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HomeMy WebLinkAboutBLD2006-00347 til1ILDING PERMIT APPLICATION ML Ty 327 Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00347 Received Date: 6/15/2006 SITE ADDRESS: 3501 OAK BAY RD PORT HADLOCK, 98339 OWNER: RENEE LINNABARY PHONE: 206-979-1646 3501 OAK BAY RD PORT HADLOCK WA 983399729 SUBDIVISION: Block: Lot: T1054 PARCEL NUMBER: 921191005 Section: 19 Township: 29 N Range: 01 E CONTRACTOR: WARREN ENTERPRISES PHONE: (360)732-7487 PO BOX 626 CHIMACUM WA 98325 Contractor's License WARREE*947BR Expires 1/19/2008 REPRESENTATIVE: TAMARA HALLIGAN PHONE: (360) 385-2628 PO BOX 862 PORT TOWNSEND WA 98368 PROJECT DESCRIPTION HTD ADDITION & DECK REMODEL TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP ADD MAIN: 899 VALUATION 110,000.00 ADD'L: 200 HEAT TYPE: EEE CODE EDITION: 2003 HEAT BASE: HEAT TYPE: OCCUPANCY: R-3 UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: 5N GARAGE: SHORELINE: CONST TYPE: DECK: 200 SETBACK: 70 BANK HEIGHT: 70 SEWAGE DISPOSAL: ALT WATER SYSTEM: PWELL BEDROOMS: BATHROOMS: Exist: 2 Exist: 2 Prop: 1 Prop: 1 Total: 3 Total: Rou//tin Date \JtTf_ Type Amount Paid By: Date: Receipt: Approved/Date _ Permit $1,049.75 LYK 06/15/06 83556 ,; r Plan Check $682.34 LYK 06/15/06 83556 State Building Code $4.50 LYK 06/15/06 83556 JUL 21 2006 Potable Water Application $55.00 LYK 06/15/06 83556 Jefferson County Planning Total: $1,791.59 & Building Department • • BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD06-00347 Received Date 06/15/2006 SITE ADDRESS: 3501 OAK BAY RD Issue Date 07/26/2006 PORT HADLOCK, 98339 APPLICANT: RENEE LINNABARY PHONE: 206-979-1646 3501 OAK BAY RD PORT HADLOCK WA 983399729 SUBDIVISION: Block: Lot: T1054 PARCEL NUMBER: 921191005 Section: 19 Township: 29 N Range: 01 E CONTRACTOR: WARREN ENTERPRISES PHONE: (360)732-7487 PO BOX 626 CHIMACUM WA 98325 Contractor's License: WARREE"e47BR Expires: 01/19/2008 PROJECT DESCRIPTION: HTD ADDITION & DECK REMODEL CALL IN FOR THE REQUIRED I SP TIONS THAT APPLY TO YOUR PROJECT. SETBACKS: OX 40 Lot UFFER: de Footing: Ok 7/4/ Foundation:6t/Di v Stormwater FINAL Approval: Underground Plumbing: N/A Underground Insulation: /f1 Shear Wall : 4-)c-1E2,v2 '�►/&-p2ws�, (J� 10,6/aG / Sheathing: g 3/q/07��,4 / Framing: U/FRMMIAZ 10/2D/OLk 414 3/4I7a7 Plumbing: elk 3/4,071W Propane Tank/ Lines: a N/A O 3 1 6f 1w aMQ1Z") Insulation: , JS t&044SECLceeveJT7*/1 P / 25 OT Sheetrock: 3/30/67 Septic Sytem Final Approval M T be obtained before final of structure can be attempted. Road Approach Final Approval: Zoning Final Approval: Final/Occupancy Approval: /gk -c c„a,1 14i3?gP 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 CASt A BLD06-00347 1.) 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. 2.) 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. 3.) 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. 4.) 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. 5.) MANDATORY MEASURES FOR AN AT RISK SIPZ: 1. For proof of potable water on a building permit application, applicant must utilize DOH-approved public water system if available. 2. If public water is unavailable, a qualifying alternative system may be used as proof of potable water or an individual well may be used as proof of potable water subject to the following requirements: a. Chloride concentration of a laboratory-certified well water sample submitted with building permit application. b. Installation of a flow meter. c. On-going well monitoring for chloride concentration. d. Submittal of flow and chloride data to the County per monitoring program. 3. If public water is unavailable, a qualifying alternative system may be used as proof of potable water. 6.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 7.) 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. 8.) 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. 41I • 9.) Outdoor residential storage shall a maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 10.) Not more than two (2) unlicensed or inoperable vehicles shall be stored on any lot less than one-half acre unless totally screened from view of neighboring dwellings and rights-of-way. Such screening shall meet all applicable performance and development standards specific to the district in which the storage is kept, and shall be in keeping with the character of the area. Screening shall meet the requirements of Unified Development Code (UDC) Section 6. Outdoor storage of thirteen (13) or more unlicensed or inoperable vehicles is prohibited except in those districts where specified as an automobile wrecking yard or junk (or salvage) yard and allowed as a Permitted Use in Table 3-1 of the UDC, and such storage shall meet the requirements of UDC Section 4.10. In no case, shall any such unlicensed or inoperable vehiclesbe stored in an Environmentally Sensitive Area (ESA). 11.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 12.) Minimum setback from Oak Bay Road right-of-way shall be 30 feet. Minimum side yard setbacks shall 5 feet. Minimum setback from shoreline top of bank is 70 feet. (Proposed garage, relocation of carport and SFR addition are located further landward behind the house and to the south of the house). 13.) 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. 14.) 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. 15.) The building height is not to exceed 35 feet. 16.) 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 • • Slope Stability Calculations (at Cross-section A-A) a 9 T # B L D 4 1 30 ft a111 4ON Weight(W) Native Soil 65 : Wedge_�el, [ Not to scale NTS)] iO4 Alpha=31 deg(60%slope) ( 1. Compute factor of safety(FS)against slipping-Static Case(Ref: "Geotechnical and Foundation Engineering- Design and Construction", by Rebert W. Day, 1999, page 10,28 FS=Resisting force/Driving force _[c'L+ N'x Tan(phi')]/[Wx sin(alpha)] =[c'L+(Wx cos(alpha)-u x L)tan(phi')]/[Wx sin(alpha)] where: FS=Factor of Safety against sliding(dimensionless parameter) c'=drained shear strength of the slide plane(c' - 350 psf for very dense silt stone-SM) phi'=angle of internal friction for dense sandy silt 30 degrees L=length of the slip plane surface(feet)=60 ft N=normal force, i.e.,the force acting perpendicular to the slip surface[(N=Wx cos(alpha)] W=total weight of the failure wedge(i.e.,W=gamma times the area of the wedge), lbs fora unit length of slope=(130 pcf)(60 ft x 19 ft)/2=74,100 lbs=74.1 kips u=average pore water pressure along the slip surface(psf)=30 psf for dense silt stone alpha=slip surface inclination(degrees)=31 degrees FS={(.35 x 60)+[74.1 x cos(31)-(.03 x 60)]tan(30)]}/[74.1 x sin(31]=(21.0+35.6)/38.2=1.48<1.6, Marginal (Note: There were no signs of slope instability on the embankment except near the toe of the slope) 2. Compute factor of safety against slipping for the Dynamic(seismic)Case, (Ref: Robert W. Day, page 10.64) seismic factor=b=.3(equivalent to 0.3 g's of ground acceleration) FS=[c'L+(Wx cos(alpha)-b x Wx sin(alpha)-u x L)x tan(phi')]/[Wx sin(alpha)+ b x Wx cos(alpha)] ={.35 x 60+[(74.1 x cos(31)-.3 x 74.1 x sin(31)-.03 x 60)]tan(30)}/[74.1 x sin(31)+(0.3 x 74.1 x cos(31)] =[21.0+(63.5-11.5-1.8)x0.58]I(38.2+ 19.1) = (21.0+29.1)/57.3=0.87<1.00, Marginal (Note: There were no signs of slope instability on the embankment except near the toe of the slope) Slope Stability Analysis for property located at 3501 Oak Bay Rd, Port Hadlock, WA 98339 Prepared for: Judson and Rene Linnabary 3501 Oak Bay Rd,Port Hadlock,WA 98339 do Tamara Halligan(360)385-2628 Prepared by: Morta Engineering&Testing,POB 250,Ocean Shores,WA 98569 (360)289-0958, (800)590-0958,(360)289-9682 fax,Smortai AOLcom May 13,2006 Analyzed by: SPM Page 2 of 2 • jfRilb # C- (..50 a ` 0.1 0 34 7 ¢$4N G, a 'p /: %\ JEFSF,+ERSON COUNTY► DEPARTMENT OF COMMUNITY DEVELOPMENT PERMIT Rill Itp „ 621 Sheridan Street • Port Townsend • Washington 98368 0 6 - 0 4 1 4'43/ozawis360/379-4450 • 360/379-4451 Fax NC` http://www.co.jefferson.wa.us/commdevelopment/ ifffERSIIIV COUNiY BCD STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# 0(0'3�^7 PROJECT/APPLICANT NAME: J U p SO i t R GN G U LI N I JA$A RY 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. Perryii;-f #I — REPOPE:i- / T711/4/& M 15 C £xr ;v t l viNCe Agef- r ouc'r1N r Ce,64174)4w ry ,'"117- 1.10 tief2(1 sr/1.\1 S'Nc, ' 4 AP:7 ,,,J::r✓ E 7civ,zi( Jt) IGUS r. p(1'i i r*3 - NEA) 51-10 F -PCPmil ALL Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. Loy.) cL OPt -1-0 7pt J3ActJIL r,gu. r 8c F T Fta fri ..fir 40 �-;.. 5e SIT P� t,i`t � O i l I fv i( L ro r STE-vE N-1 P, M n g T, 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. E V 6V, �E K) T-g s ivr ro f, ar. LOT- , cLE A 1 NCa /sv 1r-I 4. Describe the existing soils. Indicate soil type on the site map. poi - UNPE NEAT --11-1 r FC SE JIL ?INCo 5IFE coNslsr-. O .17- A PAE� R IN)fJ NttTlV>✓ HATER/AL 6Pi,F3C i l__ 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. INATE12 PeAJNS NArU PA c.Li D5 EAT N SUM 2 POUAl S EpA�CE 1oM SIDE or litLL 7`ow/IrDS -ra F CF St D� 6. Describe any excess levels of noise generated by the prqp c�¢y -.-- N6 EXC�S�iUG rJOi'9 1`i.Cr � �� 77. STORMWA"1'ER PLAN - Stormwater \ Required, rJtJN 3 0 2006 JUIv ' J `}�� Jpt:;ENY stormwater site plan template—rev.10/1/2003 JEFFERSO DEPT.OF CO j 0 T E 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. Mope A-re L'( STE 4 sLo-F5 TAM 5EA Tr ttWUS . 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.). N6101413oPIN& fio r-Tie5 HAVE Sflqlt,teir (_uND(TIOV i 1(-i 40U S ES Lo rAr i) fir fO OF Si 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. ALL STogM IPA 71E .ON\ SLR WILL `(1 oo Lica_ KI ET) ()V'E P-- E SAM 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.] Nod E au 11. Describe the performance goals and standards applicable to the project. P �f 6ili i a :; 12. Describe the flow control system. ty ii f/I U`� si N JEFRHS0111 COUNTY DCl� stormwater site plan template—rev.10/1/2003 4 : t ! 6 •;•tag=Nc )�' / ` '1! f ++' PERM BLD PERMIT -# Rio s"5 4 (4 1 �i�AI7V 13. Describe the water quality system. �J t1T7 Ma WF L<L. V/A—r R rritBYr s., ' . ,eft 14. Describe the conveyance system analysis and design. Ti6,HTLINE w/TAP fP_ M 6UTT rS + ENCI4 pRattJS `Fa PI '. ovE '-- TH f3ANY. 15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material. N0 l'ILL 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. t2-APE u 1Lp INCH 5)-Fe TO f3&A I N./co IG-F P TOPSOIL ' PA-?AT4'7,d p.. 'LA-- V OVA—JD ScT1- • 17. Describe the proposed surfacing material. 6f2 Vr✓Is AT 7F'-1 V4NA` "S NATUjef L., V C,ETATI0 18. Describe methods for restoration of the site. MATU2'AL LAHJPSCPsPibJG 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. / AU/ 20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan. 5Ee CoEcTecHcvi?cAL ?e F'CRr e( ,5T�`V tJ P. MoR-TA. 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. e. ''Ttc 'Y ' rir J u N w 5 t1006 1; 1 i stormwater site plan template—rev.10/1/2003 L— • • 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. MA gi= +ri4 rL 4-to5 A-1- 1,f'Q ARE/41- 1.,1NES AT Ul(...D/}U( 5/TES. 2. Establish Construction Access. x/STts)C, Diutc wAy 3. Control Flow Rates. 055 (;,,o7 T J L_e SILT FE1U(ES 61J U(50/A) L.L 5-/0E of l/TE5 T2( 773 PEr?,g'/ '1 — W 6 Pt - PUgIIJCo ?" MOIV77- ; 4. Install Sediment Controls. AM Y SugFI-cam w r ?4/ J© Dogi ca 6-ONST?UCT1ON ALL 5E P1er C_T I) -mum THe pVN a F- PO`ivN 6 tuiCD c;14 B- 1 5. Stabilize Soils. 6. Protect Slopes. �o Nor �r✓MOV A11 1 KIST C° VU(oE r21 TIOC] 1<J sr� sc P-ES .- 7. Protect Drain Inlets. NVM BUT t; a 4 0 JEfunlijN COUNTY OCO storrnwater site plan template—rev.10/1/2003 8 • HERMIT A RtD *EMIT A OLD , 4 5 12 Required Elements—Construction SWPPP(continued) aii d C E-f .16 It COUNTY E 4 U 8. Stabilize Channels and Outlets. e co v 1 eN b (NST1 L L PITI 0�J O 4 �lr p o/5\ Pr e e cT ra 7H; 'TOE' oF 7T-4 6A C w Ff. . -e EX L Sri rv6, eiep .X( Sri 'SPAIklPO l� 9. Control Pollutants. 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). to s:r is sc..oPEP i- 7-1.> 1- PUMP! LAJ o N' .(" Q U I I� 11. Maintain Best Management Practices(BMPs). 12. Manage the Project. _;65 CA"PTA1 I To 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). AP3A CPity tV S ApF 4fJD MLA 3 1:9ELA TI kl `r ? JAJ Ar-� -LT P i b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). H a STe-eA 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. r�o E.Nv1�aNM y- 5- wsV l /E A-eel .5 JUN 1 5 2006 stonnwater site plan terrplate—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). Al-I RC sd-l6'rv5 516N 6 F _ ()ME 5 I ((HT :.nPIIJC, 5. Construction Phasing. a. Construction sequence have 5HWD - 13UILP ADC) T1ONJ - FUILD SHOP b. Construction phasing(if_proposed) 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). 1. Provide a proposed construction schedule. T coNSZ?UGTI0/J INJ 1UL( II. Wet Season Construction Activities. a. Proposed wet season construction activities. INTO-►0 Imo- U o-2- ;- b. Proposed wet season construction activities for environmentally sensitive areas. 7. FinanciaVOwnership Responsibilities. a. Identify the property owner responsible for the initiation of bonds and/or other financial securities. Jut:)soNi ANr k'- '�► E LINNA' Y b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable. a. Sediment Ponds/Traps. N/x b. Diversions. 4f R h� �' c. Waterways. d. Runoff/Stormwater Detention Calculations &re Pre-C 4 mo ?Tr- J i-tn1SUN CDDN(Y DCD : 0 . 4 5 stormwater site plan template—rev.10/12003 J E F F L H S U N COUNTY O C D 10 • • PIRMIT REP • PERMIT # RLD R 0 4 5 SECTION II—EROSION AND SEDIMENT CONTROL PLANUIti� fiCti 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 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. i. Delineate areas that are to be cleared and graded. j. 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. 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 outlet/inlet. g. Detail controVrestrictor 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. m. 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. i y1 JUN 1 5 2006 storrnwater 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. • 6., CD (LANDOWNER OR AUTHORIZED REPRESENTATIV IGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: • PERPIT • BLO! 0 ,5 4 7 PERMIT # Bin J Utt CUIJNJY BCH 0 0 3 4 5 JEFF[BSON COUNTY OCO 12 stormwater site plan template—rev.10/1/2003 ,enik N cod JEFFERSWCOUNTY ' t;� ;' ' - W � A DEPARTMENT OF COMMUNITY DEVELOPMENT '' \ '4 621 Sheridan Street• Port Townsend•-Washitagton 98368 360/379-4450 • 360/379-4451'•t=T6X . ; q�tp' . www.co.jefferson.wa.us/commdevelopment -__J Master Permit Application °----'FIDP .gENY �t _ 3 2 pp MLA: 0 Project Description(include separate sheets as ner•Qssarv). T !2 a—WOO Ill gictf6PaXISTI No _14gp)gr 71t Rc-4;Ell BY A' pl'`� P gsVfoDE L Tax Parcel Number: / Z // / DO"J Property S Size: �-S'j (acres quare feet) Site Address and/or Directions to Property: 3i,0/ OAK 13A.r RD. doer RApLoctc, w, 16337 qjg:3 Property Owner(s)of Record: JUPSON 1. E,ta1£6 up NA-BA jZr- ��pp Telephone: I- ZO(D•g /(47/• , Fax: --- email: i�OlegLfnnabar a� Mailing Address: Pr fl'\ Al16ahce One Inc- Applicant/Agent(if different from owner): - A C 1 - #-+A 1—I G 4/V • -C4-I[ ' C7" Telephone: D d 3t)S • ZCo Z,) Fax: _ email:"�a I I j qa Ytt d O�j Ini i . LJ— Mailing Address: f f, 3t X 8(p7_ tar Ij(I N S UA3 jM fA G3 D3 - <J cJ 1S� What kind of Permit?(Check each box that applies) EYBuilding ❑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 ❑ 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 Ii Road Approach 0 Planned Rural Residential Development(PRRD)/Amendments** ❑ Propane ❑ Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis C 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 �p Please identify any other local, state or federal permits required for this proposal, if known: 'A -t� r� DESIGNATION OF AGENT I hereby designate I tl HAL.L/6o,4 Alto act:as my agent in matters relating to this1ppli tion for permit(s). OWNER SIGNATURE �1 f� Date: Z(� (/ By signing this application ,the owner/agent attests that the informatior 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 equired later inspections.Access and right of entry to this property shall be requested and shall occur only during regular business hours. Signature: L.---- Date: 4Q7(e/e, The action or actions Applicant will undertake as a result of th ssuance 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 respons. ility for adhering to and complyi ith th SA. The Applicant has read this disclaimer and signs and dates it below. Signature: G7-----27L- Date: WC& G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc /' • BUILDER STATEMENT • ' \ \ ----' The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed project. :0 \ \ Signature: /� A— _ Date: \c\' ' ' CI' GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAx: ,`J�-w ) ( ) ( ,'' MAILING ADDRESS: k1I A.rP A) etiT-Ee PF iS E C EMAIL: CONTRACTORS LICENSE WAINS NUMBER: NUMBER ' • ARCHITECT/ENGINEER: rlfflA gA Wit LU G 74 N1 A < f..r PHONE ( ) FAX: ( ) MAILING ADDRESS: �r II II!! (+ I']. WA �, T #7� /G, - EMAIL Project Type: Frame Type: f Bathrooms: Shoreline: Type of Sewage Disposal: , ❑ New ('Wood Existing: 2 ❑ Sewer • ❑ Addition 1 i Steel Proposed: / Bank Height: ❑ Community System ✓'Alteration/Remodel 1 I Concrete Total: C�Individual System _ t ��ci ❑ Repair [_i Masonry �U SEP Permit# C j 6--1 ❑ Demolition [l Other: Bedrooms: Water Supply: Existing: Z Setback: Private well ❑ Two Party Type of Heat: Proposed: I 1� I El Public Total: 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: Li Underground Tank I 1 Above ground Tank Size of Propane Tank: ❑ Heat Stove I l Cook Stove ❑ Woodstove [1 Fireplace Insert ❑ Hot Water Tank [1 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 • or • ice Use Only Amount Revision Main Floor Heated ,_1 4 r?R/q3-1 EH Bld App Review: �, f 15Cs2 � .GJ 2"tl Floor Heated 00 L�C1.Z� Consistency Review: l -A33 oi: Other Heated Base fee: Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: .2 �—'Cj Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd pproach Other TOTAL: $( _I, -L; Si Receipt Number: 3e--3- Co t Cash/Check Number: ESTIMATED COST(REQUIRED) +�f ",-. _--`Date: •Fair market value 11-1a 'on to finishs —\ --' —00 1) Initials: G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc , . . .. . , .. 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