HomeMy WebLinkAboutBLD2012-00113 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 #: BLD12-00113
SITE ADDRESS: 182 RENTER RD Issue Date: 06/7/2012
NORDLAND, 98358 Final Date: 7/29/2013
APPLICANT: DANIEL KLEMP PHONE: 541-729-4427
93825 JAY RD
BLACHLY OR 974129717
SUBDIVISION: KLEMP SHORT PLAT Block: Lot: 2
PARCEL NUMBER: 977700111 Section: 9 Township: 29 N Range: 01 E
PROJECT DESCRIPTION: NEW M/H - Per Carl Smith extension to July 30, 2013 - no renewal if
finalled prior to Jluy 30, 2013
THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2009
EDITION.
OCCUPANCY GROUP:
TYPE OF CONSTRUCTION:
SPRINKLER SYSTEM yes o "
THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 7/29/2013
\\tidemark\data\forms\F_BLD_Occupancy.rpt 9/12/2013
MANUFACMRED/MOBILE HOME INSTAtATION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT#: 1 BLD12-00113 Received Date: 4/11/2012
SITE ADDRESS: 182 RENIER RD Issue Date: 6/7/2012
NORDLAND, 98358
APPLICANT: DANIEL KLEMP
93825 JAY RD
BLACHLY OR 974129717
SUBDIVISION: KLEMP SHORT PLAT Block: Lot: 2
PARCEL#: 977700111 Section: 9 Township: 29 N Range: 01 E
CONTRACTOR/ OWNER/BUILDER PHONE:
DEALER
PROJECT DESCRIPTION: NEW M/H
MAKE: FLEETWOOD YEAR: 2012 SIZE: 60X27
Directions
To Site:
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.
Office Hours 9:00 -4:30 MONDAY-THURSDAY
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 71.3c)1 I Z.
Jc_,
Blocking&Tie Down r-gyp-(z 1,473
Skirting&Ventilation 7/2 i/3
Gas Line: Exterior
Propane Tank
Pressure Test
Drywell/Alt Drainage
Address Posted 7/246" ;
FINAL INSPECTION /
7/ZS 43 2.-- e/� C,Li,rGJr��c.i
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
SPECIAL CONDITIONS APPLY-SEE REVERSE
eILDING PERMIT APPLICA•N MLAI2-00079
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD12-00113 Received Date: 4/11/2012
SITE ADDRESS: 182 RENIER RD
NORDLAND, 98358
OWNER: DANIEL KLEMP PHONE: 541-729-4427
93825 JAY RD
BLACHLY OR 974129717
KLEMP SHORT PLAT
SUBDIVISION: Block: Lot: 2
PARCEL NUMBER: 977700111 Section: 9 Township: 29 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION NEW M/H
TYPE OF WORK MOB SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 1,386
VALUATION ADD'L: HEAT TYPE: EEE
CODE EDITION: 2009 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY:
OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: 05783
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: Prop: 2
Total: Total: 2
Routing Date'
- 11- 12-
Type Amount Paid Bv: Date: Receipt: Approved/Date
Manufactured Homes $222.00 LYK 04/11/12 131627 ADEcDVErt.
Potable Water Application $64.00 LYK 04/11/12 131627
Total: $286.00 JUN i 2012
Jefferson County Planning
& Building Denartmen
• •
SPECIAL CONDITIONS CASE # BLD12-00113
1.) 10' minimum separation required between the water line and any onsite sewage system
components including sewage transport lines.
2.) See SPAAD ZON09-00029 for findings that apply to this project and property.
3.) To help prevent seawater from intruding landward into underground aquifers, all new
development activity on Marrowstone Island, Indian Island and within 1/4 mile of any
marine shoreline shall be required to infiltrate all stormwater runoff onsite.
4.) VOLUNTARY MEASURES OF COASTAL &AT RISK SIPZ:
Water conservation measures:
1. Roof and other intercepted precipitation shall be routed to on-site detention ponds
and/or other approved means and allowed to be released to the soil slowly.
2. Water collected from Storm water and roof catchments may be used for watering
lawns and gardens. Unless catchment water has been treated to meet drinking water
standards, there shall be no cross connections allowed between the potable supply and
impounded water.
3. Water withdrawn from wells on each property shall not be used for watering of lawns
and/or gardens.
4. Ground water withdrawn from each property shall be restricted to a rate of three (3)
gallons per minute.
5. Installation of water conserving fixtures such as low flow toilets, faucets and shower
restrictors and other water saving plumbing fixtures.
6. Landscaping plan (xeriscaping, native vegetation with minimal amounts of irrigation).
Please NOTE that the above listed measures are not intended to be exhaustive, but rather
is intended to be illustrative of the types of water conservation measures.
5.) VOLUNTARY MEASURES OF COASTAL &AT RISK SIPZ:
1. Installation of a flow meter.
2. On-going well monitoring for chloride concentration.
3. Submittal of monitoring data to County.
6.) 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.
7.) The applicant is proposing to create or add 1,700 square feet of impervious surface and
2,216 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.
8.) 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.
9.) 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).
10.) The site plan as submitted with the Building Permit application on April 11, 2012 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 June 5, 2012 shall be resubmitted for review and
approval by Jefferson County Department of Community Development.
11.) This approval is for a New 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.
12.) NOTICE: This permit does no•use the proponent from complying with oS 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
The Federal Bald and Golden Eagle Protection Act requires landowners within 660 feet
(1/8th of a mile) of an eagle nest to consult with the US Fish and Wildlife Service. This
Eagle Act prohibits anyone from "taking" bald eagles. This federal law defines the term
"take" and describes the possible legal consequences when a"take" occurs. Among
other actions, "take" includes a disturbance of bald eagles or their habitat. Under federal
law a permit may still be required for activities that impact bald eagles or their habitat.
Contact the US Fish and Wildlife Service (http://www.fws.gov/pacific/eagle/) to learn more
about how this law affects your project.
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.
13.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
14.) 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.
15.) A minimum of two (2) on-site parking spaces shall be provided for the single family
residence.
16.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
17.) The building height is not to exceed 35 feet.
18.) Building setbacks from Renier Road are no less than 20 feet. Side setbacks are no less
than 5 feet. Shoreline setbacks shall be no less than 60 feet.
74'
°No° JEFFERSOOUNTY
i
h l �� V DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street • Port Townsend • Washington 98368
360/379-4450 • 360/379-4451 Fax
�` $ www.co.jefferson.wa.us/commdevelopment
�` ING
Master Permit Application MLA: I g—
Project Description include separate sheets as necessary):
0/ 4-f
Tax Parcel 'umber: t•7.2 2610 / // Property Size: 9a4:4-r;J' (acres/square feet)
Site Address and/or Directions to Property: /
/P� /e vi r c✓ Rd /���rciia vc.Cl (Q)/ � �. , P4 r rou)i�vr v J
Property Owner(s)of Record: 1eT \j r2 c vl t` c-us't R. Dccn i e.I �r-/�nh 1, • _ _S
Telephone: SS// -9-1- 7 — 6 r.4'/ Fax: SVI-- 9a 5"- 3,�(• 7 email: d k l e ran et' pI Dn e e r'.✓�r
Mailing Address: 43 k 5- iay i s , B lc:l<.[ry 1 j J OK q`9 y i 2-- I
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
at kind of Permit?(Check each box that applies 0 Lot or Road Segregation
uilding ❑ Critical Areas Stewar hip.Rlan
❑ Demolition Permit ❑Variance(Minor, Majo of as rte RenornicrJJ —"'
❑ Si�ngle Family ❑ Garage Attached/Detached 0 Conditional Use[C(a) C.( , I�' _ U r�
Manufactured Home .❑ Modular - ❑ Discretionary"D"or U 'named Use Class'Ikon
❑ Commercial* ❑ Special Use(Essential Public Facilities)** ,
❑ Change of Use ❑ Boundary Line Adjust ent APR 1 j 2O 2
❑ Address El Road Approach_ 0 Short Plat**
❑ Home Business ❑ Cottage Industry ❑ Binding Site Plan** J L I
❑ Propane ❑ Long Plat** JEFFERS
❑Sign ❑ Planned Rural Resid ntial �yolO •.„ 0 qm rt lmen **
❑Allowed"Yes" Use Consistency Analysis 0 Plat Vacation/Alteration gpMNT
❑ Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions**
❑Site Plan Approval Advance Determination (SPAAD)* ❑ Shoreline Management Substantial Development**
❑Temporary Use 0 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 ❑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 app'cation that he or she wants prior notice.
Signature: ,' ' Date: • //`?//.2--
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-transferable responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and si ns and dates it below.
Signature: l.L)�r� � /(r. el-r Date: ..//)//.--
• . .
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 assssup�ming the responsibility of the General Contractor for the proposed project.
Signature: [.r u ,rL_I/ i:°-1"" Date: —.7?// Z"'
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
( ) ( )
MAILING ADDRESS: EMAIL.:
CONTRACTORS LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
yiNew g; Wood Existing: X'Sewer
L Addition tL Steel Proposed: Bank ❑ Community System
C Alteration/Remodel ❑ Concrete Total: _ Height: ❑ Individual System 3
Repair 0 Masonry —� SEP Permit# /�--Co I
P.
E Demolition 0 Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well D Two Party
Type 4 He4t; Proposed: __ r Public
e e_c: LVAt.vte-e Total: _ _ /� Name of System: hi;G l
(1'hilil ,164ersa n (Joa -a
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 1 Above ground Tank Size of Propane Tank:
1 Heat Stove 1 Cook Stove i Woodstove 1 Fireplace Insert 1 Hot Water Tank i Pellet Stove i Other _
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No
When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property
lines, tank location and size,distances from the propane tank to all property lines,buildings and septic system components,
including the reserve area.
Square Footage Current Proposed For Office Use Only Amount Revision
Main Floor Heated ( W EH Bid App Review: �/
2nd Floor Heated 1'38'(o Consistency Review: lLn ^
Other Heated Base fee: p� O�
Mezzanine AdelitioT
Pt xn P -1�
Heated Basement Plan Check fee: ,
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee: I O
Garage/Carport SUBTOTAL II I1 ` I ,
Decks 911/Rd Approach fee:
Other TOTAL: $ ( I -t (
Receipt Number: ' N L2:1
Cash/Check Number:
ESTIMATED COST(REQUIRED) Date: I I (�I
•Fair market value of all labor and materials foundation to finish 11
Initials:
Aillilli I
JACK WESTEBNIAN III • .Jefferson County 'ourtIoose
ASSESSOR PO Rox 1220. Port Townsend, WA 98368
(360) 385-9105
MOBILE HOME INFORMATION FORM
OWNER'S NAME/MAILING
1- ADDRESS:
NAME: Kt� o �ln l Teu )3a.v ke.I i--111\r le►M �rccs�ee
ADDRESS: c{38 5 C.L+i Rc 61:3A c-/ l (� OR Q - N I Z
PHONE NO. 5-4 -`12 7- (01, /
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)MOBILE HOME DATA:
(A) MAKE k-16e`t wood. (B) MODEL a SJa3 D (C) YEAR AD IP"-
(D) LENGTH Cool (E)WIDTH 4,9-1.2 l2- (F) SERIAL # (v.ilex- Gi71r.S}ru c � t vv1
(G) YOUR PURCHASE PRICE (Do not include sales tax)96'; ,42-41 PURCHASE DATE //P'YI _
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 CIAJNT,Y LA igI J = To
If Yes, Previous address of mobile. '
If No, What County was Mobile assessed in last year. j QR 1
3)WHERE MOBILE HOME IS TO BE LOCATED: ILLij
JEFFERSON CO �
(A) WILL THE MOBILE HOME BE IN MOBILE HOME P,ARI ?PT OFF °UNITY IttViPMENT
(B)IF LOCATED IN MOBILE IIOME PARK:
NAME & ADDRESS OF PARK Lot/Space #
(C) IF NOT LOCATED IN MOBILE HOME PARK:
NAME OF LAND OWNER: "I`�1Q�"'�p ' J rti" Trusl
LOCATION ADDRESS 10- RGn i er F-(1 Z ra lGC kol IAA f W3 f
REAL PROPERTY PARCEL #/DESCRIPTION 6?-7 7 706 //
Signature of applicant
THANK YOU FOR YOUR HELP!
Lauralee Kissel, Property Technician
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o 1 • ,. p N o 863 CARLSBORG ROAD, SUITE A,
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PRESSURIZED SYSTEM FOR SEQUIM, WA 98382
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(II KLEMP
PH (360) 683-6300 FAX (360) 683-5652