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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! 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O DJ OO is r ' v e` F-3 r _ S r'0 o ----_� �- 8,2' y' O • h G \ <"ao� �c C8 w... c -I.W -0- i ,i E.74 U I I • I c Q - - : N, � _ _ oz 4- L - J_. � 0 Z.13 P Z o �0 oOc 13oo c --- n 5 m V "` 1 m1z jlN: o o Z I 10.2� MINIMUM CD Ra O_ O N N • 0 l� �a�'v�+ T (' �,, w n� ON—SI TE WASTEWATER PLANS rusl- u\ z z m m �' TAX PARCEL #977-700-111 SOILS APPLICATION, INC o 1 • ,. p N o 863 CARLSBORG ROAD, SUITE A, �' xi o No o • PRESSURIZED SYSTEM FOR SEQUIM, WA 98382 0 (II KLEMP PH (360) 683-6300 FAX (360) 683-5652