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HomeMy WebLinkAboutBLD2006-00736 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 #: BLD06-00736 SITE ADDRESS: 371 HIDDEN TRAILS RD Issue Date: 02/26/2007 PORT TOWNSEND, 98368 Final Date: 12/20/2007 APPLICANT: MICHAEL R CRONIN PHONE: 360-385-5454 JENNIFER M CRONIN 1082 S JACOB MILLER RD PORT TOWNSEND WA 98368-9654 SUBDIVISION: Block: Lot: TX15i PARCEL NUMBER: 001083002 Section: 8 Township: 30 N Range: 01 W PROJECT DESCRIPTION: NEW SFR (BLD06-00736) 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 THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 12/20/2007 I:\F_BLD_Occupancy.rpt 10/29/19 • • MLA06-00697 BUILDING PERM IT APPLICATION Review Type:I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00736 371 HIDDEN TRAILS RD Received Date: 12/29/2006 SITE ADDRESS: PORT TOWNSEND, 98368 OWNER: MICHAEL R CRONIN PHONE: 360-385-5454 JENNIFER M CRONIN 1082 S JACOB MILLER RD PORT TOWNSEND WA 98368-9654 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001083002 Section: 8 Township: 30 N Range: 01 W CONTRACTOR: STAPF CONSTRUCTION PHONE: (360)385-3199 2727 HASTINGS AVE PORT TOWNSEND WA 98368 Contractor's License STAPFC*249J8 Expires 4/25/2007 REPRESENTATIVE: RICH STAPF JR PHONE: (360) 301-6184 211 SOUTH JACOB MILLER RD (360) 385-6722 PORT TOWNSEND WA 98368 PROJECT DESCRIPTIOP NEW SFR TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION 165,000.00 MAIN: 1,743 CODE EDITION: 2003 ADD'L: HEAT TYPE: EEE OCCUPANCY: R-3 HEAT BASE: HEAT TYPE: WOD OCCUPANCY: UNHEATED: # OF STORIES: CONST TYPE: 5N OTHER: SHORELINE: GARAGE: CONST TYPE: SETBACK: DECK: 324 BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: 2WELL BEDROOMS: BATHROOMS: Exist: Exist: Prop: 2 Prop: 2 Total: 2 Total: 2 Routing Date: 1 IIZ 10 1 Type Amount Paid Bv: Date: Receipt: Approved/Date Permit $1,357.75 KAS 12/29/06 87111 Plan Check $882.54 KAS 12/29/06 87111 APPROVED State Building Code $4.50 KAS 12/29/06 87111 Potable Water Application $55.00 KAS 12/29/06 87111 FEB arc,2007 Total: $2,299.79 Jefferson County &Building Department i ng Permit Num�pP : BLD06-00736 I I! Jefferson Coin►ty Building Dillon q licant: CRONIN BUILDING PERMIT INSPECTION APPROVALS \pplicable Code: 2003 International Building Codes To schedule inspections, call (360)379-4455 no later than 7:00 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 6 1/(i/ Erosion Control Foundation Footing S /i 2/07 -Eu i" Footing Drains 5�2`.11 ` - - Foundation Stem Wall Underground Plumbing Under Floor Framing Sig1/0 rt uvS N N41L1N6 RIM 1o1ST & !o". D.C. Straps(hold downs)Ext. Shear Wall Nailing 1/5/67 41116WEA fi` APPRIyEp 2�eapers(6 ei'oorJ () Rough-in Plumbing l (,� Framing �.-6C1 Blocking Airseal / Insulation:Walls -01. Insulation: Floors Insulation: Ceiling Lam.. Int. Shear Wall Nailing '_Zt-oi Wallboard Nailing `D Gas Line: Interior Gas Line:Exterior Propane Tank Heat/Chimney Clearance Drywell/Alt Drainage Address Posted �c44 -1 FINAL INSPECTION FINAL INSPECTION MUST BE APPROVED ERM OV vDD�Pu FOR TO BUILDING BEING OCCUPIED • • CONDITIONS for Building Permit# :BLD06-00736 1.) The application was reviewed by the Jefferson County Department of Community Development staff on January 19, 2007 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: Susceptible Aquifer Recharge Area. 2.) Aquifer Recharge Areas in Jefferson County are characterized by porous geological formations that allow percolation of the surface water into the soils and the underlying zone of saturation. Aquifers are geologic formations that contain sufficient saturated permeable material to yield significant quantities of water to wells and springs. Aquifers serve as the source of drinking water within most of the rural portions of Jefferson County. 3.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to groundwater aquifers. 4.) 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. 5.) 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. 6.) The applicant is proposing to create or add 5213 square feet of impervious surface and 11355 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 for a medium project 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 revised site plan as submitted on January 9, 2007 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 19, 2007 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 10.) This approval is for a single family residence and a detached garage 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 be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 12.) Not more than 2 unlicensed vehicshall be stored on any lot unless totally seed 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 the Ingress, Egress and the Utilities Easement along the eastern property line shall be 20 ft. Minimum side and rear setbacks shall be 5 ft. 14.) Lighting fixtures shall be designed and hooded to prevent the light source from being directly visible from outside the boundaries of the property. The intensity or brightness of all lighting, during construction and after project completion shall not adversely affect the use of surrounding properties or adjoining rights-of-way. 15.) 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. 16.) Maximum lot coverage is not to exceed 25%. 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.) This parcel has been designated as Rural Residential 1:5 under the Jefferson County Comprehensive Plan Land Use Map effective August 28, 1998. 19.) A septic permit (SEP05-00351) was approved on November 28, 2005 for a system of 360 gallons per day 20.) Hidden Trails Rd (P74)is a private access road. The road approach is existing and an address of 371 Hidden Trails Rd has been assigned to the parcel 21.) A Conversion Option Harvest Plan (COHP) was reviewed under FPA05-00021 and was approved on January 23, 2006. An associated Class II FPA 2607446 was finaled on February 8, 2006. 22.) A minimum of two (2) on-site parking spaces are required for the single family residence. / • • ,,n � o�v �� PERMIT # R(R ,RE, b JEFFERSON COUNTY - - - °� ►� DEPARTMENT OF COMMUNITY DEVELOPMENT EL' / 29 ft 621 Sheridan Street • Port Townsend • Washington 98368 t/�����(, C3` O 360/379-4450 • 360/379-4451 Fax `_/]tJ//j/ �/' �N http://www.co.jefferson.wa.us/commdevelopment/ "'r�Ull�/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# c) ( l0"t '7 PROJECT/APPLICANT NAME: NEW SFR /c o N i NJ 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. vd Ca,vS2guc7,041 OF A Si vbt" Fi✓.»�se y .PES/D�✓cF /E7X44/.E/J �r4,�d6€ T7/QT !VW-t .BE PQs/rla4/E.Q od r/r/E d v17-.44- 144g5r S,6G�,/ bF A By 6 bf -e_ oRi✓ .,� DFF ///pQF,d 7A1/�.s /64o , /'kavie.E- ,VD 7'� ,PEdfat'rz <I,eEAS 4/ea v,✓a A-;,vIrAw B/s/GO%dG- ,l1//L L Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. ?AeeEL /5 GE.reF,e�tG�Y LeVe ,go,,i E?!Sr To WEST Fo' "1/4e.o,r. 4/DO-Sec Ai- 7/1/2-Al se_aP.S sou �' wEsr G,eA�ua cis, !fir /l/Peon 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. EX/S77N - V,�GA-74770AI /S Z�° GRowry T/n1QEK , G.Q45s , .¢vo 4/477y,E �/�vOF,2B�`'_us,4E 4. Describe the existing soils. Indicate soil type on the site map.. G ciE1LY �Sq�/D ' L aA,� S4P77c �SC/L Lo G S 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. A O ST//n/D,.vG- SF�ISo✓� pie "e"..4/7, F..- (.17- G1/s1Tt" G,/t/- �S/T APPROVED 6. Describe any excess levels of noise generated by the proposed use or activity: ATER PLAN : ► 007 JEFFERSON COUNTY DEFT OI: ••ytHUNITY U SIGNATURE..v `LOP, stormwater site plan template—rev.10/1/2003 __•� war=] ' 5 • • N 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. -7;fE-,E'F /7R6. Na EA/17//eO,t/ilfc 14L ,551/S/77d: 4961.5 DA] 777/5 Pl cL 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.). Pl ieCF_i /,s E DES F..o BY 0Eior DF ,t).1771,<a-_ ,e.ESOlr,PGE L_*✓D 72) T1/E Wi rr j, /f&-$a,tl Cok,v7'-1 Z.4,✓DFXL LAit/4 7 77 .Sauail f GriQp.41FD 5 116RE rPE5/DF✓r7A2. *7- e--IS To 77/s /vo e g EST 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. .S7-ognotA7,/L 1N/L.L ,8E GOLLEGTE�,O /.t/ GY/ S dN' 771-45: B!//LD>N(r f /)/SG SED 7' 4:4 ,Gse- V/f 'r7>7 .i z-4A/a sc. "ile. VM TIG,/TU.✓g• ' S44// i41.o6ef . D,ei vEw4-*s h/ru_ BF_ c/?ans/.c/A7D z s73,e/u't'47 D/5A.5P-s44 le. rt-14774g ✓E64 ?21774W• 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.] 10 11. Describe the performance goals and standards applicable to the project. N ' 12. Describe the flo control system. REV-MVP-1n DEC 2 9 2006 ,t-t: Ifff[ligi IIIN ' stormwater site plan template`=fev.10/1/2003 ��1 �����i�( 6 • • REVERTED13. Describe the water quality system. 41/4 DEC 292Cc6 14. Describe the conveyance system analysis and design. 41/4 15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material. y7 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. Ni 17. Describe the proposed surfacing material. Deiv5'NJ445 4/ic4_ .PDUe- orie41/E1... 18. Describe methods for restoration of the site. ALL D/577/ e6./9 (///LL. ,SE RE--sc - / Ad4,7rio 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. /V A 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. N/ 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. /Vo CL F:Aem/G %o T.s1,e.€ / 4'C,E woe CQn/s a a-7a.J DF. P€o. c- 2. Establish Construction Access. f�CCE$5 es74164'S4 9 BS' EY,Sr7.✓G AE-Asf/r/'EO Die/vF kv,i1 C4IE u//U- 1,5 7.244E/ 5O 7AiT <5" iniF✓r/<SD/L /S .r/DT 74f6.4E INNn P4vgp i,e; fc "'S 3. Control Flow Rates. S7T�,cfrvr'Ar�/` �✓ic� ! Gon/ /erg DN— /TE J ABSo,e-e€, /n/ n/47l*. 2_ UEGC 77 4. Install Sediment Controls. /4r/s7x/t.L $>tr — FAG/✓G I. 4/ 4 DaI4/cC'PE , Dn4 5. Stabilize Soils. Sg_a erc6'.i T7a,/ 6. Protect Slopess.. / 7. Protect Drain Inlet , R ECEMFAD DEC 2 9 2006 stormwater site plan template—rev.10/1/2003 riFFFERSONCUUND Ifl I 8 • • RECEivpin 12 Required Elements—Construction SWPPP(continued) DEC f+ 2 � 8. Stabilize Channels and Outlets. UCIr Af/Af y/ JEFEElSII !:iiItN ii:i 9. Control Pollutants. 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). N� 11. Maintain Best Management Practices(BMPs). COn/S a(470A,/ Gvj&L ,4.4 Du,Q,,vG 445- SFci 0A/ . /e7DPt-1e h✓A_L No7- dY 7Wis 12. Manage the Project. D,eY S .C414/ Cd4,157Rrec-77041 ND (#r c/G To B. )&W,,C /4/ 4 /t/g7 ,P/G#r—O F-i✓ram 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). / h>Oi Af «s APOA© b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). T G, 'g /5 /✓D .P��Fs c/s uG ,BDz Y 4 frV47 2 W/?,t/4J yGb ���, 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. ti/� stormwater site plan template—rev.10/1/2003 9 r • • 1 b. Description of sp cial requirements for working in or near environmentally sensitive areas. N/ 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). Ala Edo sia4 Aeo ' ii 5 .4✓7/6.// 4 --/, 5. Construction Phasing. a. Construction sequence ClJmA.6 r ,eI!/ L 11�s77r✓6- (/) AID4t/7J1s. 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. S7lzr 1,0f1 P,Ee,i//TED 1,1-D Dt .2 '/.Y CO.lI/G i7v.+l II. Wet Season Construction Activities. a. Proposed wet eason construction activities. N/ b. Proposed wet/eason 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. " CW4E4- C,e0 /A) b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. N,f/ 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following, if applicable. a. Sediment Ponds/Traps. b. Diversions. N/A . Waterways.d. 4MFT . Runoff/Stormwater Detention Calculatio s� J1Jl DEC 29206 stormwater site plan template—rev.loll/2003 E f li(1 J]INI I`I;I t0 • • • ,S 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 affected property. -/Zi6:e),:-., 1 (LANDOWNER OR AUTHORIZED R''-'SENTATIV SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: \RECEIV DEC 2 9 20 kalliattatitti ,2 stormwater site plan template—rev.10/1/2003 • • 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 Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAx: C5TAPF CO/JSTguc..-nor3 (36o) 385- 3199 (360) 385. - (o7ZZ MAILING ADDRESS: 2 747 /-1ASTt N65 AlE EMAIL: CONTRACTOR'S LICENSE rOFZ1' 'S7)0.1ti3<F''JD i Km 3sf C WAINS NUMBER: STAPFc. ZI-t 9 3 B NUMBER AReb-ttgre-hilfairgEER: LAt-t1=le S'CEt.41kiat PHONE (WO ) 35S_. IILiz.. FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New X Wood Existing: ❑ Sewer ❑ Addition 0 Steel Proposed: I3/4 Bank ❑ Community System ❑ Alteration/Remodel 0 Concrete Total: 13/4 Height: %Individual System ❑ Repair 0 Masonry Nha SEP Permit# 05-00351 ❑ Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well )3{ Two Party Type of Heat: Proposed: 2- 0 Public `� EL.EL'RZIL Total: Z. /�`i4 Name of System: 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 13C Occupai icy: 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: 1 Underground Tank 1 Above ground Tank Size of Propane Tank: I Heat Stove I Cook Stove Woodsto I Fireplace Insert I Hot Water Tank I Pellet Stove I 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. Square Footage Current Proposed For Office Use Only Amount': Revision Main Floor Heated 1 7u� EH Bld App Review: 15(: a'a.cc, j,, 5.OD 2"tl Floor Heated ) Consistency Review: 155. CX.'Other Heated Base fee: 1357 15 Mezzanine Additional Section: Heated Basement , '` Plan Check fee: D Se;, 54 Unheated Basement '` State Surcharge fee: - 50 Other Unheated Pot Water Review fee: r' Garage/Carport SUBTOTAL a55a 1CI Decks r 911/Rd Approach fee: Other GokrFizerr Pogcri 7i ILA , : TOTAL: $ a55a --1 ,,� Receipt Number: 1 0 0-',10* i' Cash/Check Number:ber: IIpt; ) 1 i� ESTIMATED COST(REQUIRED) •Fair market value of all labo dation to finishini 1 noilao r / 2 9 2006 gin G:\PermitCenterFORMS\DRD FORMS Permit Application 07-142006.d�Ef filSON!,((IIN I I miti fi \ C11 . 0N it��ri��t:i � �� �c(� ' i ,- i % JEFFERSON COUNTY ��l \ I 1 W 5. A DEPARTMENT OF COMMUNITY DEVELOPMENT ti ' ' 621 Sheridan Street • Port Townsend •Washington 98368 DEC 2 6 2006 360/379-4450 • 360/379-4451 Fax p' www.co.jefferson.wa.us/commdevelopment J�����J�IV�U�IV�I��U �tS't'TNG' a U'V Master Permit Application MLA: O(o (o q 7 Project Description(include separate sheets as necessary): NEvJ SIm6t_E FAMILY j'-EsiDENGS Tax Parcel Property Z l7r SOO S4 f7 Number: 6O1 D8 3 002, Size: 5- &RES (acres/square feet) Site Address and/or Directions to Property: 37 H ID DE/J "TPA i[.5 gOAD Pola-r -MA105E/JD/WA. 913 Property Owner(s)of Record: 111 IGH 4 EL 4- JEkiN I FE R.. CRo m I Telephone: i(3b0\ 365- 545`1 Fax: email: Mailing Address: i 013Z 5, TAGoi MtLt.22 Roh.13 Pog-r 0wa5rsts I t4A ci6368 Applicant/Agent(if different from owner): .rIC,I- STAPC, - STAPF Con3.5-77=t)CVD ) Telephone: (36o} 301 - /OI St.' Fax: (34.0) 365- ,'7ZZ email: 5-{'apfy0 co-b(tspe&.L-(-00,1 Mailing Address: Z I I So wni TACaB Itt!LAX E. roAD Mgr --1a..h.ls-t-J.J , ILIA. g 8366 4BWhat kind of Permit?(Check each box that applies) uilding 1 Variance(Minor, Major or Reasonable Economic Use) 1 Demolition Permit 1 Conditional Use[C(a),C(d),or C)** ✓Single Family 1 Discretionary"D"or Unnamed Use Classification 1 Garage Attached/Detached 1 Special Use(Essential Public Facilities)** 1 Manufactured Home ,Boundary Line Adjustment 1 Modular 1 Short Plat** 1 Commercial* 1 Binding Site Plan** 1 Change of Use 1 Long Plat** 1 Address 1 Road Approach 1 Planned Rural Residential Development(PRRD)/Amendments** 1 Propane 1 Plat Vacation/Alteration** 1 Allowed"Yes"Use Consistency Analysis 1 Shoreline Master Program Exemption/Permit Revisions** 1 Stormwater Management 1 Shoreline Management Substantial Development** 1 Site Plan Approval Advance Determination(SPAAD)* 1 Shoreline Management Variance I Temporary Use I Comprehensive Plan/UDC/Land Use District Map Amendment Wireless Telecommunication* 1 Jefferson County Shoreline Master Program Amendment 1 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: DESIGNATION OF ANT I hereby designate -1C-1-4 SrAPF. Tfz- to act as ent in matters relating to this application for permit(s). OWNER SIGNATURE — Date: /�? -2 9-0 4 By signing this application form,the owner/agent atte t at th information provided herein,and in any attachments,is true and correct to the best of his,her or it's knowledge. Any material falsehood o a 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. t_ 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. Staffs .e*- and right of entry will be s med unless the applicant informs the County in writing at the time of the application at h she v�ants prior otice. Date: /.--,1 e,E Signature: �� .47 The action or actions Applicant will undertake as • - of the i suance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potenti. - e"of an e dangered species as those terms are defined in the federal law known as the "Endangered Species Act"or"ESA."Jefferson Co my makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA. An individual,group or agency cor file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in compliance with the e on County elopmen ode.The Applicant acknowledges that he,she or it holds individual and non-transferable r spo ' lity for adherin to and complyi it the E . The Applicant has read this disclaimer and signs and dates it below. Signature: i 1-- Date: /? g"©6 G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 07-14-2006.doc • ' r 4.K _rot, -S%z' • 4.yZ3 4'`6 ,,, .3-0" /©=G * ,� '" z=v'1 1 &! l4 — ._c . . -- < ?' , , Ni' Mil \ I I r t !N fl f ' I i • f 1 (Q ��. Ni II `� 1'--0 T- Pri-‘24 ' D. r -- -- —7 1 f I �_ . It I 1 I i"". •(' ›... 1 01.1 • I, ZX NJAO te ' IMMUNE - t moo- . ....P-r - ' i g U_ .''• - ;.-- ri..4,744.1 ,_ gar mit • .-- 1 7N for"0(0 d w �i Q • �c R` I �� � SS v., 3 s, 0 f 1 7a • 7' • ( Qo c.„2 -r x L L.. % rtl FRv I Ov - VSte; tDW Pint -f of I l'' v ( /_I ai 4+ a • Z r r (L r (% 0 c - , i p 3- x —L 7- a} t` - OII n IF L li f (Z avest3/zAilitt. i ., YAWt,r�lct.6. . N ...R t ,• 1 a c-.R- d I ?f}D(L co . 2. .' V .; L4a R� tom, L. 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