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HomeMy WebLinkAboutBLD2006-00165 tILDING PERMIT APPLICATIN M Review eviewT0157 Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00165 Received Date: 4/4/2006 SITE ADDRESS: SR 2 i/ ( 1(L' I PORT TOWNSEND, 98368 OWNER: GARY CUMMINS PHONE: (360) 379-0771 DIANA CUMMINS 4854 EMERALD ST PORT TOWNSEND WA 98368 MOUNTAIN VIEW VISTA SUBDIVISION: Block: Lot: 1+ PARCEL NUMBER: 974600001 Section: 8 Township: 29 N Range: 01 W CONTRACTOR: DOBSON CONSTRUCTION INC PHONE: (360) 379-9040 422 DISCOVERY RIDGE RD PORT TOWNSEND WA 98368 Contractor's License DOBSOC1012K7 Expires 04/16/2007 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr NEW SFR W/ATTACHED GARAGE & DECK(S) ALSO A/G 250 GAL PROPANE TANK TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 2,090 VALUATION 275,000.00 ADD'L: HEAT TYPE: RAD CODE EDITION: 2003 HEAT BASE: HEAT TYPE: PRO OCCUPANCY: R-3 UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: 5N GARAGE: 816 SHORELINE: CONST TYPE: DECK: 98 SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: 2 Prop: 2 Total: 2 Total: 2 Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Total: APPROVED JULrA 2006 Jefferson County Planning &Building Department 0 • BUILDING PIERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD06-00165 Received Date 04/4/2006 SITE ADDRESS: 472 MALAMUTE LN Issue Date 07/28/2006 PORT TOWNSEND, 98368 APPLICANT: GARY CUMMINS PHONE: (360) 379-0771 DIANA CUMMINS 4854 EMERALD ST PORT TOWNSEND WA 98368 SUBDIVISION: MOUNTAIN VIEW VISTA Block: Lot: 1+ PARCEL NUMBER: 974600001 Section: 8 Township: 29 N Range: 01 W CONTRACTOR: DOBSON CONSTRUCTION INC PHONE: (360) 379-9040 422 DISCOVERY RIDGE RD 9 2 1.-127e PORT TOWNSEND WA 98368 (360) 379-9040 Contractor's License: DOBSOC1012K7 Expires: 04/16/2007 PROJECT DESCRIPTION: NEW SFR W/ATTACHED GARAGE & DECK(S) ALSO A/G 250 GAL PROPANE TANK CALL IN FOR THE EQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. SETBACKS: -2 O,(� OFFER: -2^D p Footing: ,c,5"-2-0ro Foundatiion: )ic - Stormwater FINAL Approval: Underground Plumbing: Underground Insulation:""" =•'' Shear Wall : i Q-1 1 Dip Sheathing: Framing: a F u RE ov Olaf UF0 8.(4-Ob on Plumbing: `lZslbi Propane Tan / Lines: 1 tJ -- i-t I i - ( �-1 1 ZAt,lc F I u)ni, c1�A4,(41��1f-/ 7 Insulation: c;�;..A..5�-•. /1- t'' rn„tu.- L V T�p6, Sheetrock:5. 2,JA-0 ( - Septic Sytem Final Approval MUST be obtained before final of structure can be attempted. Road Approach Final Approval: Zoning Final Approval: Final/Occupancy Approva . 10-23-� 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 C DITIONS APPLY - SEE REVERSE SPECIAL CONDITIONS FOR CASEBLD06-00165• 1.) Health approval based on this home using the full capacity of the septic system 2.) VOLUNTARY MEASURES OF 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. 3.) 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. 4.) 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. 5.) MANDATORY MEASURES OF HIGH 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. • 6.) MANDATORY MEASURES FOR NIGH RISK 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 requirements: a. Variance from Chapter 173 WAC standards granted by Ecology per WAC 173-160-106 for a new groundwater well within 100 feet of a sea-salt water intrusion area per WAC 173-160-171 (i.e., within 100 feet of a groundwater source showing chloride concentrations above 200mg/L or within 100 feet of the marine shoreline); or for an existing or proposed groundwater well not subject to an Ecology variance, applicant must provide evidence through a hydrogeologic assessment(relevant components of an Aquifer Recharge Area Report per UDC 3.6.10.e) of a reasonable probability that the subject aquifer will not be degraded by the proposed use of well. b. Installation of a flow meter. c. On-going well monitoring for chloride concentration. d. Submittal of flow and chloride data to the County per monitoring program. 3. If public water is unavailable, a qualifying alternative system may be used as proof of potable water. 7.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 8.) A flow meter shall be installed prior to final sign off of the building permit. 9.) On-going well monitoring for chloride concentration is required. The property owner shall allow access to Jefferson County PUD or approved contractor to take samples as required. 10.) Best Management Practices (BMPs) shall implement to minimize exposure of permeable surfaces to potential pollutants and to prevent degradation of ground water: Implementation of these BMPs is anticipated to off-set potential impacts from the well on Lot 2. 1. The well on Lot 2 does not appear to be contaminated, nor is it contributing to contamination of other wells or of the aquifer. The best way to assure that contamination does not occur is periodic sampling and reporting. A monitoring program is outlined below. 2. Wells on adjacent lot(Lot 14) which are within 1,000 feet of the off-site saltwater contaminated well should also be sampled to indicate whether any physical or chemical changes are happening which may relate to potential contamination. 3. If large drawdowns are noted or suspected, wells should be sampled to ascertain water levels as well as water quality. 4. Drainfields should be designed as per Jefferson County regulations and should be 100 feet from any wellhead as required (down gradient if feasible). 11.) A periodic monitoring program shall be implemented for a two (2) year period to ensure adequate data on the lack of contamination. The homeowner shall sample chloride and conductivity on an annual basis in order to confirm lack of contamination. Any significant increase shall be reported to Jefferson County. Test results shall be sent to Jefferson County at the conclusion of the two (2) year period along with a letter of comment by a water quality professional. Water levels shall be noted on at least an annual basis at a fixed time of year(preferably August). Any substantial drawdown (greater than 25 feet below the well log depth) shall be noted and reported. Sampling shall also be conducted on adjacent wells if feasible. The other well (Lot 14) within the 1,000 foot limit shall be sampled on the same basis as Lot 2. If increases in salt content are noted by taste or through laboratory result, sampling frequency shall be increased to a quarterly basis. 12.) 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. • 13.) A stormwater plan for a medium project has been submitted and approved by le 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. 14.) A minimum of two (2) on-site parking spaces are required for the single family residence. 15.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 16.) 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). 17.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 18.) Minimum setback from Malalmute Ln right-of-way is 20 ft. Minimum side yarrd setbacks are 5 ft. Environmnetally Sensitive Areas further impact setbacks. 19.) 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. 20.) 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. 21.) The building height is not to exceed 35 feet. I:\F_BLD_Permit_Buildng.rpt 10/29/1999 W • .g,�©zv � PERMIT # g j °, JEFFERSON COUNTYOLD 4411 DEPARTMENT OF COMMUNITY DEVELOPMENT 165 AT jam ► , ., 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 •• 360/379-4451 Fax _fr ti ZINC` http://www.co.jefferson.wa.us/commdeVrk4JON COUNTY DCP STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# MO" lc31 661- �, I PROJECT/APPLICANT NAME: 1 u ,h�/1' L t��i , h � I 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 'Ise 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 / /� � v� >" E .4 yr,,,f, x /mil (*.Jr.., ! tt � �'sil (�cx Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. S' ;rc // r 7�`ves. _2/j9057Ci1z� e1 3. Describe the existing vegetation. Indiate native vegetation areas on the site ap. , ;::: 4. Describe the existing soil . Indicate soil type on the site map. 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 applicabI2,7and indicate acreage of e �~ 6. Describe any excess lev s of noisjA4ePtR 4lipEDd use o activity: ,'-', STORMWATER PLAN ,_ �__. JUL 28 2006 i , APR 20 2006 JEFFERSON COUNTY stormwater site plan template—rev.10V1/2003 DEPT.OF C NWUNITY DF pMg 5 SIGNATURE: �- Y��p ,R NT 1 t • S 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. lGr .7/Ale/A's 8. Describe the general vicinity of the site, including adjacent land uses and structures, utilities, roads, and sensitive/critical areas (streamsJ rtlands,lakes,steep slopes,etc.). 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 existing fac'li'es. WO e e : // ��' fe. ' e- /'F).' " ec� , €z.�,,7 / f, e P 1A �/ie cr!ve to �ee Of,'4-,' e�lt< 1�1� <'l i /. j !-./:; E 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 o,bprojects that involve the potential for dispersion(oof contamirants.] / R'' /c, ( .6-0 G/Z.>IA�i �) 71Z1 L = 7 .v .V -e_E'_/7 13J e-b" /?z- 4�J.v+t R✓ y/�f 11. Describe the performance goals and standards applicable to the project. N/A 12. Describe the flow control system. S. tip _.... PERMIT # BEd JEFEERSDN COUNTY OCO 6 stormwater site plan template—rev.10/1/2003 �.r".'', ^.'t•' s • 13. Describe the water quality system. 4 /7 Li.i/ L!i i^ 0,, 1.114 /. /; `' 11// J l 0 /'oar� / 14. Describe the conveyance stem analysis and design. /' �—, J d ✓H �j' v�'L el ;A - 4— /I 6d1r h. [0 (2 /W,Fw / � le I _ 15. Describe the source o fill material,physic:,: .naractteristics of fill material,and deposition of excess r•,.ateri4.. �( f�'���'r✓ / its // i11 off 'ft'i , .r.2/ ,`�• ,7`,- ' r"'1�J�`! A , a� yc `fir vt j /'�'L zI \�0 Lt v� C t T r 2r-►.. L2.., tee..-- c.�,tt,; ,r�, 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building ode. a , e�- 5 it 7€.2k-,-i e,t-c 4,-4 4e ; _I_, J/i 12 a �,J/ G o,:�/) ' -c lz,i,1 44' `'f • / D:, /c#� -,4i:- 4 e �. 17. Describe the proposed surfacing material. Lam / `71- pee,,-, d i,e. 464-c- Cal ' 4� C e//i- - / 1 18. Describe methods for restoration of the site. /� > / �� li/� J / o"--'-�'L ice%� re -E C_ei q /1 4 a ., 19. An Operation and Maintenance Manual is required for each flow control and aggiVacity. l31�#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. Iv/A 0 6 - 0 1 6 5 JEFMA! CATTY D•CD 20. List here and include any special,worts orts or studies conducted to prepare the Stormwater Site Rap. i 7 � —i ,,. t(-, -2 ;,Le, ice/ , 4 ' A e y C-r��.e . --i "0..1 - .ev. _2- /2 ,;4//j l 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. 11/34 r: _ i APR 20 2006 ! _J stormwater site plan template-rev.10/1/2003 ,11:,3E'ar i 7 1 • • 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). 1P Required Elements—Construction SWPPP 1. Mark Clearing Limits. ^ 2. Establish Construction Access. 1 4 '� .///t..)ii e--- a-7-t, f 0 140 7 PA`-- "%a "04= (j- , t / ,;/,„,.._ / , - ,6v .lrA,�k P; `tilf �1ee <r G�tcPtte_ Z GO<,S/At 0 t a, /uses�7 ,e, -,-. Gf�1 ii-,0t'- a, a, �� h 1;c. -ae- 4— c?^1.1r'1. l." c,Y,' / --L. .c c','. e f-L.er- s°/ •A', 3. Control Flow Rates. T/ �// 1 //f /�J- ) .�// �/ A TE( E i, L,`� f)1. /�E/ : !/ fi z �g 1 2 -?_, 74'1. /1J �-•r `, 4 0 ' wL . ,'P,S! 4- ‘ e-s - zi‘beik / d/ A < 1.-t',; L r, h A 4,,Ti--._ /. .e, ' -1:-4,-/ro eC v f- s' nz ek--ii- 1 Aef 7.7--, /6,r-1vW. 4. Install Sediment Controls. it'rAs 5. Stabilize Soils. n/A- 6. Protect Slopes. �//� 4/ Lam' / 7. Protect Drain Inlets' 12 • / /7 ,,/ " PERMIT # Bin 0e - 01 -65 stormwater site plan template—rev.10V1V2003 JEFFERSON COUNTY DCD 8 1 ' • 111 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. 2 - g w d4--z( '4, .: 3 c--< Lam. /_ /�g .1 te7ri' ,� 9. Control Pollutants. /1/ 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). /2 " S" �. 4 i >-etk u. 4S ,e2 12i',/j ,('�:i1-t/i ...Y�'/a�'tc, v� �l'r et,i/!r 'Z 11. Maintain Best Management Practices(BMPs). it 4:4-14 2,,- / 4 c 77. I. {' - J`4,s^.i .'y'7G/t'e: fk✓ e07-i 12. Manage the Project. / 4 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas,roads). / itipl- ..>2'/7 ,e2e(i':4 c edz7---- ,P,e e..4-0 /lee.'- 64 44, '' /1 4 /i4:! iz"/ ✓ /4,'L 7 .J 7-fie, ��iI1 i �c f �- 2a �•�t S �1� cf y, i f — 9 ' 4., "lc-,C'.,c / 1, I.c.�/ zW,.74e4 CZr, e i7� L h c'r e41 -1 te,r7s^? J/ 97 /"r/k/r/ . n /4t'1 1q", z� � � t/ N` e b. Description of the downstream drainage path lead from the site to the receiving body of water(minimum distance of 400 yards). rot A eti:P4 C/� ; it/4 4.7 c./.1, be7—�e-7--�i r -,1 ' l :, /v` _, - 3. Environmentally Sensitive Areas. a. Description of environmentally sitive areas that are on or adjacent to the site. a. PER�Fdr ND ,F.. __-�—V.4 SPA 2 0 2006 JEFFERSON COUNTY DCD stormwater site plan template rev.10Y12003 - )t,y,ir 1 • b. Description of special requirements for working in or near environmentally sensitive areas. i/A 4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site soils(e.g.,eriWity,settleability,permeability,depth,texture,soil structure). go y c,,k►z� = .1 �.� ' e , r 4- e-c_ � , t 5. Construction Phasing. a. Construction sequence /-, 1�,:• C, �°"G E 2 `/ .. {'v�^�� � //&'/ 1 �� t`'�5/7� � /'�Ge �F;Y / (ys'i � C-� ./�1-� , 1' �'".�i'�/:.y/C��� � 1;�'z�7- /� t �iC� b.�I Construction phasing(if proposed) - f'Vv=.�f ,G' i/�2 cLf i -L, ��, -E-// _M ' 7 -�.� ev f .f n y"Li2) C1 401,z Q h /GL S'. C G� 6. Construction Schedule. Wet seasonVoctober 1 through April 30(page 2-21 of the Manual). 1. Provide a proposed construction schedule. g�/'MJ Sd AP/d, -f— Pam+ II. t Season Construction Activities. a. Proposed wet season construction activities. 2/e �- b. Proposed wet season construction activities for environmentally sensitive areas. i 7. Financial/Ownership Responsibilities. a. Identify the property owne sponsible 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. /Oa e- / e n e/AI',.1. / C c3 s; 1'1 c.. /,b,67 s'1 t. /I<i�I 17 4J1e--- 1-Li.e-Pzi" "err 8. Engineering Calculations. Provide Design Calculate s on a separate sheet for the following,if applicable. a. Sediment Ponds/Traps. b. Diversions. PERMIT !1 $Fp c. Waterways. 7t V �l d. Runoff/Stormwater Detention Calculations JEFFERSON COUNTY DCD 10 stormwater site plan template—rev.1 0✓112 0 0 3 • 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 ffected property. ( DOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: APR 2 0 2006 PERMIT # Bin JEFFERSON COUNTY DCD stormwater site plan template—rev.10/1/2003 12 �!, (.<",„:0N co�� JEFFER COUNTY • �� ,.� DEPARTMENT OF COMMUNITY DEVELOPMENT 'N ' 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax 4:4„ G�O� www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: C (C- lJ Project Description clude separate heets as necessary): S /e- ' 4-G ` ,JA/e -e, r-,' Tax Parcel Number: 17 LI(0 0 000/ PropertySize: 1/, t/ C (acres/square feet) Site Address and/or Directions to Property: _, ,r//4. L4:- L,j CP.fe A /CPS y et‘/ f 9 Property Owner(s)of Record: 6*-e ,4- ,'6.K 14 L per , ,N j Telephone: 5 7 s - C'.7 7/. Fax: VA 0.1 e email: Mailing Address: Applicant/Agent(if different from owner): 1)v IO&'t s_ Ste-/" R () ,/. Telephone: 'lip 0 .0 ei-- ' t L/O Fax: °'27 Sr `.le -t 2 en'lail: Mailing Address: 1/2 L U;'Cc t ziP r r , ; ` 104 9e • /,m What kind of Permit?(Check each box that applies) Building 0 Variance(Minor, Major or Reasonable Economic Use) 0 olition Permit ❑ Conditional Use[C(a),C(d),or C]** , rg a Fa ice, 0 Discretionary"D"or Unnamed Use Classification Garage ttache Detached ❑ Special Use(Essential Public Facilities)** 0 Manufactur ome 0 Boundary Line Adjustment ❑ Modular ❑ Short Plat** ❑ Commercial* ❑ Binding Site Plan** ❑ Change of Use ❑ Long Plat** ❑Aiess Li Road Approach 0 Planned Rural Residential Development(PRRD)/Amendments** ropane ❑ Plat Vacation/Alteration** 0 Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management 0 Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination (SPAAD)* 0 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: DESIGNATION OF AGENT I hereby designate t ) 1:10 Sin./ to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE C.��* 2 ,-•�_ / Date: 2 /6 -Q , 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 I r inspections.Access and right of entry to this property shall be requested and shall occur only during regular business hours. Signature: �fe .4 / Date: l 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 complianc- with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non- transferable resp s' il',�fe� r� ing to and complying with the ESA. The Applicant has read this disclaimer id signs and dates it below. Signature: L — / "�0 Date: G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc • 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: GENE tbe ONTRACTOR OR ANUFACTURED HOME INSTALLE PHONE: FAX: (�4:.i/" ue_ E:,. ��.- GONE 7q—. c� ��ts FAX: T2 — 0ti/� MAILING ADDRESS: -/C 2 /e:,1 dei4.,f4l e kgri, /k9 EMAIL: CONTRACTOR'S LICENSE f1 WAINS NUMBER: fib t G 1 Q 12 >L 7 NUMBER ARCHITECT/ENGINEER: Z_ e./.4y✓/e_ t,��rr PHONE ('s(e() )3 1,I-./I yZ FAX: ( ) MAILINGp DRESS: EMAIL Pr ct Type: F Type: Bathrooms: Shoreline: Type of Sewage Disposal: New Wood Existing: 2 ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank Height: ri Community System ❑ Alteration/Remodel 0 Concrete Total: -7 ❑ Individual System 1 ❑ Repair 0 Masonry SEP Per. it# ❑ Demolition 0 Other: Bedrooms: Wa upply: Existing: Z. Setback: Private well I I Two Party T pe f H at: Proposed: ❑ Public � z IIAa� Total: 2_- Name of System: If this is a Commercial Project you must answer the following: '- Number of Parking Spaces: Current: ey/ Proposed: Number of ADA Parking Spaces: Number of occupants (includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IB Type of construction: Will you have Food Service? Yes / No If this is a Propane Tank a or Appliance Installation permit,mark all items below that apply: ,, A I i Underground Taj_k Above ground Tank Size of Propane Tank: 2 3-0 61), ❑ Heat Stove wf Cook Stove [1 Woodstove 1. Fri' fireplace Insert ❑ Hot W. - Tank ti Pellet Stove Li Other Is this appliance being installed in a Manufactured/Mobile Home? Yes I01 When applying for a permit to install a propane tank you must also subtly • 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 Current Proposed For Office Use Only Amount Revision Main Floor Heated ���� EH Bid App Review: i c.— ( L; 2"a Floor Heated — _ Consistency Review: '- C C, Other Heated Base fee: - — IC --) 3 .-? �- Mezzanine Additional Section: —_ Heated Basement Plan Check fee: Unheated Basement �- State Surcharge fee: ' r a _ Lh ) U Other Unheated Pot Water Review fee: C� � .ca Garage/Carport �* \-),.i SUBTOTAL g / \C\‘-�-�� Lei o \9 Decks q S 2-17 q v 9jdAj�proahfee: I-5 :) , O G Other TOTALi a ' 1 CA --) Receipt Number: Q / Cash/Check Number: `� % ESTIMATED COST(REQUIRED) „... 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