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BLD2013-00295
EAILDING PERMIT APPLICA TICS BRD1e 00295 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD13-00295 Received Date: 9/20/2013 SITE ADDRESS: 151 GIBBS LAKE RD CHIMACUM, 98325 OWNER: DANNY D OSMER PHONE: DEANNA R OSMER PO BOX 232 CHIMACUM WA 983250232 LOWELL DAY SHORT PLAT#B SUBDIVISION: Block: Lot: PARCEL NUMBER: 901342018 Section: 34 Township: 29 N Range: 01 W CONTRACTOR: PHONE: PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr MOBILE HOME INSTALL TYPE OF WORK MOD SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 1,512 VALUATION 90,000.00 ADD'L: HEAT TYPE CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: OSS WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: 0 Prop: 3 Prop: 1 Total: 3 Total: 1 Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $228.00 MEB 09/18/13 145367 APPROVED State Building Code $4.50 MEB 09/18/13 145367 Total: $232.50 2.0:4 Jefferson County DCD Ufirlcm�r4\rle+.\franc\F RI fl Ltnn PIA rn+ ar)nrf i ■ _ CO -I p m - I "V -o C/) 0) D -p v Z m 73 m m xl , o O a,< m ai Om r- D v O � n ° z O r n m n O z O x m m m v g z O C) O �i Cl) Z -I co ^ m C r C 7 D —I X p in 73 co m til nc my —i m m -_I ° n , 00-1:3 RI oo m Xj ✓ O O w� 0 Z , z(1>0mD r N _� D z N oo D Z -0 N cn m Z O DG) Ozz c ce 2 < oo r CW CND0 O = = M Z 0 W °y in N O o 0 w m n o 0 m cnr cn m .9, ID z _ I Nm m� N� � l 1 cn r � � O0, X 3oc n m v 3 .Am ° � m -3 o = —1 N ° o m. tiN1 z I > •• * • 3 > r- --1 r oo C Z I O 3 r+C O 0 m W y o ot m = —I n m -1 o Oa 0 M c N R: 3 O 5 0 (n l 1 0 m O � = m m rv ' a n D E cn D a)CD z W .n N CD 5 Olt z m vv m � �m _ O z C m fil a) rn 11 O r � O Z Z 0 ° K3N N 0 * 2. 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NIV. , a r 1 Ck ' 4tk‘ ' y � o c9 - �`o 00 §nnn f J Cf) Le,- .' ''''' kt ' I >1;:t 11g1 5 t., ; '‘, li ' . F,, i .a$,_00,, .. d { I' '" t .,464.. , • . a ,it ......., izI , \ii ,,,t. , 1 .„. ..,,,, ,.....,, .s,,, • *91. 0.• ,,,,,,, 0 r -" w, ON cod JEFFERSON AllOUNTY � � k, ' 14' DEPARTMENT OF COMMUNITY DEVELOPMENT I' ` ''4 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 . 360/379-4451 Fax �qs hi?N0 o www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Project Description(include sepa` shee, as necce ): Tax Parcel Number: qLj 3 30/9 Property Size: (acres/square feet) Site Address and/or Directions to Pr erty: in 64&4 Property Owner(s)of Record: •Aillfk CE Rea < Telephone: Fax: email: Mailing Address: Applicant/Agent(if different from owner): - z •c2 Telephone: Fax: email* t &- - ,f,, 011.C1 Mailing Address: 49 f�ZGC —/P-5C l�ep,,Q� dam'" 4g,2........ What kind of Permit?(Check each box that applies ❑ Lot or Road Segregation ❑Building ❑ Critical Areas Stewardship PIa'1 �i�{.� ❑ Demolition Permit ❑Variance(Minor, Major or Reaso Ir- 'L�9sg)V�/7 ❑Single Family ❑Garage Attached/Detached ❑Conditional Use[C(a),C(d),or C — X Manufactured Home .❑ Modular - . - ❑ Discretionary"D"or Unnamed L assification ❑ Commercial* ❑Special Use(Essential Public Fa ies)"s E p 1 8 2013 ❑ Change of Use ❑ Boundary Line Adjustment ❑ Address ❑ Road Approach ❑Short Plat** -J ❑Home Business ❑Cottage Industry ❑ Binding Site Plan** ❑Propane ❑ Long Plat** JEFFERSON COUNTY ❑Sign ❑Planned Rural Residential De - ••.L:T: c•:..r.,:,`,14.::\A-t.a,1,':'/.DJi" ❑Allowed"Yes"Use Consistency Analysis ❑ Plat Vacation/Alteration** ❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions** ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development** ❑Temporary Use ❑Shoreline Management Variance ❑Wireless Telecommunication* ❑ Comprehensive Plan/UDC/Land Use District Map Amendment 0 Forest Practices Act/Release of Six-Year Moratorium ❑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 requir-• later inspections. Staffs access and right of entry will be assumed unless the applicant informs the Coun y in writing at the time of the applicati• 1-the or she ••r notice. Signature: i�-- — i _ • ° L 3 Date: / �► 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 a in compliance ■ • e Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferabl:,,.r- risibility fo ;• •.in• to and complying wit the ESA. The Applicant has read this disclaimer and si s and da s it below. Signature: _ ; ..,‘ ... 4 Date: "'" r •/-`.\n__:.!`__.-_\A 4444c/ln D(QJ4aii4\non cr-,o ,0\r^._-___-non •_____\It l_---_n____.. •._._i r nn nn , AO BUILDER STATEMENT III 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: 'C'—' �...1 c mil-141 ( ) • MAILING ADDRESS: , mr, `'.` I • •IL: / '... � 2 .. i1 CONTRACTORS LICENSE !l!1 1r`eg .7 471 WAINS ..-% 77' NUMBER: ` NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ' C New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: _ Height: ❑ Individual System • Repair ❑ Masonry SEP Permit# _ O Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: ❑ Public Total: Name of System: • 'J 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 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 Mount Revision Main Floor Heated EH BId App Review: --At C.t' 2nd Floor Heated Consistency Review: Other Heated Base fee: Mezzanine Additional Section: —/– Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: >,, se--- Other Unheated Pot Water Review fee: _:...„1,..---...";%; Garage/Carport SUBTOTAL ice' Decks 911/Rd Approach fee: Other TOTAL: $ Receipt Number: ( (4 cS S Cash/Check Number: t r t •ESTIMATED COST(REQUIRED) ' 1 Date: Q► /l`�j/ I •Fair market value of all labor and materi daWnish - 1/ 0 t 1 // Initials: (((itY∎igt , J G:\PermitCenter\###FORMS###\DRD FOR MC\ri,.'r„r nRn F �\4 a .«o.D.,...., .1.-..I.,-..--c �n no J__ JACK WESTERMAN III Jefferson CountySrthonse ASSESSOR PO Box 1220, Port Townsend,WA 98368 (360)385.9105 MOBILE HOME INFORMATION FORM IECIE ! VC OWNER'S NAME/MAILING ADDRESS: f�/ NAME: A� i� �` !� ' �( SEP 1 8 2013 E / ULI ADDRESS: �� /�,i � , � I j PHONE NO. _ ^c90 JEFFERSON COUNTY DEPT.OF COMMUNITY DEVELOPMENT 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 ROME DATA: p;/'&C,9 (A) MAKE (B) MODEL iL YEAI J(D) LENGTH dh, (E)WIDTH (F) SERIAL # (G) YOUR PURCHASE PRICE (Do not include sales tax09ASiED PURCHASE DA'(�E' / . t 13 2) PREVIOUS OWNER/LOCATION OF M ILE HO : (IF NEW MOVE TO I UESTION 3) (A) FROM WHOM DID YOU PUB E MO E /� .'is / WI 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 o (B)IF LOCATED IN MOBILE HOME PARK: NAME &ADDRESS OF PARK Lot/Space# (C) IF NOT LOCATED IN MOBI407 PA� LI , __ _! NAME OF LAND OWNER: %% !! �1L LOCATION ADDRESS /6'l 6/4 2/4 AV i REAL PROPERTY PARCEL #/DESCRIPTION . Signature of applicant THANK YOU FOR YOUR HELP! Lauralee Kiesel, Property Technician .4 ON CG • O 14'4'1Nc 9 JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street Port Townsend, WA 98368 Al Scalf, Director POLICY#06-01 MANUFACTURED HOMES Set up manuals for manufactured homes are not required at time of submittal when making application for permit. All other requirements such as Environmental Health, Planning, Zoning issues etc. will be required prior to permit issuance. After the permit has been issued and you are calling in for inspections, the installation manual for the home must be on site. If manual is not on site a Reinspection fee will be assessed and must be resolved prior to any further inspections. An additional installation manual must be submitted to Jefferson County Department of Community Development prior to the final inspection.This manual will remain with the file in the County records. Fred Slota 4-.i tx !:86 , Building Official 3/1/2006 POLICY#06-01 Building Permits/Inspections Development Review Division Long Range Planning (360)379-4450 ascalf( co.iefferson.wa.us FAX: (360)379-4451 I Contractors or Tradespeople Prinriendly Page • Page 1 of 2 General/Specialty Contractor A business registered as a construction contractor with L&I to perform construction work within the scope of its specialty.A General or Specialty construction Contractor must maintain a surety bond or assignment of account and carry general liability insurance. Business and Licensing Information Name NU TREND ENTERPRISES INC UBI No. 055001414 Phone 3604611999 Status Active Address 22 Agnew Parkway License No. NUTREE*273P6 Suite/Apt. License Type Construction Contractor City Port Angeles Effective Date 10/26/1973 State WA Expiration Date 2/6/2015 Zip 98362 Suspend Date County Clallam Specialty 1 General Business Type Corporation Specialty 2 Unused Parent Company Business Owner Information Name Role Effective Date Expiration Date GILLIS, KEITH E President 01/01/1980 GILLIS-SPILLER, CASSIE 01/01/1980 03/21/2013 GILLIS, WILFRED J 01/01/1980 01/01/1980 MCHUGH, LARRY 01/01/1980 01/01/1980 VAN AUSDLE, EARL R 01/01/1980 01/01/1980 Bond Information Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date 15 ICBIC 626339 01/25/2002 Until Cancelled $12,000.00 02/06/2002 Assignment of Savings Information No records found for the previous 6 year period Insurance Information Insurance Company Name Policy Number Effective Date Expiration Date Cancel Date Impaired Date Amount Received Date 17 Underwriters at PFK047864 01/29/2013 01/29/2014 $300,000.00 01/30/2013 Lloyds 16 UNDERWRITERS PFK043424 01/13/2011 01/13/2013 $300,000.00 01/12/2012 AT LLOYDS 15 UNDERWRITERS PFK043424 01/13/2010 01/13/2011 $300,000.0001/14/2010 AT LLOYDS 14 AMERICAN 01CH70974810 01/25/2009 01/25/2010 $300,000.00 01/20/2009 STATES INS CO 13 AMERICAN 01CH709748 01/25/2008 01/25/2009 $300,000.00 01/23/2008 STATES INS CO 12 AMERICAN 01CD09711540 01/25/2007 01/25/2008 $300,000.00 01/24/2007 STATES INS CO Summons/Complaint Information Cause County Complaint Judgment Status Payment Paid By 09-2-02106-3 Date:09/03/2009 Date: Date: LUMBERMENS INC THURSTON Amount:$1,198.65 Dismissed Amount: $0.00 Amount: InterPlead: No Bond(s):626339 https://fortress.wa.gov/lni/bbip/Print.aspx 9/20/2013 Contractors or Tradespeople Printeiriendly Page • Page 2 of 2 Warrant Information No unsatisfied warrants on file within prior 6 year period Infractions/Citations Information No records found for the previous 6 year period https://fortress.wa.gov/lni/bbip/Print.aspx 9/20/2013 CC • • N- H CO = O) C3 LL ,- _0 7 LL .,� 0 H O O I-1 -7 Lt) - O Z .. .. 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V.%) Qn.ci,k.. 0)01 -2,47...01 \ °)\ I\(_%.S Vi-vpd. 1.1 () ilrWal t•c)v.s V DR QIA ..S1-%oist. ›■):4.. %LtS c)%■1 filitt)? %-‘) 1 " = 50 r epi-tr Pi .-D1'1`) k)e.A.ctra triA1Z-9 ))q.(02,g E....AS'i cilf...tal piko _ O..... ........ _ ri SAM) I /...w' r4V)E42Vt . \ 1 eg el. ligum4 lk e. c■to) 4 i 4t? ISAN i W.s P" e N Siit P . 4) 0 NEw GRAWL "COM t 4, ../ 4.1(1 I 10 3 & •4-f- i cge CN4 4". -E 62..4 yl ill 4 APPROVED ,... • sITE PLAN ry, FEB I 3 2L:!1 04-3SI JEFFERSON COUNTY DEPT.OF C D.F.Y_ .Y. ELOEvIE7 SIGNE A: ' -:\) EpEov -En , L 1 , , , IAN 1 7 2014 H .10 , -, .... ,.... _____,. 11 ‘ 1 I JD 1[N3N COUNTY t nn'T OF CT UNITY DEVELOPMENT -- -- r � ' 25 5ON c z. ' 0d),' JEFFERSON COUNTY ; t, • ` `4, IA DEPARTMENT OF COMMUNITY DEVELOPMENT �. C 621 Sheridan Street • Port Townsend Washington 98368 ' ) 3601379-4450 360/379-4451 Fax 1' , p www.co.jefferson.wa.us/commdevelopment �\ Master Permit Application MLA: ii,D II? QD A5- Project Description(include separate sheets asnecessary): Tax Parcel Number Property Size: 1 ,I ) c.e r'e 3 (acres/square feet) Site Address and/or Directions to Property: t5 i 13735 LK, Rd, Crkin,.v-Ltt Property Owner(s)of Record:)41+..(Al t/ :c E-Atv/v4 Os m e 2 Telephone: iif 346-53/ 4/q4 Fax: email: Mailing Address: P<0 ,`I3ox' 3 2-- e N.,;_,,,,,L,. v'A , L„f4 9 cP,S a e"" Applicant/Agent rdiffarerntirom o rfseiwj� .r, 41.0 __ ___ i.a Z�' aa__ ]"le<°-__ Telephone: y2--2-i7- '168'7 2;16A/ Fax: email: _ Mailing Address: Ai a/ace," What kind of Permit? (Check each box that applies ❑Lot or Road Segregation ❑Building ❑ Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use) ❑Single Family ❑Garage Attached/Detached ❑Conditional Use[C(a),C(d),or n ❑ Manufactured Home .❑ Modular - • - ❑ Discretionary"0"or Unnamed ■ r �Vf 0 Commercial".- . ❑ Special Use(Essential Public F. , s O Change of Use ❑ Boundary Line Adjustment ❑ Address _ ❑ Road Approach_ 0 Short Plat** n) OCT 1 7 2013 O Home Business ❑Cottage Industry ❑ Binding Site Plan** O Propane 0 Long Plat** / ;i,n 7 Fe i ee Rural Residential De, J 6N 'irt i Aiiowed"Yes"Use Consistency Analysis 3 J Plat Vacation/Alteration`* I ❑ Stormwater Management y ❑ Shoreline Master Program Ex'emptriunPtf'er,n�t rt vialognsE10PMENT ❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Substantial Development"" C Temporary Use - ❑ Shoreline Management Variance ❑Wireless Telecommunication* ❑ Comprehensive Plan/UDC/Land Use District Map Amendment O Forest Practices AcJRe!ease of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment May require a Pre—Applica<on 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: -- ,ycr,'-/p'- N&r"e-5 z)-11 •'eij n DESIGNATION OF AGENT I hereby designate 2>o. ' lsc•, r- (Ce+--/-1 to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE <. ' s..• �i<s. • Date: /P//,.3` // 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 requir.--ter inspectio Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applicat••n that he or she a 'nor notice. Signature: -- ' _ Date: ��// `/ 3 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 art endangered species regarding your action(s)even if you in c mpliance with th efferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferabl -responsibility for adh ' nd complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. 111 'l` f (44,...... ON cod,. . JEFFERSON COUNTY • • 1 `yam .� DEPARTMENT OF COMMUNITY DEVELOPMENT OCT 15 2013 "' ` `4 621 Sheridan Street • Port Townsend • Washington 98368 QOM 360/379-4450 • 360/379-4451 Fax qs S www.co.jefferson.wa.us/commdevelopment d�,;4,J 1, tm,1 i 1 i Master Permit Application MLA: [OP? -00 AS Project Description (include separate sheets as necessary): Tax Parcel Number: Property Size: 1 ,9 ) &e r'e S (acres/square feet) Site Address and/or Directions to Property: 15 1 & l113 5 e--K, Ra. Ck∎n^Qc- Property Owner(s)of Record: AtJN y )- a) JNNl4 Os m e 2 Telephone: 4 366-53/- 4/14 :�_ Fax: email: Mailing Address: P,0 ,"l3ox' ,9.3 )-- e 1,,r,,c!c,i to , W Ft 183 Applicant/Agent(if different from owner): N e r,4.9 rm rrt P 5 Dew orr-. Ike r4 L, Telephone: '/,ZS-.237 4163''7 3)6,/ Fax: email: _ Mailing Address: ✓J'e/son What kind of Permit? (Check each box that applies ❑Lot or Road Segregation ❑Building ❑ Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family ❑Garage Attached/Detached ❑ Conditional Use[C(a), C(d),or Cj** ❑ Manufactured Home .❑ Modular • ❑ Discretionary"D"or Unnamed Use Classification I ❑ Commercial* ❑ Special Use(Essential Public Facilities)** ❑ Change of Use ❑ Boundary Line Adjustment ❑ Address _ ❑ Road Approach ❑ Short Plat** ❑ Home Business ❑ Cottage Industry ❑ Binding Site Plan** ❑ Propane ❑ Long Plat** ❑ Sign El Planned Ruda! Residential Development(PRRD)/Amendments'"* LI Allowed"Yes" Use Consistency Analysis ❑ Plat Vacation/Alteration** ❑ Stormwater Management ❑ Shoreline Master Program Exemption/Permit Revisions** ❑ Site Plan Approval Advance Determination (SPAAD)* ❑ Shoreline Management Substantial Development** ❑ Temporary Use ❑ Shoreline Management Variance ❑Wireless Telecommunication* ❑ Comprehensive Plan/UDC/Land Use District Map Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium ❑ 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: f•1er•'4w4-t W6rhej 4)-t5eCO..: DESIGNATION OF AGENT I hereby designate ►o+ mss- so e r- lie a•41 to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE ,101 Date: f0//5� / 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 1 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. t 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 requir-, ter inspectio Staff's access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applicaf•n that he or she , •dor notice. Signature: — �.- _ Date: /Oh // 3 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 -– in c•mpliance with th, efferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferabl: respon ibility for adh- .nd complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: = J , OP ' ,_3 Date: /O/, // 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: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New • Wood Existing: = Sewer L Addition 0 Steel Proposed: Bank E Community System C Alteration/Remodel U Concrete Total: Height: 0 Individual System C Repair Masonry SEP Permit# _ Bedrooms: Water Supply: C Demolition 7.71 Other: pp Y: Existing: Setback: C Private well 0 Two Type of Heat: Proposed: C Public 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: 1 Underground Tank i Above ground Tank Size of Propane Tank: i Heat Stove i Cook Stove i Woodstove 1 Fireplace Insert 1 Hot Water Tank i Pellet Stove ! 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: 2"d Floor Heated Consistency Review: Other Heated Base fee: Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $ Receipt Number: Cash/Check Number: ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish Initials: • Up Front Parcel RevievAll Parcel 901342018 • Printed: September 24, 2013 DANNY D OSMER Site Address: OSMER 151 GIBBS LAKE RD PO BOX 232 r/ CHIMACUM, WA 983250232 CHIMACUM WA, 98325 ,., ,,,.._.._...��----- Parcel Number: 901342018 S-T-R: 34-29N-01W Total Acreage 2 Legal Description LOWELL DAY SHORT PLAT#B LOT 1 Land Use: 1101 Flood District: Fire District: 1 Planning A ea: Flood Map(FIRM)Panel No: School District 49 Zoning: j f C� COMP PLAN DESIGNATION: COMMUNITY PLAN: UGA: UGA Trans [ ] Plot plan states "property line" [ ] Assessor's Map (Property lines on submitted plot plan must match the pnperty lines as identified on theAssessor's 1/4 map) [ ] Legal Access to Property YF NO [ ] Parcel Tags or Scanned Documents YES N9' [ ] ESA's: Special Reports Nearby YES NO [ ] Designated Ag YES NO/ [ ] Shoreline Designation: ES N5Y' [ ] Shoreline Slope Stability: YES Np Stream Type:YES Nr O � Fish& Wildlife:YES N9 Wetlands: YES N.- Rare Plants:YES NO, Seismic: YES Np Landslide: YES Ny Flood: YES 1\W Erosion: YES NO/ Aquifer Recharge Arrea:YES N9 SIPZ: nc9Vr At Risk High Risk Coastal CMZ: n High Risk Moderate RiskDisconnected CMZ Stormwater site plan submitted: YesNo [ ] Forest Lands: YES NO > Adjoining Forest Lands: Y Commercial/ Rural/ Inholding [ ] Mineral Lands: YES 9- [ ] Agricultural Lands: YES N� [ ] Archaeology: YES Nom. [ ] No Shooting Zone: YES N9/ [ ] Stormwater: New Impervious Surface Land Disturbing Activity ESA's Stormwater Req's:Min Req#2 Min Req#1 thru#5 Min Req#1 thru#10 Engineering [ ] Notice Provisions/Disclosure:Airport YEs Ny MRL YES NO Forest Lands YES NO [ ] Landscaping Required: Yes I'w [ ] Parking Spaces Re 'red NO 2 Other I- 1 Building Height: 35 UBC Standard [ ' ] Impervious Surface coverdie percentage: Resource Lands&Public: lier Rural Residential: Rural In rial: Per UDC Sec 6.7 Rural Commercial: 60% Area of Building C rage:60%in Rural Industrial Lands only [ ] Total Building(s).Size: RVC:20,000 SF CC:5/1000 SF NC:7,500 SF GC: 10,000 SF All others:subject to septic&water constraints/None specified [ ] Setbacks: Front: ' Left Side: 5 - Right Side: S Rear: cc- Shoreline Setback: h— LSHA Setback: [ ] Road Classification: Road Approach: EXISTING NOT REQ'D RAP [ ] SEPA Required: YES EXEM . [ ] Flood Certificate: V VI(k !/ [ ] Existing Case(s)&Cond' ion(s)��Y Violations: Vy No V �'r [ ] Recorded Date of Subdivision: i 214 J iCI f f CIAFN )1,2) Jam'6?- Over 5yrs=UDC Plat Conditions: <5yrs=Plat Conditions on plat or Old Ordinance [ ] Lots/Require Declaration of Restrictive Covenant YES N(Qsubmitted: YES NO [ ] UGA No Protest Agreement YES Np(submitted: YES NO [ ] Site Visit conducted YES NQ' [ ] Require Final Zoning Approval ES N7' [ ] ADMIN: Setbacks entered in Permit Plan case N/A YES New Parcel Tags entered in Permit Plan N/A YES Special Reports Scanned N/A YES No parcel tags found for parcel Cases Associated with APN 901342018 Cases Name Review Type Status Planner BLD90-00183 OSMER C Application Received: 3/29/1990 Permit Issued/Case closed: 4/2/1990 Case Finaled: mobile home BLD90-00184 OSMER C Application Received: 3/29/1990 Permit Issued/Case closed: 4/2/1990 Case Finaled: mobile home BLD97-00602 OSMER �y Application Received: 9/16/1997 Permit Issued/Case closed: Case Finaled: mobile home replacemen- SEP90-00598 ABERCROMBIE F Application Received: 3/13/1990 Permit Issued/Case closed: 9/17/1997 Case Finaled: 9/17/1997 BLD13-00295 OSMER p Application Received: 9/20/2013 Permit Issued/Case closed: Case Finaled: MOBILE HOME INSTALL COM09-00099 OSMER F Application Received: 6/5/2009 Permit Issued/Case closed: Case Finaled: 7/9/2009 Junk Vehicle complain SOM90-00598 OSMER RCV Application Received: 9/17/1997 Permit Issued/Case closed: 9/4/2013 Case Finaled: \\tidemark\data\forms\R_Parcel_CRMLA.rpt 9/24/2013 Page 2 of 2 Map Output • Page 1 of 1 ArcIMS HTML Viewer Map 1 1 a ' ----. 901034216 901331001 901342016 1 • 90142007 J-. 901342014 - 3 f , I 1 •01342017 1 i 1 ; --i---r— ---– ____. 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MiR-82,Trade iTura*seem 1:1 A. / ' Rural ridYm 1:1 Rural R sidrR11:70 • MfR-Si ek Fan* ■ MFRdtultifandr MM.* MFRatand Compile Pose sea Reoeeien ■ MFR-Open Spam Rune Farce SCanineaieferee 1342022' Industrial Wedding:t ® itearytrii ® Myatt®f 'ITHIM.. e% IN MFR-Wage Caster 4i II AP t20 ■ Rune Wipe Caper 1.1t Raeoune eard kW. al Light Ytduebie ,. 1342015 (,, MFRRaeaeian 4,0' waste Memt NPR El LAG ■ Crn..roadi.00 ■ cw.evade•cc 901343003 '° - ■ GnnrnadrNC 90134:1001 ■ AL 1:20 laVGA-Wean Cenmreii Mt. UGA-Urben Wit Induattial Maps • • • Jellersan County Caara.,a ioa cis 2248 - UCAd1OR UOAMOR Ut,A•Pubie UBA.W UGbViNter Oriented Coninrar MPR•*RR*wren fir-MINRLOCory Fares= FOR INFORMATIONAL PURPOSES ONLY- efferson County does not attest to the accuracy of the data contained herein and makes no warranty with respect to its correctness or validity. Data contained in this map is limited by the method and accuracy of its collection.Thu Sep 26 15:53:00 2013 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientV ersion=4.... 9/26/2013 • Map Output • • Page 1 of 1 • ArcIMS HTML Viewer Map y �901342015 ■ .-�' 901`337007 { `-,{ I 901342016 (,v -'k i j "'.,E,._ ,') f r ---"..-.ij �' `s ., 901342014 r rt 2 901342007 1 t �� 901342017'` �� I " _ t 5�1a, I - L.gand 901342021. - h 4� Selected Features ' 901342022 '� r JC Rwde �. ti , � 901331001 - � Parcels-It �: I 90134201 �'� Contours y - •w 901342018 iE :f /// ,'" — 10 Eeol sartar uti _ 1 �p / I /./1 91 Foot Contour % T 1 r _ a __,..._i a �J 9013420201 f- - ,' 901342023 N } +I 901342019 f 901342017 ' 4 j Y ' 901331007 901343003 9013430(kS ` ' ' �} {� � so13a3oo2 Maps crowded by Jaertae Cat*Carat Saracen GIS �l. 1 2240 FOR INFORMATIONAL PURPOSES ONLY- Jefferson County does not attest to the accuracy of the data contained herein and makes no warranty with respect to its correctness or validity. Data contained in this map is limited by the method and accuracy of its collection.Thu Sep 26 15:48:38 2013 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientVersion=4.... 9/26/2013 Map Output • • Page 1 of 1 ArcIMS HTML Viewer Ma. - ; 901342015 . ■. 90133100; ,.'1342016 t i� 901342014r � 90;342007 't4'4.,1:'t'''' ' Mili , 901342/7 ,27- � Lagend CI Selected Feagrea 901342021' 90134202; JC Roads c v' , Parelef1 a1331001 901342013 „ , 901342018 ����,��' tk, a , 901342023 s'>, 901342020 '44. 4 1 1.∎1342011 OP ,901331001 901343003. 901343005' 901343002 _Maps Vo,ded try Jetermi Ceury Ca.* Ser. CIS FOR INFORMATIONAL PURPOSES ONLY- efferson County does not attest to the accuracy of the data contained herein and makes no warranty with respect to its .rrectness or validity. Data contained in this map is limited by the method and accuracy of its collection.Thu Sep 26 15:55:59 2013 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientVersion=4.... 9/26/2013 Map Output Page 1 of 1 ArcIMS HTML Viewer Ma• t 4 ZEZa Legend Selected Postures JC Rords ��y-[�p�y-a- y' Parcels+$ a,dr.�.`ITZ off..:d':. 4071 Aerial Photos Maps Rammed by Jefierme County Ceekd S Meat tlS FOR INFORMATIONAL PURPOSES ONLY- efferson County does not attest to the accuracy of the data contained herein and makes no warranty with respect to its orrectness or validity. Data contained in this map is limited by the method and accuracy of its collection.Thu Sep 26 15:53:56 2013 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientVersion=4.... 9/26/2013 Screen : 01 • REAL PROPERTY MASTER 410 Mode : INQUIRY Auto Roll : OFF Parcel # 000901342018 Geo Cd 290134206211 LOWELL DAY SHORT PLAT #B Nbhd Cd 4285 LOT 1 Loc ID * Taxpayer Cd OSME 0801 OSMER, DANNY D T/P Chg Dt 12/10/1997 * Title Owner T/P Chg Usr JODI Tax Code 0211 Status TX TAXABLE Land Use 1101 MANU HM W/LN Affidavit 83212 Vol/Page / C/U Code COMPLETE ADDRESS WINDOW Taxpayer OSME0801 DANNY D OSMER DEANNA R OSMER PO BOX 232 CHIMACUM WA 98325- 0232 Search Ke CMD 6 : End Window CMD 7: End of Job DEVElpPMENT REVIEW TIME CET Date Time Comments \\tidemark\data\forms\R_MLT_Case_CRMLA.rpt September 18,2012 Map Output • • Page 1 of 1 ArcIMS HTML Viewer Ma• Illailla r 'i� .111 Z--Legend / JC Roods 901342019 county Zoning tat,, NPR,*Tram vi 1111114111111111 ., Rural RaidrRY11:0 .901342016: �''6i'r 1 ; ® Rural RaidrnNa11:10 Rural Rewidrrtit 1:20 MI MIPR-t11iMle Fa r niy ■ MMtaluldfaniy 901342017 ,,, NPR-Resort Camps' Pads and IMrranaon ■ MPR.Olsn Space ) a Rural Foist' >G.1;4{ iii Carisrcial Fare 7 'r ii` NaOldins Rogan :1 .` '...'.: •r 134201 1 ® Homy Industrial yy ® Aipart IMF 1 TY.1 ./ `' ■ MPR•Mbga Cotner -17�: ■ AP 1.30 ■ Rural Village Cants c'342020 nnc._ ■ Resource iaesd td IN Light lodueenal 901342019 901342011 VI MP0.0aorrition § ® Warne Ment@F 0111' 111 Luc III C III Croneroadir4X :' 401343003 901 ■ Crooroad-NNC 901343002 ■ AL 1:20 ! El UGA.l hta.Camrdal UGA-11 l ight iedu is ■n= n Ca Saocos GS 22419 UGA.MOR ' 1 UGA-Met � / V �4 V ✓' UGA.Ar6i e uGAa.oR LIGA-Vielese Oriented tonrrrsor MPR.RN Rriign ,51410111111.0Cornmeraiii Forest. FOR INFORMATIONAL PURPOSES ONLY- efferson County does not attest to the accuracy of the data contained herein and makes no warranty with respect to its •rrectness or validity. Data contained in this map is limited by the method and accuracy of its collection.Thu Sep 26 15:58:58 2013 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientV ersion=4.... 9/26/2013 road' • • Page 1 of 1 ADDRESS INFORMATION FOR 151 GIBBS LAKE RD ROAD NUMBER:C517509 ROAD NAME:GIBBS LAKE RD ADDRESS:151 APT: REAL MILE POST:0.16 APPLICANT:OSMER,DAN ADDRESS CREATION DATE:04/18/90 PARCEL: LEGAL:34,29,1W GRID:E-7-K FIRE DIST:1 ZIP:98325 POSTAL DISTRICT:CHIMACUM PLANNING AREA:6 VOTING DIST:302 CEMETERY DIST:- HOSPITAL DIST: SCHOOL DIST:49 WATER DIST: SITE LONGITUDE: SITE LATITUDE: SITE COORDINATE TYPE: ACCESS LONGITUDE: ACCESS LATITUDE: MODIFY DELETE ADDRESS NAME SEARCH REPORTS http://isserver/Address/RoadAddressDetail.asp?ROAD NUMBER=C517509&ADDRESS... 9/26/2013 • • • • PS CI ! I,y2:-/ zErsaz ILA � DAY SHO11 T PLAT 1 SECTION 34, TOWNSHIP 29 NORTH, RANGE 1 WEST W.M. JEFFERSON COUNTY, WASHINGTON ZB 21 2T 26 • A• 34 34 33 I LEGEND • 0 OENOTES/"CONDO/T W/TN PLAST/C SURVEY CAP ^J ji �/y STAMPED”/2,223 CLARK".3':3-GUARD PO5T SET °p\ DENOTES EASEMENT FOR/NGRE55,EGRE55 Ai \ ��Y /2l'' AND UT/L/TEES PURPOSES. � J DENOTES G EBBS LANE ROAD COUNTY ROAD ( N% NO.22-/.58 � l C 33 aroo•r n-c-8jL T94 3 5 a 3ys � N �_z NOTE� V /TV MAP O p BAS/5 OF BEAR/NGS-ASSUMED p _ SCALE /.../00' 0 /° C.' . O F D T E A T I U N A N D O F C L A R A I T I F F JA F A S C AI E N !eCi per' KNOW ALL MEN HY THESE. PRESENTS THAT WE, LOWFII R. DAY AND EDITH DAY, OWNER; - ..Q �j� TN EEL SIMPIE OF THE LAND HEREIN DESCRIBED, DELLAHE THIS SHORT PIAT TD III UJ �I TG �. CREATED BY FREE WILL AND CONSENT AND DEDICATE TO "HE USE OF THE P:IBLTC FOR_ t .... EVER A STRIP OF LANG THIRTY (30) FEET IN WIDTH AND LYTNE� SOUTH DF THE TEETER- CO (-�G/ I INF OF GIRBS LAKE ROAD, COUNTY ROAD NUMBER 22-1.S0, AS PORTRAYED ON THE FACE OF THIS PLAT AND DESCRIBED AS FOLI GWS: 3Gp Z� RESINNING AT A POINT UN THE WEST LINE DF THE NORTHWEST DIIAHTEFY OF SECTION 54, f" TOWNSHIP 29 NORTH, HANCE I WEST, W.M., JEFFERSON COUNT0, WASHINGTON, LYING "�i ‘1. u� NORTH 1^ Al,' 2R"WEST, A DISTANCE OF 845.00 FEET FROM THE WEST QUARTER CORNER V CO Z oq,' ,'� OF SAID SECTION 34 AND THE BEGINNING;OF SAID CENTERI INC DESCRIPTION: lit N` S Al ^ �� ._ THE NCE SOUTH 54' 44' 36 EAST ALONG SAID CENTERLINE, A DISTANCE D, 3F�1.7C FEET; 9a I .�r�-''1155 THENCE SOUTH 57° 15' 17' EAST, A DISTANCE OF 401.47 FEET AND THE END OF SAID �`^ -.l]�R., I A. AF ��>� �* CENTERLINE DESCRIPTION. Y! / 1 N '50r\ K (y s `y AN EASEMENT IS HEREBY RESERVED FOR AND GRANTED TO THE RESPECTIVE FOR DF V 3e c0� \/ • "•�;,_. LOTS 1, 7, 7, AND 4 AND THEIR RESPECTIVE SUCCESSORS AND ASSIGNS FOR THE I`c i • '4 N . PCRPUSE OF INGRESS, EGRESS AND UTILITIES, OVER, UNIFR AND ACROSS A STRIP �J OF LAND SIXTY (60) FEET TN WIDTH, THIRTY (30) FEET ON CACP SIDE OF THE FBI LOWING DESCRIBED CENTERLINE: M �- DE;INNINE, AT A POINT ON THE WEST LINE OF THE NORTHWEST QUARTER OF SAID SEC- .33.55- 34, LYING NORTH 1^ 40' ZR"WEST, A DISTANCE OF OWLET FEET IROM THE WEST Q �. 6d ��4%/, QUARTER CORNER OF SAID SECTION 34; Q _.RO .fie Q THENCE SOUTH S4" 54' 35"EAST ALONE, THE CENTERLINE OF SAID GIRDS IAKE ROAD, O 9 A DISTANCE OE 361.25 FEET, 4 - 5, THENCE LEAVING SAID CFNTFRI INE SOUTH 11^ 36' 39" EAST, A DISTANCE. D1 46,95 ZX31 0,�", FEET TO THE TRUE POINT OF BEGINNING AND THE REGINNING DF THE CENTER!INE � d' ' N 3 THE NCEP501DIT 603° 41' 53"WEST ALONG SAID CENTERLINE, A DISTANCE OF 291.40 FELT W CiCao ; PARCEL 3 ^" 2 PARCEL _2__ (X'� k):., 3 TO THE END DE SAID CENTERLINE DESCRIPTION. Ghh 2.33 AC. � 2./5 AC. V \i\, DWNF RB 2N1i O 0\4 • pa o I I -262.00-- ' _ — 995.89 c (( � L W LL R. a EDrT y- S 89°/7'27W 657p9 --TT-- ■ I W.CoR.,it/A Reg,. Ns•:G,SEC.dal ROIL: xHOI„ PLAT ,_'i.IET_I TU WATER HELM'S IIF FAVUR OF EDWARD x. .H_CI FL': STATE LFRT IF KATE RECORDED TENDER AUDITOR'S F II F NUTRIA 143536, HECURU', LI LEF'ERSLN CEI My, UAER I Jr TON. 1 L S E R I 11 T I U I', ' THE IDES I HAI E OF 101 ,UDIHWE FT DI TAUTER WE EEL NU HTHWF;T C:IARTLII LY INF SOUTH L• FI'I�F, I ALF CAT'T'Y FIORD H1L,HT-LF-WAY, III',POTION 34, TOWNSHIP 27 FOURTH, NANE,L , WE 1T, W.0., SIII.ATEU IN JEFFERSON CEIINFY, NASHTNRTBN. N L T 1 G E I D I ,T L I: T I A I Pi 'I L H A , - , 1. ALI 11.15 SHA11 RCUnIRE MAxTMIIM 011AIN1 IELU Ali, DAHIIAL I ILL LULAILU If: . .' I ri I. E. [ !t ' I I G A I P AREAS OE ',I_III-C I.LU, IRATE LIVE (C) OFREGNT. 2. i_DW WATER IISI_ F I/TI',RES ARE TIE CUNIITIE NOUN FIJI, ALL LOTS. I HERF:ET CLIFF IF THAI MIS SHONE PLOT ENT I,'.ES LUWE'_L DAY SHAH; I'LA" 8, i', 3. DIVERT SEASONAL IDIItFACE WATER FROM AEI. SEH'.IETES AWAY FEEDS OI.AINF IF L.1 AREA, .,A'FLF 'I UN AN AE-THAI Et:63 Y; THAT THE U•.ARSE'S AND 'AS-FAECES ALE SEINWF C '.RE-I!'t OS AI I 13115. THE11CT1'.; THAT All RCIII.THCD ;TAKES AN:T f'UO'.ICIENTS ARE "1 ACFU II.' THE EFU',,I;D IT 4. APFRDIIAI OF THIS SIIJDTIIISION 00E9 NOT CONST ITt TF APPRUVAI OF EACH IEII FOR COh1PI ANCF WITH if FF-RSUN CUI.I:TN ANU THI SIIDUIVT SINN OI%UTNANCL. TEN-'3 I IF SEWALL UISI'II AI ,/S TERS. AP ORDEAL OF EACH 13T SHAT I RE CLN.-1IT1OIJAI_ O TIN R..11 DINT PI AT PI AN S, CLINTDIIRS, AND SETLS ON TNDII ,.'SAL LETS. CJ NTACT THE JFE FFRSUN GU'.INTO HERE TH DEPARTMENT RE;ARDIS' HC GIIL AT I[I:, r E.`Q / OVE,FNINO WELL AND SFWAIF DISPOSAL SYSTCI ETUACX: OCT IIT RE TESTS. C �I/0 �Ty ,-f U. A I'OTAUI E ''DATER SC IHLF IS NUT SI;PI'LLLU 1.1 EL:IS N1YH AA C/ E.JT FTH A. CLPFK 7. COUNTY READ APPROACH PERMIT NIIM"EH 179+24' PAS FEE SE.CEEAF I: f P. TO'. t�� r.j \49, FESS IT NAL -AND SU,TVL YI:R APPRGA:TP FROM CIIIR S I AKE ,IDAU COuNIV HOR] IIMI',E''. 77 . Al' PERT-11 III q v 4 CENT F(!_'ATE NUMBER 1722"S CONDITIONS SHALL APPLY. -4,: C 1r DRAWN BY'C.../.w. SHEET / OF 2 Si a CLARK s• ASSOCIATES PLAT CNECN ■(1 a y Engineers•Planners �1 Land Construction Coordination•Materials Testing f/NAL CNECN:_„i.I .,.°,,,,, ,,,.,...r...........,r.. .............. • • • 5p ■v7JL F 1 %E L DAY HORT PLAT B SECTION 34, TOWNSHIP 29 NORTH, RANGE 1 WEST WM JEFFERSON COUNTY, WASHINGTON , t v _ - - r R T ' r , AT : ' E E U H U I N i C I H I T F I I: A T E t/v'._,,, I• ta. T5EA;I 11111 Hr FFrV l'o..:1_11 i ! „IA';A I'. llh, VII V<'I,v ILES rIIR Ill PORI) AI IHI IIE0JEST Of ���, ,�� �-_ A' All PA,F All INC Iif,I EHT'. ,',I SE Ii r�l All TJ AIiF I'! t'A I.:, a '1AY UP //� �V. 1.4 ,7 , AT /s IIII TN' 'I iAR 1^•f! - 'IN ITT', PAST 3PM ANTI HI'ARfFT Ill VpuITE AT AGE PO /A7- /../f , RFLLRUS IT iFFFUUnN LUETTY o:IOT11+. - ' 4- c-.,.•-' •.., JEFFERSON COUNTY TREASURER IGti [:BIIATV P.t;l Tf;R G ul"A HI_ Ir I..INPI IANFr TIlTO THr ',HrRT PLAT AF 01:1 HOE vis IF 'IA: "1=-iSU' LIIIAT/ , TOF.'JRTTNANCL. JEFFERSON COUNTY NEAL TN DEPARTMENT JFPFF RTT II COUNTY PURL!: WORKS III PASTAi—T -Jeri:7 y y. JFFFE RSTIN COUNTY VL ANNTIII ' . ' OEFA �ll'.T FFFl-R':IT I R1NTY OAR.) JdfISSIONERS THIS 21- IA'Y LRr rRATRmer,, :iOARO RU ur UI rpmnlssloNERs ATTEST: TTY AI9;TTUII STIR PA_UII'-TI'. I..,R Ir THE :17A1i0 OF UHIITJST04ERS SHEET 2 OF 2 IA CLARK &EnASSOCIATES ury rae, ds.eteneers Construction Coo .non•M.tei./s Testing • • ERMIT APPLICON BLD13-00295 BUILDING A PERMIT Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD13-00295 Received Date: 9/20/2013 SITE ADDRESS: 151 GIBBS LAKE RD CHIMACUM, 98325 OWNER: DANNY D OSMER PHONE: DEANNA R OSMER PO BOX 232 CHIMACUM WA 983250232 LOWELL DAY SHORT PLAT#B SUBDIVISION: Block: Lot: PARCEL NUMBER: 901342018 Section: 34 Township: 29 N Range: 01 W CONTRACTOR: PHONE: PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI MOBILE HOME INSTALL TYPE OF WORK MOD SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 1,512 VALUATION 90,000.00 ADD'L: HEAT TYPE: CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: OSS WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: 0 Prop: 3 Prop: 1 Total: 3 Total: 1 Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $228.00 MEB 09/18/13 145367 State Building Code $4.50 MEB 09/18/13 145367 Total: $232.50 +„iArnnrlArinfo\fnrr„e Ann PIrI rn+ onnil 11R �, 'S01tt c�� JEFFERSPCOUNTY • • W - ' `ti DEPARTMENT OF COMMUNITY DEVELOPMENT l ►C 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax �.q o www.co.jefferson.wa.us/commdevelopment `r87N Master Permit Application MLA: Project Description(include sep r�shee, as nece ): � - /71/14/Li Tax Parcel Number: 1013 /V Property Size: (acres/square feet) Site Address and/or Directions to Pr•fp .-rty: Property Owner(s)of Record: 'j, , , _ J+„ Telephone: Fax: email: Mailing Address: Applicant/Agent(if different from owner):ij -. f, Telephone: Fax: _ email t ;, I,C �/-���I� Mailing Address: -rs�ir'r — �®•�>d/..1•.s - �; What kind of Permit?(Check each box that applies ❑Lot or Road Segregation ❑Building ❑ Critical Areas Stewardship Plan (� n ��/(� ❑ Demolition Permit ❑Variance(Minor, Major or Rea I I�sB)V t_�_-� ❑Single Family ❑ Garage Attached/Detached ❑ Conditional Use[C(a), C(d),of ff4 Manufactured Home .❑ Modular - ❑ Discretionary"D"or Unnamed assification ❑ Commercial* ❑ Special Use(Essential Public F ies)** ❑ Change of Use ❑ Boundary Line Adjustment SEP 1 8 2013 ❑ Address ❑ Road Approach_ ❑ Short Plat** ❑Home Business ❑Cottage Industry ❑ Binding Site Plan** ❑Propane ❑ Long Plat** JEFFERSON COUNTY OUNTY o 3i n 0 Rural Residential DevPtnp artit pp "'le ppC p ❑Allowed"Yes"Use Consistency Analysis ❑ Plat Vacation/Alteration** ❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions** ❑Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Substantial Development** ❑Temporary Use ❑Shoreline Management Variance ❑Wireless Telecommunication* ❑ Comprehensive Plan/UDC/Land Use District Map Amendment ❑Forest Practices Act/Release of Six-Year Moratorium ❑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 I 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 requir later inspections. Staffs access and right of entry will be assumed unless the applicant informs the Coun in writing at the time of the applicati the or she • r notice. Signature: ° j Date: ■ 13 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 a in compliance ' • e Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferabl:-r- ••nsibility fo • to and complyin• wit the ESA. The Applicant has read this disclaimer • s and d- s it below. Signature: . _ v __1 .fl( I Date: r i. _,/ • r • G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc • 1 III 111111 , , 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: �-. %✓ C ., mil_Ill ( ) AILING ADDRESS: '7 ' •IL: r CONTRACTOR'S LICENSE 1 V"r nexx.p 7 Sr__ WAINS > 7" NUMBER: ' ' NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: • CS, New ❑ Wood Existing: ❑ Sewer ❑ Addition CI Steel Proposed: Bank " ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: _ •Height: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# C Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: ❑ Public 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: Underground Tank 1 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 I 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 1 / EH Bid App Review: (,t; Floor Heated ( Consistency Review: 22-S ,�, &I' Other Heated Base fee: Mezzanine Additional Section: ..------ Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: ),, r Other Unheated Pot Water Review fee: `�'(��� Garage/Carport SUBTOTAL �tr[0Orni 5-'S * Decks 911/Rd Approach fee: — Other TOTAL: $ Receipt Number: I –i S 'j G-el,. Cash/Check Number: ESTIMATED COST(REQUIRED) Q \ qq� Date: Q� L�j/ •Fair market value of all labor and materids'*,f aB'fl tb 1 nish l� 0 1 1 Initials: (((w\, t . G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc JACK WESTERMAN IlO Jefferson Co. Courthouse ASSESSOR PO Box 1220. Port Townsend, WA 98368 (360) 385.9105 MOBILE HOME INFORMATION FORM t) OWNER'S NAME/MAILING ADDRESS: NAME: Din 'I i Q 2013 I ADDRESS: t�7t �,��j u L1 1 J PHONE NO. JEFFERSON COUNTY DEPT OF COMMUNITY DEVELOPMENT 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: lif `9164//9 (A) MAKE x/11 4 , (B) MODEL (C)YEA (D) LENGTH (E)WIDTH 9') (F)SERIAL # (G) YOUR PURCHASE PRICE (Do not include sales tax► L PURCHASE DA�I /_ �f 3 2) PREVIOUS OWNER/LOCATION OF M ILE HO : (IF NEW MOVE TO I UESTION 3) (A) FROM WHOM DID YOU PUB E MO E �' his /I-" 'C� VII ADDRESS (B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR?Yes No H 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 (B)IF LOCATED IN MOBILE HOME PARK: NAME Ok.ADDRESS OF PARK Lot/Space # (C) IF NOT LOCATED IN MOBI HOME PA I : NAME OF LAND OWNER: Mx/ 1 /ter,1i - 1 LOCATION ADDRESS /6/ b 4� e, 2i II, REAL PROPERTY PARCEL #/DESCRIPTION 951Y-3reerg Signature of applicant THANK YOU FOR YOUR HELP! Lauralee Kiesel, Property Technician III III 7Thi 4�� °N �o6 JEFFERSON COUNTY - 0 -E {IV �,w 1. ti' 3 DEPARTMENT OF COMMUNITY DEVELOPMENT SEP i 8 2013 ,. 621 Sheridan Street• Port Townsend • Washington 98368 - 149 NOcO 360/379-4450 • 360/379-4451 Fax JEFFERSON COUNTY http://www.co.jefferson.wa.us/commdevelopment/ DEPT.OF COMMUNITY DEVELOPMENT Stormwater Calculation Worksheet MLA# PROJECT/APPLICANT NAME: i Ah N e%/k/e DETERMINING STORMWATER MANAGEMENT REQUIREMENTS: This stormwater calculation worksheet should be completed first to classify the proposal as"small,""medium,"or"large." The size determines whether a Stormwater Site Plan is required in conjunction with a stand-alone stormwater management permit application, building permit application, or other land use approval application that involves stormwater review. The basic information will also be helpful for completing a Stormwater Site Plan,if required. q i PARCEL SIZE(I.E.,SITE) Size of parcel I acres An acre contains 43,560 square feet. Multiply the acreage by this figure. Size of parcel in square feet g3 a�L• �-, sq/ft Land-disturbing activity is any activity that results in movement of earth, or a change in the existing soil cover(both vegetative and non-vegetative) and/or the existing soil topography. Land disturbing activities include, but are not limited to clearing, grading, filling, excavation, and compaction associated with stabilization of structures and road construction. Native vegetation is vegetation comprised on plant species, other than noxious weeds, that are indigenous to the coastal region of the Pacific Northwest and which reasonably could have been expected to naturally occur on the site. Examples include species such as Douglas fir,western hemlock,western red cedar,alder, big-leaf maple,and vine maple; shrubs such as willow,elderberry, salmonberry, and salal; herbaceous plants such as sword fern,foam flower,and fireweed. LAND DISTURBING ACTIVITY,CONVERSION OF NATIVE VEGETATION,AND VOLUME OF CUT/FILL Calculate the total area to be cleared,graded,filled, Answer the following two questions related to excavated,and/or compacted for proposed development conversion of native vegetation: project. Include in this calculation the area to be cleared for: Does the project convert%acres or more of Construction site for structures 19-N sq/ft native vegetation to lawn or landscaped areas? Drainfield,septic tank,etc. sq/ft Circle: Yes No Well,utilities, etc. sq/ft Does the project convert 2'/Z acres or more of native vegetation to pasture? Driveway, parking, roads,etc. sq/ft Circle: Yes Lawn, landscaping, etc. sq/ft Other compacted surface, etc. rr sq/ft Indicate Total VoIt i s of Proposed: Total Land Disturbance 1� ©� sq/ft Cu ,.J✓ _" Fill 40 (cu/yd) Y ) [over] • • Impervious surface is a hard surface that either prevents or retards the entry of water into the soil mantle'as under natural conditions prior to development. A hard surface area which causes water to run off the surface in greater quantities or at an increased rate of flow from the flow present under natural conditions prior to development. Common impervious surfaces include, but are not limited to roof tops, walkways, patios, driveways, parking lots or storage areas, concrete or asphalt paving, gravel roads, packed earthen materials, and oiled, macadam or other surfaces which similarly impede the natural infiltration of stormwater. STORMWATER CALULATIONS–IMPERVIOUS SURFACE NEW EXISTING Structures(all roof area) j60., sq/ft Structures(all roof area) sq/ft Sidewalks sq/ft Sidewalks sq/ft Patios sq/ft Patios sq/ft Solid Decks sq/ft Solid Decks sq/ft (without infiltration below) (without infiltration below) Driveway,parking, roads,etc sq/ft Driveway, parking, roads,etc sq/ft Other sq/ft Other sq/ft Total New /6e 2, sq/ft Total Existing sq/ft TOTAL NEW+TOTAL EXISTING* sq/ft This amount will be used to check total lot coverage. The following questions will help determine whether the proposed project is considered development or redevelopment. DEVELOPMENT v. REDEVELOPMENT Divide the total existing impervious surface above by the size of the parcel and convert to a percentage: Does the site have 35%or more of existing impervious surface? Circle: Yes No FURTHER INSTRUCTIONS: If the answer is yes, the proposal is considered redevelopment and the attached Figure 2 should be used to determine the applicable Minimum Requirements. If the answer is no, the proposal is considered new development and the attached Figure 1 should be used. At this juncture,the applicant should refer to the applicable Flow Chart to determine the Minimum Requirements for stormwater management. DCD staff will help verify the classification of the project and the application requirements. For proponents of "small" projects who must comply only with Minimum Requirement #2—Construction Stormwater Pollution Prevention—an additional submittal is not required. The proponent is responsible for employing the 12 Elements to control erosion and prevent sediment and other pollutants from leaving the site during the construction phase of the project. Pick up the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet. Proponents of"medium" projects—those that must meet only Minimum Requirements #1 through #5—and for "large" projects—those that must meet all 10 Minimum Requirements—are required to submit a Stormwater Site Plan. DCD has prepared a submittal template of a Stormwater Site Plan, principally for rural residential projects. Complete the template in the Stormwater Site Plan Instructions and Submittal Template or prepare a Stormwater Site Plan using the step-by-step guidance in the Stormwater Management Manual. APPLICANT SIGNATURE By signing the Stormwater Calculation 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 - -cted property. „ay k/1 (LANDOWN'' -' T U HORIZED REPR ir IVE SIGNATURE) (DATE) 'ta x �^�x3�d� r t ';' wly4 � " �: m �i��y I s ger Si Q� .r.,y stormwater talc worksheet—REV.11/5/2008 • . . r 1 I - Q 0 =SIN c j 3 ow an Dy� 27'-0` . 1ppli1i 111111111 �'_,' � I*Hip i !,c3 / 11-`1 111111111 11111 V. IIIIIIIII — B, : 111111111 . rn 111111111 _. (�D - 111 � � 1 ,.. . 1 1�1: w W OPT�e�e- 111111111 N 0" 0 ,111111111 O .11111111 (1,1!1!11 _= !i1,1,1 g Qi m ,//‘\ r" •As... % 011111 61".. III 51 kli 0- 0 , 1 t _I: I _ to ! ',111;1 I I f _r Z‘'1). r:Z. 17 F `i....... 11;1;1; , N ��I�1111111 .� -, �•P�® _ 111111111 1_L o co \\' 11/111111 cn o -_ 1111111 atal — f • IIIIIIIII w i UI ; IIIIIIIII X=. o 5- 'I,I1 1 1 'off Id il II IIIIIIIII 4 ,0 r 8 0, 11,.. [ ` 11111!1 ' °o 111111111 . I�I�I�!'I ON r N 1:1:1:1:1 .a /,; *11 -._ 4 1 aas o L .., c.n 1 '11 0 11 111 N -p H - z ffi [ Q5 O Q infil v 0 • -- ' 1 cC) Ilk IV &) 4\ pit . cr.% \ t‘ si) e ks) _ ■41\ � ,t' 4% tt ,Iiiin:, "7_)( \.i ?• %%' ' d s‘... , ._s _ ,.... - e..„.1,_ 4, _ _ . iiii,--1 -41A. .,I _no_ , Q. .. 1 `. r". """. "Th.) 4\7.1 ' af U W 1S - 'i _' 'mms d --, po. t v r ."-... . ...... ...... V s 1\41 , . _ ao...4.sti: , .......___:N..., tr.; ..... t \ ---.---■-...41. '* cc- 0A9)..... ......... .,,,., .-...„1 ( sk_, -st ,t. *--9t. ..... ,,„ „,„ , , \r) Si G; lobs � �, ��� � , U �N t\iy., bsPogo) C6M r. PARCEL 34-1 P., S alai , 5 x 197, 5 ^ 83. ° No �1-mperu 1ou5 , q I ACrzES 6 ��� �ce s 0N Prop -Iy ( ,, _ 5O EA 5 E IV r 79. 5 '7 Ter -- c POI& �_ ,iFE7a fl -. N G,4.4Ve , / 1 i F.4\r) GRr3v , .fro � Dgeiti 114 r a� © J v�` vN g Ul;y c '..'. Jli t t'vUlv(' ql//1 DEPT.OF iMuNl Y DEVE Q' ENT , SIGNATU• : I � `®<. s' / _ We.11 '� 4VC ` h°E V ip NU 611.1(1Utl'$ OCT 1 7 2013 1EFFERSON COUNiY DEP .OF COMMUNITY DEVELOPMENT REVISED date: oi i i1 l i 9 i t • 0 0 Ms ] 1444 0.01btliiA Is% OS 14*..V. -Re.-V1EV 51-ra 9 t.,(4N 151 (,\sZsbs \,..mq. VA) 0)01 #3 4' 01 c \ .c)\ I\(.%.,s ‘AIM INI t) Iri‘%Atv• •\‘,s V OR QNA .S* t°his Sg.C.C.V■cts ort VILUitc11‘,) 1 " = 50' CP w-c Pi c7 ---Doi--1 1--)t.A. ,Ni 41A el-eiALV(fA 1- _ ....... ••■•• c:.-AS'i VIV...tal ri stkko I ...,*. R.bstovt 1 1 B.41 3 T e 1 DR At s ilk S/it Li) , V) 1 % \ #) I ° i 44) I powt%/to %NEP ro‘,.vc ‘...----- El smi volitylwt / G"itL WAvt, -..t 11'XI; 41' LI Et di t t ("•1 ,0 144 :A APPROVED 1 ...% . SITE PLAN 1 Or) FEB I 3 2 014 0.4-3S1 JEFFERSON COUN1 Y DEPT.OF C*Ai oUNIIIMLYILOPMENT SIGNATURE: , . ".*:ViSEO date:J01,1,21116 ii6. 1 f , f ,JANI 1 7 2014 1 '1.2) , it ').1 0 - - _ 1 i ......._—__ JD I L'a,1\I LOUNTY 'In'T Or CO'",UNITY DFVFl ODMENT 1 • • 44,f, • • . • r • ' • 4• 44. '•■• #O." VI ' • •••9 • w 110 y• fs. • Donna Frostholm From: Susan Porto Sent: Thursday, February 13, 2014 12:25 PM To: Donna Frostholm Cc: Mary Blain Subject: BLD13-295 ready Donna, I have signed off water review, but FYI, based on the scale of the site plan I relocated the well shown to an accurate location. I don't know if you want to correct your site plan or not....let me know if you don't understand. susaw Porto R.S. jef fersow couin,tj PubLIe H-eafth Phovi,e 36.0. 3859404 FaX 360.379.4487 ALwa.s woriei,Kg fora safer t-teaLthi.erje f fersow couwtl CONFIDENTIALITY NOTICE: This e-mail message,induding any attachments,is for the sole use of the intended recipient(s)and may contain confidential and privileged information. Any unauthorized review,use,disclosure,or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. PUBLIC RECORDS ACT NOTICE: All e-mail sent to this address has been received by the Jefferson County e-mail system and is therefore subject to the Public Records Act,a state law found at RCW 42.56. Under the Public Records law the County must release this e-mail and its contents to any person who asks to obtain a copy(or for inspection)of this e-mail unless it is exempt from disclosure under state law,including RCW 42.56. IL-- 60 /te e_ J � J. pA, C/tom ' r I � 1 • • kwRSON coo JEFFERSON COUNTY ti - DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street I Port Townsend,WA 98368 I Web:www.co.Jefferson.wa.usicommunitydevelopment ySINO�o Tel:360.379.4450 I Fax:360.379.4451 I Email:dcd(a.co.iefferson.wa.us Building Permits&Inspections I Development Consistency Review I Long Range Planning I Watershed Stewardship Resource Center February 4, 2014 DANNY D OSMER DEANNA R OSMER PO BOX 232 CHIMACUM WA 983250232 RE: SITE ADDRESS: 151 GIBBS LAKE RD CASE#: BLD13-00295 Dear DANNY D OSMER: The Department of Community Development is in the process of reviewing your application. The following information is needed to continue review of your project. DCD has recently determined that potable water has not been evaluated in the past for the existing well. This must be completed as part of the building application review. Please complete and submit the enclosed Application for Determilation of Adequate Pcdable Water Supply form along with a check for$107 to cover the cost of the review. If you have any questions, I can be contacted by phone at 360-379-4466 or by email at dfrostholm @co.jefferson.wa.us Please submit the above information to the Department of Community Development by May 5, 2014. Pursuant to Jefferson County Code, JCC 18.40.110(3) and (6), if the applicant does not submit the additional information or does not request additional time to submit the required information within the ninety (90) calendar day period, the application will be considered abandoned and therefore withdrawn and the applicant shall forfeit the application fee. The Department of Community Development shall not be responsible for notifying the applicant of an impending expiration. Sincerely, epart)ient of Community Development Staff c: File • or) Iv2}Scut Itevi fiz (e_ ;l'b'oz/) \\tidemark\data\forms\F_MLT_Add Info_Requst.rpt 2/4/2014 Standard Conditions for Residelpevelopment in Jefferson County.. 1. LIGHTING: 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. 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. 2. BUILDING HEIGHT: The building height is not to exceed 35 feet. 3. OUTDOOR STORAGE: Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 4. UNLICENSED VEHICLES: 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. 5. PARKING: A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 6. This permit has been reviewed consistent with JCC 18.40.130 & 140. Notice: this permit does not excuse the applicant from complying with other local, state and federal ordinances, regulations or statues, applicable to the proposed development, but consistent with RCW 90.58. Future development beyond that specified in this permit shall require further review. 7. BMPs: 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. 8. NOTICE: This permit does not excuse the proponent from complying with other 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"Y 9 Y takes listed species (defined as causing harm, harassing, or damaging habitat for the listed species). In addition, the National Marine 2013-03-075FR_StdConditions 3/7/2013 1 Fisheries Service can levy agillits. Portions of Jefferson County, i marine waters, are included as "critical habitat"for a listies. Development of property aloWWriarine shoreline, freshwater shoreline, orfloodplains 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. 2013-09-065FR_StdConditions 9/6/2013 2 L <5 I if; 'oHo s 1.,- < edt , 1 N,tsi IQ'',1 fr E p,„\,, w pi C) ,5 ro.t.R., . Pfo)R . •.-Z_ c.) i34-/ 2.- 0 1 Y 41 ,;,,, r . 5 x 1 9 7 5 -9-- 8 3. ° 1 , q i No 4. P , c. ;7, O ' roP'('''''''l 1 I / 1 / .. . . .... . . , / , , ■ ' - i 1 i 4 ' i .:1,,C '-,t f %• .: ( - ' . ,./ E 1 ex4 r4,1.- f , I— . . • 0 'POI& , 1 nz.-14)r tqf 1 0 1)E pi / I ' / '1 '‘1 c rtzgue I 7 ,.,.. ,,,,,,,,, • i 4 :.--, . ,. _ . i , ., ,,,, .i / . .. S(o ' -----' , .... 4..... . 1 -.. . , t 1 _ i . A ..,.. ., ,., -_,./ . t , , 2 I q -: ' / ....._._ I t .•: I: c t—ii..LNI c2t, , ... ._._........._ . v t lope rt i 'N) fr) DT oFJ:E-17, LT:uTiTry I / SIGNEAPTURE': .111.4M. YDEVE I . . • • : 1 UN; OPMENT 1 i ' .„ ' We..II ., , 4Io / DEOEAV /1 1J a I 1 41t.Pyi e .1.* / I , ., . / / OCT 1 7 2013 \-.) , / 1 ..,. i / 1 DEPT.OFTI\EARMS11°t\IITIC°DUENVIVELOPMENT /0 / • REVISED date: t,0 ti . w JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT c Date: QI28-Time Received: / /0 0/pm o Tue. Wed. Thur. Fri. Date: 3_3 BLD: i 3 2,q 5` Contact Name: Owner: Contact Number: 360 -{2.5- 3g 4,y9 Address: } r'' 1 (s-1 R5c 206 Notes: Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Underground Furance Footing Rough In Air Seal Above ground Gas Stemwall Hydronic Exterior shear Exterior lines Oil Straps Hot Water Htr Interior shear Interior lines Ducts Post Hole Ventilation Appliance Underfloor Gas/Wood stove Man-Homes Insulation Final Inspection Setbacks Floor Foundation Wall Address Posted Block&Tile Ceiling ¢gON c.. '';''4441 °- JEFFERSON COUNTY :=, ,. DEPARTMENT OF COMMUNITY DEVELOPMENT 16111 N 6-6' Date: 414.47, Time Received: fr Oz/ am6 Mon. Tue. Wed. Thur. Fri. Date: BLD: )2 W-15 Contact Name: DpyA. Owner: Contact Number: 360 1--}2S A 3y 1(41 Address: )5-1 Cs,p.,A. Li< 206 Notes: Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Under ground Furance Footing Rough In Air Seal Above ground Gas Stemwall Hydronic Exterior shear Exterior lines Oil Straps Hot Water Htr Interior shear Interior lines Ducts Post Hole Ventilation Appliance Underfloor Gas/Wood stove Man-Homes Insulation Final Inspection_.lam - Setbacks Floor Foundation Wall Address Posted Block&Tile Ceiling Jefferson County Building Division Permit Number: Applicant: BUILDING PERMIT INSPECTION APPROVALS Applicable Code: International Building Codes To schedule inspections, call (360)379-4455 no later than 3:00PM the day before the inspection is needed. Requests received after 3:00 PM will not be scheduled for the next 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 Pn/O-t64-4"---;31,1)9 15 CKr 04 4 3/i jl f A final inspection will not be scheduled until all of the following are completed and signed off by the applicable Department: • Building Permit Conditions are met • Septic Permit Final/Complete for any building containing plumbing • Land Use Conditions met and signed off • Public Works Permit Final(where applicable) FINAL INSPECTION GI FINAL INSPECTION UST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR • • CONDITIONS for Building Permit# :BLD13-00295 1.) THE HOME MUST BE LOCATED AT LEAST 10' SOUTH EAST OF THE SEPTIC TANK AS SHOWN. 2.) 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. 3.) The site plan, as submitted with the building application on January 17, 2014, 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 February 13, 2014 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 4.) dlf \\firiamark\riata\fnrmc\F RI 11 PPrmif Rlrin rnt 9/13/9(114 • BUILDING PERMIT • Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD13-00295 Received Date: 9/20/2013 SITE ADDRESS: 151 GIBBS LAKE RD Issue Date 2/13/2014 CHIMACUM, 98325 Expiration Date 2/13/2015 OWNER: DANNY D OSMER PHONE: DEANNA R OSMER PO BOX 232 CHIMACUM WA 98325-0232 LOWELL DAY SHORT PLAT#B SUBDIVISION: Block: Lot: PARCEL NUMBER: 901342018 Section: 34 Township: 29 N Range: 01 W CONTRACTOR: PHONE: it PHONE: PROJECT DESCRIPTION: MOBILE HOME INSTALL TYPE OF WORK MOD SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 1,512 VALUATION 90,000.00 ADD'L: HEAT TYPE: CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: OSS WATER SYSTEM: 1 PWELL Type Amount Paid By: Date: Receipt: BEDROOMS: BATHROOMS: Permit $228.00 MEB 09/18/13 145367 Exist: Exist: 0 State Building Code $4.50 MEB 09/18/13 145367 Prop: 3 Prop: 1 Potable Water Application $67.00 ZAL 02/12/14 145759 Total: 3 Total: 1 Total: $299.50 Directions to Site: 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. Request must be received by 3pm the day before the inspection is needed. Office Hours 9:00 am -4:30 pm MONDAY - THURSDAY HOT LINE AVAILABLE 24 HOURS A DAY SPECIAL CONDITIONS APPLY-SEE ATTATCHED