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Home My WebLink AboutBLD2006-00469 • • CERTIFICATE OF OCCUPANCY Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 (360)379-4450 FAX (360)379-.4451 (800) 831-2678 PERMIT #: BLD06-00469 SITE ADDRESS: 2710 E MARROWSTONE RD Issue Date: 09/18/2006 NORDLAND, 98358 Final Date: 9/12/2007 APPLICANT: SCOTT H CASSILL PHONE: 360-385-2776 JOYCE S CASSILL 290 SMITH RD NORDLAND WA 983589530 SUBDIVISION: Block: Lot: TX37 PARCEL NUMBER: 021332021 Section: 33 Township: 30 N Range: 01 E PROJECT DESCRIPTION: NEW SFR ATT GAR U/G 500 GAL PROPANE TANK - REMOVED EXISITNG MAN HOME THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2003 EDITION. OCCUPANCY GROUP: R-3 TYPE OF CONSTRUCTION: 5N SPRINKLER SYSTEM yes no THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 9/12/2007 Building Official Signature Date I:\F_BLD_Occupancy.rpt 10/29/19E • • 10.) MANDATORY MEASURES FOR HIGH RISK SIPZ: 1. For proof of potable water on a building permit application, applicant must utilize DOH-approved public water system if available. 2. If public water is unavailable, a qualifying alternative system may be used as proof of potable water or an individual well may be used as proof of potable water subject to the following requirements: a. Variance from Chapter 173 WAC standards granted by Ecology per WAC 173-160-106 for a new groundwater well within 100 feet of a sea-salt water intrusion area per WAC 173-160-171 (i.e., within 100 feet of a groundwater source showing chloride concentrations above 200mg/L or within 100 feet of the marine shoreline); or for an existing or proposed groundwater well not subject to an Ecology variance, applicant must provide evidence through a hydrogeologic assessment(relevant components of an Aquifer Recharge Area Report per UDC 3.6.10.e) of a reasonable probability that the subject aquifer will not be degraded by the proposed use of well. b. Installation of a flow meter. c. On-going well monitoring for chloride concentration. d. Submittal of flow and chloride data to the County per monitoring program. 3. If public water is unavailable, a qualifying alternative system may be used as proof of potable water. 11.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 12.) 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. 13.) 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. 14.) Outdoor residential storage shall be maintained in an orderlymanner and shall create no fire, safety, health or sanitary hazard. 15.) Not more than 2 unlicensed vehicles shall be stored on any lot 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 Chapter 18.30 JCC. Outdoor storage of 3 or more junk motor vehicles is prohibited except in those districts where specified as an autormobile wrecking yard or junk (or salvage) yard and allowed as a permitted use in Table 3-1 or Chapter 18.18 JCC, and such storage shall meet the requriements of JCC 18.20.100, Automobile wrecking yards and junk (or salvage) yards. In no case, shall any such junk motor vehicles be stored in a critical area. 16.) Minimum setback from East Marrowstone Road right-of-way shall be 20 feet. Minimum side yard setbacks shall be 5 feet. Minimum rear(shoreline) shall be 60 feet from top of bank as required by the geotechnical report. This setback shall be measured perpendicularly from the bank to the proposed residence. 17.) 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. 18.) 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. 19.) Residential developers and individual builders shall be required to preserve shoreline vegetation and reduce the associated risk of erosion during construction and any future activity which may impact the stability of the shoreline. 20.) The building height is not to exceed 35 feet. I410 21.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 22.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 23.) A MINIMUM SEPTIC DRAINFIELD AND BUILDING SETBACK EQUAL TO THE HEIGHT OF THE SLOPE IS ADEQUATE FOR THE SITE. COMPONENTS OF THE SEPTIC SYSTEM THAT DO NOT DISCHARGE WATER INTO THE SOLS AT THE SITE (e.g. SAND FILTERS AND SEPTIC TANKS) COULD BE LOCATED CLOSER THAN 60 FEET TO THE CREST OF THE BANK. A MINIMUM SETBACK OF 30 FEET IS RECOMMENDED FOR THESE COMPONENTS. 24.) DISCHARGE OF ROOF AND FOOTING DRAINS SHOULD BE DISCHARGED TO AN INFILTRATION AREA ON THE WESTERN PART OF THE SITE, WEST OF THE PROPOSED RESIDENCE. 25.) NATIVE VEGETATION SHOULD BE USED ON AND NEAR THE BLUFF TO ELIMINATE THE NEED FOR IRRIGATION AND WETTING THE SOILS ON OR NEAR THE SLOPE. A HEALTHY VEGETATIVE COVER MAY INCLUDE LARGE, HEALTHY TREES. 26.) NO YARD DEBRIS OR FILL SHALL BE PLACED AT THE CREST OF THE SLOPE. LARGE WOOD DEBRIS AND/OR DRIFTWOOD NEAR THE TOP OF THE BEACH SHALL BE LEFT IN PLACE TO DECREASE THE RATE AT WHICH THE SLOPE ERODES. I:\F_BLD_Permit_Buildng.rpt 10/29/19 • . SPECIAL CONDITIONS FOR CASE A BLD06-00469 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.) A Geotechnical Report dated May 8, 2006 prepared by Shannon &Wilson, Inc. was submitted in conjunction with this application. The report addressed the stability of the geologic hazard area. A setback of 60-feet shall be measured perpendicularly from the top or toe of the geologic hazard to the proposed single family residence. 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 landslide hazard area 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.) To help prevent seawater from intruding landward into underground aquifers, all new development activity on Marrowstone Island, Indian Island and within 1/4 mile of any marine shoreline shall be required to infiltrate all stormwater runoff onsite. 9.) MANDATORY MEASURES OF HIGH RISK SIPZ: Water conservation measures: 1. Roof and other intercepted precipitation shall be routed to on-site detention ponds and/or other approved means and allowed to be released to the soil slowly. 2. Water collected from Storm water and roof catchments may be used for watering lawns and gardens. Unless catchment water has been treated to meet drinking water standards, there shall be no cross connections allowed between the potable supply and impounded water. 3. Water withdrawn from wells on each property shall not be used for watering of lawns and/or gardens. 4. Ground water withdrawn from each property shall be restricted to a rate of three (3) gallons per minute. 5. Installation of water conserving fixtures such as low flow toilets, faucets and shower restrictors and other water saving plumbing fixtures. 6. Landscaping plan (xeriscaping, native vegetation with minimal amounts of irrigation). Please NOTE that the above listed measures are not intended to be exhaustive, but rather is intended to be illustrative of the types of water conservation measures. • • BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD06-00469 Received Date 08/15/2006 SITE ADDRESS: 2710 E MARROWSTONE RD Issue Date 09/18/2006 NORDLAND, 98358 APPLICANT: SCOTT H CASSILL PHONE: 360-385-2776 JOYCE S CASSILL 290 SMITH RD NORDLAND WA 983589530 SUBDIVISION: Block: Lot: PARCEL NUMBER: 021332021 Section: 33 Township: 30 N Range: 01 E CONTRACTOR: PROJECT DESCRIPTION: NEW SFR ATT GAR 500 GAL PROPANE TANK - REMOVED EXISITNG MAN HOME CALL IN FOR THE REQUIRED INSJECTI NS THAT APPLY TO YOUR PROJECT. SETBACKS: e ' /a/z3/p,� U FFER: OK gj3/oLn/ Footing: Ok ,o/Z3/caL -- Foundation: (l"" /'"/ , Stormwater FINAL Approval: aX 01/07 Underground Plumbing: Underground Insulation: • ' Shear Wall : ifppF Spy,_NA/Dim OK 1/iv/o7/L Au. OSR 511614.Pwn AJAtu OK /fp, Sheathing: Framing: 1-�-0c, 0r� t,00p., D okile6066b,71) 3/2/o7� Plumbing: '7,? Propane Ticnk/ Lines: ! a vt_4 Insulation: 4,1, 514 L A wed 3 a i AILS 7 Sheetrock - 9.1 LCV..)-1 (r Septic Sytefn Final Approval MUST be obtained before final of structure can be attempted. • Road Approach Final Approval: N A . Zoning Final Approval: tvOc Final/Occupancy Approval: -tar % 91107, 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. IJAAuWyty HOT LINE AVAILABLE 24 HOURS A DAY e Zt 3/14/07, SPECIAL CONDITIONS APPLY -SEE REVERSE Il DAass :P -rje> q/r-/ -!.. ilt1 ILDING PERMIT APPLICATI!N MLA Revviewiew Type: e: r pe: I 4 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00469 Received Date: 8/15/2006 SITE ADDRESS: 2710 E MARROWSTONE RD NORDLAND, 98358 OWNER: SCOTT H CASSILL PHONE: 360-385-2776 JOYCE S CASSILL 290 SMITH RD NORDLAND WA 983589530 SUBDIVISION: Bloc-"( l� Lot: PARCEL NUMBER: 021332021 Section: 33 Township: 10 {mange: 01 E CONTRACTOR: PHONE: REPRESENTATIVE: oZ � PHONE: i tzc(3y, ^ .� l✓��1�c t C'c PROJECT DESCRIPTION NEW SFR ATT GAR A/G 500 GAL PRO ANE TANK - REMOVED EXISITNG MAN HOME TYPE OF WORK RES QUARE FOOTAGE: TYPE OF IMP NEW MAIN: 1,596 VALUATION f986.00 CODE EDITION: aio1,%4` 2003 ADD'L: 990 HEAT TYPE: PRO OCCUPANCY: R-3 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: 54 CONST TYPE: 5N GOARAGE:THER: • 988 SHORELINE: CONST TYPE: DECK: 494 SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: 4 Prop: 3 Total: 4 Total: 3 Routing Date:Q/ i . I Q(3. Type Amount Paid By: Date: Receipt: Approved/Date Permit $2,046.55 CJZ 08/14/06 81427 APPROVED Plan Check $1,330.26 CJZ 08/14/06 81427 State Building Code $4.50 CJZ 08/14/06 81427 SEP 2006 Potable Water Application $55.00 CJZ 08/14/06 81427 Total: $3,436.31 Jefferson County Planning & Building Department ID IA- „ S:jj t U ,�,�ozv 6 k °, , JEFFERSON COUNTY Aug 5 ?000 , ,��1 : :: PARTOF :::: DEVELOPMENT VI"' MG et • • Washington 98368 ;;EVELOP'i��ENT 1tu �O 360/379-4450 • 360/379-4451 Fax - $INO http://www.co.jefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# 0 ,• f ,�( PROJECT/APPLICANT NAME: CA C. -•,l L L 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. , K t".c- r ex,ct.-1 4,•:7 /,G(e u.4.c-A..sv'-cc, I& t/ 16,c 1je el .frY.y n caj/ /eel(0e-o _to, -1-1... is ci y/e - LA. e. /7 ilrefi,441,e Z .2.4,44' Altfc%aare 7',-`' Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. -/-a s•4o.-Q4..4 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. �►"-C.&c1 1 S�,�a /) b L y kr/.-e>S , it A r.u.71l,eel-- 4. Describe the existing+ soils. Indicate soil type on the site map. [.ra c:57-1 eirot rx 0..-r-@ . 2,H( S' ."7 . C' ie."A 1 I So;( crk. -7/4 ie) U¢ 7Z 4; (// 5. Describe the existing site hydrology (i.e., drainage;behavior of water on the site—above, below, and on the ground). Indicate ;)C 1i mile DD existing stormwater drainage to and from the pg�the a rj Depict separate drainage basins on the site map, if applicable,and indicate acreage of each. ��ll /VAL 6469 EFFFRSON COUNTY AP 'ROVED 6. Describe any excess levels of noise generated by the proposed use or ac-flVlfy: STORMVOAT�K PLAN 4 \i $EP 1 4 2006 ` StOrmwat "y ------) JEF N ' UN Y bFt'T.OF 11"r V MFPif Required SlGtiATUR f stormwater site plan template-rev.10/1/2003 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. 514 .- l o� 4./�>�/7iy r,<J14511L , �G ' h4,,,t< 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.). 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 fromm existing facilities. Sc�r rAM Ldat cis t c vci N s ;// /� 9 G —4-a-e-�-+ refob r>i-- w--;I) ,ks-fir // �b f r ,cfir 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.] Al/A 11. Describe the performance goals and standards applicable to the project. • 12. Describe the flow control system. AtA i t stormwater site plan template-rev.10/1/2003 . .,. 6 • • . �y/ 13. Describe the water quality system. AUG 1 5 LO ,- v )F,HENT .j 14. Describe the conveyance system analysis and design. w r t•) //co�cJ r_edr.---kee-A re cam.14.4 e-4.4(4'Wo-14 S7 15. Describe the source of fill material,physical characteristics of fill material, and deposition of excess material. 11/6 I 2 // 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. ,VA_. 17. Describe the proposed surfacing material. 18. Describe methods for restoration of the site. gt, se-`(` re —5 s IfLt 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. /4/1./ 20. List here and include any special reports or studies conducted to prepare the StormwaterrS/S''ite Plan. c" ' / fri C�ea /d , 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. /C/// - PERMIT # B 06 - 0469 JEFFFIIS1J 4 EMU OUP stormwater site plan template—rev.10/1/2003 7 • • 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. )es 2. Establish Construction Access. g /S4f44'' dCC-tSs Cc+•-LLD 3. Control Flow Rates. Al rid- 4. Install Sediment Controls. i ��« e a S Gt.ec-4af5 a 5. Stabilize Soils.(-U%�� S' ' A2-P 57L 2 a S' Lt ,e•er ,P I 6. Protect Slopess.� / �" Wr' I f f/ � !�Q-u.vt cts' 14-ee-oee_it, 6u 7?-4 41 o vr" 7. Protect Drain Inlets. stormwater site plan template—rev.10/1/2003 8 • 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. AUG ' S 20 05 utV•LUri iE tf 9. Control Pollutants. Yv 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). il/k 11. Maintain Best Management Practices(BMPs). 1/ef 12. Manage the Project. 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). �� a n►'ie. 1, ut.C_. b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). A71#1 -- 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. ?FRMI# JEFFERSON COUNTY DC stormwater site plan template—rev.10/1/2003 M • • b. Description of special requirements for working in or near environmentally sensitive areas. (1., - 1,- __06,/41-11. 7401 day 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). • fv Q14-e 5. Construction Phasing. a. Construction sequence 7/1 b. Construction phasing(if proposed) 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). Provide a proposed construction schedule. / / II. Wet Season Construction Activities. a. Proposed wet season construction activities. ec b. Proposed wet season construction activities for environmentally sensitive areas. in/7/9 7. Financial/Ownership Responsibilities. a. Identify the property owner responsible f r the initiation of bonds and/or other financial securities. Aji • b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. C JA 8. Engineering Calculations. Provide Design Calculations on a separ to eet for the following, if applicable. a. Sediment Ponds/Traps. b. Diversions. c. Waterways. d. Runoff/Stormwater Detention Calculations stormwater site plan template-rev.10/1/2003 10 • 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 my knowledge. I also certify that this application is being made with the full knowledge and consent of all owners of the a ected property. (LAN WNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: !. 0 t. 1 AUG 1 5 2006 L_ stormwater site plan template—rev.10/1/2003 12 • • 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 contrartnrc and that they will be assuming e resp ty of the General Contractor for the proposed project. Signature: Date: 1 1ZiV G GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER:. I (.outM-e. 5-,t"'t cod.r 4— PHONE (? ) 3 gc.11 km, FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: 'i1 New Wood Existing: ❑Sewer ❑ Addition • 0 Steel Proposed: 3 Bank ❑q�Community System ElAlteration/Remodel 0 Concrete Total: 3 Height: Individual System ❑ Repair ❑ Masonry Co SEP Permit# C5G --I'i 15 ❑ Demolition 0 Other: Bedrooms: Water Supply: PP Y: Existing: Setback: of Private well 0 Two Party Type of Heat: Proposed: --- — `,, El Public ro P&me_ Total: Name of System: 0 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 uIfis is a Propane Tank and/or Appliance Installation permit,mark all items below that a I : nderground Tank Above ground Tank Size of Propane Tank: 1a 45 Heat Stove Cook Stove ❑Woodstove ❑Fireplace Insert P'Hot Water Tank 0 Pellet Stove 0 Other Is this appliance being installed in a Manufactured/Mobile Home? Yes .V 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. .-)(G'Rev-t n[1i"dOer t i/a,erole an .� (-- 1 I/3Q Square Footage Current Proposed .For Office Use Only Anio t ;001STion Main Floor Heated �SyG t EH Bld App Review: 4' 2"°Floor Heated �Consistency i 6 3 �.Review: 'A % .1 rr Other Heated 7 ! 7)� tC Base fee: Mezzanine Additional Section: Heated Basement Plan Check fee: I 330 l .� 14;1,44 ' Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee:G q 0 7 q pel�{dla�C Garage/Carport )�, SUBTOTAL I_del d s 0 X, u �� 7. 3 ,c0�(, I act_°3 Decks 'Or t 911/Rd Approach fee: Ex lS fi _ Other C se-ere-of ,,pp o ,Cre-of rLb.. 5 4e !{ Z� TOTAL: $ 3 6, &9,3 414 `?'3 8/04 Receipt Number: g 11 a—A 853 <o 1'7 Cam Check Number .elt� ,p� ,l4 ESTIMATED COST(REQUIRED) e: - Sits-lob 1 .Fair market yalue ofcfllabor and materials fo • ish S !t 5 'ob if 30/0-6 7. S S Co d itials: t D:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05-2.doc .1 • • -. ,,,4'S°N co, JEFFERSON COUNTY 4. ��ti IA DEPARTMENT OF COMMUNITY DEVELOPMENT AUG 1 5 2006 „� ti `` `Q M 621 Sheridan Strect- Port Townsend Washington 98368 360/379-4450 • 360/379-4451 Fax 4. ,..„.„) www.co.jefferson.wa.us/commdevelopment .. SjjIN(}� cV I Master Permit Application rEM a�� MLA: CXe - A(p4 *--Project Description(include se arate sheets as necess . ?4'' " C L=i 15 41.4 j t i0t a K 4. �'a c� 011it>/ 5',......,q t+ Fa.,.......; �v/ ),p t...,c-� G, , a c Cr,/ a y+�'' I a Property / Number: 2, 133 2 e4 L Size: I)o x(ypp a 1.0i A. (acres/square feet) Site Address and/or Directions to Property: 'A 1/o le, N4twrv+trS4cxe 1e . Property Owner(s)of Record: j-oy c..‹/g c.,tiff C•c s S ill Telephone: 0 cc4 ??r -2. 11 c Fax: email: SCoD?o a aWruPu'i..r Mailing Address: ,2.9a $w.;•144. Ad IV o dla -/, WA4g SY$ Applicant/Agent(if different from owner): VA' Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) &Building ❑Variance(Minor,Major or Reasonable Economic Use) d Demolition Permit ❑Conditional Use[C(a),C(d),or C]** Single Family ❑Discretionary"D"or Unnamed Use Classification IV Garage Attached/Betached OSpecial Use(Essential Public Facilities)** Q Manufactured Home °Boundary Line Adjustment d Modular °Short Plat** Q Commercial* °Binding Site Plan** Q Change of Use °Long Plat** 0 Address i Road Approach °Planned Rural Residential Development(PRRD)/Amendments** R Propane ❑Plat Vacation/Alteration** DAllowed"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 Us¢ i t . ,2.. " - . ' °Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* °Jefferson County Shoreline Master Program Amendment OForest 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: Alobt- DESIGNATION OF AGENT +• . - I"hereby designate to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: '7)z Se/0 r: i• By sipning.this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of 'r • • his,her:oF itis 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 l . • ' . expenses which may in any way accrue against Jefferson County as.aiesult otorin_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. Staffs access and righttf entry wjll be assumed unless the applicant informs the County in writing at the time of the applicatiop that (� a wants eor notice. Signature: ic Date: 7 At'/G 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-transferabeyspp9ss. .. for adt�erin to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. 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