HomeMy WebLinkAboutBLD2013-00129 BLD13-00129
BUILDING PERMIT APPLICATION Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD13-00129 Received Date: 4/22/2013
SITE ADDRESS: 1253 DEER CREEK RD
QUILCENE, 98376
OWNER: YOKO ADACHI TRUSTEE PHONE: 206-972-4479
YOKO ADACHI TRUST
19223 34TH AVE S
SEATAC WA 981885313
SUBDIVISION: Block: Lot: 1
PARCEL NUMBER: 601032020 Section: 3 Township: 26 N Range: 01 W
CONTRACTOR: PHONE:
PHONE:
REPRESENTATIVE: SEALEVEL BULKEAD BUILDERS INC PHONE: 360-297-2401
PO BOX 375
KINGSTON WA 98346
PROJECT DESCRIPTIOI SHORELINE SLOPE STABILIZATION
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION 100,000.00 ADD'L: HEAT TYPE:
CODE EDITION: 2009 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: Exist:
Prop: Prop:
Total: Total:
Routing Date:
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $993.75 CJZ 04/22/13 142012 APPROVED
Plan Check $639.94 CJZ 04/22/13 142012
State Building Code $4.50 CJZ 04/22/13 142012 JUL 1 6
Total: $1,638.19 204
Jefferson County DCD
1
III •
f .., 1 \ DEPARTMENT OF COMMUNITY DEVELOPMENT r -
7 4( 621 Sheridan Street Port Townsend•Washington 98368 ,
360/379-4450 . 360/379-4451 Fax yv"i ` I`�
'Is, ��R, www.ca.Jefferson.wa.us/commdevelopment +
ERSON COUNTY
Master Permit Application MLA: (APT MHNITY D'‘ELOPMENT
( Project Description(include separate sheets as necessary):
k p.e.,- &r r x' ,11(T'Y>
Tax Parcel Number. (O( Q'QaOProperty Size: (',,_,Cr acre quare feet)
Site Address and/or Directions to Property:
ZS') ' e-t.nr- t..v._ i2.c1-
Property Ownerts)of Record: lgcs\a,_ 4., !t ' $.-tt�.
Telephone: 2.C,.-S-4-7 ke(4-(..-4.Gt Fax email:_______________t}*'_•(20.ei
Mailing Address: %<t2,2': '14 M 44-v-e, _ ',(.t.-> .,i t,J.4- ai?ivy- 2-z t a,
Applicant/Agent(if different from owner): £' OJJ AY talt r 1..Y_I Lea-L _
Telephone:kO-2.9-4-2.4 O t Fax: '.1¢O"1A -2-308 email:_____________
Mailing Address: ft,X.. 3'R-'S iNi, Ll Co.
What kind of Permit?(Check each box that applies
Building ❑Critical Areas Stewardship Plan
O Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use)
❑Single Family ❑Garage Attached/Detached ❑Conditional Use[C(a),C(d),or C)
❑ Manufactured Home ❑ Modular 0 Discretionary"D`or Unnamed Use Classification
O Commercial* ❑Special Use(Essential Public Facilities)**
❑ Change of Use ❑Boundary Line Adjustment
El Address Road Approach ❑Short Plat*'
O Home Business 0 Cottage Industry ❑Binding Site Plan*'
O Propane 0 Long Plat°"
O Sign ❑Planned Rural Residential Development(PRRD)/Amendments*"
❑Allowed"Yes'Use Consistency Analysis ❑Plat Vacation/Alteration**
❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions"
❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development**
O Temporary Use ❑Shoreline Management Variance
O Wireless Telecommunication' ❑Comprehensive Plan/UDC/Land Use District Map Amendment
O Forest 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
Please identify any other local,state or federal permits required for this proposal,if known:
DESIGNATION OF AGENT
I hereby designate 4 ,' e. j- .4_,.... .,,;.. . to act as my agent in matters relating to this application for pen-nit(s).
OWNER SIGNATURE A 411 ....A.� /....a..... Date: tt/(q.1 n_
sy signing this application tom1,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 _, •■on that he o she wants nor notice.
Signature:L-- $ f Yt ,,.41 Date: / i/LTV/2.
The action or s Applicant wHI 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
1 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 responsbility fo ciheri ng to and compiying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: .._.r- `'__�- /
�,J Date: j i II�( (a-
G:\Petmitrentcr\###Fr)R MS##';i\t)ill)PALMS\Master Permit Application 5.29-O&.doc
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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 y
they will be assuming the responsibility of the General Contractor for the proposed project.
Signature: Date: ,
_
r' 1 \r/ !
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: L_ L/ L. 1 V C�11
( )
MAILING ADDRESS: EMAIL: I
CONTRACTOR'S LICENSE WAINS 79 3 •IJ
NUMBER: NUMBER I j j u;
ARCHITEGT/ENGINEER: PHONE ( ) t
JEFFERSON "COUNTY)
MAILING ADDRESS: EMAIL 1 DEPT.OF COMMON!' I Si i'1i
Project Type: I Frame Type: Bathrooms: Shoreline: ype wage tsposa
0 New n Wood Existing: :i Sewer
ri Addition n Steel Proposed: Bank 0 Community System
1 Alteration/Remodel 0 Concrete Total: Height: 0 individual System
:i Repair 0 Masonry SEP Permit#
0 Demolition 0 Other. Bedrooms: Water Supply:
Existing: Setback: 0 Private well 0 Two Party
Type of Heat: Proposed: 0 Public
Total: Name.of System:
if this is a Commercial Project you must answer the folk)winq:
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 I 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:
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 t 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 f t t y _ ,' . ; Amount is1on
Main Floor Heated ;: ., EH Bid App Review
2n0 Floor Heated ag
Consistency Review:
rNe t w r
Other Heated •s; ., t Base fee: '13 .-I
Mezzanine - Additional Section:
Heated Basement �- Plan Check fee:
(a 39 91 91
Unheated Basement ry State Surcharge fee:
Other Unheated -•} Pot Water Review fee:
f
Garage/Carport SUBTOTAL
•
Decks ;°. 911/Rd Approach fee:
r4
Other TOTAL: $ I 4(p`19
.-_• _. Receipt Number: /4 1 9
" :r` Cash/Check Number: .6,^g,6t
ESTIMATED COST(REQUIRED) Date: 'X 2
.Fair markAt value of all! aterials foundation to finish aor 3
4 +1 tootpot._ Initials:
°-6
G:\Pere itCenter\###FORMS###\DRD FORMS\Muter Peanit Application 5-29-08.doc
APPROVED
SITE PLAN
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Aspect
CONSULTING .OIOVIG,
August 20,2014
D
AUG 2 0 2014
The Estate of Seiichi Adachi
19223 34th Avenue S JEFFERSON COUNTY
SeaTac,Washington 98188-5313 DEPT.OF COMMUNITY DEVELOPMENT
Subject: Final Construction Repair Concurrence
1253 Deer Creek Road,Dabob Cove,Washington
Project No.080029-001-03
References: GEOTECHNICAL INVESTIGATION REPORT,Landslide
Remediation-Adachi Property, 1253 Deer Creek Road,Dabob Cove,
Washington,dated October 27,2008,prepared by Aspect Consulting,LLC.
Addendum to Geotechnical Investigation Report,Dated October 27, 2008,
1253 Deer Creek Road,Dabob Cove, Washington,Design of Slope Buttress,
dated March 5,2010,prepared by Aspect Consulting,LLC.
Dear Executors of the Estate:
At the request of your contractor,Sealevel Bulkhead Builders,Aspect Consulting has prepared this letter
for Jefferson County to close the outstanding permits for your property.Aspect has observed the site during
construction on an intermittent basis with our last site observation prior to the final landscaping work.
Sealevel Bulkhead Builders has provided one-year post construction images of the work site in which the
required erosion control and planting was complete and thriving.
Based on our on-site observations and the provided post construction images.Aspect Consulting believes to
the best of our knowledge that the work has been completed as shown on the permitted as-built plans.
Thank you for the opportunity to provide these services to you.If you have any questions,please do not
hesitate to call.
Sincerely, /2)4)7 ASpect consulting, t.t.0 V/u L ii2 b-e -6-xAtut
A
% $52 IF
� ,.%p 1 l
1°A11111 t John L.Peterson,PE DIII(MI-- -
Senior Associate Geotechnical Engineer
jpeterson @aspectconsulting.com
cc: Sealevel Bulkhead Builders(via Email)
Donna Frostholm Associate Planner/Wetland Specrensc,J GI Mratn x v..,,,......,_ -,
W.I GEOTECHI080029Adachi LandslidetDeliverableslFinal LetterFinal Letter.doc
+ Aspect Consulting LLC 350 Madison Avenue N. Bainbridge Island WA 98110 206.700.9370 www.aspectconsulting.nem
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Figure 2. As-Built Site Plan
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JEFFERSON COUNTY DC-� NO. 142012
DATE 1 -2.Q- 13
RECEIVED FROM .Qa \Q\k1I �(�Ll.l.�€.ad 4 tcLe
DESCRIPTION BARS# AMOUNT
CURRENCY hReV
u�1 vat
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ft,«f , c S( ,'� HECK - \. V 639 , 11.
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RECEIVED BY TOTAL i0t96 - '61
•
Jefferson County Building Division Permit Number:
Applicant:
BUILDING PERMIT INSPECTION APPROVALS Applicable Code: International Building Codes
To schedule inspections, call (360)379-4455 no later than 3:00PM the day before the inspection is needed.
Requests received after 3:00 PM will not be scheduled for the next 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
A final inspection will not be scheduled until all of the
following are completed and signed off by the applicable
Department:
• Building Permit Conditions are met
• Septic Permit Final/Complete for any building
containing plumbing
• Land Use Conditions met and signed off
• Public Works Permit Final(where applicable)
FINAL INSPECTION R-�_,y �✓
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
• I
CONDITIONS for Building Permit# :BLD13-00129
1.) The slope stabilization project shall be implemented as per the engineered plan sheets
prepared by Aspect Consulting, as approved for the shoreline substantial development
permit(MLA10-00155/SDP10-00051)and as per the letter prepared by Aspect Consulting
on July 13, 2011 to include a retaining wall. The applicant shall submit a letter from
Aspect Consulting confirming that the As-Built(revised 10/2011)was constructed as per
the approved plans(including July 13, 2011 letter) used for shoreline permitting.
2.) Any damage to the structure shall be repaired or removed as soon a s practicable. Any
damage that interferes with natural shoreline funcnctions shall be repaired as soon as
practicable.
3.) The applicant shall implement the approved CASP. THE CASP MITIGATION AS-BUILT
SHALL BE PREPARED BASED ON JCC 18.22.510 AND SUBMITTED TO DCD PRIOR
TO BUILDING FINAL. A FINAL CERTIFICATE OF OCCUPANCY SHALL NOT BE
ISSUED UNTIL DCD HAS REVIEWED AND APPROVED THE AS-BUILT. The conditions
in the CASP permit and the shoreline substantial development permit(MLA10-00155)also
apply to this building permit.
\\tidemark\data\forms\F_BLD_Permit_BIdg.rpt 7/16/2014
BUILDING PERMIT
•
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX(360)379-4451
PERMIT#: BLD13-00129 Received Date: 4/22/2013
SITE ADDRESS: 1253 DEER CREEK RD Issue Date 7/16/2014
QUILCENE, 98376 Expiration Date 7/16/2015
OWNER: YOKO ADACHI TRUSTEE PHONE: 206-972-4479
YOKO ADACHI TRUST
19223 34TH AVE S
SEATAC WA 981885313
SUBDIVISION: Block: Lot: 1
PARCEL NUMBER: 601032020 Section: 3 Township: 26 N Range: 1V1
CONTRACTOR: PHONE:
PHONE:
PROJECT DESCRIPTION: SHORELINE SLOPE STABILIZATION
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION 100,000.00 ADD'L: HEAT TYPE:
CODE EDITION: 2009 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM: Type Amount Paid By: Date: Receipt:
BEDROOMS: BATHROOMS: Permit $993.75 CJZ 04/22/13 142012
Exist: Exist: Plan Check $639.94 CJZ 04/22/13 142012
Prop: Prop: State Building Code $4.50 CJZ 04/22/13 142012
Total: Total: Total: $1,638.19
Directions to Site:
HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION
THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED
BUILDING INSPECTION HOT-LINE 379-4455.
Request must be received by 3pm the day before the inspection is needed.
Office Hours 9:00 am -4:30 pm MONDAY- THURSDAY
HOT LINE AVAILABLE 24 HOURS A DAY
SPECIAL CONDITIONS APPLY-SEE ATTATCHED