HomeMy WebLinkAboutBLD2009-00329 IRUILDING PERMIT APPLICA•N MLLA09100p315
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD09-00329 Received Date: 9/30/2009
SITE ADDRESS: 783 PROSPECT AVE
PORT TOWNSEND, 98368
OWNER: BERNT P ERICSEN PHONE: 360-301-0324 j
MARLENE J ERICSEN
1656 S JACOB MILLER RD
PORT TOWNSEND WA 98368-9077 IRON DALE
SUBDIVISION: Block: 114 Lot: 25-32
PARCEL NUMBER: 962111408 Section: 34 Township: 30 N Range: 01 W
CONTRACTOR: REALITY HOMES INC PHONE: (253)926-6330
1308 ALEXANDER AVE E STE B
FIFE WA 98424
Contractor's License REALIH1984CN Expires 2/15/2010
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI NSFR W/ ATT GARAGE
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 1,614
VALUATION 142,661.00 ADD'L: HEAT TYPE: EEE
CODE EDITION: 2006 HEAT BASE: HEAT TYPE:
OCCUPANCY: R-3 UNHEATED: # OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: 5N SHORELINE:
GARAGE: 484
CONST TYPE: SETBACK:
DECK: 363
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: PUD
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 3 Prop: 2
Total: 3
Ripting Date:
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $1,234.55 LYK 09/30/09 111021 APPROVED
Plan Check $802.46 LYK 09/30/09 111021
State Building Code $4.50 LYK 09/30/09 111021 DEC 9 2009
Potable Water Application $62.00 LYK 09/30/09 111021
Total: $2,103.51 Jefferson County Planning
& Building Department
CERTIFICATE OF OCCUPANCY
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451 (800) 831-2678
Al Scalf, Building Official
PERMIT #: BLD09-00329
SITE ADDRESS: 783 PROSPECT AVE Issue Date: 12/9/2009
PORT TOWNSEND, 98368 Final Date: 4/21/2010
APPLICANT: BERNT P ERICSEN PHONE: 360-301-0324
MARLENE J ERICSEN
1656 S JACOB MILLER RD
PORT TOWNSEND WA 98368-9077
SUBDIVISION: IRONDALE Block: 114 Lot: 25-32
PARCEL NUMBER: 962111408 Section: 34 Township: 30 N Range: 01 W
PROJECT DESCRIPTION: NSFR W/ ATT GARAGE
THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING
CODE 2006 EDITION.
OCCUPANCY GROUP: R-3
TYPE OF CONSTRUCTION: 5N
SPRINKLER SYSTEM yes cn—iTT'
THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 4/21/2010
I:1F_BLD_Occupancy.rpt 10/29/19
• S
12 Required Elements—Construction SWPPP(continued)
8. itabilize Channels and Outlets.
Pr
9. Control Pollutants.
Mtrat 0_41-Vic iQtR .
10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
t\6y (in+► cxeakcee.
11. Maintain Best Management Practices (BMPs).
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d�5 rbina` iic tJotti gam. monii-or ciAti v
12. Manage the Project. ,
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2. Adjacent Areas.
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential
areas, roads).
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b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
rds).
OMM.
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3. Environmentally Sensitive Areas.
0 4 Description of environmentally sensitive areas that are on or adjacent to the site.
stormwater site plan template—rev.10/21/2008 9
• •
b. Description of special requirements for working in or near environmentally sensitive areas.
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,settleabilittyy permeability,depth, texture,soil structure).
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5. Construction Phasing.
a. Construction sequence
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b. Construction phasing (if proposed) 6.14 t p(a tt g y�cS
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
Provide a proposed construction schedule.
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II. Wet Season Construction Activities.
a. Proposed wet season construction activities.
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b. Proposed wet season construction activities for environmentally sensitive areas.
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7. Financial/Ownership Responsibilities.
a. Identify 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.
I�ct'snnat `R .SQonsL6111tl of Oujila
8. Engineering Calculations. Provide Design Calcula'tio I ssn on a separate sheet for the following, if applicable.
a. Sediment Ponds/Traps. N/ /T
b. Diversions. 1i
c. Waterways. Lt
d. Runoff/Stormwater Detention Calculations '1
stormwater site plan template—rev.10/21/2008 10
• S
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.
a. Vicinity Map
b. Jefferson County Approval Block
c. Erosion and Sediment Control Notes
2. Site 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(if applicable).
f. Show existing and proposed contours. 5
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—rev.10/21/2008
11
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 affected property. n p (�
_ "' g(4,644„,' �t -.9-6/'o l
(LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
stormwater site plan template—rev.10/21/2008 12
• APPROVED
STORMWATER PLAN
f ,°1: �,°64, JEFFERSON COUNTY DEC - 9 2009
� �
„, ' DEPARTMENT OF COMMUNITY DEVELOPMENT
g
J ON CO NTY I
„ 621 Sheridan Street• Port Townsend •Washington 98368 DEPT. iFco b� �PMEN 1
A.4:).'" 360/379-4450 • 360/379-4451 Fax SIG\ATV �' IX C�
'...._ http:1/www.co.jefferson.wa.us/commdevelopment/
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA. 001—35 PROJECT/APPLICANT NAME: "atemi 4 rY LvI tvtc En C.Ser.)
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.
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Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map.
'lke- 6rror.c1i `I.et S1.10ic5 -froyn PJor+Gt 40 ,5mwi (10- I5%)
3. Describe the existing vegetation. Indicate native vegetation areas on the site map.
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4. Describe the existing soils. Indicate soil type on the site map.
5015 ar. 1Da rn ti ,Srtir1 L i -ii1.e, Sams .to d ee+ 0-I 4 lest to '
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.
__applicable,
S (eees _ 00Y 40 S, cf& a) /0 -16`?o I .570 arc erYnta.bf# d
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. ++a.ut not obscr ksel an li sd n/uAI uaai--ex two- 1 Ira.
6. Describe any excess levels of noise generated by the proposed use or activity: 1
NO(maQ. Gans# l.4.L nvtse
stormwater site plan template—rev 10/21/2008 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 ma..
-10o Silf114 cart PQ h4 WC& or n meet41t, b csg.h5 v,, cerca-s
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.).
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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 site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities.
loo A.ro logii .bouM'ouk toal-cr -iv be, rit red ek t n 1a in C`i+i Zar
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.]
NIA
11. Describe the performance goals and standards applicable to the project. //
ro 41 n. i r [ r .► . i .. i,, La. . •(Nl 1 I►l , �' ,4.1
irP
12. Describe the flow control system.
)o `'low elk6ol ay-Dqc&e. 2 .
stormwater site plan template—rev 10/21/2000
6
0 0
13. Describe the water quality system.
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14. Describe the conveyance system analysis and design.
& d * wrtee,r ' o edeQ. bas rts 4 rfl-1 [-I'rdlen -/-vt>nc.�� - see_
a-�a4-67 l0t gar •
15. Describe the source of fill material, physical characteristics of fill material,and deposition of excess material.
NO -'i li atakeristi2.. it) be. 1 v, ■ O rteht pit cepf -ror (2 dirt,~, 1rave2-6'r u es-
Narage, sLe,b al;d cru-4kJ. (19 A. "(ln ]sk dr v k.9aet .
16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
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17. Describe the proposed surfacing material. .
54." G- h bas a- -f -6c n t s k d,rr�&ie M , iras35 d2l!airic� en c Into ebeet.
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18. Describe methods for restoration of the site. ,
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re.4n0 CA. OA b4c1 9 ►]1c-adity- to West . (P o'ste c- CLury 46 fo+e
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/J.
20. List het 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
restrions here. n
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slormwaler site plan template—rev.10/21/2008 7
9 • '‘‘‘ I
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 Volume II Section 3.2.3 of the Manual (beginning
on page 3-7).
12 Required Elements-Construction SWPPP
1. Mark Clearing Limits. "" �
Sire , does 110-e 1Z 9Lt'G ctY1;� tit Qrd.Y t►'1Q
2. Establish Construction Access.
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air 78'3,
3. Control Flow Rates.
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4. Install Sediment Controls.
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5. Stabilize Soils.
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6. Protect Slopes. t,. rr
C�c,nf{e
Ste R lb-t5 9, 1 'Jo So+ti t. SOLI' are, S U
7. Protect Drain Inlets.
dY tl bLb s rFeeit
stormwater site plan template—rev.10/21/2008 8
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(FILE NAME OWNER 1
ERICSEN.TRV Bemt/Marlene Ericsen .
0 30' SCALE DATE DRAWN BY '4140', i
�w 30 Ft/In 9-29-2009 Bemt Ericsen
NEI PARCEL# REVISION SHEET
962111408 1/1 1/1 J
This map drawn with TRAVERSE PC,Softws�4i 41 k Ai Pi COUNTY D CD
44-0"
5-9" _ -, . 16-5". 11-10"
4-11' - 6'4" • 5-6" - 4.6" - 411" -- 5-?"---- 5!11" 3.7"y
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NIndc 'MFG Is Mllgard&U Factor Is.55 for sl/dIng windows Main Floor Plan
and.33 for 1&ed 5hfIghls ere.56.
Extorter Poor MFG Is OrePac&U Factor Is.20. Scale 1/4"= 1'
r0NDOYYSCHEDULE
QTY FLOOR,SIZE E6RE55 I TEHPERED CLASS DESCRIPTION
2 1 13505H SINGLE KUNG
1 / 4036L5 - LEFT SLID/N6
? I 5040L5 TES LEFT SLIDING Glazing Ft
2 1 5050L5 LEFrSLIDNG 9 q 145.50 sq ft
1 I I 50610L EX EX T.SLIDER-CLASS �7 ----
I I 6040L5 . YES LEFT SLIDING Ext. Door 5q Ft _36. 17$q
1 I 6050FX DOOR SCHEDULE F1xEDGLASS r Total Glazing 5q Ft 101.67 sq fT
aTY FLOOR151ZZ �DESCRIPr1ON divided Ey
1 24 GARAGE 16
664 Heated Living space 1614 s
3 NMRIN MNGED6PANEL
g P 9 ft -
_ , 2666 L IN 14IN6ED6 PANEL Glazing 11.26%
1 3066 R EX EXT.HINGED6 PANEL 9 Percenta 9
1 50664 IN K/MCED SUNRISE PANEL **Garage JNlndows not included"
ONc
• 06 JEFFERSON COUNTY
k-c ' 4,4 DEPARTMENT OF COMMUNITY DEVELOPMENT
'' 04 621 Sheridan Street • Port Townsend •Washington 98368
4 3601379-4450 . 360/379-4451 Fax
,QSBrNG,LQ www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: CC) - 5
Project Description (include separate sheets as necessary):
.bit/i L 3 tkirr2D rIA e2 IOR:41 / I f.i it S6. 4 Sl ftg Le m 4 rt-Sx ceennCe ? ATT i, "� `1`
Tax Parcel Number: R6P,)_ I U >tag. Property Size: (acres/square feet)
Site Address and/or Directions to Property: j
783 --Ploza a.o.. Tort, Ty th cei't1, uk 1g344
Property Owner()of Record: ZoXn t" i in eve LC-n L r c )
Telephone: 3(od`30i - 03 ay Fax: 37q - �i344 email: eriG ,r,d&sininc a)1.erim
Mailing Address: I(rSG S.01.-Lir ,Jacob m'Ilief RS .
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies ❑ Lot or Road Segregation
;41Building ❑ Critical Areas Stewardship Plan
LI Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use)
ci3 Single Family X1 Garage • r_.ch-. _Detached ❑ Conditional Use[C(a),C(d),or CI"
❑ 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
Cl Forest Practices Act/Release of Six-Year Moratorium ❑ Jefferson County Shoreline Master Program Amendment
*May require a Pre—Application Conference ❑Tree Vegetation Request
**Requires a Pre-Application Conference
Please identify any other local, state or federal permits required for this proposal, if known:
DESIGNATION OF AGENT
I hereby designate to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE Date:
By signing this application form,the owner/agent attests that the information provided herein,and in any attachments, is true and correct to the best of
his, her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet
may result in this permit being null and void.
I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs, reasonable attorney's fees and
expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit.
I further agree to provide access and right of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application
review and any 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 the application that he r she wants prior notice.
Signature: L661.44 11i filff] Date: g—.2-o °-0q
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 respon • ility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: 7�`14.4V`EI- toll Date: e--/x 79q
I •
BUILDER STATEMENT
The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be assuming the responsibility of the General Contractor for the proposed project.
Signature: Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
Rea to l ±Y51 Inc.. (253) 9.14- bg - ( )
MAILING ADDRESS: 0 o a M . u' t' fi EMAIL:
CONTRACTOR'S LICENSE f%• e, tva,. q$'Wal1 WAINS
NUMBER: if Ef b`pf 1 qv(- c.4 NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
)I, New 6t Wood Existing: U Sewer
❑ Addition ❑ Steel Proposed: j_ Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: 2 Height: SI Individual System
❑ Repair ❑ Masonry SEP Permit# O1-3q i
O Demolition U Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well U Two Party
Type of Heat: Proposed 3 pi Public
I�)Q(I ,h Total:tr3 3 Name of System:.u,v
C16rLic-
If this is a Commercial Project you must answer the following:
Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces:
Number of occupants(includes owners,tenants,employees,etc) Current Proposed
IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No
If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply:
I Underground Tank 1 Above ground Tank Size of Propane Tank:
I Heat Stove I Cook Stove I Woodstove 1 Fireplace Insert I Hot Water Tank I Pellet Stove 1 Other
Is this appliance being installed in a Manufactured!Mobile Home? Yes / No
When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property
lines, tank location and size,distances from the propane tank to all property lines,buildings and septic system components,
including the reserve area.
Square Footage _ Current Proposed WOfriCe USP,46 : Amount : 001 400
Main Floor Heated LG 14 111-1--rR EH Bid App Review: "13-
2m Floor Heated Consistency Review: 1
Other Heated Base fee: C_'1�
Mezzanine Additional Section:
Heated Basement t Plan Check fee:
bZ. yb
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee:
Garage/Carport lZ SUBTOTAL �J �r^i_r3 q-k97
Decks ,R�y ,p_3i 1�1 i 911/Rd Approach fee: . u,9(..r(9-7-
Other CD Jaei III. 3SU 1 c TOTAL $
Receipt Number: I 1 (n.: 1
I 0
. Cash/Check Number: I C�
ESTIMATED COST(REQUIRED) �P Date: _
•Fair market value of all labor and materials foundation to finish
/ `�j r Initials: �_ _=�_1
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Untitled Page Page 1 of 3
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 REALITY HOMES INC UBI No. 602170782
Phone 2539266822 Status ACTIVE
Address 1308 ALEXANDER AVE License No. REALIH1984CN
E
License Type CONSTRUCTION
Suite/Apt. CONTRACTOR
City TACOMA Effective Date 2/15/2002
State WA Expiration 2/15/2010
Date
Zip 98424 Suspend Date
County PIERCE Specialty 1 GENERAL
Business Type Corporation Specialty 2 UNUSED
Parent
Company
Other Associated Licenses
Specialty Specialty Effective Expiration
License Name Type Status
1 2 Date Date
SECURITY CONSTRUCTION
SECURF*190LB FENCE CONTRACTOR FENCING UNUSED 6/2/1981 10/30/2009 ACTIVE
INC
SECURITY CONSTRUCTION OTHER WATER
SECURSI022Q0 SEALANTS CONTRACTOR (SPECIFY) PROOFING 11/20/1998 11/20/2004 EXPIRED
INC
Business Owner Information
Name Role Effective Date Expiration Date
FANCHER, THOMAS E PRESIDENT 02/15/2002
HANKEL, JAMIE SECRETARY 02/15/2002
HANKEL, LOWELL K JR VICE PRESIDENT 02/15/2002
Bond Information
Bond Bond Effective Expiration Cancel Impaired Bond Received
Bond Company Account Date Date Date Date Amount Date
Name Number
DEVELOPERS Until
1 SURETY & 856994C 02/08/2002 Cancelled 03/01/2005 $12,000.00 02/15/2002
INDEM CO
Assignment of Savings Information
Assignment of Effective Release Assignment Impaired Amount Received
Savings Savings Date Date Type Date Date
Account
https://fortress.wa.gov/Ini/bbip/Detail.aspx 9/30/2009
Untitled Page Page 2 of 3
Number
1 7000328315 02/14/2005 Until Bond $12,000.00 2/22/2005
Released
Insurance Information
Insurance Company Policy Number Effective Expiration Cancel Impaired Amount Received
Name Date Date Date Date Date
GENERAL
6 FIDELITY INS BAG000515300 02/12/2009 02/12/2010 $1,000,000.00 02/10/2009
CO
GENERAL
FIDELITY
5 BAG000308500 02/12/2007 02/12/2009 $1,000,000.00 02/25/2008
INSURANCE
CO
4 QUANTA QAG000718600 02/12/2005 Until $1,000,000.00 02/10/2005
INDEMNITY Cancelled
NORTH
3 AMERICAN BXC00039920003 02/12/2004 02/12/2005 $1,000,000.00 02/11/2004
SPEC INS CO
NORTH
2 AMERICAN BXC00039920003 02/12/2003 02/12/2004 $1,000,000.00 02/20/2003
SPEC INC
SCOTTSDALE
1 CLS0814152 02/12/2002 02/12/2003 02/12/2003 02/15/2002
INS CO
Summons/ Complaint Information
Tax
Summons / Cause Warrant Plaintiff County Complaint Complaint
Complaint Number Id Date Amount
5 072097541 JAMES Et KATHY PIERCE 11/07/2007 $0.00
MCCULLOUGH
4 072040887 JOHN & DENISE SNOHOMISH 06/21/2007 $0.00
HARTIGAN
DON Et
3 052089046 MARGARET PIERCE 02/27/2006 $0.00
LEHMAN
2 052009823 JACK Et LINNELL ISLAND 01/30/2006 $2,500.00
GRIBBLE
1 042028193 PRUDENCE P KITSAP 11/18/2004 $12,735.00
BROWN ELL
Judgement Information
Tax
Judgement Cause Warrant Plaintiff County Judgment Judgment Payment Payment Dismissal Paid
Number Id Date Amount Date Amount Date By
JAMES Et
5 072097541 KATHY PIERCE $0.00 11/26/2008
MCCULLOUGH
JOHN &
4 072040887 DENISE SNOHOMISH $0.00
HARTIGAN
DONE
3 052089046 MARGARET PIERCE $0.00 06/29/2007
LEHMAN
2 052009823 JACK & ISLAND $0.00 03/21/2006
LINNELL
https://fortress.wa.gov/lni/bbip/Detail.aspx 9/30/2009
Untitled Page Page 3 of 3
GRIBBLE
1 042028193 PRUDENCE P KITSAP $0.00 08/08/2006
BROWNELL
https://fortress.wa.gov/lni/bbip/Detail.aspx 9/30/2009
145_n- LO/ .ATM 5Ae fYl Oq - 313
JEFFERSON COUNTY PERMIT CENTER
APPLICANTTT- PHONE: S01 -0 3a4
SITE ADDRESS:73 P(TYJ? ck J4_\/ DATE: Q'3Q15:i
Appor EALTH APPROVAL
(-SEPTIC PERMIT# SEP (17-3 ?
WATER FOOD SERVICE
2. SHORELINE
BANK HEIGHT
SETBACK
3. FLOOD ZONE
4. FOREST PRACTICE APP (CLASS )
5. PLANNING APPROVAL
"ITICAL AREA REVIEW 4 '� � c- _. ay 0
ZONING
8. HEIGHT
9. LOT COVERAGE
10. ADDRESS
11. FEE
12,_CONTRACTOR'S LICENSE _or
:ENERGY SHEET
14. BOND HOLDER/LENDER
15. NTT
16. SETBACKS
17. PROVIDE WA STATE ENGINEER STAMP/ARCHITECT'S STAMP
18. STORMWATER SITE PLAN
19. D.O.T. ACCESS APPROVAL
20. RE FLOW FOR COMMERCIAL STRUCTURES
1.p_aN REVIEW ('2 -(-O j ( j- 1L> OCCUPANCY:
TYPE OF CONST:
23. EXPOSURE:
24. WIND:
25. SNOW:
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
Jefferson County Building ision Permit N. -er: BLD09-00329
Applicant: ERICSEN
BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2006 International Building Codes
To schedule inspections, call (360)379-4455
ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries.
The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection
Inspection Item Date Approval Signature Notes
Setbacks
Erosion Control
Foundation Footing (j—a4Cr
Footing Drains d V r
Foundation Stem Wall 1 � AM - hip r
Underground Plumbing
17
Under Floor Framing
Straps(hold downs)
Ext. Shear Wall Nailing i
Rough-in Plumbing 7-:•-` It
Framing s: ,
Blocking
Airseal )l�_ itir
�L , l
Insulation:Walls
Insulation: Floors
Insulation: Ceiling
Int. Shear Wall Nailing , ro
Wallboard Nailing as- 1'D
Gas Line: Interior
Gas Line: Exterior
Propane Tank
Heat/Chimney Clearance
Drywell/Alt Drainage
Address Posted
FINAL INSPECTION
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
• BUILDING PERMIT •
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD09-00329 Received Date: 9/30/2009
SITE ADDRESS: 783 PROSPECT AVE Issue Date 12/9/2009
PORT TOWNSEND, 98368 Expiration Date 12/9/2010
OWNER: BERNT P ERICSEN PHONE: 360-301-0324
MARLENE J ERICSEN
1656 S JACOB MILLER RD
PORT TOWNSEND WA 98368-9077 IRONDALE
SUBDIVISION: Block: 114 Lot: 25-32
PARCEL NUMBER: 962111408 Section: 34 Township: 30 N Range: 01 W
CONTRACTOR: REALITY HOMES INC PHONE: (253)926-6330
1308 ALEXANDER AVE E STE B
FIFE WA 98424
Contractor's License REALIH1984CN Expires 2/15/2010
PROJECT DESCRIPTION: NSFR W/ ATT GARAGE
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW
VALUATION 142,661.00 MAIN: 1,614
AD
CODE EDITION: 2006
ADDL: HEAT TYPE: EEE
OCCUPANCY: R-3 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OTHER:
CONST TYPE: 5N GARAGE: 484 SHORELINE:
CONST TYPE: SETBACK:
DECK: 363
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: PUD Type Amount Paid By: Date: Receipt:
BEDROOMS: BATHROOMS: Permit $1,234.55 LYK 09/30/09 111021
Exist: 0 Exist: 0 Plan Check $802.46 LYK 09/30/09 111021
Prop: 3 Prop: 2 State Building Code $4.50 LYK 09/30/09 111021
Total: 3 Total: 2 Potable Water Application $62.00 LYK 09/30/09 111021
Total: $2,103.51
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 3794455.
Request must be received by 3 pm the day before inspection is needed.
Monday Inspections must be received by 3 pm on Thursday before inspection is needed.
Office Hours 9:00 a.m. -4:30 p.m.
HOT LINE AVAILABLE 24 HOURS A DAY
SPECIAL CONDITIONS APPLY - SEE ATTATCHED
• •
CONDITIONS for Building Permit# :BLD09-00329
1.) Lighting fixtures shall be designed and hooded to prevent the light source from being
directly visible from outside the boundaries of the property. The intensity or brightness of
all lighting, during construction and after project completion shall not adversely affect the
use of surrounding properties or adjoining rights-of-way.
2.) Exterior lighting for commercial and industrial uses shall not exceed thirty feet(30') in
height from the finished grade. Exterior lighting for residential uses shall not exceed
twenty feet(20') in height from the finished grade, excepting when such lighting is an
integral part of a building or structure. Ground level lighting is encouraged.
3.) Minimum Setback (West) from McLellan Ave right-of-way shall be 20 feet. Mimimum rear
setback (North) is 5' and (Eas) side yard setbacks shall be 5 feet. Minimum Setback
(South) from Prospect Ave right-of-way is 20 feet. Site plan meets UDC requirements.
4.) The building height is not to exceed 35 feet.
5.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
6.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
7.) Not more than 2 unlicensed vehicles shall be stored on any lot unless totally screened
from view of neighboring dwellings and rights-of-way. Such screening shall meet all
applicable performance and development standards specific to the district in which the
storage is kept, and shall be in keeping with the character of the area. Screening shall
meet the requirements of Chapter 18.30 JCC. Outdoor storage of 3 or more junk motor
vehicles is prohibited except in those districts where specified as an automobile wrecking
yard or junk (or salvage) yard and allowed as a permitted use in Table 3-1 or Chapter
18.18 JCC, and such storage shall meet the requirements of JCC 18.20.100, Automobile
wrecking yards and junk (or salvage) yards. In no case, shall any such junk motor
vehicles be stored in a critical area.
8.) Critical Aquifer Recharge Areas may require special protection measures to mitigate water
quality degradation. The submitted proposal does not require additional aquifer
protection measures. However, during construction the project shall follow the Best
Management Practices (BMPs) and facility design standards as identified and defined in
the Stormwater Management Manual for the Puget Sound Basin.
9.) A minimum of two (2) on-site parking spaces shall be provided for the single family
residence.
10.) To help prevent seawater from intruding landward into underground aquifers, all new
development activity on Marrowstone Island, Indian Island and within 1/4 mile of any
marine shoreline shall be required to infiltrate all stormwater runoff onsite.
11.) VOLUNTARY MEASURES OFOASTAL &AT RISK SIPZ:
IIP
Water conservation measures:
1. Roof and other intercepted precipitation shall be routed to on-site detention ponds
and/or other approved means and allowed to be released to the soil slowly.
2. Water collected from Storm water and roof catchments may be used for watering
lawns and gardens. Unless catchment water has been treated to meet drinking water
standards, there shall be no cross connections allowed between the potable supply and
impounded water.
3. Water withdrawn from wells on each property shall not be used for watering of lawns
and/or gardens.
4. Ground water withdrawn from each property shall be restricted to a rate of three (3)
gallons per minute.
5. Installation of water conserving fixtures such as low flow toilets, faucets and shower
restrictors and other water saving plumbing fixtures.
6. Landscaping plan (xeriscaping, native vegetation with minimal amounts of irrigation).
Please NOTE that the above listed measures are not intended to be exhaustive, but rather
is intended to be illustrative of the types of water conservation measures.
12.) MANDATORY MEASURES FOR COASTAL SIPZ:
1. For proof of potable water on a building permit application, applicant must utilize
DOH-approved public water system if available.
2. If public water is unavailable, a qualifying alternative system may be used as proof of
potable water or an individual well may be used as proof of potable water subject to the
following requirement:
a. Chloride concentration of a laboratory-certified well water sample submitted with
building permit application.
3. If public water is unavailable, a qualifying alternative system may be used as proof of
potable water.
13.) The property owner shall comply with Water Conservation Measures (per list maintained
by the UDC Administrator).
14.) 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.