HomeMy WebLinkAboutBLD2000-00433 MANUFACTURED/MOBILE HOME INSTALLATION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
(360) 379-4450 FAX (360) 379-4451 (800) 831-2678
PERMIT #: BLD00-00433 Received Date: 6/29/2000
SITE ADDRESS: 10035 CENTER RD Issue Date: 8/29/2000
QUILCENE, 98376 Expiration Date 8/29/2001
APPLICANT: KEVIN SMITH
10035 CENTER RD
QUILCENE WA 98376
SUBDIVISION: PHILIP BOLING TRUST SHORT PLAT Block: Lot: 1
PARCEL#: 801294004 Section: 29 Township: 28 N Range: 01 W
CONTRACTOR/ OWNER PHONE:
DEALER
PROJECT DESCRIPTION MANUFACTURED HOME INSTALLATION
MAKE: SHERIDAN
YEAR: 1974
SIZE: 12x60
THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE.
THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR.
THE EXPIRATION DATE IS 8/29/2001.
REQUIRED INSPECTIONS:
[ ] Footing/Setback (If continous footings are used):
Blocking/Setbacks/Plumbing: /—/�
[ ] Final/Skirting/Vents/Porches/Steps:
OtL (-)— !At.1 -
HEALTH DEPARTMENT APPROVAL REQUIRED PRIOR TO FINAL INSPECTION
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:00 a.m. -4:30 p.m.
Inspector's Phone Hours 8:00 a.m. - 9:00 a.m.
SPECIAL CONDITIONS MAY APPLY - SEE REVERSE
HOT-LINE AVAILABLE 24 HOURS A DAY
P F `
MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD00-00433 Received Date: 6/29/2000
SITE ADDRESS: 10035 CENTER RD
QUILCENE, 98376
APPLICANT: KEVIN SMITH PHONE: (719)338-8712
10035 CENTER RD
QUILCENE WA 98376
SUBDIVISION: PHILIP BOLING TRUST SHORT PLAT Block: Lot: 1
PARCEL NUMBER: 801294004 Section: 29 Township: 28 N Range: 01 W
CONTRACTOR/ 01).311e2--
DEALER:
PROJECT DESCRIPTION MANUFACTURED HOME INSTALLATION
TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE:
TYPE OF IMP NEW MAKE: She•- ck&vs SETBACK:
VALUATION YEAR: ►q"1�-}
BANK HEIGHT:
LABOR & INDUSTRIES APPROVAL?
SIZE: iZs(o�
SEWAGE DISPOSAL: ALT
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS: PARCEL TAGS: YES NO
STORMWATER: YES NO
Exist: 0 Exist: 0 AREA Plat Conditions
Prop: 2. Prop: Wetland Erosion
Total: 2 Total: Seismic Streams
Flood Way Food Plane
Routing Date: F&W Landslide
Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: Approved/Date
Manufactured Homes $141.00 MAM 06/29/00 32022 , P O\E
Total: $141.00
3ooJ b Jv jrz 3zo Zz AUG 2 U 2Qa!
Jefferson County Planning
&Building D6partrucalt
is\F_BLD_App_Mob.rpt 10/29/99
JEFFERSON COUNTY COMMUNITY DEVELOPMENT 621 SHERIDAN ST, POT TOWNSEND WA 98368 •
t L
MANUFACTURED HOME INSTALLATION PERMIT APPLICATION
NEW BUILDING 0 REPLACEMENT
SIZE ,1-1'6 0
YEAR / i 7i/
MAKE 54 C'If' f dAit.J
ov
COST )��
BEDROOMS: BATHROOMS:
EXISTING 9 EXISTING I
PROPOSED PROPOSED
TOTAL 4- TOTAL __.1_
TYPE OF SEWAGE DISPOSAL: WATER SUPPLY:
0 SEWER 0 COMMUNITY SYSTEM g PRIVATE WELL 0 TWO PARY WELL
INDIVIDUAL SYSTEM 0 Conventional 0 PUBLIC
PERMIT # SEPOIS"t 39 ❑ Alternative Name of water system:
IF WATERFRONT PROPERTY,
DISTANCE TO BANK OR HIGH WATER LINE ft BANK HEIGHT ft
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, 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 it's employees, representatives or agents for the purpose of
application review and any required later inspections. Access and right of entry to the applicant's property or structure shall be requested and
shall occur during regular business hours.
----/.......„, i.
SIGNATURE DATE 6 • .� L?-)
NAME (PLEASE PRINT)
FOR OFFICE USE ONLY :,-�
BASE FEE _ RECEIPT# �_ O �;
ADDITIONAL SECTIONS CASH/CK# /p1-•-' .
SUBTOTAL , DATE V 1�. /�
POTABLE WATER 5
91 1/ROAD APPROACH
TOTAL llI
H:\HO ME\PLNCNTR\FORMS\MOBILEAP.10/99
HESTAT4O W , , 1�
ITT OF LABOR AND INDUSTRIES c�sun aesT ;'C'I'V-
,E P'� ALTERATION PERMIT
RATION(S)SHOWN BELOW HAVE BEEN APPROVED AS HAVING BEEN IN ` -,,Mire.
), MPLIANCE WITH RULES AND REGULATIONS FOR MANUFACTUREDIMOBILE
�.r,o,ad H 1/ IX E C E ( . E Do not complete shaded areas
i/OMES IN EFFECT AT THE TIME OF APPROVAL.RCW 43.22,360. t' Permit# �{a F �,
INSIGNIA NUMBER: - ALTERATION PERMIT NUMBER: MONTH/VR APPLIED FOR. AUGry( (� r 1 '•y j t.I
'\MH: 1; 318 1 1;3' 712982 7 �V 00 h an x). U1 6 2000 Invoice# F
A.TERATIONISY v"t./00 ! ��3-0
I See list onp'NAT.
L&I
within 15 tl� .f AN ELES Insignia#
. p.as oFa /ar l f
Owner last name first name Day time phone ` I Date _/
Address
IP
/�3� �e v G4;r.� t'e.c�e- �v� State .77 4.
Installer/Contractor/Dealer Phone / Contractors registration number
Address City State ZIP+4
Check the appropriate boxes in section A and section B. FEES
A B Alteration
❑ Commercial Coach [� Inspection(check appropriate boxes below) $
Serial No. Air Conditioning/Heat Pump
Electrical
Mobile Home Electrical Appliances
ire Safety
::::
. / l f.0Gas Furnace. Gas Piping T F 3.. 111 99295748
Plumbing :,, ?/2t;t; i e-; 7
u e_t v :� L,
Structural rii -an,-v L . '
❑ Recreational Vehicle or Park Trailer Serial No.
❑ Wood/Pellet Stove — —
Serial'No. Plan Review $
Model No.or Plan Approval No. RV Inspection
PP Original Permit
Reinspection No. $ S
Technical Inspection $ i
03���Note: Thi permit expires one year after date of purchase. (Non-refundable). Q31/ L
(Signature of ap cant or authorized repr tative Make check payable to: Dept.of Labor& tries 0/ %
f f
partment use only FEES DUES
equest approved or ❑ Request denied because of specific violations of Washington rules and regulations. Violations must
be corrected and reinspection requested within 10 days for recreational vehicles and 20 days for mobile homes''and commercial coaches
of the notice of violation date. (This does not apply to technical inspections). It is unlawful to offer for sale, rent, or lease any
non-complying mobile home,commercial coach recreational vehicle.
/V>
-I - - -- -(- - -'- c - C - - -- -- - <Jc jc.�-- - ` r.I n-
(cci.(4,7
. . .
. . . . . . . .. . . . _ Yam . - - - - tiIe ( . . - -�� _
1 'Includ-e are forms r .aired w • !be completed and fees sue, of ed before/reins••ction.
(Date ,) % il. • nspector Total pages
F62. i1 -000 alterati. permit 10-9; White-Olympia -.na Illislivur Gree•-Contr. .1 - rchaser Goldenrod-Purchaser
� n zZ_t
MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD00-00433 Received Date: 6/29/2000
SITE ADDRESS: 10035 CENTER RD
QUILCENE, 98376
APPLICANT: KEVIN SMITH PHONE: (719)338-8712
10035 CENTER RD
QUILCENE WA 98376
SUBDIVISION: PHILIP BOLING TRUST SHORT PLAT Block: Lot: 1
PARCEL NUMBER: 801294004 Section: 29 Township: 28 N Range: 01 W
CONTRACTOR/
DEALER:
PROJECT DESCRIPTION MANUFACTURED HOME INSTALLATION
TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE:
TYPE OF IMP NEW MAKE: SETBACK:
VALUATION
YEAR: BANK HEIGHT:
LABOR & INDUSTRIES APPROVAL? SIZE:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS: PARCEL TAGS: YES NO
Exist: Exist: STORMWATER: YES NO
AREA Plat Conditions
Prop: Prop: Wetland Erosion
Total: Total: Seismic Streams
Flood Way Food Plane
Routing Date: — F&W Landslide
Shoreline Aquifer
Forest: Commercial Rural
Type Amount Paid By: Date: Receipt: crtiatatV7i
P"
Irro
Manufactured Homes $141.00 MAM 06/29/00 32022
Total: $141.00 1evew 42
StarmwatefPiaa
Rewiretill"L
i:\F_BLD_App_Mob.rpt 10/29/99
•
JEJi FERSON COUNTY
STORMWATER MANAGEMENT ORDINANCE
SMALL PARCEL EROSION AND SEDIMENT CONTROL PLAN
EROSION AND SEDIMENT CONTROL WORKSHEET
Property Owner: f„; 1 i / �-,,, , � Telephone: 7 f 3 3 �7/
Address: /l>ZU 3 (12e Av�e I Cc3t4 , f C-e.v L G(/41- 5 g-5,
Assessor's Parcel Number: -Old/�/mD 1. 9 q J
Building Permit or Septic Permit Applicatib Number(if applicable):
Brief Project Description: L�.t',a-0,Al / Sc4-c/-{s 6/c-- ��cAim /e,S,"c;/(A
Site Location: /Oo q< Cov-1CL
Person Responsible for BMP Installation and Maintenance.
v .� si*1 4 k,
Address: /06 3< 0e4,'+Lit_ lcl_
Telephone: 2/9 3? - 2/�,
1. Describe/check the Best Management Practices (BMPs) that you will implement during land
disturbing activities or construction to control erosion and prevent sediment from entering water
bodies (marine waters, streams, rivers, lakes, or wetlands) or impacting adjacent property or
roads. Please check the measures you plan to implement and show their approximate location on
the site plan. You may also propose measures other than those listed. Attach additional sheets, if
more space is required.
[] Stabilize construction access route. Limit construction vehicles to one route, if feasible.
Provide a stabilized construction access by applying quarry spalls, ballast, or crushed rock
to minimize tracking sediment onto roads. (See attached illustration from Stormwater
Management Manual.) If sediment is transported onto roads, they will be cleaned
thoroughly.
[] Minimize the extent of land disturbing activity and preserve existing vegetation.
Preserve buffers of well-established vegetation between disturbed areas and property
boundaries, roads, water bodies, and designated critical areas (wetlands, fish and wildlife
habitat areas,landslide or erosion hazard area,etc.).
SPESC Instructions—Long Form
Revised June 3, 1999
9
EROSION AND SEDIMENT CONTROL WORKSHEET
[] Phase clearing so that only areas that are actively being worked are uncovered.
[] Start and complete land disturbing activities and stabilize the site between April 1 and
September 30. Stabilization means that disturbed areas will have well-established plant
cover or be landscaped to minimize erosion.
[] Stabilize exposed soil Exposed and unworked soil will be covered within 2 days between
October 1 and March 31 and within 7 days between April 1 and September 30.
[ ] Cover exposed soil with a minimum of 2 inches of straw or hay or other material
approved for this purpose.
[ ] Cover soil stockpiles with plastic sheeting and locate away from water bodies, roads,
and property lines.
[] Place gravel base on roads,driveways, and parking areas after clearing and subgrade
preparation.
Protect adjacent properties and water bodies from sediment deposition:
psi/
Place straw or hay bales in ditches and drainage ways down slope from areas
o land disturbing activity to filter runoff before it leaves the project site or enters
water bodies. (See attached illustrations from Stormwater Management Manual.)
[ ] Install a filter fence down slope from areas of land disturbing activity to filter runoff
before it leaves the project site or enters water bodies. (See attached illustration from
Stormwater Management Manual.)
[] Regularly inspect and maintain all BMPs especially after storms events.
[] Describe other erosion and sediment control Best Management Practices. Be specific
as to design and specifications.
SPESC Instructions—Long Form
Revised June 3, 1999
10
EROSION AND SEDIMENT CONTROL WORKSHEET
2. Describe how disturbed areas will be permanently stabilized(seeded, landscaped, apply gravel base
to roadways,etc.)
/ ,•� ��Z � i I( /'/A 6'evG ac ucc
.�/w4, A-i?e4 S- LL, II ,P -51eet, /"i / '-Cr
3. Describe how runoff from impervious surfaces will be controlled (disperse to vegetated areas to
infiltrate, dry well,infiltration trench,route runoff to existing drainage facilities,etc.).
16k9t. o F= �L,w I�a( (��`ti3 LVi (C r,c) w�-lz�c
tiyuk5 4- Se-5 ��GIc- ( lam{ a tc.(r/e'
SPESC Instructions—Long Form
Revised June 3, 1999
11
EROSION AND SEDIMENT CONTROL WORKSHEET
4. Specify your construction sequence. Describe the timing of all land disturbing activities (clearing
and grading, construction, installation of drainage facilities, landscaping, etc.) and Best
Management Practices.Describe proposed maintenance of BMPs.
The Best Management Practices proposed above will be implemented to control erosion, sediment, and
stormy/ter runoff. I will n .fy Permit Center for inspections as required. ef�
.gnature of Owner/Agent Date
SPESC Instructions—Long Form
Revised June 3, 1999
12
jetferson County Department of Community Development August 22, 2000
621 Sheridan Street, Port Townsend, WA 98368
(360) 379-4450
FINDINGS AND CONDITIONS OF APPROVAL AS REQUIRED UNDER THE
JEFFERSON COUNTY INTERIM CRITICAL AREAS ORDINANCE
Applicant: KEVIN SMITH
25325 JUDGE ORR RD
CALHAN CO 80808
Critical Area Review Case Number: CAR00-00227
Project Description: 130-PRESSURIZED TRENCH
Parcel Number: 801294004 S-T-R: 29-28N-01 W
Site Address: 10035 CENTER RD
QUILCENE WA, 98376
FIN DINGS:
In accordance with the authority provided under subsection 4.101 and the requirements contained in Subsection
5.402 of the Jefferson County Interim Critical Areas Ordinance, the following are findings of fact relating to the
referenced application:
1.) The application was reviewed by Jefferson County Permit Center staff on 6/06/00 for the potential presence
of critical areas regulated under the provisions of the Ordinance, and the following critical areas were
confirmed as potentially present on the subject property: Adjacent Rural Forest Lands, and Streams (Type
5).
2.) Acting upon the above information, Jefferson County staff conducted a site inspection of the subject
property on 7/07/00 and confirmed the existence of the following critical areas and/or their associated
buffers on the property: Streams (Type 5), Adjacent Rural Forestlands, Plat Conditions.
3.) The applicant obtained an HPA to install a culvert on the property. Chris Byrnes from the Washington
Department of Fish and Wildlife issued the permit.
4.) Plat Conditions have been recorded on this property. These conditions (see attached) include a
stormwater plan and the maintenance of a 15-foot vegetative buffer (measured perpendicularly)from both
side of the Type 5 Stream.
5.) Designated rural forest lands are located on the eastern adjacent property. According to the Jefferson
County Interim Forest Lands Ordinance (Ordinance No. 01-0121-97), buffer and development restrictions
are required on property located adjacent to designated forest lands. Please refer to the attached letter
regarding buffers and development restrictions for this property.
6.) Designated long term forest lands are located on the eastern adjacent property, on which a variety of forest
related activities may occur that are not compatible with residential development. These activities include
spraying, pruning, harvesting, blasting, drilling, rock curshing, and vehicle movements, which can generate
dust, smoke, noise and odor. Forest or mining activities performed in accordance with county, state, and
federal laws are not subject to legal action as public nuisances.
This waiver from the provisions of the Jefferson County Interim Critical Areas Ordinance is granted subject to the
following conditions. Any deviation from these conditions shall result in this waiver being revoked and the
application becoming subject to further review.
CONDITIONS OF APPROVAL:
:max
1.) The buffer along the identified stream shall be a vegetive buffer. The applicant has indicated that grazing
will be a predominate use of the property. Fencing along the stream will be required to maintain the
vegetative buffer.
Fish and wildlife habitat area buffers shall remain naturally vegetated. Should buffer disturbance occur
during construction, replanting with native vegetation shall be required by the Critical Area Administrator.
IVo alteration shall be made to the fish and wildlife habitat area buffer without prior authorization by the
Critical Area Administrator.
3.) Damage to vegetation to be retained on site shall be minimized by directional felling of trees away from
these areas.
4.) All construction activities, including the storage and preparation of materials, shall not encroach upon the
designated fish and wildlife habitat area, its associated buffer, or any critically important plants and trees
identified on the subject property.
5.) A Stormwater Plan must be submitted as stipulated through the recorded plat conditions (Philip Boling Trust
Short Plat, Filing Record 410757).
6.) The applicant must record in a manner required by law a covenant running with the land, a document which
establishes the maintenance of a 100-foot setback from the adjacent rural forest land located to the east of
the property.
riefjt/?..tA /44"vil FAY//
Warren Hart, AICP Date
Critical Areas Administrator
I understand that the granting of the above waiver from the provisions of the Jefferson County Interim Critical
Areas Ordinance is made subject to my complying with the above listed conditions, and that any violation of said
conditions shall result in revocation of the permit or approval and further review of the project under the Critical
Areas Ordinance.
Please ign and return to the Department of Community Development.
,...:„D- r
Ap icant's Signature Date
c: File
I:\F_CAR_Waiver_W_Conds.rpt 12/13/99
8
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ive
PLEASE MAIL TO:
JEFFERSON COUNTY ASSESSOR
JACK WESTERMAN III JEFFERSON COUNTY COURTHOUSE
ASSESSOR PO BOX 1220,PORT TOWNSEND WA 98368
(360) 385-9105
MOBILE HOME INFORMATION FORM
OWNER'S NAME / MAILING ADDRESS: THIS IS NOTA TAX STATEMENT
NAME: Weui:A-) L r-Y) /`t-kr The purpose of this questionnaire is to obtain information
regarding either the current location of a mobile home or the
ADDRESS: /U D 3'j eti 4-e previous ownership and location of a mobile home. This will
help our office determine whether the mobile home is already
on the tax rolls in Jefferson County or if it has been moved to
this county from another area. Please see reverse side for
TELEPHONE NO: I/ 'i - 3 - 7i - additional information.
1 ) MOBILE HOME DATA 04 I,
7-Z7
(A) MAKE (B) MODEL (C) YEAR
(D) LENGTH (E) WIDTH (F) SERIAL NUMBER
(G) YOUR PURCHASE PRICE(DO NOT INCLUDE SALES TAX) (H) PURCHASE DATE
2) PREVIOUS OWNER / LOCATION OF MOBILE HOME:
(A) FROM WHOM DID YOU PURCHASE MOBILE
ADDRESS
(B) 1,"/AS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR? YES NO (IF NO, WHAT COUNTY?
IF YES, WHAT WAS PREVIOUS ADDRESS OF MOBILE?
3) WHER►F MOBILE HOME IS TO BE LOCATED:
(A) WILL THE MOBILE HOME BE IN A MOBILE HOME PARK? YES
(B) IF LOCATED IN A MOBILE HOME PARK:
NAME a ADDRESS OF PARK SPACE NO.
(C) IF NOT LCCATED IN A MOBILE HOME PARK:
NAME OF L 'ND OWNER: Ajeiii ',U C _ �/Y) /
LOCATION (ADDRESS) /00 3�
REAL PROPF,2TY PARCEL NUMBER/DESCRIPTION
THANK YOU FOR YOUR HELP!
SIG ATURE
KELLI LARSON, roperty Technician
THIS FORM CONFORMS TO THE STANDARDS OF THE STATE DEPARTMENT OF REVENUE AND IS SUBJECT TO AUDIT VERIFICATION.
"' J► C
Jefferson County Department of Community Development
/ oN Co 621 Sheridan Street,Port Towi send WA 98368 (360) 379-4450
Universal Plot Plan
Fill in the following blanks as completely as possible:
Project Description:
1
9 Digit Parcel Identification Number (from your tax statement):
g0( ' 26i4 - no4
Site Address
911#: l0 o 3 5' Road Name: Co sit Zip Code: 1 3-7 6,
Legal Description
Subdivision Name: j Y co 7 Block: Lot(s):
Section: Cf Township: .1 tiC)e Range: j UJ
Parcel Size (acres or square footage): „.20 4 c
Property Owner: € ` ,1 _ �� c ( Phone:
K -
Mailing Address:
/0 0 3S' eA-+-e �� ��L. IC L,0 - 7Y-3-7
Applicant/Occupant: Phone:
(if different from owner)
Mailing Address:
Authorized Rep: Phone:
Mailing Address:
General Contractor:
Or Manufactured Home Installer: C'W ; Phone:
Mailing Address:
Contractor's State License Number. Expiration Date:
Septic Designer: cc r 1 / Phone:
v !�� tiS - 36o ySA - F50
Mailing Address:
� 0 tis �tom- ) (V 2
Architect:/Engineer: Phone:
Mailing Address:
Loan Lender/General Phone:
Contractor's Bond Holder: eQw lt'R,s .-"ra u S
Mailing Address:
FOR OFFICE USE ONLY
Fire District: Planning Area: School District: Zone:
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N > TITLE: WASTEWATER SYSTEM PLANS JOHN SCOTT FLEMING ENGINEERING, INC.
N --1 N' o TAX PARCEL # 801-294-004
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{{ CLIENT: KEVIN SMITH P.O. BOX 44
o c/o JOHNSTON REALTY, P.O.B. 88 PORT ANGELES, WA 98362
BRINNON, WA 98320 (360) 452-8500, FAX: (360) 452-3383