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HomeMy WebLinkAboutBLD2013-00120 • 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 tO■ I � 4. „ � HI II ; iI u!I $o m I11I . I �$ m 2 O 3i 2 si g° $ Mmc I I � I Il I � . $ 0 6 tg> N° > �e x l II11 ilir (n \ 8 O c�i� N� $w r III I i 1 I . 1 Q �, v 5201 1 NZ ; 5 r,g op 8 N I I I I I I I 1 I I I o � \. �� Z � � �, N�e � IIII ; IIi ;i : /f /I! ; : : . : : : Z P . w =is g0.0 70 iiI F�i CO 1914 Cl XI I // � ^ 1 , \ \` 11\ J` al -4 • I/1 II( ( I :LIN: fj 1 i : ll ,O 1 I ..... � � 1 . NI \I. 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I 1-0 : 00-`R \\ �1 Z p ___,------ \ �� CrD'I* c.; `� CA .,_. -.2:1r-1.4 I I vt . , ... 1 '•<..- gpci*ci _.. _ m Ikki o I-4 1 NI 2:1 0 SILT 1 Nis \ Zte2 .. .. 1 • - , N m r 1 cm • Jefferson County 9 Buildin vision Permit Number: 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 (� !Q —t3 y ' Erosion Control Foundation Footing 1-w— 7 rev(39, Footing Drains Foundation Stem Wall Straps(hold downs) Ext.Shear Wall Nailing qj r I/? Framing 5124 H Blocking Wallboard Nailing Drywell/Alt Drainage Address Posted -11 (-Z I I FINAL INSPECTION 1\11 I L 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. \\tirlamark\rlata\fnrmc\F RI 1) Parmit Rlrin rnt R/11/7f111 ‘4.1„ 8„0,4_4D A rAzoacd.6 ify f5 3 -,6t, 7e07 D/Fais, g 26s 4- pA„r BA44,4„00 ( &z47 ) P Ae/4, 71)4,/,, ,reC1-1' v 33 ue BUILDING PERMIT • Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD13-00120 Received Date: 4/17/2013 SITE ADDRESS: 2682 RAIN FOREST RD Issue Date 6/13/2013 FORKS, 98331 Expiration Date 6/13/2014 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 BOYNTCI9520M Expires 10/1/2013 PROJECT DESCRIPTION: DETACHED GARAGE UNHEATED NO PLUMBING 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: WATER SYSTEM: 00445 Type Amount Paid By: Date: Receipt: BEDROOMS: BATHROOMS: Permit $411.45 ZAL 04/15/13 140240 Exist: Exist: Plan Check $267.44 ZAL 04/15/13 140240 Prop: Prop: State Building Code $4.50 ZAL 04/15/13 140240 Total: Total: Total: $683.39 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 —..7 _, 1. \\I 1‘ '''',. -,,-N, t; f' zN . .., ._. _ , 4 x. T- / -.:"; , //' '.L.f.I , .. „ ..; / , '' I . , ol. a ,,-a„ . , I , — 11 0 ,.., \s 7.,,,,-,,:s,•-,- , t.,;- , -,;',„ •f, . ''',..'N i„. :7-''7 ''- f.°-.-;. : ...z.','”, ,i ,... .. , 1, ''•..',,_.,•\ >..- .- ,. c> -z-•..--.. ,..,',. '_-• '':.°°. a;:..°'_:— , ,.....: ,, , 1 1 $ C., 1, .,„ , - .7""-,-.: I I N cr, I: , '---. , .-- ,--.' I '''•.'.',.j I ',I "..g: ro -o... a.3 o.... a, .. 7, W•...., i• , f,'„?..,. Et.7'..,r(2, c.> / , 1*. .., . ,;/ 19.9 , , „, 7 f:., „!•<„,i,t,,,,,.;7,.1.4.° ", c. '?..'• 0 ,'.- .• , -.....;c; , ! ... -,,,•;:imm•-3,v.,:.;.,,;ks,k-' ,...k . ,, , • • V:V.. k •,,.k";t4t,k, • -... ! "k —-;! ._ : -k.,,,,'(!.:,,'1•!---k-g,;A.0.,k; !'.::-; t '''.0:. k •k.k‘,,,,,,V ! , 7., , 14! 1 a -1 . L , , ,.-4! • F.: ; ,.;•!, , -.J,4., 4-", -l 4,;1, !TI- r-, T,T7 • ':, -- ' , - -0- '"•;:' ;.4 ,-7, :;'„ ' t :7 ;,,; Jr; 7 :7;;1 ,-- .. • 41, I? r, 0 , ■-•, ,ti,: i ],-,- , .7., , 2, o, :':j i,., ,." ',.., —, ■ ,- I;•:, i i , •i ! . ! 4:74 o "C3491›,-/-v-t5 13 t. ,- 4P0 3-1"k''g i 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. l "-P/4. / 9 , / it 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 precc1 4.8.3 After the correct service test pressure has bei 7'J tested, the service test shall be conducted as specified _ 4.8.4 Service Test Procedure. 4.8.4.1 Each length of hose to be service tested shall 4.8.4.2 Any length of hose that fails the inspection sha IOf 10 repaired as necessary or condemned. Page2of8 Copyright b National Fire Protection Association (NFPA). NFPA 1962 is licensed, by agreement for by � 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.oro. 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 t 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 f 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/combook navigation/printerjrie... 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.org. 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 h tt P://codesonline.n�a.or com onents/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/printer frie... 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 Directions to: 2682 Rain Forest Road (Lot#7)—Property of Paul anad Cindy Ericksen Travel Highway 101 through Forks and beyond the Upper Hoh Road and Hoh River bridge you will see signage for the Hoh Clearwater-South Fork and Olympic Correction Center—Turn left onto the paved road traveling^'7.1 miles. Sign for the South Fork Hoh will be on your L—turn left.At the 2.3 mile mark you will see Maple Creek Road sign on your L—follow the road to the right road becomes gravel;travel—6.4 miles to Rain Forest Road (small sign on the right hand side of the road with pink tape/tree marked with pink tape on right hand side of the road). Turn L on to Rain Forest Road. As you near the Hoh River you will first see buildings on your right.The road will fork-turn right traveling past a yellow ranch home Brandberry Homestead see plat map with green highlights. Just before you reach lot#7 there is a tie road on the right with 3 small logs forming a corner.Turn R there. Lot 7 is on the left hand side of the road. 1 ECEovE0 April 15,2013 D Jefferson County APR 1 5 2013 Department of Community Development 621 Sheridan Street 1 DEPT OF COMMUNITYDEVEIOPMENT Port Townsend, WA 98368 To Whom it May Concern: This letter serves as a written notice that we would like advance notice of inspections relate to this application due to the remote location of the property, namely, 2682 Rainforest Road, Forks, WA. The property is approximately 140 miles from Port Townsend and a 7 hour round trip. Our intention would be to attempt to meet the inspector at the site so as to facilitate accurate and timely communication of findings during inspections so as to both expedite any needed improvements and ensure the efficient use of Jefferson County staff time. Additionally, if there is a process by which photographs can be taken and would be considered sufficient to document certain inspections,we would be happy to provide photographs for inspections deemed appropriate for needed inspection documentation. This is again suggested to ensure the efficient use of Jefferson County staff time. Thank you for consideration of this request. Paul and Cindy Ericksen 92 Ruby Road Port Anges,WA 98362 _ Cell Cindy: (360)477-93354r� ., ���: (la ., Cell Paul: (360)477-8030 rra n +he I 0-T ear fill"firt, ?id P' (tt' it(413 • • r s6O co�� JEFFERSON COUNTY DEPARTMENT OF COM UNITY DEVELOPMENT � ` 621 Sheridan Street I Port Townsend,WA 98368 I Web:www.co.Jefferson.wa.uslcommunitvdevelopment gst1iNO Tel:360.379.4450 Fax:360.379.4451 Email:dcdQco.iefferson.wa.us •) Building Permits&Inspections I Development Consistency Review I Long Range Planning I Watershed Stewardship Resource Center June 12, 2013 Property Owner: Paul & Cindy Ericson 92 Ruby Rd Port Angeles, WA 98362-9127 Permit Applied For: New Single Family Residence and Detached Garage, Unheated, No Plumb. Flood Dev. 2682 Rain Forest Rd. BLD13-120 & BLD13-121 This memo is in response to your request to prepare ground for and place forms for footings and foundation prior to permit issuance. This can be done with the following conditions: 1) The area for the structure must be staked out per the attached site plan with required setbacks. 2) The setback inspection called in and signed off before footing and foundation forms are set up. Setback Signoff 3) Foundation inspection must be called in and passed prior to pour. Ftg/Fdtn Signoff This work being completed prior to the issuance of the permit is being done at your own risk. Concurrence from the property owner or appointed representative is required by signature below. G.....c E. Lly2,........... _.., -/ Property Owner Carl Smith or Appointed Representative Director/Building Official h CCOVI "4, JEFFER 3N COUNTY hDEPARTMENT OF COMMUNITY DEVELOPM: . 1 I APR 1 5 2013 621 Sheridan Street • Port Townsend •Wash. •to,'+ 98368 360/379-4450 • 360/379-4451 Fax & p', www.co.w.cojefferson.wa.us/commdeve JEFFERSON COUNTY gs► NG' ) P D PT.OF COMMUNITY DEVELOPMENT Master Permit Application MLA.: Project Description(include separate sheets as necessary): - deicichnft Garage - t/oh ealnf2Cesl Tax Parcel Number: 991500007 Property Size: 1.25 re ac square feet) Site Address and/or Directions to Property: 2652 kainrorest Raid, forks WA 98331 Property Owner(s)of Record: TUI ' G Enbkser) Telephone:360 477.9335 ar477.i#.I Fax: email:frt.jc eop 034 ,SS net Mailing Address: ttY1 Ckeenpc�Ol}/h'pis.lit} 97 2ubyLRcrac4 R)rt Atryie5, WA X362 — Applicant/• •- (if different from owner): Tracy Gu Telephone:360 417-0501 Fax:360 40514 email:*t'a.0 y Oj'mvic_pi-t- Mailing Address: .I o . ..ru it _� 2 ' - • „o S Est,: _ , 1 9 ■.• What kind of Permit?(Check each box that applies ❑Lot or Road Segregation NBuilding ❑Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use) $)Single Family El Garage Attached/ tacked ❑Conditional Use[C(a),C(d),or C]** 1 ❑ Manufactured Home .❑ Modular . - ❑ Discretionary"D"or Unnamed Use Classification ❑ 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 - 1:1 Planned Rural Residential Development(PRRD)/Amendments** ❑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 O 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 Tracy a irir arayier� act as my agent in matters relating to this application for permit(s).•OWNER SIGNATURE •/, ►, Date: // April 206 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: //l/, i / i'h Date: l/ e jrl i ,20/3 The action or actio "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: ///, , L',!ii Date: // April 2013 G:\PemutCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc , ' ' • IP 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. k Signature: g Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: Pau 1 BOrnton A (H) 460.7747 ( ) MAILING ADDRESS: 117 Champ on Kd. Port Angeles,WA EMAIL: CONTRACTOR'S LICENSE 'n 9e362 WAINS NUMBER: BOYNTG 1952OM NUMBER ARCHITECT/ENGINEER: T r a c y G u d 9 e l F E. PHONE (3o 417,0501 FAX:(36C)4!7.0514 MAILING ADDRESS: 30l E. SIX'-h Strom: fort Atrele3 Irt A 933 2, EMAIL tmcy&ZenOVIC.het Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New kil Wood Exists •: ❑ Sewer ❑ • ;•ition ❑ Steel Propose.• i Bank ❑ Community System ❑ Alte -tion/Remo•- ❑ Concrete ; al: I _ Height: s Individual System ❑ Repair ❑ Masonry SEP Permit# 5Ept.3-cCO29 ❑ Demolitio ❑ Other: Bedrooms. Water Supply:. Existing: Setback: ❑ Private well ❑ Two Party Type of eat: Propo--d: ■ 0 Public g • U i{�/ t.• ,, • =�. f ••d Total• / Name of Syste : 'ff e2ttly Water tit, : I •00445 If this is a Commercial Proiect 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 Applianc- Installation permit,mark all items below that apply: I Un:- • ound Tank I Abov- • :. • ank Size of a Tank: 1 Heat Stove I 01:-. , • - i Fireplace Insert I H a ank I Pellet Stove i Other Is this a•pliance 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. Square Footage Current Proposed F�►,r Office UgelDillif, - Amount .T eyislon Main Floor Heated ' EH Bld App Review: � 00 2nd Floor Heated Consistency Review: W/Ai6f4 Other Heated Base fee: 1//i` 11- Mezzanine Additional Section: Heated Basement / Plan Check fee: `_7, W Unheated Basement / State Surcharge fee: (�V s° Other Unheated Pot Water Review fee: Garag /Lrt SUBTOTAL 761, 39 96 0.7bIgy Decks 911/Rd Approach fee: /3 D Other fi�rt _ TOTAL: $ 7 , .. 3 9 ,h t �7/ Receipt Number: /L/0 i - O Cash/Check Number: �U /_ ESTIMATED COST(REQUIRED) Date: i(7 1, 7/-3•Fair mark: value of all labor and materials foundation to finish ,at)0 -40-/ etee-- Initials: I IG:\PemutCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc L,,( ,L 1 ./ 9 )A ,,A( 0 i SEP13-00029 '� 2____ (,1 Review Type: ��; Jefferson County Public Health SEWAGE DISPOSAL PERMIT FILE SHEET 615 Sheridan Street, Port Townsend WA 98368 (360) 385-9444 PERMIT#: SEP13-00029 Date Received: 03/05/2013 SITE ADDRESS: RAIN FOREST RD Revised Date: FORKS, WA 98331 APPLICANT: PAUL D ERICKSEN PHONE: CINDY S ERICKSEN 92 RUBY RD PORT ANGELES WA 983629127 SUBDIVISION: RAIN FOREST#1 BLOCK: LOT: 7 PARCEL: 991500007 Section: 30 Township: 27N Range: 10 W Legal Description: RAIN FOREST#1 LOT 7 INTERESTED PARTY: DESIGNER: JOHN S FLEMING PE PHONE: (360)452-8500 J S F ENGINEERING 1240 W. SIMS WAY #45 PORT TOWNSEND WA 98368 SYSTEM DESCRIPTION: 110-CONVENTIONAL TRENCH TYPE OF WORK: NEW TYPE OF USE: RESC ADDITIONAL WORK: NONE Type Amount Paid By Date Receipt New Conventional System $555.00 SMT 3/5/2013 140804 Total: $555.00 Parcel Tags; Description Notes Updated 1.) Associated Cases Status Issued Finaled Description ADR13-00010 P 911 SEP13-00029 P \\tidemark\data\forms\F_SEP_ApplicationNW.rpt 3/5/2013 J son County Environmental Health Depart t 615 Shan St., Port Townsend, WA 98368, (360) Mr 9444 SEPTIC PERMIT APPLICATION OPERTY OWNER: Ericksen, Paul & Cindy MAILING ADDRESS:92 Ruby Road, Port Angeles, WA 98362 PHONE:360-477-8030 SYSTEM DESIGNER: JSF Engineering1240 W Sims#45 Pt Townsend WA 9836Designer Phone 360-452-8500 Job#: 13001 LEGAL DESCRIPTION: Section: 30 Township: 27N Range: 10W PARCEL#: 991-500-007 Subdivision Name: Rain Forest Lots Division: 1 Block: Lot(s): 7 Site address/Directions to site: Across road (to the south of)from #2763 Rain Forest Road, Forks, WA 98331 SOURCE OF SEWAGE/USE: TYPE OF WORK: WATER SOURCE: Residential: X New: X Tank/s only: Private: Residential ADU: Modification: Public: X Commercial: Expansion: Community: Upgrade: SITE SIZE: 1.3 Repair: Previous Evaluation: SYSTEM TYPE: Partial Repair- (tank): (drainfield): Yes, #: Susan Porto Conventional: X Designate Reserve: :: Soils 2/13/2013 Alternative: Redesign: No: SYSTEM DETAILS: Number of Gallons/Peak Day: 240 Soil Type: 5 (attach soil eval.) Application Rate: 0.4 gal./sq.ft./day Drainfield Length: 200 ft. Trench Width: 3 ft. Trench/Bed Depth: 12 - 36 in. Septic Tank Size: 1000 gal. Pump Chamber Size: - gal. TYPE OF SYSTEM: Conventional gravity drainfield By signing the application form,the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. Any material falsehood or any omission of a material fact made by the applicant/owner 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,judgements,court costs, reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or inconsequence of the granting of this permit. I further agree to provide access&right of entry to Jefferson County&its employees, representatives or agents for the purpose of application review&any required later inspections. Staff's access and right of entry will be assumed unless the applicant informs the County in writing at the time of application that he or she requires prior notice. Inspections shall occur during regular business hours. Initial here if you require notification before entry Appeal-A person aggrieved of a decision of the Health Officer may appeal. Appeals shall be submitted to the Health Division in writing within fifteen days after receiving written notice of the decision. DISCLAIMER -This application is for an on-site sewage system that meets the state and county standards in effect on the date of application. This application for an onsite sewage system DOES NOT assure you of any other County approvals. For example, it DOES NOT GUARANTEE that you will later obtain permission to build a permanent residence or other structure on this parcel. Any future application will be separately judged by the rules and laws in effect at that time. 4 Property Owner Signature Date FOR OFFICE USE ONLY PARTIAL ASBUILT FINAL APPROVED INSP/PUMP TEST PUD ALL HOLD REQ. MET Date - - /3 FeQ 4.5�J Rec#/t' '4 `' f Check#'`L !=° Case#SEP Map Output . Page 1 of 1 III ArcIMS HTML Viewer Ma• l , l i 1 i i � I i t 99•SOLO:), + r 4y 1111111barM • rf c9WC:' Legend 'to. F Selected Features S9 9.y "i JC_Roads MEW' �kq$�lG � Parcels-H ¢,t __ DRD Review Laval t 1-03000 i, a'-kre ■ Levw z ,q _3C00''t 7103CCO' 7`0:1000, et * re 4 { ?,03(X.10•x c ,� .ry ____ _----- + v- MEM 1101/0 .'ti f —' I I '-dna'a'vrehel r:_-r-te•.,t's•_wr.:�cr..t.x..;.. ... s� '., 11 -. .. ,....... I 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 b the method and accurac of its collection. Tue Mar 05 16:25:07 2013 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&Cli... 3/5/2013 Map Output 0 • Page 1 of 1 ArcIMS HTML Viewer Ma• 7 GEM C30400" ... ,aa1 99,50030 IA „t 4 r ..4494..:....3 Legend COM - `.xx "t " Selected Features 6.46 liniiM JC_Roads Parcels-H 991503034 t'a��o`' X39`.10003 FEMA FIRMS CMS. 1111 A 103OOO =MD AN i ”03 ./0'0 OEM X500 ati 99'-501"03i) Other WM "' +> } 'tkst OEM J '03'3030` .7,1:7-.:ra.Ysi 7,r•+: -m-'srr,S'GC•a Se.,:,...s.Gt5 0®`8I1 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 b the method and accurac of its collection. Tue Mar 05 16:28:38 2013 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovrnap&Cli... 3/5/2013 Map Output 410 • Page 1 of 1 ArcIMS HTML Viewer Map Legend Selected Features Yti•bax)::•!) JC_Roads 6 Parcels-H te 99'"y_t_•_.2.1 '43° Priority Habitats and Species ` _ z .r. r. a=MO 189ti 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. Tue Mar 05 16:29:29 2013 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&Cli... 3/5/2013 Map Output • • Page 1 of 1 ArcIMS HTML Viewer Map ,.03A.V.k3 Legend 5..X.4.A...! Selected Features JC—Roads ‘C2'6 Parcels-H c,V1. 99.5(Xl,00/ •2.‘ Spotted Owls ?'03(XX.)" xxx oc.X.Y.Y 1 t^ 9915CCOD8 71030:XY2 941500CCe 03txxo9 m cr.,1.1 try Cwt.,Cair.i.Se. oets miii= 8911 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. Tue Mar 05 16:30:09 2013 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&Cli... 3/5/2013 • K • a 0 • ya °: It o c 0 O o a m N CD tD A m� A -♦ O o A O z m m m O m O 8 0 Q 2 O ly 2 x O t i '^ O VJ O z m 0' o co N 1 N 3 O �•F O yyk c TF o s m- O m 2 A m 4.m O t P D o 4 i a 1_ j 73 m s II Z _ 5 Z 0 N r 0 m o -1m z m c 3 to N m 5 N O Z E G) 3 E m z� r m 1 S z O N r 0 a 0 O O r 0 5 O °-)m 1 D N 1 A 3 3 N N co N L 8 z 8 Co z I o �N.I oo a 0 2 5 z CO CO 8 m m 0 c SG)m r 'Z a m A o. IC -1 v�OD t7 - co co G) m o N CC) S.r 0 m O N I • CIVIL ENGINEERING LAND SURVEYING 19 South(� i ( 5P Angeles,Waasshington 98362 (380)417-0501 & ASSOCIATES FAX(360)417-0514 E-mail: zenovic@olympus.net INCORPORATED DATE: May 3, 2013 Job No. 13023 TO: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 ATTN: David Johnson FROM: Tracy Gudgel We are transmitting the following item: fa tached El Hand-carried DUnder Separate Cover DFAX: PROJECT: Revised Drainage& Erosion Control Plans for Ericksen Parcel No. 999-500-007 COPIES PAGES DESCRIPTION 2 2 Drainage &Site Plan 2 sets Stormwater Calculations & Site Plan Submittal Template COMMENTS: RECEIN 1r 1 0, MAY — 7 2a13 RifihSitih f[#iiiIii\ i gJ U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENCY OMB No. 1660-0008 Naonal Flood Insurance Program Ir rtant: Read the instructions on pages. Expiration Date: July 31, 2015 SECTION A-PROPERTY INFORMATION FOR INSURANCE'COMPANY USE Al. Building Owner's Name Paul Ericksen PdleyNurnber: A2. Budding Street Address(including Apt.,Unit,Suite,and/or Bldg.No)or P.O.Route and Box No Company NAtO;N r ib r * 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: ❑ NAD 1927 E1 NAD 1983 A6. Attach at least 2 photographs of the building 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 Ed No d) Engineered flood openings? ❑ Yes E1 No SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION BI.NFIP Community Name&Community Number B2.County Name B3.State Unincorp.Jefferson Co.530069-0625-B Jefferson WA B4.Map/Panel Number 85.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 ❑ FIRM ❑ Community Determined ® Other/Source:local observation and history 811. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ❑ NAVD 1988 ® Other/Source:assumed elevation B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes EI No Designation Date: ❑ CBRS ❑ OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) Cl. Building elevations are based on: ® Construction Drawings* ❑ Building Under Construction* ❑ Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations-Zones Al-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 Indicate elevation datum used for the elevations in items a)through h)below. ❑NGVD 1929 ❑NAVD 1988 ®Other/Source:assumed Datum used for building elevations must be the same as that used for the BFE. Check the measurement used. a) Top of bottom floor(including basement,crawlspace,or enclosure floor) Na. ❑feet ❑meters b)Top of the next higher floor Na. ❑feet ❑meters c) Bottom of the lowest horizontal structural member(V Zones only) Nor. 0 feet ❑meters d)Attached garage(top of slab) n/a. ❑feet ❑meters e) Lowest elevation of machinery or equipment servicing the building n/a. ❑feet ❑meters (Describe type of equipment and location in Comments) I) Lowest adjacent(finished)grade next to building(LAG) 97.N ®feet ❑meters g) Highest adjacent(finished)grade next to building(HAG) 101.16 ®feet ❑meters h) Lowest adjacent grade at lowest elevation of deck or stairs,including structural support n/a. ❑feet ❑meters SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION ram=nTirST-TZ:7"1:37:" a This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation ,s`"r' ,.-., A information.I certify that the information on this Certificate represents my best efforts to interpret the data available. ? ' ')43, i i. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S.Code,Section 1001. -WA a► . r tl L; ❑ Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a )� % ∎ *.t,.;‘,..4,- 3 CO Check here if attachments. licensed land surveyor? ® Yes ❑ No (g. ° {. ( 7 Certifier's Name Dan P.Kousbaugh License Number RLS#11983 9 f �° ; f ri :' C a 115.83 e/4:r Title President Company Name Dan Kousbaugh Surveying Inc,P.S. 9r r Address�0 Spruce Drive City Forks State WA ZIP Code 98331 d►j �1 A 05� Si natur r= e 2/1/13 Telephone (360)374-5720 M 720 '* r '4".7rj••=223747:4e 2// 13 IMPORTANT:In these spaces,copy the comaponding information from Section A. AK FOR INSURANCE COMPANY USE Building Street Address(including Apt.,Unit,Suit or Bldg.No.)or P.O.Route and Box No. Policy Number 999 Rain Forest Road x , 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= 92.51'. '1 .lid 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 E1-E5.If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B, and C.For Items E1-E4,use natural grade,if available.Check the measurement used.In Puerto Rico only,enter meters. E1. 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,crawlspace,or enclosure)is p/La. ❑feet ❑meters ❑above or❑below the HAG. b)Top of bottom floor(including basement,crawlspace,or enclosure)is n/a. 0 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 ❑feet ❑meters ❑above or ❑below the HAG. E3. Attached garage(top of slab)is nia. ❑feet ❑meters ❑above or ❑below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is n/a. ❑feet ❑meters ❑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 121 Unknown.The local official must certify this information in Section G. SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The property owner or owners 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 Comments Highest observed flood levels of 2003 flood( .31')are below projected building site elevation and floor level of old Brandeberry homstead. ®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.❑ 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. ❑ The following information(Items 04-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 010.Community's design flood elevation: ❑feet ❑meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments ❑Check here if attachments. • • 0 X C. 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Lbw-' / I r=A;i l i 0 570770 PGS : 1 WD - . 10l15/20t2 113:0, PM t ((;�pp rNC Jet forson County ip Auditor's it iu—DM:Eldridge, Ruth for is lilailliAMPARIbliV When recorded return to: Jefferson County Excise Tax Paul D.Ericksen and Cindy S.Ericksen Aft# 1 1 8 2 0 4 C?tte (0. 1:)5(2.o)Z �` Tax$ 3 s2 Ruby Road Port Angeles,WA 58382 S '� i'L a a T1, ) By . itrt: .1 .__..,II eputy Treasurer STATUTORY WARRANTY DEED 78089-JTc Escrow No.: 3597 i Title Order No.: 'Toro • THE GRANTOR(S) Karen Culver,as her separate estate a for and in consideration of ten dollars and other good and valuable co. • ••n in .: • paid,conveys, and warrants to Paul D.Ericksen and Cindy S.Ericksen,husband and wife 0 the following described real estate,situated in the Cou • Je _• , . • Washington: Lot 7 of Rain Forest Lots Division 1,as per Plat -•• •- in V. m 8 of Plats,page 47,records of Jefferson County,Washington Subject to: Easements recorded under Auditor's File ':.: 20 •and 375207 Covenants,conditions,restrictions andtor-:- - • =• under Auditor's File No.254583 Restrictions. conditons, dedications, easements and provisions contained andtor delineated on the face pf the Plat -• •:• •••-. • ,•is File Rio.254585 Loss or damage by reason that there appears -•rded right of access b end from the land herein described to a public right of Tax Parcel Number(s): 991500007 O Da,-.: 1of ll//r'.._ Culver ' STATE OF WASHING';'• ss COUNTY OF i :11T1 ) !certify that i know or•; = :: : ,:% evidence that Karen Culver is the person who appeared before me,and said pe :• : +. .1 . .• . at she signed this instrument and acknowledged it to be her free and voluntary act for - - Nod purposes mentioned in this instrument Dated: 10/1 110. 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Johnson Cc: Colleen Zmolek; Carl Smith; Stacie Hoskins; Randy Marx Subject: Another Step for the Upfront Review[FW: Paul and Cindy Ericksen: Hoh Cabin Septic Plan Permit SEP13-00029& BLD13-00120 & 121] David, Below is an email from the Ericksens. Their building permit was done as an"Up Front"review. They're concerned because Randy informed them he needs DCD sign off before he can issue the septic permit. I put their septic permit review on your desk and entered your name in the case. It appears we need to add a step in the "Up Front" process to check for pending septic permits for ESA sign off or discuss an alternative approach. I called Cindy Ericksen this morning to let her know we are working on addressing their concern. Sincerely, Zoe Ann Lamp, W d-AICP D - (ifA 1' r Associate Planner, DRD Lead _ / / (7 J _ ! I� Jefferson County Department of Community Development GtOC9� ll a / 621 Sheridan Street pa) s Port Townsend, WA 98368 ptiv6.Phone: 360-385-9406 ,,G?� GD Fax: 360-379-4473 /e!//e�+ ' 6‘k e-mail: zlamp @co.jefferson.wa.us C?.� .,g�crni Antc Jefferson County DCD Mission: To preserve and enhance the que promoting a vibrant economy, sound communities and a healthy All e-mail sent to this address will be received by the Jefferson County e-mail system and may be subject to ruouuc vsciosure unaer c.napter<rz.00 ra...vv Please note: The Department of Community Development is open to the public 9:00 a.m.—4:30 p.m. Monday- Thursday; Closed Noon- 1:00 p.m.; Closed Fridays. From: Paul &Cindy Ericksen [mailto:ericksenpc @olympus.net] Sent: Saturday, April 27, 2013 8:12 AM To: Zoe Ann Lamp Cc: Ericksen Paul &Cindy Subject: Fw: Paul and Cindy Ericksen: Hoh Cabin Septic Plan Permit SEP13-00029 & BLD13-00120 & 121 Zoe, Help!!! 1 You helped I and my wife Cindy submit our building plans for our Hoh Cabin'nnd Garage on 15 April. At that p Y Y gp time we I had mentioned our concern about the length of time it was taking for our Septic Permit to be reviewed/approved. This was in regard to timing, i.e. we need to get our Septic installed asap so we can (hopefully) proceed by summer on the actual building, or our project may be delayed until next year. In fact, we specifically submitted our Septic Permit before the Construction Permit so that we could make this happen. Please review Randy Marx's note below. As I read it, even though he's ready to approve the Septic, he won't until the Construction Permit is reviewed by DCD (whoever that is). If we can't go ahead and do our Septic now we're in a world of hurt. As a review; -We had the lot surveyed by Dan Kousbaugh. He spelled our for John Flemming (our Septic Designer)the area where the Septic System could be located related to flood certification. -Our septic system was engineered by John Flemming. John's plans are meticulous and he would not recommend a Septic System in an environmentally sensitive area. -In January, we had been told by Jefferson County we needed an "Environmental Impact Statement" which we went ahead and hired Earl Kong to do. John Flemming and Earl Kong were on the site together in January and John consulted with Earl extensively on Septic System siting. -Also, we subsequently we're told (after Earl had completed his work) that "we shouldn't have been told of the need for an Environmental Impact Statement since these are not needed on the "West Side". The point here is that I'm wondering if Randy is getting the East side requirements mixed up with the what you allow on the West side. -In February,John Flemming met Susan Porto of your department "on site" to review his plans, i.e. she agreed with them. In other words, someone from your office has already inspected the site. I'm writing you since you seemed to understand our need to progress on this project, i.e. "our triage discussion". As I told you, I will have trouble getting heavy equipment into this area once the fall rains start. Also, My carpenter said he will need to be able to have all of the outside framing, roofing and siding complete, again before the fall rains, or he is not interested in the job. Can you help out getting this? My wife will try to call you Monday afternoon to see if this can be fixed. Or, call her at 360-477-9335 (Cindy's cell phone)when you've checked into it. Paul Ericksen From Randy Marx Sent: Thursday, April 25, 2013 5:18 PM To Paul &Cindy Ericksen Cc: Colleen Zmolek Subject: RE: Paul and Cindy Ericksen: Hoh Cabin Septic Plan Permit SEP13-00029 &BLD13-00120 & 121 I completed my review and all looks great. Befor I can issue the actual permit the planning department of DCD needs to sign off the environmental sensitive areas,this includes the flood cert. They will likely combine this w/your building permit application. I have reviewed your building applications and have signed off the health review for each of those as well. Colleen in DCD is a good contact for building status and sign off of the septic. czmolek@yco.iefferson.wa.us 2 ,, ` • • I ika hx Always Working For a Safer& Healthier Jefferson County 360 385 9402 ><((((°> ><rr> ><(((5. ><((((c> ><rrr°> ><((((o> >< (( o >G((q <((((T> ><> ><> ><{{."> ><»<>><((((0> ><{{f> >G( ( r,>><( >G((((°> ><((((''> G(((c.› ><{{c> ><( ((d5 Online Septic 'ermnits "Web Link Enviro n: `ental.Health Web Site Link CONFIDENTIALITY NOTICE: This,.-,aa<aii f t.ssa e, i f ct :nu any ttaclrtznt>, is tot thn sole use ,t the iatnrr4r r ;ipit rtl ' arid may canatnat confidential and pr i vr(eaccd information. Any unauthorized rs*ttit't ut7e d:srSos+am, or distribution is prohibited. if YOU are. ,k.,t recipient. r'..aso contard: ,ilt.sender tay mpl t".,-Eta<a,l and destroy ail it31:7iZ".S of the etictinal m<iyistitsw PUBLIC RECORDS ACT NOTICE: 'di<_;mafl ihts address hats hotit itah ntod by ltae•itnItttstn<our t'e mr.ire itvittetn mid.<< Marmon, i ;as_t tinctinis tad,a stdid ,+2.56. 'nutter Hitt<'aat>h, leyttftis tin the County 3nt'r ti,.3'tlta<ase(hi=; n a.?atiti ,ks r. tintain wit\ fist int insets KO this it deejas tt t m itn:yitisitte'[rrt:tdy in. t:l rT A"42..dd From:Paul &Cindy Ericksen [mailto:ericksenpc @olympus.net] Sent: Monday, April 22, 2013 8:57 PM To: Randy Marx Subject: Paul and Cindy Ericksen: Hoh Cabin Septic Plan Permit SEP13-00029 Hi Randy- Per your note below I am checking in to determine where our septic permit is in the permitting process? We filed our building permit on 15 April at 9 am.Thank you, -Cindy Ericksen From: Randy Marx Sent:Monday, April 08, 2013 9:48 AM To: Paul &Cindy Ericksen Subject: RE: Paul and Cindy Ericksen: Hoh Cabin Septic Plan Permit SEP13-00029 Hi Cindy I am currently about 2 months out on septic permits, however,that time is beginning to decrease. Right now there are 7 applications ahead of you. If you can check back with me in two weeks I will be able to narrow the time frame down better for you. I have listed your septic permit number in the subject line. Thanks for checking in. Ras/Av. iftes.ftx Always Working For a Safer& Healthier Jefferson County 360 385 9402 >G((((- ><rr> ><(`((5 ><(((r> >y<�ur °> >f</((((°> >'�'((( 0 ><((((`> ><((((?> ><> ><:> ><{{{..> ><»<>><((((°> ><{{{> >K( (�(>/ \ 1 (1> ><(((( ><O r> ><((((°> ><{{C> ><( ((`> Online Septic Permits Web Link Environmental Health Web Site Link CONFIDENTIALITY NOTICE: EiaE.,e-mail r7tr. Makc, melr,tiirrj any 3tt? t 3¢_.at , is for i=;+?SOe use of the i,;, „rlsc3 er ip3erat. _ And indy .:,rd ,ra rnnfident, . ::nr; pnvsleged [nformatiord Any unauthorized r vi w, a_�r ch sc[asi.He; or „ vodb€rt€ora fs r <¢ri' ,eti [f you drt t the nydndoeo ,f..�i,)en ,ai..se° ontrrct the ,.',,ender by r,d2ly r..-mad destroy ail . p:es of the o yHddl message 3 • • • PUBLIC RECORDS ACT NOTICE: .� z,x,<o333, k 11.34 f,,r 3s:; 3st, ,F, 3,:, 33, . ,e .01, ,3 ?? ,3 3, E iTe hna 3,,3, t 42 r�7F� .1.'r �.3333,M93 ,:.',z [ttir:, €33 3 ,.i><s zs,. ,.. 13 hs.tia 1 kor, ir,, Ei,F- r ,a two, ,a ,o,o; r?_>t tr,a.a do,hook ondko <0<n , r<,uclas h. From:Paul &Cindy Ericksen [mailto:ericksenpcCa�olympus.net] Sent: Sunday, April 07, 2013 6:30 PM To: Randy Marx Subject: Paul and Cindy Ericksen: Hoh Cabin Septic Plan Permit Randy- I am contacting you to determine how the septic permit is progressing. I submitted it on 4 March and believe it was entered into the system on 5 March. We now have an address on The Rainforest Road property: 2682 Rainforest Road. I do not have documentation of our permit#though think it may be 1382. Any information you can share with us would be appreciated as we'd like to get the septic plans out for bid and once permitted get it installed while we are waiting on the building permit approval process. This week we are hoping to submit the Hoh Cabin building plans for permit. Thank you, -Cindy Ericksen 92 Ruby Road Pt. Angeles, WA 98362 ph. 360-477-9335 4 N. co N m O 2. X D XI II N O N N o v p mm O D D� y DD Om NII mo �� -NI W°v� i mK o '0z ° 0I-$ ���--__� O >Z Nmo OOD _�__ r \ m2 Li O C�� m m O ---_, vii sm p Drnz rn inw • p m t / ,./& ,......, n 0 0 1511 9/P�9,A � ��� \ o NS '• / ,_ �ti` v C r ? -t S� \20 \ inN 0.� / '7 I X6.5' \ 0m I NCO !, �4 l /l ,\�O�0°w / 10,10 \ ND �m/ n , / I m "r_N1 / \ A � r J oo J i OD XI v I a r ') I \ \ < N" � I a°ti IO II III 1 � v I • °AO $'-Im I may III \\\ D� fX I D co s0 rnl m° I A I , j ' U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE FEDERAL EMERGENCY MANAGEMENT AGENC OMB No. 1660-0008 National Insurance Program WI portant: Read the instructions on pag -9. Expiration Date:July 31, 2015 SECTION A-PROPERTY INFORMATION FoR INSURANCE COMPANY USE Al. Building Owner's Name Paul Ericksen Iol l ullble`r:' A2. Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No icy tc 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 R1OW,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'-Og' Horizontal Datum: ❑ NAD 1927 ® NAD 1983 A6. Attach at least 2 photographs of the building 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 El No d) Engineered flood openings? ❑ 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 ❑ FIRM ❑ Community Determined ® Other/Source:local observation and history B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ❑ NAVD 1988 ® Other/Source:assumed elevation B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? 0 Yes l0 No Designation Date: ❑ CBRS ❑ OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C1. Building elevations are based on: ® Construction Drawings* ❑ Building Under Construction* ❑ Finished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations-Zones A1-A30,AE,AN,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 Indicate elevation datum used for the elevations in items a)through h)below. 0 NGVD 1929 ❑NAVD 1988 ®Other/Source:assumed Datum used for building elevations must be the same as that used for the BFE. Check the measurement used. a) Top of bottom floor(including basement,crawlspace,or enclosure floor) n/a. ❑feet ❑meters b)Top of the next higher floor n/a. ❑feet ❑meters c) Bottom of the lowest horizontal structural member(V Zones only) n/a. ❑feet ❑meters d)Attached garage(top of slab) n/a. ❑feet ❑meters e) Lowest elevation of machinery or equipment servicing the building n/a. ❑feet ❑meters (Describe type of equipment and location in Comments) f) Lowest adjacent(finished)grade next to building(LAG) 97.90 ®feet ❑meters g) Highest adjacent(finished)grade next to building(HAG) 101.16 ®feet ❑meters h) Lowest adjacent grade at lowest elevation of deck or stairs,including structural support n/a. ❑feet ❑meters SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION szetuG'fT'._::r,a7zt+,r¶ TT'_2 °'. ,. This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation ,,,t,., 2 information.I certify that the information on this Certificate represents my best efforts to interpret the data available. .: I understand that any false statement may be punishable by fine or imprisonment under 18 U.S.Code,Section 1001. I v -4NA al �'g ti ❑ Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a C �� 1.i' '...;',,:-.-• 11 ® Check here if attachments. licensed land surveyor? El Yes ❑ No i ''',1,,i, (.:`,1 I Certifiers Name Dan P.Kousbaugh License Number RLS#11983 V t '4 ti , l^. Title President Company Name Dan Kousbaugh Surveying Inc,P.S. � ' `, ' Address 0 Spruce Drive City Forks State WA ZIP Code 98331 `'�'4t(.ASS , Signatur �� � .. r- e 2/1/13 Telephone (360)374-5720 ` ' i i 4 Zr///3 IMPORTANT:In these spaces,copy the co nding information from Section A. FOR INSURANCE COMPANY USE „ Building Street Address(including Apt.,Unit,Suite,a 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-lik. `92.51'. Signa re / 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 E1-E5.If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,B, and C.For Items E1-E4,use natural grade,if available.Check the measurement used.In Puerto Rico only,enter meters. E1. 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,crawlspace,or enclosure)is n/a. ❑feet ❑meters ❑above or❑below the HAG. b)Top of bottom floor(including basement,crawlspace,or enclosure)is >f/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 n/a. ❑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 ❑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 j� �. Date 2/1/13 Telephone (360)374-5720 Comments Highest observed flood levels of 2003 flood(•x31')are below projected building site elevation and floor level of old Brandeberry homstead. 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.❑ 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.❑ 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. 0 al _ D Ell . 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Autll for When recorded return Jefferson County Excise Tax Paul D.Ericksen and Cindy S.Erickson Aff# I V3 2 0 4 C E to 1) f 120)Z P2 t ny R WA 98362 : Tax$53 • ', S,,'(:::Ant$ �) By - ■tvpA.I , eputy Treasurer STATUTORY WARRANTY DEED 78089..,-JTc Escrow No.: 3597 Title Order No.: 1$0$9 THE GRANTOR(S) Karen Culver,as her separate estate O for and in consideration of ten dollars and oher good and valuable co• •- n : • •. • paid,conveys, and warrants to oPaul D.Ericksen and Cindy S.Ericksen,husband and wife the following described real estate,situated in the Cou , • Je • , r • • Washington: Lot 7 of Rain Forest Lots.Division 1,as per Plat '•• In V• m_6 of Plats,page 47,records of Jefferson County,Washington Subject to: Easements recorded under Auditor's File •:- 20 ,and 375207 Covenants,conditions,restrictions andlor = •• •-. under Auditor's File No.254563 Restrictions, conditona, dedications, easements and provisions contained and/or delineated on the face of the Plat --. '-• '••-. •is File No.254585 Loss or damage by reason that there appears : •: : rded right of access b and from the land herein described to a public right of Tax Parcel Number(s): 99150:1007 0 0 1Us f 1x.11 Da Culver � • STATE OF WASHINGi' ' ' ss COUNTY OF it + '. :ii I ) I certify that I know or 4, :: ,,• evidence that Karen Culver is the person who appeared before me,and said pe '_, at she signed this instrument and acknowledged it to be her free and voluntary act for - -nd purposes mentioned in this instrument Dated: t 0/I / TERESA l WAY t . / -I o/ -�' Notary Public - State of Washington W ,n ttxl My Commission Expires � ' ttie,sta.- T Y Notary P 9 May 15,2016 U'S 10-0s0u-q 24' 24' / / 16• i IA�P �Ai4, \ 4016 Y 1 4016 Y , V _}�, \ —1 \ r 1 D g4.ter / 641" - 616M N \` \ x 1 Cr G NN r 1 RE� I R K 7< 41 2. C 1 4 i ''''..-N. .'''...-Th \ ■ N oN'. 1 N u in e \ — \ g r G. O K G 4. 0 4 i' A - C 0 \^ .e , _ MANUFACTURED TRUSSES AT 24'0.G J '. D 4, G 1 -,........ 4D L j 1 I �-! \ L 1 1 1 1 J \ N. � � � 4o1e Y � I 46M sc L 6' 0-10' S-z' 6' 1_!./j 12 a g a 1 ' 1 n/± �� ` \ HI zn a C H 8 I-. z g 1 N S 1 I icS5lTfS 1. ' i MEM 0 l S S gg8 WI 88Q i a o X 'g g 'g 1 111LE: Paw CMAcz N1 05054 1-RAN FOREST MAO.di1ERSON COUNTY,IM ;1 S REVISIONS: y DATE MARK NOTE N' A g FLOOR PLAN, FOUNDATION PLAN AND BLDG SECTION D t,. G 6 N N -: WENT: 301 E.8TH STREET.SUITE 1 / N '�,' e�la� o c PAUL & CINDY ERICKSEN ENOVIC 81 PORT ANGELES,WA 96362 PHONE: (360)417-0501 a 92 RUBY ROAD ASSOCIATES FAX (xo)417-0514 DPORT ANGELES, WA 98362 INCORPORATED EMAIL: 2ErawCQEMOVIONET W 0 Up Front Parcel Review Parcel 991500007 Printed: April 17, 2013 PAUL D ERICKSEN Site Address: CINDY S ERICKSEN 2682 RAIN FOREST RD 92 RUBY RD PORT ANGELES, WA 98362c FORKS WA, 98331 Parcel Number: 991500007 S-T-R: 30-27N-10W Total Acreage 1 Legal Description RAIN FOREST#1 LOT 7 Land Use: 9800 Flood District: Fire District: 0 Planning Area: 12 Flood Map(FIRM)Panel No: School District 402 Zoning: COMP PLAN DESIGNATION: COMMUNITY PLAN: UGA: UGA Trans [ VPlot plan states "property line" [ t4' Assessor's Map (Property lines on submitted plot plan must match the property lines as identified on the Assessor's 1/4 map) [ //r Legal Access to Property ES NO [ ' Parcel Tags or Scanned ocuments YES _ • [ ESA's: Special Reports Nearby YES 0 [ V Designated Ag YES No [ Shoreline Designation:—/Es O 7 Shoreline Sloe Stability: s NO Stream Typ 0 N.x.--d Fish& Wildli e:YES NO Wetlands: YES NO Rare Plants:YES NO Seismic: YES NO Landslide: YES NO Flood: 4WD NO Erosion: YES NO Aquifer Recharge Ar ES O S ( C C Lt _ SIPZ: none At �f High Risk Coastal CMZ: none High Risk Moderate RiskDisconnected CMZ Stormwater site plan submitted: YesNo [ Forest Lands: YES Adjoining Forest Lands: Commercial/ Rural/ Inholding [ 0 . Mineral Lands: YES 0 [ Agricultural Lands: YES i [ t Archaeology: YES c [ friv- 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 ngineering [V Notice Provisions/Disclosure:Ai sort YES NO MRL YES NO ForesfL"ands YES NO [ Landscaping Required: Yes o [ V Parking Spaces Required NO •Other f 0,---Building Height: dp UBC Standard [ }• Impervious Surface cover percentage: Resource Lands&Public: 1 Rural Residenti : 25°A Rural In ial: Per UDC Sec 6.7 Rural Commercial: 60% Area of Building average:60%in Rural Industrial Lands only [ LVTotal Building(s) Size: RVC:20,000 SF CC:5,000 SF NC:7,500 SF GC: 10 SF All others:subject to ater constraints/Norse.specified [ V Setbacks: Front: t' Left Side: Right Side: Rear: 6 Shoreline Setback: LSHA Setback: [ br Road Classification: Road Approach:c _ IND NOT REQ'D RAP SEPA Required: YES EXEMPT [1/ Flood Certificate: = — S • [4A Existing Case(s)&Condition(s): Violations: Yes No [ V Recorded Date of Subdivision: AFN Over 5yrs=UDC Plat Conditions: <5yrs=Plat Conditions on plat or Old Ordinance [ Lots/Require Declaration of Restrictive Covenant YES)ubmitted: YES NO [ UGA No Protest Agreement YES 1 .ubmitted: YES NO [ CJ/Site Visit conducted YES 0 [(k Require Final Zoning Approval ES NO o 4-- . e v C'(.� [ t4" ADMIN: Setbacks entered in Permit Plan case OYES New Parcel Tags entered in Permit Plan v YES Special Reports Scanned dlp YES Title Notes Updated Parcel tags found for parcel 991500007 1.) WSRC Coaching - 2013-01-09 04/11/2013 CAO Parcel tags found for parcel 991500007 2.) WSRC Coaching - 2013-01-09 04/11/2013 Other Parcel tags found for parcel 991500007 3.) WSRC Coaching - 2013-01-31 FEMA 04/11/2013 Other Cases Associated with APN 991500007 Cases Name Review Type Status Planner ADR13-00010 ERICKSEN P Application Received: 1/30/2013 Permit Issued/Case closed: Case Finaled: 911 BLD13-00120 ERICKSEN P Application Received: 4/17/2013 Permit Issued/Case closed: Case Finaled: DETACHED UNHEAIEU GARAGE FLOOD DEVELOPMENT PERMIT BLD13-00121 ERICKSEN P Application Received: 4/17/2013 Permit Issued/Case closed: Case Finaled: NEW SINGLE-FAMILY RESIDENCE FLOOD DEVELOPMENT PERMIT PRJ13-00198 ERICKSEN P Application Received: 4/17/2013 Permit Issued/Case closed: Case Finaled: DETACHED UNHEArEU GARAGE FLOOD DEVELOPMENT PERMIT SEP13-00029 ERICKSEN P Application Received: 3/5/2013 Permit Issued/Case closed: Case Finaled: \\tidemark\data\forms\R_Parcel_CRMLA.rpt 4/17/2013 Page 2 of 2 Contractors or Tradespeopinter Friendly Page • Page 1 of 1 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 BOYNTON CONSTRUCTION INC UBI No. 602479701 Phone 3604528252 Status Active Address 117 Champion Rd License No. BOYNTCI9520M Suite/Apt. License Type Construction Contractor City Port Angeles Effective Date 9/14/2005 State WA Expiration Date 10/1/2013 Zip 98362 Suspend Date County Clallam Specialty 1 General Business Type Corporation Specialty 2 Unused Parent Company Other Associated Licenses Specialty Specialty Effective Expiration License Name Type 1 2 Date Date Status BOYNTC"OO6DF CONSTRUCTION Construction General Unused 3/6/2000 8/23/2006 Re - General CTION Contractor Licensed Business Owner Information Name Role Effective Date Expiration Date BOYNTON, PAUL W President 09/14/2005 Bond Information Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date 1 CBIC SC6658 07/01/2005 Until Cancelled $12,000.00 09/14/2005 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 Contractors 9 Bonding& C12SC6658 04/02/2013 04/02/2014 $1,000,000.0003/22/2013 Insuranc • Contractors 8 Bonding& C12SC6658 04/02/2012 04/02/2013 $1,000,000.0004/17/2012 Insuranc 7 CBIC INSSC6658 02/18/2011 02/18/2012 $1,000,000.0001/31/2011 6 CBIC INSSC6658 02/18/2010 02/18/2011 $1,000,000.0002/22/2010 5 CBIC INSSC6658 02/18/2009 02/18/2010 $1,000,000.00 02/10/2009 4 CBIC INSSC6658 02/18/2008 02/18/2009 _ $1,000,000.0001/30/2008 3 CBIC INSSC6658 02/18/2007 02/18/2008 $1,000,000.00 02/21/2007 Summons/Complaint Information No unsatisfied complaints on file within prior 6 year period 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 4/17/2013 • • Cr N H = O or LL. 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Data contained in this map is limited by the method and accuracy of its collection. Wed Air 17 10:22:06 2013 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientVersion=4.... 4/17/2013 Map Output • Page 1 of 2 ArcIMS HTML Viewer Map ■ 4 ;':111 R* WE L'i ri..?...li Ilki • 000004280 "03 1001 I , 110300007 I 710304001 ''4 -. 'y_ '', 710300004 'ati 710300005 991.50©401 '' ' ' 1.- � 9915D0002 \ ,• 71 e;V '�991500003\,t �',�M1,y ✓-' 7103{X7006 i by \i t.r y.- ,,y-`f 9915000031 y �� '� 991500007 J :`~ SCtix os - 710300011 11 *;c• ry. .,re=Av • , 1 '710300012�! 3 +:;u:1"7 ?9 991500008___._. y, �`n 99150Gar ' • 71a304011 j' ,1' V 55710300012 991 ts“- 9915+€30008 I,3!_=' 710302010 1, 7103000C4 1 7103(30002 710300017 tik"r:6xa'o) 110313001 I 1 Ma-r::war Jed 7d..ea--ari r'at'ty Ce t.a Sa°.•x-e5 GIS . http://gis server/servlet/com.e sri.esrimap.Esrimap?S erviceName=ovmap&C lientV ersion=4.... 4/17/2013 Map Output • • Page 2 of 2 Legend JC_Roads Pa rue ls-H County Zoning MPR.SF Tracts Rural Residential 1:5 Rural Resident aI 1:10 Rural Resident wal 1:20 NPR-Single Fam y ■ MPR Munifamity M PR-Resort C ompink Parks and Rocreal ton ■ MPR-OpcnSpace Rural Forest Commercial Forest Inholdmg Fares' Heavy Industrial Airport CRT ■ AI PR•VillagoCenter AP 1:20 MIRural Village Center ■ Resource Based Ind. Lrg h1 Industrial M PR-Rocroatren Wade Mgmt CPF LL'M LLC ■ Crossroads-GC ■ Crossroads•CC ■ Crossroads-NC ■ AL 1:20 UGA•Urban Commercial UGA-Urban Light.Industrial UGA M UGA-IIOR UGA-Putrllc UGA-LO R UGA-Vrsdor Oriented Commercial MPR BRN Brinnon CF.ttteM RLO Commercial Forest Mineral Resou roe Chrerlay 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. Wed Apr 17 10:21:37 2013 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientVersion=4.... 4/17/2013 . . _ _ .. . .. _ "-- .._ . - _ • ..:.. . . .- . ..., . _ ... • - - . • . . - . • - . .z.o....iftP., •, . ,,,..,-.4-,..7:1.60.?. ;,...1. ..Z-.*17-i.-,,,,,,..x..3,-. . . - . • - 5.1,74-.Ti5114:53VA . . . . . Tiggi.,A47,47.417,W. . . .- . -----r‘..4---..--. . . . . lit, - . IR'. - • Date 7/1.7-//3 time received / 6 _3 CD pm Mon. Tues. ‘Wed Thur. -Pri. - • BLD: 13.- Co I7_° an_ . Date: 7 - I . - („,- - . • . . . . . . OWNER:. _ EievEscu . . - Contact Name . • •do - ADDRESS: 2,4Z 1Z 414.1 Fa"417 b • Contact Number.360 460 r. 42 48 • - . . 206 .. . Notes: - .i. • • . - ' . - - - • . - . . . . . - - • „Foundation "Plumbing - Framing' . . Propane Tank Mechani . cal . - . . Setbacks - Under-ground- Framing . _ Under ground Furnace - Footing % Rough in Air seal Above ground - Gas • Stemwall Y. llydronic Exterior shear Exterior lines Oil Interior lines -----. Straps X Interior shear Ducts t • . Fast Hole " - Ventilation . . Appliance •• . • Underfloor • _ _ Eastwood stove Man4-lomes - . . Setbacks • Insulation. . • • Final Inspection • Foundation-- . • - • -1: ,z,--1 7..5 . . - . _wall -..,. Block&Tie floor wall ceiling. . Address Po --,.:Sted • . • s • .•.... . .. . . . s.4.42.41,..44s • \ . •. . .V.4:-..-..*.,..', ••■:-..&4,47.Fin. . . ■ • 14-77:176. ..,-.,....". ..,76,-,......A . . • . . 141.41% a§ -I,' EsSfesrg • . Itc:49,..A.,...:*.P. i:re.Ail . . . - - ....... . Date 7/1V/3 'time received /O:03 0 pm Mon. AkWed-: Thur. —Fri. - BED: i3 • Oc)rt.I +Iota 1-7,--ZZygo - Date: 7-1 4,-13 . . • - r. • • OWNER: Cielti(50,-) - Contact Namer. A 4V)e . • . ADDRESS: 2 is,4a 2, FA b4 re,it,T. 1, Contact Number:360 440 - 4146 ' t.....- . . , - . 206 Notes: - - - ' • • . - . . Foundation .Plumbing - Framing' . . Propane Tank Mechanical .. . Setbacks Under-ground Framing Underground Furnace - Footing K Rough in Air seal Above ground . • Gas Sternwall ..)t Hydronic Exterior shear Exterior lines • Oil Straps "A Interior shear Interior lines . Ducts f Post Hole Ventilation • Appliance Underfloor Gas/wood stove Man-Homes , - Setbacks • Insulation. . • Final Inspection -..1. Foundation-. • Block&Tie floor wall ceiling Address Posted -... ' . • I 45°N co JEFFERSON COUNTY G2 XDEPARTMENT OF COMMUNITY DEVELOPMENT g�sSHr °-c°$ Date: Time Received: am/pm C----)Mon Tue. .Wed. Thur. Fri. Date: /al 1- --V-2-0 (3 t 2_1 I Contact Name: Owner: 'Contact Number: 360 `f77-ei 335" Address: 206 Notes: Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing 7 Under ground Furance Footing Rough In Air Seal X 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