HomeMy WebLinkAboutBLD2009-00076 • •
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 #: BLD09-00076
SITE ADDRESS: 2753 CLEARWATER RD Issue Date: 04/23/2009
FORKS, 98331 Final Date: 9/29/2009
APPLICANT: EUGENE H BUNKER PHONE: (425) 255-2316
ANN C BUNKER
14603 157TH PL SE
RENTON WA 98059-7438
SUBDIVISION: Block: Lot: TX 18
PARCEL NUMBER: 412192017 Section: 19 Township: 24 N Range: 12 W
PROJECT DESCRIPTION: NEW MFH and shoreline exemption permit
SERIAL NO. 30337/MODEL: SILVERCREST
THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING
CODE 2006 EDITION.
OCCUPANCY GROUP:
TYPE OF CONSTRUCTION:
SPRINKLER SYSTEM yes no i
THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 9/29/2009
I:\F_BLD_Occupa ncy.rpt 10/29/19
MANUFAURED/MOBILE HOME INSTOLATION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD09-00076 Received Date: 3/16/2009
SITE ADDRESS: 2753 CLEARWATER RD Issue Date: 4/23/2009
FORKS, 98331
APPLICANT: EUGENE H BUNKER
ANN C BUNKER
14603 157TH PL SE
RENTON WA 98059-7438
SUBDIVISION: Block: Lot: TX 18
PARCEL#: 412192017 Section: 19 Township: 24 N Range: 12 W
CONTRACTOR/ WASHINGTON HOME CENTER INC PHONE: (360) 748-6604
DEALER PO BOX 176
CHEHALIS WA 98532
Contractor's License WASHIHC0770A Expires 3/19/2011
PROJECT DESCRIPTION: NEW MFH and shoreline exemption permit
SERIAL NO. 30337/MODEL: SILVERCREST
MAKE: CHAMPION YEAR: 2006 SIZE: 68 X 27
Directions SEE MAP QUEST DIRECTIONS AND MAP IN FILE;
To Site:
THIS PERMIT IS VALID FOR ONE YEAR.
THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR.
CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT.
Setbacks/Footing (CONTINUOUS FOOTING, SLAB or PADS USED):
Stormwater FINAL Approval:
Blocking/Plumbing:
Propane Tank/Lines
Zoning Final Approval:
Septic System Final Approval (If not on sewer):
Road Approach Final Approval:
eAy1ei. Final/SkirtingNents/Porches/Steps:
4 S 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
4110 • MLA09-00088
Review Type: I
MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD09-00076 Received Date: 3/16/2009
SITE ADDRESS: 2753 CLEARWATER RD
FORKS, 98331
APPLICANT: EUGENE H BUNKER PHONE:
ANN C BUNKER
14603 157TH PL SE
RENTON WA 98059-7438
SUBDIVISION: Block: Lot: TX 18
PARCEL NUMBER: 412192017 Section: 19 Township: 24 N Range: 12 W
CONTRACTOR/ WASHINGTON HOME CENTER INC PHONE: (360) 748-6604
DEALER: PO BOX 176
CHEHALIS WA 98532
Contractor's License WASHIHC0770A Expires 3/19/2009
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION: NEW MFH
SERIAL NO. 30337/MODEL: SILVERCREST
TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE:
TYPE OF IMP NEW MAKE: CHAMPION SETBACK:
VALUATION 93,523.00 YEAR: 2006
LABOR & INDUSTRIES APPROVAL?
SIZE: 68 X 27 BANK HEIGHT: 15
SEWAGE DISPOSAL: CON
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: 2 Prop: 2
Total: 2 Total: 2
Routing Date: 3r 1 r_ CI 0,4.?
APAPROYEL
Type Amount Paid By: Date: Receipt:
Manufactured Homes $213.00 KAS 03/16/09 105540 APR zz. 20CR
Potable Water Application $62.00 KAS 03/16/09 105540
Jefferson County Planninc
Total: $275.00 &Building Department
•
SPECIAL CONDITIONS CASE # BLD09-00076
1.) DESIGN CRITERIA FOR SPLASHBLOCKS:
A VEGETATED FLOWPATH OF AT LEAST 50 FEET SHOULD BE MAINTAINED
BETWEEN THE DISCHARGE POINT AND ANY PROPERTY LINE, STRUCTURE,
STEEP SLOPE, STREAM, WETLAND, LAKE, OR OTHER IMPERVIOUS SURFACE.
SENSITIVE AREA BUFFERS MAY COUNT TOWARD FLOWPATH LENGTHS.
A MAXIMUM OF 700 SQUARE FEET OF ROOF AREA MAY DRAIN TO EACH
SPLASHBLOCK.
A SPLASHBLOCK OR A PAD OF CRUSHED ROCK (2 FEET WIDE BY 3 FEET LONG
BY 6 INCHES DEEP) SHOULD BE PLACED AT EACH DOWNSPOUT DISCHARGE
POINT.
NO EROSION OR FLOODING OF DOWNSTREAM PROPERTIES MAY RESULT.
FOR SITES WITH SEPTIC SYSTEMS, THE DISCHARGE POINT MUST BE
DOWNSLOPE OF THE PRIMARY AND RESERVE DRAINFILED AREAS.
2.) 2005 DOE STORMWATER MANUAL DRYWELL DESIGN CRITERIA
ALL INFILTRATION SYSTEMS SHOULD BE AT LEAST 10 FEET FROM ANY
STRUCTURE, PROPERTY LINE, OR SENSITIVE AREA.
FOR SITE WITH SEPTIC SYSTEMS, INFILTRATION SYSTEMS MUST BE
DOWNGRADIENT OF THE DRAINFIELD UNLESS THE SITE TOPOGRAPHY CLEARLY
PROHIBITS SUBSURFACE FLOWS FROM INTERSECTING THE DRAINFIELD.
DRYWELL BOTTOMS MUST BE A MINIMUM OF 1 FOOT ABOVE SEASONAL HIGH
GROUNDWATER LEVEL OR IMPERMEABLE SOIL LAYERS.
EACH DRYWELL MAY SERVE UP TO 1000 SQUARE FEET OF IMPERVIOUS
SURFACE FOR EITHER MEDIUM SANDS OR COURSE SANDS.
TYPICALLY DRYWELLS ARE 48 INCHES IN DIAMETER (MINIMUM) AND HAVE A
DEPTH OF 5 FEET (4 FEET OF GRAVEL AND 1 FOOT OF SUITABLE COVER
MATERIAL).
FILTER FABRIC (GEOTEXTILE) MUST BE PLACED ON TOP OF THE DRAIN ROCK
AND ON TRENCH OR DRYWELL SIDES PRIOR TO BACKFILLING.
SPACING BETWEEN DRYWELLS MUST BE A MINIMUM OF 4 FEET.
3.) CONSTRUCTION ENTRANCES SHALL BE STABILIZED WHEREVER TRAFFIC WILL
BE LEAVING A CONSTRUCTION SITE AND TRAVELING ON PAVED ROADS OR
OTHER PAVED AREAS WITHIN 1,000 FEET OF THE SITE.
THE ENTRANCE SHALL BE CONSTRUCTED ON A FIRM COMPACTED SUBGRADE.
QUARRY SPALLS (OR HOG FUEL) SHALL BE ADDED IF THE PAD IS NO LONGER IN
ACCORDANCE WITH THE SPECIFICATIONS. (BMP C105, 2005 DOE STORMWATER
MANUAL).
ANY SEDIMENT THAT IS TRACKED ONTO PAVEMENT SHALL BE REMOVED BY
SHOVELING OR STREET SWEEPING. THE SEDIMENT COLLECTED BY SWEEPING
SHALL BE REMOVED OR STABILIZED ON STIE.
ANY QUARRY SPALLS THAT ARE LOOSENED FROM THE PAD, WHICH END UP ON
THE ROADWAY SHALL BE REMOVED IMMEDIATELY.
UPON PROJECT COMPLETION AND SITE STABILIZATION, ALL CONSTRUCTION
ACCESSES INTENDED AS PERMANENT ACCESS FOR MAINTENANCE SHALL BE
PERMANENTLY STABILIZED.
4.) A SILT FENCE SHALL BE 10-ALLED AT THE WETLAND BUFFER A4ENT TO
THE DRAINFIELD PRIOR TO ANY LAND DISTURBING ACTIVITY.
THE MINIMUM HEIGHT OF THE TOP OF SILT FENCE SHALL BE 2 FEET AND THE
MAXIMUM HEIGHT SHALL BE 2 1/2 FEET ABOVE THE ORIGINAL GROUND
SURFACE.
THE SILT FENCE SHALL BE BURIED IN A TRENCH TO A MINIMUM DEPTH OF 5
INCHES BELOW THE GROUND SURFACE. THE TRENCH SHALL BE BACKFILLED
AND THE SOIL TAMPED IN PLACE OVER THE BURIED PORTION OF THE SILT
FENCE, SUCH THAT NO FLOW CAN PASS BENEATH THE FENCE AND SCOURING
CAN NOT OCCUR.
ANY DAMAGE TO THE SILT FENCE SHALL BE REPAIRED IMMEDIATELY.
SEDIMENT DEPOSITS SHALL EITHER BE REMOVED WHEN THE DEPOSIT
REACHES APPROXIMATELY ONE-THIRD THE HEIGHT OF THE SILT FENCE, OR A
SECOND SILT FENCE SHALL BE INSTALLED.
5.) A"Construction Drawing" Flood Elevation Certificate was prepared by a licensed surveyor
and submitted with the application. The lowest floor of the structure is required to be
elevated at least two (2) feet above base flood elevation. PRIOR TO FINAL BUILDING
INSPECTION, PROPONENT SHALL PROVIDE THE DEPARTMENT WITH AN
ORIGINAL "FINISHED" CONSTRUCTION" FLOOD ELEVATION CERTIFICATE THAT
HAS BEEN VERIFIED BY A LAND SURVEYOR, ENGINEER, OR ARCHITECT
AUTHORIZED BY LAW TO CERTIFY ELEVATION INFORMATION IN THE STATE OF
WASHINGTON.
6.) Fully enclosed areas below the lowest floor that are subject to flooding are prohibited
unless designed to automatically equalize hydrostatic flood forces on exterior walls by
allowing for the entry and exit of floodwater. Designs for meeting this requirement must
either be certified by a registered professional engineer or architect or must meet or
exceed the following criteria: a. A minimum of two openings having a total net area of not
less than one square inch for every square foot of enclosed area subject to flooding shall
be provided. b. The bottom of all openings shall be no higher than one foot above grade.
c. Openings may be equipt with screens, louvers, or other coverings or devices provided
that they permit the automatic entry and exit of floodwater.
7.) Flood hazard reduction measures are to be used as required by the Jefferson County
Flood Damage Prevention Ordinance 07-0515-06 (Jefferson County Code Chapter
15.15).
8.) Construction Materials and Methods of Construction to Reduce Flood Hazard
(i)All new construction and substantial improvements shall be constructed with materials
and utility equipment resistant to flood damage.
(ii) All new construction and substantial improvements shall be constructed using methods
and practices that minimize flood damage.
(iii) Electrical, heating, ventilation, plumbing, and air-conditioning equipment and other
service facilities shall be designed and/or otherwise elevated or located so as to prevent
water from entering or accumulating within the components during conditions of flooding.
Locating such equipment below the base flood elevation may cause annual flood
insurance premiums to be increased.
9.) New construction and substantial improvement of any residential structure shall have the
lowest floor, including basement, elevated two feet or more above the base flood elevation
(BFE).
10.) The application was reviewed by the Jefferson County Department of Community
Development staff on April 6, 2009 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:
conservancy shoreline designation; Ns stream, wetlands; flood; SUSC aquifer recharge
area.
11.) Aquifer Recharge Areas in Arson County are characterized by porousiblogical
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.
12.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions
that promote rapid infiltration of recharge waters to groundwater aquifers.
13.) A Type Ns Stream (Fish and Wildlife Habitat Conservation Area) has been identified on
the subject property. The stream will require a buffer of 50-feet. The buffer shall be
measured horizontally from the Ordinary High Water Mark (OHWM). Fish and Wildlife
Habitat Areas shall also have Buffers and Building Setbacks established.
14.) Stream and wetland buffers are areas that shall be maintained in their natural condition,
however, minor pruning or alteration of vegetation may be permitted as long as the
function and character of the buffer are not diminished.
15.) Among the native conifer species which may be used in buffers or for re-vegetation
include, but are not limited to: Grand Fir (Aibes grandis), Sitka Spruce (Picea sitchensis),
Shore Pine (Pinus contorta), Douglas Fir(Pseudotsuga menziesii), Western Red Cedar
(Thuja plicata), and Western Hemlock (Tsuga heterophylla).
Among native tree species which may be used includes: Vine Maple (Acer circinatum),
Big-Leaf Maple (Acer macrophyllum), Red Alder(Alnus rubra), Pacific Madrone (Arbutus
menziesii), Quaking Aspen (Populus tremula), Black Cottonwood (Populus trichocarpa),
Bitter Cherry (Prunus emarginata), Oregon White Oak (Quercus garryana), Cascara
(Rhamnus purshiana), Pacific Willow (Salix lasiandra), and Scouler's Willow (Salix
scouleriana).
Among the native shrub species which may be used are: Sevice-Berry (Amalanchier
alnifolia), Red Osier Dogwood (Cornus stolonifera) Salal (Gaultheria shallon), Ocean
Spray (Holodiscus discolor), Indian Plum (Oemlaria cerasiformis), Pacific Ninebark
(Physocarpus capitus), Red Flowering Currant (Ribes sanguineum), Wild Rose (Rosa
nutkana), Swamp Rose (Rosa pisocarpa), Willows (Salix ssp.), Red Elderberry
(Sambucus racemosa), Snowberry (Symphoricarpos albus), Evergreen Huckleberry
(Vaccinium ovatum), Red Huckleberry (Vaccinium parvifolium).
16.) A setback of 50-feet, measured perpendicularly from the wetland edge, shall be
permanently maintained as a buffer. No filling, grading, clearing, or other alteration of the
wetland or its buffer is allowed.
17.) Wetland buffer perimeters shall be marked with temporary signs at an interval of one per
parcel or every one hundred (100) feet, whichever is less. Signs shall contain the
following statement: "Wetland & Buffer- Do Not Remove or Alter Existing Vegetation."
18.) A permanent physical separation along the upland boundary of the wetland buffer area
shall be installed and permanently maintained. Such separation can include installing
logs, trees, a hedgerow, or any other prominent physical marking approved by the UDC
Administrator.
19.) 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.
20.) The identified Fish and Wildlife Habitat Area (Type Ns Stream), shall maintain a
vegetative buffer setback of 50 feet. The setback shall be measured horizontally from the
Ordinary High Water Mark (OHWM) to the proposed development.
21.) An additional setback of five (5) feet is required from the edge of the stream buffer area to
the proposed development.
22.) A permanent physical separation along the boundary of the stream buffer area shall be
installed and permanently maintained. Such separation can include installing logs, trees,
a hedgerow, or any other prominent physical marking approved by the UDC Administrator.
23.) Stream buffer perimeters shall be marked with temporary signs at an interval of one per
parcel or every one hundred (100) feet, whichever is less. Signs shall be in place prior to
and during construction activities. The signs shall contain the following statement: "Buffer
- Do Not Remove or Alter Existing Vegetation."
24.) The applicant is proposing tSate or add 1813 square feet of impervioirface and
2213 square feet of land disturbing activities. JCC 18.30.060 and 18.30.070 require your
proposal comply with Minimum Requirement#2 (Construction Stormwater Pollution
Prevention) of the Department of Ecology Stormwater Management Manual for Western
Washington 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.
25.) The project shall comply with Construction Stormwater Pollution Prevention (SWPP)
Elements#1 through#12 of the Department of Ecology's Stormwater Management
Manual for Western Washington 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.
26.) 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.
27.) 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).
28.) The site plan as submitted with the manufactured home application on March 16, 2009
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 April 23, 2009 shall be resubmitted for
review and approval by Jefferson County Department of Community Development.
29.) This approval is for a manufactured home 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.
30.) The parcel has been designated as 1:20 under the Jefferson County Comprehensive
Land Use Map effective August 28, 1998.
31.) NOTICE: This permit does•excuse the proponent from complying wither local,
state, and federal ordinances, regulations, or statutes applicable to the proposed
development, but consistent with RCW 90.58.
Development pursuant to this permit shall be undertaken subject to the applicable policies
and performance standards of the Jefferson County Shoreline Management Master
Program and the Jefferson County Unified Development Code.
If during excavation or development of the site an area of potential archaeological
significance is uncovered, all activity in the immediate area shall be halted, and the
Administrator shall be notified at once.
The Federal Endangered Species Act rules to protect threatened Chinook and
Summer-run Chum salmon became effective on January 8, 2001. Bull trout have been
listed as threatened since early 2000. Under the ESA, any person may bring lawsuit
against any individual or agency that"takes" listed species (defined as causing harm,
harassing, or damaging habitat for the listed species). In addition, the National Marine
Fisheries Service can levy penalties. All areas in Jefferson County are included as
"critical habitat" for a listed species. Development of property along any marine shoreline,
freshwater shoreline, or floodplains could harm habitat if protective measures are not
taken. To minimize the potential to damage habitat, all property owners developing
adjacent to marine shoreline, freshwater shoreline, or floodplains are advised to do the
following:
-All development activities should avoid unstable slopes, wetlands, and forested areas
near surface waters
- Remove minimal vegetation for site development, especially large trees
-Allow trees that have fallen into surface waters to remain there
- Infiltrate stormwater from buildings and driveways onsite through drywells rather than
discharging directly into surface waters or roadside ditches
Any individual, group, or agency can bring suit for a listed species "taking", even if you are
in compliance with Jefferson County development codes. The risk of a lawsuit against
you can be reduced by consulting with a professional fisheries habitat biologist, and
following the recommendations for site development provided by the biologist. For more
information, contact the National Marine Fisheries Service in Seattle, or the U.S. Fish and
Wildlife Service.
32.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
33.) 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 automobile 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 requirements 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.
34.) A minimum of two (2) on-site parking spaces shall be provided for the single family
residence.
35.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
36.) The building height is not to exceed 35 feet.
37.) Minimum setback from Clearwater Road right-of-way shall be 20 feet. Minimum north and
south propertysetbacks shall be 5 feet. Minimum setback from the Type Ns stream shall
be 55 feet. Minimum setback from the wetland shall be 50 feet.
38.) 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.
39.) 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.
40.) Residential developers and.idual builders shall be required to preserlehoreline
vegetation and reduce the associated risk of erosion during construction and any future
activity which may impact the stability of the shoreline.
41.) An address of 2753 Clearwater Road, Forks has been assigned to the parcel.
CLearwater Road is a county minor collector(C107508).
42.) The proposed manufactured home is located approximately 400 feet east of the
Clearwater River. Therefore, the proposal is not within shoreline jurisdiction.
43.) A septic permit (SEP94-0342) was finaled on December 5, 1995. A critical area review
(CAR94-0097) for a septic permit was finaled on November 7, 1994. A road approach
permit(RAP05-0131)was finaled on October 21, 2008. A well review(USR08-0077)was
decommissioned due to a dry well. A second attempt at a well (USR09-0003)was
decommissioned also due to a dry well. A well review (USR09-0004)was finaled on
March 17, 2009.
44.) The parcel is served by an individual on-site well (USR09-0004) that was finaled on March
17, 2009.
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JACK WESTER1'IAN III Jefferson Conntetirthousc
ASSESSOR PO 11os 1220, Port Town, nd N':I 98368
43601 :185-9105 CE VE SD;
MOBILE HOME INFORMATION FORM
MAR 182009
OWNER'S NAME/MAILING ADDRESS:
NAME: C i; f:`Ei7 urn
ADDRESS: /4/603 / 5 7 "` 4 PL 5E WE,Jtev l.vA c ge:'&"
PHONE NO. "/a5- ASS - 2 3 i 4
The purpose of this questionnaire is to obtain information regarding either the
current location of a mobile home or the previous ownership and location of a mobile
home. This will help our office determine whether the mobile home is already on the
tax rolls in Jefferson County or if it has been moved to this county from another area.
1)MORILE HOME DATA:
(A) MAKE C 14 Amp:v-rt (B) MODEL S i L u F 2 c �=`uT (C)YEAR 2 0O CQ '
(D) LENGTH Co (E) WIDTH 7 (F)SERIAL# 3 Q337
qy it)(G)YOUR PURCHASE PRICE (Do not include sales tax)N 93, Jam'a3, PURCHASE DATE/2•$-'D
2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3)
(A) FROM WHOM DID YOU PURCHASE MOBILE
ADDRESS
(B)WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR? Yes No
If Yes, Previous address of mobile.
If No, What County was Mobile assessed in last year.
3)WHERE MOBILE HOME IS TO BE LOCATED:
(A)WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes (N-O____)
(B)IF LOCATED IN MOBILE HOME PARK:
NAME &ADDRESS OF PARK Lot/Space #
(C) IF NOT LOCATED IN MOBILE HOME PARK:
NAME OF LAND OWNER: Ev�f Nr -.N /1NN 00 g1Z
LOCATION ADDRESS z 7 53 C.L E A R.Lo i PARCEL
- RD rok.I4S, i i 98'33/
REAL PROPERTY PARCEL #/DESCRIPTION PARCEL 1'1 Ili a2. /9 a2 O! 7
9s�� zk l ow,3s 1.h p NoA.fe-i /ZAi c. r 2 wESi W.M. :1 EF'FAP- bnj2) 12-CaiLj
ign Lure of applicant
THANK YOU FOR YOUR HELP!
4 �D SS-Q Q Q.
JO COSSELL, Property Technician
e-- ON c0� JEFFERSOF UNN ``,f"'�'a` z .Y •
W \q DEPARTMENT OF COMMUNITY) VLOPMENT •' : �.r
ti v rk, 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax ,, , . r
p� www.cojefferson.wa.us/commdevelopiiient 16 ZiA/J
\N,......_
�`rHINO`S
Master Permit Application ,JFFf[ SRN CfUi41Y III MLA: oQ -c6
S
Project Description(include separate sheets as necessary): ri
Tax Parcel Number: it/;2 ( q 2. 0 17 Property Size: l,3C1 /6 a 5 1,51••`/ (acres/square feet)
Site Address and/or Directions to Property:
a 753 CLEAR w riYt iZ RoRD roe/ s WA 9r33 I
Property Owner(s)of Record: E.u f r N E " lJ U N/.4 tE lZ
Telephone: 462 5 - 2 5 5 -- Z3 -/N pi/ 4' Fax: -- email: //E RAT 61t/
y eomCy4,5T•Nor
Mailing Address: /1-/4P O 3 15 7 t14 Pt- $E IR E au-1-e 10, (,v(4 G/ SO:S c'
Applicant/Agent(if different from owner): ,---
Telephone: Fax: email:
Mailing Address:
What kind of Permit? (Check each box that applies
❑Building 0 Critical Areas Stewardship Plan
❑ Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
❑ Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a),C(d),or C]**
rii. Manufactured Home 0 Modular 0 Discretionary"D"or Unnamed Use Classification
❑ Commercial* 0 Special Use(Essential Public Facilities)**
❑ Change of Use 0 Boundary Line Adjustment
❑ Address 0 Road Approach ❑Short Plat**
❑ Home Business ❑ Cottage Industry 0 Binding Site Plan**
❑ Propane ❑Long Plat**
❑Sign 0 Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration**
❑ Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions**
❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Substantial Development**
0 Temporary Use 0 Shoreline Management Variance
❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use Distt ict Map Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment
*May require a Pre—Application Conference 0 Tree Vegetation Request
**Requires a Pre-Application Conference
Please identify any other local, state or federal permits required for this proposal, if known:
DESIGNATION OF AGENT
I hereby designate 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 its 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. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the applic t{on that he or she w s prior otice.
�u y
' rSi9nature: �.-.. �/ f/n• (�i Date: . ' J `,RL
The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or
endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the
"Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this
permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transf able responsibil't" or adh " g to and c plying wi/tp�,the ESA. The Applicanthas read this disclaimer and signs and dates it below.
Signature: /` Li — kt2..-L� Date: 9 " -. .Z2/2 r
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
• 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:
Lk)A:4.4 c r°)C -6-0+r) 4 0 GMT &e,i t e..h.� (3 60) `7 Q 3 to/0 u(1 ( )
MAILING ADDRESS: 1:? 0- SaNi I -1 (,n EMAIL:
CONTRACTOR'S LICENSE WAINS I /
NUMBER: W Ij S t-J ( I-} C 01 70.4 NUMBER / L c95O
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
h New Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: o9.. Bank ❑ Community System
❑ Alteration/Remodel 0 Concrete Total: vL Height: al Individual System
❑ Repair 0 Masonry /sj / SEP Permit# `/4 -3
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: Private well ❑ Two Party
Type of heat: Proposed: e- i ❑ Public
e.(•a ri C__-- Total: ,91 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
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:
1 Underground Tank 1 Above ground Tank Size of Propane Tank:
1 Heat Stove 1 Cook Stove 1 Woodstove 1 Fireplace Insert 1 Hot Water Tank 1 Pellet Stove 1 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 EH Bld App Review: 15, DD
22 Floor Heated Consistency Review: p�h v i' �,10
Other Heated _V Base fee: o0
Mezzanine
�`�'cE :v'"IThj
a)�
Additional Section:
Heated Basement M R R . C Pl2C09an Check fee: _
H
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee:
100• Ub
Garage/Carport SUBTOTAL 5 99. 001
Decks �71 l(J(Pi ttlQ.OPFN 4 q 7.Op
Other TOTAL: $ /0 Oy(o 00
Receipt Number:
l 0 5 /Ad
Cash/Check Number: °I,O5'
ESTIMATED COST(REQUIRED) Date: �r
.Fair market value of all labor and materials foundation to finish t "J
Initials: k ) _
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
i
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_t�i��fl�E 'E
ON CO
lier11141 .1., JEFFERSON COUNTY MAR 16 2009
►., ,.d DEPARTMENT OF COMMUNITY DEVELOPMENT pppA' N
�$ , . 621 Sheridan Street• Port Townsend •Washington 98368 JEFFERSUN COON I I HD
DSO 360/379-4450 • 360/379-4451 Fax
�$INO http://www.co.jefferson.wa.us/commdevelopment/
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# OCt" "(Z PROJECT/APPLICANT NAME: Elk-‘6- AnAA r6 U-An-t-14--..-
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 osition'and relative size of proposed improvements on the
site map. Al S r..-1- It 13 S9 1,V- oN i.n Ul.kt l l.i(� In1Z WI e ORS £ 1 Sf1v1.e. S I+e
E-KI s#v1 dl.ctv-t .J .5.6' ( i8: 4oJ r� LX I -3 i CLGMeS -
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Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map. I-(o s,fC'� L-e-Oe� 0( S I i5Lt Sto re
on StY,.LA-h/euSi uOC-5tsld1, S(Vec C're-e te.etr ,pt -'-O
Cl e-ar- Joj e — Fit k.)-e r
3. Describe the existing vegetation. Indicate native vegetation areas on the site map.
-Pc(2.4' CO v t-e�G CAk, ra_s-E. t6.1--C,,, Say Q 'e?ten&s t 4i tr�e,S
6 r LA)4- , A ,w- Y fn G crt-4 et e v`dG r-o n s ) !_Z 4 v l0L 1- h ul ar x-v. A-
4. Describe the existing soils. Indicate soil type on the ssitemap. p_
S 6 I( l S 1-0 C e�S4- o-p cx _ °f V-�° "?� E'J 2N IN\-Q.ayJ(e. Q/"r cir-eAjC.__
N CA.to curco tat ki V.e,r so t l t S ( o vy,
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.
-1,e...l t e % ex- 93-e-- s 11.1-s 4 raj, vs , L4Jal eX" dr ns rQ t.l)i cX
t wA-t• £L) A Ox 015 • C I a n a-b SO r b-I--us r. e tc Ge I t t _
APPROVED
6. Describe any excess levels of noise generated by the proposed use or activity: STORM WATER PLAN
no e k:.C C,S 5 (1.a l S e t•e---V- -2.S
APR 2 3 2009
Stot mwa - ` ''i•
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Require/ DEPT.OF ]lI D• LAI$!N",
SIGNAT ' ': 111���'.1..E i
stormwater site plan template—rev.10/21/2008 5
• • •
7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams,
steep slopes,etc.)on the site. Indicate location on the site map..
Icio pexttlb o par& ecs Q t,e cc,x€,r R,v-ex S ife&w. I-u.A,s
10 c,114 ) 4.1) So-u)k-e. at Ue�s tiVE,r1 IMAd poi ►\t- S>✓.e. w-eA (a_1,42, 1T,
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.). .
b I�J►-,. p i c, u i-vim. R 4-o fl ts-r'i-Le4Q,s-t /12 'LUetf &t, Pi u-ec.>
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LAC.ec,vv, To-u,--n a f- C ex: sry).46,,1 Caw',kAA itAA L U) ft
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IV u r - Lr-s S rrvo�,l Sfi'-e m t r� P�ne,.�. oetz,Pro k► c. IAA Ic 1 ' .
Permanent Stormwater Control Plan£L-K Ct�P. -(1 1J� ) ���- t l�--n
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.
't Sw...& 1frc ee4 Cv ; tI t,.[s e D ,)y_Li..i.. - .oL t)S OT cn1Ft(rArtod
ki
pig,_51-, blooms
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.]
it)A-
11. Describe the performance goals and standar applicable to the project. `
10 ptcue. OL, ifeQ €. o 14 per`i/ 0-E
/&S 1- sumo-(I S'{-burb IL'ne e .
12. Describe the flow control systPm
RECEIVE R—
•
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stormwater site plan template-:uev..10/21/2008 ` 6
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13. Describe the water quality,system.
Si+e C9-CCUAS ex C crin. \l,c. i,u e)I— Ar cuv ks- q ► .AcX1.
14. Describe the conveyance system an lysis and design.
d o w r\ , a wts c y w a LI MAR 16 2009
_
JEFFERSON COUNTY DCO
15. Describe the source of fill material, physical characteristics of fill material, and deposition of excess material.
5t c'-15smp - r t
16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
o rn p acA- one, c- a,(3 p r r u - S r pfi
17. Describe the proposed surfacing material.
Gbmeacs}- rp-f'
18. Describe methods for r storation of the site.
E is c riv Humestte, , to Lewd&
a- r k c AA.--t A a i(\ Q. U +-auk.r-v,
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.
r
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.,
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stormwater site plan template—rev.10/21/2008 7
S •
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 Volume ll Section 3.2.3 of the Manual (beginning
on page 3-7).
12 Required Elements—Construction SWPPP
1. Mark Clearing Limits.
2. Establish Construction Apcess.G� IS cri�,1,U I '' a
MR 1 2003
3. Control Flow Rate .
a roz-+�s tS r'• l vc-h) SB-1 t juircau,3z,.. . .,,A t l n f 3
4. Install Sediment Controls.
0` ch a.,vL, p acl S 1 (Act._s S p Lars e. rct s s 01, I,0-ozds
5. Stabilize Soils.
NA
6. Protect Slopes. n
S l o e_ o r) w �� S I AZ1 I.C 'e--"F I CIL 14 cQ_
7. Protect DrainInlets.
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stormwater site plan template—rev.10/21/2008 8
•
12 Required Elements—Construction SWPPP(continued)
8. Stabilize Channels and Outlets. (� n
S C 1 v sWr 6 n C) t2&x.it'1,0 of uu I '
TE D
9. Control Pollutants. 20
10. Control De-Watering (the act of pumping groundwater or stormwater away from an active construction site).
11. Maintain Best Management Practices(BMPs).
44-o prey ems' (.CShcwv 0..c wre-te ( t m.
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12. Manage the Project. -
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'a- - k ay„e o n.J ttJt R s i t p vv'r
2. Adjacent Areas.
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential
areas, roads).
ti 0 j L_ t 44'1'
b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
yards).
k -C--1 l 2 & v•-eti
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3. Environmentally Sensitive Areas.
a. Descriotion of environmentally sensitive areas that are on or adjacent to the site.
Cam• 664-t � ' �Le� — S a S o r
CA sl Ca-
stormwater site plan template—rev.10/21/2008 9
• •
b. Description 9,f special requirements for working in or near environmentally sensitive areas.
S i 11 v1. S"t a- --e_c
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).S t'f tr-- -vans Soil Lose.),t Q t Wit,(p 4 c
.eirdStyx v. cobleN
5. Construction Phasing.
a. Construction sequence
(,V e,(l d,► _ v P�- l\o m L¢c,vid S r_C e._
b. Construction phasing (if proposed)
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
Provide.0 proposed construction schedule. n
ORA i WS r u f eJ Ct`1
t - -(1 ICU t ayi ct "�l re- o cx e f�°
C,orcparr �r5* / &It ermiis 0Cf !- QP_C 3 Gue-li
II. Wet Season Construction Activities. / — f Zoe)
a. Proposed wet season construction activities. (�
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b. Proposed wet season construction activities for environmentally sensitive areas.
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7. Financial/Ownership Responsibilities.
a. Identify the property owner responsible for the initiation of bonds and/or other financial securities.
6 it. L,v e cv ,q-►J'.) u n kz1 /ow ri e rS
b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation
impacts. 0
p {�r"S n a� he S f" a 1' S r h t /r
8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following, if applicable. /
a. Sediment Ponds/Traps.b. Diversions. RECEIVED
c. Waterways.
d. Runoff/Stormwater Detention Calculations MAR 6 2JIS
stormwater site plan template—rev.10/21/2008 10
• •
Stormwater Site Plan Changes
If the designer wishes to make changes or revisions to the originally approved Stormwater Site Plan, the proposed revisions shall be
submitted to DCD prior to construction. The submittal shall include substitute pages that include all proposed changes, revised
drawings showing any structural changes,and any other supporting information that explains and supports the reason for the change.
Final Corrected Plan Submittal
If the project included construction of conveyance systems, treatment facilities,flow control facilities, or structural source control BMPs
(not standard on-site stormwater management BMPs), the applicant shall submit a final corrected plan ("as-builts")when the project is
completed. These should be engineering drawings (stamped by a licensed civil engineer) that accurately represent the project as
constructed.
APPLICANT SIGNATURE
By signing the Construction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and
correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all
owners of the affected property.
c-13
( NER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
RECEIVED
MAR 1 e 2001
JEFFED$TI CDD'"tiTY CCD
stormwater site plan template-rev.10/21/2008 12
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