Loading...
HomeMy WebLinkAboutBLD2005-00029 • 0 BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD05-00029 Received Date 01/18/2005 SITE ADDRESS: 9796 FLAGLER RD Issue Date 05/18/2005 NORDLAND, 98358 APPLICANT: MARK L SECORD PHONE: CONTACT AMY I LINDA B SECORD 1238 E NEWTON ST SEATTLE WA 98102-4104 SUBDIVISION: Block: Lot: 4+ PARCEL NUMBER: 021201001 Section: 20 Township: 30 N Range: 01 E CONTRACTOR: —BLUE HERON CONSTRUCTION CO Le fie,- reLLt►.'eil 1ONE: (360)379-6977 PO BOX 71FY a/ /OS l,Ci/}t,t-er�l'JAUG &1St r t C�I-i o/) 1 PORT TOWNSEND W 8 New CO +►'oCt —ee C at-1wC/ Contractor's License: BLUEHCC109D8 Expires: 8/19/2006 ----� PROJECT DESCRIPTION: NEW SFR CALL IN FOR THE QUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. SETBACKS: UFFER: , -Z Z.-o.r Footing: W ic,oNto t -22-o.S Foundation . w+croN►) G-LZ-oS- Stormwater FINAL Approval: Underground Plumbing: Underground Insulation: Shear Wall : mic4eI.)4i L /04/L/1,16 Ole II. �/ Sheathing: /� Framing: pi( /z�.3/is5 I' Plumbing: �( / /�/Os f Q Propane Tank/ Lines: L4/6 7" /k 1pe7-- -,,f9L =jet-F,P0' /hoc, D,�! Ilya/4,,jo- Insulation: / e SE/flL dtC /��i9DS //�s`�t-- -/3-v Sheetrock: Septic Sytem Final Approval (If not on sewer): Road Approach Final Approval: Zoning Final Approval: . Final/Occupancy Approval: 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 BUILDING PERMIT APPLICAIN SEEP04--00026 Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00029 Received Date: 1/18/2005 SITE ADDRESS: 9796 FLAGLER RD NORDLAND, 98358 OWNER: MARK L SECORD PHONE: CONTACT AMY I LINDA B SECORD 1238 E NEWTON ST SEATTLE WA 98102-4104 SUBDIVISION: Block: Lot: 4+ PARCEL NUMBER: 021201001 Section: 20 Township: 30 N Range: 01 E CONTRACTOR: ANDERSON RESIDENTIAL INC. PHONE: (206)789-9790 1392 ROSE ST PORT TOWNSEND WA 98368 REPRESENTATIVE: AMY HIATT PHONE: 234 SAND RD PORT TOWNSEND WA 98368 PROJECT DESCRIPTIOr NEW SFR TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 703 VALUATION 80,750.00 ADD'L: HEAT TYPE: PRO CODE EDITION: 2003 HEAT BASE: HEAT TYPE: OCCUPANCY: R-3 UNHEATED: #OF STORIES: OCCUPANCY: CONST TYPE: 5N OTHER: 202 SHORELINE: CONST TYPE: DECKLE 242 SETBACK: 100 BANK HEIGHT: 140 SEWAGE DISPOSAL: ALT WATER SYSTEM: PWELL PARCEL TAGS: YES NO BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA Exist: Exist: Wetland Erosion Prop: 1 Prop: 1 Seismic Streams Total: 1 Total: 1 Flood Way Floodplain Routing Date: F&W Landslide ���°�f Shoreline Aquifer Forest: Commercial Rural Type Amount Paid By: Date: Receipt: /� n rQp d/ tc ,E D Permit $860.75 BAC 01/14/05 68892 /�-� U V Plan Check $559.49 BAC 01/14/05 68892 MAY 1 8 2005 State Building Code $4.50 BAC 01/14/05 68892 Potable Water Application $53.00 BAC 01/14/05 68892 Jefferson County Planning Total: $1,477.74 &Building Department • SPECIAL CONDITIONS FOR CS A BLD05-00029 1.) 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. 2.) 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. 3.) 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." 4.) All construction activities shall not encroach upon the buffer. This includes the storage or preparation of materials. 5.) 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. 6.) A setback of 225-feet, measured perpendicularly from the wetland edge, shall be permanently maintained as a buffer. No filling, grading, clearing, or other alteration of the wetland or its buffer is allowed. 7.) Buffer perimeters shall be marked with temporary signs at an interval of one per parcel or every one hundred (100) feet, whichever is less. Signs shall contain the following statement: "Wetland & Buffer- Do Not Remove or Alter Existing Vegetation." 8.) A permanent physical separation along the upland boundary of the wetland buffer area shall be installed and permanently maintained. Such separation can include installing logs, trees, a hedgerow, or any other prominent physical marking approved by the UDC Administrator. 9.) 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. 10.) 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. 11.) 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. • 12.) 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. 13.) 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. 14.) A Medium Stormwater 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. 15.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire,,safety, health or sanitary hazard. 16.) Not'm.ore 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.) The building height is not to exceed 35 feet. 19.) Setback from the private road right-of-way adjacent to the north property line is no less than 20 ft., side setbacks are no less than 5 ft. and the rear setback is no less than 100 ft. from the shoreline bluff. If an environmentally sensitive area (ESA) is present, then the more restrictive setback shall apply. 20.) A minimum of two (2) on-site parking spaces is required for the single-family residence. 21.) The standard setback for residential structures, including common appurtenant structures such as garages and workshops, shall be thirty(30) feet or one (1) foot for each foot of bank height, whichever is greater. The setback shall not exceed 100 feet. This setback shall be measured from the bank's edge when the bank's height exceeds 10 feet. When the bank's height is less than 10 feet, the setback shall be measured from the ordinary high water mark. • I:\F_BLD_Permit_Buildng.rpt 10/29/19 c i tri, JEFFERSON COUNTY 4 DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax O http://www.co.jefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# !"Li4 t S 0 U 0 3 PROJECT/APPLICANT NAME: 6E467 1z1 7 e_p,fl Please answer all of the following questions to the best of your ability. Where the question calls for depiction on a site map, the applicant may choose to either incorporate the elements into the general plot plan for the Master Land Use Application or to submit a separate stormwater site plan map. Project Overview 1. Describe the proposed developed conditions of the site. Indicate position and relative size of proposed improvements on the site map. -1"ERzMI Anot.! OI xlsrl NCB tom' \moo G RAV6l., 2oAD IN '90 Iis su l✓Ac 5 YU`LNINCi GIZU. , PARKIN A . L'.orf - ik,- Iat,1 OF 21'j& R Nt✓IIELD IN zUZ p -rn REMAIN CONsrticrroH 700 Nor; t✓ U1"I wry I J I L7t Nla IMtNrMAt�..CLF�,r2rN�, i rstmg Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. 51-r is /1•MOsr PLAT'. NC MORETHAN " 'OP VAIzIATIONi Ac12056 2 AG AEA.., IN �vralc t; cEV P iE H Is TO SUP 3. Describe the existing vegetation. Indicate native vegetation areas on the site map WITO 0EP MA AK, NaN,WIL_LUV/ FQr2EST 17oMIrjATE17 S( 1 I, 012.1 V5-NAY CL Aiz-1 Gg6aTE.19 i I I'i L4' 4Iikj y' 11 N, Gt ar .� AREA,s a-IAv �N r 11 YEGI SsE1s Nis C� EEps UNr, RT'd2' .sExv'ri ERE. 15 SEAL- I 4. Descnbe the existing soils. Indicate soil type on the site map.(ZE J S 'RAC(,O72F-VN i146,17�. IILS AKE MAPPEp As MI Dr3E ( a tJ r7Y 1.4A1\11 1 11-4 PERM EAFSI L,I r( I5 PooR Exce.p-[' IN A -6v/ $MAL,L 1R. ds_ (171GT"Arp LQ4rioN OF -(FIE PI AINrIE.L-D. 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. see. A J , MO/EM ENr OP SURF WAY K PUE=J TD riLdr N I;SS 05 SIT1-", Ho FIN DI N el E.xr,E.pr AILS IN GL .-ARI t4( . 6. Describe any excess levels of noise generated by the proposed use or activity: NONE E;xtEPI INrieF- QUENT fJsT cTlot� tt'ERY. A STORMWATF PLAN MAY I stormwater site plan template—rev.10/1/2003 5 JEFFERSON COUNTY DE PT.OF C yi Y DEVELOPMENT 1IGNATI:RF. i 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. ,'p� Al I . / ,a t1s. • I IIIa I L1 ! ELF e of the site,including adjacent land uses and structures,utilities, roads,and sensitive/critical areas 8. Describe the general vicinity sl es,etc.). (streams,wetlands,lakes,steep oP Permanent Stormwater Control Plan stormwater control BMPs construction of the project is completed. This portion of the Stormwater Site Plan consists of the selection and installation.of the appropriate and facilities to remain in place afterimpervious surfaces, pollution-generating impervious "Meares, sande projects are required a have the totals c verify of all imps eratin pervious surfaces to verify that the thresholds for treatment facilities and flow control surfaces, and pollution-generating facilities are not exceeded. (i.e.,per BMP T5.30 ed site hydrology, as proposed. Indicate whether stormwater will be fully dispersed 9 Describe the develop proposed facilitiesthes from a existing thresholdcies. withinin the Manual). Locate if not what types of stormwater flow control will be utilized for the site or specific discharge areas or the site. these facilities o��site and differentiate .� / V '_�. ,UN-0 f� © 17 SPERSE17 'ID _ �(� IV DI RED- P 0 V S :hi. u� _O � 1`d 'P� describe the types of stormwater treatment facilities proposed 10. forf ue project therequires the e these of facilities es treatment facilities, r osed facilities from existing facilities. [This I t or projects that involve the potential for dispersion of contaminants.] use on site. Locate facilities on the site plan and differentiate p • normally for large"projects 11. Describe the performance goals and standards applicable to the project. 12. Describe the flow control system. a;. stormwater site plan template—rev.10'12003 ,, d 13. Describe the water quality system. N/A 14. Describe the conveyance system analysis and design. N/A (LIMi-re To WI-'-1I0 11.510r- �UII�JIiJa1 \ - 15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material. lu, HATEIz-IALsYa F E UMITEp To WA,SHE2 0i141,\/E•ii, FOR. PRANit-,b.61 AIz111aS GL62:4--1 CRUSNI✓2 i a K UI,IDEF= PpT{L < SLAp74, MMATEK.IiL. � OM i'puNrATIDN SXCAYAf Oi-1 Tv Fel)>EIp TO RAiS� �aRA17I�. A�ZOU J 2 51I U7ftJ 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. P>✓6G�ME 15Y HANa Ao MA 44INE AsAPeUGA1 / ME6,14ANiGAL "LOMR TIdN U eI2— F'A7"IdS S14.5S. 17. Describe the proposed surfacing material. GRiEWi Q ; Pii-RUN �2R 'E4 , 1N ) 1'oPPI�C/ V �o�r'P��'I-�S ' �� N WU5 C-�SIa� G-�R�:�/E1_, 18. Describe methods for restoration of the site. 2IL, AMEN17M61 T, RoTt1 TILEIIJ( , 5 c)I Nc, ©P ' C-1R4SS IN Gal-rE ar- m'ewA /'-► Le , M U LC -!114 d FLA JT ILI DD f2_00 t l D-642V EELS !N '/jeAN ir( DP ISUILt)INGIS, 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. N/A 20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan. NiA 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. storrrwater site plan template-rev.10✓12003 7 CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN(SW nd sated by the applicant in the construction. The B is arepplicant in for P) temp all construction phases of the project. Theproponent The Construction SWPPP addresses sediment and erosion control during preventieng that sfollowsediment nd erosion be installed impactsled o the v ground during arts the Constructiony with rural residential ite olti s reventi and to environmentally sensitive Packetsforaguidance,�spult Stormwater Pollution Prevention (SWPP) Best Management Practices development. SECTION 1—CONSTRUCTION SWPPP NARRATIVE lien nts has been or Stormwater Pollution Plan Elements. Descridb i how satisfyeach of the Construction the required element.SWPPP lf an element es °(beginningapplicable on page 1 willonstracdion the type and location of BMPs use be addressed. Identify to the proposal,justify in writing. Descriptions of the 12 Elements are found at section 2.5.2 of the Manual 2-15). 12 Required Elements—Construction SWPPP _ � Sl✓� 1, Mark Clearing Li .• �Aki0---AZA D St-1120 A I. D � D p - L D EWFS MI -►� 0 2. Establish Construction Access. D i , s t1C. D I I U LJ I I� t7 . 3. Control Flow Rates. U , La. Q 4. Install Sediment CSro1s. RIJN_D1✓ tfW W[tit. QED IA 5. Stabilize Soils. S DL I O '' S A L., t , W S S G W 5 � G WI1.1, I CON! 1-r 6. Protect Slopes. '5I 7. Protect Drain Inlets. r I © d warm- S s storrrrwater site plan template—rev.10/1/2003 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. NVA NO GHAH t.J E LS (5g cv trLEr5 RE 9. Control Pollutants. f/)MPiN& DP SoL�/ENr�. / 0tL T '-ESI PUE GrE.R CEM f414J LS WI LL, Nor 'E PE. M IrrED , ► JMPi FAINN�a O� 00I-IGl2E� , WAS HMI slxjzfzy WI 1e irrE.D ONLY IN THEf�I� p2SEp PARK:N( 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). N/A No )(.c-ass L)N n WArER. ANTI»i c2Arr:'b pot✓ LL 1-oP,(2 11. Maintain Best Management Practices(BMPs). A 7LL1"�Ly • 12. Manage the Project. 1712AIFIriEun TR V‘)12. UrttA TIES CONSTIz-UGTI ONI Dr nizi Ala yh '( ,1 PARK-I N 61 : c_oNSrw)GrtoN or U1ILir"( �l)ILAr71N/a 4 ; c. Nsr12tJGri oN dP gESI pS-Nc,E 5 : INsYALLAfIoN a� �l✓PrIGTA S PLAIN �"(t�ENG I� 1~tHAL RA1JINI6 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas,roads). SI-I0I2 LA Ep"IE Is HdRETHAN IDOI riZOM AO), SI1 pisrllz&N.I ,E. , NOT'.}iNk ELSE SEASIl'1vE WITHIN 7 ' 10R- MORE. b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). Nor Eb sY ro DETEI2M I N P3Ur ivea .F3t,y Vey A(,a DU4L- SLOP; PovVN1 I N) NORr xTERtY PI 12-ELT I ON TOWARD W rrrLAN P3 SN ovvNi ON VI GI N i T( MAR 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. SHCIZELINE FBI-Ur - J watL4 4p sfiowt-d IrY MAe. stormwater site plan template—rev.10/1/2003 9 b. Description of special requirements for working in or near environmentally sensitive areas. N/A bUE bf ST4NGE 4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site soils(e.g.,erodibility,settleability,permeability,depth,texture,soil structure). N/G, ptl p LAr sI-rE 5. Construction Phasing. a. Construction sequence sEe I- I2- 0212 PkIAges b. Construction phasing(if proposed) 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). I. Provide a proposed construction schedule. � E I -12- -EOI2 PHASES , &Ns- rlot-I ro IN ASAP cOHfl 1.Jvs r 1p t�aNrl4! . II. Wet Season Construction Activities. a. Proposed wet season construction activities. HTD) r14s CPNsr TiON WILL, G tJF - 1D1)1t.I( t1-IE Wit.sor-1. b. Proposed wet season construction activities for environmentally sensitive areas. 1\14p` 7. FinanciaVOwnership Responsibilities. a. Identify the property owner responsible for the initiation of bonds and/or other financial securities. N/A b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. N/A 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable. a. Sediment Ponds/Traps. b. Diversions. I''r c. Waterways. d. Runoff/Stormwater Detention Calculations stormwater site plan template—rev.10/12003 10 i SECTION II—EROSION AND SEDIMENT CONTROL PLAN Sediment and erosion control measures may be depicted on the master land use application plot plan, a stormwater site plan,and/or a separate Construction SWPPP site plan. This is a checklist to ensure that the following are depicted on a site plan: 1. General. a. Vicinity Map ? b. Jefferson County Approval Block c. Erosion and Sediment Control Notes s .e. ( Ir c p I NV Q tS > 2. Site Plan. a. Legal description of subject property. \ b. North arrow. c. Indicate boundaries of existing vegetation(e.g.,tree lines,pasture areas,etc.). d. Identify and label areas of potential erosion problems. e. Identify FEMA base flood boundaries and Shoreline Management boundaries(if applicable). f. Show existing and proposed contours. \g. Indicate drainage basins and direction of flow for individual drainage areas. h. Label final grade contours and identify developed condition drainage basins.SE-a- WI U7'f t-W1 E1-S/t T7df.1S " i. Delineate areas that are to be cleared and graded. (Jpj. Show all cut and fill slopes indicating top and bottom of slope catch lines. 3. Conveyance Systems. a. Designate locations for swales,interceptor trenches, or ditches. b. Show all temporary and permanent drainage pipes,ditches,or cut-off trenches required for erosion&sediment control. c. Provide minimum slope and cover for all temporary pipes or call out pipe inverts. N�A d. Shows grades,dimensions,and direction of flow in all ditches,swales,culverts and pipes. e. Provide details for bypassing off-site runoff around disturbed areas. f. Indicate locations and outlets of any dewatering systems. 4. Location of Detention Best Management Practices(BMPs). Identify location of detention BMPs. 5. Erosion and Sediment Control Facilities. "a. Show the locations of sediment trap(s),pond(s),pipes and structures. b. Dimension pond berm widths and inside and outside pond slopes. c. Indicate the trap/pond storage required and the depth,length,and width dimensions. d. Provide typical section views through pond and outlet structure. e. Provide typical'details of gravel cone and standpipe,and/or other filtering devices. �� f. Detail stabilization techniques for outletAnlet. < g. Detail control/restrictor device location and details. h. Specify mulch and/or recommended cover of berms and slopes. i. Provide rock specifications and detail for rock check dam(s),if applicable. j. Specify spacing for rock check dams as required. k. Provide front and side sections of typical rock check dams. I. Indicate the locations and provide details and specifications for silt fabric. gym. Locate the construction entrance and provide a detail. 6. Detailed Drawings. Any structural practices used that are not referenced in the Ecology Manual should be explained and illustrated with detailed drawings. 7. Other Pollutant BMPs. Indicate on the site plan the locations of BMPs to be used for the control of pollutants other than sediment(e.g.,concrete wash water). 8. Monitoring Locations. Indicate on the site plan the water quality sampling locations to be used for monitoring water quality on the construction site. Sampling stations should be located upstream and downstream of the project site. stormwater site plan template—rev.10/1/2003 11 • 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. r J u (LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: • stormwater site plan template—rev.10r12003 12 • OWNER BUILDER STATEMENT • The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed proidt. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: at71,4Sr. PHONE: FAx 3TE\/ . ANveKsON/ A.NtE-} ON.I- .1GFN. 1i C<C, 1N6, (2G(o) -]S`c . `�190 ( ) MAILING ADDRESS: 39 2 Qoc'E ,SI- Pc EMAIL: CONTRACTORS LICENSE ' , WAINS NUMBER: &631I. pup 154 NUMBER D ARCHITECT/ENGINEER: AM y H I A--r, j .H I-re&- PHONE ( ))3b 5 r 1 2 FAx-( ) MAILING ADDRESS: 011 EIZ 5112E- EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: X New X Wood Existing: _C4 0 Sewer ❑ Addition CISteel Proposed: I Bank 0 Community System i ' 9 ❑ Alteration/Remodel 0 Concrete Total: __ I Height: K Individual System tk' O Repair 0 Masonry AO Fm SEP Permit# Of..00 2 4o ❑ Demolition ❑ Other. Bedrooms: Water Supply: Existing: _" Setback: X Private well 0 Two Party Type of Heat: Proposed: __L__ 0 Public OrANI E,.rI IUD Total: I I OD PT Name of System: sPe.6E N .Ta 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: O Underground Tank , . Above ground Tank Size of Propane Tank: ZO C U 4'1 x Heat Stove X Cook Stove 0 Woodstove 0 Fireplace Insert X Hot Water Tank 0 Pellet Stove 0 Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / No t OH-t7aNIANP ArrL.(A.NLA 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 f s t. . e , te+ :Z u a t I �- %;. Current Proposed h � • 4 •, 4' - A• Main Floor ` t � ,- � - , re 'O it; 2 Floor �`� � �-�� �, h ,, Floor .`y`" "r -' * ��' ^'x A€ � , ,' n I,,....,--..,t w° rr -Yet +,:l .. .j jk�yr }, 4 "y- a ., it. '''''''N'i''' 'is''''..--' -'14rafftlfitiiafeii'';'''''-''''::-:,1,`",, ,i "-: .?4,t:',,::Vls''.,-f,'';',,z(-,,fg-'fttZg104-•'' --'''' ' e,,,F.,--,,,L, - ,'-z.*,..-i Heated Basement . .�s®~ `' fir fi 4r4� w ; Unheated Basement - a` �``. , '" , -: r ; Other Unheated 941'I/Rd Ap p 5 .• -. t,, }� • Ii a� � �� * }, e,g _ mkt 0,- .teal _ r °`''' : tr Garage/Carport ti 4 V kI4t �pr �, �. t,4 4 n spy;c ". e t 1. Decks +ReceIt N mtier a` `�x r' � *. .P' pu f k ": z , ` 4 °' Nu J• . 't o q'vOther Ltd fO es ,...A` Zi „�' aY *k. ' ESTIMATED CO REQUIRED 4 , y fi f �. `� 7s F:'t a^' = - 1 i ` +-w � ti ,'�'a : -.aY a 'St�h < •Fair market I labor and materials o n , . •0tt f $ .w 0 •Mali. • } .p1i4 '� N F S ritt)kt l .,ke -k �. f' NOr tl Ire 12--ais, Cs714LY 50 sr- WIrN , 5' f-I RooM ) ♦ G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc olv co JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT `• '41 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax O www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: 1A otDn -23 Project Description(include separate sheets as necessary): ' s- -t7 C-,V2j N' DNSi5ePfzooM Tax Parcel Property Number: 2 � — 20I — O A 6,1 Size: � rl 2` • 2. AC-. (acres/square feet) Site Address and/or Directions to Property: J 7 47 )%LAG(L.E f A b / NOjZ r 2L.AN C Property Owner(s)of Record: t2-I< U N OA SEGO r-D Telephone: Fax email: Mailing Address: 1 evt ''GJIJ On9--E.EX SFA-I''(L.I✓ .e8102 Applicant/Agent(if different from owner): ANC`` H l Arr 1 AAGN IT'�CX Telephone: �©• S 25J - I 11 2_ Fax: 7(pG) •2)7 ) • 179 o email: )1'-iQt; O�YMr14 .11et, Mailing Address: 2?).1 AHt7 120 D1 PDR--1' fDYJN SENO '1?3!0 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 0 Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** ❑ Manufactured Home 0 Boundary Line Adjustment ❑ Modular 0 Short Plat** ❑Commercial* ❑ Binding Site Plan** ❑Change of Use 0 Long Plat** ❑Address 0 Road Approach 0 Planned Rural Residential Development(PRRD)/Amendments** Propane ❑ Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis ❑ 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* 0 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: F Rv1 lr DESIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE 6 L ( /� � � �: By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of his,her or it's knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attomey's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide arrpcs and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any required later ins -ons.Access and ng$'t of entry to this property shall be requested and shall occur only during regular business hours. ��} Signatur 2y c.:'zt,t4.4„ f G'I ! / Date: f:1 E%'7 (-, 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- you are in compljance with the Jeffersdn County development code.The Applicant acknowledges that he,she or it holds individual and non-tra cable respo/9pibi(ty for adhering to�_ar�com T/yi,ng with the ESA. The Applicant has read this disclaimer andme signs and dates it below. /t'Signature: Zr- V 1Z.'t�L-Z(14' l 1 GI Date: �: ' Ci if) • t'% S G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc Vil —‹ ,--3 ..... til ‘p co 1-cl 0 t-4 _ N > _ 1 , ---- / • 7, ._.., r 7 . . --<----- -viz-- „. ,, Ili ,/ • / // ;I) 6114, i T` isk v P s: . I - -N _ .... 1 _ —-- X-- •D il ...,- t , c.; I ,- fE. ...-1 r r --- t ---c-' ab 6 ;it r / e ,or $ ....,. ___ .-- %_. i ...._ vi .r 4, i 1 1 1 > A''' .R1 za-A or r- 31 liti' Ns / r I C _ r.-. It ll , s• , '-' -- ' 1? is-'"L'(sc __. . .._ _ - --17- \A. I1 11:1:iC)liica11 --ill -111,..:\C:1, -11:1117:---ILI::513,.,i.. 0-L-- 1 1 '1101 7-- 1 1 1 i I I ' ' .. mil; , _____ ._ : , 1, , 1,m io . ,I ‘\vry "''' ."-:: grigigt—iiiii P I 4T: 0 'izik- T V /A . , 1, _,- -' fiat\ors -'! -fi .T : * g-t .4411til ' 1 F . ,,, 4. '---Z-- T ,k _ .1 v -.1 g (--- ./- ,t\_.‘ x- ".., \ \ , PI m I 1 _ 1 !I • ____z_.-- ,...\\ ,i„. t-. ..- , ,•..;!‘ ! .. _ . I _L IS' 74 OW vIlete 4 j-\ '- - ------ , , $ 7, 5 t Mitt etst. c‘l , 3 c, \\M ri — I `44-- \\--t • ... ,,. \ ! ..__-- , "-Kz_11,-,-• _:t.g =A. Nt '-' ri t i- , P$ 0 g IR 4 E ak',' e .,, 4-c _ ...,$... 3,,k 4 .. ,-- r- °I 1 % & •-1 Ol --....„ Z.' A ‘--r. ,}1•-•-•-k 1 / -_,--"----\----'-r-1- i 1 ,7 0 , ' 1, . 1 ; NI .'" , ,,, ....____,•_____ 4Pkt '' L., .) / - •-•--- ' , ( I, '14- r- 1 C31 St 7— , ; I 1-1 ls. i --A- \ ( t \ 1 , \ , C • ___ --: - -, I.._. \ 1 ' w \• ...,, \ (1 \ \s ) \ I '\ \\ tW.SK: U.&-rd 5,,AN.244-11rw to VEF-I Ps( PI HPLe 1.1.24.44.1 OA_OP ALL.M9P05 E 9 rFzticri)REs Ai ttrIlAn EA, ot,Forze, Mpii r4 I-1 1 WI EX A,‘/ATI 01-1 I ... ._ . , ,.., ecord Cabin Amy Hiatt, Architect t 4693 REGISTE ' 0 LA-4 P Mark , 'ileiM,& Linda Secord 234 Sand Road U )jf IMA Iti 9796 Flagler Road Port Townsend, WA 9836 - AM MARINA HIATT Vile fit t A ia((;2.--, 13-11.1\\P Nordland, WA 98358 360.385.1172 STATE OF MASHIHOTON A