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HomeMy WebLinkAboutBLD2006-00200 !UILDING PERMIT APPLICAI�N MRL Review Ty 19I ype Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00200 Received Date: 4/24/2006 SITE ADDRESS: 385 OLD OAK BAY RD PORT HADLOCK, 98339 OWNER: JERRY E COBURN TRUSTEE PHONE: 360-437-0840 DIANA J COBURN TRUSTEE 83 TIMBER MEADOW DR PORT LUDLOW WA 983658249 GLAVICH SHORT PLAT SUBDIVISION: Block: Lot: 2 PARCEL NUMBER: 921182024 Section: 18 Township: 29 N Range: 01 E CONTRACTOR: SCHWEIZER CONSTRUCTION CO PHONE: (360)385-7119 6727 CAPE GEORGE RD PORT TOWNSEND WA 98368 Contractor's License SCHWECI001BG Expires 1/21/2008 REPRESENTATIVE: TOM MITCHELL PHONE: 206-395-3151 PO BOX 3952 SEATTLE WA 98124 PROJECT DESCRIPTIOr NEW DETACH GARAGE W/ PLMB & UTILITY SINK TYPE OF WORK GAR SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 20,000.00 ADD'L: HEAT TYPE: CODE EDITION: 2003 HEAT BASE: HEAT TYPE: OCCUPANCY: R-3 UNHEATED: # OF STORIES: OCCUPANCY: OTHER: CONST TYPE: 5N GARAGE: 720 SHORELINE: CONST TYPE: DECK: SETBACK: 100 BANK HEIGHT: 50 SEWAGE DISPOSAL: ALT WATER SYSTEM: OTHER BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 0 Prop: 0 Total: 0 Total: 0 Routing Date: / 5/0(OC/a- Type Amount Paid By: Date: Receipt: Approved/Date Permit $321.25 LYK 04/24/06 80985 Plan Check $208.81 LYK 04/24/06 80985 APIDRO\/EED State Building Code $4.50 LYK 04/24/06 80985 Total: $534.56 JUL 21 2006 Jefferson County Planning & Building Department • BUILDING P • ERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD06-00200 Received Date 04/24/2006 SITE ADDRESS: 385 OLD OAK BAY RD Issue Date 07/26/2006 PORT HADLOCK, 98339 APPLICANT: JERRY E COBURN TRUSTEE PHONE: 360-437-0840 DIANA J COBURN TRUSTEE 83 TIMBER MEADOW DR PORT LUDLOW WA 983658249 SUBDIVISION: GLAVICH SHORT PLAT Block: Lot: 2 PARCEL NUMBER: 921182024 Section: 18 Township: 29 N Range: 01 E CONTRACTOR: SCHWEIZER CONSTRUCTION CO PHONE: (360)385-7119 6727 CAPE GEORGE RD PORT TOWNSEND WA 98368 (360) 385-6991 Contractor's License: SCHWECI001BG Expires: 01/11/2008 PROJECT DESCRIPTION: NEW DETACH GARAGE W/ PLMB & UTILITY SINK CALL IN FOR THE REQUIRED IN PcCTI• S THAT APPLY TO YOUR PROJECT. SETBACKS: ©k /D it/06 UFFER: Oj /0 // 04, r:, Footing: ,Ok /p // 06 Foundation: Ok Wl f/b4, Stormwater FINAL Approval: nK ph" 1 Underground Plumbing: f)k av o l� Underground Insulation: Shear Wall : 1V i//Dia7 if Sheathing: Framing: Qk ///6/D7, Plumbing: Q/( /0d/47, Propane Tank/ Lines: /Jitel Insulation: A A Sheetrock: Septic Sytem Final Approval MUST be obtained before final of structure can be attempted. Road Approach Final Approval: Zoning Final Approval: Final/Occupancy Approval: K 4 r cin4J b/ /') k HEALTH DEPARTMENT AND 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 CAS # BLD06-00200 1.) 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. 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.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 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) unlicense• inoperable vehicles shall be stored on any 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.) Minimum setback from Old Oak Bay Road right-of-way shall be 20 feet. Minimum side yard setbacks shall be 5 feet. Minimum rear(shoreline) setback shall be 70 feet as depicted on the revised site plan. 12.) 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. 13.) 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. 14.) The building height is not to exceed 35 feet. 15.) Residential developers and individual builders shall be required to preserve shoreline vegetation and reduce the associated risk of erosion during construction and any future activity which may impact the stability of the shoreline. 16.) A minimum of four(4) on-site parking spaces (two for the single family residence and two for the ADU) shall be provided for the proposal. 17.) A Geotechnical Report dated June 23, 2006 prepared by Shannon &Wilson, Inc. was submitted in conjunction with this application. The report addressed the stability of the geologic hazard area. A minimum setback of 50-feet is required as measured perpendicularly from the top of the steep slope to the proposed single family residence. (Proponent has elected to locate the residence at 70 foot setback from top of bank per the revised site plan). A minimum septic drainfield setback of 100-feet from the top of the steep bank is also required. 18.) Landslide Hazard Areas and their associated buffers shall remain naturally vegetated. Should buffer disturbance occur during construction, the Unified Development Code (UDC)Administrator shall require replanting with native vegetation. No alterations shall be made to the Landslide Hazard Area or its associated buffer without prior authorization by the UDC Administrator. 19.) A vegetative buffer of 30-feet shall be permanently maintained from the top or edge of the Landslide Hazard Area. All buffers shall be measured perpendicularly from the top of the Landslide Hazard Area. 20.) In general, the risk of soil movement on a slope can be reduced by not over-steepening the slope (e.g., do not excavate the toe of the slope), not increasing the weight on the slope (e.g., do not place yard debris or fill at the crest of the slope), maintaining the slope as dry as possible (e.g., locate septic drain fields away from the bank, route roof downspouts, yard drains, trench subdrains, and footing drains to the base of the base of the slope or storm drain system, and minimize the amount of surface water that could flow down the face of the slope), and maintaining a vegetative cover on the slope. 21.) Prior to and during approved construction activities, the perimeter of the landslide hazard area buffer shall be marked with a temporary sign. The sign shall be placed in such a manner that it can be directly observed from the construction area. The sign shall contain the following statement: "Landslide Hazard Area and Buffer- Do not Remove or Alter Existing Vegetation." 22.) All construction activities shall not encroach upon the landslide hazard area buffer. This includes the storage or preparation of materials. 23.) The applicant shall permanently separate the boundary of the Landslide Hazard Area Buffer from the remainder of the subject property through installing logs, trees, a hedge row, or any other prominent physical marking approved by the UDC Administrator. 24.) A TRENCH SUBDRAIN (CURADRAIN) BE CONSTRUCTED IN THE NE• DRAINAGE EASEMENT, FOOTING DRAINS BE CONSTRUCTED AROUND THE RESIDENCE, AND SURFACE DRAINS SHALL BE CONSTRUCTED AND MAINTAINED TO COLLECT WATER FROM IMPERMEABLE SURFACES ON THE PROPERTY AND DIRECTED TO THE EXISTING TIGHTLINE TO THE BASE OF THE STEEP WATERFRONT SLOPE. THE TRENCH SUBDRAIN (CURTAIN DRAIN) SHALL BE CONSTRUCTED IN THE NORTH-SOUTH ORIENTED PORTION OF THE NEW DRAINAGE EASEMENT. THE PURPOSE OF THE SUBDRAIN IS TO INTERCEPT NEAR-SURFACE GROUNDWATER IN ORDER TO REDUCE SEEPAGE AND GROUNDWATER LEVELS IN THE STEEP WATERFRONT SLOPE. AS INDICATED, THE PIPE'S CIRCUMFERENCE SHOULD BE SURROUNDED BY WASHED PEA GRAVEL. THE REMAINDER OF THE TRENCH SHOULD BE BACKFILLED WITH COMPACTED DRAINAGE SAND AND GRAVEL MEETING THE SPECIFICATIONS OUTLINED IN FIGURE 4 OF THE GEOTECHNICAL REPORT. THE DRAIN PIPE SHOULD BE APPROXIMATELY 8 TO 12 FEET BELOW THE ADJACENT GROUND SURFACE OR AS LOW AS PRACTICAL TO STILL PROVIDE GRAVITY FLOW INTO THE EXISTING TIGHTLINE DRAIN SYSTEM. SOME OF THE EXISTING TIGHTLINE SYSTEM MAY NEED TO BE MODIFIED (E.G., LOWERED) TO PROVIDE THE GRAVITY FLOW. AT THE CONNECTION BETWEEN THE TIGHTLINE AND PERFORATED SUBDRAIN PIPE, AN IMPERVIOUS DITCH DAM SHOULD BE PLACED AROUND THE PIPE TO FORCE WATER IN THE TRENCH BACKFILL INTO THE TIGHTLINE. A DITCH DAM MAY BE CONSTRUCTED BY PLACING SACKS OF CONCRETE IN THE BOTTOM OF THE TRENCH, AROUND THE PIPE TO A HEIGHT OF APPROXIMATELY 18 INCHES ABOVE THE TOP OF THE PIPE. A CLEAN-OUT AT THE GROUND SURFACE AT THE UPSTREAM END (SOUTHEND) OF THE DRAIN SHOULD BE PROVIDED TO FACILITATE PERIODIC CLEANING OR OTHER MAINTENANCE. 25.) FOOTING DRAINS SHALL BE INSTALLED AROUND THE PERIMETER AND ON THE UPSLOPE SIDE OF INTERIOR FOOTINGS TO IMPROVE SOIL DRAINAGE IN THE IMMEDIATE VICINITY OF THE STRUCTURE. FOOTING SUBDRAINS SHOULD CONSIST OF SLOTTED, 4-INCH DIAMETER MINIMUM PLASTIC PIPE BEDDED IN WASHED 3/8-INCH PEA GRAVEL. FIGURE 5 OF THE GEOTECHNICAL REPORT ALSO INCLUDES SUBDRAINAE AND FOUNDATION WALL BACKFILL RECOMMENDATIONS. NOTE THAT THE PERIMETER SUBDRAIN INVERT SHOULD BE LOCATED AT LEAST 18 INCHES BELOW THE LOWEST ADJACENT GRADE OR FLOOR SLAB. ROOF OR OTHER DRAINS SHOULD NOT BE CONNECTED TO THE FOOTING SUBDRAINS. ALL OUTSIDE DRAINS SHOULD SLOPE AWAY FROM THE RESIDENCE. 26.) MAINTAINING A HEALTHY VEGETATIVE COVER ABOVE AND ON THE SLOPE CAN REDUCE EROSION AND THE RATE OF SLOPE REGRESSION. IN GENERAL, NATIVE VEGETATION SHOULD BE USED ON AND NEAR THE SLOPE TO ELIMINATE THE NEED FOR IRRIGATION AND WETTING THE SOLS ON OR NEAR THE SLOPE. A HEALTHY VEGETATIVE COVER MAY INCLUDE LARGE, HEALTHY TREES. • 27.) EARTHWORK SHOULD OCCUR DURING DRY WEATHER MONTHS; JUNE THROUGH MID-OCTOBER. THE FOLLOWING CONDITIONS ARE APPLICABLE IF EARTHWORK IS TO BE ACCOMPLISHED IN WET WEATHER OR IN WET CONDITIONS: FILL MATERIAL SHOULD CONSIST OF CLEAN, GRANULAR SOIL, OF WHICH NOT MORE THAN 5 PERCENT BY DRY WEIGHT PASSES THE NO. 200 MESH SIEVE, BASED ON WET-SIEVING THE MINUS 3/4-INCH FRACTION. ANY FINES SHOULD BE NON-PLASTIC. THE GROUND SURFACE IN AND SURROUNDING THE CONSTRUCTION AREA SHOULD BE SLOPED AND SEALED WITH A SMOOTH-DRUM ROLLER TO PROMO9TE RUNOFF OF PRECIPITATION AWAY FROM WORK AREAS AND TO PREVENT PONDING OF WATER. EARTHWORK SHOULD BE ACCOMPLISHED IN SMALL SECTIONS TO REDUCE EXPOSURE TO WET CONDITINS. IF VEHICULAR TRAFFIC IS EXPECTED TO BE OVER THE EXPOSED SUBGRADE DURING CONSTRUCTION, THE SUBGRADE SHOULD BE PROTECTED WITH A COMPACTED LAYER (GENERALLY 8 INCHES OR MORE ) OF CLEAN CRUSHED ROCK. THE SIZE OR TYPE OF EQUIPMENT MAY HAVE TO BE LIMITED TO PREVENT SOIL DISTURBANCE. NO SIL SHOULD BE LEFT EXPOSED TO MOISTURE OR UNCOMPACTED. A SMOOTH DRUM VIBRATORY ROLLER, OR EQUIVALENT, SHOULD BE USED TO SEAL THE SURFACE. SOILS THAT BECOME TOO WET FOR COMPACTION SHOULD BE REMOVED AND REPLACED WITH CLEAN CRUSHED ROCK. EXCAVATION AND PLACEMENT OF STRUCTURAL FILL DURING WET WEATHER SHOULD BE OBSERVED ON A FULL-TIME BASIS BY A GEOTECHNICAL ENGINEER/ENGINEERING GEOLOGIST (OR REPRESENTATIVE) EXPERIENCED IN WET WEATHER EARTHWORK, TO DETERMINE THAT ALL UNSUITABLE MATERIALS ARE REMOVED AND SUITABLE COMPACTION IS ACHIEVED. 28.) COVERING WORK AREAS, SOIL STOCKPILES, OR SLOPES WITH PLASTIC, SLOPING DITCHING, INSTALLING SUMPS, DEWATERING, AND OTHER MEASURES SHOULD BE EMPLOYED, AS NECESSARY, TO PERMIT PROPER COMPLETION OF THE WORK. STRAW BALES AND/OR GEOTEXTILE S LT FENCES SHOULD BE APTLY LOCATED TO CONTROL SOIL MOVEMENT AND EROSION. 29.) PRIOR TO FINAL BUILDING OCCUPANCY, PROPONENT SHALL SUBMIT A WRITTEN LETTER FROM BILL PERKINS, L.E.G. FROM SHANNON &WILSON, INC. STATING THAT THE STORMWATER FACILITY HAS BEEN CONSTRUCTED IN ACCORDANCE WITH THE REQUIREMENTS OF THE "GEOTECHNICAL REPORT" DATED JUNE 23, 2006. 30.) The applicant/owner and all future owners are responsible for maintaining and protecting the stormwater runoff tightline to the beach against damage due to normal wear, weather exposure, and/or trees, rocks and debris. If and when damage occurs to the tightline that renders it ineffective, the responsible party must execute the necessary repairs as soon as possible and no longer than 30 days. 31.) No fill or other material may be placed in the waters or intertidal areas of Jefferson County. 32.) Work within the jurisdiction of the Shoreline Master Program other than as described above shall receive separate review from this Department. I:\F_BLD_Permit_Buildng.rpt 10/29/1999 0 BUILDER STATEMENT • The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: Ce-11to eiv_r- r0 Cotersf ctcoln _ 340)3es-711.D oG)Sas'G�/ MAILING ADDRESS: 4727 CCU ,ry _� EMAIL: v(�.s a 4 �. ejory, CONTRACTOR'S LICENSE WAINS NUMBER: c H IWEL, 0 1 Q / NUMBER ARCHITECT/ENGINEER: G .l �/�'V_/ 1G?L7 ARCHITECT/ENGINEER: IN: T2'w �:fCr ) Q� /� PHONE ('2o6) c ls.3tS1 FAX: ( o4) ¶ ?,�71 MAILING 3oy 3d362. e4. j J8"'1" EMAII f , L ;16,ctle CC�IA�ee,s+*IvIct Project Type: me Type: Bathrooms: Shoreline: Type of Sewage Disposal: `ty New Wood Existing: 0 ❑ Sewer ❑ Addition ❑ Steel Proposed: _�_ Bank Height: ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: S� ' Individual System ❑ Repair ❑ MasonrySEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: —Q— Setback: ❑ Private well [1 Two Party Type f Heat: Proposed: ❑ Public ,J t/'- Total: a WI Name of System: 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: CJ Underground Tank ❑ Above ground Tank Size of Propane Tank: Heat Stove LI Cook Stove ii Woodstove [1 Fireplace Insert ❑ Hot Water Tank tI 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 Current Proposed For Office Use Only Amount Revision Main Floor Heated EH BId App Review: +A ;a-K5F2. 2nd Floor Heated Consistency Review: wi-K-SF� Other Heated Base fee: 3a r.a t 3 Mezzanine Additional Section: l Heated Basement Plan Check fee: I Unheated Basement Stale Surcharge fee: ' 0 Other Unheated Pot Water Review fee: Garage/Carport 720 He 970.1° SUBTOTAL 5341. 5 49 Decks 911/Rd Approach fee: 1 Other _ ------1 TOTAL: $ 5 32 5S6' I Receipt Number: 6 G 6(gb ��Cppash/Check Number: ' '1 ' � ESTIMATED COST(REQUIRE-DJ- Cie 4 6 .Fair market value of all labor and materials foundation to finish 7 441) ( -1;1 1�jlp n —' Initials: �y � (/ G:\Permit en r\FORMS\DRD FORMS er Permit Application 12`30-OS.doc ��¢Sox cow JEFFERSO UNTY 0 Wry' r, DEPARTMENT F COMMUNITY DEVELOPMENT R r ` `d 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax 41/ ,9 �p'� www.co.jefferson.wa.us/commdevelopment L 4 2006 Master Permit Application MLA: Imo , J PP ,,, ;�-,F:kr,r I Project Description (include separate sheets as asp necessary): •}}- Ott ` _` ol-66.6,4 & 1ca � W11t1 Vl 4 r 1tnk, Property `Tax Parcel Number: 'Z(I ISZO' . V Size: VIS 71V4 (acres/square feet) Site Address and/or Directions to Property:� 3$�j Old QC,k. ,, f2 t . f G� .A k. Property Owner(s)of Record: VG4'� lQbUr'h Telephone: Sepb-43?.O40 Fax: email: Mailing Address: SS TtMbcr PIC 1('t Y() 41.14 LL)411.60 9$S44 Applicant/Agent(if different from owner): "TOM M*k .t% 1. Telephone: 20L, °j34.3I5 I Fax: 24l0 41,017-6 11 email .L.Inn:1 dial Mailing Address: $k. foe- 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 CI** ❑ Single Family ❑ Discretionary"D"or Unnamed Use Classification 'Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** ❑ Manufactured Home ❑ Boundary Line Adjustment ❑ Modular ❑ Short Plat** ❑ Commercial* ❑ Binding Site Plan** ❑ Change of Use ❑ Long Plat** ❑Address ❑ Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑ 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: DESIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date:_ By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of his,her or it's knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application review and any required later inspections.Access and right of entry to this property shall be requested and shall occur only during regular business hours. R,� Signature: Q Date:_ O4/z// 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 responsibility for adhering//toy�an complying siwith the ESA. The Applicant has read this disclaimer and s d dates it below. Signature: !✓I� u..+G ��. Date: 1/at.- G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc r 411 PERMIT # Bfn s h Z4 1- c° JEFFERSON COUNTY 0 2 DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend • Washington 98368 it49 (0 360/379-4450 . 360/379-4451 Fax �1NO http://www.co.jefferson.wa.us/commcfevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# —fq PROJECT/APPLICANT NAME: 014) b .) 1 j) % t�h' x Ed 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. t y i'I lA t 'le:. t_C' '. Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. c't 4/ jr - fC - nk ct c. yr?6('<Ii4 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. 4. Describe the existing soils. Indicate soil type on the site map. jrr i c c i•'t't,r` /-e j fir, St So...cGt(L lvitJCG,•rtki "ti r C(re) 4.4 U 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. �t44y,,;r:. �.;--- APPROVED 6. Describe any excess levels of noise generated by the proposed use or activity: STORM WATER PLAN JUL 2 6 2006 Sh9Tmt,Ja>1T Storr►►wa r 's ) JEFFERS UN ha,P.e CiPm Re uiPe � 111 ra/ CVn Crmd;1613 d- 6e q DEPT. DEV ENT SIGNATURE: stomnwater site el template—rev.10/1/2003 vr� rt 5 • , 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. 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.). 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 these facilities on the site plan and differentiate proposed facilities from existing facilities. , . . 4- r - C tot 'r9 Ct.L L 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.] 11. Describe the performance goals and standards applicable to the project. 12: Describe the flow control system. • C s stormwater site plan template—rev.10/1/2003 6 •• 13. Describe the water quality system. 14. Describe the conveyance system analysis and design. 15. Describe the source of fill material,physical chpracteristics of fill material,and deposition of excess material. kh- it • G ny. ✓ roe 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. 17. Describe the proposed surfacing material. ✓`. :✓ `1. 18. Describe methods for restoration of the site. v►IGQ 'S ("; , <7` r° -,. t' , {_(%.i; G,fe1-47 . e A ,.fe• 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 studies conducted to prepare the Stormwater Site Plan. 21. List other necessary permits and ap provals as required by other regulatory agencies. If thole hermits or approvals include conditions that affect the drainage plan or contain more restrictive drainage-related requirements,describe those conditions or restrictions here. • C i� I 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 Construction Access. • �� l - E t tnf:li :f`;/,¢ !/' 1-i1)C1 !O, -(iX tC—.• Erta-e c+"i e- t v% p 3. Control Flow Rates. • �r r.:L. 4. Install Sediment Controls. 1.irc -i%C'.v•!Q /I. t i . ; E: �:. �.•(_c`-f" 5. Stabilize Soils. 6. Protect Slopes. • Ft(ter -71;k irLL a Gtri 7. Protect Drain Inlets. ! / t iE nrll GIEFFhiS4A1 (HIM stormwater site plan template—rev.10/1/2003 • • 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. cf _ ,� c 9. Control Pollutants. bL,eA/-, G6-657 r'L'e-1 (UYt �s IUYt i CcJO.r \ecoCt 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). J 11. Maintain Best/Management Practices(BMPs). 12. Manage the Project. 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). • 3. Environmentally Sensitive Areas. Ink 1006 a. Description of environmentally sensitive areas that are on or adjacent to the site. D L �40-0 tit U stormwater site plan template—rev.10/1/2003 9 • • b. Description of special requirements for working in or near environmentally sensitive areas.n t/G 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,permea¢ility,depth,texture,soil structure). 2,1„ Ait -1 fC {7a'©tr t - �fhn t L,J3 , t'eC��ICr Ya 1 5. Construction Phasing. a. Construction sequence b. Construction phasing(if proposed) 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). Provide a proposed construction schedule. �,, df>nr ?lalr� �s,J CJeG , it c it G .'•_ '1'isc4/6 / rIUJI II. Wet Season Construction Activities. a. Proposed wet season construction activities. NL . , bu tt,. E�- , Stec �xcJc..rt "-ty.-ie 94-. A' b. Proposed wet season construction activities for environmentally sensitive areas. 7. Financial/Ownership Responsibilities. a. Identify the property owner responsible for the initiation of bonds and/or other financial securities. b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts., APR 2 4 20( 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable. a. Sediment Ponds/Traps. b. Diversions. c. Waterways. d. Runoff/Stormwater Detention Calculations Wz stormwater site plan template-rev.10/1/2003 70 • Stormwater Site Plan Changes If the designer wishes to make changes or revisions to the originally approved Stormwater Site Plan, the proposed revisions shall be submitted to DCD prior to construction. The submittal shall include substitute pages that include all proposed changes, revised drawings showing any structural changes,and any other supporting information that explains and supports the reason for the change. Final Corrected Plan Submittal If the project included construction of conveyance systems,treatment facilities,flow control facilities, or structural source control BMPs (not standard on-site stormwater management BMPs), the applicant shall submit a final corrected plan ("as-builts")when the project is completed. These should be engineering drawings (stamped by a licensed civil engineer) that accurately represent the project as constructed. APPLICANT SIGNATURE By signing the Construction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all owners of the affected property. (LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) j THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: `s , Fta~OJT i PERMIT # BID 0 , {, 0 rr JFtisolv j �.. 1 1IY ccc stormwater site plan template—rev.10/1/2003 12 O O 3D D O D O O IZD 31 70 C) O Q P 0 a 1 7'n7"�_ PLOT PLAN DETAIL \ SEE ENgNFEMNO MANN iOR UTUtlE9 \ 1 I \\ I I \\ MAWI R6ERVE I / /i- \ " I I--�'NTo w 91 N - I I I �-- \\ \ SEE ENgNFEMNO U DRAWNOS FM lIU11E9 \ 1 I \ ORAEd1 I eESEq�E I ' / S89'17'07'E 713.90' EDPLOT PLAN ill =40' 1 I I E1�IMNCF/'. DRAINAGE PLAN 1"=40' i� HOUSE �I_ I IIIIII_�I 252.57' DRAWING INDEX 1 PLOT PLAN, PROJECT NOTES 2 FLOOR PLAN, MATERIALS LIST 3 FLOOR PLAN MATERIALS LIST CONTINUED 4 EXTERIOR ELEVATICNS 5 EXTERIOR ELEVATICVS, INTERIOR ELEVATIONS 6 INTERIOR ELEVATI01!S 7 SECTIONS, DETAILS 8 FOUNDATION PLAN 9 FRAMING PLANS S1 STRUCTURAL NOTES AND DETAILS S2 STRUCTURAL NOTES AND DETAILS 10 ELECTRICAL PLAN 11 HEAT DUCT PLAN G1 GARAGE 12 GENERAL NOTES SURVEY PROJECT NOTES OWNER JERRY AND D;ANA COBURN 83 TIMBER MEADOW DRIVE, PORT LUDLOW, WA. 98365 TELEPHONE 36C-437-0840 MOBILE 360-301-0031 LEGAL DESCRIPTION REVISED LOT 2 GAVICH SHORT PLAT, RECORDED IN VOLUME 1 OF SHORT PLATS, PAGE 165, AMENDED BY VOLUME 4 OF SHORT PLATS, PAGES 79 AND EO, RECORDS OF JEFFERSON COUNTY WASHINGTON SITE ADDRESS: SEE "EXHIBIT A" FOR COMPLETE DESCRIPTION. TAX LOT : 921182024 ifff \ ' nrx➢HIME -0 oc N/- HEATING SYSTEM NEW ELECTRIC HEAT PUMP _ - r `- DI IN INRS r' MICNORMC ROCKS ---- INSULATION WALLS: R-21, CEILING: R-38, FLOOR R-30 _ _ WINDOWS UMAX = 0.40 VENTILATION: NEW EXHAUST FANS IN BATHS AND KITCHENS WHOLE HOUSE VENTILATION INTEGRATED WITH FURNACE I I �OI,SE �"cI II 11 11 ENERGY CODE OPTION IV II n 11 ®1\ v rtw s r ku !AIN (E) ` \`\ r -,,----PIPE FROM CATCH BASIN al NO HOLES PIPE END FABRICATED FROM V PIPE READED PLUG EA END W-CEOVE D pp00Cp0 JUL 18 0 0 O O 1' HOLES SPACED 1-1/2" MIN 1 DIFFUSER T NTS DEPT. OF CO ENT C 0) V' F\ ■� N O 0) n,cn co Q O C N U x U m .0 CIO n' U U) LL O W QN_� _ U /■� _- Lf) i U L co I i xL .}� m E p � Z .0 O - ADT2004 COBURN REVISION DATE 04/10/06 04/12/06 05/16/06 06/29/06 COMM aCa �vw _ I OZ) = O z" O co co rr W Ow Uw 1