HomeMy WebLinkAboutBLD2005-00591 MLA05-00553
4113UILDING PERMIT APPLICATION Review Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD05-00591 Received Date: 9/13/2005
SITE ADDRESS: 1521 DABOB RD
QUILCENE, 98376
OWNER: DIANE JOHNSON PHONE: 360-620-2949
70 MARKET ST
PORT HADLOCK WA 983399616
SUBDIVISION: Block: Lot: +
PARCEL NUMBER: 801213015 Section: 21 Township: 28 N Range: 01 W
CONTRACTOR: PHONE:
PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr NSFR
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 1,488
VALUATION 201,603.00 ADD'L: 606 HEAT TYPE: RAD
CODE EDITION: 2003 HEAT BASE: HEAT TYPE: EEE
OCCUPANCY: R-3 UNHEATED: # OF STORIES:
OCCUPANCY:
CONST TYPE: 5N OTHER: SHORELINE:
GARAGE:
CONST TYPE: SETBACK:
DECK: 591
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 2 Prop: 2
Total: 2 Total: 2
Routing Date: i
Type Amount Paid Bv: Date: Receipt: Approved/Date
Potable Water Application $53.00 SLE 09/13/05 76630 APPROVED
State Building Code $4.50 SLE 09/13/05 76630
Plan Check $1,017.22 SLE 09/13/05 76630
Permit $1,564.95 SLE 09/13/05 76630 OCT 2 8 20
Total: $2,639.67 ):fferson '- 'tanning
'&Bui • :rtment
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A �I. eon JEFFERSOCOUNTY t `�'
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\ DEPARTMENT OF COMMUNITY DEVELOPMENT ; I ;
`-4 621 Sheridan Street• Port Townsend •Washington 98368 } 1 �r
360/379-4450. 360/379-4451 Fax . `, S E 3 2U
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,p www.co.jefferson.wa.us/commdevelopment L_____ _
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Master Permit Application { '
Project Description(include separate sheets as necessary):
Ni El0■ V.-E•S[INCI,.
Tax Parcel Property _
Number.
C7 Size: �
7 ��%�-�i 5 ; 5� i$64P-'j2(;)-j (acres/square feet)
1 .
Site Address and/or Directions to Property: Ak r•e ,7,q Lot; i2d ; U,4„, e.,,,
Property Owner(s)of Record: • t tLr e.... e(i Za t1 yAp I
Telephone: 3670- 3V _`'I 02,6 Fax: email:
Mailing Address: Ma rk'_f .S.l-- ` 4- /-Izt.a/lo c _ LCD f el`Jj'3:3 q
Applicant/Agent(if different from owner): I;(.../. JQA 1,)c,? r>,,
Telephone: 31",e)- 20-..29 9 Fax:_ email:
Mailing Address: 0 -,. - : _ e,,7:,: i,_)/
What kind of Permit?(Check each box that applies)
0 Building 0 Variance(Minor,Major or Reasonable Economic Use)
0 Demolition Permit ❑Conditional Use[C(a),C(d),or C]**
.Single Family ❑ Discretionary"D"or Unnamed Use Classification
❑Garage Attached/Detached ❑Special Use(Essential Public Facilities)**
0 Manufactured Home ❑ Boundary Line Adjustment
❑Modular ❑Short Plat**
❑Commercial* ❑ Binding Site Plan**
❑Change of Use ❑ Long Plat**
0 Address ❑ Road Approach ❑Planned Rural Residential Development(PRRD)/Amendments**
0 Propane ❑ Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisions**
0 Stormwater Management ❑ Shoreline Management Substantial Development**
❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance
El Temporary Use ❑Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* El Jefferson County Shoreline Master Program Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium
*Ma re.uire a Pre-A••lication Conference **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 "`Gk }j?de,fsctrl to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE - , f,..../ -'l ) _ -_ __, Date: o Ct I I V
By signing this application form,the owner/ant attests that the information provided herein,and in any attachments,is true and correct to the best of
his,her or it's 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.Access and right of entry to this property shall be requested and shall r onl during regular business
hours. - ( ���
Signature: _ ..„.. // >U Date:
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 compfi- -with the Jefferson County development code.The Applicant acknowledges he,she or it holds individual
and non-transf .ble res.• ibility f•r ay, eying to and complying with the ESA The Applicant has read this d' i er an igns an it below.
Signature: /,� 41 ,,IL 2, &?iZ. Date:
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
OWNER BUILDER STATEMENT
I
The signer of this statement d• hereby certify that y are the Owners of the parcel referenced herein,tha ley are not licensed contractors and that
they will be assu• g the r- ponsib ity o the General Contractor for the proposed project.
Signature: / /. , , ii .1 iiiliA _ Date: 9—/2 —0,c—
,
GENERAL CONTRACTOR OR MANUFACTURES-Hat INST4 t t = HONE: FAX:
a '- - `;( )
MAILING ADDRESS: i i I I' = L:
CONTRACTORS LICENSE SEP 1 3 LUUb NS
NUMBER: i N MBER
ARCHITECT/ENGINEER: l i P ONE ( ) FAX:( )
MAILING ADDRESS: ,IEFFEI;JCM 6O!Ty
nr-coMMuh!TY DEVELOPMENE L
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
pi New 111 Wood Existing: '" ❑ Sewer
❑ Addition ❑ Steel Proposed: 2 Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: 2- Height: i.Individual System
❑ Repair ❑ Masonry SEP Permit# O 4 —312_-
❑ Demolition ❑ Other. BedrOOms: Water Supply:
Existing: Setback: 1:1. Private well ❑ Two Party
T of Heat: / Proposed: 2 ❑ Public
I 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
it this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply:
❑ Underground Tank 0.Above ground Tank Size of Propane Tank: 'X)O Gz LC-0 N 9
❑ Heat Stove j . Cook Stove b Woodstove ❑ Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove ❑ Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes /®
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,
includin! the reserve area.
� ' .:Square Footage orOffice 9 y " � n•Current Proposed a *, '1,.„1.51. 7.5...,.: t A:t
: F
Main Floor ons -Re� ' ` t`'" "' .�p , . � ,
2'' Floor :,
e„G
, tas4?fae
3rd Floor At d tior al Seetrott. •+
1 ` L k
Mezzanine: lan.Check ■a/
`� • hR "ys r t 3
Heated Basement ah. 1"
Unheated Basement ot latt i x ` ; £. N1*.,. 00$_ j
Other Unheated %1/Rd •• i s ya , ,g '+: ,I � q4?...
• _n s, - \x +~a t 7 i ms's` ' a�:44.. �a+. .:,-
Garage/Carport T _ s° { ► `,* � 1�,A r"
Decks h
570 5 c r .' - ,� �?- . .Iii, c
�• Y .",�
,tae,+"`'�.i . of 5 ....-:? f's_...'•3^...::7
Other 1�.��N � �� 5 f f_ s � -r.� �"�;�f'� .�-.
ESTIMATED COST(REQUIRED) # "rte 3
*Fair market value of all labor and materials foundation • .. .,,_ x ,
G:\Per itCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
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0 •
BUILDING PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD05-00591 Received Date 09/13/2005
SITE ADDRESS: 1521 DABOB RD Issue Date 10/28/2005
QUILCENE, 98376
APPLICANT: DIANE JOHNSON PHONE: 360-631)-2949
70 MARKET ST
PORT HADLOCK WA 983399616 w gc1-O9OZ
SUBDIVISION: Block: Lot: +
PARCEL NUMBER: 801213015 Section: 21 Township: 28 N Range: 01 W
CONTRACTOR:
PROJECT DESCRIPTION: NSFR
CALL IN FOR THE REQUIRED,INSPECTIONS THAT APPLY TO YOUR PROJECT.
SETBACKS: I/
UFFER: Jiv5TA L.-A—p 7/3/
Footing: 19i&.. 7/ Lf j • CifcL� > C 2'(/ Q, . - 0a-4,k rc.s OK to/C/t ?
Foundation: 7 (it C ') ,'
7
Stormwater FINAL Approval:
Underground Plumbing:
Underground Insulation: _
Shear Wall : 1 014------".IC - 'L: `�'F
Sheathing: G c E-c , ev7.: it_. n 6 c!:3 ',
Framing: ! . •or. i_ '? oc ;� _: eau cites o :: P 1 c dC_ f t%: ,
Plumbing: 4/ i247'/2t3
Propane Tank/ Lines: A) '4 •
Insulation: ,r _ );:).- PPM 4 ►s ,/�] �IIw
! > d -�/ Q kG /A E4 Litt I�ivLt 5T-, Ram*? / 4- L, 1. f
Sheetrock: �� _ k cc r
Septic Sytem Fin-I Approval (If not on sewer):
Road Approach Final Approval:
Zoning Final Approval: ?
Final/Occupancy Approval: (:N1 F-/-,
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. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:00 a.m. -4:30 p.m.
HOT LINE AVAILABLE 24 HOURS A DAY
SPECIAL CONDITIONS APPLY - SEE REVERSE
' 1
SPECIAL CONDITIONS FOR C• t BLD05-00591
•
1.) A FOREST PRACTICE APPLICATION MAY BE REQUIRED BY THE DEPARTMENT OF
NATURAL RESOURCES IF TREES WILL BE REMOVED ON THE PARCEL. CONTACT
ROSS GOODWIN OF DEPARTMENT OF NATURAL RESOURCES AT (360) 732-7175
FOR FURTHER INFORMATION.
2.) A vegetative buffer of 30-feet shall be permanently maintained from the top or edge of the
Landslide Hazard Area. All buffers shall be measured perpendicularly from the top of the
Landslide Hazard Area.
3.) Landslide Hazard Areas and their associated buffers shall remain naturally vegetated.
Should buffer disturbance occur during construction, the Unified Development Code
(UDC)Administrator shall require replanting with native vegetation. No alterations shall be
made to the Landslide Hazard Area or its associated buffer without prior authorization by
the UDC Administrator.
4.) Prior to and during approved construction activities, the perimeter of the landslide hazard
area buffer shall be marked with a temporary sign. The sign shall be placed in such a
manner that it can be directly observed from the construction area. The sign shall contain
the following statement: "Landslide Hazard Area and Buffer- Do not Remove or Alter
Existing Vegetation."
5.) All construction activities shall not encroach upon the buffer. This includes the storage or
preparation of materials.
6.) The applicant shall permanently separate the boundary of the Landslide Hazard Area
Buffer from the remainder of the subject property through installing logs, trees, a hedge
row, or any other prominent physical marking approved by the UDC Administrator.
7.) Critical Aquifer Recharge Areas may require special protection measures to mitigate water
quality degradation. The submitted proposal does not require additional aquifer
protection measures. However, during construction the project shall follow the Best
Management Practices (BMPs) and facility design standards as identified and defined in
the Stormwater Management Manual for the Puget Sound Basin.
8.) 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.
9.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
10.) Not more than two (2) unlicensed or inoperable vehicles shall be stored on any lot less
than one-half acre unless totally screened from view of neighboring dwellings and
rights-of-way. Such screening shall meet all applicable performance and development
standards specific to the district in which the storage is kept, and shall be in keeping with
the character of the area. Screening shall meet the requirements of Unified Development
Code (UDC) Section 6. Outdoor storage of thirteen (13) or more unlicensed or inoperable
vehicles is prohibited except in those districts where specified as an automobile wrecking
yard or junk (or salvage) yard and allowed as a Permitted Use in Table 3-1 of the UDC,
and such storage shall meet the requirements of UDC Section 4.10. In no case, shall any
such unlicensed or inoperable vehiclesbe stored in an Environmentally Sensitive Area
(ESA).
11.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
12.) The building height is not to exceed 35 feet.
13.) Minimum setback from Dabob Rd right-of-way is 20 ft. Minimum setback from the
western parcel boundary (adjacent land designated Commercial Forest) is 250 ft.
Minimum side and rear setbacks are 5 ft. Environmentally Sensitive Areas further impact
setbacks.
14.) A minimum of two (2) on-site parking spaces are required for the single family residence.
15.) 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.
I:\F_BLD_Permit_Buildng.rpt 10/29/19