HomeMy WebLinkAboutBLD2005-00349 OUILDING PERMIT APPLICA#N ML vTy 332
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Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD05-00349 Received Date: 5/31/2005
SITE ADDRESS: 4973A DABOB RD
QUILCENE, 98376
OWNER: MARK REITZ PHONE: 360-385-6882
TERRY REITZ
353 E ARDEN ST
PORT HADLOCK WA 98339
SUBDIVISION: Block: Lot: T 4+
PARCEL NUMBER: 701053004 Section: 5 Township: 27 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
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PROJECT DESCRIPTIOr WEAVING STUDIO, MAiNTWOR & PORT
- 2ND FLOOR 1480s.f. MUSIC-ROOM
TYPE OF WORK RES SQUARE FOOTAG200 irffRa /1,1'✓ L
TYPE OF IMP / NE 1� MAIN: -3 000- LPG- /o ce`D /4Ije
VALUATION •• " ADD'L: 3,000 HEAT TYPE: --R,4B--
CODE EDITION: 20. HEAT BASE: HEAT TYPE:
OCCUPANCY. UNHEATED: # OF STORIES: /
OCCUPANCY: OTHER:
CONST TYPE: —13 GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS:
Exist: . Exist:
Prop: 0 Prop: 2
Total: 0 Total: 2
Routing Date:
:P/1/6
Type Amount Paid Bv: Date: Receipt: Rroi
Permit ." $3,414.25 BAC 05/31/05 73302 DEC30 2005
Plan Check $2,219.26 BAC 05/31/05 73302
State Building Code $4.50 BAC 05/31/05 73302 Jefferson County Planning
Total: $5,638.01 & Building Department
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BUILDING PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD05-00349 Received Date 05/31/2005
SITE ADDRESS: 4973A DABOB RD Issue Date 12/29/2005
QUILCENE, 98376
APPLICANT: MARK REITZ PHONE: 360-385-6882
TERRY REITZ
353 E ARDEN ST
PORT HADLOCK WA 98339
SUBDIVISION: Block: Lot: T 4+
PARCEL NUMBER: 701053004 Section: 5 Township: 27 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
PROJECT DESCRIPTION: WEAVING STUDIO
CALL IN FOR THE QUIR INSPECTIONS THAT APPLY TO YOUR PROJECT.
SETBACKS: 2//6 TW . LiN,LPei o%✓rsyt.
UFFER: .5"-- 4/.?
4
Footing: A10")4 .2 3
Foundation:
Stormwater FINAL Approval:
Underground Plumbing:
Underground Insulation:
Shear Wall :
Sheathing:
Framing: . 0K e,-t ,1 (`-7 - (0v ADU DK 3J/3/D7f
Plumbing: OX S B/7
Propane Tank/Lines: /or le +?,Q,),' . 'k 4/5 en
Insulation: Off( 3/,1<3/7 A ft1fl2S dK 03/07#
Sheetrock: 11(Df MIA Z 2 0 1
Septic Sytem Final Approval If t on sewer):
Road Approach Final Approval:
Zoning Final Approval:
Final/Occupancy Approval: 'X4T--10 7
HEALTH DEPARTMENT D PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION
THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:00 a.m. -4:30 p.m.
HOT LINE AVAILABLE 24 HOURS A DAY
SPECIAL CONDITIONS APPLY -SEE REVERSE
SPECIAL CONDITIONS FOR C• A BLD05-00349 •
1.) The identified Fish and Wildlife Habitat Area (Type 3 Stream), shall maintain a vegetative
buffer setback of 100-feet. The setback shall be measured horizontally from the Ordinary
High Water Mark (OHWM) to the proposed development.
2.) All construction activities shall not encroach upon the stream buffer. This includes the
storage or preparation of materials.
3.) An additional setback of five (5) feet is required from the edge of the stream buffer area to
the proposed home weaving studio/music room.
4.) A permanent physical separation along the boundary of the stream buffer area shall be
installed and permanently maintained. Such separation can include installing logs, trees,
a hedgerow, or any other prominent physical marking approved by the UDC Administrator.
5.) Stream buffer perimeters shall be marked with temporary signs at an interval of one per
parcel or every one hundred (100) feet, whichever is less. Signs shall be in place prior to
and during construction activities. The signs shall contain the following statement: "Buffer
- Do Not Remove or Alter Existing Vegetation."
6.) The project shall adhere to the Best Management Practices (BMPs) to control stormwater,
erosion and sediment during construction. BMPs shall address permanent measures to
stabilize soil exposed during construction, and in the design and operation of stormwater
and drainage control systems.
7.) A Stormwater Site Plan has been submitted and approved by the Department of
Community Development. Once the subject permit has been issued the applicant shall
fully implement the provisions of the submitted plan and contact the Jefferson County
Department of Community Development to arrange a schedule to inspect the property for
plan compliance. A Certificate of Occupancy will not be issued until the Department
verifies plan compliance. No clearing for roadways or utilities shall occur on the project
site until clearing necessary for the installation of temporary sedimentation and erosion
control measures have been completed.
8.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
9.) Not more than two (2) unlicensed or inoperable vehicles shall be stored on any lot less
than one-half acre unless totally screened from view of neighboring dwellings and
rights-of-way. Such screening shall meet all applicable performance and development
standards specific to the district in which the storage is kept, and shall be in keeping with
the character of the area. Screening shall meet the requirements of Unified Development
Code (UDC) Section 6. Outdoor storage of thirteen (13) or more unlicensed or inoperable
vehicles is prohibited except in those districts where specified as an automobile wrecking
yard or junk (or salvage) yard and allowed as a Permitted Use in Table 3-1 of the UDC,
and such storage shall meet the requirements of UDC Section 4.10. In no case, shall any
such unlicensed or inoperable vehiclesbe stored in an Environmentally Sensitive Area
(ESA).
10.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
11.) The building height is not to exceed 35 feet.
12.) Minimum setback from Dabob Road right-of-way is 20 feet. Minimum setback from Lone
Star Road right-of-way is 20 feet. Minimum side and rear setbacks are 5 feet. Minimum
setback from the Type-3 stream is 105 feet(100 feet stream buffer plus 5 feet side yard
setback). Minimum setback from the neighboring property zoned CF 1:80 is 250 feet.
13.) Exterior lighting for residential uses shall not exceed twenty feet(20') in height from the
finished grade, excepting when such lighting is an integral part of a building or structure.
Ground level lighting is encouraged.
14.) Lighting fixtures shall be designed and hooded to prevent the light source from being
directly visible from outside the boundaries of the property. The intensity or brightness of
all lighting, during construction and after project completion shall not adversely affect the
use of surrounding properties or adjoining rights-of-way.
15.) The cottage industry shall be operated by at least one full-time, bona fide resident in a
single-family residence of the parcel on which the proposed use is being requested.
16.) The cottage industry may not employ more than four(4) persons on the site at any one
time who reside off the subject property.
17.) This is a cottage industry home weaving studio for wholesale only. No customer shall visit
site. Any business requiring customers to visit the site shall provide adequate on-site
parking spaces, in addition to one (1) for each full-time equivalent employee who reside
off the subject property, and two (2) for the owners of the property. All parking spaces
shall meet the standards of Section 6.10.
18.) All structures and outside activities shall be so located or screened from adjacent
properties to avoid disturbance through glare, noise, dirt or other nuisances or hazards.
19.) All activity related to the conduct of the business or industry, except for activities related to
the growing and storing of plants, shall be conducted within an enclosed structure or be
sufficiently screened from view of adjacent residences.
20.) All cottage industry activities shall be sufficiently screened from view of adjacent
residences, using site location, topography, landscaping, fencing, the retention of native
vegetation, or a combination thereof necessary to meet the Type A screening
requirements of Section 6.13.
21.) Traffic generated by the cottage industry shall not exceed the level of service adopted for
the public roadway which accesses the use, nor generate significant traffic in excess of
that normally generated by typical uses found within the particular district.
22.) No business may provide drive-through service.
23.) Cottage industries shall be limited in their hours of operation. No business on-site
customer service shall be conducted before 8:00 a.m. or after 8:00 p.m., Monday through
Friday, and before 9:00 a.m. or after 6:00 p.m., Saturday and Sunday.
24.) The granting of the proposed cottage industry use shall not constitute a rezone. No
expansions of approved cottage industries are permitted, except as specified in Section
3.6.12 concerning the Remote Rural overlay districts.
25.) No exterior display of goods for sale shall be allowed.
26.) The cottage enterprise is an accessory use to the residential use of a dwelling unit, and
the residential function of the buildings and property shall be maintained.
27.) Any new structure constructed to accommodate the cottage industry shall be limited in
scale so that it is in character with neighboring properties. In no case shall more than five
thousand (5,000) square feet of total building area on the property be devoted to the
cottage industry.
28.) No more than one (1) sign is allowed, consistent with the sign standards in Section 6.15 of
this UDC.
29.) No on-site direct retail sales of products not produced on-site are allowed, except for
items collected, traded and occasionally sold by hobbyists, such as coins, stamps and
antiques, and their accessories.
30.) Minimum parcel size shall be one (1) acre gross site area.
31.) No use shall be made of equipment or material which produces unreasonable vibration,
noise, dust, smoke, odor, or electrical interference to the detriment of the quiet use and
enjoyment of adjoining and surrounding property. Any after-hours business activities shall
not have noise impacts discernable beyond the property boundaries.
32.) Not more than one (1) cottage industry shall be allowed in or on the same premises.
33.) The illumination of signs shall be shaded, shielded, or directed so as not to adversely
affect surrounding properties or public and private rights-of-way or create a hazard or
nuisance to the traveling public, or to surrounding properties.
34.) No sign or part thereof shall consist of rotating, revolving, or moving parts; consist of
banners, streamers, or spinners; or involve flashing, blinking, or alternating lights.
35.) The total square foot of the sign shall not exceed 32 square feet per business.
36.) Only one side of a double-faced sign shall be counted when determining total square
footage. The square footage of the sign shall be calculated by the outside dimensions
necessary to frame the information displayed.
37.) There shall be no more than one (1) on-premise free standing or projecting signs or
combination thereof.
38.) Signs attached to or painted against the structure to which it relates shall not be computed
as part of the overall total square footage or number.
39.) All signs shall be continuously maintained. Signs that present a hazard shall be subject to
abatement.
40.) Free-standing signs shall include measures to restrict vehicles from passing beneath
them.
41.) Signs shall be incorporated into the landscaping of the site when landscaping is provided.
42.) The Jefferson County Building Official should be contacted to determine whether or not a
building permit is required for the sign.
43.) A minimum of two (2) parking spaces are required for the cottage industry or 1 parking
space per 2 employees. A minimum of two (2) on-site parking spaces are required for the
single family residence. A minimum of one (1) handicap parking space is required.
44.) All parking surfaces shall be provided with an all-weathered surface.
45.) All parking spaces shall be provided with wheel stops, striping or similar measures.
46.) The handicap parkng space shall be a minimum of 13 feet wide and be properly signed in
accordance with the Washington State Regulations for barrier-free facilities (WAC 51-10).
47.) The permitted cottage industry shall not grow beyond the scale permitted for such
activities. Should the cottage industry grows beyond the limits, it must move to a location
designated for commercial or industrial uses.
48.) Based on septic system capacity the commercial activity proposed for the building served
by this permit is approved for a maximum of 4 employees and the 2 home residents, 6
persons total. No use by the public other than employees is approved.
I:\F_B LD_Perm it_Bu ildng.rpt 10/29/1999
JsoSEND PI
RII 411PI OR7 T
o�-- City of Port Townsend >°gyp _' °`��,
�,0. I I Fire Department a is?,�� �o
[fl-_' !°I " 1 Office of the Consulting Fire Code Official for Jefferson County u� 1
9
1256 Lawrence Street,Port Townsend,WA 98368 WAS
(360)344-4607 Email: asstfirechief@ci.port-townsend.wa.us Fax: (360)344-4604
PLAN REVIEW MEMORANDUM
TO: Stan Southworth, Plans Reviewer,Jefferson County Department of Community Development
FR: Tom Aumock,Asst. Fire Chief, and Consulting Fire Code Official to Jefferson CoulaT44.44.4-01.---
DT: 21 November 2005
RE: BLD05-00349,Weaving Studio,Parcel#701053004,Reitz
CC: Fire Chief
This department is in receipt of a plan revision for the above-referenced proposal from your office.
The above-reference proposal was reviewed by this department relative to the International Fire Code
[I.F.C.], 2003 Edition, and the Jefferson County Coordinated Water System Plan, and Jefferson County
Department of Community Development,Fire Code Official policy.
Findings &Determinations: Ct
1. The proposal was reviewed as etwe- ory fixed occupancy with 3,200 square feet of total fire area
of a Group F-1 occupancy with a 7 co s io classification[s]; and,
2. Fire flow and fire hydrant review r this osal is derived from the requirements of the Jefferson
County Coordinated Water System Plan, and Jefferson County Department of Community Development,
Fire Code Official policy.
a. No fire hydrants are available for this project; and,
b. The fire area calculation is 3,200 square feet [without area separation wall]; and,
c. Fire flow requirement based upon the, fire area determination including provision a. above, and
the proposed construction classification for this proposal [Type I]: 500 gallons per minute by
minimum default sustainable for two [2] hours; and,
d. Fire flow delivery can only be met by Fire District pumper capacity from tender operation,
allowable under NFPA 1142, at a maximum of 500 gpm; and,
Please advise the applicant that unless there is an occupancy separation requirement, that this proposal
does not require an area separation wall, as proposed in the plan.
0.5 hours time was consumed in the review of this proposal
It is the administrative determination of this department that the proposal be approved subject to the
aforesaid requirements of the International Fire Code and NFPA standards.
C:\Documents and Settings\toma.COUNIY\Desktop\Tom's Cabinet\Jefferson Co.Plan Review\Jeferson County Plan Review\Reitz BLD05-349 Weaving Studio
Ill.doc 11/21/05
I.S.COIRE FLOW CALCULATION WORK ET
Building Permit Number 05- OD3¢9
Proponent
Location - Fire District 45.amoveut/
Parcel Number -7-0/D -3 D 24
Fire Area Calculation (A]
Base c3,zp0 SF
Overhangs _.-- SF Square Ft. Total 13:Z,OO
• I.B.C. Construction Type 1
• I.S.O. Construction Coefficient [C] p,(o
▪ Total Fire Flow from ISO Formula:
18 C[A] 05 =[F]-/+H%
18041 5 Zoo ]°.5=Base Fire Flow GPM[F] Base Fire Flow GPM f 7/
Debits or Credits (H]
• I.S.O. Occupancy Hazard Low [-25%] n High [+25%] Adj. GPM A09-
I.S.O. Exposures Debit or Credit Distance/Type Debit/Credit%
<30'add 20% North
31-60'add 15% South
61-100 add 10% East
101-150 add 5% West
>150'subtract 25%
Total Debit or Credit [Max. Credit @ 25%] % Adj. GPM ,v/,d
• Sprinklers Credit n deduct 0.75% Multiply by 0.25 Adj. GPM k/iqr
Q One-Hour Construction Credit n deduct 0.25% Multiply by 0.75 Adj. GPM N,a
• Area Separation Credit Calculation
Largest Internal Fire Area:Adjusted Fire Flow •
Factored to SF: 1 gpm •
Maximum Fire Area Separation Calculation Square Feet
• Required Total Fire Flow Requrement [But not less than 500 GPM] Required GPM Lf25 d
- Proponent Design Change Credits
Type Percentage
Exposure Ti
Sprinklers Ti
One-Hour Construction n
Area Separation n
Other n
Total
Adj. GPM I N/
Plans Examiner
Date // ..2//p
Fire Flow Worksheet 11/21/2005
PERMIT # 11113
°) ° JEFFERSON COUNTY ��c;cTY DCD L11:111)11
. „ 1A DE PARTMENTOF COMMUNITY DEVELOPMENT MAY31 2Q�5 621SheridanStreet • PortTownsend • ashington 98368 r
360/379-4450 • 360/379-4451 Fax __ _.
G' http://www.co.jefferson.wa.us/commdevelopment/
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# `, ' 'l `9 PROJECT/APPLICANT NAME: M it h I J E1 T//
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. 1 / }IJ 1// /� p✓ r^
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Existing Conditions Summary
2. Describe t e existing topography. Indicate contours on the site map.
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3. Describe the existing vegetation. Indicate native vegetation areas on the site map.
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4. Describe the existing soils. Indic to soil type on the site map.
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5. Describe the existing site hydrology(i.e., drainage;behavior of water on the site—above,below, and on the ground). Indicate
existing stormwater drainage to and from the site on the site map. Depict separate drainage basins on the site map, if
applicable,and indicate acreage of each.
6. Describe any excess levels of noise generated by the proposed use or activity: APPROVED
STORMWATER PLAN
Storm /a is
JUL 1 2 2005
stormwater site plan template-rev.10/1/2003 Require JEFFERSON UN 5
DEPT.OF C , ' ' WI I P. EN
SIGNATURE
7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams,
steep slopes, etc.)on thy site. Indicate location on the site map.
8. Describe the general vicinity of the site, including adjacent land uses and structures, utilities, roads,and sensitive/critical areas
(streams,wetlands, lakes,steep slopes,etc.).
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Permanent Stormwater Control Plan
This portion of the Stormwater Site Plan consists of the selection and installation of the appropriate stormwater control BMPs
and facilities to remain in place after construction of the project is completed.
"Medium" size projects are required to have the totals calculated of all impervious surfaces, pollution-generating impervious
surfaces, and pollution-generating pervious surfaces to verify that the thresholds for treatment facilities and flow control
facilities are not exceeded.
9. 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 thesefacilities` on the site plan and differentiate proposed f(a/cilities from existing facilities. 2�}�7ZJi sev! p,-.6 1 r. kn f I & ter i t/ d t �+ "•'c m't, �r��Lam. Ft � r J 30
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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.]
I
11. Describe the performance goals and standards applicable to the project.
•
12. Describe the flow control system. --� Ili
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2005 •
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stormwater site plan template—rev.10/1/2003
13. Describe the water quality system.
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14. Describe the conveyance system analysis and design. E
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15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material.
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16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform
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Building Code.
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17. Desc�rii the proposed surfacing material.
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18. Describe methods for restoration of the site.
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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.
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20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
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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.
/IA .
stomiwater site plan template—rev.10/1/2003
7
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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.
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2. Establish Construction Access. / J,
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3. Control Fiow Rates / /
4. Install SSe^�diment Controls. / f {
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5. Stabilize Sops.
6. Protect Slopes.
• MAY 3 1 2005
7. Protect Drain Inlets.
8
stormwater site plan template—rev.10/1/2003
12 Required Elements—Construction SWPPP(continued)
8. Stabilize Channels and Outlets. t{( ,
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9. Control Pollutants.
10. Control/ De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
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11. Maintain Best Manag ment Practice (BMPs). �f
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12. Manage the Project.
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2. Adjacent Areas.
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential
area roads).
4
b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
yards).
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3. Environmentally Sensitive Areas.
a. Description of environmentally sensitive areas that are on or adjacent to the site.
stormwater site plan template—rev.10/1/2003 9
b. Description of special requirements for working in or near environmentally sensitive areas.
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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).
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5. Construction Phasing.
a. Construction sequence , )
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b. Construction phasing(if proposed)
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
I. Providei � a proposed construction sc edule.
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II. Wet Season Construction Activities.
a. Proposed wet season construction activities.
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b. Proposed wet season construction activities for environmentally sensitive areas.
7. Financial/Ownership Responsibilities.
a. Identify the property owner responsible for the initiation of bonds and/or other financial securities.
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b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation
impacts.
8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable.
a. Sediment Ponds/Traps. IV/` ) MAY J 2005 i..1
b. Diversions.
c. Waterways.
d. Runoff/Stormwater Detention Calculations
1. ''iyH�_tstt
stormwater site plan template—rev.1 W12003 10
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 SW PPP 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 pro erty.
(LANDOW R OR AUTHORIZED R ESENTATIVE SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
l 1 - i
MAY 31 2005 '
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stormwater site plan template—rev.10/1/2003
i
, orrco JEFFERSON �,JUNTY' DEPARTMENT OF COMMUNITY DEVELOrTon
MEN
621 Sheridan Street• Port Townsend 98368 MAY 3 r'
360/379-4450 • 360/379-4451 Fax I i �i;'15 ;`�
p www.co.jefferson.wa.us/commdevelopment 1____
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S�i!INp� ( ----_�
t_i I
Master Permit Application MtA - j- ._._
At
Project Description(include separate sheets as necessary): 7 Cr °
Tax Parcel Property 7Gars
Number: / 0I - 0 5 3 `-0 0 ISize: 2 J&/ /00 / (acres/square feet)
Site Address and/or Directions to Property: til 7'S 007 0C if(// Lacl i le
Property Owner(s)of Record: -c 1 G is f
Telephone: -360 3 Q5 l� YZ- Fax: email: (-c'fo"1441 i/cS 6 cafe.57.4.,"
Mailing Address: 357,3 15 , 6 gl) C---.is/ CT,y it,f He a(c,:.1s/ t,41- c `_53 7 r(0 iti
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies)
Building ❑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 ❑ Special Use(Essential Public Facilities)**
❑ Manufactured Home ❑ Boundary Line Adjustment
Cl Modular ❑ Short Plat**
❑ Commercial* ❑ Binding Site Plan**
[I Change of Use ❑ Long Plat**
❑Address ❑ Road Approach ❑ Planned Rural Residential Development(PRRDyAmendments**
kPropane ❑ Plat Vacation/Alteration**
Li Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions**
❑ Stormwater Management ❑ Shoreline Management Substantial Development**
❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance
❑Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment
Li Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment
L] Forest Practices Act/Release of Six-Year Moratorium
*May require 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 attorneys 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 Acce and right of entry to this property shall be requested and shall occur only during regular business
hours. c /y _—Li
L --
Signature: Date: —Uj
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 lake"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-tra sffrabe resp srbi• for ad ring to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: t C%v' L `✓ Date: 5 -t_( 0 5`
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
0 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 r sponsi ility of a General Contractor for the proposed project.
Signature: }T7 C-th Date: 5 ` Li 'L')
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: Lm. 7
MAILING ADDRESS: EMAIL: !f A� 3 1 �nnr ill I I
CONTRACTOR'S LICENSE WAINS , i WY Lr7tlJ
NUMBER: NUMBER f
ARCHITECT/ENGINEER: PHONE ( ` ) ' FAX ( )
MAILING ADDRESS: EMAIL---• - - ___ ._�_...__. ._. _
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
X New X. Wood Existing: —
CI Sewer
❑ Addition ❑ Steel Proposed: _ Bank ❑ Community System
❑ Alteration/Remodel 0 Concrete Total: a _ Height: Ix.,Individual System
O Repair 0 Masonry SEP Permit# 7S-O/6A
O Demolition 0 Other: Bedrooms: Water Supply:
Existing: Setback: X Private well ❑ Two Party
Type of Heat: Proposed: LI ❑ Public
Total: —v'— Name of System:
If this is a Commercial Project you must answer the following: q
Number of Parking Spaces: Current: Proposed: ! Number of ADA Parking Spaces: I /
Number of occupants(includes owners,tenants,employees,etc) Current Proposed 6(1. - ,,e4- --s 2 e,L,t,/�
1e-
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:
❑ Underground Tank g,Above ground Tank Size of Propane Tank: i'.,ZG 6:x- /
❑ Heat Stove ❑ Cook Stove ❑ Woodstove I 1 Fireplace Insert 0 Hot Water Tank 0 Pellet Stove ❑ 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 Consistency Review:
3C3C70 4S VI Gi. cc,
2m)Floor 3 3 �� -Base fee:
(;8mfo : 4-Iq )
3n°Floor ' Additional Section:
Mezzanine: Plan Check fee:
Heated Basement State Surcharge fee:
Unheated Basement Pot Water Review fee:
r,
YroovyttivIilk VIM O'k-110\
Other Unheated 911/Rd Approach fee: csi_+t Re u�," �I L PLATE-- I`�
Garage/Carport TOTAL $ C
Decks
Receipt Number: 1 1 l 0
Other Cash/Check Number:
r %DU,
ESTIMATED COST(REQUIRED) Date: ,
.Fair market value of all labor and materials foundation to finish = r) t J 1. 1 6CO/0CX) ' .� >> �1 0 (�� ,els,
li
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc ,
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PROPERTY LINE PERMIT # B,R
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SCALE: 1"= 75'— 0" REITZ WEAVING STUDI❑
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QUILCENE, WA. 98376
DRAWN BY: MARK REITZ (360) 385 6882 DATE: 9/26/05 TAX — 701-053-004
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