Loading...
HomeMy WebLinkAboutBLD2007-00063 • 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 #: BLD07-00063 SITE ADDRESS: 159 LOUISA ST Issue Date: 03/16/2007 PORT TOWNSEND, 98368 Final Date: 3/3/2008 APPLICANT: JAMES E EADES PHONE: 360-385-5653 MARSHA EADES 2911 SHERMAN ST PORT TOWNSEND WA 98368-590C) SUBDIVISION: EISENBEIS BAY VIEW Block: 32 Lot: F+ PARCEL NUMBER: 948603207 Section: 16 Township: 30 N Range: 01 W PROJECT DESCRIPTION: NSFR W/ATT GARAGE & A/G 250 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 (no THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 3/3/2008 I:\F_BLD_Occupancy.rpt 10/29/19 UILDING PERMIT APPLICA�ON MReview0082 Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00063 Received Date: 2/20/2007 SITE ADDRESS: LOUISA ST PORT TOWNSEND, 98368 OWNER: JAMES E EADES PHONE: 360-385-5653 MARSHA EADES 121 LOUISA ST PORT TOWNSEND WA 983688714 EISENBEIS BAY VIEW SUBDIVISION: Block: 32 Lot: F PARCEL NUMBER: 948603207 Section: 16 Township: 30 N Range: 01 W CONTRACTOR: HOPE INC PHONE: (360)385-5653 DBA HOPE ROOFING PO BOX 1199/105 LOUISA AVE PORT TOWNSEND WA 98368 Contractor's License HOPER**043N7 Expires 2/16/2009 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOF NSFR W/ ATT GARAGE & AEG 250 GAL PROP TANK TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION 289,000.00 MAIN: 1,858 ADD CODE EDITION: 2003 'L: HEAT TYPE: RAD OCCUPANCY: R-3 HEAT BASE: HEAT TYPE: PRO OCCUPANCY: UNHEATED: # OF STORIES: OTHER: CONST TYPE: 5N GARAGE: 454 SHORELINE: CONST TYPE: DECK: 235 SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: CITY BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 3 Prop: 2 Total: 3 Total: 2 Routing Date: al 1109 Type Amount Paid By: Date: Receipt: prinemei Permit $2,052.15 LYK 02/20/07 89430 Plan Check $1,333.90 LYK 02/20/07 89430 State Building Code $4.50 LYK 02/20/07 89430 MAR (b 2007 Potable Water Application $58.00 LYK 02/20/07 89430 Jefferson County Planning Total: $3,448.55 &Building Department Jefferson County Building Division Permit NumbeiLD07-00063 Applicant: EADES BUILDING PERMIT INSPECTION APPROVALS applicable 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 014/61 04- PER Fi_,4,J Erosion Control Foundation Footing 4/q//7 F R /k)51 LLED Footing Drains Foundation Stem Wall y4B�G1 a 1< Underground Plumbing Straps(hold downs) (� 6144 (N ti St( Mil- -Ext. Shear Wall Nailing nn Rough-in Plumbing 4,11510 / ✓ O Framing - LS_c 7 ' - Airseal , Insulation:Walls C(' Insulation: Floors Insulation: Ceiling Int. Shear Wall Nailing f_i11��) r 1� Wallboard Nailing / /U 7 /1 Gas Line: Interior / ) f5-07 Gas Line: Exterior 1:3l1)I0 9 Propane Tank *I° ��-,( Heat/Chimney Clearance !�`� Drywell/Alt Drainage Address Posted FINAL INSPECTION 33 o e cr. FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR • • CONDITIONS for Building Permit# :BLD07-00063 1.) PRIOR TO OCCUPANCY; FINAL APPROVAL OF SEPTIC SEP06-332 IS REQUIRED. 2.) A MINIMUM OF 10' MUST BE MAINTAINED BETWEEN BUILDING FOUNDATION AND EDGE OF DISPOSAL COMPONENT AND 5' BETWEEN BUILDING FOUNDATION AND SEPTIC TANK. 3.) The application was reviewed by the Jefferson County Department of Community Development staff on March 2, 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: SARPA & SUSC aquifer recharge area. 4.) 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. 5.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to groundwater aquifers. 6.) Critical Aquifer Recharge Areas are defined as Seawater Intrusion Areas, and Special Aquifer Recharge Protection Areas and the following land uses located within Susceptible Aquifer Recharge Areas (1)All Industrial Land Uses (2) All Commercial Uses (3)All Rural Residential Land Uses requiring a Discretionary Use or Conditional Use Permit (4)All Rural Residential Land Uses with nonconforming uses that would otherwise require a Discretionary Use or Conditional Use Permit (5) Unsewered Planned Rural Residential Developments (6) Unsewered residential development with gross densities greater than one unit per acre. All of the above listed uses shall be subject to the applicable requirements and standards of the Jefferson County Unified Development Code. 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.) The applicant is proposing to create or add 3759 square feet of impervious surface and 5387 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. 9.) 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. 10.) 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. 11.) 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). 12.) The revised site plan as submitted on March 14, 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 March 15, 2007 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 13.) This approval is for a single family fence with attached garage and 250 gallo. 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. 14.) Outdoor residential storage shall be maintained in an orderly manner 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 Louise Street right-of-way shall be 20 feet. Minimum south and west property line setbacks shall be 5 feet. Minimum setback from SR 20 right-of-way shall be 50 feet (comprised of a 30 foot vegetative buffer and a 20 foot building setback from the buffer). 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.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 20.) The building height is not to exceed 35 feet. 21.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 22.) An address of 159 Louisa Street, Port Townsend has been assigned to the parcel. Louisa Street is a private road (P483). 23.) The parcel has been designated as RR 1:5 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 24.) The lots were created through the Eisenbeis Bay View Subdivision on April 4, 1890 (no AFN). 25.) A septic permit (SEP06-0332)was approved on November 1, 2006. A boundary line adjustment (SUB6-0009) was recorded on August 31, 2006 under AFN 414101. 26.) The parcel is served by PUD#1 public water. 27.) CONSISTENT WITH THE JEFFERSON COUNTY CODE (JCC) TABLE 6-1 NOTE 1: THE APPLICANT SHALL MAINTAIN A SETBACK FROM THE RIGHT-OF-WAY OF SR 20 OF 50 FEET, COMPRISED OF A 30-FOOT VEGETATIVE BUFFER AND A 20 FOOT SETBACK FROM THE BUFFER. 28.) The adjacent rights of way of Eisenbeis Avenue, Louisa Street and Charles Avenue were Quiet Titled under Court Cause 05-2-00382-0 on January 13, 2006. • , %, JEFFERSON COUNTY FEB 2 0 2007 kkil DEPARTMENT OF COMMUNITY DEVELOPMENT 411. 621 Sheridan Street • Port Townsend • Washington 98368 F S' ° t 360/379-4450 • 360/379-4451 Fax J �FEHMIk INC' http://www.co.jefferson.wa.us/commdevelopment/ IR 1E4A.1}FA VE 11 ) STORMWATER SITE PLAN SUBMITTAL TEMPLATE cx.I MLA# '1� 2- 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 improvements on the site map. ►'tSfc�l I d,ri vet n. � f o new Sin I� � r�-�i 1� Y�5 i dni c� o f-(r, P, Existing Conditions Summary 'ERA # �� 2. Describe the existing topography. Indicate contours on the site map. 0 Q ` 3 Lth5-�cu-ri'i a J 1�, i , Ina-i r kj te1Ve.� .11 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. C'1eo r ILJ i o �-r eP.s - C�cLa r^ ,R r ScA1 o f 4 to r u s lrt YlII 4 ye 1/Pje, �i on 4. Describe the existing soils. Indicate soil type on the site map. U Sancti 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 ach.X��/ ' JJ-ey2-e APPROVED 6. Describe any excess levels of noise generated by the proposed use or activity: STORM WATER PLAN C�0ua inn 0 f slj-.e. nor rnal ecn,5}r«c4fi©n p-oce-5S MAR - 22007 Stormwa ' JEFF •• DEPT.OFC require• aft� SIGNATUREJtTL�..`.i stormwater site plan template-rev.10.1/2tx13 — • 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. l(1OX‘e, - N 1 IA 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.).TV-1 i i 5 a res i de/11+i al ACM,Aop rri P.t'1 Guree— [b'-5 ACA/RAe ' c.¢.r1dr}r Go►7 roes',h art -t1 (,nr,ve.t()Fed. (nl. -Li 0.s t 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. • 9. 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 pr posed facilities from existing facilitie . co ()DnsDolA-(-s Et f-o0}in 5 ckrairis are, erne t ect u.tn cl^ t o e41- 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.] Y\Dre- 11. Describe the performance goals and standards applicable to the project. to n erne .._.' '12 Describe the flow control system; 1/41 5 fair ie, 54- oxi yU cle. 4 rQ f Yl i(1 q n ek 1 11P ect) t u0n5Qowi9 -t-D art' tl! \. stormwater site plan template'—rev.10/1/2003 • 6 • REcFvII13. Describe the water quality system. CO Of' —A/i FF ?, II ?t iti'tial litreir Kb 14. Describe the conveyance system analysis and design. YIDn-e, — N/--- 15. Describe the source of fill material,physical characterist'cs of fill material, and deposition of excess material. no -fi ( ( n-e-eded 1 /fl- 6 r-c4 p 1-1- r LA' __r) Fr ri✓ 0 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. _ D ri v e_wat - c_z h c✓'e_4-e. 18. Describe methods for restoration of the site. I CL_Ina5CA.91 n 1 4, I CLLO n a-reSL 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. nr lV °nC— - nJ/ � 20. List here and include any special repo or studies con uc)ed to prepare the Stormwater Site Plan. ii\r- One - lir 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. SP,1 ( 1c stormwater site plan template—rev.10V12003 7 • I CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN(SWPPP) The Construction SWPPP addresses sediment and erosion control during construction. The BMPs indicated by the applicant in the template that follows must be installed on the ground during all construction phases of the project. The proponent is responsible for preventing sediment and erosion impacts to environmentally sensitive areas and off-site areas. Consult the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet for guidance, particularly with rural residential development. SECTION I—CONSTRUCTION SWPPP NARRATIVE 1. Construction Stormwater Pollution Plan Elements. Describe how each of the Construction SWPPP elements has been or will be addressed. Identify the type and location of BMPs used to satisfy the required element. If an element is not applicable to the proposal,justify in writing. Descriptions of the 12 Elements are found at section 2.5.2 of the Manual(beginning on page 2-15). 12 Required Elements—Construction SWPPP 1. Mark Clearing Limits. „v,(\1k-td cia.e,ctri n j eun or�S c ckr ckoun 51 4e., — hru.5h 2. Establish Construction Access. ()r ' U.` `fib ham) n U 5 -cvr Con*U CAlo 3. Control Flow Rates. 4. Install Sediment Controls. 5. Stabilize Soils. siTW / S4raAAD 6. Protect Slopes. p f-ex.; 9krt)-u) _needc..ek 7. Protect Drain Inlets. A 8 stormwater site plan template—rev.10/1/2003 • • 12 Required Elements—Construction SWPPP(continued) # ;VIik 8. Stabilize Channels and Outlets. �m P 9. Control Pollutants. El 6 „t 01 P - (Y1 ) u n ,(-(-ccn r rk)-I-1-- -c-+i n rt s /re c j cle, 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). N`1 i 11. Maintain Best Management Practices(BMPs). je—S 12. Manage the Project. f6m P--p h cs l e\ p r o f�c�- �ti--spec 'o n Ef t'Y1.G�.r-. .&a Q rner) J 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). r ' ` !V AA) CF)f'�5- r.0 t�1(()-4'l 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—rev.10/1/2003 9 • • b. Description of special requirements for working in or near environmentally sensitive areas. NIA" 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 se uenc9, I (' C l2ctx- r jt�t rtd o�;OYi �Y<A.�, , r o o i i Ill tf car 1 31 i CCa S , * 1 ielis v I rr jl b. Construction phasing(if proposed) C� 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}abet season construction activities. b. Proposed wet season construction activities for environmentally sensitive areas. 7. Financial/Ownership Responsibilities. a. Identify the prop rty owner res onsible for the initiation of bonds and/or other financial securities. .a.C�\ Focte5 b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. M- 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable. a. Sediment Ponds/Traps. b. Diversions. I" A. c. Waterways. d. Runoff/Stormwater Detention Calcula ons 10 stormwater site plan template—rev.1 d1/2003 • • Stormwater Site Plan Changes If the designer wishes to make changes or revisions to the originally approved Storrnwater 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. WNER OR AUTHORIZED REPRES ATIVE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: stormwater site plan template—rev.10/1/2003 12 „.4 ..., . . (4. '��”' `�r,� jEFFERSfCOUNTY •4 DEPARTMENT OF COMMUNITY DEVELOP v `4 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax ..gk,.Ne,"' www.co.jefferson.wa.us/commdevelopment FEB 2 0 2007 Master Permit Application W' • 0 7— '2 Project Description(include separate sheets as necessary): iti t; la Nr Cor134-r t-C.a- Sin�l e. -f�rs l j home 1-Of Property Tax Parcel Number: LOT r q uS o )c)-7 Size: I7, j!D$ (acres/square feet) Site Address and/or Directions to Property: _ - (-40 U-)S0-5 '• - Property Owner(s)of Record: ZAck EMI e S Telephone: (3(oo ) 3g I -o31-j-a Fax:13(,b) 7ci -$`45G email: rt,oq ef Mailing Address: I 0 1 �- n t�.,i Sat, -�eei-f- t I?or±. To W t'l S e t W(1 c' �4e`J��Ct cJ t UxS.r Applicant/Agent(if different from owner): V --o pe c.t In . Telephone: (3(00) 535- 55653 Fax:1',)(oh) 7)7 9- S /5tp email: roe: no 0:Q1 jrnp cS.r1e Mailing Address: X I I R°I Ar+- I - t�J r`-��'?C�, C()f� 4836� What kind of Permit?(Check each box that applies) S.Building 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use[C(a), C(d),or C]** Single Family ❑ Discretionary"D"or Unnamed Use Classification ❑ Garage Attached/Detached 0 Special Use(Essential Public Facilities)** ❑ Manufactured Home ❑ Boundary Line Adjustment [I Modular 0 Short Plat** ❑ Commercial* ❑ Binding Site Plan** ❑ Change of Use ❑ Long Plat** , -Address X.Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** Propane ❑ 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 ❑ 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: ,1 DESIGNATION OF AGENT I hereby designate tt-,Dp , C,- _to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: 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: a.",-C z Date: % The actn'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- transferable res sibility for adherin ,and cgmplying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: � �p�G� � �- -r Date: `v- G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc v 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: Piope. 1 Inc, . (360 ) 3g5- 5653 ( 3%a) 377- )'/6 MAILING ADDRESS: ?O Boy. ( 19 9 EMAIL: -c O ci rtcJ ,0@ (f, us nE,,�... CONTRACTOR'S LICENSE WAINS J NUMBER: E-F,o4 esZ.0 ()Lf. N 7NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: X New Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: .Q. Bank Height: ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: )Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well 0 Two Party y g Proposed: .3 y Public T P o..Feat: /f4� Total: Name of System: If his 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: e�,)C1, II Heat Stove CI Cook Stove ❑ Woodstove �ri eplace Insert 61.1-tot W t r Tank ❑ Pellet Stove ❑ Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / o 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 51:6 ((o10532.54 EH Bid App Review: 2nd Floor Heated Consistency Review: Other Heated Base fee: Mezzanine f Additional Section: ___7 Heated Basement Plan Check fee: 132)3.moo Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: 13 Garage/Carport i4 5 ' 109C0-jg SUBTOTAL 33 Decks 5538. 9 d Approac ee: ay r 15Q ' Other TOTAL: $ 55 Receipt Number: Q^ tD Cash/Check Number: c- 1 Lo0 -..:, ESTIMATED COST(REQUIRED) 13,072 Date: �7 .Fair market valu !abut aunt ' Is foundation to finish V 1 ) 0 V Initials: <`__ \ G:\Pe J er Permit Application 12-30-05.doc 1 I I _ _mI g i 1 •w Bp .� 1 : � \ . 32Ai _: "t,., , •' �� a \ \ v lie \ N r r410 --i <.@es1.sgi Fr . ill 1 ls s tip r 11 liksli igl le I 40 65'-0' 2r-4' 43'-8• f 3'-9 3/4' N'-N N'-A V2' 6'-4' 10'-5 3/4' 9'-4 3/4' , 3'-0' ), 8'-0 V4' t f'-9 3/4', 2'-8' , 2'-8'7-9 3/4, 3'-3' ,2'-8'I I9'2'-1r/ 3'-3' / ,2'-2' '-0'),2'-2', 5'-1' /2'-O'},2'-0•I/4' I IR' 11/2' r ll 0 \ \ \N ' r �uuuuuu� uu�u�eaau�umuuuuu��uh ��uuuuu�wu�uuu�uuuuuuwo��a��tx.�uuuuu��a..uu„�uao���o�u� au��u�uu�u\�uu�uuuuuu�� �uuuu�uuuucN1uuuw auuu�u .uuu�u�u�uu�ouuuuuuuo Z6. al _, . • a, a Y 1.... II I, .... m m 0I Ill_ u u• „. .; , 0 0 , i '." iti 1). t teu Li 1 A A , _1 , o 0 , I - , 0 11 I 0 . 4f. x p Oit R/6 w. O N....,.,.....a... „.. ‘3.4 P® 1 KO.40 war 1 1 ` m i 8'5- 13.-11 V4' ►L83/ k t 1'-4 V1' 3'1 V2' I- 4.-0' I. • 6'-4' bt 3'-4' 0T-13/4' �; 4 Ln 4f f N... _ 4 �9 o OA 1 q. [ P 4.1" a . N., \ • 1 -•— ===rr rt. I b $ u . s �� lJ �� (.c ) U ` -it P.4,.. js ' Imam r . rx -r z 1 as } t OZ - 4 \ m R \ \ \y �uuuu�uuuuuu�.uuuuuuu�u�uu�u�u\uc. a \ s1W S �(� r rC yo Nine00 { S z1 *4 00 Z. o _ r0 Z. 4kt - %I hi g , t Ilk All -r r-r 1 N 4' 74. ec 4 033�1- gq r�AL L-C r- 5 IC99 F f ni f 09, TQt' juj MP€2Uior - A -7 o 11 140 otA� 3 � 5 9 1 C:,oT�N c 00 u UN Dti� Go�ST(L-'c,lGi Nfm W, u .11 vv O D�E'o P�4� c oT R PRO Pf� N'\ 8 es' 44' m9' Ur IS 7, % (p r..._.._.._.._.._.._.._.._.._.._.._........ �� MIfJ �j Is s � %f I OL MW to S y5'" wl -7 1 �5ysr�M - I �J �� � � - i j S�L 6501IL m„�� I j g s7C2 / I (y 9cpr ` S I i � � a ' �� w f Ruh (o mirJ5t-r K�J (rTIG to I Q � ��• IS SLAT p G2��1� ���(,� j Nut, r I I I I I I _J HIM. il�_.� •��� IVISED SIT Py ` I I dated 3 � \ \ I t I Has been APPROVED I F— — �O (r (� r — by JEFFERSON DEPT. OF C V ENT SIGNAAA mL �q)G-�-(o3 KEv .Spcl 14