HomeMy WebLinkAboutBLD2006-00343 BUILDING PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD06-00343 Received Date 06/14/2006
SITE ADDRESS: 1591 DABOB POST OFFICE RD Issue Date 08/28/2006
QUILCENE, 98376
APPLICANT: JEANETTE MIFSUD PHONE: (360) 379-9591
JOSEPH VAUGHAN
1775 CAPE GEORGE RD
PORT TOWNSEND WA 98368
SUBDIVISION: Block: Lot: 4+
PARCEL NUMBER: 701044004 Section: 4 Township: 27 N Range: 01 W
CONTRACTOR: JOSEPH VAUGHAN CONSTRUCTION PHONE: (360) 379-9591
1775 CAPE GEORGE RD
PORT TOWNSEND WA 98368
Contractor's License: JOSEPVC085J3 Expires: 04/16/2007
PROJECT DESCRIPTION: NEW DETACHED SHOP WITH TOOL ROOM - NO PLUMBING - NO
HEAT
TOO ROOM IS 133 SQ FT
CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT.
SETBACKS: c50 4-Ats 9cq.ii-o
OFFER: 9 -(1-o4 /
Footing: 9-tI-ob
Foundation: -t-G1-(,h 4✓
Stormwater FINAL Approval:
Underground Plumbing:
Underground Insulation:
Shear Wall : OX 4/z37o7A05AS/C1-6r,(SE DNLY)
Sheathing:
Framing: f/- (&-' 1
Plumbing:
Propane Tank/ Lines:
Insulation:
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: 3I$0 I
HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION
THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:00 a.m. -4:30 p.m.
HOT LINE AVAILABLE 24 HOURS A DAY
SPECIAL CONDITIONS APPLY - SEE REVERSE
tILDING PERMIT APPLICA1N MLA06-00324
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Poit Townsend, WA 98368
PERMIT #: BLD06-00343 Received Date: 6/14/2006
SITE ADDRESS: 1591 DABOB POST OFFICE RD
QUILCENE, 98376
OWNER: JEANETTE MIFSUD PHONE: (360) 379-9591
JOSEPH VAUGHAN
1775 CAPE GEORGE RD
PORT TOWNSEND WA 98368
SUBDIVISION: Block: Lot: 4+
PARCEL NUMBER: 701044004 Section: 4 Township: 27 N Range: 01 W
CONTRACTOR: JOSEPH VAUGHAN CONSTRUCTION PHONE: (360) 379-9591
1775 CAPE GEORGE RD
PORT TOWNSEND WA 98368
Contractor's License JOSEPVC085J3 Expires 04/16/2007
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION NEW DETACHED SHOP WITH TOOL ROOM - NO PLUMBING - NO
HEAT
TOO ROOM IS 133 SQ FT
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION 31,678.00 ADD'L: HEAT TYPE: UH
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY:
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: OTHER: 133 SHORELINE:
CONST TYPE: GARAGE: 1,211 SETBACK: 30
DECK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 0 Prop: 0 AUG 2$
2006
Total: 0 Total: 0
Routing Date: l Jefferson County Planning
(.0 //5/0&&% & Building Department
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $461.95 KAS 06/14/06 83554
Plan Check $300.27 KAS 06/14/06 83554
State Building Code $4.50 KAS 06/14/06 83554
Total: $766.72
• •
SPECIAL CONDITIONS FOR CASE A BLD06-00343 6(44 0,04
ti I , CI(q/ (,
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 landslide hazard area 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 100-feet for the category II and 50-feet for the category III, 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.) Wetland & stream buffer perimeters shall be marked with temporary signs at an interval of
one per parcel or every one hundred (100)feet, whichever is less. Signs shall 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.) Critical Aquifer Recharge Areas may require special protection measures to mitigate water
quality degradation. The submitted proposal does not require additional aquifer
protection measures. However, during construction the project shall follow the Best
Management Practices (BMPs) and facility design standards as identified and defined in
the Stormwater Management Manual for the Puget Sound Basin.
10.) 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.
11.) The identified Fish and Wildlife Habitat Area (Type 3 Stream), shall maintain a vegetative
buffer setback of 100 feet. The setback shall be measured horizontally from the Ordinary
High Water Mark (OHWM) to the proposed single family residence.
12.) An additional setback of five (5) feet is required from the edge of the stream buffer area to
the proposed single family residence.
13.) A permanent physical separation along the boundary of the stream buffer area shall be
installed and permanently maintained. Such separation can include installing logs, trees,
a hedgerow, or any other prominent physical marking approved by the UDC Administrator.
•
14.) 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, faubets 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.
15.) 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.
16.) 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.
17.) The property owner shall comply with Water Conservation Measures (per list maintained
by the UDC Administrator).
18.) 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.
19.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
20.) Not more than two unlicensed or inoperable vehicles shall be stored on any lot 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 Chapter 18.30 JCC. Outdoor storage of three
or more junk motor 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 or Chapter 18.18. JCC, and such storage shall meet the requirements of JCC
18.20.100, Automobile wrecking yards and junk(or salvage) yards. In no case, shall any
such junk motor vehicles be stored in a critical area.
21.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
22.) Minimum setback from Dabob Post Office Road right-of-way shall be 20 feet. Minimum
side yard setbacks shall be 5 feet. Minimum rear yard setback shall be 250 from
commercial forest lands. If a Critical Area is present, then the more stricter setbacks shall
apply.
23.) Exterior lighting for residential uses shall not exceed twenty feet (20') in height from the
finished grade, excepting when such lighting is an integral part of a building or structure.
Ground level lighting is encouraged.
•
24.) Lighting fixtures shall be designed and hooded to prevent the light source from being
directly visible from outside the boundaries of the property. The intensity or brightness of
all lighting, during construction and after project completion shall not adversely affect the
use of surrounding properties or adjoining rights-of-way.
25.) The building height is not to exceed 35 feet.
26.) 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.
I:\F_BLD_Permit_Buildng.rpt 10/29/19
SPECIAL CONDITIONS FOR CASE A BLD06-00343•
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 landslide hazard area 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 100-feet for the category II and 50-feet for the category III, 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.) Wetland &stream buffer perimeters shall be marked with temporary signs at an interval of
one per parcel or every one hundred (100) feet, whichever is less. Signs shall 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.) Critical Aquifer Recharge Areas may require special protection measures to mitigate water
quality degradation. The submitted proposal does not require additional aquifer
protection measures. However, during construction the project shall follow the Best
Management Practices (BMPs) and facility design standards as identified and defined in
the Stormwater Management Manual for the Puget Sound Basin.
10.) 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.
11.) The identified Fish and Wildlife Habitat Area (Type 3 Stream), shall maintain a vegetative
buffer setback of 150 feet. The setback shall be measured horizontally from the Ordinary
High Water Mark (OHWM) to the proposed single family residence.
12.) An additional setback of five (5) feet is required from the edge of the stream buffer area to
the proposed single family residence.
13.) A permanent physical separation along the boundary of the stream buffer area shall be
installed and permanently maintained. Such separation can include installing logs, trees,
a hedgerow, or any other prominent physical marking approved by the UDC Administrator.
•
14.) VOLUNTARY MEASURES OFIPASTAL&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.
15.) 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.
16.) 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.
17.) The property owner shall comply with Water Conservation Measures (per list maintained
by the UDC Administrator).
18.) 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.
19.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
20.) Not more than two unlicensed or inoperable vehicles shall be stored on any lot 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 Chapter 18.30 JCC. Outdoor storage of three
or more junk motor 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 or Chapter 18.18. JCC, and such storage shall meet the requirements of JCC
18.20.100, Automobile wrecking yards and junk (or salvage) yards. In no case, shall any
such junk motor vehicles be stored in a critical area.
21.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
22.) Minimum setback from Dabob Post Office Road right-of-way shall be 20 feet. Minimum
side yard setbacks shall be 5 feet. Minimum rear yard setback shall be 250 from
commercial forest lands. If a Critical Area is present, then the more stricter setbacks shall
apply.
23.) Exterior lighting for residential uses shall not exceed twenty feet(20') in height from the
finished grade, excepting when such lighting is an integral part of a building or structure.
Ground level lighting is encouraged.
11)
24.) Lighting fixtures shall be designs and hooded to prevent the light source from being
directly visible from outside the boundaries of the property. The intensity or brightness of
all lighting, during construction and after project completion shall not adversely affect the
use of surrounding properties or adjoining rights-of-way.
25.) The building height is not to exceed 35 feet.
26.) 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.
I:\F_BLD_Permit_Buildng.rpt 10/29/1999
• • PERMIT # BM.
06 - 0343
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JEFFERSON COI1$1 'ON COUNTY DCDr� ' '
:. ►q DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
NO` http://www.co.Jefferson.wa.us/commdevelopment/ ,, r,,,
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# '4 PROJECT/APPLICANT NAME:
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.
C,rea\-e. .SF Z_ \A/J :�shr)f) (5,A A\C\\nr3
•
Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map.
pre,\rI`� _V.\e \c\ c �, \GvoQ.4" 21:2, `<1)(---C-�.-\0v- Vv i 1,---\ e_ ja-T
-kc��reL;\-.c-3 1--\ \\ \ c".1--, 1)1 y am`' `/_. c -\ '�'r-- y +P, �\\
v---:,
3. Describe the existing vegetation. Indicate native vegetation areas on the site map. I
C�J c" x V�'�� G��(' g� W 1 V1 .c-i vv e j`r;S'-eC I c Y ?Cis
r\\c \v\c:\\v-v Cc--1 cd Lee\cif, rrlr„\-)\ -�W .
4. Describe the existing soils. 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
applicable,and indicate acreage of each.
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A PPROVED
6. Describe any excess levels of noise generated by the proposed use or activity: STORMWATER PLAN
::_L.`y.), k 0 L;BSc:- ''\c_v r,rr-)t`'C t v-)C / 60,\`v't v,c A- ) c C , ti
AUG 2 8 2006
Storrnwcat JEFEE•i O OU Y
stormwater site plan template—rev.1 W1/2003 Required DE PT.OF I • E PME T
SIGNATURE: 7' 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.
`i \()nCY a U'K--) -ce_se tev\- vv i- -- m c\c S� �� �rc-6 m rV�nr1>>nc,
,cxc .c) -may ,tee- ,21 •� �c
8. Describe the general vicinity of the site,including adjacent land uses and structures, utilities, roads,and sensitive/critical areas
(streams,wetlands, lakes,steep slopes,etc.).
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Permanent Stormwater Control Plan
This portion of the Stormwater Site Plan consists of the selection and installation of the appropriate stormwater control BMPs
and facilities to remain in place after construction of the project is completed.
"Medium" size projects are required to have the totals calculated of all impervious surfaces, pollution-generating impervious
surfaces, and pollution-generating pervious surfaces to verify that the thresholds for treatment facilities and flow control
facilities are not exceeded.
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 from existing facilities.
c c cc y > c r�v �c�`-
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.
# Bin
12. Describe the flow control system.
86 - 0343
JEFFERSON UUUNIY DCD
•
stormwater site plan template—rev.10/1/2003 6
•
PERMIT RE
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13. Describe the water quality system. O
w 3 4 3N/1 ,
JEFFERSON COUNTY OCp JENSON COIINIY on
14. Describe the conveyance system analysis and design.
15. Describe the source of fill material,physical characteristics of fill material, and deposition of excess material.
16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
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17. Describe the proposed surfacing material.
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18. Describe methods for restoration of the site. /
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•
19. An Operation and Maintenance Manual is required for each flow control and treatment facility. [This is normally required for
"large"projects only and only those for which facilities are required to control flow or treat runoff.] If included,list the Manuals
here.
20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
ry C.
21. List other necessary permits and approvals as required by other regulatory agencies. If those permits or approvals include
conditions that affect the drainage plan or contain more restrictive drainage-related requirements,describe those conditions or
restrictions here.
stormwater site plan template-rev.10/1/2003
7
•
CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN(SWPPP)
The Construction SWPPP addresses sediment and erosion control during construction. The BMPs indicated by the applicant in the
template that follows must be installed on the ground during all construction phases of the project. The proponent is responsible for
preventing sediment and erosion impacts to environmentally sensitive areas and off-site areas. Consult the Construction Stormwater
Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet for guidance, particularly with rural residential
development.
SECTION I—CONSTRUCTION SWPPP NARRATIVE
1. Construction Stormwater Pollution Plan Elements. Describe how each of the Construction SWPPP elements has been or
will be addressed. Identify the type and location of BMPs used to satisfy the required element. If an element is not applicable
to the proposal,justify in writing. Descriptions of the 12 Elements are found at section 2.5.2 of the Manual(beginning on page
2-15).
12 Required Elements—Construction SWPPP
1. Mark Clearing Limits.
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2. Establish Construction Access. \ `
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3. Control Flow Rates. \
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4. Install Sediment Controls.
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5. Stabilize Soils.
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6. Protect Slopes.
PEST # BID
7. Protect Drain Inlets.
06 - 034- 3-
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stormwater site plan template—rev.10/1/2003
• •
PERMIT # BID
12 Required Elements-Construction SWPPP(continued) 0 6 0 3 4 3
8. Stabilize Channels and Outlets. JEFFERSON COUNTY Dco
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9. Control Pollutants.
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10. Control De-Watering(the act of pumping groundwater or storpwater away from an active construction site).
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11. Maintain Best Management Practices(BMPs). r
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12. Manage the Project.
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2. Adjacent Areas.
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential
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.
a. Description of environmentally sensitive areas that are on or adjacent to the site.
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stormwater site plan template—rev.10/1/2003
9
• • •
b. Description of special requirements for working in or near environmentally sensitive areas.
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).
5. Construction Phasing.
a. Construction sequence _
C_\E'c c rc%c t ti-> dry sec.1S0►rNS
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.
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II. Wet Season Construction Activities.
a. Proposed wet eason construction activities.
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b. Proposed wet season construction activities for environmentally sensitive areas.
7. Financial/Ownership Responsibilities.
a. Identify the property owner responsible for the initiation of bonds and/or other financial securities.
b. Describe bonds and/or other eGidence of financial responsibility for liability associated with erosion and sedimentation
impacts.
8. Engineering Calculations. Provide Design Calculations on a separate sheet for the foU(1y� n9,if applicable.
arstlpyte ,i Li Li)
a. Sediment Ponds/Traps.
b. Diversions.
c. Waterways. 0 3 4 3_
d. Runoff/Stormwater Detention Calculations
JEfu nsON Cliggy g.0
10
stormwater site plan template—rev.10/1/2003
a
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.
3W4, 3 ) 1 7 ) (-1
(LANDowNENDR AUTHORIZED REPRESE ATIVE SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES,IF NEEDED:
PERMIT # BED
0 -
JEFFERSO6N COUNTY034 3 OCR
12
storrnwater site plan template—rev.10/12003
O _JEFFERSO OUNTY .� �.,` w ),;; W
rra DEPARTMENT OF COMMUNITY DEVELOPMENT 9836$
`4 621 Sheridan Street • Port Townsend •Washington
,. 360/379-4450 •• 360/379/-4451 Fax �'���
4rilik
a404
1,9, (O IING www.co.Jefferson.wa.us/commdeveloprnent
Master Permit Application }�E�RSUN NuNR aCI1
MLA: Elp —3a/-1---
Project Description(include separate sheets as necessary):
DE'' tc.ic plea ))c>r: 0 l .,, n o P I IA fnbi 4 s - n e e1�CCL.f,
Tax Parcel I T • l L Wppbperty
Number: / �3E-,
0\ CA4 C)C // Size:
acr care feet)
Site Address and/or Directions to Property: 1 � �ON ? ( V
Property Owner(s)of Record: �;e �)1e.V qq �� r ��-
Telephone: 3� 37G n� G5 \ � �1 F2'>Yl��-1P �`\\
Fax: email:4 VC.ONS a
'-�
Mailing Address: 1� 5 C c4yllsLa , 1.�GtY)
Applicant/Agent(if different from owner):
Telephone: Fax:
email:
Mailing Address:
What kind of Permit?(Check each box that applies)
❑ Building ❑Variance(Minor,Major or Reasonable Economic Use)
❑Demolition Permit ❑Conditional Use[C(a),C(d),or C]**❑pingle Family 0 Discretionary"D"or Unnamed Use Classification
Garage Attached/ t 0 Special Use(Essential Public Facilities **❑Manufactured Home 0 Boundary Line Adjustment )
❑Modular 0 Short Plat**
❑Commercial* 0 Binding Site Plan**
❑Change of Use 0 Long Plat**
0 Address ❑ Road Approach ❑ Planned Rural Residential Development(PRRD)/Anlendments**
❑Propane 0 Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis Cl Shoreline Master Program Exemption/Permit Revisions**
❑ Stormwater Management ❑ Shoreline Management Substantial Development**
0 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
0 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 permits .
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 attomey's fees and
expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit.
I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any required later inspections.Aerr s and right of entry to this property shall be requested and shall occur only during regular business
hours.
Signature 6 ,+A�r _
�Ji"N^ _ Date: tO J ' 0 (0
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-trarlsferabl��si i ity for adhering to and complying with the ESA. The
// Applicant has read this disc "mer nd signs and dates it below.
Signature ft hn^ _ /�7(,/a r
"(� _ Date: l l�J
G:\PecmitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
• OWNER BUILDER STATEMENT •
The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be assuming the responsibility of the General Contractor for the proposed project.
Signature:si, �\(i,p,,( \, Date: V )Cc,l 0\-0
GENERAL •ar Rr II!SAC!�"MANUFACTURED HOME INSTALLER: PHONE: FAX:
se Ph 4:-.44.4fi hi,.n Co Asti,c_6 o,'1 ( ) ( )
MAILING ADDRESS 19.- s Ccpe, EMAIL:
CONTRACTOR'S LICENSE ' 2 WAINS
J GSL 1r �G `� `:� 5 NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Fra9e Type: Bathrooms: Shoreline: Type of Sewage Disposal:
&3"New ood Existing: _ 0 Sewer
0 Addition 0 Steel Proposed: Bank 0 Community System
Total: Height: ❑ Individual System
CI Alteration/Remodel ❑ Concrete Li SEP Permit#�
❑ Repair 0 Masonry
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well 0 Two Party
Type of Heat: Proposed: ❑ Public
_ unheaVO
Total: (' .4 C' Name of System:
tf this is a Commercial Protect 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:
0 Underground Tank ❑ Above ground Tank Size of Propane Tank:
❑ Heat Stove 0 Cook Stove ❑ Woodstove 0 Fireplace Insert ❑ Hot Water Tank 0 Pellet Stove ❑ Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No
When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property
lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system components,
including the reserve area.
Square Footage t+'O'Office Use Only 1''1 't•
Current Proposed Uf,
Main Floor Consistency teview: ✓ -,.` ,
2Nu Floor ( T°,11�' l�f4 1l Base fee: `�' f Iri
1
3"tl Floor Additional Section: __ _
Mezzanine: ,, iJ i, 1 r'.t' Plan Check fee: r j t
Heated Basement r'n State Surcharge fee: << r.: `r
,di.-�i9StIti t J
Unheated Basement Pot Water�Review fee:
Other Unheated 1` F r'rcc 1 911/Rd AAppri ach fee:
(51V.$1 �-l.S9-t\ci 'RAP 05 QS(47:'
Garage/Carport L,, i l t�C 3L 3 J� TOTAL: $ (r' ; 0, s . -,
Decks `
Receipt Number: ?�
Cash/Check Number: "
Other `
1.
Pate:
., -
ESTIMATED COST(REQUIRED)`, ,.. .. , h ,
.Fair market value of all labor and materials . nda ''1' 1 . { Lt�r 4. is. k,,
as l 3 l � .4 ./- ' initials _ *t�A . ,d
'--
GAP ermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
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anc)ica�tiI 41 sol�cl `��C'[ar woli�CQWp>
contact the Building Department
At 379.4450 prior to making changes
or revisions to the approved •la s
JEFFERSON COUNTY DCO
BUILDING PLAN REVIEW
❑ APPROVED AS SUBMITTED
$ APPROVED AS NOTED
❑ REJECTED 1I�11rr���
Date 1 Reviewers
NOTICE. Plans are approved excepting
any errors or omissions. All work must
pass inspection in conformance with
all applicable codes and regulations.
226
JEFFERSON COUNTY 0C9
Workshop at Tarboo Bay
1591 Dabob Post Office Road, Quilcene
Parcel # 701044004
Jeanette Mifsud and Joseph Vaughan
360 379 9591
y
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