HomeMy WebLinkAboutBLD2010-00323 • •
CERTIFICATE OF OCCUPANCY
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
Carl Smith, Director/Building Official
PERMIT #: BLD10-00323
SITE ADDRESS: 762 MOUNTAIN TRAIL RD Issue Date: 11/9/2010
BRINNON, 98320 Final Date: 7/9/2012
APPLICANT: TONYA SHRUM PHONE: 503-292-7501
NORMA BRIDGES
8400 SW FAIRWAY DR
PORTLAND OR 97225-2758
SUBDIVISION: OLYMPIC CANAL ADDITION 7 Block: 14 Lot: 66
PARCEL NUMBER: 981901406 Section: 16 Township: 25 N Range: 02 W
PROJECT DESCRIPTION: M/H REPLACEMENT - SER#17740
THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2009
EDITION.
OCCUPANCY GROUP:
TYPE OF CONSTRUCTION:
SPRINKLER SYSTEM yes (no
THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 7/9/2012
\\tidemark\data\forms\F_BLD_Occupancy.rpt 7/30/2012
! !
II To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection.
1. 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
Erosion Control
MH Foundation
Blocking&Tie Down
Skirting&Ventilation
Gas Line: Exterior
Propane Tank
Pressure Test
Drywell/Alt Drainage
Address Posted
Miscellaneous n, PRIOR TO FINAL BUILDING INSPECTION, PROPONENT SHALL
PROVIDE THE DEPARTMENT WITH AN ORIGINAL "FINISHED'
CONSTRUCTION" FLOOD ELEVATION CERTIFICATE THAT
CO 3 HAS BEEN VERIFIED BY A LAND SURVEYOR, ENGINEER, OR
ARCHITECT AUTHORIZED BY LAW TO CERTIFY ELEVATION
INFORMATION IN THE STATE OF WASHINGTON.
FINAL INSPECTION 1±c2
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
SPECIAL CONDITIONS APPLY-SEE REVERSE
MLA10-00339
•UILDING PERMIT APPLICAON Review Type:I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD10-00323 Received Date: 9/7/2010
SITE ADDRESS: 762 MOUNTAIN TRAIL RD
BRINNON, 98320
OWNER: TONYA SHRUM PHONE: 503-292-7501
NORMA BRIDGES
8445 SW BRENTWOOD ST
PORTLAND OR 972252721 OLYMPIC CANAL ADDITION 7
SUBDIVISION: Block: 14 Lot: 66
PARCEL NUMBER: 981901406 Section: 16 Township: 25 N Range: 02 W
CONTRACTOR: KOZELISKY'S HOME SERVICE INC PHONE: (360)385-3215
1112 S JACOB MILLER RD
PORT TOWNSEND WA 98368
Contractor's License KOZELHS027C3 Expires 1/6/2011
REPRESENTATIVE: JAIME KOZELISKY PHONE: (360) 385-3215
1112 S JACOB MILLER RD (360) 385-3215
PORT TOWNSEND WA 98368
PROJECT DESCRIPTION M/H REPLACEMENT
TYPE OF WORK MOB SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 840
VALUATION
CODE EDITION: 2009 ADD'L: HEAT TYPE: EEE
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 2 Prop: 2
Total: 2 Total: 2
(
uting Date:
Type Amount Paid By: sate: Receipt: APPROVED
Manufactured Homes $213.00 LYK 09/07/10 120038
State Building Code $4.50 LYK 09/07/10 120038 NOV 9 2010
Potable Water Application $98.00 LYK 09/07/10 120038
Total: $315.50 Jefferson County Planning
& Building Department
• .
SPECIAL CONDITIONS CASE # BLD10-00323
1.) See SPAAD ZON09-00011 for findings that apply to this property and project.
2.) See SPAAD ZON09-00011 for conditions that apply to this property and are adopted for
BLD10-00323.
3.) A"Construction Drawing" Flood Elevation Certificate was prepared by a licensed surveyor
and submitted with the application. The Certificate identified the base flood elevation of
17.5 feet. The lowest floor of the structure is required to be elevated at least one (1) foot
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.
4.) 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).
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 2,500 square feet of impervious surface and
1,800 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 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 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.) The site plan as submitted with the Builiding Permit application on September 7, 2010 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 November 5, 2010 shall be
resubmitted for review and approval by Jefferson County Department of Community
Development.
9.) This approval is for a Manufactured Home Replacement 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.
10.) A Declaration of Restrictive Covenant has been recorded on January 26, 2007 under AFN
519859 for the purpose of consolidating the lots to meet minimum land area requirements
for on-site septic ad to allow zero lot line setbacks. The Covenant is strictly for building
and septic purposes only.
11.) 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.
12.) This parcel is within a no shooting area per JCC 8.50.
13.) A minimum of two (2) on-site parking spaces shall be provided for the single family
residence.
14.) Minimum setback from Mountain Trail Road right-of-way shall be 20 feet. Minimum side
yard setbacks shall be 5 feet. Minimum setback from Duckabush River shall be landward
of the Meander line as identified on the face of the recorded plat.
15.) 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.
JACK WESTERMAN III • Jefferson Count urUwuse
ASSESSOR I'O fox 1220. Port Townsend, OVA 98368
(360) 385-9105
MOBILE HOME INFORMATION FORM
OWNER'S NAME/MAILING ADDIt SS:
NAME: r'/ c_ I S� 6-i,2 / l9/'1 :�12 t'��f
ADDRESS: -2-- /U r;al e'��4'Z _ fiI--� R���
PHONE NO. �03-- 292 — 73-0 /
>/i r- 9/3oD e400 .ski) ray /.v c6i-i ye Ar//a // Die 97
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.
10MOBILE HOME DATA:
(Al MAKE P0,4 ` (B) MODEL �`��e K.
(C) YEAR / < --'
0 /
(D) LENGTH (E) WIDTH ��' (F) SERIAL # I 7 7 T-
(G) YOUR PURCHASE PRICE (Do not include sales tat 7/ 5(961 PURCHASE DATE/0/09
2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE,, TO QUESTION 3)
(A) FROM WHOM DID YOU PURCHASE MOBILE / l7 +fir/ dq - -S
ADDRESS 20/ 6 ,d., 'J r 1)e S0 LC/� f'2J/(J ! 9e3e a
(B) WAS }MOBILE HOME ASSESSED IN,JEF,FERSON COUNTY LAST YEAR?Yes
`_h cue-- MAC/s r-Gi e i/ /i4 .she er) i�'t �Eet:A.,C,
If No, What County was Mobile assessed in last year. �i/c?' if aA-( Z L‘‘..z. y
3)WHERE MOBILE HOME IS TO BE LOCATED:
(A) WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes 161t...7
(B)IF LOCATED IN MOBILE HOME PARK:
NAME tt ADDRESS OF PARK Lot/Space #
(C) IF NOT LOCATED IN MOBILE HOME PARK: ----/ - / , �/
NAME OF LAND OWNER: l 0.1yQ ''` ru"z" l
LOCATION ADDRESS 76 2 Daptiebk /,----,;/ / -C, S6 /iifro k'/�f 1�
REAL PROPERTY PARCEL #/DESCRIPTION 9.0-/?0,46 t e l e//g2/4v7
...... ------7____
11
Signature of applicant
THANK YOU FOR YOUR HELP!
Lauralee Kiesel. Property Technician
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NOV 0 5 2010 12o.o.
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DEPT I L PMENT
SIG U D311. -_______
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• BUILDER STATEMENT •
The signer of this st ement does hereby certify(that hey are the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be assu . g the responsibility of the a al Contractor for the proposed project.
Signature: ' Date: L"i— Z S —/
GENERAL CONTRACTOR MANUFACTURED HOME INSTALLER: PHONE: Fax:
o Z.e %/S k y 1/0 $ ir'- i�.. a)3 S 32-Ls (g6v 3e.--32Ls
MAILING ADDRESS: 5-.3 Al, G ,�t�P f r-/- T, tfe EMAIL: �pg/k7C: ?a` L��/K
CONTRACTOR'S LICENSE ,/ ( WAINS j/ r D L.,1 f-^1;
NUMBER: t OZE-L H_c 0 rL-7C-3 NUMBER /` L V ��V/.':I v
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
►'��New 0 Wood Existing: .4/ 0 Sewer
❑ Addition ❑ Steel Proposed: Bank 0 Community System
❑ Alteration/Remodel ❑ Concrete Total: Height: 0 Individual SystemM
O Repair ❑ Masonry SEP Permit# ('n ro
—
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type of Heat: Proposed: ❑ Public
E ic=f i Total: 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:
i Underground Tank i Above ground Tank Size of Propane Tank:
i Heat Stove i Cook Stove i Woodstove 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 I'
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 FiorOffice Use:Onlyfft. m..,Ot -Amount ° Revision,t ;
Main Floor Heated , EH BId App Review:
Floor Heated r Consistency Review:
C9)3 —
Other Heated Base fee: t
Mezzanine 4 Yin �1C1�
Heated Basement Plan Check fe�
Unheated Basement State Surcharge fee: /'
Other Unheated Pot Water Review fee: ``
1`
Garage/Carport SUBTOTAL '
Decks ' 911/Rd Approach fee: Cy 1
3
Other
a TOTAL: $ 1 I3(40
Receipt Number:
., -'• F Cash/Check Number: (�q
sis'
::,„,_:: „.,:,,,,
ESTIMATED COST(REQUIRED) Date: b�
*Fair market value of all labor and materials foundation to finish `•'�✓
Initial • '
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
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4`S0N cQ� JEFFERSON •uNTY •
DEPARTMENT OF COMMUNITY DEVELOPMENT4\. 621 Sheridan Street• Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
4�' p' www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: to l3, 09
P ject Description (include separate eets as necessary):
Qrapi
Tax Parcel Number: 98/9 1 TVO < �r yDI�-07 Property jSize: / (acres/square feet)
Site Address and/or Directions to Property: -7 -2 Mc4.0i 4,`,/._ t%wtt{ rd 6r1126104( wA
Property Owner(s)of Record: L�nyY Al.,,,,74
Telephone: 503— 272—7si) / F x: /email:
Mailing Address: f�0 l �l�t (a r 9722$'
Applicant/Agent(if different from owner): 1^1 L $ L4r►1 Ofr .1g,i-t-e-- A27 -d0/ism"
Telephone: 5 3— 797-36'04� / Fax:l�" mail: SCA-a�� cPSSGO,uS
Mailing Address: 2 — (,4^-zb l V'G ' " r4 4`2e 0
What kind of Permit?(Check each box that applies
OifBuilding 0 Critical Areas Stewardship Plan
❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use)
❑Single Family ❑Garage Attached/Detached 0 Conditional Use[C(a),C(d),or C]**
0 Manufactured Home 0 Modular ❑ Discretionary"D"or Unnamed Use Classification
❑ Commercial* 0 Special Use(Essential Public Facilities)**
❑ Change of Use ❑ Boundary Line Adjustment
❑ Address ❑ Road Approach 0 Short Plat** i
❑ Home Business 0 Cottage Industry 0 Binding Site Plan**
0 LongPlat**
❑Sign Propane 0 Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration**
0 Stormwater Management Cl Shoreline Master Program Exemption/Permit Revisions**
❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development**
❑Temporary Use ❑Shoreline Management Variance
❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District 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:
�r2•� J ,I 2 DESIGNATION OF AGENT Oh \it<f 71t-€. /c ; e/ilk y
I hereby designate to act as my agent in matters relating to this application for permit(§).
OWNER SIGNATURE or 4.i' "v Date: Z
By signing this application form,the .lner/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 pro ide access and right of ent o Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any req red later inspections. Staff' ss and right of entry will be assumed unless the applicant informs the County in writing at the
time of th appf on that he or she wants prior n ti 7 —7/ 7 `Signature: 1 Date: - JO
The action or actions Appl c nt 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 iss ed will not violate the ES;. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)even if yo are in compliance with th il Je rson County development code.The Applicant acknowledges that he,she or it holds individual
and non- ansfe le responsibility for adhenn sand complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: aL1E l ' 'tea... Date: - Z:-in
i
G:\PemtitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc