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BLD2006-00640
• BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD06-00640 Received Date 11/13/2006 SITE ADDRESS: 403 EMBODY RD Issue Date 11/30/2006 PORT LUDLOW, 98365 APPLICANT: RICHARD J BREES PHONE: 360-710-8955 MARIE B BREES 407 EMBODY RD PORT LUDLOW WA 983658771 SUBDIVISION: MARSH AND MEADOW SHORT PLAT Block: Lot: 4+ PARCEL NUMBER: 801124014 Section: 12 Township: 28 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: PROJECT DESCRIPTION: NSFR W/ATT GARAGE &A/G 250 GAL PROP TANK CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. SETBACKS: UFFER: Footing:tA f 7 ,2,-I c.6-7 Foundation: 2 Stormwater FINAL Approval: Underground Plumbing: Underground Insulation: Shear Wall : £tr 3//243/07 /br �,428 OE 7�07ft Sheathing: JHe-A'r�1in+C OK zb�� %` Framing: u F.q Okl5 e7 O/l� l9 61 1A Plumbing: 4� 441 Propane Tank/ Lines: An PROPAar haws 1k 41./c$7, Insulation: ktfzcptt.6UC Cot--6�,t WOW dK_ 444/070i Sheetrock: 7/1/9 Septic Sytem Final Ap rovaST be obtained before final of structure can be attempted. Road Approach Final Approval: Zoning Final Approval: Final/Occupancy Approval: Of( 4or- B/17/67 HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIR D 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 CASE A BLD06-00640 1.) Wetland buffer perimeters shall be marked with temporary signs at an interval of one per parcel or every one hundred (100) feet, whichever is less. Signs shall contain the following statement: "Wetland & Buffer- Do Not Remove or Alter Existing Vegetation." 2.) A permanent physical separation along the upland boundary of the wetland buffer area shall be installed and permanently maintained. Such separation can include installing logs, trees, a hedgerow, or any other prominent physical marking approved by the UDC Administrator. 3.) 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. 4.) 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. 5.) A AStormwater 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. 6.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 7.) 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. 8.) Setback from Embody Road right-of-way and private ingress/egress easements shall be a minimum of 20 feet. Minimum side and rear setbacks shall be 5 feet. If an environmentally sensitive area (ESA) is present, then the more restrictive setback(s) shall apply. 9.) 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. 10.) 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. 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.) The building height is not to exceed 35 feet. 13.) A minimum of two (2) on-site parking spaces are required for the single family residence. 14.) There shall be no disturbance of soil or vegetation within the streams and wetlands including their associated buffers of any sort, including the prohibition of livestock grazing and vehicular access. The buffers are marked with fencing and signs. I:\F_BLD_Permit_Buildng.rpt 10/29/19 BUILDING PERMIT APPLICATIl MRAOW00624 Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00640 Received Date: 11/13/2006 SITE ADDRESS: 403 EMBODY RD PORT LUDLOW, 98365 OWNER: RICHARD J BREES PHONE: 360-710-8955 MARIE B BREES 407 EMBODY RD PORT LUDLOW WA 983658771 MARSH AND MEADOW SHORT PLAT SUBDIVISION: Block: Lot: 4+ PARCEL NUMBER. 801124014 Section: 12 Township: 28 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTION NSFR W/ATT GARAGE & A/G 250 GAL PROP TANK 4tbLWn Ifilb1D1 G: TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW Sir VALUATION 247,863.00-2wv' MAIN: 2,519- I4S4 CODE EDITION: 2003 ADD'L: I2g2, HEAT TYPE: EEE OCCUPANCY: R-3 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: 5N OTHER: SHORELINE: CONST TYPE: GARAGE: .511 :20' SETBACK: DECK: .433 '"D BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: PWELL BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 4 Prop: 3 Total: 4 Total: 3 Routing Date: I I '1410.0 Type Amount Paid By: Date: Receipt: Approved/Date Permit $1,822.55 LYK 11/13/06 86858 Plan Check $1,184.30 LYK 11/13/06 86858 API'--21��1\ /\I)\ ' +� �.J V . '-.:. State Building Code $4.50 LYK 11/13/06 86858 NOV Potable Water Application $55.00 LYK 11/13/06 86858 Total: $3,066.35 --.. .7 ji . _2 C • ak Ire ... R EC iiv ti 11.k ��+ oN eOG� JEFFERSON COUNTY al five` DEPARTMENT OF COMMUNITY DEVELOPMENT NOV1 3 �rt�� 621 Sheridan Street• Port Townsend •Washington 98368 ''t U 360/379-4450 • 360/379-4451 Fax q www.co.jefferson.wa.us/commdevelopment `s$INO Master Permit Application MLA: O(j y LQ4 Project Description(include separate sheets as pecessaryj. G\1 : S i. C /,9-v-,4 L . l<5t-O tat5 )//47-lticj/iZL) Ghitii 6J- Tax Parcel Property Number: O 11 Zy0 I. Size: /5:o'/35" acres/ quare feet) Site Address and/or Directions to Property: (la 3 t.pti U6 pi--) Pt Property Owper(s)of Record: i�PEE S Telephone: L3'o) fit>- Y.S 5 Fax: (3E0) ?,32 a 963 email: lujfo il§tqSS%57c:SELL fa=>-4.G7"y Mailing Address: '(0') Ei'n i3r ) y R. 1) ,, DP-r ALDLot.�J, WA T93es- Applicant/Agent(if different from owner): .5;4 Al E Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) uiiding ❑Variance(Minor, Major or Reasonable Economic Use) d Demolition P .nait ❑Conditional Use[C(a),C(d),or C]"* Single Fa II ODiscretionary"D"or Unnamed Use Classification Garage Attached etached OSpecial Use(Essential Public Facilities)** Q Manufact me C]Boundary Line Adjustment Ci Modular °Short Plat" 0 Commercial* [Binding Site Plan" 0 Change of Use 90P1 °Long Plat** OitAddress '-103/ZigIc:. I Road Approach 1%] l[]Planed Rural Residential Development(PRRD)/Amendments" R.Propane ❑Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisions** ❑Stormwater Management ❑Shoreline Management Substantial Development" OSite 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 C,Onference Please identify any other local,state or federal permits rdq fired for this proposal, if known: DESIGNATION OF AGENT I hereby designate R.5f4jZ ID .RC5 to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE c. y� Date: 12.y/d 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 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 required later inspections. Staffs access and right of entry wil(be as6ulned unless the applicaneinformsthe County in writing at the time of the a.. e n that or she wants prior notice. r. 7 Signature: Date: / „C. /e' s • fr The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if ou are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-train fera leees ibility for adhering to and complying with the ESA. The Applicant has read this disc me find signs nd dates it below. Signature: Date: 2 C a D:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05-2.doc Ai lir 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;as5u ing e responsibility of the General Contractor for the proposed project. Signature: - Date: /J/2 e�J,, GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: �I /� (mod 1)10-Sq. '� Via)`,/'7 -n0}7'3 MAILING ADDRESS: 4I,Uf) 1... f.(.)O py 1\i L) EMAIL: �'�f / /4sCvi r„tUJriic re`�'Tt y CONTRACTOR'S LICENSE / WAINS t9u NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: ' Type of Sewage Disposal: New x Wood Existing: 0 Sewer _ ❑ Addition D Steel Proposed: =S Bank Community System SKI ` ,/1'f ❑ Alteration/Remodel 0 Concrete Total: '� Heigh NI Individual System 40 ❑ Repair 0 Masonry SEP Permit# Pia Fic . ❑ Demolition ❑ Other: Bedrooms: 111 Water Supply: Existing: Setbac : El Private well Two Party Tyr Heat: Proposed: — Total: � �")t" �'� ❑Public C✓ — 4 - 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 belo ' -,priy: []Underground Tank gAbove ground Tank Size of Propane Tank: 2<T l) ❑Heat Stove %Cook Stove 0 Woodstove RjFireplace Insert ❑Hot Water Tank 0 Pellet Stove j 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 Prop sd ed For Office Use Only Amount Revisio 171Q1b'' Main Floor Heated 14M Tfq-1%"1 I PH Bld App Review: 6 5 ,.,h 2"°Floor Heated 12q,�. Consistency Review: l�5 (r, C 51. DO "� 0 115,$bl. h �--�i Other Heated o Base fee: t q IQ I (C k r�}n^ ! '77 J ('tea• . Mezzanine Additional Section: 0 Heated Basement Plan Check fee: 0 I11,3 .3° lba.cc Unheated Basement State Surcharge fee: ` Other Unheated Pot Water Review fee: Garage/Carport I SUBTOTAL (DZL i - 1. t _ 1 _ R70,(OD Decks 2.2.8 L��, .t1/Rd Approach fee: ,i,t5F l ,,A Other TOTAL: $3319.35 a70•100 0 Receipt Number: ()'5W $i l a g rash/Check Number:EST `.F/�(� ' - = - • _ -ED) Date: l l l fy_ ` ,I 1 D .Fair arket value of all laborarnf ria ndatio flip [ Initials: - zbS, gCO. S.D. D:\PermitCenter\FORMS\DRD FORMS\Master Permit Appli ... . . - •. 1111 • I g5ozv ° , JEFFERSON COUNTY REC IVEL` DEPARTMENT OF COMMUNITY DEVELOPMENT NOV 3 2006 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 . 360/379-4451 Fax $?Na` http://www.co.jefferson.wa.us/commdevelopment/ tib«k WONE UCD STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# Oo-cp a1 PROJECT/APPLICANT NAME: R,, ,,/-btgi-) E Please answer all of the following questions to the best of your ability. Where the question calls for depiction on a site map, the applicant may choose to either incorporate the elements into the general plot plan for the Master Land Use Application or to submit a separate stormwater site plan map. Project Overview 1. Describe the proposed developed conditions of the site. Indicate position and relative size of proposed improvements on the site map. 1 4-`7`t 4-C, R9 Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. +n r n ir e 'i n- 7G47 _ 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. 4. Describe the existing soils. Indicate soil type on the site map. �Fz� lq-�fit'f 1 J 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. ` 1 V 4 APPROVED STORMWATER PLAN 6. Describe any excess levels of noise generated by the proposed use or activity: ,NON Nnv 3 n ;nOn Storm water JEFFt:RSUN rY - , ( DEPT.OF C IT ELO ME T Requireo SIGNATURE: starmwater site plan template—rev.10/1/2003 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. th c:.� E E -7` f�.11,J 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.). 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 stomiwater 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. iDbtJ ' 10. If the project requires the use of stomiwater 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.] /14 11. Describe the performance goals and standards applicable to the project. /V7.4- 12. Describe the flow control system. AM ^7 U(� stormwater site plan template—rev.10/1/2003 6 . S • 13. Describe the water quality system. IV /Pr- Sri 14. Describe the conveyance system analysis and design. n ` /ik - 15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material. 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. / pq- 17. Describe the propose0_surfacing material. /.Siiid--C // j -t, 21-ki 18. Describe methods for restoration of the site. rCt-ZA- 19. An Operation and Maintenance Manual is required for each flow control and treatment facility. [This is normally required for "large"projects only and only those for which facilities are required to control flow or treat runoff.] If included,list the Manuals here. N/A- 20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan. 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. p intrtfiNiP t.i 1j i t + ;0 stormwater site plan template—rev.10/1/2003 7 • • CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN(SWPPP) The Construction SWPPP addresses sediment and erosion control during construction. The BMPs indicated by the applicant in the template that follows must be installed on the ground during all construction phases of the project. The proponent is responsible for preventing sediment and erosion impacts to environmentally sensitive areas and off-site areas. Consult the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet for guidance, particularly with rural residential development. SECTION I—CONSTRUCTION SWPPP NARRATIVE 1. Construction Stormwater Pollution Plan Elements. Describe how each of the Construction SWPPP Iements has been or will be addressed. Identify the type and location of BMPs used to satisfy the required element. If an eleent 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. 2. Establish Construction Access. i/ 3. Control Flow Rates. f 4. Install Sediment Controls. X S c Frz.Gtt°C'', ., 5. Stabilize Soils. 6. Protect Slopes. 7. Protect Drain Inlets. //1- stormwater site plan template—rev.10/1/2003 • 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. N, /4_ 9. Control Pollutants. NO/V.l t 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). 70,5m75, 11. Maintain Best Management Practices(BMPs). ys 12. Manage the Project. yrs 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas,roads). hh A./0/LC b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). Mo w 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. 5 L ,s/7' = / stormwater site plan template—rev.10/1/2003 9 • • b. Description of special requirements for working in or near environmentally sensitive areas. 4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site soils(e.g.,erodibility,settleability,permeability,depth,texture,soil structure). 5. Construction Phasing. a. Construction sequence ,-- . 1tc1) D o � —Affig E Con c..,,` uJ `Dr�5� e: b. Construction phasing(if proposed) 7. 7/rt 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). 1. Provide a proposed construction schedule. NOV o — V'VI. tg-2c/ II. Wet Season Construction Activities. a. Proposed wet seson construction activities. b. Proposed wet season construction activities for environmentally sensitive areas. 7. FinancialOwnership Responsibilities. a. Identify the property owner responsible for the initiation of bonds and/or other financial securities. (c, fk-rz-b,-( L(;- b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. (4- 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable. a. Sediment Ponds/Traps. IVOu- b. Diversions. Lej i�b A - c. Waterways. / o d. Runoff/Stormwater Detention Calculations No Al X- stormwater site plan template—rev.10/1/2003 10 S i . . 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 ers of the a ect rty. (f/ /zo6 (LAN WNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: stormwater site plan template—rev.10/1/2003 12 t ' . , ,c, :',1 9‘ 91 -0, 5.4 P.' 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