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HomeMy WebLinkAboutBLD2006-00436 • • 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 Al Scalf, Building Official PERMIT #: BLD06-00436 SITE ADDRESS: 207 POND RD Issue Date: 09/12/2006 PORT TOWNSEND, 98368 Final Date: 5/22/2012 APPLICANT: MARK BOLDUC PHONE: 360-385-1965 BONNIE J BOLDUC 207 POND RD PORT TOWNSEND WA 98368-9664 SUBDIVISION: Block: Lot: PARCEL NUMBER: 002121007 Section: 12 Township: 30 N Range: 02 W PROJECT DESCRIPTION: NSFR W/ATT GARAGE & U/G 500 GAL PROP TANK THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2003 EDITION. OCCUPANCY GROUP: R-3 TYPE OF CONSTRUCTION: 5N SPRINKLER SYSTEM yes THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON5/22/2012 I:\F_BLD_Occupancy rpt 10/29/19 •ILDING PERMIT APPLICATI!N ML ReviewTy425 Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00436 Received Date: 7/27/2006 SITE ADDRESS: 201 POND RD PORT TOWNSEND, 98368 C OWNER: MARK BOLDUC PHONE 5�-�(qCJ BONNIE J BOLDUC 1172 MAPLE ST PORT TOWNSEND WA 98368 SUBDIVISION: Block: Lot: TX 3 PARCEL NUMBER: 002121007 Section: 12 Township: 30 N Range: 02 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr NSFR W/ATT GARAGE & U/G 500 GAL PROP TANK TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 1,192 VALUATION 116,044.00 ADD'L: HEAT TYPE: PRO CODE EDITION: 2003 HEAT BASE: HEAT TYPE: RAD OCCUPANCY: R-3 UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: 5N SHORELINE: CONST TYPE: GARAGE: 1,152 SETBACK: 145 DECK: 470 BANK HEIGHT: 160 SEWAGE DISPOSAL: ALT WATER SYSTEM: PWELL BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 1 Prop: 1 Total: 1 Total: 1 Routing Date: r1a7a, f—r- Type Amount Paid Bv: Date: Receipt: Approved/Date Permit $1,088.95 LYK 07/27/06 83918 APPR Plan Check $707.82 LYK 07/27/06 83918 State Building Code $4.50 LYK 07/27/06 83918 SE? iZ 2006 Potable Water Application $55.00 LYK 07/27/06 83918 Total: $1,856.27 Jefferson County Planning & 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 #: BLD06-00436 Received Date 07/27/2006 SITE ADDRESS: 207 POND RD Issue Date 09/12/2006 PORT TOWNSEND, 98368 APPLICANT: MARK BOLDUC PHONE: 360-385-1965 BONNIE J BOLDUC 1172 MAPLE ST PORT TOWNSEND WA 98368 SUBDIVISION: Block: Lot: TX 3 PARCEL NUMBER: 002121007 Section: 12 Township: 30 N Range: 02 W CONTRACTOR: OWNER/BUILDER PHONE: PROJECT DESCRIPTION: NSFR W/ATT GARAGE & U/G 500 GAL PROP TANK CALL IN FOR THE QUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. SETBACKS: J Footin I i -13-0 Zo on: Stormwater FINAL Approval: v- f we\(ki-t-vw__6 �E- kk-xci,-d-, Underground Plumbing: ke/" <<^x; TJ he-" 14Rdergr +nsulatlsn: SOlearWatt-- Framing: - `-'� Plumbing(¢-95-D-7 Propane ank/ Lines: 1 A Lf Lf-D7 fC u T;- " '- ?j-L.Gic.7 Insulation: MILL fiep_" faii/Ni 070 Sheetrock: i1 0'l Septic Sytea�i Fina Approval MUST be obtained before final of structure can be attempted. Road Approach Final Approval: Zoning Final Approval: Final/Occupancy Approval: Jr 2,ry'' C v ( o HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:00 a.m. -4:30 p.m. HOT LINE AVAILABLE 24 HOURS A DAY SPECIAL CONDITIONS APPLY -SEE REVERSE SPECIAL CONDITIONS FOR CAS• BLD06-00436 • 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.) A Geotechnical Report was submitted in conjunction with this application. The report addressed the stability of the geologic hazard area. A setback of 100-feet shall be measured perpendicularly from the top or toe of the geologic hazard to the proposed single family residence and septic tanks and drain field. 3.) 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. 4.) 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." 5.) All construction activities shall not encroach upon the buffer. This includes the storage or preparation of materials. 6.) 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. 7.) 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. 8.) 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. 9.) 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. 10.) 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. 11.) MANDATORY MEASURES FOCOASTAL 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. 12.) 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. 13.) The project shall comply with Construction Stormwater Pollution Prevention (SWPP) Elements#1 through #12 of the Department of Ecology's Stormwater Management Manual for Western Washington to control stormwater, erosion and sediment during construction. BMPs shall address permanent measures to stabilize soil exposed during construction, and in the design and operation of stormwater and drainage control systems. 14.) A stormwater plan for a medium project has been submitted and approved by the Department of Community Development. Once the subject permit has been issued the applicant shall fully implement the provisions of the submitted plan and contact the Jefferson County Department of Community Development to arrange a schedule to inspect the property for plan compliance. A Certificate of Occupancy will not be issued until the Department verifies plan compliance. No clearing for roadways or utilities shall occur on the project site until clearing necessary for the installation of temporary sedimentation and erosion control measures have been completed. 15.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 16.) Not more than 2 unlicensed 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 autormobile 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 requriements 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. 17.) Minimum setback from the edge of Pond Rd right-of-way shall be 20 ft. Minimum side yard setbacks shall be 5 ft. Minimum setback from the top of the steep shoreline slope shall be 100 ft. Environmentally Sensitive Areas further impact setback. 18.) 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. 19.) 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. 20.) 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. 21.) The building height is not to exceed 35 feet. 22.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 23.) Native vegetation, particularly trees and low native brush on the bluff slope shall be disturbed as little as possible. No grading shall be performed on the bluff face. If a trail is proposed, the trail layout and support structures shall be approved by a qualified engineering geologist and obtain proper permittings. 24.) Waste and other deleterious material shall not be placed on or over the slope. Such material smothers vegetation, retains water and acts to destabilize the slope. • 25.) Stormwater from roof run-off and driveway run-off shall be dispersed as much as possible through allowing sheet run-off and lateral dispersion spreaders such taht stormwater is not concentrated anywhere on the property and onto the bluff face. 26.) The proposal was reviewed for consistency with the Shoreline Management Master Program Section 3.402.5 and found to be consistent. The proposal is (1) a single family residence, (2) does not exceed 35 feet in height, (3) does not involve over-water construction and is located landward of the OHWM, (4) and meets all required setacks as set forth in said SMMP. 27.) A minimum of two (2) on-site parking spaces are required for the single family residence. I:\F_BLD_Permit_Buildng.rpt 10/29/19 '• • • RECEIVED ,oive, __ID re i 6td• JEFFERSON COUNTY )." - DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 JEFFERSON COUNTY ��� � O. 360/379-4450 •360/379-4451 Fax [r r[ 'T �i7N0 http://www.co.jefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# PROJECT/APPLICANT NAME: filely'A 1/0/ I L 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 impro fnents they' site ma . "'_ �/ i r f thy fig'7 'V//V / ac" / ce 1..—>I ap rt-ta// cru 4 roc�l cover a'r,v�ri:v'/c e lisle i frkf7-z`f -A e Pr,45ed tgi,-,72r,ovev ems, f, Existing Conditions Summary 2. Describe the existing topogra h Indicate contours on the site map. TA e c r A r�z. ci 7`'/ C 7C/e t,,t./ e 41t ./ae-Ave /gtf � -Me- Ici,/ 't ,i7 , r ee. / S elrir . c c, 4,,ni .A,s 4r�' reiftve -Ivati9r .30-Ir.�G/^-easi a�0i/e -fie ,& u ram° 3/i V,-! *X.e-A7- as-al �/u/e57` 3. Describe/ the existing vegetation. InTicate native vegetation areas on thi ite ma . i 7t o v/ a -feu. oferfor� e eir s .boa i lA e ce/ f L PI c /o r a z �i�, 7`/ de-vent At ioyike 9i.1 fr/c des 0ti}Goo 4d/W1 et., 7t r9 �,9 r 45Aie. es,V 4. Describe the existing soils. Indicate soil type on the site map. ,4//c e sd`%ri A��e7sc, ts'' ice core Lvf i` i kenease)-Ic 5ai 4 J 5 i/f c o(,r0..ve, 'i'i e d';v i 'Cie 'eafe5 740 �111--74-e,e771— 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 ,�to rip, if applicable,and indicate acreage of each. Weft& i 3 0 c,r/ r c e be.„..'fj9f e v/c/ i / 0,--2,. s/�e� 7Z e- w ez e_r see s ,fv fa,9.7Y'a re- ,i/v >le- 547.241 seil5 odd? / f e€;/1 >he5ut5.�Tr7Z7'e ve_r, ,re ,f7., 6. Describe any excesc levels of noise generated by the proposed use or activity: 7y t��/ r 1iS f/T,f' i4/1�/ / 4 .IIe Zet i/(0 /e'1 C/04- o! . ��� 5/it/IC- cei ,. ge .rim APPRO .1) STORMWATER PLAN PERMIT # BLIJ 52006 siorm�ratersite plan template.doc-rev.10/12/20e3 A _ SEP - 5 u 6, O436 JEFFERSON COUNTY JEFFERSON COUNTY DCD SI DEPT. ORF° �ITY E a) 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 on the site map. _�^ ��� j ,S C'o t.f1 /ts d,;,7,q (gri D ibt-T ^'�> ehe f.,,I et,,dQ r`->,P.t t S /'ai e f G+� (le 1irl cyt shed rr► 7r 8.-- 5 i`7�� e cx�� ,'v, c ( ed /D./vd. 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.). 7Z e,- ir(S a-1/3f /s41QI'/ e t �✓/i,l �t=c�tee✓, h *7/14- r— -4 e i e pro,Tr 1 is Surre��st/�4v 5/n 1e ic.� ;/)/�7fc ,,ems,` *e Al-- -7*2 e /o ti4 rlurre#17`/ z Grs<,7`, Permanent Stormwater Control Plan This portion of the Stormwater Site Plan consists of the selection and installation of the appropriate storrnwater 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. M ar y. L4-Ser igt77n f z 01;e4, ,-f<,OFf/fc f e Acl uS e-"eeC /'l,�,// cceed/n t a c* 1rY�e✓/%-a,c- vrs>V/ he- &eel,T��l',.-"h riol '- e- Acus�. Tie /;s z�e?r frier Ls # czec ce t ti t 1-iO"7t 0h r it �i�'11>`f ft/e2 e`!/ S a/" Et Me_ 4• t 7c/' 5O;/ 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"larg 'projects or projects that involve the potential for dispersion of contaminants.] 11. Describe the perfo goals and standards applicable to the project. 12. Describe the flow control system. stormwater site plan template.dac—rev.10/12/2003 S 'o� ' 4izt f 4 i.Vi;.` i' l'iiITV r • • 13. Describe the water gquality system. /4/7` 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. .��A,1 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. /47.04- 17. Describe the proposed surfacing material.✓ 18. Describe methods for restoration of the site. 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 inyl udefany special reports or studies conducted to preppaare the Sto water Site Plan. 6ecc/aic cg _ �ctcve/� &-a S Cer-A7 suet or ? ref /'Per t �d :s /OlG�te� �ii► fe /}off Y a7� V415 /._Q 21. List other neceosary 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. R10EIlNrEL.._1' PERMIT # OLD stormwater site plan templae.doc—rev.10/12/2003 7 06a 0436 JEFFERSON COUNTY DCD JEFFERSON COUNTY OCU • • 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 /� 11 ,�/ /, 1. Mark r,cLimits.toss iL�S �� �,c' )/,V',��/ h e- 3 T /� �x/t�� e T� L Blar, 7 S'fis-nl'tyr•-0/'A/c ,'ir i% G .t✓57i2t to t/Qpe.a r✓i�//.oe_j�k tt/e 740 r e c Lr-A c-4 e r e Gi/reet /r7 QSy coo/ �r//M ,t/aes rrPr//Af 7`S. `�}��2. Establish ConstructionAccess. �[i y `/L�j j��+y�© // /-X A.cc ;.c 44� '// 6Ci / i �" / e c u / ✓ le ve.'!if/�t{�C • I' /Vo 4'.Sec/0/.ra/ rS:ec yvr%/ISe ecess�rrr"¢ 7 ' 'e- :s ..I...,7;,//e c'f iv/�a�P twat/ .4e_74wee-A/ �'trsprc7 er / /9t 6/L j"D�rGt'� :"-te r e4 f. ',i/ I /c7 c o-ii 144G /`>°4T 17� �' Chi i�v-Curl- 3. Control Flow Rates. 7erGQre //a rc/cre-i Lsco/ wy 47 ozar,t ot/e 4i5 'hie; 4. Install Controls., s. aa/tf,��s L,/ ,�,4// a/J y/ afeu 7179 et//ors - , e rv-47,-gr le,/011 2v-a p raw >0 f 09, i i> Y-hg. .stir')fc e fail, 77' - //le fv #3/;011rr Ef cr it ee7<gPr" et;'scifeiryl n e LS/LM ' ec/9e, 5. Stabilize Soils. 'J 51 a Stabilize SsL7 // /`/eaS 1.4 /I tf er lei h Ge!f cn.l ui re-e te,0747z.s a s�6/ i/// e s-e't det27 C�-r` /ors S c jat st/€, - Protect Slopes. i e- 5-47,? g .5 f/>4e- ,`//6�/2/ Gf 4,14edf 7. Protect Drain Inlets. —Mere are- ,c io /7e fj ''r� e - around//17i is,pr i stormwater site plan template.doc--rev.10/12/2003 8 S 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. -o <7,. 6,0 ellicimo ajernt 1-6177551 bttlefli pfkri r7Lirt wrc ! ui;`/r.ffnfr /gyve. rag ®<=�'7��7' 0 1Slc�S Cam. 9. Control Pollutants. / L 2 - i o f�S 4 Wf` Ct'//oweJ � , t�i Te Ai(� k' d's err' g rei mot. arm 10. Control De Watering(the act ofpumpi�ng groundwater or stormwater away from an active`instruction site). ��is 1'ls' fs��i7`e j Anc ld S¢ /G'Gr/l�i�L7Le1 7 b1e cat r4 1A' /EiX � C7 �b1 &id>`;:t f }LI rP et �c !s ne ASS /� I rev;��11�e Maintain BestLMana emen Practices(BMPs). / f //dam S7e�f'G'!f" 1G?!/� Gf1 /I he 7�1D�/f�E G`Nlaf/rr ! 4=t/8r �G771� 4 12. Mangey the Proj_ect.. 7e, Cf/777/3'7� �f' XCd G ��!,�5 rc,5;d�'r /�vr/��� �r�� c/U.vv l v fa /vse urfy o =s la Ord�z e ���;?� ; 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas,roads). / 1 PrP g r1' t I/O 5 "el/l,i1 hAec 02 vim/ lay ii? T!/i3 /�'GC 2 !�` ,`rl r� r � si p a. 1 e-} aroma des!` �e-� s/r� l �b �a b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). iye e /Na dr. v. a.//' . �r114A 4,14d c pn f isP�^,� / ,�`r� 1 . freer r�r �//�l c 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacentto the site, %cr.- i �� it �� G PAL/Ff— ee 1/G Q1y),„6{ a2' c €f' /fS PERMIT # BED RE FAVEI' stormwater site plan temptate.doc—rev.10/12/2003 5 06 - 0436 JEFFERSON COUNTY DCD JEFFERSON COUNTY DC} I • b. Descriptiop of special requirements for working in or near environmentally se sitive areas. 7 �Cr7't a/ 'ram .��ie��ir/il� j,'o7 �`1�GC�Lt�C%/S�)e- �?!�'r i 4. Erosion Problem Areas. Description of potential erosion problems ori site in the context of the characteristics of the on-site soils(e.g.,erodibility,settleability,permeability depth,texture,soil structure). / 5 7 cal/ � a,-- 4 t s> �._ 7%� 9 /S f/Vett- d/v f',�G> jlOjl/ 9 cs�'ji /& s4sti e / v O4 5. Construction Phasing. a. Construction sequence ' ! �� l X"G a i.G�}Ci�t,� /:251 z//c�iy 1�i6/t— /'©uileVa l,G/r— `✓"ar,;.r — �ir��� ..•r /er,t/a S /,/5t„ ��ieg eire•• — sep7 // 4,,,v a,7/JeJ/ b. diinaruction phasing(if proposed) 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). Provide a proposed construction edule. /1 // ✓, fe 9'-frru a//.br� A— y p/) /fe- cunt /e� -(Jc,o/A-7`) -507 c (Oc ek/-i /a- scc?› - y Q6. am,' (Oc II. Wet Season Construction Activities. a. Proposed wet season co struction activities. J usf o7. /r1�ro�;2 vria 7e1 ,�rs7i� b. Proposed wet season construction activities for environmentally sensitive areas. 7. Financial/Ownership Responsibilities. a. Identify the pperty owner responsible for the initiation of bonds and/or other financial securities. 7�i. b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. / /77 " ' ' 8. Engineering Calculations. Provide Design Cal�ns on a separate sheet for the following,if applicable. a. Sediment Ponds/Traps. b. Diversions. c. Waterways. d. Runoff/Stormwater Detention Calculations • i.,. E ! [•t stormwater site plan template.doc-rev.10/12/2003 10 „Cf,1 1I • • Stormwater Site Plan Changes If the designer wishes to make changes or revisions to the originally approved Stormwater Site Plan, the proposed revisions shall be submitted to DCD prior to construction. The submittal shall include substitute pages that include all proposed changes, revised drawings showing any structural changes,and any other supporting information that explains and supports the reason for the change. Final Corrected Plan Submittal If the project included construction of conveyance systems, treatment facilities,flow control facilities, or structural source control BMPs (not standard on-site stormwater management BMPs),the applicant shall submit a final corrected plan("as-builts")when the project is completed. These should be engineering drawings (stamped by a licensed civil engineer) that accurately represent the project as constructed. APPLICANT SIGNATURE By signing the Construction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all owners of the affected property. (LANDOWNER OR AUTHORIZE REPRESENTATIVE SIGNATURE) (D MOM THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: • • it stormwater site plan ternplate.doc—rev.10/122003 12 . t 11 pipttr5't 7i i ,jYi 3 .i ..! i t 14* ,7)SY ..i›. ON cow JEFFERSOTCOUNTY • l•� +;(� IF�1VED L DEPARTMENT OF COUNTY__ T DE ELOPMEN 1 ~' ` '� 621 Sheridan Street • Port Townsend •Washington 98368 JUL ,� „�- 360/379-4450 • 360/379 4451 Fax !. 2bua �q � www.co.jefferson.wa.us/commdevelopment Master Permit Application MLAJtrr al 1; 1• .! 9 Project Description(include separate sheets as necessary): /V-- * 4> _//o/-/ -Xg7y G Y ,fir 1 ./ x t // 6,1R/42l E Tax Parcel Property Number: Or )- ---/2 /- o ry 7 Size: /)V �6G i'e Xl G fe) (acres/square feet) Site Address and/or Directions to Property: ; e tt/)- /`e Gyre& t i ij 62Ih jw 7�G/�5 Property Owner(s)of Record: /i2g4�,- - a c7,6�%N/,e/c7� V Telephone: 3(G� 31sj- /f t'S' Fax: email:,rheii`/X, eZf?`eor/ ,C�' Mailing Address: //7,2 to/e ;.7‘, i,-,=-7 f ti�j`'//c� G'l// 9`��6T- Applicant/Agent(if different from owner): 5;¢/77 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]** 'Single Family 0 Discretionary"D"or Unnamed Use Classification /Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** ❑ Manufactured Home 0 Boundary Line Adjustment ❑Modular ❑ Short Plat** ❑Commercial* ❑ Binding Site Plan** ❑Change of Use ❑ Long Plat** ZAddress ❑ Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** gPropane 0 Plat Vacation/Alteration** Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** 0 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* 0 Jefferson County Shoreline Master Program Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium *May require a Pre—Application Conference **Requires a Pre-Application Conference Please identify any other local, state or federal permits required for this proposal, if known: DESIGNATION OF AGENT I hereby designate / .. to act as my agent in matters relating to this application for permit(s). OWNER SIGNATU /" �/ /• - Date: -7 /rS G� 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 I ins ctions.Access and right of entry to this property shall be requested and shall occur only during regular business hours. y" Signature: Date: �/ ```� 907r fs ( 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 rmit 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 :ion(s)even if you are i compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual Aid non-transfe po 7ty herig to aid plying with the ESA. The Applicant has read this disc! '�jer a ' ' s and dates it below. Signaturi�' � cJ/ 7�J I Date: �� G:\PcrmitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc I • OWNER BUILDER STATEMENT • IThe signer of this statement s hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assu f the ra��ntractor for the proposed project +gnature, --- Date: l,� �li GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: 1FM• 0U MAILING ADDRESS: � 7 ( ) 1F .kttiS C(J�JNI I 'gb V EMAIL: CONTRACTOR'S LICENSE WAINS , NUMBER: NUMBER '�+ ARCHITECT/ENGINEER: PHONE fl` MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: I y: New VWood Existing: Sewer r ❑ Addition ❑ Steel Proposed: / Bank 0 Community System • ❑ Alteration/Remodel ❑ Concrete Total: / Height:/�`���� ❑ Individual System Q 0 Repair a Masonry - SEP Permit it P7�•-,2// 0 Demolition a Other: Bedrooms: Water Supply: Existing: Setback: tl-Private well ❑ Two Party -4 Type of Heat- p Proposed: I II Public g f>,i:ve/ecrc%4rr�� Total: ! y °fir 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 Proposedr-4 IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: Underground Tank 0 Above ground Tank Size of Propane Tank: SC, ,A:Heat Stove )'hook Stove 0 Woodstove J Fireplace Insert ❑ Hot W Tank ❑ Pellet Stove a Other 4)I Is this appliance being installed in a Manufactured/Mobile Home? Yes / No (v 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, d including the reserve area. Square Footage For Office Use Only E t-�/8(•j�A2e-i La 03 to Current Proposed ` Main Floor ''r(318•Io— Consistency`Review: I� `OD /66 • 22°D Floor Base fee: 33 Floor Additional Section: ''i, -y Rr� Mezzanine: - Plan Checkfee: - 1 O r J • "L Heated Basement State y Sur#t `fee: 4 � ',, Unheated Basement Pot Water Review fee: q Other, n eat � �0 Ig�$<.(.p 4 d Approach fee 1U Garage/Carport lgi )rJ2 p/ //�,� TOTAL: $ asaI , ari ,4 yr Decks q tqz 3i7 �P 3 9Receipt Number: Q 29 17 O Other Cash/Check Number �h.., U a 10 TIMATED COST(REQUIRED) I I(o0 )ate: t i"}a , -y.'° air market value of all labor and materials foundation f --- inish — ',� #`t IDS F/ j q_aCY 7 Initials: G:\PennitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc / i" ZB- " / 4-6' � Z4-0" I Z-0" lZ-0" vI V V I V8' O..4.DOOR U"U .\ \� _ — _ 1'_ —- _-- iil • ', m n s J C.x c s. d. a mN t C'' 67- "?), li ,\,___)3v j'J_ la 1 a N \ cld .1 • .,$ ss ,. _ d 1. a _ ik ti 0 01 '')'‘ '3': 4_ _} \ o al p Ai S\ -� a ��r \ ;d 3G` a • 0, '5,33 1 sS\ .I\ ' ; 7 - -.N., i _ 1 • d �.c S' I m ::"."...)‘'.. 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