HomeMy WebLinkAboutBLD2010-00342 • •
Jefferson County Building Division Permit Number: BLD10-00342
Applicant: SAIA
BUILDING PERMIT INSPECTION APPROVALS Applicable Code: 2009 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
Miscellaneous inspection prior to placement of new rocks to replace logs
Miscellaneous '/„Inspection for compliance with mitigation plan required prior to
• V�scheduling final inspection. Contact Donna Frostholm at 360 379 1150
or 360-379-4466. (see conditions 1 & 3)
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
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
• •
CONDITIONS for Building Permit# :BLD10-00342
1.) Inspection for compliance with the Habitat Management Plan and the addendum is
required. The inspection shall be scheduled after the retaining wall and bulkhead are
constructed but prior to a scheduling final inspection. Contact Donna Frostholm
360-379-4450 or 360-379-4466 to schedule this inspection.
2.) Prior to final inspection the applicant shall submit original, signed, "wet stamped" letters
from the geologist and engineer stating the retaining wall and bulkhead were constructed
in compliance with the geotechnical report and with the engineered plans.
3.) After the Habitat Management Plan was approved, the applicant requested to remove one
to three mature trees near the marine shoreline. These trees shall be replaced 1:1
(example: if two trees are removed, two trees shall be replanted). All trees planted will be
western red cedar and will be at least 12 feet tall. Trees shall be planted in the same
locations as those to be removed. Irrigation will be provided and any tree that does not
survive shall be replaced.
4.) The proposal shall comply with all requirement of the geotechnical report.
THERE SHALL BE NO USE OF, OR ENCROACHMENT INTO, THE TIDELANDS FOR
BULKHEAD OR DRAINAGE MAT CONSTRUCTION. WDFW OWNERSHIP IN THIS
EGARD IS ALL TIDELANDS BELOW THE MHW LINE TO ELLW. NO
ONSTRUCTION EQUIPMENT, LANDING OF EQUIPMENT, PLACEMENT OF
MATERIALS OR OTHER CONSTRUCTION RELATED USES SHALL BE ALLOWED ON
THOSE TIDELANDS.
6.) Per staff discussion with building department staff on March 12, 2014 no building permits
are required for the outbuildings and kayak sheds.
7.) 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.
8.) Prior to commencing development activity, the proponent is responsible for informing the
US Army Corps of Engineers (COE) in order for COE to determine whether a Department
of the Army permit or review is required. Generally, review is required for construction and
dredging in or around navigable waters of the US and for work or fill in hydrologically
connected wetlands. Contact the US Army Corps of Engineers, Seattle District Regulatory
Branch, PO Box 3755, Seattle WA 98124, (206) 764-3495, for more information.
9.) Prior to commencing development activity, proponent is responsible for informing the
Washington Department of Fish and Wildlife (WDFW) in order for WDFW to determine
whether this action is subject to the Washington State Hydraulic Code (Chapter 220-10
WAC). Hydraulic Project Approval (HPA) is required for all hydraulic projects, which are
defined as construction or performance of other work that will use, divert, obstruct, or
change the natural flow or bed of any of the salt or fresh waters of the state.
10.) In addition to Jefferson County permit conditions, the project proponent shall comply with
all conditions set forth by the Washington Department of Fish and Wildlife through
Hydraulic Project Approval.
\\tidemark\data\forms\F_BLD_Permit_Bldg.rpt 5/9/2014
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``eriJEFFERSON COUNTY
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�' DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street• Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
�QS, NO,sO$ www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: 1 () '?),
Project Description include separate sheets as necessary): `�` i�e►ia 44i „(` L�tlk.�./,.,� Ivkr' /a.P� Q,�,S�i b+sik1 rofeJ' tosl e»
Tax Parcel Number: 10 it y iQOL
,-,i1 Property Size: nJ L3 a c1tit,,, (acres/square feet)
Site Address and/or Directions to Property:
14 (02. Ci7(r✓ 9-1-
Property Owner(s)of Record: M 1 c.tukt,1 s..r‘.
Telephone: as-3'033"")(of Fax: email:
Mailing Address: (''l LZZ. 4'114' St. 5E L,AtA t w A' 9$oV 1
Applicant/Agent(if different from owner) c. Iq,t,a F J 41 I,tt0} ,l". I�� )4 t?
Telephone: 160-.351'Ile$g Fax:
�---} email:
Mailing Address: i�1/I C.ri*w1,e, L. Or. w�0.e
, s . It' Lit t W/t 'i )(p
What kind of Permit?(Check each box that applies
❑Building 0 Critical Areas Stewardship Plan
0 Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use)
0 Single Family ❑Garage Attached/Detached 0 Conditional Use[C(a),C(d),or C]"•
0 Manufactured Home ❑ Modular 0 Discretionary"D"or Unnamed Use Classification
❑ Commercial* ❑Special Use(Essential Public Facilities)**
❑ Change of Use 0 Boundary Line Adjustment
❑ Address ❑Road Approach 0 Short Plat**
❑Home Business ❑Cottage Industry ❑Binding Site Plan**
❑Propane 0 Long Plat**
❑Sign 0 Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes'Use Consistency Analysis 0 Plat Vacation/Alteration••
❑Stormwater Management Shoreline Master Program Exemption/Permit Revisions••❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development**
❑Temporary Use 0 Shoreline Management Variance
❑Wireless Telecommunication• 0 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 Conferenca 0 Tree Vegetation Request
**Requires a Pre-Application Conference
Please identify any other local,state or federal permits required for th this proposal, if known:
504 at 'e.Fr►ifviroA ) NPA cm t,JDCO 1101tWQ(t PHrh EroLG)y j Se i'oA 'log! ETNA Guts
OF AGENT
I hereby designate like v%S
IT L 4l llry l .hc, to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE ne,4"'
"""'"'1111 Date: 8-i 2a II U
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 bei,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. iI
I further agree to provide access and right of entry to Jefferson County and its employees,represeitatives 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 applati n that he ors 'wan prigs notice.
Signature: '
Date: `d r/®
The action or actions Applicant will undertake as a result of the issuance of this —f
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-transferable re pons. lily for adhering to and complying with the ESA. The Applicant has read this disOaio1er and signs and dates it below.
:Signature / G //0
Date.
G:\PermitCenter\###FORMS###\DRD FORMS\Mask/I'cnnit Application 5-29-08.doc
• •
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 e responsib y of the General Contractor for the proposed project.
Signature: 774,a7>cLfll'J a•G4-- Date: f2'> /lb
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New 0 Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank 0 Community System
❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System
❑ Repair CIMasonry 2O u~!. fie. SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: i.t Private well ❑ Two Party
Type of Heat: Proposed: ❑ Public
Total: iti/A, 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
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:
1 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 'For,Offici3 Use:bnly4& ar` 'I IN„ . .Ambunt.,.,. �._` s(bn
Main Floor Heated ' 3 _ EH Bld App Review:
2na Floor Heated I = erts1rn"�� ta tir
Gj
Other Heated :',1' Base fee:
xi Z Z-SJ
Mezzanine Additional Section:
Heated BasementPlan Check fee: 33 c�
Unheated Basement : State Surcharge fee: ///`)
Other Unheated Pot Water Review fee: '_
Garage/Carport SUBTOTAL �t c �`}
Decks 911/Rd Approach fee:
Other if �, I TOTAL: $
L -� f , Receipt Number: /- ---'0 1 .). 7
Cash/Check Number: Z ,J
y
ESTIMATED COST(REQUIRED) Date:
.Fair arket value of all labor and materials foundation to finish �— 7 —�0
l If ANtfel Zv?a 5 v Initials: o f /( G f.
---)- '-12/c7 r
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