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HomeMy WebLinkAboutBLD2000-00752 BUILDING PERMIT Y Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 (360)379-4450 FAX(360)379-4451 (800) 831-2678 PERMIT #: BLD00-00752 Received Date 11/20/2000 SITE ADDRESS: 440 Srni+h L rJ Issue Date 12/6/2000 QUILCENE, 98376 Expiration Date 12/6/2001 APPLICANT: FRED HILLIARD PHONE: (360)765-4009 BARBARA HILLIARD 1055 DEER CRK RD QUILCENE WA 98376 SUBDIVISION: 0 1 0 0)4 Block: Lot: 8 PARCEL NUMBER: 501041008 Section: 4 Township: 25 N Range: 01 W CONTRACTOR: OWNER PHONE: LOAN LENDER/ BOND HOLDER: PROJECT DESCRIPTION STORAGE SHED REQUIRED INSPECTIONS: [ ] Footings/Setbacks (Shoreline Setbacks): [ ] Foundation: [ ] Underground Plumbing/Underground Insulation: [ ] Shear Wall: [ ] Framing/Plumbing: [ ] Propane Tank/Lines: [ ] Insulation: [ ] Sheetrock: [ ] Final/Occupancy Approval: HEALTH DEPARTMENT 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. 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 04/14/2000 16:57 3604523333 JS FLEMING ENGINEER PAGE 02 llo r 1 I J"l r 1 R I77; 000 _�� , gyp q V iir" 0 Ilp 1�1' -o w1. �1 2. f .. N I ink, 1 1: ' 1 1 Ig3 1 1. g1 O lZ yr11 i cc TECIEHEB 1 I6'3. 1 1 ,1 �� � JEFFERSON COUNTY \1 � p�g DEPT. OF COMMUNITY DEVELOPMENT Y \\ ,-1,0„,_ N rip /Voiti, 1 .2._ a -IAA 1 , zA 1: i $ 0 - * .,.4 Jr 64 \� pf = 1151 li VS. 9.% \ , 4 i -. ','''. '0,0 f 4 I 5i all --'. IVO N . i t. . ire \ $ _ 1 •1 ; i "„.E: SOIL TEST PIT MAP ► sCOTr FI NG INc. NC "� Lei S4f1�-Q41-006 do 501-432—020 /S o I! CLIEN' FREDERia4 flARUARA IiILUARD P.C. BOX 44 ", cg q 1055 DEER CREEK ROAD PORT ANGELES. WA 88342, QUILCENE, WA P8376 (380) 452-8500, FAX (360) 452-3383 04/1412000 16:57 3604523383 JS FLEMING ENGINEER PAGE 134 • SITE P LAN E ; saAL. ,- _ SO" LOCATIONS OF STE FEATURES ARE AFPROXft ATE 1 1 JEFFERSON COUNTY DEPT. OF COMMUNITY DE'lELOPMENT IP 1 1 ALTERNATIVE DRAINFIELD SITE: I PRESSURIZED DRAINFIELD, BUT WITH 550' MORE TRANSPORT PIPE 0 $5/FT. 11 OR $2750 MORE THAN PREFERRED LOCATION OFF SITE IN UTILITY EASEMENT uSOLL TEST I SOIL TEST 1 R..07" R=40" 362.6' .IPN 501 032 020 I SOIL TEST 4PN 501--O41--0O8 I �PI I' TEST R 24� I R38" m I I \t• ROL TEST PIT T F!®T7" I 1 I I Try iri r r .� t rZ I r 1 ��, W I ''' r r 1 ,--- 75 --._,_ - 1 1 I 1 f1 1 04/14/2000 16:57 3604523393 JS FLEMING ENGINEER PAGE 05 CEOVED 1SF John Scott Fleming Engineering, Inc, -- P.O. Box 44, Port Angeles, WA 98362 voice: (360)452-8500, 800-248-6008, fax: (360) 452-3383, email: jsfen phatEkn; DWI: CIFM IUNI TY 0 VELOPMENT - SOIL LOG - March 30, 2000 Client: Fred& Barbara Hilliard 1055 Deer Creek Road Quilcene, WA 98376 Location: Parcel#501-032-020(off-site drainfield, SW corner of lot to east) Excavated: 3-20-00 by George De Vries Excavating Logged: 3-20-00 by John S. Fleming, P.E. Weather. Partly cloudy Test Pit#1: Restrictive at 75+" 0-24" Light brown loamy sand, weak granular structure, many medium &coarse roots,wavy boundary from 18-32'. Type 3 soil. 24-75' Light yellowish gray gravelly medium sand with very gravelly coarse sand pockets, low penetration resistance with pockets of moderate penetration resistance, few fine& medium roots.Type 28 soil. Teat Pit#2: Restrictive at 40" 0-32" Light reddish brown sandy loam,weak subangular block structure,few charred roots, common medium &coarse roots, wavy boundary from 30-34". Type 4 soil. 32-40" Light yellowish brown sandy loam, pockets of gravelly medium sand on south end of test pit,common medium &coarse roots, few fine faint light reddish brown mottles, low to moderate penetration resistance, wavy boundary from 32-54'. Type 4 soil. 40-77' Gray fine sandy loam, moderately platy, common medium distinct reddish brown mottles, few medium&coarse roots, moderate penetration resistance, Type 4 soil. 77-78" Light gray sandy loam, massive structure, high penetration resistance.Type 4 soil. Test Pit#3: Restrictive at 774" 0-24" Reddish brown gravelly sandy loam,weak granular structure, many medium roots, • irregular boundary from 18-30". Type 4 soil. 24-77" Gray with light yellowish brown gravelly medium sand,single grain structure, low penetration resistance, discontinuous lenses of moderate penetration resistance, very few fine distinct yellowish brown&reddish brown mottles, pockets of common medium roots, highly penetration-resistant lenses at south end of test pit from 24-30". Type 2B soil. Test Pit#4: Restrictive at 41" 0-24" Light reddish brawn gravelly sandy loam, weak subangular block structure, few small pockets of charred roots,wavy boundary from 10-30", common medium roots. Type 4 • soil. 24-53" Light yellowish brown gravelly loamy sand,weak granular structure, common medium Sot Log for FRED&DARSARA HILLIARD, Page 1 of 2 04/14/2 00 16:57 3604523333 JE FLEMING ENGINEER PAGE 06 roots, lenses of few fine faint light reddish brown &light gray mottles,wavy boundary from 34-60", common medium distinct reddish brown mottles&moderate to high penetration resistance from 41-53". Type 3 soil 53-65" Gray fine sandy loam, moderately platy, few medium roots, moderate to high penetration resistance, Type 4 soil. Job Number 99143 TECEOWED JEFFERSON COUNTY DEPT. OF COMMUNITY DEVELOPMENT • Soil Log for FRED&BARDARA HILLIARD,Page 2 of 2 • ._, • -/ U. 1 • . - • ..-t-,), •-•., „ • I• In I. • f t "war-+..it. ... 1 iy .. . • i '; . ##„ • T t • { i / t s 0,....- 1 i f 1, ;.'. =NINE c I • OW r 1 • • fpp' '1 -f� Yi ' j, li— \,..) I • 1 T._ I ,. .. . _ .• .___ .___ . . -..:.. . . _., _ ... , , .. . .. .... .W ' 1 _ . /i7'------4.4 ,, , gsa g , .. jrp� • 4. ..1 1` • i _ '...,.X ,, .. .. n y—^ c' �} , ... n- ,. , .,.., .. . , ... ...., ._,_ ... , _ . . . :„.,.,.. _. _. . :. , ,,,,,,, , , , . ,,... ..,._ , „.7 .. . CSJT - L ' +.� sit 0 f j.,..t - f . ' . - --ky 1 lil . ..-f —t-- r` • ... -..1,-( . . . . .... . • i . . . . . • .• 1 h . ., f -fi‘ tlitki\l'i ' .. A A A I A ii yj 3 x:' 1 ,. 1 • .. / l'!_...:,,.:--' • f ("/ ".' . I t ' BUILDING PERMIT APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 ,`' PERMIT #: BLD00-00752 7 „ I / Received Date: 11/20/2000 SITE ADDRESS: EATON RD / QUILCENE, 98376 APPLICANT: FRED HILLIARD \\ 'X PHONE: (360)765-4009 BARBARA HILLIARD 1055 DEER CRK RD QUILCENE WA 98376 SUBDIVISION: Block: Lot: 8 PARCEL NUMBER: 501041008 Section: 4 Township: 25 N Range: 01 W CONTRACTOR: OWNER PHONE: ARCH ITECT/ ENGINEER : PROJECT DESCRIPTION: STORAGE SHED \\ 1 TYPE OF WORK GAR SQUARE FOOTAGE: 4 '�\ TYPE OF IMP NEW ,� ,J MAIN: VALUATION 6,000.00 1 ADD'L: HEAT TYPE: l CODE EDITION: 1997 OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OTHER: CONST TYPE: SHORELINE: CONST TYPE: GARAGE: 600 SETBACK: 75 DECK: BANEIGHT: 75 SEWAGE DISPOSAL: i' WATER SYSTEM: PWELL PARCEL TAGS: YES NO X BEDROOMS: BATHROOMS: STORMWATER: YES NO k' EA Exist: Exist: Wetland /Y) Erosion Prop: Prop: Seismic fie? Streams Total: Total: Flood Way ,')7 Flood Plane F&W �,/i7 Landslide Routing Date: ' ZZ �l� Shoreline tr ',i!SS1Z)) Aquifer (, � ' Forest: Commercial i/O Rural /''C) Type Amount Paid By: Date: �rQecerp Hi at ted/t teons Receipt: Cr Approve a e� Ste Permit $139.25 MAM 11/20/00 34585 \ti1K` Plan Check $41.78 MAM 11/20/00 34585 Requlrec_ State Building Code $4.50 MAM 11/20/00 34585 I gea n ttca .. Total: $185.53 . 1 i:\F_BLD_App_Bld.rpt 10/29/99 Reieig ._0_,\,___ ,_ _ f iNi � � "AItZ � _� :tcs() 51 ZcJ' x zo' 0 IFcll 3 G -o5 014 F7° o•H, (4)\IF.AGS {Z17--I I °7° 0,E-t• <aD,►zAC, per \ / 011 }� r Zo' -0" County Department of Community Development November 30, 2000'an Street, Port Townsend, WA 98368 rr . *-4450 FINDINGS AND CONDITIONS OF APPROVAL AS REQUIRED UNDER THE JEFFERSON COUNTY INTERIM CRITICAL AREAS ORDINANCE Applicant: FRED HILLIARD BARBARA HILLIARD 1055 DEER CRK RD QUILCENE WA 98376 Critical Area Review Case Number: CAR00-00503 Project Description: storage shed Parcel Number: 501041008 S-T-R: 4-25N-01W Site Address: EATON RD QUILCENE WA, 98376 FINDINGS: 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 (11/20/00)for the potential presence of critical areas regulated under the provisions of the Ordinance, and the following critical areas were confirmed as potentially present othe subject property: (susceptible aquifer recharge area, shoreline conservancy designation, and landslide hazard area-moderate). 2.) Acting upon the above information, Jefferson County staff conducted a site inspection of the subject property on (11/28/00) and confirmed the existence of the following critical areas and/or their associated buffers on the property: (lanslide, aquifer and shoreline designation). 3.) The geotech report by Krazan and Assoc. that was previously submitted for CAR99-00443 was referenced and the recommendations of a 75 foot setback from the top of the shoreline bluff will suffice for the siting of a storage shed. 4.) Aquifer recharge areas in Jefferson County are characterized by porous geologic formations that allow percolation of the surface water into the soils and the underlying zone of saturation. Aquifers are geologic formations that contain sufficient saturated permeable material to yield significant quantities of water to wells and springs. Aquifers serve as the source of drinking water within most of the rural portions of Jefferson County. 5.) Susceptible aquifer recharge areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to groundwater aquifers. This includes any portion of Jefferson County with a DRASTIC index of greater than or equal to 180 points as determined using the U.S. Environmental Protection Agency DRASTIC methodology: Drastic: A Standardized System for Evaluating Ground Water Pollution Using Hydrogeologic Settings (EPA 600/23-87-035). 6.) Geologically Hazardous Areas in Jefferson County are characterized by slope, soil type, geologic material, and groundwater that may combine to create problems with slope stability, erosion, and water quality during and after construction or during natural events such as earthquakes or severe rainstorms. 7.) These bluffs are considered unstable and are subject to catatrophic slides. The potential for an earthquake of a high magnitude occuring in western Washington in the near future is considered a high probability by regional experts. 8.) The fish and wildlife habitat area is entirely associated with the shoreline. The minimum buffer for fish and wildlife habitat area along the shoreline is 30 feet as measured from the beginning of the vegetation line along the beach. In this instance, the required fish and wildlife habitat area buffer is entirely contained within the landslide hazard area and its associated buffer and needs no additional consideration. 9.. This waive' also includes findings and conditions for evaluation of shoreline areas as regulated under the provision of The Jefferson County Shoreline Management Master Program, adopted March 7, 1988, as amended. , 10.) The standard setback for residential structures, including common appurtenant structures such as garages and workshops, shall be 30 feet, or 1 foot for each foot of bank height, whichever is greater. This setback shall be measured from the bank's edge when the bank height exceeds 10 feet. 11.) The bluff height is greater than 30 (75)feet. The required setback from the top of the bluff is 75 feet. GJ )• 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: 1.) A vegetive buffer of 30 feet shall be permanently maintained from the top or edge of the 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, replanting with native vegetation shall be required by the Critical Area Administrator. No alteration shall be made to the landslide hazard area or its associated buffer without prior authorization by the Critical Area Administrator. 3.) Among the native conifer species which may be used are: grand fir(Aibes grandis), sitka spruce (Picea sitchensis), shore pine (Pinus contorta), Douglas-fir(Pseudotsuga menziesii), western redcedar(Thuja plicata), western hemlock (Tsuga heterophylla). 4.) Among the native tree species which may be used are: vine maple (Acer circinatum) big-leaf maple (Acer macrophyllum), red alder(Alnus rubra), Pacific madrone (Arbutus menziesii), quaking aspen (populus tremula), black cottonwood (Populus trichocarpa), bitter cherry (Prunus emarginata), Oregon white oak (Quercus garryana), cascara (Rhamnus purshiana), Pacific willow (Salix lasiandra), Scouler's willow (Salix scouleriana). 5.) Among the native shrub species which may be used are: service-berry (Amalanchier alnifolia), red osier dogwood (Cornus stolonifera) salal (Gaultheria shallon), ocean spray (Holodiscus discolor), indian plum (Oemlaria cerasiformis), Pacific ninebark (Physocarpus capitus), red flowering currant (Ribes sanguineum), wild rose (Rosa gymnocarpa), Nootka rose (Rosa nutkana), swamp rose (Rosa pisocarpa), willows (Salix ssp.), red elderberry (Sambucus racemosa), snowberry (Symphoricarpos albus), evergreen huckleberry (Vaccinium ovatum), red huckleberry (Vaccinium parvifolium). 6.) All construction activities, including the storage and preparation of materials, shall not encroach upon the designated geologically hazardous area, or its associated buffer. 7.) Damage to vegetation to be retained on site shall be minimized by directional felling of trees away from these areas. 8.) All trees and understory lying outside of approved construction limits shall be retained during clearing for roadways and utilities. Understory damaged during approved clearing operations may, however, be pruned. ki--6(4)4 1 7i iti( 6 0 rren Hart,AIC 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 sign and /return to the Department of Community Development. v` 'CP id • cf) A n i na ure ate aitec1/2 _ c: File KA No. 062-00017 Pa e No. 7 Utility Trench Backfill Utility trenches should be exca torvated according (Occupational Safety and Health Administration) tandardsacceptby a contractor experieed engineering nced following OSHAir The responsibility for the safety of open trenches should be borne by the ontractor.InTr f worfic d vibration adjacent to trench walls should be minimized; cyclic wetting and drying of excavation side slopes should be avoided. Depending upon the location and depth of some utility trenches, groundwater flow into open excavations could be experienced, especially during or shortly following periods of precipitation. CWell-graded sand with gravel and silty sandy soil conditions were encountered throughout the site. the event that cohesionless sandy soils are encountered, they have a tendency to cave in trench wall excavations. Shoring or sloping back trench sidewalls may be required within these sandy soils Utility trench backfill placed in or adjacent to buildings and exterior slabs should be compacted to at least 95 percent of the maximum density based on ASTM Test Method D1557. The upper 2 feet of utility trench backfill placed in pavement areas should be compacted to at least 95 percent of maximum density based on ASTM Test Method D1557. Pipe bedding should be in accordance with pipe manufacturer recommendations. p The contractor is responsible for removing all water-sensitive soils from the trench regardless of the backfill location and compaction requirements. The contractor should use appropriate equipment and methods to avoid damage to the utilities and/or structures during fill placement and compaction. Foundations The proposed structure may be supported on a shallow foundation system bearing on native soils. Spread and continuous footings may be designed for an allowable bearing pressure of 2,500 psf allowable bearing pressure may be increased by one third to resist short-term wind or seismic loads.This Exterior footings should have a minimum depth of 18 inches below pad subgrade (soil grade) or adjacent exterior grade, whichever is lower. Interior footings should have a minimum depth of 12 inches below pad subgrade (soil grade) or adjacent exterior grade, whichever is lower. Footings should have a minimum width of 12 inches, regardless of load. If constructed as recommended, the total foundation settlement is not expected to exceed about 1 inch. Differential settlement, along a 20-foot exterior wall footing, or between adjoining column footin s should be less than %2 inch, producing an angular distortion of 0.002. Most of the settlement isg ed to occur during construction, as the loads are applied. However, additional post-construction settlement may occur if the foundation soils are flooded or saturated. Seasonal rainfall, water run-off, or normal watering practice of trees and landscaping areas around the proposed building, should not flood and/or saturate footings. Provided the site is prepared as recommended in our report additional post-construction settlement should be minimal. Resistance to lateral footing displacement can be computed using an allowable friction factor of 0.40 Krazan&Associates, Inc. With Ten Offices Serving The Western United States 062-00017-Hilliard Residential KA No. 062-00017 Page No.8 acting between the base of foundations and the supporting subgrade. Lateral resistance for footings can alternatively be developed using an allowable equivalent fluid passive pressure of 350 pounds per cubic foot acting against the appropriate vertical footing faces. The frictional and passive resistance of the soil may be combined without reduction in determining the total lateral resistance. A 1/3 increase in the above value may be used for short duration, wind or seismic loads. In areas wh ere it is desired to reduce floor dampness, such as living space areas where floors are covered with moisture sensitive floor coverings, concrete slab-on-grade floor should be underlain by a water vapor retarder system. The water vapor retarder system should be installed in accordance with ASTM Specification E1643-94 and Standard Specifications E1745-97. According to ASTM Guidelines, the water vapor retarder should consist of a vapor retarder sheeting underlain by a minimum of 4 inches of compacted, clean, crushed, open-graded coarse rock of%-inch maximum size. The vapor retarder sheeting should be protected from puncture damage with 2 inches of sand. The sand should be well moistened prior to placement of the concrete slab. The exterior floors should be poured separately in order to act independently of the walls and foundation system. Exterior finish grades should be sloped a minimum of 1 to 11/2 percent away from all interior slab areas to preclude ponding of water adjacent to the structures. All fills required to bring the building pads to grade should be Engineered Fills. Compacted Material Acceptance Compaction specifications are not the only criteria for acceptance of the site grading or other such activities. However, the compaction test is the most universally recognized test method for assessing the performance of the Grading Contractor. The numerical test results from the compaction test cannot be used to predict the engineering performance of the compacted material. Therefore, the acceptance of compacted materials will also be dependent on the stability of that material. The Soils Engineer has the option of rejecting any compacted material regardless of the degree of compaction if that material is considered to be unstable or if future instability is suspected. A specific example of rejection of fill material passing the required percent compaction is a fill which has been compacted with an in situ moisture content significantly less than optimum moisture. This type of dry fill (brittle fill) is susceptible to future settlement if it becomes saturated or flooded. Moisture content of fill soils shall not vary by more than±2 percent of optimum moisture. Testing and Inspection A representative of Krazan & Associates, Inc. should be present at the site during the earthwork activities to confirm that actual subsurface conditions are consistent with the exploratory fieldwork. This activity is an integral part of our service, as acceptance of earthwork construction is dependent upon compaction testing and stability of the material. This representative can also verify that the intent of these recommendations is incorporated into the project design and construction. Krazan & Associates, Inc. will not be responsible for grades or staking, since this is the responsibility of the Prime Contractor. Krazan&Associates, Inc. With Ten Offices Serving The Western United States 062.00017-Hilliard Residential r KA No.062-00017 Page No.10 If you have any questions, or if we may be of further assistance, please do not hesitate to contact our office at(360) 598-2126. dem 'espectfully submitted, I ' : i%: RARD KRAZAN&ASSOCIATES,INC. e � Shaw n E. Williams ;s Senior Environmental Geologist ioNAL SE W/TGB: ksm ExPtRes: t t/10100 Timothy G. Beckerle, P.E. CEngineering Manager I. ` s L ; With Ten Offices Serving The Western United States 383 Northwest Equestrian Drive•Poulsbo,Washington 98370•(360)598-2126•Fax:(360)598-2127 062-00017 ` BUILDING PERMIT APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLDon-nn752 Received Date: 11/20/2000 SITE ADDRESS: 44 0 5r11.-rH t-41/41 QUILCENE, 98376 APPLICANT: FRED HILLIARD PHONE: (360)765-4009 BARBARA HILLIARD 1055 DEER CRK RD QUILCENE WA 98376 SUBDIVISION: Block: Lot: 8 PARCEL NUMBER: 501041008 Section: 4 Township: 25 N Range: 01 W CONTRACTOR: OWNER PHONE: ARCHITECT/ ENGINEER : PROJECT DESCRIPTION: STORAGE SHED TYPE OF WORK GAR SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 6,000.00 ADD'L: HEAT TYPE: CODE EDITION: 1997 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: 600 SHORELINE: CONST TYPE: DECK: SETBACK: 75 BANK HEIGHT: 75 SEWAGE DISPOSAL: WATER SYSTEM: PWELL PARCEL TAGS: YES NO BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA Exist: Exist: Wetland Erosion Prop: Prop: Seismic Streams Total: Total: Flood Way Flood Plane F&W Landslide Routing Date: Shoreline Aquifer Forest: Commercial Rural 1-'roximit - flat G• d ions Type Amount Paid By: Date: Receipt: - Permit $139.25 MAM 11/20/00 34585 �' , � -16; vE� Plan Check $41.78 MAM 11/20/00 34585 r V to..442. State Building Code $4.50 MAM 11/20/00 34585 DEC 0 6 2000 Total: $185.53 Jefferson County Planning & Building Department i:1F BLD_App_Bld.rpt 10/29/99 �° co Jefferson County Department ofDevelopment �� , l ed.i 6213heridan Street,Port Townsend WA 08368 Community0l 318-4450 r r3 o �, -1�,-�. ►.q Perm : o � O o0 � ...�000iS00 0 0 0 o o��_ o 0 Project Description: Building Type: Project Type: Frame Type: Single Family New X Wood Garage Attached/Detached Li Addition ❑ Steel Modular 70Alteration/Remodel ❑ Concrete Commercial10 Repair ❑ Masonry iid Multi-family/#of Units ❑ Demolition ❑ Other: ❑ Industrial Other: IA'. NI i Bedrooms: !athrooms: Type of Sewage Disposal: Type of Heat: / Choose one: Existing: Existing: ❑ Sewer ❑Community System PiElectrici Oil Proposed: Proposed: ❑ Individual System ❑ Wood ove ❑ Propane Total: Total: If not sewer,fill out the following: ❑ Hea p ❑ Conventional ❑ Alternative ❑ Other Permit# SEP Water Supply: Private well ❑ Two Party Well❑ Public:Name of water system: Square Footage: , ; For Office Use Only • Main Floor / ..r UBC OCCUPANCY GROUP • 2ND Floor �•�#` Base fee 3rd Floor Plan Check fee' Y,��• Htd Basement ate Surcharge fee O Unhtd Basement ;/ \ ubtotal „01 - T Garage/Carport )� ` Pot Water Review fee Decks 911/Rd Approach fee q Q 440 Commercial TOTAL A , I • r3 Industrial y +• Receipt # 7% v Other Cash/Check# Total Valuation: Initials Orit Date • 1 •liiiifilfiesookigio.0," Estimated Cost: If within 200' of the Shoreline, �J Distance to Bank or Ordinary High Water Mark L S ft.Bank Height 1 ) ft. By signing the application form,the applicant/owner attests that the information provided herein is true and cotueu 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 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 it's employees,representatives or agents for the purpose of application review and any required later inspections. Access and right of entry to the ' s pr erry or structure hall be requested and shall o cur during regular business hours. i �Signature: i Date: /I • / Q,J , 612) aT---"ZcP* (oar) :kVA '0og9---Zcil (0 C) 9L �6 "3N3O�ilf 10 9 � t� +1 'S3 i3 N 160 d CIvoe# N33�O 8l33C 5c'0 t co 0�-' XOE ' 'd a21VIT11H V21V821V8 v )IO12:13a3ad :�J,S7) .1vJ� ii o i, -4- •• OZO—Z20—LOS V 900-1i'0—LOS Ndb . 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