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HomeMy WebLinkAboutBLD2006-00728 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 #: BLD06-00728 SITE ADDRESS: 201 BALDWIN LN Issue Date: 01/26/2007 PORT LUDLOW, 98365 Final Date: 10/30/2007 APPLICANT: CHARLOTTE K EIDLIN PHONE: MICHAEL B EIDLIN 268 BLAINE DR SE RENTON WA 980568860 SUBDIVISION: PORT LUDLOW NO. 2 AREA 1 Block: Lot: 3 PARCEL NUMBER: 990600103 Section: 9 Township: 28 N Range: 01 E PROJECT DESCRIPTION: NSFR W/ ATT GARAGE & A/G 120 GAL PROP TANK 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 n�o THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 10/30/2007 I.\F_BLD_Occupancy.rpt 10/29/19 Jefferson County Building Division Permit Number•BLD06-00728 Applicant: EIDLIN BUILDING PERMIT INSPECTION APPROVALS \pplicable Code: 2003 International Building Codes To schedule inspections, call (360)379-4455 no later than 7:0C)AM the day of the inspection. Requests received after 7:00 AM will not be scheduled for that day's inspections. ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries. The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection Inspection Item Date Approval Signature Notes Setbacks � 3/ilti7 Erosion Control Foundation Footing #9: GA Dk 3/i7/o Footing Drains Foundation Stem Wall 3Y177 Underground Plumbing / Under Floor Framing Straps(hold downs) Ext. Shear Wall Nailing 4WD.7 I' A;erfr;e 4. oF- B4-D6 OMY Rough-in Plumbing 4/21/167 Framing A)4rF „Peek Acee3's BAQVCAoE.D S/z4/67 / OK /0/3lle* Blocking Airseal S/z4/07 Insulation:Walls # LE-r/Fie9re Insulation: Floors /3a/47 # et-kr/PU-1Z" Insulation: Ceiling � /D 3D 0 EErt/F/cArg" Int. Shear Wall Nailing 5/z4g/0i Jru e>SB SAtralea#M4s Wallboard Nailing / li//Z/4 /I' Gas Line: Interior 040 dk Gas Line: Exterior ttI� A Propane Tank N /OO 0 Heat/Chimney Clearance 0///340 G7 Drywell/Alt Drainage /00/4 Address Posted /D/.„/„ A/ FINAL INSPECTION 1106��I • ,k -Oar- G/ I FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR w CONDITIONS for Building Permit# :BLD06-00728 1.) The application was reviewed by the Jefferson County Department of Community Development staff on December 28, 2006 for the potential presence of Environmentally Sensitive Areas (ESAs) under the provisions of the Unified Development Code (UDC). After an initial Geographic Information Systems mapping review and an investigative site inspection, the following ESAs were confirmed to be present on the subject property: Coastal SIPZ. 2.) Marine shorelines and islands are susceptible to a condition that is known as seawater intrusion. Seawater intrusion is a condition in which the saltwater/freshwater interface in an aquifer moves inland so that wells drilled on upland areas cannot obtain freshwater suitable for public consumption without significant additional treatment and cost. Maintaining a stable balance in the saltwater/freshwater interface is primarily a function of the rate of aquifer recharge (primarily through rainfall) and the rate of groundwater withdrawals (primarily through wells). The Washington Department of Ecology is the agency with statutory authority to regulate groundwater withdrawal for individual wells in Jefferson County. New development, redevelopment, and land use activities on islands and in close proximity to marine shorelines in particular should be developed in such a manner to maximize aquifer recharge and maintain the saltwater/freshwater balance to the maximum extent possible by infiltrating stormwater runoff so that it recharges the aquifer. 3.) The parcel is located within a coastal SIPZ (seawater intrusion protection zone) according to the County GIS map. There are voluntary and mandatory measures identified in the Jefferson County Seawater Intrusion Policy (Resolution 44-22, effective September 23, 2002) that apply to well drilling proposals and building permit applications on existing lots of record. A Coastal SIPZ is defined as: all islands and area within one-quarter mile of marine shoreline, but no history of chloride concentration above 100 mg/L in groundwater sources within 1000 feet. 4.) 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. 5.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 6.) The applicant is proposing to create or add 4557 square feet of impervious surface and 5500 square feet of land disturbing activities. JCC 18.30.060 and 18.30.070 require the project applicant submit a stormwater plan meeting Minimum Requirements#1 through#5 of the Department of Ecology Stormwater Management Manual for Western Washington. The stormwater plan shall address measures to control stormwater, erosion and sediment during construction and shall address permanent measures to stabilize soil exposed during construction, and in the design and operation of stormwater and drainage control systems. 7.) 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. 8.) Jefferson County determined that this proposal is categorically exempt from review under the State Environmental Policy Act (SEPA) pursuant to WAC 197-11-800(1)(b)(i). 9.) The site plan as submitted with the building permit application on December 26, 2006 has been reviewed for consistency under the UDC, and has been approved by Jefferson County Department of Community Development. Any modifications, changes, and/or additions to the stamped, approved site plan dated January 25, 2007 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 10.) This approval is for a single family residence with attached garage and 120 gallon above-ground propane tank only. Any future permits on this site are subject to review for consistency with applicable codes and ordinances and does not preclude review and conditions which may be placed on future permits. 11.) Outdoor residential storage shall b•intained in an orderly manner and shall cle no fire, safety, health or sanitary hazard. 12.) 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. 13.) Minimum setback from Baldwin Lane and Montgomery Lane rights-of-ways shall be 20 feet. Minimum side and rear yard setbacks shall be 5 feet. 14.) 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. 15.) 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. 16.) Maximum lot coverage is not to exceed 45%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 17.) The building height is not to exceed 35 feet. 18.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 19.) Per MPR Code Section 3.17, Accessory dwelling units (ADU's) shall not be allowed in the MPR-SF zone. 20.) An address of 201 Baldwin Lane, Port Ludlow has been assigned to the lot. Baldwin Lane is a county local access (C544109). 21.) The lot is served by Olympic Water and Sewer Inc. 22.) The lot has been designated as MPR SF4:1 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 23.) A road approach (RAP06-0248) will be issued with the building permit. 24.) The lot was created through the Port Ludlow No. 1 Area 4 Subdivision onJune 3, 1968 under AFN 196207. 25.) All stormwater from patios and/or sidewalks shall be dispersed of on site. The driveway shall be at such a grade as to allow the stormwater to enter into the county road ditch and shall not be allowed to drain onto neighboring properties. IU ILDING PERMIT APPLICA•N MLA06-00681 Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00728 Received Date: 12/26/2006 SITE ADDRESS: BALDWIN LN PORT LUDLOW, 98365 OWNER: CHARLOTTE K EIDLIN PHONE: MICHAEL B EIDLIN 268 BLAINE DR SE RENTON WA 980568860 PORT LUDLOW NO. 2 SUBDIVISION: Block: 2 Lot: 3 PARCEL NUMBER: 990600103 Section: 9 Township: 28 N Range: 01 E CONTRACTOR: KELLEY SHIELDS INC PHONE: (360) 385-7156 260 KALA POINT DR PORT TOWNSEND WA 98368 Contractor's License KELLES1150LF Expires 6/6/2007 REPRESENTATIVE: KELLEY SHIELDS INC PHONE: (360) 385-7156 DENNIS KELLEY 260 KALA POINT DR PROJECT DESCRIPTIOI NSFR W/ATT GARAGE &A/G 120 GAL PROP TANK TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 2,497 VALUATION 423,302.00 ADD'L: 1,835 HEAT TYPE: EEE CODE EDITION: 2003 HEAT BASE: HEAT TYPE: HTP OCCUPANCY: R-3 UNHEATED: #OF STORIES: OCCUPANCY: CONST TYPE: 5N OTHER: SHORELINE: CONST TYPE: GARAGE: 960 SETBACK: DECK: 526 BANK HEIGHT: SEWAGE DISPOSAL: SEW WATER SYSTEM: LUDLOW BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 4 Prop: 4 Total: 4 Total: 4 Routing Date: _ — - -:,_;_TEp CITA Type --Amount Paid By: Date: Receipt: Approved/Date Permit $2,808.15 LYK 12/26/06 86977 Plan Check $1,825.30 LYK 12/26/06 86977 State Building Code $4.50 LYK 12/26/06 86977 JANa. 2007 Potable Water Application $55.00 LYK 12/26/06 86977 Total: $4,692.95 �_ �� a9:mail.1�9ir ,SON i{ ( DECr:tl��r' °14 JEFFERSON COUNTY DC 2 6 _0 E , DEPARTMENT OF COMMUNITY DEVELOPMENT I i W I ti `'N CI: 621 Sheridan Street• Port Townsend •Washington 98368 i VELOPME ._j %. �C�' 360/379-4450 • 360/379-4451 Fax -_.-- 1 N http://www.co.jefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# 1Q( { C.�I PROJECT/APPLICANT NAME: 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 it rovements on the site map. v "Y j LOT f r• F6,4er l oQi-bW • ir„ CS Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. 3. Describe the existing egetation. Indicate native vegetation areas on the site map. 4. Describe the existing soils. Indicate soil type on the site map. God w) G(.lAr 4 W N Q rvc.h •) . 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. ("Ro it 1 0 evii/ „ "T o 7W u S 1.4611,61. tAi t ON 1N�t�►�`CcQw�ls7fAy ©6.4 d Ir 1x,.lxt.uJe rw • 6. Describe any excess levels of noise generated by the proposed use or activity: -� APPROVED Nam'• 1.- % STORMWATER PLAN JAN 2 5 2007 stormwater site plan template. —rev.10/12/2003 5 Stormwa -r �i�, ''IN JEFF U Require§ I'\` I� . Af ► DEPT.OF ' , , , IT • L P EN'4 • SIGNATURE: . • • 1.; ij tt rt' T-- 7. Describe significant geographic features and critical areas (i.e., environmentally sensiti areas such as wetlands, streams, l steep slopes,etc.)on the site. Indicate location on the site map. ;� rl i .,- ,,,�C, 2 6 R l Jt1,1i_O NIENt 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 from existing facilities. -tom. earVILVA 4dilorrldt Pc-O - u, PRAd0119.4.43 Pt 714-4411- Ut 7-CT-Io,--4 - Ca!ikt.n -A-t.M2.NS C.o ►+-.IA.tt s s,o 7'L cq.= T4.- ?LT>a_ 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.] 11. Describe the performance goals and standards applicable to the project. 12. Describe the flow control system. —W Wrtgg_ Fir-o w. I wt Pwe,o✓5. Su a-pic.ta5 TA I- - 7-0 4" Pt Pus. I. 'be St:,tt"+A/2((40 I Ta Lk'f c.77i Swt4Lk.aea . stormwater site plan templala.doc—rev.10/12/2003 6 • • • :, , r- iF„ ti 1 r^ 13. Describe the water quality system. i ` A 1 n.:lv 2 6 ,,, 14. Describe the conveyance system analysis and design. Y — 15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material. 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. 17. Describe the proposed surfacing material.fwk Peat L./� ' CQ}+S l c N —O C-1 ShK RO a t � DI-ca*• >•7C.c1,sc Per coAA Pc kali ow - (Sty Aa►4%4t A . 18. Describe methods for restoration of the site. !� L00•dO C.i P( . r L!2- LO IM►rl.0b.,l.1 1``&X)t 12.0 2(rj 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. / 20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan./ 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. Ic9Pki ifm_ 641 W T'W Cr'A 9.1%.4, U. 1 Ft, D stormwater site plan template.doc—rev.10/12/2003 7 ii 1r rF r Z 6 ... I CONSTRUCTI ON STORMWATER POLLUTION PREVENTION PLAN (SWPPP) � The Construction SWPPP addresses sediment and erosion control during construction. The BMP' indicated by the applicPiltP11.4101ENT 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. 2. Establish Construction Access. tdn, L t- . 3. Control Flow Rates. ��cSl f3 13Ut ,at2.1Nt -w�t2t ►aG 4. Install Sediment Controls. ,{.� 401,"� 1 i '" s 7 5. Stabilize Soils. My�.c.AA ek -PtSTC)lsRt1 6. Protect Slopes. 7. Protect Drain Inlets. lit144 4 stormwater site plan template.doc—rev.10/12/2003 8 • 1 ` ilf !1 ' 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. DEC 2 6 .i 'ice.✓ PP—z>>i q- e-XtS77 P-7O u,1 _,,VEl.01t.1CrtT j 9. Control Pollutants. 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). 11. Maintain Best Management Practices(BMPs). 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). _ te+prl..tiEj f��►Lop i ��wy�[_�MC) 7NrT7Cattt. L�2 T 8e trt.0 t�)t t,. N C:'e` Jt tar 1 ` v"f't...T1 -13 t.!"•�- 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. stormwater site plan template.doc—rev.10/12/2003 9 • i i,.r E b. Description of special requirements for working in or near environmentally settive.areas. // + '' 2 6 . . .nr 1 1 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). 5. Construction Phasing. a. Construction sequence //b. Construction phasing(if proposed) 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). I. Provide a proposed construction schedule. t= 1 — CI—C=van. + 1",,,t 0 t'Si'r- F w ti4.,ce-s 540As II. Wet Season Construction Activities. a. Proposed wet season construction activities. b. Proposed wet season construction activities for environmentally sensitive areas. 7. Financial/Ownership Responsibilities. a. Identify the property owner responsible for the initiation of bonds and/or other financial securities. CAA+ ivtom. - 140 M► 0,,/-cr'1 t5 ) 14c0f41-1-.. ..e. b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. 0f 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable. a. Sediment PondsfTraps. b. Diversions. /---------- — c. Waterways. d. Runoff/Stormwater Detention Calculations stormwater site plan template.doc—rev.10/12/2003 10 • 111 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. 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JEFFERS COUNTY 7 '. 1;4 DEPARTMENT OF COMMUNITY DEVELOPMENT r 621 Sheridan Street• Port Townsend•Washington 98368 / 360/379 4450• 360/379-4451 Fax q�,kTN`/ www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: 06 8( Project Description(include separate sheets as necessary): 1.)0 '3fpet Ge perm I 'iRizepi ao.cL Tax Parcel QQ Property 42F Number: -/'-! p ,C)O /0 3 Size: \ (acres/square feet) Site Address and/or Directions to Property: (.,0(24./trt of IVI p,t.+Y4Uwtrxra.A1 Lk, , 1` ant..C vi,/J Property Owner(s)of Record: Telephone: Fax: email: Mailing Address: 7663 edik k, rid. 5 a iZ.61-draw L A ' e p SG, Applicant/Agent(if different from owner): 14 IrRL aI/ l i47(c_i'2 Telephone: ► Fax: email: Mailing Address: ZEoQ •{4 , (},Q_, �'. e 3[c What kind of Permit?(Check each box that applies) Building J Variance(Minor,Major or Reasonable Economic Use) u Demolition Permit J Conditional Use[C(a),C(d),or Cj** XL-Single Family J Discretionary"D"or Unnamed Use Classification U Garage Attached/Detached _1 Special Use(Essential Public Facilities)** O Manufactured Home 7 Boundary Line Adjustment u Modular _J Short Plat** u Commercial* J Binding Site Plan** lJ Change of Use J Long Plat*" u Address i Road Approach J Planned Rural Residential Development(PRRD)/Amendments** *.Propane J Plat Vacation/Alteration" U Allowed"Yes"Use Consistency Analysis J Shoreline Master Program Exemption/Permit Revisions** u Stormwater Management J Shoreline Management Substantial Development*" u Site Plan Approval Advance Determination(SPAAD)* J Shoreline Management Variance u Temporary Use J Comprehensive Plan/UDC/Land Use District Map Amendment u Wreless Telecommunication* J Jefferson County Shoreline Master Program Amendment u Forest Practices Act/Release of Six-Year Moratorium *May require a Pre—Application Conference **Requires a Pie-Application Conference Please identify any other local,state or federal permits required for this proposal, if known: DESIGNATION OF AGENT I hereby designate 42.4,446"1 1(45 I or-. to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: c2"�1 7 Cy 1 6 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 attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any required later inspections.Access and right of entry to this property shall be requested and shall occur only during regular business hours. Signature: , rl � � 1�,�,— Date: () z 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 lake"of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferable respopsibility or adhering to and complying with the ESA. The Applicant has read this disclai r and si s and dates it below. Signature: el/IA. , - Date:._ V 24 \ U C:\Documents and Settings\mocha\Desktop\Master Permit Application 7-S-04.doc 1 y • • OWNER BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General Con or for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: U` rt Si+•fL x le4C,. (-5foo) 335' 7) (3be) 395-- )1 MAILING ADDRESS: _ `,j'1 - l EMAIL: ask tdd.c tp C/y M1 ,s, //)r-t CONTRACTOR'S LICENSE WAINS I NUMBER: IL•..L :..ST ISO LF NUMBER ARCHITECT/ENGINEER: it ST l(,E I,„.a l3 aru,,•..j am t7'T-{ PHONE (3� )3Q S.715( F ( ) MAILING ADDRESS: .y t 1C�M�M pr. , P j) • f"4, T . EMAIL Project Type: lll�����„"F___ra��rme Type: Bathrooms: J Shoreline: Type of Sewage Disposal: New Wood Existing: , U Sewer U Addition a 3 Steel Proposed: (2 Bank '! Community System Li Alteration/Remodel U Concrete Total: ',WI.. Height: U Individual System Li Repair LI Masonry SEP Permit# Li Demolition Li Other: Bedrooms: Water Supply: Existing: Se ck: a Private well Li Two Party Type of Heat Proposed: d "I Public N-� ?u t,-,0 Total: 4 Name of S ste ©l► µ� ele.�fR l c, St1 �L 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, employees,etc) Current Proposed IBC Occupancy: I ype 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: i Underground Tank ove ground�I a .,› Size of Propane Tank: t 10 a! i,�1'ea't Stove Cook tovee Woodstove i Fireplace Insert i Hot Water Tank i Pellet Stove I Other Is this appliance installed in a Manufactured/Mobile Home? Yes / No When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. ----_ __-_ __-__ ___ Square Footage For Office Use Only ,w, ff f Current Proposed I' ' Amount Main Floor �� �� ♦ I b i f Consistency Review: �l 2NUFloor 1 F 3, 1 �1 ioSBase fee: (q g 0$ 6 3f°Floor Additional Section: t Mezzanine: Plan Check fee: 1 )Cj�j5e3O Heated Basement .� State Surcharge fee: 1 SO Unheated Basement I Pot Water Review fee: l 0 Other Unheated 911/Rd Approach fee: ]00 `a Garage/Carport ( 3 7O TOTAL: 9 J 71"] "1.� Decks •i a yA D�*7 400 �� 21,ya8, Number:Receipt Nb �'�C'"� 1 Other Sri Cash/Check Number: eejveR zcJ AAch /2 G �Iv.� _ c1= t---/ ESTIMATED COST(REQUIRED) sate: .Fair market value of all la and materials foundatio •• nisi? `�' n ..- 4..,_.),0(0 _ ,3�A, I,itials: n vC f � . 26 C:\Documents and Settings\mochil\Desktop\Master Permit Application 7-8-04.do¢ " i 1 .'-^l�El.Ttw6R�Rf.Rir!r:RT2aa 6'¢yyi{E6Mr `RJ'S.. _ - - - _ - GRAVEL �, C 9 „�.,. �.,_ F � 0<t E'Ell ASPH WP 8 N, LEGEND MONUMENT (FOUND AS NOTED) �']^C CONIFEROUS TREE TRo TELEPHONE RISER QD STORM DRAIN MANHOLE INVERT (END OF CULVERT) WM� WATER METER WVW WATER VALVE R FIRE HYDRANT HB0 HOSE BIB IC0 IRRIGATION CONTROL VALVE ASPH ASPHALT CONC CONCRETE EG EDGE OF GRAVEL EP EDGE OF PAVEMENT IE INVERT ELEVATION PA PLANTED AREA PVC POLYVINYL CHLORIDE PIPE RR RAIL ROAD GRAVEL HIGH POINT OF ROOF DN �VA li—OII a 138. Ntr� c SURVEY CENTER LINE DITCH LINE EDGE OF GRAVEL DR DIRT PROPERTY LINE €XISTING RIGHT-OF-WAY LINE STOP.II DRAIN 20" CONC LOT 4 HIGH POINT OF ROOF U14E �TVAfii3fl i e 1329 LOT 2 GRAVEL \\„r,� 8" HEMOCK 2" � , L; 7 SAVE TREE���s�, `ma's a 6" CEDAR 0 LDP OIF FOOII�NG �ENCIIMNRK ELEVATION a I08' �pF PV O .4. 14" CEDA9 F 6' CEDAR 0 Q` FOUND REBAR AND CAP 1 GRAVEL 00 l PA n.� I W Q� V 0. M t� O LO 3 • PORT LU LOW NO.2 �VOL. 5 PG. 42 �_ ASPH FOUND RR SPIKE WITH PUNCH MARK, FLUSH WITH GROUND 9IV o GRAVEL HIGH POINT OF ROOF DN �VA li—OII a 138. Ntr� c SURVEY CENTER LINE DITCH LINE EDGE OF GRAVEL DR DIRT PROPERTY LINE €XISTING RIGHT-OF-WAY LINE STOP.II DRAIN 20" CONC LOT 4 HIGH POINT OF ROOF U14E �TVAfii3fl i e 1329 LOT 2 GRAVEL \\„r,� 8" HEMOCK 2" � , L; 7 SAVE TREE���s�, `ma's a 6" CEDAR 0 LDP OIF FOOII�NG �ENCIIMNRK ELEVATION a I08' �pF PV O .4. 14" CEDA9 F 6' CEDAR 0 Q` FOUND REBAR AND CAP 1 GRAVEL 00 l PA n.� I W Q� V 0. M t� O LO 3 • PORT LU LOW NO.2 �VOL. 5 PG. 42 �_ ASPH FOUND RR SPIKE WITH PUNCH MARK, FLUSH WITH GROUND 9IV o a TR O RIM = 'J.3.Dt$ 8" PVC SW I.E.- 86.9 6" CONC SE I.E.- 88.8 8" CONC NW LE.- 86.9 ASPH FOUND 1 1(2" BRASS CAP WITH PUNCH IN 04 CONCRETE MONUMENT IN CASING, DOWN 0.5' fflidil # BID �?—-728- D 5 w E JAN 1 9 2007 D SON COUNTY DEPT. OF COMMUNITY DEVELOPMENT 1: �1,4v't' " L ac, eAe4> i •D5w. ►-S PouT I.oCA'-n ow - . 4�tf Cu IC F 17�eA I A.% NOTES J. THIS TOPOGRAPHIC SURVEY WAS PERFORMED ON MAY 26, 2006 IN SUPPORT OF A SITE DEVELOPMENT PROJECT AND IS INTENDED TO BE USED FOR THIS PURPOSE ONLY, SPECIFIC INFORMATION SHO,'01 HEREON SHOULD BE VERIFIED AS TO ITS ACCURACY IF THIS SURVEY IS TO BE USED FOR PURPOSES OTHER THAT WHAT IT WAS INTENDED FOR, 2 @�SI5_Qf KARING PLAT OF PCRT LUDLOW NO. 2 AS FILED IN VOLUME 5 OF PLATS, PAGE 42, RECORDS OF JEFFERSON COUNTY, WASHINGTON, 3. VER'i1rAL DATUM ASSUMED 4, BENC.IiMARE A RAIROAD SPIKE SET AT THE CENTERLINE OF BALDWIN LANE 127' SOUTHWEST OF THE CENTERLINE INTERSECTION OF BALDWIN LANE AND MONTGOMERY LANE. ELEVATION = 100.0) FEET (ASSUMED) 9. PROPERTY L!RU THIS IS NOT A BOUNDARY SURVEY, PROPERTY AND RIGHT OF WAY LINES SHOWN HEREON ARE GRAPHIC PURPOSES ONLY. PROPERTY CORNERS WERE NOT STAKED IN CONJUNCTION WITH THIS SURVEY. 6. tLLIIML TA¶:LN_:VISITA_,TI9N ALL SURVEY MONUMENTS AND OTHER SURVEY MARKERS SHOWN HEREON WERE VISITED DURING MAY, 2606 UNLESS OTHERWISE INDICATED. 7, NCAMjDRAqQ-E5 THIS SURVEY WAS PERFORMED WITHOUT THE BENEFIT OF A TITLE REPORT, ACCORDINGLY, ANY EASEMENTS OR RESTRICTIONS OF RECORD WHICH MAY BE REVEALED IN A TILE REPORT HAVE NOT BEEN INCLUDED HERON. 6, OC�ITOSjR_INFR11L 2 FEET `j i t.. F 0 \ ._. C-) U co z tfJ G ,00 ,OG021 rn >4 c� N Lo w—a'a _Q it z a M REVISIONS: APPD. DATE: JUNE 23, 2006 DESIGN: DRAWN: DEV CIIECKED: REVISION NUMBER: SCALE: 1 "=10' PROJECT NUMBER: DEAX0030 DRAWING FILE. SVTPXEIDLINPROP.DWG SIIEET NO. OF i