TOTAL $ , q,
(04
- Y Receipt Number: 1 'q4'T
— ~ Cash/Check Number:
137`)
ESTIMATED COST(REQUIRED) Date: (�,.-�/07 '
•Fair market value of all labor and materials foundation to finish - -4
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