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BLD2013-00119
BUILDING PERMIT APPLIC!-ION BLD13-00119 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD13-00119 Received Date: 4/17/2013 SITE ADDRESS: 136 GEREAUX LN QUILCENE, 98376 OWNER: GARY ELMER TRTEE PHONE: 206-948-0094 JACQUELINE GARDNER TRTEE 5111 NE 201ST PL LAKE FOREST PARK WA 981551817 SUBDIVISION: Block: Lot: PARCEL NUMBER: 501031016 Section: 3 Township: 25 N Range: 01 W CONTRACTOR: TOWN & COUNTRY POST & FRAME PHONE: 425-743-1555 16521 HWY 99 SUITE C LYNNWOOD WA 98037-3161 Contractor's License TOWNCPF099LT Expires 7/7/2013 REPRESENTATIVE: TOWN & COUNTRY POST FRAME PHONE: (425) 743-1555 BRYAN BORCHERS (425) 742-4378 16521 HWY 99 STE C PROJECT DESCRIPTIOP DETACHED UNHEATED GARAGE - NO PLUMBING SHORELINE PERMIT EXEMPTION TYPE OF WORK GAR SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 840 VALUATION 2,813,944.00 ADD'L: HEAT TYPE: UH CODE EDITION: 2009 HEAT BASE: HEAT TYPE: OCCUPANCY: OCCUPANCY: UNHEATED: #OF STORIES: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: OSS WATER SYSTEM: 1PWELL BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: 9/7/3 Type Amount Paid By: Date: Receipt: Approved/Date Permit $431.65 ZAL 04/11/13 140237 Plan Check $280.57 ZAL 04/11/13 140237 APPROVED State Building Code $4.50 ZAL 04/11/13 140237 JUN 7 2U13 Total: $716.72 Jefferson County DOD 111lrlcmar44lo+o\fnrmo\G RI ff Ann Old rn+ AN7/9f 1 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 #: BLD13-00119 SITE ADDRESS: 136 GEREAUX LN Issue Date: 06/17/2013 QUILCENE, 98376 Final Date: 10/21/2013 APPLICANT: GARY ELMER TRTEE PHONE: 206-948-0094 JACQUELINE GARDNER TRTEE 5111 NE 201ST PL LAKE FOREST PARK WA 981551817 SUBDIVISION: Block: Lot: PARCEL NUMBER: 501031016 Section: 3 Township: 25 N Range: 01 W PROJECT DESCRIPTION: DETACHED UNHEATED GARAGE - NO PLUMBING SHORELINE PERMIT EXEMPTION THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2009 EDITION. OCCUPANCY GROUP: TYPE OF CONSTRUCTION: SPRINKLER SYSTEM yes no THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 10/21/2013 \\tidemark\data\forms\F_BLD_Occupancy.rpt 10/28/2013 Fe rian lown&Coun�® 16521 Highway 99,suite C•Lynnwood,WA 98037.3161 PI,ase Check After Doing Site Plan: ptic and drainfield I,�.,y.,��' POST FRAME BUILDINGS Everett:(425)2584171 • Puyellupr(253 840-9552 13f. le atio rtyaw North Arrow in Cin:le roperty dimensions wer ks of [L,��eodiation of property -�*�� , FAX:(425)7 -4378• 800-(425)743-1556 xisting buildings etbacks o1 proposed& buildings L7�odies of water - �— Ctr�t1�^ Cont(425) 7X.4376• 800-8249552 [[W Q L rnaroxw Ct'IIYW BILT Contractor's DC.lF:TOWNCPF099LT Proposed budding �tlpaln road with name F,16orplan Quality:O, Future Depend,On Ir"' permabineom•facebook.com/permabin Easements..,,. [ 'Access to proposed building CP/Slopes&Contours(5'increments) Job Name: rt.r:wt .. i Job Site Address: f 2i4 4/�K. L,�/ TarACCOUnt#:,_co 031 01 is Legal Description: Si. �r �, �� / 1 iota_ Iy�q �} ��� 4itifL w13 5.16 ;7(i ,eP.e _ /71° qJel'i-5181' Irk ' . oaacC Lin /az(s — -*d-+Ac fez ) ' ,(_. / ,QZ 0 104).06_19, - 6-v7taex-a---Th-c • . / _ L. ! i d �nd7rcirvx� f 56-0. 7il / 5734 ' • z�� r� Latia0CallCbad- s�c�cC ,s . �= /f7 .._ 42Of . .=-•• $p ' * 3,4 5 = 1081 i * . i 1 0 ' I , r 11 ?ftawB� - ._ t r q tit ‘5, Q f ` ; i-2o,� 0 `'c , 1i1 I, r 16'�t3n' s A A ow 12 Axy, I 1 PtsTiut2.8ftK) 0 a NI • i `•,_l` 4 rn N. �/- V. 1 'k / V� i "i N Y 'j Ltr. • - �a ? 1 t e /A@ 5 ` col rn n CI jF9ft(,.• f 1& t4 ! 5 Art,,2r44 Dt I�GSf4 , �yA: ` ` ''tip 115 /G1+ II Pr ', t t,,.rJ , ? sc t,ek i)NK. , PH f g 44 6.71•I? . • t-' 0 K : SCI 4 .a� w y t+, Y ` � DO NOT SIGN INCOMPLETE SITE PLAN! U9 Customer has verified and approved the location of the building,on tation of the building to the North,and verifies that all Grid White-Customer Copy Plain White-Office Copy +•! utilities are shown on this drawing in the corre I ation. CUSTOMER SIGNATURE _ ! LEAD# -77 5-"Q J ®2012 Perma-Bill®Industries FR-34 07/12 I IIIIII III!"II IIII i - -1 O hI I r • .. 10 I I A g N i/ m O 1 y i C CO P. f. -or' n -o O O p0 I- D z� a N ° c'./ C n r i o n p z -1K 17-1 SPAN I,.j T Pro z \ .7.--- a I BLac m a~m gt POST SPACING (40' MAX.) POST SPACING POST SPACING g o D v o m m z am m o > o ; z z m 0 xi y '• ya :,$" ( 4 MAX.) (ta' MAX.) (14' MAX)£m ® • 1"; Z g8pa O O y gmj p m Q r il L i B z V A 11\\, P A Z im V y• z El P IQ m m o m ■ • C D Z r 0O V r R q y D • ,.: 0 _ y D y m IA -0 • CC .Ln C� - ___ . 'pp y g 2 I. _ y-_•lmnZ mm�1�lO�+ C� fm*IZ \CIl/' , 0 y '� ���� Ni y_N n)%O Irl ZCy _ .O 0 y• rrl CLEARSPAN PER SEL1100 X -- ? 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F 6 4111 111111 ca ° 9� • Q Z 8 5 z O N 0 DETAILS ■�' io ` ; s i '.•MI ire �' ��'�+*•1R r- rr ,i Ai' 1-I I 1 :•1011 aa.,, a.BLEKAM :7r�:� r� :;� SCHEDULES it a _ .1 -_>•� �, J�FI�c—Je 5�t Bun • .i •. m s .ate apd to r r�T11•. AND NOTES n �nr- .^r �� date +o/�/� / t a• or Future Depends On It- MIIIIMMIIIIIIIIIIIIMI ' N �'`O JEFFER•COUNTY • ji.E_________C 0 V ofrtf.; DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 APR 1 1 2013 A A. 360/379-4450 . 360/379-4451 Fax • www.co.jefferson.wa.us/commdevelopment - JEFFESON CO!'NTy Master Permit Application N[ • ; DEPT.OF COMMLINrn gwrl.OPMMFNI Project Description(iwlude separate she as('7ecessary): 6a 4e i V- rJt1 ,,�Jtlrr7 9�.tC Tax Parcel • ber. 50 ( c231 0 114 Property Size: (acres/square feet) Site Address and/or Directions to Property: J3ev l c�-r-.4?./,k LILAv6-. Property Owner(s)of Record: 144202y El.-4.4tE7G Telephone: 2.06-9Vc-0O9 41 Fax: email: Mailing Address:37// it t� /•'r f-- E /�// _ Applicant/Agent(if different from owner):7 WAJ f au,uTiey4? rn�W4 '"SreVe-= 7-7,?/PCE77 Telephone: 177 7Y3 i` Fax:41.15"-2 /l"41378 email: r P. f (,r<;y.k. Mailing Address:/661/ _ V • N cc, tn..44 9P13-7 What kind of Permit?(Check each box that applies 9uilding ❑Critical Areas Stewardship Plan ❑ Demolition Permit 7 ❑Variance(Minor, Major or Reasonable Economic Use) ❑Single Family l.�Garage Attached/Detached ❑Conditional Use[C(a),C(d),or C]'* ❑ 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 ❑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 ❑ 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: v • DESIGNATION OF AGENT I hereby designate 1 efA'N, Rrr.Ar7iP,, to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE _- 2// Date: 0 - By signing this application fonn,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 attomey'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 o wants prior nogp. Signature: Date: C� .7_/�C�/ / The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been Issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual • and non-transferable respons�for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs aq/d dates it below. Signature: }i t' —�_ Date: C: .. / Z S- )3 G:\PeanitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc J • . " RECEIVED • )31 _exr Pe72 t�r�,Ny MAR 1 9 2013 le s, JEFFERSON COUNTY s DEPARTMENT OF COMMUNITY DEVELOPMENT P�j,(,r(=a•t&- -C 4/6/9/ ` 621 Sheridan Street•Port Townsend • Washington 98368 360/379-4450• 360/379-4451 Fax / /3 //9 '.„)*-,,',.:7.-- .,, :r. www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Project Description(include separate sheets as necessary): . Tax Parcel / Property Number. 50/D3/ 0/6, Size: s i 3/}c- (acres/square feet) Site Address and/or Directions tc Property: i 436 6 //QE.s4ak /.¢N4 Property Owner(s)of Record:( 4/ y ELA-1.E . Telephone: Zo.—94/r9" Co 941 Fax: email: Mailing Address: $/// Ate 20/ PL-- �) Applicant/Agent(if different from owner):7it I.61,471 04...c'f ije47N(—.,.SsT4'V 7/P!,' 77 Telephone: 12,-7Va/555 Fax: 9Z5-74/2—413742 email: ,COM Mailing Address: / .,, � " •- C Ncudeb , : 1,03 / T-T What kind of Permit?(Check each box at applies tiBuilding ❑Variance(Minor,Major or Reasonable Economic Use) . ❑ Demolition Permit ❑Conditional Use(C(a),C(d),or C)'* ❑Single Family Ut4Garage Atta /Detach ❑Discretionary"Cr or Unnamed Use Classification ❑ Manufactured Home ❑ Modular ❑Special Use(Essential Public Facilities)** ❑ Commercial* ❑Boundary Line Adjustment ❑ Change of Use ❑Short Plat** ❑ Address 0 Road Approach 0 Binding Site Plan • . ❑Home Business ❑Cottageindustry ❑Long Plat*' ❑Propane ❑Planned Rural Residential Development(PRRD)/Amendments"* ❑Sign ❑Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisions** 0 Stormwater Management ❑Shoreline Management Substantial Development** ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Variance ❑Temporary Use ❑Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment . ❑Forest Practices Act/Release of Six-Year Moratorium ❑Tree Vegetaion Request 'May require a Pre-Application Conference '*Requires a Pre-Applicazion Conference • Please identify any other local,state or federal permits required for this proposal, if known: Ir < D SIGNATION OF AGENT • I hereby designate 7-0 Cv A., 0 ..,el Lot 7In to act as my agent in matters relating to this application for pernit(s). OWNER SIGNATURE Date: 3,f 6//3 '" 1 I'H;i By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of "'t his,her or it's knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet t may result In this permit being null and void. i 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. r/) • • 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 ;.-I 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 applicat' that he er she nt pri r notice. I••) Signature:` ti„ Date: .5/J-/3 �4 • The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or , 0 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 ;''\j "Endangered Species Act-or"ESA'Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this -s, 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 iti1 actton(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferable responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: Date: (Lj 2 t: C\Doeoments and Settings\call\Local Settings\Temporary Internet Files\OUG6\,Vlateer Permit Application t2-39-2006.doc SZ (i (I) €€b . f I c I 1 04/08/2013 MON 14: 07 FAX 425 742 4378 PERMASILT 2002/002 1 , BUILDER STATEMENT t 1 The signer of this abatement does hereby certify Mal they are the Owners of the parcel referenced herein,that they are not lioensed contractors and that l they will be awaiting the responsibility of the General Contractor for the proposed project ' Signature: Date: ( GENERAL CONTRACTOR OR ACTIatED HOME INSTALLER: PHONE: FAX: - 7'vAri efA y s;� l lir, 017113-) 55 (tom 7+12-4378 MAII.Ne Ess: /4,621 ,999 6 G lys rv�r�sl_aan y�l.EMAIL IIRih iiseP',CRAW A, ecfk CONTRACTOR'S LICENSE -�' �s�,,,94 337 WAINS s NUMBER: 70Bt1rt/Cf (.09 41— 6L.T+fi9 NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) g MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: C New p1- Wood Existing: a Sewer Addition le Steel Proposed: Bank 0 Community System C Alteratbn/Remodel ❑ Concrete TOW: Height: r%Individual System 0 Repair ❑ Masonry SEP Perrot# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing; Setback: Private well ❑ Two Party Type of Heat: Proposed: ❑ Public Total: Name of System: t If this is a Commercial Protect you must answer the followinn; i Number of Parking Spaces; Current Proposed: Number of gag Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed ..IBC Occupancy:. IBC Type of construction: WIN you have Food Service? yet/Jig iia If this is a Propane Tank sacker ADnnce Installation permit.mark all items below that apply; , , ClUnderground Tank C]Above ground Tank Size of Propane Tank: ) C]Heat Stove 0 Cook Stove Ii Woodstove ❑ Fireplace Insert 01 Hot Water Tank LI Pellet Stove 0 Other �� 1 Is this sa:xance beina installed In a Manufactured/Mobile Nome? Yes / No When applying for pone* Install a propane tank you must also submit a site plan showing all of the bulldinge all property `a Mi Saes,tank/ocadon and size,distances from the propane tank to all property lines,buildings and septic system components, fnckad/n• the reserve area. , r1Y t,A,r i y rn it �I� ; ' . . • . .. •.9= .:re FOOfa! = , vi „t Is � - ... � _ 7 (; . , Main Floor Heated EH Bid App Review: • 2"Floor Heated Consistency Review: i n ti fi T Z`i =r Other Heated i u i Base fee: 31 ,l4,5' i a Mezzanine f: c ; Add S rrel Sediat: „� .. -` CD. Heated Basement ' 1 Plan Oliedk fees 1 oz go. Unheated Basement , State Surcharge fee: NI Other Unheated •,, ;; Pot Water Review fee: x C9arage/Garporl 0i I �.'191 SUBTOTAL i f O 7 r, ■ Decks ;''' ' 911/Rd Approach lee: lea 0.0 • Other r ,Ti TOTAL.: $ /SS'-1_7 Z l'.i Receipt Number 0 Cash/Check Number: '1.1 ESTIMATED UIRi -- Date: lei ara+r of all babOt end 2maafested ra J I • Initlals: ILI CADocumann Settings\cossraLocal S \Tareporwp 1itemetNes 1OLK86\MaerarPermitAppricaaoe12.492 b6.4:1c tri L.. L/)) E • i JeI1 \y,ry yeeAr JYIHAP,OudM1C•LVmw.J.We PMiI).3f6' yRBBLM01[!>,}bl DpAnQ&N RAM: Heiev I,A4 S.4rm•m ��/bltlm �W AVewNl9bb -._A. E- +(aPNaRNl a�tas�x 1$�IOperly olmeratne rime QEbVllOa of prCpery am He.uOC•,m rOAS)}U.reS6 �Wapekap lot dl pro=bE efes'kg bchitngs rr�pem00w water KIM BILT t...r4+nv p:tr� aropemel hWC"Chy yan roeaaun.m. rpieo i'I\1 Rmui6 na..r A1•pa(r QS}, wwit.enn•6mebedmnr?.oraan eeaemMS'dr Npapnsed ppdAg A&Lmtane(61nONmonN) \•'� ry Job-Nerve; YL/dhl .IOy"RA PIO'eee:cLczeiviw.7mrA0601/M—yr01.�71 Ol b Le9el OnOtipMen: uA r ,..,.; =. 3� .r 64. .. .. . .tiL., kdlblecks Doosed--u qi,.il/ors _ ,-4, eza2 itw• e • 0 c.:-1baa0wf 4 -C =`nta di,enefar.e..",_ . . i r dd . SOU. . irx� anafuc r r '^uO f y r r 213, • 6:1Joed. ' izzA• d -&2- '117641 I •- A,2ultb•428le`! '' 1 ■4il r r 1 Q r rK7Mwi"",,.— r A.1 2,6;. / 1 pl. (^ r IIc • A .r r F A r it p . -Ra• . r 4% Ge04.Acai ` ., i q u.-.'t. ,er-'-lfie..., ...,:,,. .. r .. ... 1. M s r w • l.. �ir.c v r a � ' ' ;ff, tad , a . 01 . T E ,(0 .. • • cyt f-Kr TAE N7 rS jatoax4 or 476A-0 Pr= .541 04 !kkcCi,C. "c k,, Pcw&a 4..6Iv1L ft' Sw&4 W ' @Y MAIY.CiLM -TraeG y • µl DO NOT BM tNLCNPL[TP.SITE RI.ANI - w G11Sarx nan walled am apIYWOtl ha looaxan of Ina brANO pyglAuaA d k•bulking ro the Norm,and'wanes m.A WI end W*..awanv Cam aiWn wNb nice Dopy a u"trtlec a le shown en thb MIMIC In rra I A nb-/ Y COMMER S ONRIURH P1 l�✓��'� LBMf ( O 2012 Pe81"o1 P-A 012 I■■ rticraN71IId 8L£17 Fi SZ4 lid 9£itl (IHS £TOZ/9Z/£0 ! • 4O 7/ N °�6 JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT TM ,,, 621 Sheridan Street • Port Townsend •Washington 98368 'Is. .•0 360/379-4450 . 360/379-4451 Fax http://www.cojefferson.waus/commdevelopment/ Stormwater Calculation Worksheet MLA# PROJECT/APPLICANT NAME: k7.-/A-CA DE f =oz, 44644 Z":" DETERMINING STORMWATER MANAGEMENT REQUIREMENTS: This stormwater calculation worksheet should be completed first to classify the proposal as"small,""medium,"or"large." The size determines whether a Stormwater Site Plan is required in conjunction with a stand-alone stormwater management permit application, building permit application, or other land use approval application that involves Stormwater review. The basic information will also be helpful for completing a Stormwater Site Plan,if required. PARCEL SIZE(I.E.,SITE) Size of parcel 4,3 acres '/ An acre contains 43,560 square feet. Multiply the acreage by this figure. Size of parcel in square feet •7" £/ZSs sq/ft Land-disturbing activity is any activity that results in movement of earth, or a change in the existing soil cover(both vegetative and non-vegetative) and/or the existing soil topography. Land disturbing activities include, but are not limited to clearing, grading, filling, excavation,and compaction associated with stabilization of structures and road construction. Native vegetation is vegetation comprised on plant species,other than noxious weeds,that are indigenous to the coastal region of the Pacific Northwest and which reasonably could have been expected to naturally occur on the site. Examples include species such as Douglas fir,western hemlock,western red cedar,alder,big-leaf maple,and vine maple;shrubs such as willow,elderberry, salmonberry, and salal;herbaceous plants such as sword fern,foam flower, and fireweed. LAND DISTURBING ACTIVITY,CONVERSION OF NATIVE VEGETATION,AND VOLUME OF CUT/FILL Calculate the total area to be cleared,graded,filled, Answer the following two questions related to excavated,and/or compacted for proposed development conversion of native vegetation: project. Include in this calculation the area to be cleared for: Does the project convert'/.acres or more of Construction site for structures ,rya sq/ft native vegetation to lawn or landscaped areas? Drainfield,septic tank,etc. U sq/ft Circle: Yes Well,utilities,etc. 0 sq/ft Does the project convert 2 Y2 acres or more of native vegetation to pasture? Driveway, parking, roads,etc. ('2-5 sq/ft Circle: Yes Lawn,landscaping,etc. C, sq/ft Other compacted surface,etc. //r) sq/ft Indicate Total Volumes of Proposed: Total Land Disturbance '45 sq/ft Cut Fill (cu/yd) lover) Stormwater calk worksheet—REV.2/20/2008 1 • • Impervious surface is a hard surface that either prevents or retards the entry of water into the soil mantle as under natural conditions prior to development. A hard surface area which causes water to run off the surface in greater quantities or at an increased rate of flow from the flow present under natural conditions prior to development. Common impervious surfaces include, but are not limited to roof tops,walkways, patios, driveways, parking lots or storage areas, concrete or asphalt paving, gravel roads, packed earthen materials, and oiled,macadam or other surfaces which similarly impede the natural infiltration of stormwater. STORMWATER CALULATIONS—IMPERVIOUS SURFACE NEW // EXISTING ry -7 Structures(all roof area) S"`t"� sq/ft Structures(all roof area) /$ I / sq/ft Sidewalks sq/ft Sidewalks sq/fl Patios sq/ft Patios sq/ft Solid Decks sq/ft Solid Decks sq/ft (without infiltration below) (without infiltration below) q Driveway, parking,roads,etc (pZS' sq/ft Driveway,parking, roads,etc -/y5*-6 sq/ft Other i sq/ft Other 1-7 sglft Total New / 7 S sq/ft Total Existing //�X/ / sgfft TOTAL NEW+TOTAL EXISTING* /21 ?'Z- sq/ft "This amount will be used to check total lot coverage. The following questions will help determine whether the proposed project is considered development or redevelopment. DEVELOPMENT v. REDEVELOPMENT Divide the total existing impervious surface above by the size of the parcel and convert to a percentage: Does the site have 35%or more of existing impervious surface? Circle: Yes ono FURTHER INSTRUCTIONS: If the answer is yes, the proposal is considered redevelopment and the attached Figure 2 should be used to determine the applicable Minimum Requirements. If the answer is no, the proposal is considered new development and the attached Figure 1 should be used. At this juncture,the applicant should refer to the applicable Flow Chart to determine the Minimum Requirements for stormwater management. DCD staff will help verify the classification of the project and the application requirements. For proponents of "small" projects who must comply only with Minimum Requirement #2—Construction Stormwater Pollution Prevention—an additional submittal is not required. The proponent is responsible for employing the 12 Elements to control erosion and prevent sediment and other pollutants from leaving the site during the construction phase of the project. Pick up the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices(BMPs) Packet. Proponents of"medium" projects—those that must meet only Minimum Requirements #1 through #5—and for "large" projects—those that must meet all 10 Minimum Requirements—are required to submit a Stormwater Site Plan. DCD has prepared a submittal template of a Stormwater Site Plan, principally for rural residential projects. Complete the template in the Stormwater Site Plan Instructions and Submittal Template or prepare a Stormwater Site Plan using the step-by-step guidance in the Stormwater Management Manual. APPLICANT SIGNATURE By signing the Stormwater Calculation Worksheet, I as the applicant/owner attest that the information provided herein is true and correct to the of my knowledge. I also certify that this application is being made with the full knowledge and consent of all owners of tcted property. �r —al `irridd'/ 3//S/ 2 (LANDOWNER OR AUTHORI- ' F "� -77 SIGNATURE) (DATE) r 3 T` i wt v";` " tir7" ■ h°= stormwater wlo worksheet—REV.220/2008 2 ' JEFFERSON COUNTY h _ '' DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend • Washington 98368 vie` NG � http:3www .co.jefferrson.a.s/ommdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# PROJECT/APPLICANT NAME: L 2_I•/�� 2& COED .4•R/¢c7 - Please answer all of the following questions to the best of your ability. Where the question calls for depiction on a site map, the applicant may choose to either incorporate the elements into the general plot plan for the Master Land Use Application or to submit a separate stormwater site plan map. Project Overview 1. Describe the proposed developed conditions of the site. Indicate position and relative size of proposed improvements on the site map. 1-10A/S�.Pl./CT a'RriP6�.4cNfED (ag e,66,,:tt/L5 25X ZS;74,.. 4 orF /S7 MN, ii/E-W47f Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. 4'7; S/oyx "/Pe.2 1/37 ' 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. L�E,tr " V 72 - h 'oFpAiP7rs/�s i�✓E a,4 6( 4. Describe the existing soils. Indicate soil type on the site map. Al/14-77e/ 5. Describe the existing site hydrology(i.e., drainage; behavior of water on the site—above, below, and on the ground). Indicate existing stormwater drainage to and from the site on the site map. Depict separate drainage basins on the site map, if applicable,and indicate acreage of each. #ifl.1 ofItD, rt'6 44-f.e /Ot LvR t 6. Describe any excess levels of noise generated by the proposed use or activity: stormwater site plan template doc—rev.10/12/2003 5 • • 7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams, steep slopes,etc.)on the site. Indicate location on the site map. S/67/4) . g -4 bs p/)g s ea/94"- 8. Describe the general vicinity of the site, including adjacent land uses and structures, utilities, roads,and sensitive/critical areas (streams, wetlands, lakes,steep slopes,etc.). _avT Permanent Stormwater Control Plan This portion of the Stormwater Site Plan consists of the selection and installation of the appropriate stormwater control BMPs and facilities to remain in place after construction of the project is completed. "Medium" size projects are required to have the totals calculated of all impervious surfaces, pollution-generating impervious surfaces, and pollution-generating pervious surfaces to verify that the thresholds for treatment facilities and flow control facilities are not exceeded. g. Describe the developed site hydrology, as proposed. Indicate whether stormwater will be fully dispersed (i.e., per BMP T5.30 in the Manual) or, if not, what types of stormwater flow control will be utilized for the site or specific threshold discharge areas within the/s�ite. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. 6u/-5kies"n p�eorr v 3rb cc js 7o S/11-5 de 2v trr7rr �i t.�2 10. If the project requires the use of stormwater treatment facilities,describe the types of stormwater treatment facilities proposed for use on the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. [This is normally for"large" projects or projects that involve the potential for dispersion of contaminants.] A//# 11. Describe the performance goals and standards applicable to the project. 12. Describe the flow control syste N471!c A ' / stormwater site plan template.doc—rev.10/12/2003 6 • • 13. Describe the water quality system. n 14. Descri a the conveyance system analysis and design. if 15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material. 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Unifoyrm!, ilding Code. Nve- 17. Describe the proposed surfacing material. /f/v9Ti,C rar yRAv/v/fire 414:7"e-c 18. Describe methods for restoration of the site. /� // /r+/i"/�n,4— 7J fsTi,+.p�€,*"fc e )4R b/tc �oo1/ /•t/J1,4.v?s ,QtrAile...1. o vGV 19. An Operation and Maintenance Manual is required for each flow control and treatment facility. [This is normally required for "large"projects only and only those for which facilities are required to control flow or treat runoff.] If included, list the Manuals here. NI 20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan. 21. List other necessary permits and approvals as required by other regulatory agencies. If those permits or approvals include conditions that affect the drainage plan or contain more restrictive drainage-related requirements,describe those conditions or restrictions here. ij/O/t.e stormwater site plan template doc—rev.10/12/2003 7 • • CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN(SWPPP) The Construction SWPPP addresses sediment and erosion control during construction. The BMPs indicated by the applicant in the template that follows must be installed on the ground during all construction phases of the project. The proponent is responsible for preventing sediment and erosion impacts to environmentally sensitive areas and off-site areas. Consult the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet for guidance, particularly with rural residential development. SECTION I-CONSTRUCTION SWPPP NARRATIVE 1. Construction Stormwater Pollution Plan Elements. Describe how each of the Construction SWPPP elements has been or will be addressed. Identify the type and location of BMPs used to satisfy the required element. If an element is not applicable to the proposal,justify in writing. Descriptions of the 12 Elements are found at section 2.5.2 of the Manual(beginning on page 2-15). 12 Required Elements-Construction SWPPP 1. Mark Clearing Limits. /L.-7-r uc. .--,b0u SLOP. AriAieE4 .9P-04)/51-1r, .., C2 2. Establish Construction Access. 3. Control Flow Rates. 4. Install Sediment Controls. .-/L7-.4:.--NL � 5. Stabilize Soils. A Diu/c? 4,e s 01 L— F.rPns i e. 4e 54,1A1 jP 1.4,4"5 6. Protect Slopes. 7. Pro ect Drain Inlets. /VA stormwater site plan templete.doc—rev.10112/2003 8 • • 12 Required Elements-Construction SWPPP(continued) 8. Stabilise Channels and Outlets. A(/jA 9. Control Pollutants. N 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). 11. Maintain Best Management Practices(BMPs). r si -r r.VS7 tC -41 Lf L PaojC C 4 O.c/ 12. Manage the Project. 4./Z-7'F vC� /s ec/41 a.C?- 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas,roads). b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). l 7 - .per/ irfeok /94'x6 stvS�ae 3. Environmentally Sensitive Areas. a Description of environmentally sensitive areas that are on or adjacent to the site. G1,17eA- gedia !7 stormwater site plan template doc—rev.10/12/2003 • • b. Description of special requirements for working in or near environmentally sensitive areas. SJL7/ ,/ e e e-,-,,,,...) ,A=4.41.11 4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site soils(e.g.,erodibility, settleability, permeability,depth,texture, soil structure). /J1A 5. Construction Phasing. a. Construction sequence �i //e Piee/o 4-,' //crtrne.J / 4/e i 2 ,¢,v#!4 /ros/.uij�0e 7X74JV' --6? brte�.c.�73 b. Construction phasing (if proposed) 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). I. Provide a proposed ronst-uction schedule_ _. 1 t'!'Wore ,144.v ore,/o 4fe fz ,e .z;G l t/k?c-: -5 II. Wet Season Construction Activities. Proposed wet season construction activities. AIL— b. Proposed wet season construction activities for environmentally sensitive areas. 7. Financial/Ownership Responsibilities. a. !dent y the property owner responsible for the initiation of bonds and/or other financial securities. b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following, if applicable. a. Sediment Ponds/Traps. fb. Diversions. c. Waterways. d. Runoff/Stormwater Detention Calculations slormwater site plan template.dos—rev.10/12/2003 10 • • SECTION II—EROSION AND SEDIMENT CONTROL PLAN Sediment and erosion control measures may be depicted on the master land use application plot plan, a stormwater site plan,and/or a separate Construction SWPPP site plan. This is a checklist to ensure that the following are depicted on a site plan: 1. General. (9 Vicinity Map fli Jefferson County Approval Block Erosion and Sediment Control Notes 2. Slte Plan. a. Legal description of subject property. b. North arrow. c. Indicate boundaries of existing vegetation(e.g.,tree lines, pasture areas, etc.). d. Identify and label areas of potential erosion problems. e. Identify FEMA base flood boundaries and Shoreline Management boundaries Of applicable). f. Show existing and proposed contours. g. Indicate drainage basins and direction of flow for individual drainage areas. h. Label final grade contours and identify developed condition drainage basins. i. Delineate areas that are to be cleared and graded. j. Show all cut and fill slopes indicating top and bottom of slope catch lines. 3. Conveyance Systems. a. Designate locations for swales, interceptor trenches, or ditches. b. Show all temporary and permanent drainage pipes,ditches, or cut-off trenches required for erosion&sediment control. c. Provide minimum slope and cover for all temporary pipes or call out pipe inverts. d. Shows grades, dimensions,and direction of flow in all ditches,swales, culverts and pipes. e. Provide details for bypassing off-site runoff around disturbed areas. f. Indicate locations and outlets of any dewatering systems. 4. Location of Detention Best Management Practices(BMPs). Identify location of detention BMPs. 5. Erosion and Sediment Control Facilities. a. Show the locations of sediment trap(s),pond(s),pipes and structures. b. Dimension pond berm widths and inside and outside pond slopes. c. Indicate the trap/pond storage required and the depth, length,and width dimensions. d. Provide typical section views through pond and outlet structure. e. Provide typical details of gravel cone and standpipe, and/or other filtering devices. f. Detail stabilization techniques for outlet/inlet. g. Detail control/restrictor device location and details. h. Specify mulch and/or recommended cover of berms and slopes. i. Provide rock specifications and detail for rock check dam(s), if applicable. j. Specify spacing for rock check dams as required. k. Provide front and side sections of typical rock check dams. I. Indicate the locations and provide details and specifications for silt fabric. m. Locate the construction entrance and provide a detail. 6. Detailed Drawings. Any structural practices used that are not referenced in the Ecology Manual should be explained and illustrated with detailed drawings. 7. Other Pollutant BMPs. Indicate on the site plan the locations of BMPs to be used for the control of pollutants other than sediment(e.g.,concrete wash water). 8. Monitoring Locations. Indicate on the site plan the water quality sampling locations to be used for monitoring water quality on the construction site. Sampling stations should be located upstream and downstream of the project site. stormwater site plan template.doc—rev.10/12/2003 11 • • Stormwater Site Plan Changes If the designer wishes to make changes or revisions to the originally approved Stormwater Site Plan, the proposed revisions shall be submitted to DCD prior to construction. The submittal shall include substitute pages that include all proposed changes, revised drawings showing any structural changes,and any other supporting information that explains and supports the reason for the change. Final Corrected Plan Submittal If the project included construction of conveyance systems, treatment facilities, flow control facilities, or structural source control BMPs (not standard on-site stormwater management BMPs), the applicant shall submit a final corrected plan ("as-builts")when the project is completed. These should be engineering drawings (stamped by a licensed civil engineer) that accurately represent the project as constructed. APPLICANT SIGNATURE By signing the Construction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all owners of the ected property. �-/3 0 ER OR AUTHORIZED RE ESENTATIVE SIGNATURE) (DATE THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: stormwater site plan template.doc—rev.10,12/2003 12 a re plan �� OWII �• 16521 Highway 99,Suite C•Lynnwood,WA 880373161 PI se Check Attar Doing Site Plan: ptic and drainfield f/ waimmormserimemiff POST FRAME BUILDINGS Everett:(425)2584171 • Puyallup:(253)840-9552 -roperty dimensions tN Jsof size Draw North Arrow in Circle e Administrative Headquarters: (425)743.1585 istin buildings er Ifpes L�7' levatlon of property +���.r— ERMA BI LT Fes' (425)742-4378•8011-824x552 g g aro a of proposed 8 existing buildings j�3odles of water �� � °ryM10NpF Contraetor's Lic.e:TOWNCPFOeeLT Proposed building ylain road with name f�P,lborplan (`�('\j) Quality:Our Future Depend,On It.'' pe mabilt.com•facebook.corNpermabia Easements/ � /J Access to proposed building C13�Slopes&Contours(5'increments) Job Name: i!;1:L4 Cale... ; • Job Site Address: /ark. lafP .ikt IL LA/ ' TaxAccount#: Ca)I C 1 01 to Legal Description: Q(l�'� �� van e 37 l . a. ` Vii' � / Lo J / o � 'L-/L'[X' NY, 5-7(L1(GtXXY - ifL,, /0I7 I 6 ' 74/t11A-E)66LISILL141°Litt .nieltleicle6iiat+/-0 qd. 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DO NOT SIGN INCOMPLETE SITE PLAN! 4fl Customer has verified and approved the location of the building,on���i��7Qptation of the building to the North,and verifies that all Grid White-Customer Copy Plain White-Office Copy IZ utilities are shown on this drawing in the torte I cation. t CUSTOMER SIGNATURE hit LEAD# ? 5-9/ ©2012 Perma-Bilt®Industries FR-34 07/12 I 11111111111111111 - 1 0 Up Front Parcel Review. Parcel 501031016 Printed: April 17, 2013 GARY ELMER TRTEE Site Address: JACQUELINE GARDNER TRTEE 136 GEREAUX LN 5111 NE 201ST PL LAKE FOREST PARK, WA 98 QUILCENE WA, 98376 Parcel Number: 501031016 S-T-R: 3-25N-01W Total Acreage 6 Legal Description S3 T25 RI W TAX 15 &TL TAX B3 (3.41 CH) Land Use: 1101 Flood District: Fire District: 2 Planning Area: Flood Map(FIRM)Panel No: School District 48 Zoning: Rs--- COMP PLAN DESIGNATION: COMMUNITY PLAN: UGA: UGA Trans [ fr( Plot plan states "property line" [ ✓ - Assessor's Map(Property lines on submitted plot plan must match the property lines as identified on the Assessor's 1/4 map) [1,1" Legal Access to Property 4231, NO [ 1.47 Parcel Tags or Scanned Documents YES ( o) [ V}' ESA's: Special Reports Nearby YES NO [[ Designated Ag YES NO [t( Shoreline Designation:_ NO COd� �v4.UL [ Shoreline Slope Stabile : YES NO Stream Type:YES NO Fish& Wildlife:YES NO Wetlands: YES NO Rare Plants:YES NO _ Seismic: ES NO 51,►-fp Landslid NO � [,Lcl CA-t-- Flood: YE NO Erosion: eV NO e la Aquifer Rec arge Area:YES NO SIPZ: none At Risk High Risk Coastal CMZ: none High Risk Moderate RiskDisconnected CMZ Stormwater site plan sub a itted: YesNo [f Forest Lands: YES e Adjoining Forest Lan.s: Commercial/ Rural/ Inholding [1/1"-- Mineral Lands: YES l [ (,r Agricultural Lands: YES 4) [Csr- Archaeology: YES @ r [ [J Stormwater: New Impervious Surface h Land Disturbing Activity ( /i(o t ESA's Stormwater Req's:Min Req#2 Min q#1 thru#5 Mm Req#1 thru#115 Engineering Notice Provisions/Disclosure:Ai ort YES NO MRL YES NO Forest Lands YES NO [,Landscaping Required: Yes L ) [ V Parking Spaces Re. 'red NO Other l LY Building Height: 4110 UBC Standard [ .]I-Impervious Surface cover percentage: Resource Lands&Public: I Rural Residential. 25°/ Rural In al: Per UDC Sec 6.7 Rural Commercial: 60% Area of Building Coverage:60%in Rural Industrial Lands only [ V' Total Building (s) Size: RVC:20,000 SF CC: 5,000 SF NC: 7,500 SF GC: 10,000 SF All others:subject toeptic&water constraints/NAB specified [ Setbacks: Front: 0 Left Side: i Right Side: t-, Rear: 4 Shoreline Setback: 192 p LSHA Setback: i;r [ 4--- Road Classification: Road Approach: XISTIN NOT REQ'D RAP [ C ' SEPA Required: YES { Flood Certificate: [ kr Existing Case(s) &Condition(s): Violations: Yes No [ Recorded Date of Subdivision: AFN Over 5yrs–UDC / Plat Conditions: <5yrs=Plat Conditions on plat or Old Ordinance I' [ r Lots/Require Declaration of Restrictiv• .venant YES NO, submitted: YES NO [ UGA No Protest Agreement YE' ; • ,submitted: YES NO [' ] Site Visit conducted YES 0 [ Require Final Zoning Approval YES [ ADMIN: Setbacks entered in Permit Plan case 4k/0%M New Parcel Tags entered in Permit Plan - 'YES Special Reports Scanned YES No parcel tags found for parcel Cases Associated with APN 501031016 Cases Name Review Type Status Planner CAR00-00521 ELMER F K RUSSELL Application Received: 12/5/2000 Permit Issued/Case closed: 2/2/2001 Case Finaled: 2/2/2001 manufactured home installation BLD01-00189 ELMER F Application Received: 4/3/2001 Permit Issued/Case closed: 4/3/2001 Case Finaled: 4/18/2001 Propane Tank Installation BLD13-00119 ELMER TRTEE P Application Received: 4/17/2013 Permit Issued/Case closed: Case Finaled: DETACHED UNHEAI l U ((AKAGE - NO PLUMBING SHORELINE PERMIT EXEMPTION BLD00-00778 ELMER F Application Received: 12/5/2000 Permit Issued/Case closed: 2/21/2001 Case Finaled: 6/27/2001 MANUFACTURED HOME INSTALLATION FPA2611642 ELMER TRTEE F Application Received: 3/1/2012 Permit Issued/Case closed: 3/30/2012 Case Finaled: 4/2/2012 5.4-acre timber harvest. (Approved subject to two conditions: (1) Notify the local forest practice forester two business days prior to starting operations. (2) No harvest is allowed below the steep break in slope above the Type Ns stream). SOM99-00160 ELMER TRTEE F Application Received: 6/14/2001 Permit Issued/Case closed: Case Finaled: CAR99-00228 ELMER F K RUSSELL Application Received: 6/8/1999 Permit Issued/Case closed: Case Finaled: 1/14/2002 New alternative septic sys em. SEP99-00160 ELMER F Application Received: 6/8/1999 Permit Issued/Case closed: 2/9/2001 Case Finaled: 6/14/2001 \\tidemark\data\forms\R_Parcel CRMLA.rpt 4/17/2013 Page 2 of 3 L15k98-00105 ELMER A Application Received: 11/12/1998 P rmit Issued/Case closed: 4/9/1999 se Finaled: \\tidemark\data\forms\R_Parcel_CRMLA.rpt 4/17/2013 Page 3 of 3 BUILDING PERMIT • Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD13-00119 Received Date: 4/17/2013 SITE ADDRESS: 136 GEREAUX LN Issue Date 6/17/2013 QUILCENE, 98376 Expiration Date 6/17/2014 OWNER: GARY ELMER TRTEE PHONE: 206-948-0094 JACQUELINE GARDNER TRTEE 5111 NE 201ST PL LAKE FOREST PARK WA 981551817 SUBDIVISION: Block: Lot: PARCEL NUMBER: 501031016 Section: 3 Township: 25 N Range: 01 W CONTRACTOR: TOWN & COUNTRY POST& FRAME PHONE: 425-743-1555 16521 HWY 99 SUITE C LYNNWOOD WA 98037-3161 Contractor's License TOWNCPF099LT Expires 6/30/2013 PROJECT DESCRIPTION: DETACHED UNHEATED GARAGE - NO PLUMBING SHORELINE PERMIT EXEMPTION TYPE OF WORK GAR SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 840 VALUATION 28,139.00 ADD'L: HEAT TYPE UH CODE EDITION: 2009 HEAT BASE: HEAT TYPE: OCCUPANCY: OCCUPANCY: UNHEATED: #OF STORIES: OTHER: CONST TYPE: SHORELINE: CONST TYPE: GARAGE' SETBACK: 100 DECK: BANK HEIGHT: 100 SEWAGE DISPOSAL: OSS WATER SYSTEM: 1PWELL Type Amount Paid By: Date: Receipt: BEDROOMS: BATHROOMS: Permit $431.65 ZAL 04/11/13 140237 Exist: Exist: Plan Check $280.57 ZAL 04/11/13 140237 Prop: Prop: State Building Code $4.50 ZAL 04/11/13 140237 Total: Total: Total: $716.72 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 Jefferson County Building Division Permit Number: BLD13-00119 Applicant: ELMER TRTEE 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 days 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 8/3013 Erosion Control B !3 30 Post Holes / I' d\0 1/43 Straps(hold downs) �J Framing 4/l!//3 Blocking Drywell/Alt Drainage 04's Address Posted /e/4,-.3 C, / FINAL INSPECTION /(1.2 i/i /mil FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR • • CONDITIONS for Building Permit# :BLD13-00119 1.) A vegetative buffer of 30-feet shall be permanently maintained from the top or edge of the steep slope or Landslide Hazard Area. All buffers shall be measured perpendicularly from the top of the Landslide Hazard Area. 2.) Landslide Hazard Areas and their associated buffers shall remain naturally vegetated. Should buffer disturbance occur during construction, the Unified Development Code (UDC)Administrator shall require replanting with native vegetation. No alterations shall be made to the Landslide Hazard Area or its associated buffer without prior authorization by the UDC Administrator, 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.) This project reviewed and approved as a Shoreline Exemption under JCC 18.25.090(5). 6.) No plumbing has been reviewed or approved for this project by Jefferson County Public Health. Additional requirements may apply if plumbing is proposed. 11tiriamark\rlatalfnrmc\F RI fl Permit RIrin rnt F/1712n13