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HomeMy WebLinkAboutBLD2005-00710 •UILDING PERMIT APPLICA1N MLLA05 00663 Review Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00710 Received Date: 11112005 SITE ADDRESS: 603 BLOSSOM LN PORT TOWNSEND, 98368 OWNER: RANDI BLOSSOM PHONE: 360-385-4715 DONNA BLOSSOM 603 BLOSSOM LANE PORT TOWNSEND WA 983689609 SUBDIVISION: Block: Lot: T24+ PARCEL NUMBER: 001202014 Section: 20 Township: 30 N Range: 01 W CONTRACTOR: G T BLEEDORN CONSTRUCTION PHONE: (360)587-4488 PO BOX 378 SUQUAMISH WA 98392-0378 Contractor's License GTBLEC*132DB Expires 2/28/2005 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI N ADU W/ATT GARAGE &A/G 110 GAL PROPANE TANKS TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 1,150 VALUATION 97,750.00 ADD'L: HEAT TYPE: PRO CODE EDITION: 2003 HEAT BASE: HEAT TYPE: OCCUPANCY: R-3 UNHEATED: #OF STORIES: OCCUPANCY: CONST TYPE: 5N OTHER: GARAGE: 358V---', SHORELINE: CONST TYPE: DECK: 4121/ SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: 2WELL BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 2 Prop: 2 Total: 2 Total: 2 Routing Date: 1111 (1 105 Type Amount Paid By: Date: Receipt: A FORM/ E D Total: FEB c2 2006 Jefferson County Planning & Building Department k4') N cO 7JEFFERSO�COUNTY y DEPARTMENT OF COMMUNITY.. Et/,EL NT``s,, L 621 Sheridan Street • Port To� � ljgt@in 34 f((''",,��"\ I& $ 360/379-4450 • 360/379-445`fl a;'t .'I I O www.co.efferson.wa.us/comrr i (4�opment I j �`)BING� ' NOV 1 4 2005 1 Master Permit Application IMLA: r; -W.i, j Project Description(include separate sheets as necessary): Tax Parcel Proplerty Number: �iC Z0? E, 0.i Size: 1-1(')2--" - 1, S3 (acres/square feet) Site Address and/or Directions to Property: ()9j 3 31...E 5t")IA Lt=k t-J€ 0 c 6--`C t r5 , .. �'c4.l 92;3 Property Owner(s)of Record: .....mr.a,cmab7w, ilgau , . - / , • ' ' . ,414 Telephone: 3 .(` 3 5";"-- '1 7/ 5-- Fax: q z,:o 5-9.5-- 3 j email: . Mailing Address: (CO-3 ZL(SSCIL\ L -tw�`c 4'a4r2_T ttni")OSS-_CJV:., \, i (7)9,,-3(-)%rte Applicant/Agent(if different from owner): Telephone: - -)r • r : ;. - 'j Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) C. Building 0 Variance(Minor, Major or Reasonable Economic Use) U Demolition Permit 0 Conditional Use[C(a),C(d),or C)*` K Single Family.__ ,; 0 Discretionary"D"or Unnamed Use Classification V Garage (Attached/l1 Detached ❑ Special Use(Essential Public Facilities)** U Manufactbrediiarfte 0 Boundary Line Adjustment 0 Modular u Short Plat** 0 Commercial* 0 Binding Site Plan** D Change of Use U Long Plat** U Address Li Road Approach 0 Planned Rural Residential Development(PRRD)IAmendments** 1 Propane U Plat Vacation/Alteration** U Allowed"Yes"Use Consistency Analysis U Shoreline Master Program Exemption/Permit Revisions** 0 Stormwater Management 0 Shoreline Management Substantial Development** U Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Variance U Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* 0 Jefferson County Shoreline Master Program Amendment U Forest Practices Act/Release of Six-Year Moratorium *May require a Pre—Application 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 /%4--6///2.,i, _, Ct ()--7 a to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE 4 ept if ! ! }�� Date: // //! ( f"1 �� J !ll---��� ��t---444 // / 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 it's knowledge. Any material falsehood orriy 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 occur only during regular business hours. / Signature: 4✓tr4,. / LrL - �, Date: if /// .//!i 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 compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transfe ble responsibility for adheriing to and complying with the ESA. The Applicant has read this disclaimer an signs and dates it below. Signature: �4 -y1iJ.it-i . /5 (..:t..-..44-0-C4i1 Date: // �//an9 `� G-\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc 1 • OWNER 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 MANIJFACTURED HOME INSTALLER: PHONE:G�/,(sp`y 3V-4.‹,y FA): 6-�:rtez'( ISl ' odes (3to) 59g- 44a8 ( ) MAILING ADDRESS: T fl aOx 3 76 5i,fiu •1+isN GA i MAIL: CONTRACTORS LICENSE WAINS NUMBER: &`" ISi... r a Q j NUMBER ARCHITECT/ENGINEER: [S PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Fame Type: Bathrooms: Shoreline: Type of Sewage Disposal: �d New v2] Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: G- Bank ❑ Community System ❑ Afteration/Remodel ❑ Concrete Total: 2 Height: irr individual System ❑ Repair ❑ Masonry SEP Permit# c:! 0033-5 ❑ Demolition ❑ Other: Bedrooms: Water Supply Existing: '& Setback: ❑ Private well t'Two Party Type of Heat: Proposed: L ❑ Public 0 c" ,X.u�.v , Total: Name of System: 1,4 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 If this is a Propane Tank and/or Appliance Installation permit, mark all items below that apply: ❑ Underground Tank li,Above ground Tank Size of Propane Tank: Cain C-1,t\i,ter r.! (S-Heat Stove tA Cook Stove I I Woodstove Cl Fireplace Insert N Hot Water Tank ❑ Pellet Stove ❑ Other Is this appliance being installed in a Manufactured/Mobile Home? Yes /0 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 For Office Use Only Current Proposed Amount Main Floor Consistency Review: (1-0, C) - r15 tfla,cc LI ci.G,f*,., 2Nu Floor I Base fee: ( [ � t 1 7�� ,-y 5 3°Floor Ad�l 6! V 'E. I t, ( Mezzanine: Plat) fee: - 1, Heated Basement State Sudchar'W fee: 1 50 1 4 2005 �C tO 4- Unheated Basement Pot Water ROVIIM fee: Other Unheated 911/Rd Apprpabh fee: I / t � YIVC ( Garage/Carport 378'.2. 7 I X43 vy 1 TOTAL: $ 1 � 5'?, Del Decks IA ,Z.. 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L g • s BUILDING PERMIT • Jefferson County ptm 621 Sheridan De Stree ar t, Port of TownsendCommunity, AD 98368 Development (360)379-4450 FAX (360)379-4451 PERMIT #: BLD05-00710 SITE ADDRESS: 603A BLOSSOM LN Received Date 11/14/2005 PORT TOWNSEND, 98368 Issue Date 02/3/2006 APPLICANT: RANDI BLOSSOM DONNA BLOSSOM PHONE: 360-385-4715 603 BLOSSOM LANE PORT TOWNSEND WA 983689609 SUBDIVISION: PARCEL NUMBER: 001202014 Block: Lot: T24+ Section: 20 Township: 30 N Range: 01 W CONTRACTOR: G T BLEEDORN CONSTRUCTION PO BOX 378 PHONE: (360)587-4488 SUQUAMISH WA 98392-0378 Contractor's License: GTBLEC*132DB Expires: 2/28/2007 PROJECT DESCRIPTION: N ADU W/ATT GARAGE &A/G 110 GAL PROPANE TANKS CALL IN FOR THE RE P UIRED INSP CTI O NS THAT APPLY TO YOUR PROJECT. SETBACKS: . ,.. .��, .zz e • UFFER: Footing:k; N , 27 • • Foundation: i Stormwater FINAL Approval: Underground Plumbing: Underground Insulation: Shear Wall : Sheathing: ,_ Framing: ��,,6 , r Plumbing: ' ' "I •- r - Propane ank/Li es: ;. S�eC, Insulation: „� � i - /2. o�� - Sheetrock: er•- Septic Sytem Fin-I Approval (If not on sewer): Road Approach Final Approval: Zoning Final Approval: Final/Occupancy Approval 0 _ : HEALTH DEPARTMENT AND PUBLIC WO 1 RKS APPROVAL REQUIRED PRIOR TO Fl AL 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 SPECIAL CONDITIONS FOR CASE•LD05-00710 • 1.) A setback of 75-feet, measured perpendicularly from the wetland edge, shall be permanently maintained as a buffer. No filling, grading, clearing, or other alteration of the wetland or its buffer is allowed. 2.) Buffer perimeters shall be marked with temporary signs at an interval of one per parcel or every one hundred (100) feet, whichever is less. Signs shall contain the following statement: "Wetland & Buffer- Do Not Remove or Alter Existing Vegetation." 3.) A permanent physical separation along the upland boundary of the wetland buffer area shall be installed and permanently maintained. Such separation can include installing logs, trees, a hedgerow, or any other prominent physical marking approved by the UDC Administrator. 4.) 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. 5.) 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. 6.) Stormwater shall be retained and infiltrated on site. The owner shall control all sedimentation and erosion on the property. 7.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 8.) 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). 9.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 10.) The building height is not to exceed 35 feet. 11.) Exterior lighting for residential uses shall not exceed twenty feet(20') in height from the finished grade, excepting when such lighting is an integral part of a building or structure. Ground level lighting is encouraged. 12.) Lighting fixtures shall be designed and hooded to prevent the light source from being directly visible from outside the boundaries of the property. The intensity or brightness of all lighting, during construction and after project completion shall not adversely affect the use of surrounding properties or adjoining rights-of-way. 13.) Setback from Blossom Lane right-of-way is no less than 20 ft., side and rear setbacks are no less than 5 ft. If an environmentally sensitive area (ESA) is present, then the more restrictive setback shall apply. 14.) A minimum of two (2) on-site parking spaces is required for each single-family residence on the parcel. I:\F_BLD_Permit_Buildng.rpt 10/29/1999