HomeMy WebLinkAboutBLD2011-00266 8
RILDING PERMIT APPLICATIINI ReAewType:I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD11-00266 Received Date: 9/28/2011
SITE ADDRESS: 100 SHINE RD
PORT LUDLOW, 98365
OWNER: JOHN M FABIAN PHONE: 360-437-7911
DONNA K FABIAN
100 SHINE RD
PORT LUDLOW WA 98365-9274 SHINE
SUBDIVISION: Block: 1 Lot: 1
PARCEL NUMBER: 994400101 Section: 33 Township: 28 N Range: 01 E
CONTRACTOR: BROCKMAN BUILDERS INC PHONE: (360)638-1125
33165 HOFFMAN RD NE
KINGSTON WA 98346
Contractor's License BROCKB1961 ON Expires 9/15/2012
REPRESENTATIVE: BROCKMAN BUILDERS INC PHONE: 360-638-1125
PETER BROCKMAN
33165 HOFFMAN RD NE
PROJECT DESCRIPTIOF STAIRS TO THE BEACH
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION 4,500.00 ADD'L: HEAT TYPE:
CODE EDITION: 2009 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY:
CONST TYPE: OTHER: 85 SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 0 Prop: 0
Total: 0 Total: 0
R ting Date:
Type Amount Paid By: Date: Receipt: pipvi4 Date
Permit $111.25 LYK 09/28/11 128183 V E F.,
Plan Check $72.31 LYK 09/28/11 128183 NOV nil
State Building Code $4.50 LYK 09/28/11 128183
Total: $188.06 Jefferson County Plannin•
& Building Department
Jefferson County Building Dion Permit Num• BLD11-00266
Applicant: FABIAN
BUILDING PERMIT INSPECTION APPROVALS applicable 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 - I _.
Erosion Control
Post Holes t^yt- I L ',IL--
Foundation Footing
Framing
• C IZ
FINAL INSPECTION
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
� •
CONDITIONS for Building Permit# :BLD11-00266
1.) 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.
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.) 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.
4.) Residential developers and individual builders shall be required to preserve shoreline
vegetation and reduce the associated risk of erosion during construction and any future
activity which may impact the stability of the shoreline.
5.) Builidng Setbacks from Shine Road are no less than 20 feet. Side setbacks are no less
than 5 feet. Shoreline setback is no less than 30 feet from top of bank.
1 - ee oQ� JEFFERSOSOUNTY
w ' `�' DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street O.
Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
�,,ts o www.co.jefferson.wa.us/commdevelopment
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Master Permit Application MLA: iS ( -)
Project Description(include separate sheets as necessary):
..-i-Gtir s 4o -i{-1e beach
Tax Parcel Number. 194 y 00 I 0 i Property Size: •77 4Cd'G- (acres/square feet)
Site Address and/or Directions to Property:
MO Sk1(Le ► d.,_ ?� r 4- &uct ivtt (4).9 . Qr34
Property Owner(s)of Record: c Job obid A4(a 1 - 46 a/!
o
Telephone:3 -9 7_79// Fax:_ email:
Mailing Address: /OD Sf11iii Rc •f pi•. <4d/'�,� W4 �f_w•c �,/�
Applicant/Agent(if different from owner): Pe}P 8V a r/7 X v'c/C 5tli/GuVS .'/(-
Telephone: ,340"40, Fax: �,/ /� email:/42✓0 hl4 2
Mailing Address: .&P.O. C 4/4 Akit fJk'z All• 9fS Co ea" /iok.net
Wh t kind of Permit?(Check each box that applies oetlIBuilding ❑Critical Ar as t •� � ZM
, emolition Permit ❑Variance in ,
i),) e)
Ingle
Family ❑ Garage Attached/Detached ❑Condition I',l js a),C(d),or C)""
❑ Manufactured Home 0 Modular 0 Discretion d "or Unnamed Use Classifi ' n
❑ Commercial* ❑Special U e ientiat PubliciFilities)**
❑ Change of Use ❑Boundary ine Adjustment U
❑ Address 0 Road Approach 0 Short Plat j 1;'
❑Home Business 0 Cottage Industry ❑Binding Si Plan JEFFERSON COUNTY
❑Propane ❑Long Plat
0 Sign ❑Planned RtiralRgdgtfa`itOi' yr P endments**
❑Allowed"Yes'Use Consistency Analysis ❑Plat Vacation/Alteration**
❑Stormwater Management ,Shoreline Master Progra I Exem•tio •emiit Revisions'"'
❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substan is •evelopment**
❑Temporary Use ❑Shoreline Management Variance
0 Wireless Telecommunication* ❑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
**Requires a Pre-Application Conference
Please identify any other local,state or federal permits required for this proposal, if known:
____ DESIGNATION OF AGENT
I hereby designate'PGfeT 8(004")141,B(Ofkn1011 to act as my agent in matters relating to this application for permit(s).
��u�ic.
OWNER SIGNATURE -iG C. Date: I fZ VA (
By signing this application form,the r/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 materia 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 inspectio Staffs access and-right of entry will be assumed unless the applicant informs the County in writing at the
time of the a lication that he or he a sprior no \ q %Z /yr
Signature: PP c (i) Date: 7
The action or actions Applicant will undertak 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 ential"take"of an endangered species as those terms are defined in the federal law known as the
"Endangered Species Act"or"ESA."Je erson 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 wit the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
an:n :ran5fee
responsibty r a ring to an plyi 'th the ESA. The Applicant has read this discla r s s and dates it below.
: Cr
Date: l 'Ye-
/ !/
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• 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: _ Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
134-0 Ck mail W lcp2Q/S // i4,C • &)�03e-ilo'�.' (/) ) `
MAILING ADDRESS: �0. &ix )V01 1�I/LQ$4•VA,( A. EMAIL: p.brGc 426)�4/,�G44.f4'461--
CONTRACTOR'S LICENSE 'I/ q JJ 9Vgy/( WAINS
NUMBER: BROl,1�31 /G1x)N NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
New �erGVood Existing: ❑ Sewer
O Addition ❑ Steel Proposed: Bank ❑ Community System
LI Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System
❑ Repair ❑ Masonry SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: l Private well ❑ Two Party
Type of Heat: Proposed: ❑ Public
Total: Name of System:
If this is a Commercial Project you must answer the following: //4
Number of Parking Spaces: Current: Proposed: r_Number-of ADA Parking SPA :
Number of occupants(includes owners,tenants,employees,etc) Current T 4-, ,es `I'IBC Occupancy: IBC Type of construction: Wfli yfai w I0\,
If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: 4 a_ 1
1 Underground Tank 1 Above ground Tank Size of Propane Ta :1-' 3, !
1 Heat Stove 1 Cook Stove 1 Woodstove 1 Fireplace Insert 1 Hot Water Tank 1 Pellet Stove 1 Other I
Is this appliance being installed in a Manufactured!Mobile Home? Yes / Noo -1/7
When applying for a permit to install a propane tank you must also submit a Site p an shamiipgall Alttho buildings, ll property
lines,tank location and size,distances from the propane tank to all property lines,buildings and septic�systent co ponents,
including the reserve area. I'.. p � TtY?
Fo �
Square Footage Current Proposed r,Offiee se-,Only ;.: �„, „ . . -:Aimto ; w-:i . ,,,'
Main Floor Heated tY 5'' ` EH Bid App Review: -
r Vlf
2`"'Floor Heated • , b Consistency Review:
Other Heated `'^' ' ,' ' Base fee
Mezzanine 44 1 ;rIX' ' �t '41(1 ' ��I
Heated Basement ` Plan Check fee: r), 3 ,,,,.,
Unheated Basement . 5 :}: State Surcharge fee: ,/_{. ��i
Other Unheated a Pot Water Review fee: —.
„;lip
Garage/Carport • r f SUBTOTAL C p .0�
0
Decks /t /-t,i'5 22 L( (�'5 ` -'- 911/Rd Approach fee: ..._.----
Q
Other , r TOTAL: $'Ci8 . ` (4)
-1-i-..
`' Receipt Number: lc '1 S3
4 _ Cash/Check Number , f
ESTIMATED COST(REQUIRED) Date: I
.Fair market value of all labor and materials foundation to finish - . ` ''
y/ rev Initials: ' -
G:\I'crrnit-Center\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc (------.
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AT TIME OF EOIANDATION INSPECTION
PROPERTY LINES MI.ISTBE MARKED
YSTRIN4 LINES TO VERIP`(Stl ISACKS.
IF PROPERTY LINES ARE NOT MARKED A
REINSPECT-ION FEE MAYBE REQLURED
PRIOR TO FLARTI-1-ER INSPECTION.
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JWERSON COUNTY DCD � I 2 8 r I,l
JEFFERSON COUNTY
T)'b DEPT.OF COMMUNITY DEVELOPMENT
Contact the Building Department
at 379-4450 prior to making changes
or revisions to the approved plans
NOTICE: Plans are approved excepting
any errors or omissions. All work must
pars Inspection In conformance with ,'
ail applicable codes and regulations. '
JEFFERSON COUNTY DCD •
BUILDING PLAN REVIEW
[7 APPROVED AS SUBMITTED
\.9( APPROVED AS NOTED
0 REJECTED
Date l 0.5-- 'u Reviewer ` ` 9 FILE COPS
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