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HomeMy WebLinkAboutBLD2006-00480 • • BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD06-00480 Received Date 08/21/2006 SITE ADDRESS: 52 EBB TIDE CT Issue Date 10/12/2006 PORT LUDLOW, 98365 APPLICANT: PORT LUDLOW ASSOCIATES LLC PHONE: 360-437-2101 70 BREAKER LN PORT LUDLOW WA 983659766 SUBDIVISION: LUDLOW COVE DIV 1 PHASE 2 Block: Lot: 8+ PARCEL NUMBER: 968800008 Section: 17 Township: 28 N Range: 01 E CONTRACTOR: PORT LUDLOW ASSOCIATES LLC PHONE: (360)437-2101 70 BREAKER LN PORT LUDLOW WA 98365 360-437-2522 Contractor's License: PORTLAL9G4L8 Expires: 05/02/2008 PROJECT DESCRIPTION: NEW SFR W/ATTACHED GAR ••A/G 120 GAL PROPANE TANK CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. SETBACKS: As SaRVEYED r� OY notJisilt 3/4107 UFFER: ArsTALLEp Footing: l'K 7/4/47#711 Foundation: °K day." ta goi..aRooms -re ABA ) afQ ,7 Stormwater FINAL lApproval: %c L/NC OK Z/ 07 'C A Underground Plumbing: A Underground Insulation: /J Shear Wall : t iz/1/I07 STR_OPs Ole l2/z//o7l Sheathing: Framing: �_ z/���s dam' 'O�' ,////AB limmgruor. bK /4/2/67 f Plumbing: jd4S>� �� V/-ms- 0 1:W Propane Tank/ Lines: OV 2 f%/,: '%K///2/ Insulation: ____/;ik k_ z/7/4',5,7 Sheetrock: 2/27/O$ Septic Sytem FinalA royal MUST be obtained before final of structure can be attempted. Road Approach Final Approval: Zoning Final Approval: Final/Occupancy Approval: m( - ,r t'/o ;//ZIIeg 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. HOT LINE AVAILABLE 24 HOURS A DAY SPECIAL CONDITIONS APPLY - SEE REVERSE // 10 ASSlcLpff AF7CsK AtPROVAc C9G � G(PiGA lS^� �1�/ 'frg 4h2//frggi • • SPECIAL CONDITIONS FOR CASE A BLD06-00480 1.) VOLUNTARY MEASURES OF COASTAL &AT 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. 2.) MANDATORY MEASURES FOR COASTAL 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 requirement: a. Chloride concentration of a laboratory-certified well water sample submitted with building permit application. 3. If public water is unavailable, a qualifying alternative system may be used as proof of potable water. 3.) 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. 4.) All construction activities shall not encroach upon the buffer. This includes the storage or preparation of materials. 5.) No development shall be approved for any new or expanded residential building or structure more than 35-ft in height above average grade level. 6.) Call Jefferson County Permit Center, Development Review Division for inspection of erosion control measures. (360) 379-4463 7.) 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. 8.) Construction of structures on these residential lots are subject to the following setbacks: A) minimum front yard setback shall be 20-ft., B) minimum side setback shall be 54-ft, C) minimum shoreline setback shall be 30-ft from OHWM or 30-ft from top of bank if bank height exceeds 10-ft, and D) maximum impervious surface on any lot, shall not exceed 45 percent. 9.) 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. 10.) All noise emitting machinery that cannot in any other way operate below the maximum permitted noise level shall be housed in a sound-attenuating structure. 11.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. • • 12.) The minimum shoreline setback shall be 30-ft from OHWM or 30-ft from top of bank if bank height exceeds 10-ft. Per Notice of Purchasers on the Final Plat, appurtenant structures such as decks, sheds and stairways shall be located landward of the OHWM. 13.) Motor vehicle parking between new structures and the ordinary high water mark (OHWM) is prohibited. 14.) Per the Notice to Purchaser on the Final Plat, no fence, wall, hedge or barrier greater than 42-inches in height shall be placed or enlarged nearer to the water than the building set back line (BSBL). No fence, wall or similar structure shall be placed water ward of the ordinary high water mark (OHWM). 15.) Geotechnical report ('Report') dated 3/22/95, prepared by GeoEingeers, Inc. has been prepared for this plat, A copy of the report has been in the file for this project in the office of the Jefferson County Department of Community Development. The report contains information and recommendations relating to site work, construction activity and related matters associated with soils and slope staiblity. All construction and clearing activities on any lot within the plat shall either(1) comply with the recommendation set forth in the report: or(2) comply with the recommendations of an alternative geotechnical/engineering report. In the event an alternative geotechnical/engineering report is proposed, then prior to commencement of any land-disturbing or construction activities on any lot and prior to the issuance of any building permit, the alternative report shall be prepared by a licensed geotechnical engineer, a professional geologist, or a licensed professional engineer knowledgeable in the regional conditions with professional experience in landslide, erosion, or seismic hazard evaluation and submitted to the Department of Community Development- Development Review Division. The geotechnical/engineering report shall illustrate the exact location of all proposed residential foundations, reinforcements, rock walls, etc., based on the recommendations of the report. An inspector working under the supervision of a licensed engineer shall be on the site during subgrade preparation. 16.) Herbicides used for maintenance along roads and drainage systems shall follow the performance standard outlined under'Chemical Application' of the Forest Management' Section of the Jefferson County Shoreline Management Master Program. 17.) 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 stred in a critical area. 18.) A Stormwater Site Plan Submittal Template 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. During construction, the applicant has proposed the use of silt fencing and straw to control sediments and stabilize soils. Restoration will be through landscaping. 19.) Per the Notice to Purchasers on the Final Plat, "Mechanical apparatus rather then chemicals, shall be used for brush clearing maintenance wherever practicable. Herbicides used for maintenance along roads and drainage systems shall follow the performance standard outlined under"Chemical Application" of the"Forest Management" Section of the Jefferson County Shoreline Management Master Program. 20.) Per the Notice to Purchasers on the Final Plat, "Truck Route and Work Hour Restrictions - Construction within this plat is subject to Truck Route and Work Hour Restrictions. All construction activity shall be conducted between the hours of 7 AM to 6 PM Monday through Friday and 8 AM to 5 PM on Saturdays". • • 21.) Per the Notice to Purchasers on the Final Plat, lot owners shall be aware that Jefferson County has approved the Ludlow Cove Archeological Resources and Traditional Cultural Places Assessments (Dated 6/30/03) and should be aware of the contents of said report. As delineated in the field by orange painted 1" x 2" stakes. No earth disturbing activity shall be allowed in sensitive areas unless witnessed by Larson Anthropological/Archeaological Services (LAAS). Approved Construction Drawings designate this area as a Sensitive Area rather than "Shell Midden" in compliance with State Law (See Special Note#1 on Sheet 5 of the Approved Construction Drawings). No earth disturbing activity is allowed within the sensitive area unless witnessed by Larson Anthropological/Archeological Services (LAAS). In the event Archeological items are discovered during construction, builders and lot owners shall observe the following protocol: Stop Work. Do not further disturb the area or remove any materials there from. Notify immediately the Jefferson County Director of Community Development 360-379-4450. The Director of Community Development will immediately notify the Washington State Office of Archeology and Historic Preservation (OAHP)(306-407-0752). Protect the area from vandals and collectors. Obtain services of a qualified archeologist to evaluate the site and make recommendations for further work in the area. If further excavation or disturbance of the site is necessary, obtain the appropriate permit from the OAHP. Proceed only in compliance with the terms and conditions of said permit. 22.) Buffers shall remain naturally vegetated. Where buffer disturbance occurred during construction replanting with native vegetation shall be required. Minor pruning of vegetation to enhance views may be permitted on a case-by-case basis with prior approval by the Jefferson County Department of Community Development. 23.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 24.) Per MPR Code Section 3.17, Accessory Dwelling Units (ADU's) shall not be allowed in the MPR-SF Zone. I:\F_BLD_Permit_Buildng.rpt 10/29/1999 QUILDING PERMIT APPLICAI N ML Review T Ty y 473 pe:I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00480 Received Date: 8/21/2006 SITE ADDRESS: EBB TIDE CT OWNER: PORT LUDLOW ASSOCIATES LLC PHONE: 360-437-2101 70 BREAKER LN PORT LUDLOW WA 983659766 LUDLOW COVE DIV 1 PHASE 2 SUBDIVISION: Block: Lot: 8 PARCEL NUMBER: 968800008 Section: 17 Township: 28 N Range: 01 E CONTRACTOR: PORT LUDLOW ASSOCIATES LLC PHONE: (360)437-2101 70 BREAKER LN PORT LUDLOW WA 98365 Contractor's License PORTLAL9G4L8 Expires 5/2/2008 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION NEW SFR W/ATTACHED GAR -A/G 120 GAL PROPANE TANK TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION 355,423.00 MAIN: 2,465 CODE EDITION: 2003 ADD'L: HEAT TYPE: PRO HEAT BASE: 1,238 HEAT TYPE:OCCUPANCY: R-2 OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: 5N OTHER: GARAGE: 632 SHORELINE: CONST TYPE: SETBACK: DECK: 366 BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: 4 Prop: 5 Total: 4 Total: 5 Routing Date:8 1 /Q `I 6 Type Amount Paid By: Date: Receipt: Approved/Date Permit $2,427.35 CJZ 08/21/06 81444 Plan Check $1,577.78 CJZ 08/21/06 81444 State Building Code $4.50 CJZ 08/21/06 81444 Potable Water Application $55.00 CJZ 08/21/06 81444 Total: $4,064.63 • `.,,r .t.1,..'!, • +r . , AUG 1 g 2003 • PERMIT # BED � n l 0 6 0480 JEFFERSON COUNTY DCD ' 0 1'1 1 if-- �`--ram ( ....� YJ F:. f \,,,,,,,,........„,..,, . w N=d i �_ _.1._.. \ ! t .% I �\ -•,, \ � ,F l l • \:, ,,,. • r11• ' • Js tl: / 4 � //_ y. .\ (j• ,/� 1t'.,•t /fie ti i..�•w ;`r\ S Imo"` ` `11 - 1 K 1E / � e 11` / �'\ i° ti � /V i. f ; , -44":44.7 • .L.,- \ `w a��� %,-.. t� w �� ( - -� -E S +^ \ \ A/ F' i .0 1, o. ,, \f. /7 fC-1-` �`•• _( w r; I t c8/t9\ . �1 ' t 'a Sletl 1 ' j c •� w� I/4 . ,; tr. C� 1\ ' I r •r A ,.. RS0� tie \` y ,: ,, . 'mod` tiib%i i`,1 v\ 7 .#' �. . 0 • �� �• #*� JEFFERSON COUNTY 4 _.-. ;,„ DEPARTMENT OF COMMUNITY DEVELOPMENT 4' f � I 4ir ,, - i1.e: 621 Sheridan Street • Port Townsend • Washington 98368 ,,i ,„,� 360/379-4450 • 360/379-4451 Fax r* -), • http://www.co.jefferson.wa.us/commdevelopment/ Stormwater Calculation Worksheet MLA# PROJECT/APPLICANT NAME: ...\:)(3( L 1t.o \N ssoCIAI`-S DETERMINING STORMWATER MANAGEMENT REQUIREMENTS: This stormwater calculation worksheet should be completed first to classify the proposal as"small,""medium,"or"large." The size determines whether a Stormwater Site Plan is required in conjunction with a stand-alone stormwater management permit application, building permit application, or other land use approval application that involves stormwater review. The basic information will also be helpful for completing a Stormwater Site Plan,if required. PARCEL SIZE(I.E.,SITE) Size of parcel , d' acres An acre contains 43,560 square feet. Multiply the acreage by this figure. Size of parcel in square feet 1`I 040 sq/ft Land-disturbing activity is any activity that results in movement of earth, or a change in the existing soil cover(both vegetative and non-vegetative) and/or the existing soil topography. Land disturbing activities include, but are not limited to clearing, grading, filling, excavation, and compaction associated with stabilization of structures and road construction. Native vegetation is vegetation comprised on plant species,other than noxious weeds,that are indigenous to the coastal region of the Pacific Northwest and which reasonably could have been expected to naturally occur on the site. Examples include species such as Douglas fir,western hemlock,western red cedar,alder,big-leaf maple,and vine maple; shrubs such as willow,elderberry, salmonberry, and salal;herbaceous plants such as sword fern,foam flower,and fireweed. LAND DISTURBING ACTIVITY, CONVERSION OF NATIVE VEGETATION,AND VOLUME OF CUT/FILL Calculate the total area to be cleared, graded,filled, Answer the following two questions related to excavated,and/or compacted for proposed development conversion of native vegetation: project. Include in this calculation the area to be cleared for: Does the project convert%acres or more of Construction site for structures `c11� sq/ft native vegetation to lawn or landscaped areas? Drainfield,septic tank,etc. ® sq/ft Circle: Yes No� Well,utilities,etc. 5 0 sq/ft Does the project convert 2 A acres or more of Q . Driveway, parking,etc. Le U3 sq/ft native vegetation to pasture? I f 1'.CD Circle: Yes No Lawn, landscaping, etc. `"1 V sq/ft Other compacted surface,etc. sq/ft Indicate Total Volumes of Proposed: Total Land Disturbance W' WO sq/ft Cut Fill (cu/yd) PERMIT # OLD [over] 0 6 - 0 4 8 0 stormwater calc worksheet.doc—REV.10/12/2003 JEFFERSON COUNTY D C C 1 • PERMIT # BED 06w0400 k JEFFERSON COUNTY F F F E R S�N COUNTY D 1+D STORMWATER MANAGEMENT' L Il COUNTY 1, SMALL PARCEL EROSION AND SEDIMENT CONTROL PLAN EROSION AND SEDIMENT CONTROL WORKSHEET Property Owner: Port Ludlow Associates Telephone: 437-2101 Address: 70 Breaker Lane, Port Ludlow, WA 98365 Assessor's Parcel Number: Building Permit or Septic Permit Application Number(if applicable): Brief Project Description: New Single Family Residence W/ attached garage. Site Location: Person Responsible for BMP Installation and Maintenance: ), Address: Same as a bovE Telephone:Same as above 1. Describe/check the Best Management Practices (BMPs) that you will implement during land disturbing activities or construction to control erosion and prevent sediment from entering water bodies (marine waters, streams, rivers, lakes, or wetlands) or impacting adjacent property or roads. Please check the measures you plan to implement and show their approximate location on the site plan. You may also propose measures other than those listed. Attach additional sheets,if more space is required. [) Stabilize construction access route. Limit construction vehicles to one route, if feasible. Provide a stabilized construction access by applying quarry spalls, ballast, or crushed rock to minimize tracking sediment onto roads. (See attached illustration from Stonnwater Management Manual.) If sediment is transported onto roads, they will be cleaned thoroughly. [] Minimize the extent of land disturbing activity and preserve existing vegetation. Preserve buffers of well-established vegetation between disturbed areas and property boundaries, roads, water bodies, and designated critical areas (wetlands, fish and wildlife habitat areas,landslide or erosion hazard area,etc.). I APPROVED SPESC Instructions—Short Forma STORMWATER PLAN Revised July 17,2002 , n � 3 i1, v c e fck "eo ! Gt f rf if-4 c* JEFFERSON COUNTY DEPT.OF CO, MUNIT!,Y DEVELO S1ONATURF at l� ( /� r r . • • f EROSION AND SEDIMENT CONTROL WORKSHEET 4. Specify your construction sequence. Describe the timing of all land disturbing activities (clearing and grading, construction, installation of drainage facilities, landscaping, etc.) and Best Management Practices.Describe proposed maintenance of BMPs. After excavation the _soil Piles will be covered and silt fence will be installed. Silt fence will be left in place until we are ready to landscape and all roof drains/ catch basin_are in. Landscaping will be installed as early as possible on the exterior of the building when all exterior concrete work is completed,(. The Best ge ctices propo above will be implemented to control stormwat I ' y .1 the Je rson County for inspections as erosion, sediment, and of Owner/Agent to BID Q s - Q48O 41 .q �DE � t i SPESC Instructions--Short Form {i Revised July 17,2002 AUG 2306 }• 6 1 - ., .: EROSION AND SEDIMENT CONTROL WORKSHEET 2. Describe how disturbed areas will be permanently stabilized(seeded, landscaped,apply gravel base to roadways,etc.) Areas that are distrubed will be landscaped with natural type vegetation and lawn to property line 3. Describe how runoff from impervious surfaces will be controlled (disperse to vegetated areas to infiltrate,dry well,infiltration trench,route runoff to existing drainage facilities,etc.). All impervious surfaces will he run to roof drains and catch basins as designed into the plat requirements. BID 480 JEFFLH AuNIY-DCD SPESC Instructions—Short Form I AUG Revised July 17,2002 5 ., 77 • • l E EROSION AND SEDIMENT CONTROL WORKSHEET [] Phase clearing so that only areas that are actively being worked are uncovered. [] Start and complete land disturbing activities and stabilize the site between April 1 and September 30. Stabilization means that disturbed areas will have well-established plant cover or be landscaped to minimize erosion. • [4 Stabilize exposed soil Exposed and unworked soil will be covered within 2 days between October 1 and March 31 and within 7 days between April 1 and September 30. [ ] Cover exposed soil with a minimum of 2 inches of straw or hay or other material approved for this purpose. [] Cover soil stockpiles with plastic sheeting and locate away from water bodies, roads, and property lines. [] Place gravel base on roads,driveways,and parking areas after clearing and subgrade preparation. [f Protect adjacent properties and water bodies from sediment deposition: [] Place straw or hay bales in ditches and drainage ways down slope from areas of land disturbing activity to filter runoff before it leaves the project site or enters water bodies.(See attached illustrations from Stormwater Management Manual.) [ ] Install a filter fence down slope from areas of land disturbing activity to filter runoff k before it leaves the project site or enters water bodies. (See attached illustration from Stormwater Management Manual.) [X Regularly inspect and maintain all BMPs especially after storms events. [] Describe other erosion and sediment control Best Management Practices. Be specific as to design and specifications. Site is very flat with sandy soils. So I believe the above measures will be sufficient. 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IIII 111111 •=1:.!.. V ' iit ,.:2 _.......0 ---7 L., CD 1 1 0:D CD : 49 r 1 .. P Z. > >> t w Ir ' gl,g 1W '-, Hi'. i lo e !i. N H 1 e 2 S • § q : ) k 4 °II Rig t._ N4V11111111' H s'.: Al .5 _1_. Aiddr.N Er I 1 k •fr _-,-,-= I -0 x >> 1 1 I A,id,[A --- ,,1,h ft.!! \ 6a 56 4 g A— 0 R `ii,!ii 4 t. sli ;051 4 i 1 il i gi ci4MOIlvlir440?i& ,q1 .,, ,,A ,..0 ,f z z 1'A,. OP iE;i'1' E P .ZItIl i 1 A.° gwi `-'c,. >,'; 'A , T l>. i PLAN 4A WITH BASEMENT ; '", '-': '- > E i BASEMENT FLOOR PORT LUDLOW ASSOCIATES, LLC .6 .° PLAN g — F ON I 1.1.ULOW WASHINGTON 2 , § g .6, ¢SON cod JEFFEF�)N COUNTY • _.` ` DEPARTMENT OF COMMUNITY DEVELOPMENT - - � 621 Sheridan Street• P �; __..__.� . Port Townsend •Washington 98368 ,, 360/379-4450 • 360/379-4451 Fax I AUG 8 2006 - Q�, O� www.co.jefferson.wa.us/commdevelopment '" ' I Master Permit Application MLA: a Co _G _ ENT j Project Description(include separate sheets as necessary): Ale& Vjeza e 6_117//u !es'de,x-e w/at'ae,4 , • ecQ'e. Tax Paf el •I Prope //Number:7� I� �i©UO�- Size: l l I OLI (acres/•g Site Address and/or Directions to Property: L bo-I I` L (DULA Property Owner(s)of Record: Laid/Dw Ac 0 LLC Telephone: 6%0) y37-2/0 / .Fax: (SO) ' - 2522 email: Mailing Address: 79 ef-, a% ,- lam., Are lad/04), Len' 911.34S Applicant/Agent(if different from owner): AIM Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) ( Building ❑Variance(Minor,Major or Reasonable Economic Use) El Demolition Permit ❑ Conditional Use[C(a), C(d),or C]** M"Single Family ❑ Discretionary"D"or Unnamed Use Classification V'Garage(Attached)Detached ❑Special Use(Essential Public Facilities)** ❑Manufactured Home ❑ Boundary Line Adjustment ❑Modular ❑ Short Plat** ❑Commercial* ❑ Binding Site Plan** ❑Change of Use El Long Plat** ❑Address ❑ Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments"* II�Propane El Plat Vacation/Alteration** ❑Allowed"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 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment El 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: •ESIGNATION AGENT I hereby designate / / o act my agent O 'n matters relating to this appli tion for permit(s). OWNER SIGNATURE /., jrllAii� Date: �j/f Zf�} By signing this application f• , ,the owner/agent attests that the inf. provided herein,and in any attachments,is e and correct to the best of his,her or it's knowledge. Any material falsehood or any omission of. aterial 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 -rmless Jefferson County against all liabilities,judgments,court costs,reasonable attomey's fees and expenses which may in any wa -ccru- :,-iv- Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide •..: a . r, •f:Au,/o Jeffe . .unty and its plo ees,representatives or agents for the sole purpose cation review and any requir-• a -r in .-«'• . • '.- and right• entryto I.': . • g egula of busappiness hours r 9tlerty shall be requested and shall occur ly during regular business Signature: ‘ " iv i �.4✓A IIIIMINIMMEnommommuffAII Date: Cam / INV The action or actions Applicant will undertake as a res dr a issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of-n endangered species as those terms are defined in the federal law known as the "Endangered Species . « or • "Jefferson County '�"es no assurances to the applicant that the actions that will be undertaken because this permit has been .•. II •,•,1f';.=to the-A. Any i i:vidual,groul or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even i ou , e I L.. •ian.- p i e J- e -on .. �tdevelopment code.The Applicant acknowledges that he,she or it holds individual and non-tran-e .•e •,.. .ility f e-, g r'. :. plying with the ESA. The �•�` Syr Applicant has read this dis aimer nd signs and dates it below. Signature- /' L /' dis / ..... Date. / j d�ij GAP. 'tCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc • OWNER BUILDER STATEMENT • The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that.theyare nbtlicensed contractors and that they wine a sunning the responstnyof the General Contractor for the proposed project. • Signature: _ Date: — AUG 1 8 ZUUU ~1 i GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAxi, !ore Lid/out �,SSaciat s I C (360 ) V37-.2/0 (3!�'0 ) V.3?25zZ MAILING ADDRESS: 70 6/Q44er lane/Art-zitalhW Lv19 EMAIL: T CONTRACTOR'S LICENSE / / Q 98365 WAINS NUMBER: A e T�'94 9994(� NUMBER - ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Ptroject Type: frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: R"New V Wood Existing: -3- i'Sewer 0 Addition 0 Steel Proposed: S Bank o Community System ❑ Alteration/Remodel 0 Concrete Total: ' Height: ❑ Individual System ❑ Repair ❑ Masonry i SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: 4 (Public /fit "Pv01 P Total: 1 Name of System: OW S 2- 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 %Above ground Tank Size of Propane Tank: I O g al 10 i ❑ Heat Stove ❑ Cook Stove 0 Woodstove iFireplace Insert ❑ Hot Water Tank ❑ Pelfet Stove ❑ 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. vsz t , opng,n47,., ti+w f r.r^Apti,E. 1- max,a l "r 1 Square Footage t `J. �,t" " ,- `,;-. _ �; 3. Current Proposed "' . '' "�i: a for + _.e,, '. Main Floor a y 4- "� i"'' t ,,^$ ,_ a k a `F -> M 7 (O �� �r f e. y -: w -°r3 ..' x n ,.' a .c r �i�+x 3 t+t 2riu Floor — `+X' �. . 4 ,x$ #, 5.`0 ° +°'a� a� a.-1 In .�,�--'� ':feekd���1t.' E` ;.i4. W'244.7a'� 4 sr Y: 3 Floor r ___ _. �,, .. g- �'{ cf eras a.,;U � _ Mezzanine: or E§; i:.- , x ,- , ��` �� , ' -V-1,---:''le,7 Heated Basement 0 38 f ,: , :kwa s 4 ' ` �_`.,: ..„,,.„„4.,_ � ;� '_ SO a P�' ' }, 1 - ti .�� iA Unheated Basement t � 4" � `%ak„r> ,,r , ,,a '�� — �t • ;'`_ , hit i, '. Other Unheated - rig t y'#.7Ne ghat: T Rat r.$: a ,' .f-td iy, ., t ,t t.'." t_ ,,,,__ Garage/Carport &,c� z 'ir.,,,,,,v,,,,tv,4,,,,z,o.,,,,,,,-,-„, y"^Y w ,i t r ....-4,,,:;,-: r 0 �y 64.GI 3 - v -/ Ar ,s :.,fg �r SN`r'�i, 'y1'R � -- '' a 'b T, • 1 -_Jl_, Decks ^/ ♦ /y � fi�.1'Y�� �;� tty:1r07¢, \� �;�Y k�:� S�y� 4 � V 4 '�^• c ter° S. ' s- . Sa ' t *.. P +czt "¢-..olio. AY'. nil r., t �y d.,�f"I IvY .�tS.^+ Ot • f4f.e0/CO✓Cretin G { ` �t i Yffit yr } c q "' w,k ;� o , s A a I.5D r} ESTIMATED COST(REQUIRED) 3554,E t r 4, , 1 r, r ,,,,i5....417014. 8 i o .Fair market value of all labor and materials foundation to finish _� , ',t rF a 14v' "7 '`*i - .' G:\PennitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc Jv�