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HomeMy WebLinkAboutBLD2005-00723 CERTIFICATE OF OCCUPANCY Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 (800) 831-2678 PERMIT #: BLD05-00723 SITE ADDRESS: 421 FREDERICKS ST Issue Date: 12/21/2006 PORT TOWNSEND, 98368 Final Date: 07/14/2006 APPLICANT: CRAIG W GOSS PHONE: 360-385-3914 CAROL E GOSS 2156 14TH ST PORT TOWNSEND WA 983688227 SUBDIVISION: COVE ADDITION Block: 11 Lot: 1+ PARCEL NUMBER: 945901102 Section: 16 Township: 30 N Range: 01 W PROJECT DESCRIPTION: NEW MAN HOME THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2003 EDITION. OCCUPANCY GROUP: rtipnk•Cachl rc D Norm,— 4)4114 •�.� ��► TYPE OF CONSTRUCTION: 0 C SPRINKLER SYSTEM Why �`'� bait 11 X yes no THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 07/14/2006 r am` m 14. Building Official Signature Date I:\F_BLD_Occupancy.rpt 10/29/19£ • • MLA05-00676 Review Type: I MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00723 Received Date: 11/17/2005 SITE ADDRESS: 421 FREDERICKS ST PORT TOWNSEND, 98368 APPLICANT: CRAIG W GOSS PHONE: 360-385-3914 CAROL E GOSS 2156 14TH ST PORT TOWNSEND WA 983688227 SUBDIVISION: COVE ADDITION Block: Lot: PARCEL NUMBER: 945901102 Section: 16 Township: 30 N Range: 01 W CONTRACTOR/ OWNER/BUILDER PHONE: DEALER: REPRESENTATIVE: PHONE: PROJECT DESCRIPTION: NEW MAN HOME TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW MAKE: KARSTEN SETBACK: VALUATION 67,000.00 YEAR: 2006 LABOR & INDUSTRIES APPROVAL? SIZE: 60 X 26.8 BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: CITY BEDROOMS: BATHROOMS: Exist: Exist: 0 Prop: 3 Prop: 2 Total: 3 Total: 2 Routing Date. it( APPROVEr Type Amount Paid By: Date: Receipt: Approved/Date Permit $157.00 SLE 11/17/05 77424 DEC a 12005 Potable Water Application $53.00 SLE 11/17/05 77424 Jefferson County Planninu Total: $210.00 &emu Building Department C�� rid �a. 0 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 PERMIT#: BLD05-00723 Received Date: 11/17/2005 SITE ADDRESS: 421 FREDERICKS ST Issue Date: 12/21/2005 PORT TOWNSEND, 98368 APPLICANT: CRAIG W GOSS 3s5,3Ci. A CAROL E GOSS 2156 14TH ST PORT TOWNSEND WA 983688227 SUBDIVISION: COVE ADDITION Block: Lot: PARCEL#: 945901102 Section: 16 Township: 30 N Range: 01 W CONTRACTOR/ OWNER/BUILDER PHONE: DEALER PROJECT DESCRIPTION: NEW MAN HOME MAKE: KARSTEN YEAR: 2006 SIZE: 60 X 26.8 THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 12/21/2006. CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. I Setbacks/Footing (CONTINUOUS FOOTING, SLAB or PADS USED): 6�a� �?i,�bi Stormwater FINAL Approval: Blocking/Plumbing: )1---11/3(OP Propane Tank/Lines Zoning Final Approval: Septic System Final Approval (If not on sewer): Road Approach Final Approval: g Final/Skirting/Vents/Porches/Steps: ' (�1j/ 1,(l /('C((P HEALTH DEPARTMENT AND PUB C 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 CASE # BLD05-00723 1.) Dry well must be located 10' min. from any portion of the septic system. 2.) The application was reviewed by the Jefferson County Department of Community Development staff on December 20, 2005 for the potential presence of Environmentally Sensitive Areas (ESAs) under the provisions of the Unified Development Code (UDC). After an initial Geographic Information Systems mapping review and an investigative site inspection, the following ESAs were confirmed to be present on the subject property: SUSC aquifer recharge area; coastal SIPZ. 3.) Aquifer Recharge Areas in Jefferson County are characterized by porous geological 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. 4.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to groundwater aquifers. 5.) Marine shorelines and islands are susceptible to a condition that is known as seawater intrusion. Seawater intrusion is a condition in which the saltwater/freshwater interface in an aquifer moves inland so that wells drilled on upland areas cannot obtain freshwater suitable for public consumption without significant additional treatment and cost. Maintaining a stable balance in the saltwater/freshwater interface is primarily a function of the rate of aquifer recharge (primarily through rainfall) and the rate of groundwater withdrawals (primarily through wells). The Washington Department of Ecology is the agency with statutory authority to regulate groundwater withdrawal for individual wells in Jefferson County. New development, redevelopment, and land use activities on islands and in close proximity to marine shorelines in particular should be developed in such a manner to maximize aquifer recharge and maintain the saltwater/freshwater balance to the maximum extent possible by infiltrating stormwater runoff so that it recharges the aquifer. 6.) The parcel is located within a coastal SIPZ (seawater intrusion protection zone) according to the County GIS map. There are voluntary and mandatory measures identified in the Jefferson County Seawater Intrusion Policy(Resolution 44-22, effective September 23, 2002) that apply to well drilling proposals and building permit applications on existing lots of record. A Coastal SIPZ is defined as: all islands and area within one-quarter mile of marine shoreline, but no history of chloride concentration above 100 mg/L in groundwater sources within 1000 feet. 7.) Critical Aquifer Recharge Areas may require special protection measures to mitigate water quality degradation. The submitted proposal does not require additional aquifer protection measures. However, during construction the project shall follow the Best Management Practices (BMPs) and facility design standards as identified and defined in the Stormwater Management Manual for the Puget Sound Basin. 8.) To help prevent seawater from intruding landward into underground aquifers, all new development activity on Marrowstone Island, Indian Island and within 1/4 mile of any marine shoreline shall be required to infiltrate all stormwater runoff onsite. 9.) VOLUNTARY MEASURES*COASTAL&AT RISK SIPZ: • Water conservation measures: 1. Roof and other intercepted precipitation shall be routed to on-site detention ponds and/or other approved means and allowed to be released to the soil slowly. 2. Water collected from Storm water and roof catchments may be used for watering lawns and gardens. Unless catchment water has been treated to meet drinking water standards, there shall be no cross connections allowed between the potable supply and impounded water. 3. Water withdrawn from wells on each property shall not be used for watering of lawns and/or gardens. 4. Ground water withdrawn from each property shall be restricted to a rate of three (3) gallons per minute. 5. Installation of water conserving fixtures such as low flow toilets, faucets and shower restrictors and other water saving plumbing fixtures. 6. Landscaping plan (xeriscaping, native vegetation with minimal amounts of irrigation). Please NOTE that the above listed measures are not intended to be exhaustive, but rather is intended to be illustrative of the types of water conservation measures. 10.) VOLUNTARY MEASURES OF COASTAL &AT RISK SIPZ: 1. Installation of a flow meter. 2. On-going well monitoring for chloride concentration. 3. Submittal of monitoring data to County. 11.) MANDATORY MEASURES FOR COASTAL SIPZ: 1. For proof of potable water on a building permit application, applicant must utilize DOH-approved public water system if available. 2. If public water is unavailable, a qualifying alternative system may be used as proof of potable water or an individual well may be used as proof of potable water subject to the following requirement: a. Chloride concentration of a laboratory-certified well water sample submitted with building permit application. 3. If public water is unavailable, a qualifying alternative system may be used as proof of potable water. 12.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 13.) The applicant is proposing to create or add 2250 square feet of impervious surface and 8900 square feet of land disturbing activities. 14.) 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. 15.) 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. 16.) Jefferson County determined that this proposal is categorically exempt from review under the State Environmental Policy Act (SEPA) pursuant to WAC 197-11-800(1)(b)(i). 17.) The site plan as submitted with the manufactured home application on November 17 2005 has been reviewed for consistency under the UDC, and has been approved by Jefferson County Department of Community Development. Any modifications, changes, and/or additions to the stamped, approved site plan dated December 20, 2005 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 18.) This approval is for a manufacture home only. Any future permits on this site are subject to review for consistency with applicable codes and ordinances and does not preclude review and conditions which may be placed on future permits. 19.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 20.) Not more than two (2) unlice'I' ed or inoperable vehicles shall be stored 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). 21.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 22.) The building height is not to exceed 35 feet. 23.) 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. 24.) 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. 25.) REVISED 3/28/06: Minimum setback from Fredericks Street right-of-way shall be 20 feet. Minimum setback from 7th Street right-of-way shall be 15 feet. (Administrative setback fariance granted by UDC Administrator). Minimum side and rear yard setbacks shall be 5 feet. 26.) A minimum of two (2)on-site parking spaces are required for the manufactured home. 27.) This parcel is a legal nonconforming parcel designated Rural Residential 1:5 under the Jefferson County Comprehensive Plan Land Use Map effective August 28, 1998. 28.) These lots were created through the Cove Addition subdivision September 27, 1889 through the Cove Addition Plat recorded with the Jefferson County Auditor under Vol 2, P 27. 29.) A septic permit (SEP05-0356)was approved on November 14, 2005. 30.) An address of 421 Fredericks Street, Port Townsend has been assigned to the parcel. Frederick Street is a county local access (C693419). 31.) A Boundary Line Adjustment was finalized on June 8, 1998 and recorded on June 12, 1998 under AFN 411539 to consolidate Lots 1 &2 with Tax 60 (west 1/2). 32.) The parcel is served by the City of Port Townsend water system. 33.) MANUFACTURED HOMES INSTALLATION SET UP MANUAL MUST BE ON SITE FOR ALL INSPECTIONS AND A ADDITIONAL INSTALLATION MANUAL MUST BE SUBMITTED TO JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT. 34.) 3/28/06: The UDC Administrator granted a 15 foot front yard setback based on the following findings: The road surface that is currently in use is an additional 8 to 10 feet beyond the 15 foot setback. When the house was staked in the field it was staked in error. A slab inspection was conducted on February 8, 2006 and approved by the building inspector. The front yard setback was not varified at this time. Consequently the manufactured home was had already been placed on the slab and septic components have been installed. Therefore, the 5 foot reduction in the front yard setback has been requested. 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'k. '' ( - tr--7) • i EL t2 i EL N/0� 6 4-2 (II • ; Utilities. • • • ' • ` t . - .• • - - ' • ••_ . . . - • • • • Fredericks• • - .- • - JACK WESTERMAN Va Jefferson (Amity Courthouse ASSESSOR VP PO Box 1M Port Townsend.W.I 98368 (360)38-9105 MOBILE HOME INFORMATION FORM OWNER'S NAME/MAILING ADDRESS: COPY NAME: C.:.A(R G` 65S / ADDRESS: i,5�i' I C/�41 (5?" V270)1,)-e 4 c2 Li/4 wyc,O PHONE NO. 3(p() The purpose of this questionnaire is to obtain information regarding either the current location of a mobile home or the previous ownership and location of a mobile home. This will help our office determine whether the mobile home is already on the tax rolls in Jefferson County or if it has been moved to this county from another area. 1)MOBILE HOME DATA: (A)MAKE K-Aas tev (B)MODEL art, '.� (C)YEAR e20 (D)LENGTH CO 0 (E)WIDTH )(C � (F)SERIAL# t( ,'a n(,� )1 (G)YOUR PURCHASE PRICE (Do not include sales tax) (Or. OM PURCHASE DATE pn-C. 2)PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3) IS-fi(,tom (A) FROM WHOM DID YOU PURCHASE MOBILE ADDRESS (II)WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR?Yes No If Yes, Previous address of mobile. If No, What County was Mobile assessed in last year. 3)WHERE MOBILE HOME IS TO BE LOCATED: (A)WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes No (B)IF LOCATED IN MOBILE HOME PARK: NAME &ADDRESS OF PARK Lot/Space# (C) IF NOT LOCATED IN MOBILE HOME PARK: NAME OF LAND OWNER: LOCATION ADDRESS qa' F/i'vZEck, ST pi L` oc,1,,, .Cf,(t(ir,, REAL PROPERTY PARCEL#/DESCRIPTION ! .� d ` / cio %Y Signature of ap licant THANK YOU FOR YOUR HELP! �Ss e Q Q NOV 1 1 ^ ', JO COSSELL, Property Technician • • RETURN ADDRESS SS74TEOF'�SHINGTON MANUFACTURED HOME = a lIcEnsinc APPLICATION ®TITLE ELIMINATION ❑TRANSFER IN LOCATION 0 REMOVAL FROM REAL PROPERTY Anyone who knowingly makes a false statement of a material fact is guilty of a felony,and upon conviction may be punished by a fine,imprisonment,or both. (RCW 46.12.210) D MANUFACTURED HOME TPO/PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) +430091 2006 KARST 28/60 STA0275240R © LAND LEGAL DESCRIPTION ON PAGE 2 REAL PROPERTY TAX PARCEL NUMBER MANUFACTURED HOME WILL BE ®AFFIXED ❑REMOVED 945 901 102 LOT BLOCK PLAT NAME OR SECTION/TOWNSHIP/RANGE QUARTER/QUARTER SECTION 1,2,7&8 11 COVE ADDITION GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER Donald J.Hoffman NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER Joan M.Hoffman ADDRESS CITY STATE ZIP CODE 12427 63rd Ave.E Puyallup WA 98378 NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER Wells Fargo Home Mortgage NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE 3212 NW Byron St Suite 106 Silverdale WA 98383 GRANTEE NAME Donald J.Hoffman and Joan M.Hoffman I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I/WE AM/ARE THE REGISTERED OWNER(S)OF THIS VEHICLE AND THIS INFORMATION IS ACCURATE: Signature of Registered Owner and Title,IF APPLICABLE Signature of Additional Registered Owner and Title,IF APPLICABLE NOTARY SEAL OR STAMP NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE State of Washington Signed or attested County of Jefferson before me on by Donald J.Hoffman Signature PRINTED NAME OF REGISTERED OWNER NOTARY OR AGENT by Joan M.Hoffman PRINTED NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY County/Office No.OR Title AND: Dealer No.OR DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date D TITLE COMPANY CERTIFICATION 1 certify that the legal description of the land and ownership is true and correct per the real property records. NAME(TYPED OR PRINTED) TITLE COMPANY/PHONE NUMBER First American Title Of Jefferson County • (360)385-1322 SIGNATURE/POSITION DATE Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs. ® BUILDING PERMIT OFFICE CERTIFICATION I certif that: the manufactured home has been affixed to the real property as described. y ❑ a building permit has been issued for this purpose and the attachment will be inspected upon completion. NAME(T PED OR PRINTED) BLDG PERMIT OFFICE/PHONE# BLDG PERMIT# 4) \lam ri 4- r 3cco�:vtq-LI LiSt3 BI.no5- oo 1 3.3 SI URE/P SITION l DATE TD-420-72 MANUF HOM‘.-4PPL(R/2/0 EXT(W)Page I of 2 I • • MANUFACTURED HOME—FROM SECTION 1 TPO/PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) +430091 2006 KARST 28/60 5TA0275240R © SIGNATURE OF LEGAL OWNER SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR ELIMINATION OF TITLE/REMOVAL FROM REAL PROPERTY. Signature of Legal Owner and Title,IF APPLICABLE Signature of Additional Legal Owner and Title,IF APPLICABLE NOTARY SEAL OR STAMP NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE State of Washington Signed or attested County of before me on by Signature PRINTED NAME OF REGISTERED OWNER NOTARY OR AGENT by PRINTED NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY County/Office No.OR Title AND: Dealer No.OR DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date DLAND DESCRIPTION(A legal description of the land can be obtained from the local County Assessor's Office.) Lots 1,2,7 and 8,Block 11,Cove Addition to the City of Port Townsend As per plat recorded in Volume 2 of Plats,page 27,records of,County of Jefferson,State of WA. Ell DEALER'S REPORT OF SALE I CERTIFY THAT THIS INFORMATION IS CORRECT,THE VEHICLES IS CLEAR OF ENCUMBRANCES EXCEPT AS SHOWN. ANY REQUIRED SALES TAX HAS BEEN COLLECTED. DEALER NAME(TYPED OR PRINTED) WA DEALER NUMBER DATE OF SALE PURCHASE.PRICE TAX JURISDICTION/TAX RATE DEALER'S AUTHORIZED SIGNATURE $199,000.00 USE TAX EXEMPT Sale to a Certified Tribal member on the reservation(attach notarized statement of delivery). 9 COUNTY AUDITOR/AGENT LICENSING OFFICE APPROVAL: (Not for use by Subagents) I certify that the above application appears to have been completed correctly,and the applicant has sufficient documentation to proceed with the recording of this form. NAME(TYPED OR PRINTED) COUNTY OFFICE/VFS OPERATOR NUMBER SIGNATURE DATE ® TITLE FEES FILING FEE APPLICATION MOBILE HOME FEE ELIMINATION FEE USE TAX SUBAGENT FEES TOTAL FEES&TAX IMPORTANT: Once the application has been approved by the County Auditor/Vehicle Licensing Office,take your application form to the County Recording Office. Retain proof of the recording fees paid, If the Recording Office retains your original application form,obtain a certified copy of the recorded form. APPLICANTS: Once recorded, you must return to a Vehicle Licensing office to file the Manufactured Home Application,paying all required fees. Vehicle licensing subagents charge a service fee. For full instructions on completing this form for Title Elimination,Removal from Real Property or Transfer in Location,see form TD-420-730,Manufactured Home Application Instructions. The Department of Licensing has a policy ofproviding equal access to its services. !/you need special accommodation,please call(360)902-3600 or TTY(360)664-8885. TD-420-729 MANUF HOME APPL(R/2/02)EXT(W)Page 2 of 2 w ��gsoly c0�, JEFFE•N COUNTY ' DEPARTMENT OF COMMUNITY DEVELOPMENT _ '� eet • Port Townsend •Washington 98368 621 Sheridan Str ___ -" 360/379-4450 • 360/379-4451 Fax .q O� www.co jefferson.wa.us/commdevelopment NOV � 7 2005 i i KING 1': :,: Master Permit Application , p Tr Project Description(include separate sheets as necessary): U 7 � J U rF-cu _ Tax Parcel �f . K Number: q�3 �)/ I(fi.,. Property r C( q feet) / 7 � (acres/square Site Address and/or Directions to Property: ,,;)I IJ(? E 0 ER 1 c - j ai l rk4 , C 3 Property Owner(s)of Record: c- 6' < - � C Telephone:3(r C 3�5-39 ILI Fax: email: ( T 4u f oc1 f 04,1 Mailing Address: a(.lr. /(44-`'l j tOT flii)IiJ -&Air) (f A G, ."9(n�i 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 p Garage Attached/Detached ❑Special Use(Essential Public Facilities)** anufa❑ Manufactured Home El Boundary Line Adjustment El Short Plat ❑Commercial* ❑ Binding Site Plan** ❑Change of Use 0 Long Plat** El Address ❑ Road Approach ❑ Planned Rural Residential Development(PRRD)/Anmendments** ❑ Propane ❑ Plat Vacation/Alteration** ❑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 ❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment ❑ 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: I hereby designate / f DESIGNATION OF AGENTto act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: Bysigning this application36 g ng 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 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 an right of entry to this property shall be requested and shall occur only during regular business hours. °� j� Signature: e. `(,t`-�/�I Date: 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 ponsibirty fgf-adh "ng to and complying with the ESA. The Applicant has read this disdaime and si ns and dates it below. Signature: / G`i .r 1' 1y_ Date: `f//C1/el 5 G:\PemutCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc • 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 Gene I Contractor for the proposed project. _ Signature: '<AL( _�4 t'/ _ Date: / / P1/03 GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New X Wood Existing: ❑ Sewer ddition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual Syste ❑ Repair ❑ Masonry SEP Permit#. 1 ❑ Demolition ❑ Other: Bedrooms: Water Supply:003,--(t' Existing: Setback: ❑ Private well ❑ Two Party T of_Heat: Proposed: Public f ] 'El cc 1 Q 1c , Total: Name of System: ii 1 Y 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: ❑ Underground Tank ❑ Above ground Tank Size of Propane Tank: ❑ Heat Stove ❑ Cook Stove ❑ Woodstove ❑ Fireplace Insert ❑ Hot Water Tank ❑ 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 'F1*70 lCe -flhly �' Current Proposed 5 - l�.�:' " Main Floor n�baniy 5c 2 Floor . . . � ' ��'x°s Se lee: ! 1fj, 3f'Floor , 1— (Wm,'s8ftloh T, am• , E! Mezzanine: � 1 �arr Check fee: ./` ?, ZOEI3 Heated Basement f Unheated Basement 7 ! 1N2itoi` �+ :4 `, �. - 1r Other Unheated Y r iY - ' : P -,s t ` yWr K , Garage/Carport TOTAL. .4 l > _} k �3 -tali Decks �'' : fi ,� ` .>:ci�""� ��v� G��,� mom"` `' I Other Cashf. k Number' `,' ` ESTIMATED COST(REQUIRED) Rate: 5.i 1aa ,#� 4 } t i t 't 0 , ..-11 It . vo,,. . .Fair market value of all labor and materials foundation to finish Initials: - , G:\PemritCenter\FORMS\DRD FORMS\Tofaster Permit Application 7-8-04.r1"-^ 'EMIT # BID soN kr.. , e JEFFERSON COUNTY 5 2 OV t 2005 ti DEPARTMENT OF COMMUNITY DEVELOPIagr NM BED 41. 621 Sheridan Street • Port Townsend • Washington 98368 �!�� �O 360/379-4450 • 360/379-4451 Fax "tIIN http://www.co.jefferson.wa.us/commdevelopment/ IT �a � �✓��CLUCC" STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# G c� PROJECT/APPLICANT NAME: L c153 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 m/agpp�} J/��- !� / N / / ) (� /&( Il." s�J 1T , vt'— t//1 W�.t (f1 �l tjrl- O �2IC��Y 14-a e 4. Al4�T i tJ E �� � 1Y1 2 - ' r/-1 i 111 ei + str' ci,c, olivcc rc �t. Existing Conditions Summary N �� 0 '5 r L� �3�� 10 2. Describe the existing topography. Indicate contours on the site map. " ! ,:4 "` - 9lf j/20-Or 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. e () Op )Lot15 13c a , c' -nc- 3RD kcj e -T r7E:s vie l4 S z 4 (� a tom' T 01 trig f F(Z(I}L 5 CT-t2c;[.i' it t e_ C 6 C.At(8 f ��Q1ii s I�/ !x'Q fi 5 I iO t1 (=cria2. 4. Describe the existing soils. Indicate soil type on the site map. , :f �,-i2 4q( p, e 6 ,/ 6- 8') .O f2 -4r 146•C__ 5. Describe the existing site hydrology(i.e., drainage; behavior of water on the site—above, below, and on the ground). Indicate existing storrnwater 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. i F•- A{,) 0 6J ' ' / cw-('r-[ ( p 6. Describe any excess levels of noise generated by the proposed use or activity: APPROVED STORMWATFR PLAN i \ CrEC 2 0 2005 Storlw0t �1 ` stonu..ater site plan template-rev.10/1/2003 Required I t �EF 0 DUNT DEPT.OF IN" DEVEL EN SIGNATU NI • • . t 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 on the site map. Akio c;+9 I�t t-c ,�• 0 --1-- . ' -1- s, 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.). )e 0e,1oc e -4--• �..t N �D e�.. e Io o ��t K. i ..c.--111 A L_ ;Ks--, p t� --A e '5 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 ropp�sed facilities from existing facilities. ( 50�'Sc L'[ r 1uVC_ ,eY fj)lt /- _ ifs 6 u )e_I r� /4, , A/ tqn ten ,e /i` ' �`�. . ,C t, _ N- , e- /C_ -t A 1 L'C_ (76=C- toil / 1�51 2�SC_ T S �` 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 pote tial for dispersion of contaminants.] l 11. Describe the performance goals and standards applicable to the project. i) 6)t /L4 • dC,Q.O ` `t1 W A O N 65 x 12. Describe the flow control system. A(4111— ..„. 4 - NOV 1 7 2005 i stot4tar Ake plaA template rev.t0f1/200 -I 6 • • • 13. Describe the water quality system. /Vid- 14. Describe the conveyanceytem analysis and design. VitrA1X-I A/-6"-=' (t-e)77 afitiyivoLa15 ,opy tt4 15. Describe the source of fill material,physical characteristics of fi l material,and deposition of excess material. 16. Proposed methods of placement and compaction consistent with the applicable standards on gppn kC Chapter 33 of the Uniform Building Code. NOV NeTYLP:, Aft-Lei/CP 17. Describe the proposed surfacing plat,%ial. ir 18. Describe methods for restoration of the site. till 1/ Aleti.44 r5. 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. 20. List here and include any special reports or stu ies conducted to prepare the Stormwater Site Plan.or 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. stormwater site plan template—rev.10/1/2003 7 • • 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. 2. Establish Constru tion Acce . • . i 3. Control Flow Rates. ockeeziwo 7t-L6 62.44,--benik 401 PP 1 4. Install Sedi ent Controls. W 3172 9 ga / 5 0 S �'= L— c 5 ( 'a-e v t p etrr...42.t r -Y 5. Stabilize Soils. t • le 0) 6. Protec Slopes. 7. Protect Drain Inlets. NOV 17 2005 storwater site plan template—rev.10/1/2003 8 m • • • 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlet . •. Control Pollutant . , w 10. Control De-Watering� ((tthe act of pumping groundwater or stormwater away from an active construction site). 11. Maintain Best Ma gement Pra ices(BMPs). 11';a PC T--At q ) - - , t 0-1-' , y zt________ (Cite-117 .1F 4l di -. 12. Manage the Pro'- t .o- ,r,__ _ `r 4 �:e 11 Cry, .- c-�. ;, ,�i c ty ,= r ctl' ��� 'that- �, �. L ,/.t 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands residential areas, roads). b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). /VAL 3. Environmentally Sensitive Areas. a. Description o vir nmentally sensitive areas that are on or adjacent to the site. JJ stormwater site plan template—rev.10/1/2003 - -- - 9 • • • b. Description of special re ui ements for working ii i or near envr r'onmentally sensitive areas. C a� (Jo c LeA t Q._eq 2f0 4. Erosion Problem Areas. Description of potential erosion probl ms on site in the context of the characteristics of the on-site soils(e.g.,erodibili ,settleability,perme bility,depth,texture,so structure). �— ( AA(- C/' 5. Construction Phasing. a. Construction sequepce OP b. Constructio phasing(if pros osed) t ��._/ 5 M 1. :_ O6 Qom! 0. t MOM •ab4 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). I. Provide a pr osed construction schedule. / t C. J II. Wet Season Construction Activities. if`zLirrt_ % `/1Z, '_ r l L-`�.--C_-.__. a. Proposed wet season const tion activities.LW\ p( cf �y «--- --- 1 441LGq b. Proposed wet season cotngtruction activities for environmentally sensitive areas. /V() r S0iLACE CC _AC,C'aj (a' ' 3SCL' (k9 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. 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable. a. Sediment Ponds/Traps. b. Diversions. X I c. Waterways. d. Runoff/Stormwater Detention Calculations $O\, 1 7 2005 ,I storrnvrter site plan template—rev.1 d1Y2003 .__ 10 i 1 r 111 • 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 stormwatvr 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. (LANDO'NN 4 AUTHOF(IZED RSENTATIVE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: l • NOV 1 7 2005 12 stormwater site plan template—rev.10/1/2003