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HomeMy WebLinkAboutBLD2003-00287 • BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD03-00287 Received Date 05/7/2003 SITE ADDRESS: 30 AZALEA LN Issue Date 06/17/2003 BRINNON, 98320 APPLICANT: GERALD WILLIAMS PHONE: (360)796-9985 160 DOGWOOD LN BRINNON WA 98320 SUBDIVISION: PLEASANT TIDES DIV 2 Block: Lot: 2 PARCEL NUMBER: 988600002 Section: 15 Township: 25 N Range: 02 W CONTRACTOR: OWNER/BUILDER PHONE: LOAN LENDER/ BOND HOLDER: PROJECT DESCRIPTION: ENCLOSE EXISTING POLE STRUCTURE (ROUGH IN PLUMBING ONLY- NO BATHROOM) REQUIRED INSPECTIONS: [ ] SETBACKS /Footings: [ ] Foundation: [ ] Underground Plumbing/Underground Insulation: [ ] Shear Wall: [ ] Framing/Plumbing: I 1 Propane Tank/Lines: [ ] Insulation: I 1 Sheetrock: 1 1 Septic System Final Approval: [ ] Zoning Final Approval: ( 1 Final/Occupancy Approval: 6)1{ —0 HEALTH DEPAR 6_�TMENT 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 V • • SPECIAL CONDITIONS FOR CASE # BLD03-00287 1.) SEPTIC APPROVAL BASED ON THE WATER LINE CURRENTLY THROUGH THE FOUNDATION BEING FILLED IN W/CONCRETE. MUST BE VERIFIED BY COUNTY STAFF. 2.) H2O LINE AND SEWER LINE MUST BE MIN 10'APART. VERIFY BY COUNTY STAFF. is\F_BLD_Permit_Buildng.rpt 10/29/1999 0 B U I L D I N G PERMIT APPLICRION BL Review vy287 iew T Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00287 Received Date: 5/7/2003 SITE ADDRESS: 30 AZALEA LN BRINNON, 98320 OWNER: GERALD WILLIAMS PHONE: (360)796-9985 160 DOGWOOD LN BRINNON WA 98320 SUBDIVISION: PLEASANT TIDES DIV 2 Block: Lot: 2 PARCEL NUMBER: 988600002 Section: 15 Township: 25 N Range: 02 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr ENCLOSE EXISTING POLE STRUCTURE TYPE OF WORK GAR SQUARE FOOTAGE: TYPE OF IMP ALT MAIN: VALUATION 5,500.00 ADD'L: HEAT TYPE: UH CODE EDITION: 1997 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: OSS WATER SYSTEM: PARCEL TAGS: YES NO BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA Exist: Exist: Wetland Erosion Prop: Prop: Seismic Streams Total: Total: Flood Way Floodplain Routing Date: 51 F&W Landslide /03 Shoreline Aquifer Forest: Commercial Rural Type Amount Paid Bv: Date: Receipt: /1 CA'm ••�'OV ED Permit $125.25 MAM 05/07/03 56094 /'�r �/ Plan Check $81.41 MAM 05/07/03 56094 JUN 1 7 2003 State Building Code $4.50 MAM 05/07/03 56094 Total: $211.16 Jefferson County Planning t & Building Department i/(//// , /po i Jefferson CounDepartment of Community Development ""� ©zv ° 621 Sheridan Street,Port Townsend WA 88368(3601370-4450 ` e0,4 .. �. prmot��s �aApp ' No I 0 MAY Project Description: r Building Type: Project Type: ;FxravvmoeoTdy,pecout. uF'�EL—av v--�! ID Single Family ❑ NewVEL " �� GPMEN i ❑ Garage Attached/Detached 0 Addition ❑ Steel ❑ Modular Alteration/Remodel ❑ Concrete ❑ Commercial ❑ Repair ❑ Masonry ❑ Multi-family/#of Units ❑ Demolition ❑ Other: ❑ Industrial ff�� Al( Other: r(V/ /-,t. &67, Agz4 Bathrooms: Bedrooms: Type of Sewage Disposal: Type of Heat: Choose one: Existing: Existing: ❑ Sewer ❑ Community System ❑ Electricity ❑ Oil Proposed: Proposed: ❑ Individual System ❑ Woodstove ❑ Propane Total: Total: If not sewer,fill out the following: ❑ Heat Pump k' Conventional ❑ Alternative ❑ Other /VD ry Permit# SEP Water Supply: ❑ Private well ❑ Two Party Well❑ Public:Name of water system: Square Footage: // For Office Use Only ls/ ML, Q eaR Main Floor Consistency Review ✓I�,Q�" 2ND Floor Base fee « .2S' 3rd Floor Plan Check fee—65% D cj t •4 Htd Basement State Surcharge fee 4493 Unhtd Basement Subtotal 21 Garage/Carport Pot Water Review fee (!� Decks 911/Rd Approach fee (15 Commercial TOTAL //�-j( �4p Industrial Receipt# b0q471 Other Cash/010 .503 Total Valuation: Initials 912130 Or 3. :(119 Date 5fi to3 Estimated Cos, / If within 200' of the Shoreline, Distance to Bank or Ordinary High Water Mark ft.Bank Height ft. By signing the application form,the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. Any material falsehood or any omission of a material fact made by the applicant/owner 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 it's employees,representatives or agents for the purpose of application review and any required later inspections. Access and right of entry to the applicant's property or structure shall be requested and shall occur during regular business hours. ' Signature:g '' - Date: r OVER_ H:HOME\PLNCNTR\INFOBLDG\FORMS\BLDpert itApplication 11-8-01 •„soxeoR{, c E 11 ki ) irk>tt. Aso JEFFERSON COUNTY _ ILL' �lAY 7Z003 '� ° DEPARTMENT OF COMMUNITY DEVELOPMENT. 4-.1110r, JEFFERSON CpUNTY 7 621 Sheridan Street• Port Townsend •Washington 98368 DEPT. OF COMMUNJ DE itELOPMEN I 1�NG 360/379-4450 • 360/379-4451 Fax http://www.cojefferson.wa.us/commdevelopment/ Stormwater Calculation Sheet MLA# PROJECT/APPLICANT NAME: -% ; %�/ / u i' This stormwater calculation sheet should accompany stand-alone stormwater management permit applications, building permit applications,and other land use approval applications that involve stormwater review. STORMWATER CALULATIONS-IMPERVIOUS SURFACE NEW EXISTING Structures(all roof area) sq/ft Structures(all roof area) 6 sq/ft Driveway sq/ft Driveway sq/ft Sidewalks sq/ft Sidewalks sq/ft Patios sq/ft Patios sq/ft Solid Decks sq/ft Solid Decks sq/ft Other sq/ft Other sq/ft Total New 0 sq/ft Total Existing sq/ft TOTAL NEW+TOTAL EXISTING* JZ e sq/ft *This amount will be used to check total lot coverage Please also indicate the amount of land-disturbing activity, in addition to the creation of impervious surface, that will take place: LAND DISTURBING ACTIVITY Drainfield area cleared sq/ft Well,Structures, Utilities,etc. sq/ft Driveway sq/ft Other sq/ft Total Land Disturbance (� sq/ft STORMWATER MGMT PERMIT.DOC REV.12/23/2002 �ONC Af� „ ° JEFFEON COUNTY ! J( - .. DEPARTMENT OF COMMUNITY DEVELOPMENT , l� 621 Sheridan Street• Port Townsend •Washington 98368 IszrrsC3�0 360/379-4450•800/831-2678•360/379-4451 Fax www.co.jefferson.wa.us/commdevelopment Master Land Use Permit Application Form PROPERTY INFORMATION Tax Parcel Number: E E E 11 1 E1 ® ® Q Subdivision Name: c it; `t' � /S fety Z Lot Number:Property Size: (acres/square feet) Existing Use of Property: Site Address and/or Directions to Property: de A 7 A L_ ,4 1 4:v<' R.44 ,! 7g ?X, APPLICANT& OWNER(INFORMATION Applicant(if applicable): GE 2 A L, . L ) c7' Telephone: NCO Address: /C Q C'D L s,. ert, City: o , ,.� � ,., State: G✓ Zip vp Code: ` ,,g Zc) Email Address Applicant's Signature.: - __ . J—�/Z�il _ Property Owner(s)of Record: (-7t707.- t_E) i4,L/4 elephone: '360—7 6 4F 9 Address: ) 1 Z.•,C7 ,. City: � , ,. State: Zip Code: 8 7 r) Email Address I acknowledge that the applicant above is applying for a building permit on my property. Owner's Signature I hereby designate to act as my agent in matters relating to this application for permit(s). (PROPERTY OWNER SIGNATURE) (DATE) DESCRIPTION OF PROPOSED USE OR ACTIVITY(include separate sheets as necessary) [THIS SECTION FOR OFFICE USE ONLY] Refer to the specific sections of the UDC referenced below for more information and further requirements. An asterisk(*) indicates that a supplemental application or questionnaire may be required. Type I Permits Refer to: ❑ Septic Permit/Evaluation of Existing System(EES) UDC Section 6.4.1 and Chapter 8.15 JCC ❑ Building/Demolition Permit UDC Section 3.2.1 and Table 3-1 ❑ Allowed"Yes" Use Consistency Analysis UDC Section 3.2.1 and Table 3-1 ❑ Home Business Table 3-1 and UDC Section 4.20 ❑ Stormwater Management* UDC Section 6.7 ❑ Road Access* UDC Section 6.8 ❑ Boundary Line Adjustment* UDC Section 7.2 ❑ Minor PRRD Amendments UDC Section 3.6.13.15 ❑ Sign Permit* UDC Section 6.15 ❑ Site Plan Approval Advance Determination (SPAAD) UDC Section 8.7 ❑ Shoreline Master Program Exemption/Permit Revisions UDC Section 5 ❑ Temporary Use(based on use may be Type II or Type III)* UDC Sections 4.38 and 4.39 (OVER) Type II Permits • Refer to: 11111 1r ❑ Discretionary"D"or Unnamed Use Classification UDC Sections 3.2.1,3.2.2 and Table 3-1 ❑ Cottage Industry UDC Section 7.3 and Table 3-1 ❑ Short Plat, Preliminary and Final* UDC Section 7.3 ❑ Binding Site Plan* UDC Section 7.5 ❑ Conditional(Administrative)"C(a)" Use UDC Table 3-1 and Section 8.8 ❑ Conditional(Discretionary)"C(d)"Use UDC Table 3-1 and Section 8.8 (Discretionary Permit Review Process Determined by Administrator) ❑ Variance, Minor* UDC Section 8.9 ❑ Wireless Telecommunication Ordinance 06-0712-99(UDC Appendix C) ❑ Shoreline Substantial Development(Primary Use) UDC Section 5 ❑ Forest Practices Act/Release of Six-Year Moratorium for Single- UDC Section 4.16.5(c) Family Residence ❑ Appeal UDC Section 8.4.2 SEPA 8.10.12(b) Type III Permits ❑ Conditional"C"Use UDC Section 8.8 ❑ Long Plat, Preliminary* UDC Section 7.4 ❑ Planned Rural Residential Development Preliminary Approval UDC Section 3.6.13(must be in conjunction with an (PRRD)and Major Amendments* underlying land division application) ❑ Plat Vacation/Alteration UDC Section 7.1.3(d) ❑ Variance, Major* UDC Section 8.9 ❑ Reasonable Economic Use Variance* UDC Section 3.6.4(h) ❑ Wireless Telecommunication Ordinance 06-0712-99 UDC Appendix C ❑ Shoreline Management Substantial Development,Secondary Use* UDC Section 5 ❑ Shoreline Management Conditional Use* UDC Section 5 ❑ Shoreline Management Variance* UDC Section 5 ❑ Appeal UDC Section 8.4.3 SEPA 8.10.12(c) Type IV Permits ❑ Long Plat, Final UDC Section 7.4 ❑ PRRD, Final UDC Section 3.6.13 Type V Permits ❑ Special Use(Essential Public Facilities) UDC Section 3.3.5 ❑ Jefferson County Comprehensive Plan/UDC/Land Use District Map UDC Section 9 Amendment* ❑ Jefferson County Shoreline Master Program Amendment* UDC Section 5 ❑ Appeal of SEPA UDC Section 8.10.12(d) Other Local,State or Federal Permits ❑ Please identify any other local, state or federal permits required for this proposal,if known: ACKNOWLEDGEMENTS [PLEASE NOTE THAT TWO SIGNATURES ARE REQUIRED] By signing the application form, the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. I also certify that this application is being made with the full knowledge and consent of all owners of the affected property.Any material falsehood or any omission of a material fact made by the applicant/owner 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. This right of entry shall expire when the County (through the Administrator or the Administrator's representatives)concludes the application has complied with all applicable laws and regulations.Access and right of entry to the applicant's prope y shall be requested .hall occur only during regular business hours. 1. PROPERTY OWNER (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 compliance with the Jefferson County development code The Applicant acknowledges that he, she or it holds individual and non-transferable responsibility for adhering to and complying with the ESA. The Applicant ha ead thi di clai er signs and dates it below. 2. _ ..- PROPERTY OWNER (DATE) .,, . I t5t. Et eleei•MY = C rim GI I = N ma = .r, __I 00 G; • -4 N/ ® I),^� / f.,...c., c_A: / CO w R-+ ^ / s 2 /c;) �� 0. ) 10 S9S'"j" "' / a ,� v°' Soo A� 11, i g "7i yew FT • \ z./.. RI ao, . s 707 4.,,,, •. ,E1/44-tLgpree ai _i_4„,,,..z.i. 0 / / s). 10 \ 0 c.) o - N-. .., ,..2., - Z I W �� ;. O t. O• �� ,—.\\ \V a '.y S \''f)1.:ks (21 . , u) (-0, .k.:- \ ' • J -xi,. >' _ �Q ' ', C� AFT if, C., \$ l„ • ,tit •p `1 V) 01 r c� • -.) t o 7.0 O(y-k1P/ A 4 O • `�jJ, U -O -1 si FR To 0 • `00 v O .c. x a UFNDRONt.rn ___ - __ yIn D- ` _ 164Wil --^ _ _. 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