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HomeMy WebLinkAboutBLD2006-00410 CERTIFICATE OF OCCUPANCY Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 (360)379-4450 FAX (360)379-.4451 (800) 831-2678 PERMIT #: BLD06-00410 SITE ADDRESS: 1802 DABOB RD Issue Date: 08/15/2006 QUILCENE, 98376 Final Date: 10/30/2006 APPLICANT: RONALD D WEBER PHONE: 360-620-5884 GLORIA J WEBER PO BOX 429 CHIMACUM WA 983250429 SUBDIVISION: Block: Lot: TX 12 PARCEL NUMBER: 801213012 Section: 21 Township: 28 N Range: 01 W PROJECT DESCRIPTION: NEW M/H (GREENBRIAR) SERIAL NO. 9U910259 THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2003 EDITION. OCCUPANCY GROUP: menu fOCj,1 re d //bm . 15u,1T o /'/'sl l_ TYPE OF CONSTRUCTION: hJ pQe.lic p toti SPRINKLER SYSTEM yes no THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 10/30/2006 46,d'akit)41- /G, i/O&- Building Official Signature Date 1:\F_BLD_Occupancy.rpt 1 0/29/1 9 • . MANUFACTURED/MOBILE HOME INSTALLATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD06-00410 Received Date: 7/17/2006 SITE ADDRESS: 1802 DABOB RD Issue Date: 8/15/2006 QUILCENE, 98376 APPLICANT: RONALD D WEBER GLORIA J WEBER PO BOX 429 CHIMACUM WA 983250429 SUBDIVISION: Block: Lot: TX 12 PARCEL#: 801213012 Section: 21 Township: 28 N Range: 01 W CONTRACTOR/ GOLDEN HOMES OF POULSBO PHONE: 360-697-3456 DEALER 19647 VIKING AVE NW POULSBO WA 98370 360-697-4606 Contractor's License GOLDEHP950KB Expires 5/18/2007 PROJECT DESCRIPTION: NEW M/H (GREENBRIAR) MAKE: SKYLINE YEAR: 2006 SIZE: 44 X 27 THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 8/15/2007. CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. Set 4cks/Footin (CONTINUOUS FO T NG, SLAB or f?qD US D): t Stormwater FINAL Approval: Blocking/Plumbing: bk-{�/t-t -(o of I' Propane Tank/Lines Zoning Final Approval: Septic System Final Approval (If not on sewer): Road Approach Final Approval: 0`� GV-01 Final/Skirting/Vents/Porches/Steps: ie) U� HEALTH DEPARTMENT AND PUBL C 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 APPLICATI!N MLA06-00395 Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00410 Received Date: 7/17/2006 SITE ADDRESS: \jQ?-DABOB RD QUILCENE, 98376 OWNER: RONALD D WEBER PHONE: 360-620-5884 GLORIA J WEBER PO BOX 429 CHIMACUM WA 983250429 SUBDIVISION: Block: Lot: TX 12 PARCEL NUMBER: 801213012 Section: 21 Township: 28 N Range: 01 W CONTRACTOR: GOLDEN HOMES OF POULSBO PHONE: 360-697-3456 19647 VIKING AVE NW POULSBO WA 98370 Contractor's License GOLDEHP950KB Expires 5/18/2007 REPRESENTATIVE: GOLDEN HOMES OF POULSBO PHONE: 360-697-3456 19647 VIKING AVE NW 360-697-4606 POULSBO WA 98370 PROJECT DESCRIPTIOI' NEW M/H (GREENBRIAR) TYPE OF WORK MOB SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION ADD'L: HEAT TYPE: EEE CODE EDITION: 2003 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: OTHER BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 3 Prop: 2 Total: 3 Total: 2� Routin Date: o-FE6 �� Type Amount Paid Bv: Date: Receipt: Approved/Date Manufactured Homes $163.00 LYK 07/17/06 83777 , Potable Water Application $55.00 LYK 07/17/06 83777 (I , .f i Total: $218.00 AUG I'4 2 Jetfersor 1*.:(:)Lirity F'darmir 1 BwIdm Department • • SPECIAL CONDITIONS CASE # BLD06-00410 1.) The application was reviewed by the Jefferson County Department of Community Development staff on August 3, 2006 for the potential presence of Environmentally Sensitive Areas (ESAs) under the provisions of the Unified Development Code (UDC). After an initial Geographic Information Systems mapping review and an investigative site inspection, the following ESAs were confirmed to be present on the subject property: osprey; SUSC aquifer recharge area. 2.) Aquifer Recharge Areas in Jefferson County are characterized by porous geological formations that allow percolation of the surface water into the soils and the underlying zone of saturation. Aquifers are geologic formations that contain sufficient saturated permeable material to yield significant quantities of water to wells and springs. Aquifers serve as the source of drinking water within most of the rural portions of Jefferson County. 3.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to groundwater aquifers. 4.) 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. 5.) The applicant is proposing to create or add 2200 square feet of impervious surface and 1700 square feet of land disturbing activities. 6.) The project shall adhere to the Best Management Practices (BMPs) to control stormwater, erosion and sediment during construction. BMPs shall address permanent measures to stabilize soil exposed during construction, and in the design and operation of stormwater and drainage control systems. 7.) A Stormwater Site Plan has been submitted and approved by the Department of Community Development. Once the subject permit has been issued the applicant shall fully implement the provisions of the submitted plan and contact the Jefferson County Department of Community Development to arrange a schedule to inspect the property for plan compliance. A Certificate of Occupancy will not be issued until the Department verifies plan compliance. No clearing for roadways or utilities shall occur on the project site until clearing necessary for the installation of temporary sedimentation and erosion control measures have been completed. 8.) Jefferson County determined that this proposal is categorically exempt from review under the State Environmental Policy Act(SEPA) pursuant to WAC 197-11-800(1)(b)(i). 9.) The site plan as submitted with the manufacture home installation permit application on July 18, 2006 has been reviewed for consistency under the UDC, and has been approved by Jefferson County Department of Community Development. Any modifications, changes, and/or additions to the stamped, approved site plan dated August 3, 2006 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 10.) This approval is for a manufacture home only. Any future permits on this site are subject to review for consistency with applicable codes and ordinances and does not preclude review and conditions which may be placed on future permits. 11.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 12.) Not more than 2 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 3 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. 13.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 14.) Minimum setbacks from Dabob Road and Old Tarboo Road rights-of-ways shall be 20 feet. Minimum side and rear yard setbacks shall be 5 feet. • 15.) 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. 16.) 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. 17.) The building height is not to exceed 35 feet. 18.) A minimum of two (2) on-site parking spaces shall be provided for the manufactured home. 19.) The parcel has been designated as RR 1:20 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 20.) An address of 1802 Dabob Road, Quilcene has been assigned to the parcel. Dabob Road is a county minor collector(C348808). 21.) A well review (USR06-0057)was approved on July 26, 2006 for an on-site individual well. 22.) A septic permit(SEP06-0141) was approved on June 25, 2006. A road approach (RAP06-0151) will be issued with the building permit. A well review(USR06-0057)was approved on July 26, 2006. 23.) Per email dated March 15, 2004 from Jeff Davis, WDFW biologist, Osprey are no longer a priority species. JACK WESTERMAN Ns Jefferson Oily Courthouse ASSESSOR PO Hoyt 1220, Port TowRI W 9a3Ga 13601385•9105 MOBILE HOME INFORMATION FORM JUL 1 8 'A ;; OWNER'S AME/MAILING ADDRESS: NAME: ' Dr\ 4- l` 1)r t CA-.- l.�✓(3 -'_^K� df frEI1Jo'I Lill nnrr ADDRESS: P E C) ? C' (r ! mVa r I( rr- (Av} (. 3 up PHONE NO. 0 --- , ' K('1- The purpose of this questionnaire is to obtain information regarding either the current location of a mobile home or the previous ownership and location of a mobile home. This will help our office determine whether the mobile home is already on the tax rolls in Jefferson County or if it has been moved to this county from another area. 1)MOBILE HOME DATA: (A) MAKEC . -t.'y t"�' (B► MODEL(ce , y, V t � 4 � a"1 �r 1�. (C) YEAR (D) LENGTH + (E)WIDTH (F)SERIAL # (G)YOUR PURCHASE PRICE (Do not include sales tax ��0)� f PURCHASE DATE /i 2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3) (A) FROM WHOM DID YOU PURCHASE MOBILE p IL - 4991/(L S ADDRESS \ "1 b 1 OLCZ,n A.A. (, S6 0 (B) WAS MOBILE HOME ASSESSED IN JEFERSON COUNTY LAST YEAR? Yes No If Yes, Previous address of mobile. If No, What County was Mobile assessed in last year. 3)WHERE MOBILE HOME IS TO BE LOCATED: (A)WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes lNo (B)IF LOCATED IN MOBILE HOME PARK: NAME &.ADDRESS OF PARK Lot/Space # (C) IF NOT LOCATED IN MOBILE OME #'A NAME OF LAND OWNER: -Kon, £ ( 0 r _ LOCATION ADDRESS I 1.DC)(> RO(1ALd , (kIke n e k.- - REAL PROPERTY PARCEL #/DESCRIP 3TION qc)) A I - 0 fo -kk, THANK YOU FOR YOUR HELP! nre of app c t ASS-F_Q Q_ JO COSSELL, Property Technician • e_a LC.....,c. e cn I. OCI a c..a . . e-•! o mu ido owCI* Ip�MaMM/iM1 6i- AaMIIMPAM1 - "-I �MIgM'•MMI Ly./ " 3 nak.` i.i ' UM Wit Z . , _ ai 4 Mi. - 0 W. i -.:aaMP• - i s_imaf a i �aaMa1 0 -sin nrrizeinup-- ®ioiiiiI I Oh swesmo sae WI. aaaaa.Naedaaaaa1•:. I Maa51.MI aaN}4Yaia■1 . a III Ia'� aaaal c 2 M MI 117aaaaaaaall MI MI fy1111a••aaaa• ,_O • CZ�i uant N34NY9 d1 Q Z.. m? E7Ga»MN� M M CD2 f mum iaaM= • aaaaaaarMMMaMMaMaM aMManuMaaMMMaaaMM /- 9 C MaMaaaM■MMaMMaaaaMM cc --------- aMMM�aaMaaa aMaaaM 2 MMMNaaaaaMaaaM MI MEN aMaaaMaMaaMM = maMMaaaaaaaaaM �' NNE- aaaaauaaM -J ��'0a aaaMaaaaaM g SinV, MMMMaa..MM fM aaaMaMaaaaaM. Cu MN UMaaa.UMaaaal W NI-mu. \aaaaaaal +� NMI �MMaaaal = G * O �����C4�4y+� MMaMaI Q _ 11aaaaaa'cr0 7RNIMMI o 03 .. • IUUUUUUUI►UMMINiiil - oce i UHUMMEM\N�IIMMININI S 0°r° m naaaaaaaaaaaaaaal S N d J c 9 Q.gilt AN1NYd OC Ir-�. O � a ® IX ,� iir MM..P1111•1111Ma\al I IMaaM�l uM■o• 1+- N co M oo 7 Q Z o do N W Z o co •V • m coO O N z^y ,ti4: : .. . W 0 .. �I O II f=- iI I a 1 ;I • I � ozv o II, off, JEFFERSON COUNTY tiY `i 4ce r� DEPARTMENT OF COMMUNITY DEVELOPMENT ` 4,. E]I V A D '4 621 Sheridan Street • Port Townsend •Washington 98368 �. ,� 360/379-4450 • 360/379-4451 Fax �,� 020 www.co.jefferson.wa.us/commdevelopment JUL 1 8 2006 Master Permit Application '� JEFFERSON fi, -- 7 Projept Description (include separate sheets as necessary): t.llUtl l l ems✓ Tax Parcel Number: r' Property � -T) l Size: Lj• l C { ' 1 3:Si CN: (a e� s/square feet) Site Address and/or Directions t roperty: r (r 0 Property Owner(s)of Record: (�• r�-� 'f -). ) \-_ l��t Ile_ t t2 Telephone: it;)(! -4'Z a--5 4K S "f F'ax: ,. email: Mailing Address: R7 i2 x L/r Cf e 4 l f c.C (IL IA-N\— Applicant/Agent(if different from ow en r % /� `� `�(.t Telephone) 4i)-(Q �� t t- L ' ,� F7 i ( �� Mailing Address:J� -1 l0 t�.l As)1 le j t rj b Li)* iN 3 10 =+t_- i,ti Fh^" cii c1 CD vk What kind of Permit? (Check each box that applies) ❑ Building ❑ Variance(Minor,Major or Reasonable Economic Use) ❑ Demolition Permit 0 Conditional Use[C(a), C(d),or CI** ❑ Single Family ❑ Discretionary"D"or Unnamed Use Classification ❑ Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** A.Cmanufactured Home ❑ Boundary Line Adjustment ❑ Modular 0 Short Plat** ❑ Commercial* 0 Binding Site Plan** ❑ Change of Use ❑ Long Plat** ❑Address ❑ Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑ Propane ❑ Plat Vacation/Alteration** 0 Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management 0 Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination (SPAAD)* ❑ Shoreline Management Variance 0 Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* ❑ Jefferson County Shoreline Master Program Amendment 0 Forest Practices Act/Release of Six-Year Moratorium *May requite a Pre—Application Conference ion Please identify any other local,state or federal permits required for this proposal, ift known: erence 1 DESIGNATION OF AGENT I hereby designate_ ) to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE An�� I IFS %HA Date: ,4-) I I 1 1() By signing this application form,the owner ent attests that the information provided herein,and in any attachments, is true and correct to the best of his,her or it's knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs, reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application review and any r u'ed-later inspections.Access and right of entry to this property shall be requested and shall occur only during regular business hours. Signature: _ 11. yt Y-Yr Date: 5 /(1 i l,.Jj.�/The action or actions Applicant willke 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 ompliance 'th th Jefferson County development code.The Applicant acknowledges that he, she or it holds individual and non- transferabl resp sibili for dher,' t and complying with the ESA. The Applicant has read this disclaimer and signs n dates it below. Signatures r.� / 4 (+ ;t�l v V V \ Date: _LA l Ly • • BUILDER STATEMENT The signer of this }a -eent do ereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and thai they will be ss g the r sp6 sibili the General Contractor for the proposed project. , //7 I� "1 Date: / 1 ( / Signature: . 1 (AENERAL CONTRACTOR OR MANUFACTURED H E INSTALLER: PHONE: FAX: y MAILING ADDRESS:[ l�j� ( U I / yr, tkU _ iv o 4-,,,i2o EMAIL: CONTRACTORS LICENSE 1 c j' S'- 7O WAINS // NUMBER: UCA_� .4- p4� Sv t4- NUMBER /.�'S`( L.� ARCHITECT/ENGINEER: PHONE UV )4_f 7. y56-Ax:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New ti Wood Existing: ❑ Sewer ❑ Addition c Steel Proposed: Bank Height: ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: ,- 3- Individual System ❑ Repair ❑ Masonry SEP Permit# 067 " 1 ci I ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: -a Private well ❑ Two Party Type,of Heat: Proposed: ❑ Public t.e c*1Z rr 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: ❑ Underground Tank ❑ Above ground Tank Size of Propane Tank: ❑ Heat Stove ❑ Cook Stove ❑ Woodstove ❑ Fireplace Insert ❑ Hot Water Tank ❑ 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. c" u �* 3 4 1 s � 3 Square Footage Current Proposed . * � _ � .., !> } .s �� �'='� = b0o� T= Main Floor Heated I e. EH Bid App Review: CO r •F< 4v�w J �a '"' k x Consistency Review: 2 Floor Heated I 53 Other Heated Base fee: F (03 Mezzanine s,, Additional Section: — Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: 9 6 Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $ (0R3 • Receipt Number: -`:2)1.--)'--) • Cash/Check Number: ESTIMATED COST(REQUIRED) Date: -- �(( .Fair market value of all labor and materials foundation to finish I l`-`� Initials: 17 G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc It ICED iF i f el �, JEFFERSON COUNTY 0 € :: C DEPARTMENT OF COMMUNITY DEV -OPMENT 621 Sheridan Street• Port Townsend-Washington 98368 y 360/379-4450 . 360/379-4451 Fax JEFFERSON http://www.co jefferson.wa.us/commVebpment/de COUNTY � � STORMWATER SITE PLAN SUBMITTAL TEMPLATE I M # j /- t `/^�`� PROJECT�APPUGANT NAME;e ( �(�`1L s. Please answer all of the following Please may e to either incorporatequestions to the best of your ability.plot the question calls for depiction on a site map, the the elements into the general bt plan for the Master Land Use Application or to submit a applicantplia may choose pelan map. Project Overview 1. Descrbe the proposed developed conditions of the site. Indicate site map. position and relative size of proposed improvements on the SCWECN , u)vJ4 8 ni I. . ,. r _ I S d'Up b S1upc Qv of Ru.� ' o if iAJaV-d + h aCk prJl�Lt Gf� fiv VLtjs�rre Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. VOAR,Ve. -hAe. KWYUZ i c plA C to 4-.Q i-e j S a C l l k- h, kiI - Tht- "- evl-1/ s th v CS 1A(1 w2 a . Lt S kJ c -.01 vo 1/1.(S VYt c a . Vl ra �.,-G€d�-f'Ie CL� 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. g►2c(SS, A vu sk, e velecj V -e,e.4f-1 c', ,tcLui-s 4. Describe the existing soils. Indicate soil type on the site map. vOAli.t< voy, a irCt t I/1ifle La,a.14‘e(ititt,(4 rs to CQ a i i s 011i . MI,C a ("-e PYIsl-1'1M0� Ctk Ivi f eta a rS J - el IQ-1 - 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 Depict separate drainage basins on the site map, ifapplicable,and indicate acreage of each. hthivtk usi 11 b G f)(4 CQoL all (4 c I I.1--e, ki lit 1Jot ov cpou f ot3---4 c lid tm u ti0 is l t -1\wa V Q to AOc to}t-e v t 1-a, 1� 11��`-e ;� ap p�-C�.�S tv a�e �iv,.e. t.c.rc���- J1?,k►� 0 f� � 6. Describe any excess levels of noise generated by the proposed use or activity; imoott rate- vlot'se,____n ►poise. wi I be AED SMRMWATFR Pi AN r\`' Require AUG - 3 2006 Storrnwat riAP's stormwater site plan template—rev.t D/12003 j rr 5 t 1EFFERS OU iT DEPT.OF O. EV P ENTr SIGNATURE: i • 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 nn tha city man �� e ( ^ /� f ` 0o5 .-4 P. S i M.'a 5 1 7 „l�/�''9 11 f'¢6t / �Lf -fie areas v�nU. V oi- be-I th cliu,vfilaeal Q{ �.c�v�r rn wra, -e ' e�1 h vtl �m Y dam. U by uia t� . :-�-�VI 1\ seess v��t� � a � � indu 6►K dv-cant i-e(ol a 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. . Ct4�/1 fits' r — o1 '� r ' c r e 'er pII 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 facilities site or sfropecific threshold discharge areas 9 facilities.within the site. Locate these facilities on the site plan and differentiate proposed ,rl ins-l vt WI (,I ht (fit S f t LP of AP a Kid ,0 h s/OOCL it- lea O(= . 10. If the project requires the use of stormwater treatment facilities,describe the types of stormwater treatment facilities proposed for use on the sffe. 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. occavaruSVt j S fiu 1oc. Y t vi t VYLa I Cl vt of SO i I + lrtak i s a t-Stu. 9-e-d- IS ma(v)lt foe- d►elt-tWG,9 alitd pay K1 lj c wtc( 1K2 146rAt. t3v P W°U taSCct dukg.1 *1l S pmAer-- sov.te,t S-ed at ��Q \ s ainr� si 1t sin ULOt 12. Describe the flow control system. time uced . BtAKVY'S AvLd Stret tau LA + UI loe- used as • t 5 Y 6 stormwaler site plan template—rev.10/1/200S ' • 1111 13. Describe the water qualtiy system. - , j� 'ta t; �R-bS1 _ ' '' Z avw4 wa}-I- ,,v) 0 I-E 1f1 q. l lot a i- Vh c v) wl u vy, -Th is 14. Describe the ronvevar sys - A/o-A..) � analysis and design. a /c j •<� 0 S< < ki_ /_____.. 15. Desch the source of fill material,physicalcharacteristic;of fill material,and deposition of excess material. canAa, c av<d 6 16. Proposed methods of placement and compaction Uniform Building Code. consistent with the applicable standards on ��� C�1� ���GS I. - Appendix Chapter 33 of the _L Z a V11 14f G� 17. Describe the proposed surfacing material. lil latA I R-i-e V l kit a I V 1 V1 G h Gve[ASV) U� 18. Describe methods for restoration of the site. wd d ceoof 11 vyl Ll_ 6 Ea�~� �Py�n e/r teat yt a P G��f2✓t a 19. An Operation and Maintenance Manual is required for each flow control and treatment facility. [This is normally required for large"Protects only and here. only those for which facilities are required to control flow or treat runoff.] ff included,1st the Manuals 20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan. 21. List other necessary permits and conditions that affect the drainage as required by other regulatory agencies. If those condctions here. �e plan or contain more restrictive drainage-related requiremens permits rdor approvals n ition _Noi ,descIL those conditions or atRM.AfT .-4- ! stonnwater 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 2.52 of the Manual(beginning on page 2-15). 12 Required Elements—Construction SWPPP 1. Mark Clearing Limits. *ES 2. Establish Construction Access. g0C14 - shra 1 3. Control Flow Rates. 4. Install Sediment Controls. Vi1,P 5. Stabilize Soils. VAP 6. Protect Slopes. Iv.u 7. Protect Drain Inlets. N a storm water site plan template—rev.10/1/2003 • • EF CEIV 12 Required Elements-Constriction SWPPP(continued) 8. Stabilize Channels and Outlets. NjIx 9. Control Pollutants. N f 'c 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). NI/ 11. Maintain Best Management Practices(BMPs). Mt- 12. Manage the Project. 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas,roads). b. Description of the downstream drainage path leading from the site to the yards). receiving body of water(minimum distance of 400 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. Nfrr- stommater site plan template—rev.10/1/2003 9 41110 • 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). WIK 5. Construction Phasing. a. Construction sequence Dul l Q 3-a LI home-- ,1 11 i h '-'e-h L il �� eDU.y1C�-A-`h,W1 d.vI vevua ► Ai ink.I c v O b. Construction phasing(if proposed) 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). I. Prgvide a proposed construction schedule. Pit/ II. Wet Season Construction Activities. a. Proposed wet season construction activities. iv/Pr b. Proposed wet season construction activities for environmentally sensitive areas. 7. Financial/Ownership Responsibilities. a. Identify the property owner responsible for the initiation of bonds and/or other financial securities. b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. n� 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable. a. Sediment Ponds/Traps. b. Diversions. c. Waterways. d. Runoff/Stormwater Detention Calculations 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-buifts")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 Const ction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and correct to the best of y knowledge. I also certify that this application is being made with the full knowledge and consent of all )."________ owners of the affected, roperty. C/" (LANDOWN ER 0LkZED REPRESENTATIVE SIGNATURE) ( TE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: 12 stormwater site plan template—rev.10/12003 • • RETURN ADDRESS L41D EOFfoWIASHWG- MANUFACTURED HOME IICEnsinc APPLICATION ®TITLE ELIMINATION ❑TRANSFER IN LOCATION El Anyone who knowingly makes a false statement of a material fact is guilty REMOVAL FROM REAL PROPERTY RIof a felony,and upon conviction may be punished by a fine,imprisonment,or both. (RCW 46.12.210) MANUFACTURED HOME TPO/PLATE NUMBER I YEAR006 I MAKE Skyline 44' / 7 9E9I LENGTH/WIDTH(FEET) LE IDENTIFICATION NUMBER(VIN) © LAND LEGAL DESCRIPTION ON PAGE 2 MANUFACTURED HOME WILL BE ®AFFIXED ❑REMOVED REAL PROPERTY TAX PARCEL NUMBER 801213012 I,OT I BLOCK PLAT NAME OR SECTION/TOWNSHIP/RANGE R1Vy I QUARTER/QUARTER SECTION S 21 / SW © GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER NUMBER OF REGISTERED OWNERS I NUMBER OF LEGAL OWNERS 2 1 NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER Ronald D.Weber NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER Gloria J.Weber ADDRESS CITY STATE ZIP CODE 1802 Dabob Road Quilcene WA 98376 NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER Frontier Bank NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE 10705 Silverdale Way NW ZIP CODE Silverdale WA 98383 GRANTEE NAME Ronald D.Weber and Gloria J.Weber I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I ARE E REGI$FERED OWNER(S)OF THIS VEHICLE AND THIS INFORMATION IS ACCURATE: J� Signature of Registered Owner and Title,IF APPLICABLE Signature,q(,41:klit)pyal Registered Owner and Title,IF APPLICABLE �j�/'a�k_ �Yf NOTAIVAPAIE 1Nekiq NOTARIZATION/CERTIFICATION FO EGISTERED OWNER(S)SIGNATURE (.., ��•'E,;pires••.•/1/ '- State of Washington Signed or attested County of Jefferson before me on I O-d 7,U C. 1'.' :. .`P.\ZY p , Ronald D.Weber / -_-J :F O : t— by 4- -41J :Q ..... (J Signature / r�^ t V % ,0\., o,;.. �. PRINTED NAME OF REGISTERED OWNER NOTARY OR AGENT U / Q\) cJ.• Gloria J.Weber �i..- '. ,�%L.�c4\�� by m�4.a.(G 1.4 a n—terJ a v. •••., O2•"•.• � PRINTED NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY /!!!/!/S/�A iE1G��: \\\\ Title Gloria J.Weber AND:CountyDfeeNo.OR DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date © TITLE COMPANY CERTIFICATION I certify that the legal description of the land and ownership is true and correct per the real property records. NAME(TYPED OR PRINTED) TITLE COMPANY/PHONE NUMBER SIGNATURE/POSITION DATE ®Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs. BUILDING PERMIT OFFICE CERTIFICATION the manufactured home has been affixed to the real property as described. I certify that: a building permit has been issued for thisy purpose and the attachment will bebe inspected yupon completion. 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