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BLD2013-00120
• BUILDING PERMIT APPLIfflION BLDI3-00120 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD13-00120 Received Date: 4/17/2013 SITE ADDRESS: 2682 RAIN FOREST RD FORKS, 98331 OWNER: PAUL D ERICKSEN PHONE: 360-477-9335 or CINDY S ERICKSEN 477-8030 92 RUBY RD PORT ANGELES WA 983629127 RAIN FOREST#1 SUBDIVISION: Block: Lot: 7 PARCEL NUMBER: 991500007 Section: 30 Township: 27 N Range: 10 W CONTRACTOR: BOYNTON CONSTRUCTION INC PHONE: 360-460-7747 117 CHAMPION RD PORT ANGELES WA 98362 Contractor's License BOYNTCI952OM Expires 10/1/2013 REPRESENTATIVE: TRACY GUDGEL PHONE: 360-417-0501 ZENOVIC 301 EAST 6TH STREET, STE 1 PROJECT DESCRIPTIOI DETACHED UNHEATED GARAGE FLOOD DEVELOPMENT PERMIT TYPE OF WORK GAR SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 960 VALUATION 26,784.00 ADD'L: HEAT TYPE: UH 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: OSS WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: d / 7 /3 Type Amount Paid By: Date: Receipt: Approved/Date Permit $411.45 ZAL 04/15/13 140240 APPROVED Plan Check $267.44 ZAL 04/15/13 140240 r r R V State Building Code $4.50 ZAL 04/15/13 140240 JUN 13 2013 Total: $683.39 Jefferson County DCD Wir4cmor4\rl.f.\fnrme1G RI Il Ann R lrl rn+ All 7/71112 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#: BLD13-00120 APPLICANT: PAUL D ERICKSEN PHONE: 360-477-9335 or CINDY S ERICKSEN 92 RUBY RD PORT ANGELES WA 983629127 SITE ADDRESS: 2682 RAIN FOREST RD Issue Date: 06/13/2013 FORKS, 98331 Final Date: 7/25/2014 SUBDIVISION: 9915 Block: Lot: 7 PARCEL NUMBER: 991500007 Section: 30 Township: 27 N Range: 10 W PROJECT DESCRIPTION: DETACHED GARAGE UNHEATED NO PLUMBING FLOOD DEVELOPMENT PERMIT THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2009 EDITION. OCCUPANCY GROUP: TYPE OF CONSTRUCTION: SPRINKLER SYSTEM yes no S y THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 7/25/2014 \\tidemark\data\forms\F_BLD_Occupancy.rpt 7/25/2014 Jefferson County Building I 'ivision Permit N•er: BLD13-00120 Applicant: ERICKSEN BUILDING PERMIT INSPECTION APPROVALS Applicable Code: 2009 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 Setbacks f —Ii c Erosion Control Foundation Footing '2 —9 t_re! ini Footing Drains Foundation Stem Wall Straps(hold downs) Ext. Shear Wall Nailing (/ ?1/3 Framing 124)iL1 Blocking Wallboard Nailing Drywell/Alt Drainage Address Posted 1 III Iir FINAL INSPECTION -, \ !i\) LI FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR • • CONDITIONS for Building Permit# :BLD13-00120 1.) A"Construction Drawing" Flood Elevation Certificate was prepared by a licensed surveyor and submitted with the application. The Certificate identified the base flood elevation of feet. The lowest floor of the structure is required to be elevated at least one (1) foot above base flood elevation or feet. PRIOR TO FINAL BUILDING INSPECTION, PROPONENT SHALL PROVIDE THE DEPARTMENT WITH AN ORIGINAL"FINISHED" CONSTRUCTION" FLOOD ELEVATION CERTIFICATE THAT HAS BEEN VERIFIED BY A LAND SURVEYOR, ENGINEER, OR ARCHITECT AUTHORIZED BY LAW TO CERTIFY ELEVATION INFORMATION IN THE STATE OF WASHINGTON. 2.) New construction and substantial improvement of any residential structure shall have the lowest floor, including basement, elevated one foot or more above the base flood elevation (BFE). 3.) 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. 4.) The site plan as submitted with the Building Permit application on April 17, 2013 has been reviewed for consistency under the UDC, and has been approved by Jefferson County Department of Community Development. Any modifications, changes, and/or additions to the stamped, approved site plan dated April 17, 2013 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 5.) No plumbing has been reviewed or approved for this project by Jefferson County Public Health. Additional requirements may apply if plumbing is proposed. \\tiriamark\data\fnrmc\F RI fl PPrmit Rlrin rnt R/1�/7f11 ,1n CEIN ED (isON wc06, JEFFERJN COUNTY I-11 i i °��.r� DEPARTMENT OF COMMUNITY DEVELOPMENT APR 1 5 2013 "� 1 621 Sheridan Street • Port Townsend • Washinigtnn:98368 360/379-4450 • 360/379-4451 Fax .gS, N jj www.co.jefferson.wa.us/commdevelopment o JEFFERSON COUNTY T OF COMMUNITY DEVELOPMENT Master Permit Application MLA: Project Description (include separate sheets as necessary): eta- ridachrd dative; - Hot) , .ci1nfcrrj Tax Parcel Number: 991500007 Property Size: / 25 a-C e /square feet) Site Address and/or Directions to Property: 2632 l..aTn{orest,.cad, forks M/A 9833 I Property Owner(s)of Record: t/Ul 1, an Enckken Telephone:360 477 .9335 Qr.177•i#.I Fax: Mailing Address: BY'1 Ck �� h-y-y�� email:By/����Oh�j�f/S.Pet Mailing art Pc)Q •r"_"_".pet-, 92 ruby 1Ztz RY1- Armes, WA 2 pp (if different from owner): Tracy Gu e/ Telephone:36Q 417-050j Fax:360 417-0514- email: *rac LJz& vic.nni- Mailing Address:301 Ea5f 61h otret31- st2Tte 1: Ma- Av /l WA 9Q362 y What kind of Permit? (Check each box that applies ❑ Lot or Road Segregation Building 0 Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) EJ Single Family 1 Garage Attached/ tached > 0 Conditional Use[C(a), C(d),or C]** ❑ Manufactured Home .0 Modular 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* 0 Special Use(Essential Public Facilities)** Change of Use 0 Boundary Line Adjustment ❑ Address ❑ Road Approach 0 Short Plat** ❑ Home Business 0 Cottage Industry 0 Binding Site Plan** 0 Propane ❑ Long Plat** 0 iyrj 0 Planned Rural Residential Development(PRRD)/Amendments** • ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** ❑ Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions** ❑ Site Plan Approval Advance Determination(SPAAD)* 0 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 ❑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: I hereby designate Ti'aC �L1C�P. /.�rr1�%tPi".f DESIGNATION OF AGENT y .// j Pd'7`r�l/ i act as myagent in matters relating to this application for permit(s). OWNER SIGNATURE , j, Date: // April 20/3 By signing this application f ,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 application that he or she wants prior notice. Signature: dt) '4F"1 70/3 Date: J/ The action or actin 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 resp nsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: Date: // Apr/l 200 G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc ' 1110 BUILDER STATEMENT 410 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: PFu:NE: FAX: Paul aornton ,./ ( 0) 4607747 ( ) MAILING ADDRESS: I/7 Champion Kd. Port Angeles,WA EMAIL.: CONTRACTOR'S LICENSE 9636z WAINS 80YNTC/9520M NUMBER NUMBER: --ARCHITECT/ENGINEER: FAX:(5� L�1"7.O5'c}. CZ50I Tracy Gtldgel P.E• PHONE (550 417"EMAIL MAILING ADDRESS: f e 0Zenovic.net 30I E. SiXth SI(COI, fart At�eles, WA 9t?362 Shoreline:eline: Type of Sewage Disposal: Project Type: Frame Type: Bathrooms: pewer New Wood ExistiM: Steel Propose . Bank a Community System • iti tal: I _ Height: g Individual System • Alte tion/Remo ❑ Concrete SEP Permit# 5EPla-00029 Ei Repair ❑ Masonry Bedrooms. Water Supply: • Demolitio Other: Existing: _ Setback: ❑ Private well ❑ Two Parry Propo d: ri Public $ U ig Type of eat: d Total: I Name of Syste : IY h JVa1°x OS', c0445 If this is a Commercial Project you must answer the following: Number of ADA Parking Spaces: Number of Parking Spaces: Current: Proposed: Number of occupants (includes owners,tenants,employees, etc) Current Proposed IBC T e of construction: Will you have Food Service? Yes / No 13C Occupancy: Type If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: I Un ound Tank i Above ground Tank Size of OfcaTe Tank: i Heat Stove I ----1_WriStnve i Fireplace Insert i H ank i Pellet Stove I Other Is this a piia ce being installed in a Manufactured/Mobile Ho e? 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. Amount Revision S•uare Foota•e Current Proposed For Office Use O EHBld App Review: �j. 00 Main Floor Heated ' / 2"°Floor Heated — Consistency Review:460-1 1,t)/NsF4 Other Heated Base fee: '7 i /r ZIs Mezzanine Additional Section: Heated Basement Plan Check fee:/ ()bit 7/9/Unheated Basement / State Surcharge fee: Li, Sv Other Unheated Pot Water Review fee: SUBTOTAL 7 / �• �(� Gag /Carp It ' 96 &/_ 7gY vi / V'� (/J ! JJ� 911/Rd Approach fee: 2 Decks �cJ ° Other _ TOTAL: $ 7�(, 39 front Forth Receipt Number: /L/0 al./O Cash/Check Number: �703 / ESTIMATED COST(REQUIRED) Date: L�/ �s/�3 'Fair maalue of all labor and materials foundation to finish Initials: ( I G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc i 12" MIN. * 2' MIN. / z j Of P:1'PN O Z o C H fm�l II— D O D m m to (n •Axm _—)I . 0)��o�ZD _III 'r) r••���•••���•� r -1 m III=I O A o -II �- ►1••❖.•o••• xl o D 0 D2 -I COI-III- _ -III-III ; In -I I • .o•.0000• o m O 0 W z I I-III=1 m r i 1= ••000••o•• 411) O o 2,0( =III—I I I— �''"D -II 00000 W� � Z m�OD � � III=III—III _ -i •••••••••••1• D D 0 to O Z m Z D r D co 0 I— ••••••••1••••• X x O n m o r m ♦•••••♦ r my m O 1—III—III-1 CA m A m -I I •••••••••••• v co N r bd m-0 m III-III-III; p Z •�•••••••••• n N ~ - cn z m , O i ••••••• a O m 0 2 I—III—III '�/ 0 , m •••••••••••• D m .00m -III—III—"/w m r _ _-1 �••••••••••••• X 0 x I m,c m K D I-III-I ,4 1=141-1-11�••• rD O r X)ZN111 �_40 < ,_,_ • �iiiiii m y °z " -I I I I I�� ,,I� .❖❖oo� ,� O m�m o D -III- I I I�e cn II- ;.,.;.;.�.;.p; 0 3 O-al 2?_z(4 -III-III 1 �-I -I I g....;.;�. 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N .t.----. vW v C oco \ m ` I 1 I o 0to \ \ m ZOmDpD \ yN �ZOz� c000 N. \ COcn NN� U Q pi 03 $ /CO \\ c) I I C m 0 W �t A N., rbc 0D= Pr \ IV _ r- * tna -0 >v • H Im�rn D tnN z0 t n x - go .,1:ii II$M •�� 1= � D z m �` \ }�nr COz � l I N w m oo i m - U.S.DEPARTM5NT OF HOMELAND SECURITY ELEVATION CERTIFICATE FEDM,AL EMERGENCY MANAGEMENT AGENCY Ask OMB No. 1660-0008 Na:ional Flood Insurance Program Ir rtant: Read the instructions on pages IIII. Expiration Date: July 31, 2015 SECTION A-PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name Paul Ericksen Policy Number: A2. Building Street Address(including Apt.,Unit,Suite, and/or Bldg. No.)or P.O.Route and Box No. Company NAIC Number: 999 Rain Forest Road City Forks State WA ZIP Code 98331 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) Parcel#991500007 Lot 7 Rain Forest Lots(Vol.6 Pg.47-Plats) SE1/4 SE1/4 S.30,T27N R10W,W.M A4. Building Use(e.g., Residential,Non-Residential,Addition,Accessory,etc.)bare ground A5. Latitude/Longitude:Lat.47-48.-33" Long. 124-02.-09" Horizontal Datum: El NAD 1927 ® NAD 1983 A6. Attach at least 2 photographs of the budding if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number Not built A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) 0 sq ft a) Square footage of attached garage 0 sq ft b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage or enclosure(s)within 1.0 foot above adjacent grade 0 within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A8.b 0 sq in c) Total net area of flood openings in A9.b 0 sq in d) Engineered flood openings? ❑ Yes ® No d) Engineered flood openings? El Yes ® No SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1.NFIP Community Name&Community Number B2.County Name B3.State Unincorp.Jefferson Co.530069-0625-B Jefferson WA B4.Map/Panel Number B5.Suffix B6.FIRM Index Date B7.FIRM Panel B8. Flood B9. Base Flood Elevation(s)(Zone 625 of 1625 B 7/19/82 Effective/Revised Date Zone(s) AO,use base flood depth) 7/19/82 A Local evidence B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. ❑ FIS Profile 0 FIRM ❑ Community Determined ® Other/Source:local observation and history B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 El NAVD 1988 0 Other/Source:assumed elevation B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? 0 Yes 0 No Designation Date: ❑ CBRS 0 OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) Cl. Building elevations are based on: 0 Construction Drawings' 0 Building Under Construction' El Finished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations-Zones A1-A30,AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,AR/AE,AR/A1-A30,AR/AH,AR/AO.Complete Items C2.a-h below according to the building diagram specified in Item A7.In Puerto Rico only,enter meters. Benchmark Utilized: NW cor.PUD pad Vertical Datum: 100.00'assumed L' Indicate elevation datum used for the elevations in items a)through h)below. ❑ NGVD 1929 ❑ NAVD 1988 El Other/Source:assumed Datum used for building elevations must be the same as that used for the BFE. Ul Check the measurement used. I a) Top of bottom floor(including basement,crawlspace,or enclosure floor) n/a. ❑feet ❑meters b) Top of the next higher floor n/a. 0 feet ❑meters c) Bottom of the lowest horizontal structural member(V Zones only) Na. El feet ❑meters / d) Attached garage(top of slab) n/a. ❑feet ❑meters 6 e) Lowest elevation of machinery or equipment servicing the building Na. El feet 0 meters (Describe type of equipment and location in Comments) f) Lowest adjacent(finished)grade next to building(LAG) 97.80 ®feet ❑meters g) Highest adjacent(finished)grade next to building(HAG) 101.16 ®feet 0 meters h) Lowest adjacent grade at lowest elevation of deck or stairs,including structural support Na. ❑feet 0 meters SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION ''S ,y. This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation T' w .�°;,`• t, .. information.I certify that the information on this Certificate represents my best efforts to interpret the data available. Ii 0 I understand that any false statement may be punishable by fine or imprisonment under 18 U.S.Code,Section 1001. �<`-;=, O Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a 'v: '.1.- i i ® Check here if attachments. licensed land surveyor'? 0 Yes 0 No j ( �' s • t j Certifiers Name Dan P. Kousbaugh License Number RLS#11983 1 13 � /, ? <-i G. �, 1iS":34.›...1,: Title President Company Name Dan Kousbaugh Surveying Inc,P.S. : \ ti �,/ `•'' �'' Address 0 Spruce Drive City Forks State WA ZIP Code 98331 `�J�AL LAt1O8�` i Signature. , to 2/1/13 Telephone (360)374-5720 \ 'hl ` � � 2 / /3 IMPORTANT: In these spaces,copy the cifiEsponding information from Section A. iv_ FOR INSURANCE COMPA lY USE Building Street Address(including Apt.,Unit,Suit /or Bldg. No.)or P.O.Route and Box No. Policy Number: 999 Rain Forest Road City Forks State WA ZIP Code 98331 Company NAIC Number: SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agent/company,and(3)building owner. Comments This site is bare ground at the present but did contain two travel trailers at one time. A benchmark was established on the property at the NW corner of the base pad for the PUD transformer at 100.00'. Two local property owners were consulted as to their highest observed flood levels in this area. They picked different sites about 500'east-west of each other. Flood level noted was 91.31'at each site. The original Brandeberry homestead floor level com m t92.51'.� Signa ure Date 2/1/13 SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zones AO and A(without BFE),complete Items El-E5. If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B, and C.For Items El-E4,use natural grade,if available.Check the measurement used.In Puerto Rico only,enter meters. El. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade(HAG)and the lowest adjacent grade(LAG). a)Top of bottom floor(including basement,crawispace,or enclosure)is n/a. ❑feet ❑meters ❑above or❑below the HAG. b)Top of bottom floor(including basement,crawispace,or enclosure)is n/a. ❑feet ❑meters ❑above or❑ below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 8-9 of Instructions),the next higher floor (elevation C2.b in the diagrams)of the building is Na. ❑feet ❑meters ❑above or ❑below the HAG. E3. Attached garage(top of slab)is n/a. ❑feet ❑meters ❑above or ❑below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is n/a. ❑feet ❑meters El above or❑below the HAG. E5. Zone AO only: If no flood depth number is available,is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? ❑Yes ❑ No ® Unknown.The local official must certify this information in Section G. SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The property owner or owner's authorized representative who completes Sections A,B,and E for Zone A(without a FEMA-issued or community-issued BFE) or Zone AO must sign here.The statements in Sections A,B,and E are correct to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name Dan P. Kousbaugh Address 450 Spruce Drive City Forks State WA ZIP Code 98331 Signature ;/ Date 2/1/13 Telephone (360)374-5720 /L - Comments Highest observed flood levels of 2003 flood( .31')are below projected building site elevation and floor level of old Brandeberry homstead. 0 Check here if attachments. SECTION G-COMMUNITY INFORMATION(OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A,B,C(or E),and G of this Elevation Certificate.Complete the applicable item(s)and sign below.Check the measurement used in Items G8-G10.In Puerto Rico only,enter meters. G1. El The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,engineer,or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO. G3. El The following information(Items G4-G10)is provided for community floodplain management purposes. G4.Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for: ❑ New Construction ❑Substantial Improvement G8. Elevation of as-built lowest floor(including basement)of the building: ❑feet ❑meters Datum G9. BFE or(in Zone AO)depth of flooding at the building site: ❑feet ❑meters Datum G10. Community's design flood elevation: ❑feet ❑meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments ❑Check here if attachments. • r O S 1 11.L., . .. . . . .. . —... :-. . . . . G. M 4 r Ell . ,.... 1-4 -1 - �O • - ., ..... \ _________ rn Z \\\\ 11 al N ,� / 0 tr ii 11 xa017 WfloS I I —J !I II I II IAmmiliggillk // Al gomi&'a aQ�x� a8Qa� o' pq p�tp mM,777,—;;4,-77; ii� fNfp!�T� r� `+ '.��y.j 't7 O �am�� 8f C 9~ z ra � C i 7J „p_q 3 =as O i1r' Cs7 ,' •-''..2:- tT 0 A D�'?�Q G x� .may 7" y I X —& e 11 rim m oo y ��3 m e oD �Z a • v Hill I r� II r Oq n g �`w tom a H31. NI m erg corn camp o$ °�°� tOy CT z rn m. EU!! r Da s Topo USA®6.0 • Ericksen Exhibit Map a / CO m 7. i m Highest observed flood=91.31'in this area p �� / P Proposed Ericksen Homesite Srandeberry Homestead floor Elev.=92.51' Ground Elev. 90.58'to 100.09' al.RANDE6ERRY RD U:'- �j.l Bi letem-R l NpE 8RP Scale 1:6.400 ft 0 200 400 600 800 1000 MN(16.8°E) 1"=533.3 ft Data Zoom 15-0 H-1000 Data use subject to license. ©2006 DeLorme.Topo USA®6.0. www.delorme.com 1. • • . • .,. {{jjy • €� ^ flux g c�---Z—�— tom, Y4 3 a !a ; �€iy #u^�e: yziiii '� t co 4 i N I F : S YCC i4 '�izil R a.� Y 1,11116i •;. 1 6$ tN. ; a7 L x 11Mt gs ``'' i lii ;j§ lrg t= xiC r-I.s.-4 #rill z al Gsa •% fL •f i`.A r cgs ' 'i%�c,, S' 1 bs`{ i s i^Lt r ei 13,xt'i q1ii i=f` B L+ F7j `t "� t \ '1 ! F�'e IIij . ::Iit1W1i i.ni PISi3t1;� • a �,�- Is 1— -, 4 I.-\s,,„ i;i4i-t.'451.:r i g I 1-"ce n, ?. ! 0f� + =8: % m co Avg A . ' in \ j,� - \\� W L 3 - Rg 0 rn cgt\ �� o \� - v� of O J < "S, _'' Q a \ r - J N h a l i t ‘. 01° � -y/j"d i 0 Z \ . o\ -,_\- 1 . =-61 N \,r ,„j, - z r ^° \ - �� i try\ }�r g•'\ �\ +� H 0. .eo \ l,:4,, Sg&il:...."." \t\\I,\\\ § --'�0�•]p'1-ia — fit—. lliI.: ai 1 p r o 4• i I 4: n rg 1 :,;. Aaii j'ill J :L. ° f,.... ., ,„...wee--7'r-------\-c\7- -:' -------___.!..\it I, it 2 1: a s Y 'I i' : ; t,Y,IX H, g E Q SI y r 4.R� t i :11.........., ` c g 1 1! ...1, 0;11 . . • 1 f l'a 1 I t,.) ... , , .1 ,.3.. 7 E81 1 i! -1 .., a v F • 570770 PGS F1•WDl� Jefferson County •p c. tor's Offio•- Donn Eldridp•, ikdilor k�'il�all�tlM,l1 'L�NII ,i�+611Y4' rl*Via Pi i When recorded recOf return`" Jefferson County Excise Tax Paul D.Ericksen and Cindy S.Ericksen Aft # 1 1 82 0 4 C'te t b�)�j12.D) 92 Ruby Road Port Angeles,WA 98382 Tax 53t� . ��'F °:r�i �b?611) fly eputy Treasurer STATUTORY WARRANTY DEED 78089—JTc Escrow No.: 3597 Title Order No.: 1$08''9 THE GRANTOR(S) Karen Culver,as her sepal ate estate for and in consideration cf ten dollars and other good and valuable col =.•n in •.nd paid,conveys, and warrants to Paul D.Ericksen and Cindy S.Ericksen,husband and wife the following described real estate,situated in the Coun of Je = • , . •f Washington: Lot 7 of Rain Fore3t Lots Division 1,as per Platt •ed In V m 6 of Plats,page 47,records of Jefferson County,Washington Subject to: Easements recorded under Auditor's File 205g3 and 375207 Covenants,conditions,restrictions and/or easements recorded under Auditor's File No.254563 Restrictions, conch ors, dedications, to easemerlis and provisions contained and/or delineated on the facto of tho Plat record der ditor's File No.254585 Loss or damage by reason that there appears recorded right of access to and from the land herein described to a public right of w• Tax Parcel Number(s): 9915(}v007 Dat : /UfJ 4_f/� Ka Culver STATE OF WASHING ss COUNTY OF ( ) I certify that I know or fact evidence that Karen Culver is the person who appeared before me,and said pe ackedg at she signed this instrument and acknowledged it to be her free and voluntary act for se and purposes mentioned in this instrument Dated: 1 V 2 TERESA I.WAY Notary Public State of Washington My Commission Expires Notary P c the sta,e Was ngton May 15, 201 6 Residin TA 1(1, My a nt ex r.:i � LPB 10-05(Ir-I) LQ�\ o .30.�s2✓-c,j -34.4,6 31lt 'g Z 3 z Page 1 of 8 Copyright by National Fire Protection Association (NFPA). NFPA 1962 is licensed, by agreement for individual use. No other reproduction or transmission in any form permitted without written permission of NFPA. For inquires or to report unauthorized use, contact licensing@nfpa.org. ?\/ / 9 Print (Close) Chapter 4 Care Use Inspection Service Testing And Replacement Of Fire Hose 4.8 Service Testing Attack, Supply, and Forestry Hose. 4.8.1 Hose manufactured prior to July 1987 to meet the requirements of the 1979 and previous editions of NFPA 1961, Standard on Fire Hose, shall be removed from service. 4.8.2* Hose manufactured during July 1987 or after that date to the 1987 or subsequent editions of NFPA 1961 shall be service tested as specified in Section 4.8. 4.8.2.1 Attack fire hose shall be service tested to a minimum of 300 psi (20.7 bar or 2070 kPa) or a pressure not to exceed the service test pressure marked on the hose. 4.8.2.2 Supply fire hose shall be service tested to a minimum of 200 psi (13.8 bar or 1380 kPa) or a pressure not to exceed the service test pressure marked on the hose. 4.8.2.3 Forestry fire hose shall be service tested to a minimum of 300 psi (20.7 bar or 2070 kPa) or a pressure not to exceed the service test pressure marked on the hose. 4.8.2.4 Occupant-use hose shall be tested to the service test pressure marked on the hose. 4.8.2.5 Proof pressure tests for hoses shall be conducted only at the point of manufacture or at a facility equipped to perform those tests. 4.8.2.6 Tests in the field shall not subject the hose to its proof test pressure. 4.8.3 After the correct service test pressure has been determined for each length of hose to be tested, the service test shall be conducted as specified in Section 4.8.4. 4.8.4 Service Test Procedure. 4.8.4.1 Each length of hose to be service tested shall be inspected as specified in Section 4.5. 4.8.4.2 Any length of hose that fails the inspection shall be removed from the service test area and repaired as necessary or condemned. / .. II I I• !` I . I I I • / • , !` • I n V"n L1 IN 1 Page 2 of 8 Copyright by National Fire Protection Association (NFPA). NFPA 1962 is licensed, by agreement for individual use. No other reproduction or transmission in any form permitted without written permission of NFPA. For inquires or to report unauthorized use,contact licensing@nfpa.org. 4.8.4.3 All lengths of hose in the same hose line shall be of the same service test pressure. 4.8.4.4* The total length of any hose line in the hose test layout to be service tested shall not exceed 300 ft (91 m). 4.8.4.5 The hose test layout shall be straight, without kinks or twists. 4.8.4.6* All 3 1/2 in. (89 mm) and larger diameter hose shall be service tested while lying on a horizontal surface. 4.8.4.7* A test location shall be selected that allows connection of the hose testing apparatus (pressure source) to a water source. 4.8.4.8* A hose testing machine, a stationary pump, or a pump on a fire department apparatus shall be used as a pressure source. 4.8.4.8.1 If a hose testing machine is used, the procedure defined in 4.8.5 shall be used. 4.8.4.8.2 If a stationary pump or a pump on a fire department apparatus is used, the procedure defined in 4.8.6 shall be used. 4.8.4.9 At the conclusion of the test, the hose records specified in Section 4.11 shall be updated to indicate the results of the service test for each length of hose tested. 4.8.4.10* Any hose that fails the inspection defined in Section 4.5, bursts or leaks during the service test, or has couplings that leak or are otherwise found defective as defined in 7.1.3 shall be tagged as required in 4.11.1.6 or 4.11.3.6 and removed from service. 4.8.4.10.1 If the hose leaks or the hose jacket fails inspection, a distinguishing mark noting the location of the defect(s) shall be placed on the hose. 4.8.4.10.2 If the couplings fail or are defective, they shall be repaired or replaced. 4.8.4.10.3* If the hose cannot be repaired, the couplings shall be removed from both ends. http://codesonline.nfpa.org/components/com book navigation/printer frie... 10/29/2013 Page 3 of 8 Copyright by National Fire Protection Association (NFPA). NFPA 1962 is licensed, by agreement for individual use. No other reproduction or transmission in any form permitted without written permission of NFPA. For inquires or to report unauthorized use, contact licensing@nfpa.org. 4.8.4.11 If the hose is repaired, or the couplings are repaired or replaced, the hose shall be service tested in accordance with Section 4.8 before being placed back in service. 4.8.4.12 After testing, all hose shall be thoroughly cleaned, drained, and dried as specified in Section 4.6 before being placed in service or in storage. 4.8.5 Service Test Using a Hose Testing Machine. The procedure defined in this subsection shall be used when hose is service tested using a hose testing machine. WARNING: Because there is a potential for catastrophic failure during the service testing of fire hose, it is vital that safety precautions be taken to prevent exposure of anyone to this danger. Do not deviate from the procedures prescribed herein. 4.8.5.1 Hose Testing Machine Integrity. The condition of the hose testing machine shall be thoroughly checked daily before each testing session and before the machine is used after being transported to a new testing site. 4.8.5.1.1 The hose testing machine shall be carefully examined for damaged components that might fail during the test. 4.8.5.1.2 If any damage is discovered, the hose testing machine shall not be used until the damaged component(s) is repaired or replaced. 4.8.5.1.3 A pressure leak integrity test shall be performed on the machine to determine whether the pressurized outlet side of the machine and its related components are leak-free. 4.8.5.1.3.1 The fire hose outlet connection(s) of the machine shall be capped or otherwise closed. 4.8.5.1.3.2 Pressure shall be applied through the machine using the integral pump to a level that is 10 percent higher than the highest service test pressure needed for the hose to be tested. 4.8.5.1.3.3 The pressure shall be held for 3 minutes with the pump turned off. 4.8.5.1.3.4 If leaks are detected, the testing machine shall not be used until the leaking component (s) is repaired or replaced. 4.8.5.1.4 The test gauge that is used to read the test pressure shall have been calibrated within the previous 12 months. http://codesonline.nfpa.org/components/com book navigation/printer frie... 10/29/2013 Page 4 of 8 Copyright by National Fire Protection Association (NFPA). NFPA 1962 is licensed, by agreement for individual use. No other reproduction or transmission in any form permitted without written permission of NFPA. For inquires or to report unauthorized use, contact licensing@nfpa.org. 4.8.5.1.5 If the hose machine incorporates elevated outlets for water supply that are higher than the inflated diameter of the hose from the testing surface, a means to vent trapped air shall be provided between the hose and the outlet valve. 4.8.5.2 Conducting the Test. 4.8.5.2.1 The test layout shall be connected to the outlet side of the water supply valve on the hose testing machine. 4.8.5.2.2 A test cap with a bleeder valve shall be attached to the far end of each hose line in the test layout. If a test cap is not available, a nozzle with a nontwist shutoff shall be permitted to be used. 4.8.5.2.3 With the test cap valve or the nozzle open, the pressure shall be raised gradually to 45 psi ± 5 psi (3.1 bar ± 0.35 bar or 310 kPa ± 35 kPa). 4.8.5.2.4* After the hose test layout is full of water, all the air in each hose line shall be exhausted by raising the discharge end of each hose line above the highest point in the system. WARNING: All air must be removed from the hose before the valve in the test cap or the nozzle is closed and the pressure raised. The development of test pressures introduces the potential for a serious accident if air remains in the system. 4.8.5.2.5 If the hose testing machine incorporates elevated outlets for water supply that are higher than the inflated diameter of the hose from the testing surface, air shall be vented next to the water input end. 4.8.5.2.6 The nozzle or test cap valve shall be closed slowly, and then the outlet water supply valve shall be closed. 4.8.5.2.7* The hose directly in back of the test cap or the nozzle shall be secured to avoid possible whipping or other uncontrolled reactions in the event of a hose burst. 4.8.5.2.8 With the hose at 45 psi ± 5 psi (3.1 bar ± 0.35 bar or 310 kPa ± 35 kPa), it shall be checked for leakage at each coupling and the couplings tightened with a spanner wrench where necessary. 4.8.5.2.9* Each hose shall then be marked around its full circumference at the end or back of each coupling or collar to determine, after the hose has been drained, if the coupling or collar has slipped during the test. 4.8.5.2.10 All personnel other than those persons required to perform the remainder of the http://codesonline.nfpa.org/components/com book navigation/printer frie... 10/29/2013 Page 5 of 8 Copyright by National Fire Protection Association (NFPA). NFPA 1962 is licensed, by agreement for individual use. No other reproduction or transmission in any form permitted without written permission of NFPA. For inquires or to report unauthorized use, contact licensing@nfpa.org. procedure shall clear the area. 4.8.5.2.11 The pressure shall be raised slowly at a rate not greater than 15 psi (1 bar or 103 kPa) per second until the service test pressure is attained and then maintained, by pressure boosts if necessary, for the duration of the stabilization period. 4.8.5.2.12 The stabilization period shall be not less than 1 minute per 100 ft (30 m) of hose in the test layout. 4.8.5.2.13 After the stabilization period, the hose test layout shall hold the service test pressure for 3 minutes without further pressure boosts. 4.8.5.2.14 While the hose test layout is at the service test pressure, the hose shall be inspected for leaks. 4.8.5.2.14.1 If the inspecting personnel walk the test layout to inspect for leaks, they shall be at least 15 ft (4.5 m) to the left side of the nearest hose line in the test layout. The left side of the hose line shall be defined as that side that is to the left when facing the free end from the pressure source. 4.8.5.2.14.2 Personnel shall never stand in front of the free end of the hose, on the right side of the hose, or closer than 15 ft (4.5 m) on the left side of the hose, or straddle a hose in the test layout during the test. 4.8.5.2.15 If the hose test layout does not hold the service test pressure for the 3-minute duration, the service test shall be terminated. 4.8.5.2.15.1 The length(s) of hose that leaked shall have failed the test. 4.8.5.2.15.2 The test layout shall be drained and the defective hose removed from the test layout. 4.8.5.2.15.3 The service test shall be restarted beginning with the procedures required in 4.8.5.2.1. 4.8.5.2.16 After 3 minutes at the service test pressure, each test cap or nozzle shall be opened to drain the test layout. 4.8.5.2.17 Coupling Slippage. 4.8.5.2.17.1 The hose and any marks placed on the hose at the back of the couplings or at external http://codesonline.nfpa.org/components/com book navigation/printerfrie... 10/29/2013 Page 6 of 8 • Copyright by National Fire Protection Association (NFPA). NFPA 1962 is licensed, by agreement for individual use. No other reproduction or transmission in any form permitted without written permission of NFPA. For inquires or to report unauthorized use,contact licensing@nfpa.orq. collars shall be observed for coupling slippage after completion of the service test and after the hose has been drained. 4.8.5.2.17.2 If the hose assembly shows any sign of coupling slippage, the hose assembly shall have failed the test. 4.8.6 Service Test Using a Stationary Pump or a Pump on a Fire Department Apparatus. The procedure given in 4.8.6.1 through 4.8.6.16.2 shall be used when hose is to be service-tested using a stationary pump or a pump on a fire department apparatus. WARNING: Because there is a potential for catastrophic failure during the service testing of fire hose, it is vital that safety precautions be taken to prevent exposure of anyone to this danger. Do not deviate from the procedures prescribed herein. 4.8.6.1 The test gauge that is used to read the test pressure shall have been calibrated within the previous 12 months. 4.8.6.2* A hose test valve consisting of a fire department gate valve with a 1/4 in. (6.4 mm) opening drilled through the gate and designed to withstand the service test pressures shall be used between the pump and the hose test layout. 4.8.6.3 The test layout shall be connected to the hose test valve. 4.8.6.3.1 If a pump on a fire apparatus is used, the hose test valve shall not be attached to any discharge outlet at or adjacent to the pump operator's position. 4.8.6.3.2 The hose test valve end of the hose line shall be secured with a belt tie-in or rope hose tool at a point 10 in. to 15 in. (250 mm to 400 mm) from the coupling. 4.8.6.4 A test cap with a bleeder valve shall be attached to the far end of each hose line in the test layout. If a test cap is not available, a nozzle with a nontwist shutoff shall be permitted to be used. 4.8.6.5 With the hose test valve open and the test cap valve or nozzle open, the pressure shall be gradually raised to 45 psi ± 5 psi (3.1 bar ± 0.35 bar or 310 kPa ± 35 kPa). 4.8.6.6* After the hose test layout is full of water, all air in each hose line shall be exhausted by raising the discharge end of each hose line above the highest point in the system. WARNING: All air must be removed from the hose before the valve in the test cap or the nozzle is closed and the pressure raised. The development of test pressures introduces the potential for a serious http://codesonline.nfpa.org/components/com_book_navigation/printer_frie... 10/29/2013 Page 7 of 8 Copyright by National Fire Protection Association (NFPA). NFPA 1962 is licensed, by agreement for individual use. No other reproduction or transmission in any form permitted without written permission of NFPA. For inquires or to report unauthorized use, contact licensing@nfpa.org. accident if air remains in the system. 4.8.6.7 The nozzle or test cap valve shall be closed slowly, and then the hose test valve shall be closed. 4.8.6.8* The hose directly in back of the test cap or the nozzle shall be secured to avoid possible whipping or other uncontrolled reactions in the event a hose bursts. 4.8.6.9 With the hose at 45 psi ± 5 psi (3.1 bar ± 0.35 bar or 310 kPa ± 35 kPa), it shall be checked for leakage at each coupling and the couplings tightened with a spanner wrench where necessary. 4.8.6.10* Each hose shall then be marked around its full circumference at the end or back of each coupling or collar to determine, after the hose has been drained, if the coupling or collar has slipped during the test. 4.8.6.11 All personnel other than those persons required to perform the remainder of the procedure shall clear the area. 4.8.6.12 The pressure shall be raised slowly at a rate not greater than 15 psi (1 bar or 103 kPa) per second until the service test pressure is attained and then maintained for 3 minutes. 4.8.6.13 While the test layout is at the service test pressure, the hose shall be inspected for leaks. 4.8.6.13.1 If the inspecting personnel walk the test layout to inspect for leaks, they shall be at least 15 ft (4.5 m) from either side of the nearest hose line in the test layout. 4.8.6.13.2 Personnel shall never stand in front of the free end of the hose, stand closer than 15 ft (4.5 m) on either side of the hose, or straddle a hose in the test layout during the test. 4.8.6.14 If, during the test, a section of hose is leaking or a section bursts, the service test shall be terminated. 4.8.6.14.1 The length(s) of hose that leaked or burst shall have failed the test. 4.8.6.14.2 The test layout shall be drained and the defective hose removed from the test layout. http://codesonline.nfpa.org/components/com_book navigation/printerfrie... 10/29/2013 Page 8 of 8 • . ' Copyright by National Fire Protection Association (NFPA). NFPA 1962 is licensed, by agreement for individual use. No other reproduction or transmission in any form permitted without written permission of NFPA. For inquires or to report unauthorized use, contact licensing@nfpa.org. 4.8.6.14.3 The service test shall be restarted beginning with the procedures required in 4.8.6.3. 4.8.6.15 After 3 minutes at the service test pressure, the pump shall be shut down, the hose test valve opened, the pressure allowed to equalize with the source, the pump discharge gates closed, and each test cap valve or nozzle opened to drain the test layout. 4.8.6.16 Coupling Slippage. 4.8.6.16.1 The hose and any marks placed on the hose at the back of the couplings or at external collars shall be observed for coupling slippage after completion of the service test and after the hose has been drained. 4.8.6.16.2 If the hose assembly shows any sign of coupling slippage, the hose assembly shall have failed the test. http://codesonline.nfpa.org/components/com book navigation/printer frie... 10/29/2013