Loading...
HomeMy WebLinkAboutBLD2006-00020 BUILDING PERMIT APPLICION MRLA06r00014 Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00020 Received Date: 1/18/2006 SITE ADDRESS: 523 BLUE RIDGE RD PORT TOWNSEND, 98368 OWNER: PATRICIA M BRITT PHONE: 360-385-0221 GWENDOLYN B MOORE 5162 FLAGLER RD NORDLAND WA 983589690 DISCOVERY BAY RIDGE DIV IV SUBDIVISION: Block: Lot: 33 PARCEL NUMBER: 001305033 Section: 30 Township: 30 N Range: 01 W CONTRACTOR: PAUL KAASE CONSTRUCTION PHONE: (360)385-0221 2021 HILL ST PORT TOWNSEND WA 98368 Contractor's License PAULKC*061C5 Expires 4/25/2006 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr NSFR W/ 250G AG PROP TANK ws)ih E- YLA h Crc!L I)-tC wl LAp pad ,eV is 4-5152i2-A5 L 1 TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 4,156 VALUATION 415,211.00 ADD'L: HEAT TYPE: RAD CODE EDITION: 2003 HEAT BASE: HEAT TYPE: PRO OCCUPANCY: R-3 UNHEATED: #OF STORIES: OCCUPANCY: OTHER: 1,812 CONST TYPE: 5N GARAGE: SHORELINE: CONST TYPE: DECK' 44D SETBACK: D.E Li) BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: PUD BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 3 Prop: 3 Total: 3 Total: 3 Routing Date: ///67 /0 (.3, Type Amount Paid By: Date: Receipt: AP OVE Permit $2,763.35 LYK 01/17/06 78762 Plan Check $1,796.18 LYK 01/17/06 78762 JUN d 2006 State Building Code $4.50 LYK 01/17/06 78762 Jefferson County Planning Potable Water Application $55.00 LYK 01/17/06 78762 & Building Department Total: $4,619.03 L'&QC.nfrN 6.1211-1 • • BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD06-00020 Received Date 01/17/2006 SITE ADDRESS: 523 BLUE RIDGE RD Issue Date 06/2/2006 PORT TOWNSEND, 98368 APPLICANT: PATRICIA BRITT & GWENDOLYN MOORE PHONE: 1806 WALNUT STREET PORT TOWNSEND WA 98368 SUBDIVISION: DISCOVERY BAY RIDGE DIV IV Block: Lot: 33+ PARCEL NUMBER: 001305033 Section: 30 Township: 30 N Range: 01 W CONTRACTOR: PAUL KAASE CONSTRUCTION PHONE: (360)385-0221 2021 HILL ST PORT TOWNSEND WA 98368 360-385-0154 Contractor's License: PAULKC*061C5 Expires: 2/12/2008 PROJECT DESCRIPTION: NSFR W/250G AG PROP TANK CALL IN FOR THE REQUI ED INSPECTIONS THAT APPLY TO YOUR PROJECT. SETBACKS: J Ce UFFER: `` Footing: 9;-:7/¼- rOl �vv� ,;� 3c)cFoundation: i -(1—©L ?e,„ 51) Stormwater FINAL Approval: r- Underground Plumbing: �-� �:>. 7`6 Cie L7 fT T/ '' 25 �? 7 7 �i I Jl�tT rU6 Underground Insulation: 7 06 Shear Wall : ✓ Sheathing: Framing: (,—( Pf Plumbing:b (4'b7 Fb Propane Tank/ Lines: Insulation: Sheetrock: Septic Sytem Final Approval MUST be obtained before final of structure can be attempted. Road Approach Final Approval: Zoning Final Approval: Final/Occupancy Approval: z'I/oo HEALTH DEPARTMENT,XND 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 rn. -4:30 p.m. HOT LINE AVAILABLE 24 HOURS A DAY SPECIAL CONDITIONS APPLY -SEE REVERSE • SPECIAL CONDITIONS FOR CASE A BLD06-00020 1.) 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. 2.) 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. 3.) 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." 4.) All construction activities shall not encroach upon the landslide hazard area buffer. This includes the storage or preparation of materials. 5.) 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. 6.) 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. 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.) A Stormwater Site Plan has been submitted and approved by the Department of Community Development. Once the subject permit has been issued the applicant shall fully implement the provisions of the submitted plan and contact the Jefferson County Department of Community Development to arrange a schedule to inspect the property for plan compliance. A Certificate of Occupancy will not be issued until the Department verifies plan compliance. No clearing for roadways or utilities shall occur on the project site until clearing necessary for the installation of temporary sedimentation and erosion control measures have been completed. 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.) 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. 14.) 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. • • 15.) Minimum setback from Blue Ridge Road right-of-way and private ingress/egress easement right-of-way shall be 20 feet. Minimum side and rear yard setbacks shall be 5 feet. If an ESA is present, then the more stricter setback(s) shall apply. 16.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. I:\F_B LD_Perm it_Bu ildng.rpt 10/29/1999 1 ON 00 rilV, JEFFERSON COUNTY , DEPARTMENT OF COMMUNITY DEVELOPMENT ;', 621 Sheridan Street •• Port Townsend •• Washington 98368 PERMIT # BID Is O 360/379-4450 • 360/379-4451 Fax NO http://www.co.jefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# PROJECT/APPLICANT NAME: ✓9 J 4-)47M Please answer all of the following questions to the best of your ability. Where the question calls for depiction on a site map, the applicant may choose to either incorporate the elements into the general plot plan for the Master Land Use Application or to submit a separate stormwater site plan map. Project Overview 1. Describe the proposed developed conditions of the site. Indicate position and relative size of proposed improvements on the site map. A? o/ (,r .R/n<S /S OL-7Jf.:L0/3676.. .4 o7Nls2 /. 1/ //LL &G-`- DL(/":"LDEQ_• . —771/S LC=Aui S 90. 3 `A or / VJC- /1^c2 a P/Grit: ei26.2&2Ui 0 Au iv4-7 Ui L . UEa LE TAT/0r/ P 'i/OilfC / 2 /?C_ . Q/S/ /?pooh AS" /e 6I (',y7 5:30 Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. i A Ge 7L6.7 S'./,oA.T Gvi7-iJ //p/4/6 ?/.TC CUT s ciGG..l1 f ^ 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. Ei2, e6,cla-ke, /-/12,-.tifL v c, 4e.4 i ,J2j,1OJ /FS, , L4,z l7(e i//&-ae 2 7 on/ G PL P 2n/S 4. Describe the existing soils. Indicate soil type on the site map. (o „ -roe trAl L DULR S2,T2/e1 7/0 /A‘lc=2 5. Describe the existing site hydrology(i.e., drainage; behavior of water on the site—above, below, and on the ground). Indicate existing stormwater drainage to and from the site on the site map. Depict separate drainage basins on the site map, if applicable,and indicate acreage of each. //CILE /S' / - 6L/1Q1- 10 = ' _1124.7 /?wL/07 F ,c,_ 434-s/OS (VA! i/a;� S/_re. . . S''-'n NI a)_azJ-'�y/Z2z uT4 G DAS'PL�/2 SCS SP /,v,Ta N/f 7U/ZA-,- L'/ /= TA 7/nn/ APPROVED 6. Describe any excess levels of noise generated by the proposed use or activity: STORM WATER PLAN APON/_ d 3 0 2006 �'� Stormwt t JEFFERS ,C NTY RegUlred DEPT.OF(' Y ( E El OP.` ENT storrnwater site plan template—rev.10/1/2003 S 1� \AT[,R F: 5 • • 7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams, steep slopes, etc.)on the site. Indicate location on the site map. /U/0 62 17 / ,42a4 s 8. Describe the general vicinity of the site,including adjacent land uses and structures, utilities, roads, and sensitive/critical areas (streams,wetlands, lakes,steep slopes,etc.). US /DL/VT/ G ( 4ciz )... dL-:Af.TGg: Permanent Stormwater Control Plan This portion of the Stormwater Site Plan consists of the selection and installation of the appropriate stormwater control BMPs and facilities to remain in place after construction of the project is completed. "Medium" size projects are required to have the totals calculated of all impervious surfaces, pollution-generating impervious surfaces, and pollution-generating pervious surfaces to verify that the thresholds for treatment facilities and flow control facilities are not exceeded. g. Describe the developed site hydrology, as proposed. Indicate whether stormwater will be fully dispersed (i.e., per BMP T5.30 in the Manual) or, if not, what types of stormwater flow control will be utilized for the site or specific threshold discharge areas within the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. 57o12 //A7-6-2 Zvit fJS'F'L;/2SOJ 4/ 2311 7-6 gD 10. If the project requires the use of stormwater treatment facilities, describe the types of stormwater treatment facilities proposed for use on the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. [This is normally for large"projects or projects that involve the potential for dispersion of contaminants.] 0(/-A . 11. Describe the performance goals and standards applicable to the project. 144/ v74 cov .4s n422A2 4N 4 oi/0/ 0/is 4i ,- 4 c- P7)6SigLI //1J Lin/r 117 ;Xis /A/C 12. Describe the flow control system. &4 A. stormwater site plan template—rev.10/1/2003 6 i • 13. Describe the water quality system. ill(4 - 14. Describe the conveyance system analysis and design. NcA 15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material. AL it. 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. �C r c2 TD Eft/(�1R1/_r��Jel/ �/�,C/L s) R APP..G �fLort AsS,2C/47E s" 17. Describe the proposed surfacing material. .2e,/L r C/d u /44-o 18. Describe methods for restoration of the site. Aea/T 74E/= s S'/-/RU, a01"67.4j,/x1G 19. An Operation and Maintenance Manual is required for each flow control and treatment facility. [This is normally required for "large"projects only and only those for which facilities are required to control flow or treat runoff.] If included,list the Manuals here. 1h4. 20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan. /JWiet,7 / '26-P02 i /1-s P, # P - 21. List other necessary permits and approvals as required by other regulatory agencies. If those permits or approvals include conditions that affect the drainage plan or contain more restrictive drainage-related requirements,describe those conditions or restrictions here. stormwater site plan template—rev.10/1/2003 7 • i CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN(SWPPP) The Construction SWPPP addresses sediment and erosion control during construction. The BMPs indicated by the applicant in the template that follows must be installed on the ground during all construction phases of the project. The proponent is responsible for preventing sediment and erosion impacts to environmentally sensitive areas and off-site areas. Consult the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet for guidance, particularly with rural residential development. SECTION I—CONSTRUCTION SWPPP NARRATIVE 1. Construction Stormwater Pollution Plan Elements. Describe how each of the Construction SWPPP elements has been or will be addressed. Identify the type and location of BMPs used to satisfy the required element. If an element is not applicable to the proposal,justify in writing. Descriptions of the 12 Elements are found at section 2.5.2 of the Manual(beginning on page 2-15). 12 Required Elements—Construction SWPPP 1. Mark Clearing Limits. t14 1,1/ g ge"),t1 61/241L ,A-L1 /t' q3U/o(IS 2. Establish Construction Access. ebN5 72(1GT/i)(I OV AlaZ.i,74'�I s LS°70 7A-I C A-/Z5/4 2 G� L/ 3. Control Flow Rates. R/-7- c'�L I f x/s7/atIG /t/t-TOJ7 -L /)/4,uT/ev6 7 e(9412 J 'Th RUB_or''- 4. Install Sediment Controls. 4 A S' (_,/-J/G/I /M tJ,; /2L3-LSAJ ,O✓S'TUR YO d(2-) 5. Stabilize Soils. (iG-=GAT r/o/J A-a6-/-O G��7Th2L1 /I O 6. Protect Slopes. G`2l ,2T6 o/l %�L i C2�o ✓J4I2 - l/Sa1 BLS-�'Gs j -) . G L3G�.47/0 Al ,CS7.AeL/s 0 7. Protect Drain Inlets. i 11 2/- .4a&_ AI o ,0 0/1i AJ LAJ( /._2 8 stormwater site plan template—rev.10/1/2003 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. 1tlo C/4/4,vcle:Tos 62 OUT,L�rS 9. Control Pollutants. / / Qt)7 T 7V/L L PAO&ice ,lJb Az c✓JT4NTs (/Ji'To T/14-/v, is-4/a"/-rii 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). .tl o ,yam d 11. Maintain Best Management Practices(BMPs). aAt[JatT/R14 J'lziPP s 5Mp A-c/2 -7.3 AS 1u 9es'Q A2.,7-/.16/Jt 6 _0 rl- .P 14.5. 24SA-S'O//4RI., liA/. 7-4-/AJ 12. Manage the Project. A7.4/,v r /it A.0 y I&4c;/er✓ /reTAel.,/eilcO /2&4a; il/116-,0 0 A.s/r<r$ .#N o /f o<,14nJ. a i l2 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). �ieo i ,zT9 b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. &N /T/lLL A2 ,415° stormwater site plan template—rev.10/1/2003 i�4kiht akat ivu'otf�� DCt 9 . • , b. Description of special requirements for working in or near environmentally sensitive areas. N.A. 4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site soils(e.g.,erodibility,settleability,permeability,depth,texture,soil structure). ,'QE47D ,2i r7-' /14-5' (20.4.4 /DT�sUZJA-C Lsf )S/ , fib S° XidLc 66LQ/ Oe-.i1 T /.i0 l.1 tTWW R1=sI(---F)/L 4 _ U Oi i1AT1114.1 / y IL J J ,P7 4e%,/S'i-iL 5. Construction Phasing. a. C nstruction sequence z S',7? /0ieE/' -- C.X/3'T((I6 C'Y /-Jo0ci?6 ccluP7p00 /DJ b. Construction phasing(if proposed) Re6,1,J4,;" 1,/cra9 Ae/)LFAf/ . —j''r pc NArZeil 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). I. Provide a proposed construction schedule. II. Wet Season Construction Activities. Proposed wet season construction activities. giA/ 47/D/d, /. '/G£, NAG //l/.1Lii/z /2 F'.ARl MJ6, eo o r c? / in '7 1 1 b. Proposed wet season construction activities for environmentally sensitive areas. iti o f •US'/T/U/_s 4/Z1 A- 7. Financial/Ownership Responsibilities. a. Identify the property owner responsible for the initiation of bonds and/or other financial securities. ‘aiLM'QGL/t ,1J /-fo02e- f 47&/e44 B,e`T b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. Ai,A . 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following, if applicable. a. Sediment Ponds/Traps. b. Diversions. ,(J•A. c. Waterways. d. Runoff/Stormwater Detention Calculations 10 stormwater site plan template—rev.10/1/2003 • 0 Stormwater Site Plan Changes If the designer wishes to make changes or revisions to the originally approved Stormwater Site Plan, the proposed revisions shall be submitted to DCD prior to construction. The submittal shall include substitute pages that include all proposed changes, revised drawings showing any structural changes,and any other supporting information that explains and supports the reason for the change. Final Corrected Plan Submittal If the project included construction of conveyance systems,treatment facilities,flow control facilities, or structural source control BMPs (not standard on-site stormwater management BMPs), the applicant shall submit a final corrected plan ("as-builts")when the project is completed. These should be engineering drawings (stamped by a licensed civil engineer) that accurately represent the project as constructed. APPLICANT SIGNATURE By signing the Construction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and correct to the best of y knowledge. I also certify that this application is being made with the full knowledge and consent of all owner of e affected p operty. ln.L�. � (LANDOWNER OR AU� IZED REPRESENTATIVE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: 12 stormwater site plan template-rev.10/1/2003 iii-9lv °Ot, JEFFERSONNUNTY • ti `i 1j DEPARTMENT OF COMMUNITY DEVELOPMENT `4 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax �q NO� www.co.jefferson.wa.us/commdeveloprr�ent SGrS Master Permit Application MLA: Ok, — (1 Project Descriptio9(include separate sheets as necessary): AJ o /jai& /!o i/Xe-770il Tax Parcel x.v q05. 0�3 Property Number: Size: S/f e2E (acres/square feet) - Site Address and/or Directions to Property: t.5.2gdI& 42/D66 .„0,,,IO _. Property Owner(s)of Record: /6LUEfJOQ,C'i^/ /1-160 e $•= P4T , ,Q,TT Telephone: ._1? 0 - ' ' ,Z‘:7 Fax: / email: Mailing Address: ,S/(�Z ��r.�, az�� 4A-a /U0120414/ G(J� �,, , / 7 e Applicant/Agent(if different from owner): ? it.'1<-)4 4S'E" Telephone: 3roO •3ST": 02 2/ Fax: ' ' ' p/S / email: Mailing Address: 7o2 I /t/LL $'T, p ,I (�14,,, 91736i 7hat kind of Permit?(Check each box that applies) Building ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use[C(a), C(d), or C]"* ti Single Family ❑ Discretionary"D"or Unnamed Use Classification ❑ Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** ❑ Manufactured Home ❑ Boundary Line Adjustment ❑ Modular ❑ Short Plat** ❑ Commercial* ❑ Binding Site Plan** El Change of Use ❑ Long Plat** ❑Address ii Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** O 2lPropane ❑ Plat Vacation/Alteration** owed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management ❑ Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance ❑Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment .❑ 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: I DESIGNATION OF AGENT hereby designate /�(/L /l �'r to act as my agent in matters relating to this application for permit(s). OWNER SIGNATU E �� c�p* � _ Date: /-Or. OG 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 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 attomey's fees and expenses which may in any way a against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to vide access and ri ht of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any equi d later inspecti s.Access and right of entry to this property shall be requested and shall oc 'jr only during regular business hours. n Signature: i Q X C. c::::---..—..._ Date: /" .S.• O fo 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 etS!dangered species as thosA`terms are defined in the federal law known as the "Endangered Species Act"or"ESA."Jefferson County makes nd assurances to the applicant that the actions that will be undertaken because this permit has been issued will t iolate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even' u are in com lance with the Jefferson County development code.The Ap.plicant acknowledges that he,she or it holds individual and non-trans r respopsi lity for adhering to and complying with the ES a li Signature: ex—de,. � �r � s read this disclaimer and signs and dates it below. .1r,ls,=i; Date: i l'O S- O t ' i G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc tLOPMENT 1 • OWNER BUILDER STATEMENT III 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: /NA _ Date: GENERACONTRACT R OR MANUFACTURED HOME INSTALLER: PHONE: FAX: UL / 4s6 aOT/OAI PHONE: a ) Sif O z z/ (3 O ) 3FS /CV MAILING ADDRESS: 202/ /444 ,Pi. q�� /u4/].,,. Cjr[�3x37 EMAIL: CONTRACTOR'S LICENSE `/L // I (�^" a WAINS NUMBER: RqoL( c..:l� c6/C S NUMBER ARCHITECT/ENGINEER: eam Cat1StiL2:4/1/74' PS- PHONE (gee )'7/. / 3 FAX: ( ) MAILING ADDRESS: ha/S' 6- 69A,AluA go,,/r o/2c/IA40 E ,„9 f'36 Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: X New X Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: g - Bank ❑ mmunity System ❑ Alteration/Remodel ❑ Concrete Total: 3 _ Height: Individual System �/ ❑ Repair ❑ Mason SEP Permit#r)S=9 y ❑ Demolition ❑ Other: ,q 77 4 Bedrooms: Water Supply: ,61.L Da_ Existing: Setback: ❑ Private well [_1 Two Party T e of Heat: Q�UT Ft,2.t' Proposed:Total: S. Name Public System: f32oM*JE If this is a Commercial Proiect 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 X Above ground Tank Size of Propane Tank: Z75' (2;4L NW. ❑ Heat Stove "ACook Stove LI Woodstove fl Fireplace Insert Hot Water Tank ❑ Pellet Stove ❑ Other,e40/4A)T/A4T Is this appliance being installed in a Manufactured/Mobile Home? Yes t1t3 ao/LE2 When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all properly 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 -) Main Floor 7/3.- 315 2 Consistency Review: t 53 i 2N0 Floor Base fee: aeg i � 3q. ' a � • , 3`d Floor Additional Section; _______— Mezzanine: Plan Check fee: i g 20 ^Cy ' 11141 rl a, ( 4 •�/ ,t cy Heated Basement State Surcharge fee: I_ ►(Q.sLly ?ZA �t Unheated Basement Pot Water Review fee: Other Unheated M a Z ( 01 911/Rd Approach fee: E Xt'L a I 0 Garage/Carport TOTAL: $ AirD,0 3 .- 4 , p Decks VriCI D u7JL O.Qri-- - PML Ij 4' U 1.1,1 , Receipt Number t, � I�0 c , dC. Other Cove l' — 4 1� Cash/Check Number: --T 1730 �� ` fa- `� 6 I-S 511 1 ESTIMATED COST(REQUIRED) Date: I .Fair market value of all labor and materials foun• on to finish J i�N 1 7 2006 I't 1 lac j ! I r c, l/ , fr�-, —�r ©00. cooql 11 r Initial 7"- (;:-\\pccrnitCenteA FORMS\DRD FORMS\M. r Permit .. cation 7_li __ - t:1.0-4-56----C-1-PMENT 1 /,C( 1 .. . ., ,.. . 1 II k7 i . . 'S133HS ....„.., , - , , • =, t—1 • i - AO .OXIYN . ,,.219140 7 rof eo -tot . 1, -g• c-, • Pi :-•‘ --•• ' "Aa- li • „ • , cA0771441+, 133HS .....‹ ... ..1-cyriti4 ..., _ c—p . • /. /./ AdrirK4MITil APAPIIIIIIIIIIIIIIIIIMIll ....,11FigliS //ii A • iii iiiii c=;7 111/41` / Eva 0000 r , ..;:.--' • i ' 1 '1. . 1 I 1 ..,..,,... ' 1. • i „ ii i -zi'., L. Thili 1 - • ,, , . • H ____________.....m.........••••••••0 litilr I ., 11.. I ... •.:1:::lit. \ \ cs9111 te7100dt cYclal6t1-2)/ v•;-.- . ' ; 1 ;;ics,,4 , ; ; II .---TE-29----- ..1 -4 '4" : Stii T. i" • . i i I i.-',1 -•-4--ii -1; I- P t..-.I i-. id]. . 1 . - - - - -_, — —7 ...,........ i , -, 4. f--4-4. t--1 ; Z • ..f,...:,1...1C • 1..1:K...i. l• ; . c.- .. : 17 111111111111eleigri I r / /. iii \ \ ‘ 1111111111111111111111111111 1 \.9 . i- , r All ,PF 7 .... • ••••••••H ••••t 1 ,:. - _ 4. 11. .„_1_••••••••1••• --c4_1=7H _- • . T.1 L ..111\111 • l•,- , I--°- 'I' -1-1. I-4- C kith ...........1•••••••••• ZaAad 1111111117111011111111WO il' '."17 7r7Qd SI t t 1 • I '' 144 . • t i : : 1 i . i,--,17,Y.• di il, I I I AIII , . . .1-1 , 4 t ••1. . '.„I tAl2..*(1) p ' ii ,Etg 1,1 (1411016 = • , 4.,k, ol, •• i! .,1a...whi 3110.. .--,-. . , f 4. •••••1.- 4,4v 1_111, 111 t..4•;',:5•VI'''-:FWArifraltierjr.blV.- ::::'.-zi, AM 0, , i-....1. t- lt "WC11,111 ' ( 1 ,\t, -,j‘s y../N4A1YA4 s2N6 .1 1 ,...______ .-1.400 170 --10 a7V-A 0-1-atL-t6 I i.--.77-....... 4.........1.. -- • -- / tit . . 1 : • k-..1-ill /1Nig ..---_ I t i , • • 1 -4. ....... .1 . (11W111 r ?I'nt AO • .1-1 .J• -.-D71.-- ---F --6 --------1 Ig -IL il tt LA- -.4_1 1 1 1 .I ip.,-- %to-IQ — „oil/4 c6 -,i71 i ! I .1 1 1 'JA-I =u--. 1 ‘.11XIG-HI , I .1 , ! iN 4 -11;11 : . :-t-• , i ; . , st- i t 1 i.-..+..-t-- • -1-171-1,7- -.1 • 4-----r- t t 1-. 1 i 1 , . Ny-U -• NIV\I•V------------_-_-. -_ 09k ..!. . li Hlt • i .. 1•1• II, , - Tatit--...1. , .. • :. •.i ..-% • .,... \). ., .i.,444,,H . • -„-1---i-- ; • • • : -. ---t- i• 1 . - + 4 4 4)----71---Z--- --:"---1- '"-"t---1 ' • i' 1 '1 -0- hi '0 t :. • 1..1 t. ... n, n, • . . . • i T i 1--- , 21' 1 '• , ; ' / ':•-- . -1 7 _,---, 1_ cf.-7.,....... .._.*:,,,,,,,...,,,,,,,- 4 A , r • ---":44"7". 1"---7 '.-. - -,r07740227- AO I • 11111111V 4 ZAIA 571 t•-lk. . 1 ., 1 ,.. ...r.,.... i. ...;i. ...it:...1 ?. 1 1 1 1 0 .1.-1 1..-.. ;411 .' : ; i ‘ 1-i X. . ..1..t7 .12,..-.; 4:1 9X ... • - ... -t—i ii ...- .... . ,„• . . , -••,, , : . . Aill. • 0 • , ..... ! ,...., ill , - _____:----_ ..1, 4. I- 1 . 1 .1-- I 4 (-1 QXV I , . I .1 . 11.,.„ ... ...... I . ---wir ------- — 1,,T 1 1 i I ; r j. TT'. 1 i.. • • 6) ' .t, • cp1-Xl'aLH.C43Xt7 .. . • ,.. i I i 1.... "-i•"--1 i• 1. a 1 _i • , Iiii ____._:_Sk._.______' 1 • tgal., '1 ; 4 t • rii t ; 1 . -;,1 ) ; ; i ..t...1 i F!...!.‘rwriff4 ,..,,,... .. • [ ! : 1 i i , , •• ., I \ • f,,,.• -.),o .... .•::,,,,,$•'.:.::.,,!:.•„. • . , ... ,..r.,. ,, ,,....,...„„,„„:..., , .....,.._-,„•„:„ ,.. _.,:.•.,,„.„,,,,..,•, -, • . . . . ,. . ,'".„.,. .., • _, , 1,"...------] . ,,,,,,' ..„...,,,,,_„,._ . v. 1973- -:N 1---":?1--------q'116. 'III 1-- , ,i. - 0--li INI a <M.14/{00,— ' --) / ,...,..:;:li 7 ---- . • .i, . _ . . ,,, , .,. ....,.. .., . , ., , ..,.. ..,.....,....., , . a '. . .:',.,...,..- ., .,. .',.. ', ..',.....', . • , ! ..... ! ,. , . 1 • ' • • ',.i ' --- - - --- ,, . .. ...... . MM.. IN 1111111.1=11•1 - ..A., l -SDI �..�7a•=�E-- �� .�.,� .r.. \ \ Al �. $ p`I -- \ '�, � � 0 �rna33a ->_T i ' lJ ,�O LJ \O� y Y h '�yy--��O ) -- r. X / �n1�A='r�s� s �(, ° ^' off G � � o� � 1i6 sp �3cC I L `l ''''', �` �� �u CAI_._ O _ _'/..-.$CIF:,' 3 G0 O _ 1\'1 �\ /r \ a � G Ilf , I 1 T_r I S3 ��. i7. C� k+l ,�_/. �,�'D_ ry�� ^\ I D �, < / I I 5.,. RI t / lvSl n utl fi , I�_� �� L a �% '<m� it �� �--— �- to c3 �rourard�J�"/ v � cDuei[Ers C I JELL errn I ' , J _,J�1 a �3 �s !� III I��� � Ir W7 Iig� i o -_--� J � ° m � � � ry L-J L �L_-LIJ.L _�:,_ " I < `I i r ���• � SdEll,lES -i m I \y luv � IU- � -- N a, � 1 ,.. C D 11� a s 114: cam-}- � � I{� N ` I / ,, --``•i,rE,,s� ,na P / { '11' m III"' Ory R FYI A 3'G .k—. —_ 1 I I 32-IU"1 ID __.___._ --_ __I —_ _—__. __1._ n 'I � , rn I. , L n '` � I � - — - -- I,I�_ - _ � I ,..rot 3 — • s '� [ c .COAT ` SHE LVF-- I /Ipp``JNIII__ _ �,yl—_ �� ` mn L 1p !_7yL _ ',1 —` - i - I\yl 4�_ 1(--'1 ;✓'L. , -- ---(- •n- _ n _— it -II `.____- 4 tie—�1 fir fir`*`-'r -�' ; A I ft `-:i 11 - • -r ..X` `-- -: ::,, 1.., --t I I �' m Y :`. I 1;'r �Y ' I] K 5 -I-- u I o. y , I I y t- -- —— : --r_rt,.u. 3t '\-'7'-•y, JI%'i S — — 1 k. 11 f � E 5f �� I v.� II j D T 1 m } F C \ �I �.lf) ��Z sl o f sr .-`I I---'": -—1 lei i 43 \�=—�I 1M1s. T x L ,,J-J \ sAs f o�\/( 1 F "° \ 9 I I vim I I "7D➢ECv �A \ I I 1�; I'- `\ Q `� l --_ - ---- ---- \ I \ f . J4I Io" iL_Is'-6" a 2x-a" IL ,I '.10" N. _ F - __.— N. _ \ _ q (� 9 (� Z ‘,.1 ' I"-_ ri ‘2 . 4 1 lit g xs Z P "P 4 11 f _J s 2K{S1 $ui oh'raoni '' - u1 SPA 1 z l'-.,1!g. cs- -,i. A g it „L t 1,I I 1r-r I ' ,. uou■MINI W..uu■uu■■■..u...■1 R aa, rot c., 1 + ,, - .uu.x.auu.u�u.0 ■mu■■■u I mouuuuuuuuuuu.u.u. II I a• {� �._ P 1 u. �. Intl■A■.m..u.N■■■■■■■■1■■■■■■■ - 1 .' L O 'n u1api 01�y��1'dlPiyl7��a ��■r711 , .Awarm r 1u®uN.umum■■■■B■■■■■■■■�■NN■■■B ( , 41 O p j ran■1■S■M ,R iLiim" 1■■■■■.■■■u■■��. ■�■■■/r'■■ i ■ f.s I[•y ) �f� 'r/r'a,,v �Ca9' y 4 n n 5 y c O !` m 1N. lu■■■■■■O�./�., �1.1Y sll`\..... it �', {�.I,,15 .Tram 1 --r— I m Y r m L . . .,�uuu.m.u.■■■■u■.uu.... ....................��.■....■� MATRIX I _ �I 1 - ` .■�■■mU �■j■�■■ us. u■■■.■■■.■anti■ ■■uu..■u■■imin I 1 DRA.,„.-.£SIGN ' 1 q. 3 r z uu..u .wl.�u ■ .. m■uuu � .uouu.uuuuuuuou.� Twirl r,c �T rt I T ■.■■ - ■■W■Y 1..■■YO� ..■■...■u.■1 +,. x35��2H2J ,n, .. _!_ 1�-3`$ ' I 1 1P (w,: 32 PLO7 /1AA/... /(Jer 7"o Ja41.,E I I L30033 c.. c d/�.., G���vaoc Div �ooc ��T�/c%� �2/rT s/o�/�c r r • ._.---.__ 6223 ,L(G /2/o&: 20 V ,off% Tc6.4219L-'J ,`!JA. 9PF62 7 130 is 14.. 774X P4/2e6 /u0/12Ek : om/ Y06' 63,Y 4b, 4SO4 IOV 0//�1/ G °2 &2 %U L OL / 4H- E ,.. JT�� ��olL /uu�Q�2 = 2 .o . 3S oz z l - 4 t-.1 411t. Go/¢7 , Lptk.- - - i/ /fi7 k i N[: 0�.4/nl- - - - - - - - - _ . Pa ro R rE0 F/2C/v c/10/0/A/ ✓3�Cace�til �� � --- /�a2i�! �6 - 3/ cp z 4Q, cL,ur.:./��sS�i p�nrTiA� / ,In I / c �N�7�Ir' 12" w v 1 -- / -�- -- 9G 3.23 __,L___________Iita .", ' _III°�"' I / • / D� I 1 / I\ !"�/ // `� •O� ••• - __ - I /I� /' III 1 / 1 '/ / kxis71 wrn ,,_.-� I F�/�G Sd El) 10 z ✓Ed r, / - - - — T� �UL L�lA7EiZ..LIF(E. yam, .�r� �. WATgR bvlETER. ' pNONErP.YLON it, / , , ' I D/1�f/VF/LzLI R I Y E V/A f' r i __� (,--, / aP , a 1 5�E/'Tic - , , :K \ /;)2.5-4,6,44 . . . I ..______L,_4,__,,kt:,.- __.), I ' .4(..76.:12 I\I/4-7-6- ' i 10,/____...,,, (,. _ O_PA-ov_r/4.7---.±./3_, _.: .1 ff , . -7,5.-.a -7).-1=-1--if-723.--7° --+:71 . . I I & t-----------. ''\''' .„...1..__ -1 61\ 10.2- /* 461 ----------1 : 1 .1, ) r', -- I I \ �/ 1. I ' t I 1 �.. - _' --t- - 1 • I I 3 to ' I I : Ir_— II i rr_j--- ,1 ... ?I I I 1 1 II IoI I . • Cil � 14,c7 oG 1 1 !J 1'6.0vIIZTYAR0 ! ;.! 1 t, _.!.' — 40) Ih,kGK Gt 0➢E I !I II I — 1 I — \ 52, T C PILLNI I. a I. I --4 : � � . V1 j . - -.� . ..I DfZE.S'7L r) SO I Yz�6I D5 f`1�S_ I �"o/� �v�� 11 I �` 9 I . 1 --- fS'P6-dS// I ' r ) �L - - ------- I 1 ./1 - ( `; I — I ! I I 1 / �/; • j I ' ' ___ _ ...ff. _(t._ 'Z 0 5E,47,4;E.ii1-'4...\ (..N,:t._C,..)________.__________ __ ._ I I I {,� 1 1 i/ I 'p2(S'TC0 - �c/GC o/sPE2S'/od l lh'/oo/ ll -4.--A's i hl B`l° 211 I'L" (J /' 4 7 APPROVED . ,,-,ii nor 3'i Ao,-4-c�"Nr,.. Re5P/06svi/.�-� SITE PLAN ii,*174 41 z..7 1 I Z/�V _ '. JAN 3 0 2006 o , il j ., g Aricil .�� ,� ;,.orrnw P s ,� c� �. 111 •� ;quir DEPT.OFJ O OUNT1Yo CO.—NE���,'1;9 ,� �� SIGNATUR . N R INE uF 2t-Fo•T -- ;*1) _ • 'ASM•NTF•- I GRES•, ER . S •U•P6SES P'R HIS :UR EY \\