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Home My WebLink AboutBLD2001-00027 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 #: BLD01-00027 Received Date: 1/12/2001 SITE ADDRESS: 1654 S JACOB MILLER RD Issue Date: 1/30/2001 PORT TOWNSEND, 98368 Expiration Date 1/30/2002 APPLICANT: TERESA D TETZLAFF PO BOX 841 PORT TOWNSEND WA 98368 SUBDIVISION: IRVING PARK ADDITION Block: 24 Lot: 1-10 PARCEL#: 963302401 Section: 16 Township: 30 N Range: 01 W CONTRACTOR/ DEALER INSTALLER: KEVIN ALLEN WAINSOO75 Expires: 8/1/2001 1951 N NATIONAL CHEHALIS WA 98532 PROJECT DESCRIPTION MANUFACTURED HOME INSTALLATION MAKE: SKYLINE YEAR: 2001 SIZE: 28 X 66 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 1/30/2002. REQUIRED INSPECTIONS: [L'1, Setbacks: ;,/K � /2 r' [9 Footing(If continous footings are used): U/C, _.- ,1//6/ lockin /Plumbin `' " � "� [ /Vents/Porches/Steps: c'�Kag o -%Ne,c. aA=-X�y,�j 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. HOT-LINE AVAILABLE 24 HOURS A DAY MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD01-00027 Received Date: 1/12/2001 SITE ADDRESS: 1654 S JACOB MILLER RD PORT TOWNSEND, 98368 APPLICANT: TERESA D TETZLAFF PHONE: (360)385-0658 PO BOX 841 PORT TOWNSEND WA 98368 SUBDIVISION: IRVING PARK ADDITION Block: 24 Lot: 1-10 PARCEL NUMBER: 963302401 Section: 16 Township: 30 N Range: 01 W CONTRACTOR/ DEALER: INSTALLER: KEVIN ALLEN WAINS0075 8/1/2001 (800)241-5187 1951 N NATIONAL CHEHALIS WA 98532 PROJECT DESCRIPTION MANUFACTURED HOME INSTALLATION TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW MAKE: SKYLINE SETBACK: VALUATION 71,586.00 YEAR: 2001 LABOR & INDUSTRIES APPROVAL? SIZE: 28 X 66 BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: PUD BEDROOMS: BATHROOMS: PARCEL TAGS: YES NO Exist: Exist: STORMWATER: YES NO Prop: .0' 9 Prop: 2 AREA Plat Conditions Total: ? o q� Total: 2 See sm d E St t eion reams Flood Way Floodplain F&W Landslide Routing Date: [ ( ti 0d vvig Shoreline Aqr Forest: Commerci I Type Amount Paid By: Date: Receipt: e Manufactured Homes $141.00 MAM 01/12/01 37225 Potable Water Application $30.00 MAM 01/12/01 37225 JAN 3 0 2001 Total: $171.00 JEFFERSON COU DEPT. OF COMM ITY EVELO /V�E�IT SIGNATURE: o-G� Y t JEFFERSON COUNTY COMMUNITY DEVELOPMENT 621 SHERIDAN ST, PORT TOWNSEND WA 98368 MANUFACTURED HOME INSTALLATION PERMIT APPLICATION jEr NEW BUILDING El REPLACEMENT SIZE p1 �f)( C9 YEAR .2040 [ MAKE 6 K\/ 1lvke. (r� 6l 3 c COST ( } S 8( BEDROOMS: BATHROOMS: EXISTING EXISTING PROPOSED 3 PROPOSED -Z TOTAL 3 TOTAL 2. TYPE OF SEWAGE DISPOSAL: WATER SUPPLY: CI SEWER 0 COMMUNITY SYSTEM 0 PRIVATE WELL 0 TWO PARY WELL J�+INDIVIDUAL SYSTEM Conventional PUBLIC PERMIT # SEP ❑ Alternative Name of water system: F L% iD IF WATERFRONT PROPERTY, DISTANCE TO BANK OR HIGH WATER LINE N ✓1 ft BANK HEIGHT IV/AL 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. SIGNATURE .......-4/et.A-ti. DATE I,_. I I —C7 1 NAME (PLEASE PRINT) -1.--e.Y'ir' l -1---,e_. Z la.c-- FOR OFFICE USE ONLY BASE FEE L' . s C . RECEIPT# -t-_l_a_____ �. ADDITIONAL SECTIONS CASH/CK# G SUBTOTAL 14 I •°C DATE /it_r�1 ` POTABLE WATER . 91 1/ROAD APPROACH ___ TOTAL I*1 r UU H:\HOMEIPLNCNTRIFO RMS1MO81LEAP.10/99 • .. I -----------‘20,' \-, . . • ........, ! ...--- ...c..:.:, 1 I --V ,-•..! 1 1 4'° •y( - \...) ,,,. ..) :N., i i 4.••••• ---' 4, _ cN) ""•••-..c: 4‘,1 410 riTh -I • , e) O'Gr • S' 1 1 I L ! -- -,4 g JO, I _ ---2. /09\ 1, .7 9 tie\ t, ,.`n i / ><79 , , 1 ,-041-,..„.....-------N,- %, , -I. 14- ; ! I i, -_,. ; I 1 t.1 ;c- ; , ; . U , -...... LQ c-- \ .. ,•.‘ i n ti j : I 1 i z- 'EL . v\. t .. . a „ . i t,, 11,,It°‹..; N.- (r- o -s;1, I N : ill -I'Q- s. -t ' -c! ‘T .4 .S'• I i ; ---, .., J 0 N `.=-1 < •q-\ ...4._ , i — •- __. — •_....„_. 1 t--- - / C.' C19 Z-- -..‘r 09 Q... , ai. nr) • •.- \ - -...) N . .+- .)' —, \ --i : 1 s p i ,, ...,. Jefferson County Department of Community Development / oN coG 621 Sheridan Street,Port Townsend WA 98368 (360) 379-4450 ( j try $ Universal Plot Plan Fill in the following blanks as completely as possible: Project Description: vtl iA � t&{ 9 Digit Parcel Identification Number (from your tax statement): C1(3 C2. -1O Site Address 5 ,Sckccb i\€)r- 911#: 1 Road Name: Zip Code: Legal Description Subdivision Name: Block: 2'( Lot(s): — I 0 Section: Township: Range: Parcel Size (acres or square footage): Property Owner: —r Phone: ex_r Ac i_kcx�- s� —�^ 3(c)0 3 N -6(o S Mailing Address: p•6 jC.: < T( 1 C c.c�V^�s rC vNC. Lt_ cx. 9 S-3 CD Applicant/Occupant: Phone: (if different from owner) Mailing Address: Authorized Rep: Phone: Mailing Address: General Contractor: 3(00 t{Z(o - -<i q3 Or Manufactured Home Installer: Wao j 41 f� on {4M' Ct't1'�v Phone 090 y z Mailing Address: Contractor's State License Num'ber: Expiration Date: Septic Designer: w t 6,;44 6,1h e ` Phone: Mailing Address: Architect:/Engineer: Phone: Mailing Address: Loan Lender/General Phone: Contractor's Bond Holder: tJ/if Mailing Address: FOR OFFICE USE ONLY Fire District: Planning Area: School District: Zone: 1 1/00 H:\home\pincntr\forms\universal plot plan MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD01-00027 Received Date: 1/12/2001 SITE ADDRESS: 1654 S JACOB MILLER RD PORT TOWNSEND, 98368 APPLICANT: TERESA D TETZLAFF PHONE: (360)385-0658 PO BOX 841 PORT TOWNSEND WA 98368 SUBDIVISION: IRVING PARK ADDITION Block: 24 Lot: 1-10 PARCEL NUMBER: 963302401 Section: 16 Township: 30 N Range: 01 W CONTRACTOR/ DEALER: INSTALLER: KEVIN ALLEN WAINSOO75 8/1/2001 (800)241-5187 1951 N NATIONAL CHEHALIS WA 98532 PROJECT DESCRIPTION MANUFACTURED HOME INSTALLATION TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW MAKE: SKYLINE SETBACK: VALUATION 71,586.00 YEAR: 2001 LABOR & INDUSTRIES APPROVAL? SIZE: 28 X 66 BANK HEIGHT: SEWAGE DISPOSAL: CON n� WATER SYSTEM: PUD 1"'v 1 'S BEDROOMS: BATHROOMS: PARCEL TAGS: YES NO 7< Exist: Exist: STORMWATER: YES NO AREA Plat Condi_tip s $'Prop: 9 Prop: 2 Wetland _ Erosion N�Total: , 9 Total: 2 Seismic Streams i _ Flood Way Floodplain i}! Routing Date: ti ( 0 d fi2V8 F&W Landslide Shoreline Aquifer , ' Forest: Commercia Rural i, Type Amount Paid By: Date: Receipt: Approved/Date Manufactured Homes $141.00 MAM 01/12/01 37225" Potable Water Application $30.00 MAM 01/12/01 372251 Reke(t- ii� Total: $171.00 ,}fi: c,1°.i ,...- \ ilk ki f STORMWATER CALCULATIONS w Oner/Applicant: I -err l �-� C ❑ PROPOSED LAND DISTURBING ACTIVITY Site Address: (Lc S' 6 a co f r Drainfield area cleared sq.ft. Driveway Length 0 ft. /� 3 2 X Width C) ft. 9 Digit Parcel Identification No.: ct lU3O ego/ = Total Driveway 6 sq.ft. Permit Number: Clearing and Grading for Site Development PLOT PLAN (Well/Structures/Utilities/etc.) sq.ft. zoo° sq.ft. INDICATE the following information. Total Land Disturbance Z 3cD d sq.ft. Draw entire parcel to scale. Indicate scale of plot plan: One inch equals IMPERVIOUS SURFACE Proposed Structures (all roof area) /85 sq.ft. • 1. North arrow Existing Structures (all roof area) sq.ft. 2. All property boundaries and dimensions Sidewalks sq.ft. 3. Names of adjacent streets Concrete Patios sq.ft. 4. Driveway/s & parking spaces Proposed: • 5. Major features such as ravines, Driveway Length ft. seasonal creeks, bodies of water, etc. X Width ft. • 6. Septic tank, drainfield and reserve area location, = Total Driveway sq.ft. existing or proposed, and distance to Total Impervious Surface ( S 0 sq.ft. closest structure 7. Sewer lines The Stormwater Manual sets forth the following Small Parcel Minimum Requirements: 8. Wells and/or water lines • Construction Access Route Stabilization: 9. Neighboring wells within 1 50 feet Construction vehicle access shall be, whenever feasible, limited to one route. Access points shall be stabilized with 10. Paved surfaces (patios) quarry spalls or crushed rock to minimize the tracking of 1 1. Structures, existing and/or proposed sediment onto public roads. If sediment is inadvertently transported onto public roads, roads shall be cleaned - 12. Setbacks (distances to property thoroughly at the end of the day by shoveling or sweeping. boundaries, structures, banks, Street washing should only be done after the bulk of the sediment has been removed by sweeping. and shorelines) • Stabilization of Exposed Soil: All exposed and unworried soil shall be stabilized by sodding, - 13. Easements for access or utilities seeding, mulching, plastic covering, application of gravel base - 14. Arrows showing direction of slope-- on roads and driveways, or other appropriate means within seven days during the period from May 1 to September 30 assume an elevation of 100 feet at one and within two days during the period from October 1 to April lot corner and indicate the other lot 30. Mulch shall be applied to a minimum depth of two inches. • Protection of Adjacent Properties: corner elevations in relation to it Adjacent properties shall be protected from sediment deposition by appropriate use of vegetative buffer strips, sediment barriers or filters, dikes, mulching, or by a FOR APPLICATIONS ADJOINING SHORELINES, combination of these measures and other appropriate Best INDICATE: Management Practices (BMPs). • Maintenance: 15. Ordinary high water mark All erosion and sediment control BMPs shall be regularly inspected and maintained to ensure continued performance of 2 16. Top of bank, if over 10 feet high their intended function. Ei 17. Slope of bank in degrees • Other Appropriate BMPs as required by Jefferson County to mitigate the effects of increased runoff shall be applied. H:\HOME\PLNCNTR\FORMS\PLO TPLN.FR M9i 97 PLEASE MAIL TO: i 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: —rev r l k Z,ck.c-1- c The purpose of this questionnaire is to obtain information ADDRESS: 0, p ( 1 regarding either the current location of a mobile home or the previous ownership and location of a mobile home. This will "�`� �� a q �G help our office determine whether the mobile home is already ` O 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: 3(o0 J 8. S �-0 ( g" additional information. 1) MOBILE HOME DATA: (A) MAKE 5F-y ti e. (B) MODEL (oat 3 CT (C) YEAR 2UCO t. (D) LENGTH (0(0 0 (E) WIDTH 2 g / (F) SERIAL NUMBER ' / 6,D (G) YOUR PURCHASE PRICE(DO NOT INCLUDE SALES TAX) 7 111 S"$(.0 (H) PURCHASE DATE lI/'// 0"O 0 2) PREVIOUS OWNER / LOCATION OF MOBILE HOME: (A) FROM WHOM DID YOU PURCHASE MOBILE W 0SIA l(li 4o , HOW1 e Ce Wi-e� ADDRESS & 1 5 E R c tiN a?_ ‘rvek#a ' _ (B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR? YES NO (IF NO, WHAT COUNTY? ) IF YES, WHAT WAS PREVIOUS ADDRESS OF MOBILE? 3) WHERE MOBILE HOME IS TO BE LOCATED: (A) WILL THE MOBILE HOME BE IN A MOBILE HOME PARK? YES NO (B) IF LOCATED IN A MOBILE HOME PARK: NAME 8T ADDRESS OF PARK SPACE NO. (C) IF NOT LOCATED IN A MOBILE HOME PARK:NAME OF LAND OWNER: 1-e'r- I. t ZACt C'.R LOCATION (ADDRESS) i O S 1 qGLob M i t l�r -Pork -To rj nc4 REAL PROPERTY PARCEL NUMBER/DESCRIPTION (Ito 3 302. 410 t THANK YOU FOR YOUR HELP! SIGNATURE KELLI LARSON, roperty Technician THIS FORM CONFORMS TO THE STANDARDS OF THE STATE DEPARTMENT OF REVENUE AND IS SUBJECT TO AUDIT VERIFICATION. Sent By: Wash,ingtgr, Home Center, Imc. ; 360 426 8493; Jan-18-01 2:47PM; Page 2/2 i . ga o m' ktiil *ail g Filli _ ' -4k 0 0 0 — Zi § rb i 154wP n P fin CI . ro fill A fi t r WI. , !, .......... ---L '•., Lre: I 6 g Z t -i to -_ _ i 1 tP1 i v II 1 j (Th : ..B 1 0 1,1p { / ilill i 01 .a 1 ( , pT lelp 0L " `ii i il gillrg. t-- V 01 U L W uHf lip 2 1,1- m 1- 0 — _ill . -.1- g, i -„, §iJf?. . ;444- a. y 1N3WdOl3A31Nf130�AlNQSa3INnWW433O`�P 40'1d30 •.... i n ra A tOOZ 8 t NYP „r , -1\7---CD -I 0001 /- MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD01-00027 Received Date: 1/12/2001 SITE ADDRESS: 1654 S JACOB MILLER RD PORT TOWNSEND, 98368 APPLICANT: TERESA D TETZLAFF PHONE: (360)385-0658 PO BOX 841 PORT TOWNSEND WA 98368 SUBDIVISION: IRVING PARK ADDITION Block: 24 Lot: 1-10 PARCEL NUMBER: 963302401 Section: 16 Township: 30 N Range: 01 W CONTRACTOR/ DEALER: INSTALLER: KEVIN ALLEN WAINSOO75 8/1/2001 (800)241-5187 1951 N NATIONAL CHEHALIS WA 98532 PROJECT DESCRIPTION MANUFACTURED HOME INSTALLATION TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW MAKE: SKYLINE SETBACK:VALUATION 71,586.00 YEAR: 2001 LABOR & INDUSTRIES APPROVAL? SIZE: 28 X 66 BANK HEIGHT: SEWAGE DISPOSAL: CON U'� V G 0 WATER SYSTEM: PUD BEDROOMS: BATHROOMS: PARCEL TA .S: YES NO Exist: Exist: STORMWAT: R: YES NO AREA Plat Conditions Prop: 3 Prop: 2 Wetland , Erosion Total: 3 Total: 2 Seismic a Streams Flood Way U11 Fl Routing Date: F&W andslide I li Qt f�j Shoreline Aquifer l Forest: Commercial Rural Type Amount Paid By: Date: Receipt: Approved/DaC �;� Manufactured Homes $141.00 MAM 01/12/01 37225 ''), „ ; . Potable Water Application $30.00 MAM 01/12/01 37225FilTotal: $171.00 ” � -� d Jefferson County Department of Community Development January 17, 2001 621 Sheridan Street, Port Townsend, WA 98368 (360) 379-4450 CRITICAL AREA STANDARD WAIVER Applicant: TERESA D TETZLAFF PO BOX 841 PORT TOWNSEND WA 98368 Critical Area Review Case Number: CAR01-00018 Project Description: manufactured home installation Parcel Number: 963302401 S-T-R: 16-30N-01 W Site Address: 1654 S JACOB MILLER RD PORT TOWNSEND WA, 98368 FINDING: The development, as proposed and portrayed on the Universal Plot Plan, does not encroach on an identified critical area nor any associated buffers. CONCLUSION: The proposed development meets the waiver requirements established in Jefferson County Ordinance 05-0509-94. CONDITION: The development shal as proposed and portrayed on the Universal Plot Plan. Deviation, additions or relocation f oposed development activities will require further review pursuant to the Jefferson County C Ic Areas Ordinance. Departme t of Commun Development Staf c: File is\F_CAR_Waiver_Standrd.rpt 12/13/99 Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 CRITICAL AREAS QUESTIONNAIRE Applicant Name --�- XBuilding Application Land Use Application Shoreline Application On-site Sewage Application Subdivision Application Other: 1 . Is there any standing or running water on the surface of the _ Yes ✓ No property or on any nearby property at any time during the year? If YES, please describe: 2. Has any portion of the property or any nearby property ever been _ Yes YNo identified as a wetland or swamp? If YES, please describe: 3. Are any willows, skunk cabbage, alders, or cottonwoods present _ Yes ✓ No on your property or adjacent properties? If YES, please describe: 4. Are there any indications on any portion of the property or on any YES ✓ No nearby property of rockslides, earthflows, mudflows, or landslides? If YES, please describe: 5. Please indicate which line best represents the steepest slope found on your property. (Check appropriate box) — ❑ n � n / // / / // - / / i rldIII//// /_. ----- ---- Z7 (Questionnaire Continues on Back) Page 1 of 2 6. Does the site have steep slopes with little to 'no vegetation? YES %.7 No If YES, please describe: 7. Does the site contain high percentages of silt and/or very fine YES VNO sand? If YES, please describe: 8. Does the site contain ground water seepage or springs near the YES NO surface of the ground? If YES, please describe: 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. Signature Date l--ll—® FOR OFFICE USE ONLY Wetlands CRITICAL AREAS ON OR C Aquifer Recharge Area (zone ) Fish & Wildlife Area 1 IMMEDIATELY ADJACENT TO SITE: C Frequently Flooded Area Fish & Wildlife Area 2 C Erosion C Landslide Seismic Commercial Forest Section Township North Range Parcel Number: Parcel Size: Comprehensive Plan Land Use Designation: Reviewed by: Community Plan: Date: Page 2 of 2 h:AhomeApincntr\forms\car.doc r ioo