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HomeMy WebLinkAboutBLD2004-00739 3S2I3A32I 33S- A1ddV SNOI110N001VI33dS Ava V S2inOH bZ 318V1IVAV 3NI1 _OH 'w'd 0£:p- w*e 00:6 san0H eol140 .SNOI103dSNI 3111a3H0S 013ONVAOV NI S2ifOH tz 11VO '99i'P 61£ 3NI1-IOH NOI103dSNI ONIa1In8 03M3N321 A1213d021d 38 ISf W II 21O 2IV3A 3NO 2103 anvn SI 1IIN2I3d SIHI NOI103dSNI 1VNId 012IOR1d 432IIf1032I 1VA02IddV S)210M 0119ld ONV 1N3W12IVd30 H11V3H AMA ''19 91 -01 —9 :lenoaddy 1(ouednoo0/Ieu13 :Ien0addy 1eu13 6uluoZ :lenoaddy Ieu13 goeoaddy peol :(Jamas uo lou 41) lenoaddy Ieu13 wa1AS o11do / :)looalaa4S 4$ SO/4/0/ At7 A3°S7j bb .)'0 trl.Vg.1s$a? :uolielnsul po/s/s- Srra.(3 '�t1fdfj�rI lay ,7 /// la 11.49 :saun /)1ue1 auedoad ��y�,�, s VYJ>r.Pc ir /�'so/A/b a9 Pf Vg J.5rw7 :6ulgwnld D� 'W 5c-0e,-, 71Q :6ulww -whib,iv 4virr'Y alV9W5 W71x9 : IIeM aeauS :uollelnsul punoa6aapun 's-9 .'/b N s' *"!y dor/Hy_ % 4(500Av wocVgar174 J.117 Orf0.25t ,yv it 791dirss7y.�rz3 j:6ulgwnld punoa6aapun - 4 gt10 Wall ►st, :IenoaddV 1VNI3 Jo OMwaol9 la PM9 ta 4r c') 7d/di/)Sati1y/ S9�lJ 710 (wJ Qd 200 jr,,ivtici It,"'s Elk. 1Q +i 1 :uollepuno3 e TahliI 7'Q #'50l/�- �JIQ: (10270IYfey vctai Ply el3 .i J,h V = may :6uiioo T✓ f ,pso�/Z//i 1v s9ni j 7crideardl Fcs2k) ,�57 : I3d3n �(v l /.I ly j 0 5i/-; ,,›' :S>10V813S 10 3f O2Id 2Il0A 01 A1ddV 1VH1 SNOI13dSNI O3tflO321 3H12I0 I NI 11VO 30N30IS32I ONIISIX3 13O0W32I '8 N0111aav :NOIld12I3S30 13 CO2Id `dM aNViS1 30a12i8NlV8 406#3AV NOSIaV1N 0617 601717-Zti8(90Z) :3NOHd 3H1 '00 N3N1'1321 :2i01OVJ1NO0 3 60 :a6ue2i N 6Z :dlusumol gZ :U01lo0S 900£8ZLZ6 :2i38Wf1N 130IVd +I. :loi :)10o18 :NOISIAIa9fS LL086 VM 31IIANIa00M 3N H1LZZ 171.£176 2i3N13H 1 V IV8IV8 :3NOHd 2i3NI3H V QIAVCI :1NV3flddV 59£86 'MOgann 12:10d i 00Z/ZZ/ZI, elea anssl a2i 1NI0d 31310 E65 :SS32iaay 311S 1700Z/1734I. ale() penlaoa1 6£L00-iOa18 :# JIW2:18d I•9tt7-6LE(09£) X`dd 05tr17-6L£(09£) 89E86 VM `puesunnol4aod `4aaaiS uepuayS 1.Z9 }uawdolanaa A unuauaoa to luaualaedad /4unoa uosaagar c 1IW213d JNIa1Il8 _ Iiiiiiiiummilmi, lit!Ll31yG Jefferson County De ar PERMIT APPLlCAlik MLA04-00660 p nt of Community Development Review Type;I 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD04-00739 Received Date: 11/24/2004 SITE ADDRESS: 513 OLELE POINT RD PORT LUDLOW, 98365 OWNER: DAVID A HEINER BARBARA T HEINER PHONE: 14314 227TH NE WOODINVILLE WA 98077 SUBDIVISION: PARCEL NUMBER: 28 921283005 Section: Block: Township: Lot: 1 CONTRACTOR: 29 N Range: 01 E ?Az_4401 - Peu e PHONE:ottEitirtITEUER Q ) ���Ago i�N ME N. 'If- LDI REPRESENTATIVE: �5D) AQ8l((� PHONE: PROJECT DESCRIPTIOt ADDITION & REMODEL EXISTING RESIDEN CE TYPE OF WORK RES SQUARE TYPE OF IMP FOOTAGE: � VALUATION ADD $ 400,000.00 MAIN: CODE EDITION: 2003 ADD'L: , OCCUPANCY: HEAT BASE: �, "l' g HEAT TYPE: HTP OCCUPANCY: UNHEATED: HEAT TYPE: �ONST TYPE: OTHER: # OF STORIES: 3ONST TYPE: GARAGE: SHORELINE: DECK: 737 SETBACK: ;EWAGE DISPOSAL: ALT VATER SYSTEM: BANK HEIGHT: DWELL PARCEL CEL TAGS: YES BATHROOMS: NO xist: 2 Exist: 3 STORMWATER: YES AREA°p� 2 Wetland O �tal: 4 Prop: 1 Erosion Total: 4 Seismic Streams EED8tefz / / Flood Way FloodplainV F&W Landslide Shoreline Forest: Commercial Aquifer Pe Amount Paid Rural rmit Bv: Date: Receipt: $2,673.75 BAC 11/24/04 68802 Approved/Date in Check $1,737.94 BAC to Building Code 11/24/04 68802 A PRable Water Application $4.50 BAC 11/24/04 68802 r VED $52.00 BAC 11/24/04 68802 Total: $4,468.19 DEC 2 3 2004 Jefferson County Planning 4t1.4:4..ildi, . !eiartmen/L 1 SPECIAL CONDITIONS FOR CA•# BLD04- 00739 • 1 ) The project shall adhere to the Best Management Practices B erosion and sediment during construction. BMPs shall address stabilize soil exposed during ( MPs) to control stormwater, and drainage control systems construction, and in the design and ermanent measures to 2 ) A stormwater Plan has been submitted and approvedoperation of stormwater Development. Once the subject permit has been issued the applicant implement the provisions of the submitted plan and cont cthe Department of Community Department of Community Development to arrange a schedule shall fully t the Jefferson County plan compliance. A Certificate of Occupancy will not be issued until verifies plan compliance. to inspect the property the Departmentp perty for p No clearing for roadways or utilities shall occur on the project site until clearing necessary for the installation of temporary sedimentationei control measures have been completed. 3.) The building height is not to exceed 35 feet. and erosion 4.) Maximum lot coverage is not to exceed 25%. Lot coverage is impervious surface which includes roof tops, driveways, concrete, etc. 5.) The front setback from Olele Point Road (County Road#560 defined as amount of of the riot setback . e (shoreline-Suburban) setback is 33 feet 6 nchess a 5 foot side k from property is 20 feet from the edge 6.) Fabricated Steel. P perty lines. The rear All fabricated steel structural components shall be fabricated 1704.2.1 and 1704.2.2. At completion of work done and prior to final the approved fabricator shall submit to the Buildingper IBC /�� stating the work was Official a certificate of compliance l °n, C,� performed in accordance with the approved construction documents. • I:1F_BLD_Permit_Buildng.rpt 10/29/1999 r • • II U II U II II II II i t I 5Vj DtTTOst i MASTER 1 BEDROOM 0 ( 200 ) 0 0 0 0 _ — [ __''-', , i 1 t t ---11t91 tATIVStit 0 0 0 MASTER o Ji- DRESSING — ( 2 01 ) r I y lt' 1 1 STEAM SLAT I SHOWER i I aneUStR- - 0( 202B ) 0 00 MASTER 0 WC BATH O ( 2o2A ) ( 202 ) _ 0 i f_ II r ll 1_1 if 11- 0 MAC . cLtti6 ttt161k1 t'11t\G ISO1Z nP i �w j 5 1 -- MS °I1 11 2-65 • '��•SpN C©6, JEFFERSON COUNTY 4' �',-,, A DEPARTMENT OF COMMUNITY DEVELOPMENT Pe `4 621 Sheridan Street• Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax p www.co.jefferson.wa.us/commdevelopment K"Q'`4INGrS Master Permit Application MLA: b'• Oo4,4,0 Project Description(include separate sheets as necessary): Tax Parcel 9 Z1 • 2t3 • bob Size:Property Number: S.23/2z1 N et (acres/square feet) Site Address and/or Directions to Pro rty: ' I O.��` %'O1 MO Property Owner(s)of Record: itak y',�H, 1° �1 Telephone: ZS• 261• 2 Fax: email: l IltiAark CIA‘crASkohck Mailing Address: f 22-7"1 \ kl bcsitww... , Wv—gp 7 Applicant/Agent if different from/ owner): Sp J►1 S vats_ Ii �h� Telephone: ?a� fr - 474• "•�,b Fax: 66 • 62 • 3 O email: i,'mlr► oLanto tetai.epNft Mailing Address: MI SOU.% —511&S �Z 1 61‘k ,ode.. 5 1tt %'t4 elblo Z What kind of Permit?(Check each box that applies) Building i Variance(Minor,Major or Reasonable Economic Use) ' Demolition Permit l Conditional Use[C(a),C(d),or C]** 11 Single Family I Discretionary"D"or Unnamed Use Classification I Garage Attached/Detached I- Special Use(Essential Public Fadlities)** I Manufactured Home Boundary Line Adjustment 1 Modular I Short Plat** Commercial* _I Binding Site Plan** 11 Change of Use i-' Long Plat** Address 1 Road Approach Planned Rural Residential Development(PRRD)/Amendments** 1 Propane l Plat Vacation/Alteration** Allowed"Yes"Use Consistency Analysis Li Shoreline Master Program Exemption/Permit Revisions** i Stormwater Management I Shoreline Management Substantial Development** Site Plan Approval Advance Determination(SPAAD)* Shoreline Management Variance Temporary Use Comprehensive Plan/UDC/Land Use District Map Amendment Wireless Telecommunication* L I Jefferson County Shoreline Master Program Amendment Forest Practices Act/Release of Six-Year Moratorium *May requite a Pre—Application Conference **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 it's 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.Access and right of entry to this property shall be requested and shall occur only during regular business hours. I ` Signature: VI.el.k.--\V— Date: lO• ��.7 5 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 sp sibility for adhering to and complying with the ESA. The Applicant has read this isdaimer and signs and dates it below. MJ. .Signature: .4, Date: VO .VI. 700 (::ADocuments and Settings mocha Desktop Master Permit.A PPGcation 7-8-04.doe • • OWNER 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: (21 )M2 ' FAX:'�I�M� �Pkti�( .4409 (24) S4Z• 852:.3 MAILING ADDRESS: ` CONTRACTOR'S LICENSE P�tKgF ��Wb IA MIA 1w ‘,qt1,0 WAINS V kv ��=�1~> A . A M NUMBER: ftVn ' t 95 Z2D G t NUMBER ARCHITECT/ENGINEER: �l V PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New X.Wood Existing: 3 1 Sewer Xf Addition Steel Proposed: _4_ Bank 1 Community System Alteration/Remodel Concrete Total: Height: Individual System 1 Repair MasonrySEP Permit# '1�5 Demolition Other: Bedrooms: Water Su I Existing: Z Setback: pp y Private well 1 Two Part Type of Heat: Proposed: Public y Total: S31 6~ Name of System: �1�lUpM tot TIt � woe - l 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 i Above ground Tank Size of Propane Tank: I Heat Stove i Cook Stove i Woodstove i Fireplace Insert i Hot Water Tank I Pellet Stove i 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 For Office Use Only Current Proposed Amount Main Floor Z2.54 111 Consistency Review: 2Nu Floor 536 1o,i Base fee: • 3f0 Floor 0 Or Additional Section: Mezzanine: Plan Check fee: Heated Basement 0 0 State Surcharge fee: Unheated Basement 0 Pot Water Review fee: Other Unheated 0 0 911/Rd Approach fee: Garage/Carport 484 VEr TOTAL: $ Decks "" t113 It51 Receipt Number: Other Cash/Check Number: ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish Initials: (:.ADocuments and Settings\mochil\Desktop\Master Permit Application 7-8-04.doc • • (,4 oN cob JEFFERSON COUNTY (,al \, DEPARTMENT OF COMMUNITY DEVELOPMENT 4.. ,„ 621 Sheridan Street • Port Townsend • Washington 98368 90N0�,0 360/379-4450 • 360/379-4451 Fax http://www.co.jefferson.wa.us/commdevelopment/ Stormwater Calculation Worksheet MLA# o 4 • WbbO }� .INL`R PROJECT/APPLICANT NAME: , NGx.. DETERMINING STORMWATER MANAGEMENT REQUIREMENTS: This stormwater calculation worksheet should be completed first to classify the proposal as"small,""medium,"or"large." The size determines whether a Stormwater Site Plan is required in conjunction with a stand-alone stormwater management permit application, building permit application, or other land use approval application that involves stormwater review. The basic information will also be helpful for completing a Stormwater Site Plan, if required. PARCEL SIZE(I.E.,SITE) Size of parcel �•Z3 acres ti An acre contains 43,560 square feet. Multiply the acreage by this figure. Size of parcel in square feet 2Z`t U1 q /ft Land-disturbing activity is any activity that results in movement of earth, or a change in the existing soil cover(both vegetative and non-vegetative) and/or the existing soil topography. Land disturbing activities include, but are not limited to clearing, grading, filling, excavation, and compaction associated with stabilization of structures and road construction. Native vegetation is vegetation comprised on plant species, other than noxious weeds, that are indigenous to the coastal region of the Pacific Northwest and which reasonably could have been expected to naturally occur on the site. Examples include species such as Douglas fir,western hemlock, westem red cedar, alder, big-leaf maple, and vine maple; shrubs such as willow, elderberry, salmonbeny, and salal; herbaceous plants such as sword fern, foam flower, and fireweed. LAND DISTURBING ACTIVITY,CONVERSION OF NATIVE VEGETATION,AND VOLUME OF CUT/FILL Calculate the total area to be cleared, graded, filled, excavated, and/or compacted for proposed development conversr ion of nativeng two questions related to project. Include in this calculation the area to be cleared for conversion native vegetation: Construction site for structures 75t Does the project convert Y..acres or more of sq/ft native vegetation to lawn or landscaped areas'? Drainfield, septic tank, etc. 7' sq/ft Circle: Yes (� o Well, utilities, etc. sq/ft Does the project convert 2 1/2 acres or more of Driveway, parking, etc. 6 t 6 sq/ft native vegetation to pasture? Lawn, landscaping,etc. sq/ft Circle: Yes No Other compacted surface,etc. 2fp Z.1 sq/ft Indicate Total Volumes of Proposed: Total Land Disturbance ^��3 sq/ft Cut a Fill aI� ` .� (cu/yd) [over] stormwater calc worksheet.cloc-REV.10/12/2003 1 A • • Impervious surface is a hard surface that either prevents or retards the entry of water into the soil mantle as under natural conditions prior to development. A hard surface area which causes water to run off the surface in greater quantities or at an increased rate of flow from the flow present under natural conditions prior to development. Common impervious surfaces include, but are not limited to roof tops, walkways, patios, driveways, parking lots or storage areas, concrete or asphalt paving, gravel roads, packed earthen materials, and oiled, macadam or other surfaces which similarly impede the natural infiltration of stormwater. STORMWATER CALULATIONS—IMPERVIOUS SURFACE NEW EXISTING Structures(all roof area) 1122, sq/ft Structures(all roof area) 40 sq/ft Sidewalks UM, sq/ft Sidewalks 211 sq/ft Patios Q sq/ft Patios sq/ft Solid Decks { )13 sq/ft Solid Decks sq/ft (without infiltration below) (without infiltration below) // Driveway e16 sq/ft Driveway 11-10 > sq/ft Other "" sq/ft Other 2-6°1 sq/ft Total New 0 sq/ft Total Existing 24'k `S sq/ft TOTAL NEW+TOTAL EXISTING* 2V Z4 sq/ft `This amount will be used to check total lot coverage. The following questions will help determine whether the proposed project is considered development or redevelopment. DEVELOPMENT v.REDEVELOPMENT Divide the total existing impervious surface above by the size of the parcel and convert to a percentage: 1b•1 % Does the site have 35%or more of existing impervious surface? Circle: Yes No FURTHER INSTRUCTIONS: If the answer is yes, the proposal is considered redevelopment and the attached Figure 2 should be used to determine the applicable Minimum Requirements. If the answer is no, the proposal is considered new development and the attached Figure 1 should be used. At this juncture, the applicant should refer to the applicable Flow Chart to determine the Minimum Requirements for stormwater management. DCD staff will help verify the classification of the project and the application requirements. For proponents of "small" projects who must comply only with Minimum Requirement #2—Construction Stormwater Pollution Prevention—an additional submittal is not required. The proponent is responsible for employing the 12 Elements to control erosion and prevent sediment and other pollutants from leaving the site during the construction phase of the project. Pick up the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet. Proponents of"medium" projects—those that must meet only Minimum Requirements #1 through #5—and for "large" projects-those that must meet all 10 Minimum Requirements—are required to submit a Stormwater Site Plan. DCD has prepared a submittal template of a Stormwater Site Plan, principally for rural residential projects. Complete the template in the Stormwater Site Plan Instructions and Submittal Template or prepare a Stormwater Site Plan using the step-by-step guidance in the Storm water Management Manual. APPLICANT SIGNATURE By signing the Stormwater Calculation Worksheet, I as the applicant/owner attest that the information provided herein is true and correct to the 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. • . 0. (LANDOWNER 0 A HO I ED REPRESENTATIVE SIGNATURE) (DATE) { e °; .`. � �s., as z" ., stormwater talc worksheet.doc—REV.10/12/2003 2 • 40 „sox L .. L,O� JEFFERSON COUNTY 7 4;,,, DEPARTMENT OF COMMUNITY DEVELOPMENT '' ><; 621 Sheridan Street • Port Townsend • Washington 98368 4,1 j„ '', . 360/379-4450 • 360/379-4451 Fax �'S�INf-sS p www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: DI: —�(,6 0 Project Description(include separate sheets as necessary): Tax Parcelf� q, Property e� Number: {�� z4,51..., iv�• �tt�� p,� size: n5.2S 2776 1 (acres/square feet) Site Address and/or Directions to Property:` �.1V S O 1"�M f INT `F'� Property Owner(s)of Record: 1d� � a� ` t1 Telephone: 425*269 • Z 12 Fax: email: IMthi«GtOwie Mailing Address: �31� 227TM 11►leD(Jtt J%W I VA A�r/ Applicant/Agent(if different from owner): O h `d3SZQt laltS16 NUM #WVII:CAIS 4 W*Utct1 =ilgtt) Telephone: 7Ct • 424• r7d Fax: Zo(�• 6Z�•3750 email: tiJ; %44.o‘ �.Ca►. Mailing Address: i5q 5601!t y t STErT, 01 FLP°R '3f--ktill.1\I#'l 1 D t 0`t What kind of Permit?(Check each box that applies) Building 1 Variance(Minor,Major or Reasonable Economic Use) Demolition Permit Conditional Use[C(a),C(d),or C]** Single Family Discretionary"D"or Unnamed Use Classification Garage Attached/Detached 1 Special Use(Essential Public Facilities)** Manufactured Home J Boundary Line Adjustment Modular 1, Short Plat** Commercial* Binding Site Plan** ! Change of Use Long Plat** Address 1 Road Approach Planned Rural Residential Development(13R512)/Amendments** Propane Plat Vacation/Alteration** ' ' `-- ~---`---- Allowed"Yes"Use Consistency Analysis Shoreline Master Program Ex4m flop Permit Revisions** Stormwater Management Shoreline Management SubstB�lfal 4veloprjieittr** F nn i Site Plan Approval Advance Determination(SPAAD)* Shoreline Management VarianOe4 , -- �' Temporary Use Comprehensive Plan/UDC/Land'Ust t]istrict Map Amendment Wireless Telecommunication* ' Jefferson County Shoreline Ma ter Pro ram Amend menL__._.------., 1 Forest Practices Act/Release of Six-Year Moratorium �G� �;�!JNTY *May require a Pre—Application Conference **Requires a Pre-Application Copfe/!�rFL I,N•tjwI�Y I,LVLLC 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 it's knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attomey's fees and expenses which may in any wa = crue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide a - :nd right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any require. • •-ctions.Access a •ht of entry to this property shall be requested and shall occur only during regular business houra. ��� _ / _ �7„)C Signature: -i Date: X,/ (/UJ J 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 A."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued wi of iolate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you a • in pli.nce with the Jeff- son County development code.The Applicant acknowledges that he,she or it holds individual and non-transfera• re ..�' ^f or.dh: ing ; a.d complying with the ESA. The Applicant has read this dis imer and sii n�s�and�dates it below. Signature: �� Date: trLi o J (::‘,Documents and Settings Amuchil\Desktop AMaster Permit.Application--M-n4.doc • • ENT The signer of this statement does hereby certify that they are the Ow OWNER BUILDER off the parcel EMe referenced herein, they will be assuming the responsibility of the General Contractor for the proposed project. Signature: that they are not licensed contractors and that Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: ii PHONE: MAILING ADDRESS: ,, 6�{ty�� FAX: CONTRACTOR'S LICENSE �� i• "� WI EMAIL: ) z. ' O• q� NUMBER: R attspi a EMAIL: (� 8�Z U �� �.kdhk 9-�lo WAINS - _ ^ �` di co.cow ARCHITECT/ENGINEER: t4 4Z71J4 NUMBER MAILING ADDRESS: PHONE EMAIL ) FAX: Project Type: New Frame Type: Bathrooms: X Addition X Wood Existing: 3 Shoreline: Steel Type of Sewage Disposal: Alteration/Remodel Proposed: Sewer Repair Concrete Total: Bank Community Demolition Masonry — Height: System L Individual System Other: Bedrooms: SEP Permit# �``•�{5 Type of Heat: Existing: Z Setback: Water Supp►y-�— Z'�MP Proposed: �— Private well Two Party Total: 3' (��� Public Name of System: 61XtibbT1 If this is a Commercial Project ouI� ■ • 44 Number of ParkingS must answer the followin : paces: Current.• Number of oc k S (includes owners, tenantemployees,o eo)eCurrent IBC Occupant --� Number ofA ParkingS y' IBC Type paces: If this is a Occupancy: . Tank and/or A of construction: ProposeddService? liance Installation ermit mark all items Will ellow that a you have Food Service? Yew i Underground Tank I Above ground Tank Size of Propane Tank: Heat Stove i Cook Stove i Woodstove I Fireplace Insert i Is this a fiance bein installed in a Manufactured/Mobile Home? _ Hot Water Tank i Pellet Stove i When applying for a permit to install a propane tank Yes / No Other When tank tior and size, distances from the l you must also submit a site plan showing all of the buildings,a//pro e sines,to. the reserve area. propane tank to all property P P rty lines,buildings and septic system components,P � Square Footage For Office U Main Floor 1.1111111111 imminent Pro osed Only pi 2"Floor Z25`t 846 i14 ` Consistency Review: Amount 5 1067MillBase fee: �._. as 3'Floor _ NM Additional Section: i 1 . Heated Basement ljilijalIllMmllMallMilijall ' I JA 1 $ % State Surcharge fee: i 0� - Unheated Basement .... �■ _ v_ Pot Water Review fee DEPT. DF CDl�iriUNi Y EVEIU Itl�l I Other Unheated Garage/Carport QQ MEM v_ 911/Rd Approach fee: Decks 13i U 1 TOTAL: $ 11 Other -eceipt Number: IIIIIIIII 111. � O ( ,`eash/Check Number: — ESTIMATED COST(RE IIIIIIIIIIII 'Fair market value of all labor and materials foundation to finish Date: Initials: IIIIIIIIIIII ^,Uocumcnts and:crtinty\mochll\Desktop A Master Pcrmir.A prlication 7-8_I lq.dre r ' • • 4gsoJv COS ti f ��� JEFFERSON COUNTY y ; 4 ; DEPARTMENT OF COMMUNITY DEVELOPMENT 4 ~. 621 Sheridan Street • Port Townsend • Washington 98368 'I NGO 360/379-4450 • 360/379-4451 Fax I http://www.co.jefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MIA# Q ` QQ 6�o PROJECT/APPLICANT NAME: 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. c Oink • r i c t �. . •0 ;Ai: A . 0 O. 0 -5 Sn I �ak'! ► W t H ;. ' t‘ is 0 - • - _ - U\c-tp \kaV a; 'S 22' x Z • (P1`k�t.Tt .510 Uc Existing Conditions Summary 2. Describe the existin. topo.ra.h . Indicate contours on the site ma.. .W I., • o. _ `El t oV �h eT e Z• 0• Ct �� S1, - . .. . p * 4E • . r o� 3. Describe the existin. v-.etation. Indicate native ve.etation areas on the site m.,.. - S `C �C N k° \tk -._. i�vto n _ •-• b MktE�OPMt-Li \S ►V 1V \ •lit •i+\J v. _1 tii_ • . A ice. IS t. \b \ '4% A Vr-- leO.oS \ o_ ‘0 4. Describe the existin. soils. Indicate soil t •e on the site ma.. I-S G S') V '3 dN1 off mil. %,...,N t4.-1 `i - ' 1kv ikt;10 C�- U.. . S :_ soil 7t) ai CI 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 a..licable, and indicate a.,--•e of each. � 1` _— map, if ...-IL A 1-5 6. Describe an excess levels of noise .enerated by the proposed use or activi �i STORM WATER PLAN PrialcM11111111111701,11111111 stonnwater site plan template.doc—rev /0/122003 �'�'�"` JEFF Giliat•SON COUNTY DEPT.OF COMMUNITY DEVELOPMENT SIGNATURE. • • 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 n� onthe site map. a tS Vitt" Al "%s. Wt Ce>ft'*. 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.). TAY. \S ("cv T1' cR 0\xx.E FbICiC'. 1S' \S i&Uh'P ro\NT 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. -1RSTING Sk1V_ tq kr.0�Y \ 5� oPMEKC, �Mc11DV 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.] IA/Pk 11. Describe the performance goals and standards applicable to the project. FR*asT-O MitIPVTAVWc i,,AAD C� -C RM.\a$kE " MEN\ re S\Zx. ,fie Lv-x E'tQAt\ Mt.t\-r- FEgSeN G�tJCCr�c 12. Describe the flow control system. stormwater site plan template.doc—rev.10/12/2003 • • 13. Des ibe the water quality system. IA k 7 14. Des i ibe the conveyance system analysis and design. NR 15. Describe the source of fill material,physical characteristics of fill material, and deposition of excess material. oF 111) ft% nita. G WAL . t ko o 111C. C \t►►M. IS E F irT. 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. M ItTlUt"l et qo% MftxtIVIA D'EV`1sM . 17. Describe the proposed surfacing material. Rtc e-A c_orO t. Vts\I-' S . 18. Describe methods for restoration of the site. SM. NAM- U. 111T NMIMk litfeCAN Ar4SS 7 Mb salmi 14Rk5 °V 1tMM -*K tOtIVE. DES, slWUQS, Pttu Ai?ovtkOco4ERS. 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. NIA 20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan. nPt 21. List other necessary permits and approvals as required by other regulatory agencies. If those permits or approvals include conditions that affect the drainage plan or contain more restrictive drainage-related requirements,describe those conditions or restrictions here. 1\ i! I stonnwater site plan template.doc—rev.10/12/2003 • • CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN(SWPPP) The Construction SWPPP addresses sediment and erosion control during construction. The BMPs indicated by the applicant in the template that follows must be installed on the ground during all construction phases of the project. The proponent is responsible for preventing sediment and erosion impacts to environmentally sensitive areas and off-site areas. Consult the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet for guidance, particularly with rural residential development. SECTION I—CONSTRUCTION SWPPP NARRATIVE 1. Construction Stormwater Pollution Plan Elements. Describe how each of the Construction SWPPP elements has been or will be addressed. Identify the type and location of BMPs used to satisfy the required element. If an element is not applicable to the proposal,justify in writing. Descriptions of the 12 Elements are found at section 2.5.2 of the Manual(beginning on page 2-15). 12 Required Elements—Construction SWPPP 1. Mark Clearing Limits. To ,MMT.-%k ki' t> 2. Establish Construction Access. GWHsck4-vC-�"-sL NCaSS S,xM11E� n 1405X 3. Control Flow Rates. . -S *CW F 1tk`t5 VALL BF- kM "(b CottleoL 'F\- & 4\tS• 4. Install Sediment Controls. �3' �Qc\ tg'S W\1l C rttrit•cA. Al't-l`C� 5. Stabilize Soils. 6. Protect Slopes. 51.05MS c't " ViksX \tl Tttt. Aro\ °Pb SEO 7. Protect Drain Inlets. GAR\h \ W S 1`� 1.07 ��C 145 ttk . ttyk iNkt. GaC1SZRC\oc\ • stormwater site plan template.aoc—rev.10/12/2003 • • 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. 1"�U L 41t1G Pt% PsiW to.ver s \11wx., otl Sty C\\K11t1-LS 9. Control Pollutants. k-ett-ak uS M4 \DVS lAk1. \t\ Cam_ \11 CCtk_ 'Mt s \�tT Vb st\U-AGt, '\ CovtsttA ' 11tct%%Y M1E \- l� PI\.-� tk UP• 10. Control De-Watering (the act of pumping groundwater or stormwater away from an active construction site). tytit 11. Maintain Best Management Practices (BMPs). WoM ick .D t\r0 `\ rePb vWc NR.armS ?.estkoit, \yillAktk V `(S °"F cprwLZT\o'\ ot. 12. Manage the Project. �p� Utz #CSQ"F-cC� °F 1 tAktil6tVt.t.M \tg T--64.1.04.A.t. 166 WA. #S eVAtg 'S {cr\-VAZA.- 11' F.- S cT P' R 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areeas, roads). b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). m/tk 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. NSA tormwater ste plan temolate.doc-rev 10/1212003 • • . . b. Description of special requirements for working in or near environmentally sensitive areas. 8IN 4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site soils(e.g., erodibility, settleability, permeability, depth,texture, soil structure). ? A1V-- - - °V \►lock Ok sNW-k•• TC4G\P%-t. 4C\ tALIIAPA.V. s\\A- \ Atk 6t AUF.\. "Milt ` MIA MAI) ostbct GdC\ oV. St _1 * C\UE v t ' . Ci GG AWS s klA \. \\,.. 5. Construction Phasing. a. Construction sequence 1. UCk\IM 1\o TantYmS %706 t G Cr44ttk5 @ tWIt\ Oa: Z. as( c°Nso :tE Vet *Nth \JIB IS. 3. tt t1. ' 1tt ka. t tNs, 4. tNP41 lltt.- s . \t•tSVc1. WAMS b. Construction phasing (if proposed) 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). I. Provide a proposed construction schedule. �7 II. Wet Season Construction Activities. a. Proposed wet s ason construction activities. (KNIT 4T It1.L ToR- 1 .0t1 G}\ C P-ittWACz. b. Proposed wet season construction activities for environmentally sensitive areas. 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. clokkt• • 8. Engineering Calculations. Provide Desi n Calculations on a separate sheet for the following, if applicable. a. Sediment Ponds/Traps. k b. Diversions. ti. lit c. Waterways. M!ik d. Runoff/Stormwater Detention Calculations i j storrnwater site plan template.00c—rev.10/12/2003 l 0 • • 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. to . — -- . .200 (LANDO ER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: stormwater site plan template.Aoc—rev. I0/12/2003 12 to O vi 1 is\/UJS'.°q°'/�u;.�•;::AJ�c:,� \'..W.u�y m ^ 'm • ) c--) 4 090 f1.2. 11 K m NI I,i4 . .... ligg 70 z m ,v C� v >,,.._ __.__.,;x..., , , top of eao O o, n 7 • ,/1 / -g IL w, 0, 1 - :j. "S'''' -.-. ,_._ -- 1 , r_f,.. 4.--- (-1\ oz ji � t �x. 11 ,Asl. .. —ip _7111-1. � j v� j ,, ra. . ficir y " Rd \ ' \4 N! 'S , 14,...9. I 11 __I:A__ 4 ir, .1„ f, --4 ii:.-__ 11 i._, : _,r 1! ,4_ uli i - v 0 I' ER; . qr ,_ A li I, __- ir N , ( ....y 0 0 ji l i i 8R ED- 1 o r' a 1-[1 �•g ! 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