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HomeMy WebLinkAboutBLD2007-00076 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#: BLD07-00076 SITE ADDRESS: 152 N CARNEGIE AVE Issue Date: 03/28/2007 PORT TOWNSEND, 98368 Final Date: 2/23/2009 APPLICANT: DEBORAH BOYLES PHONE: 379-0962 RICHARD BOYLES 152 N CARNEGIE AVE PORT TOWNSEND WA 98368-2552 SUBDIVISION: IRONDALE Block: 152 Lot: 25+ PARCEL NUMBER: 962115209 Section: 35 Township: 30 N Range: 01 W PROJECT-DESCRIPTION;NEW DETACHED-GARAGEW/STORAGE AREA ABOVE ALL UNHEATED; UNFINISHED AND NO PLUMBING (BLD07-00076) THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2003 EDITION. OCCUPANCY GROUP: U-1 TYPE OF CONSTRUCTION: 5N SPRINKLER SYSTEM yes no THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 2/23/2009 I:\F_BLD_Occupancy.rpt 10/29/19 89 I UILDING PERMIT APPLICA1N MRevOW00pe0: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00076 Received Date: 2/27/2007 SITE ADDRESS: 152 N CARNEGIE AVE PORT TOWNSEND, 98368 OWNER: DEBORAH BOYLES PHONE: 379-0962 RICHARD BOYLES 2910 KIMBALL CT UNIT 1 PORT TOWNSEND WA 98368-615'1 IRONDALE SUBDIVISION: Block: 152 Lot: 25-29 PARCEL NUMBER: 962115209 Section: 35 Township: 30 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: -Rwthw ' 151t13 PROJECT DESCRIPTIOP NEW DETACHED GARAGE W/EXERCISE ROOM"5ko a9¢- ltbdw ALL UNHEATED, UNFINISHED AND NO PLUMBING TYPE OF WORK GAR SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 25,644.00 ADD'L: HEAT TYPE: UH CODE EDITION: 2003 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: OCCUPANCY: OTHER: 360 CONST TYPE: SHORELINE: GARAGE: 728 CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: PUD BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 0 Prop: 0 Total: 0 Total: 0 Routing Date: a /o / Type Amount Paid By: Date: Receipt: Approved/Date Permit $401.35 KAS 02/27/07 894.52 APPRc \JEEPlan Check $260.88 KAS 02/27/07 894.52 State Building Code $4.50 KAS 02/27/07 894.52 MAR ZS 2007 Total: $666.73 Jefferson County Planning & Building Department • Jefferson County Building Division Permit Number: BLD07-00076 Applicant: BOYLES BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2003 International Building Codes To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection. Requests received after 7:00 AM will not be scheduled for that day's inspections. ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries. The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection Inspection Item Date Approval Signature Notes Setbacks 41izjo-7 Erosion Control Foundation Footing 14[7,0 10-7 Straps(hold downs) `--3 wOAu S(2(a7 Ext. Shear Wall Nailing /010/07 r Rough-in Plumbing (e'11--LT) C,ispei t--s Nic - Framing Wallboard Nailing 1--0‹ �— ' n' tlz-( WI/kr-NCIV Drywell/Alt Drainage co I I ( a (1) Address Posted � FINAL INSPECTION 43-Y6 FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR • • CONDITIONS for Building Permit# :BLD07-00076 1.) NO PLUMBING HAS BEEN REVIEWED OR APPROVED FOR THIS PROJECT BY JEFFERSON COUNTY PUBLIC HEALTH. ADDITIONAL REQUIREMENTS MAY APPLY IF PLUMBING IS PROPOSED. 2.) The application was reviewed by the Jefferson County Department of Community Development staff on March 12, 2007 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: Special Aquifer Recharge Protection Areas and Coastal Seawater Intrusion Protection Zones (SIPZ).. 3.) 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. 4.) Critical Aquifer Recharge Areas are defined as Seawater Intrusion Areas, and Special Aquifer Recharge Protection Areas and the following land uses located within Susceptible Aquifer Recharge Areas (1) All Industrial Land Uses (2)All Commercial Uses (3) All Rural Residential Land Uses requiring a Discretionary Use or Conditional Use Permit (4)All Rural Residential Land Uses with nonconforming uses that would otherwise require a Discretionary Use or Conditional Use Permit(5) Unsewered Planned Rural Residential Developments (6) Unsewered residential development with gross densities greater than one unit per acre. All of the above listed uses shall be subject to the applicable requirements and standards of the Jefferson County Unified Development Code. 5.) Marine shorelines and islands are susceptible to a condition that is known as seawater intrusion. Seawater intrusion is a condition in which the saltwater/freshwater interface in an aquifer moves inland so that wells drilled on upland areas cannot obtain freshwater suitable for public consumption without significant additional treatment and cost. Maintaining a stable balance in the saltwater/freshwater interface is primarily a function of the rate of aquifer recharge (primarily through rainfall) and the rate of groundwater withdrawals (primarily through wells). The Washington Department of Ecology is the agency with statutory authority to regulate groundwater withdrawal for individual wells in Jefferson County. New development, redevelopment, and land use activities on islands and in close proximity to marine shorelines in particular should be developed in such a manner to maximize aquifer recharge and maintain the saltwater/freshwater balance to the maximum extent possible by infiltrating stormwater runoff so that it recharges the aquifer. 6.) The parcel is located within a coastal SIPZ (seawater intrusion protection zone) according to the County GIS map. There are voluntary and mandatory measures identified in the Jefferson County Seawater Intrusion Policy(Resolution 44-22, effective September 23, 2002) that apply to well drilling proposals and building permit applications on existing lots of record. A Coastal SIPZ is defined as: all islands and area within one-quarter mile of marine shoreline, but no history of chloride concentration above 100 mg/L in groundwater sources within 1000 feet. 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 C TAL &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 FOR COASTAL SIPZ: 1. For proof of potable water on a building permit application, applicant must utilize DOH-approved public water system if available. 2. If public water is unavailable, a qualifying alternative system may be used as proof of potable water or an individual well may be used as proof of potable water subject to the following requirement: a. Chloride concentration of a laboratory-certified well water sample submitted with building permit application. 3. If public water is unavailable, a qualifying alternative system may be used as proof of potable water. 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 applicant is proposing to create or add 2968 square feet of impervious surface and 6068 square feet of land disturbing activities. JCC 18.30.060 and 18.30.070 require the project applicant submit a stormwater plan meeting Minimum Requirements#1 through #5 of the Department of Ecology Stormwater Management Manual for Western Washington. The stormwater plan shall address measures to control stormwater, erosion and sediment during construction and 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 Site 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.) 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). 16.) The site plan as submitted with the building permit application on March 12, 2007 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 March 27, 2007 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 17.) This approval is for a single family residence with detached garage 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. 18.) Outdoor residential storage shall tikaintained in an orderly manner and shall ate no fire, safety, health or sanitary hazard. 19.) 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. 20.) Minimum setbacks from N Carnegie Ave right-of-way and E Island View right-of-way shall be 20 ft. Minimum side and rear setbacks shall be 5 ft. 21.) 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. 22.) 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. 23.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 24.) The building height is not to exceed 35 feet. 25.) This parcel has been designated as Rural Residential 1:5 under the Jefferson County Comprehensive Plan Land Use Map effective August 28, 1998. 26.) N Carnegie Ave (P487) is a private road. The road approach is existing and an address of 151 N Carnegie Ave has been assigned to the parcel. 27.) A septic permit (SEP06-00133) was approved on June 10, 2006 for a system of 240 gallons per day 28.) The lots were created through the Irondale#6 Subdivision on June 28, 1910 under AFN 30490. 29.) A Declaration of Restrictive Covenant to consolidate Blk 152, Lots 25-29 for building and septic purposes was recorded on May 5, 2006. 30.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 31.) No plumbing has been reviewed or approved for building permit(b1d07-00076) for a new garage by Jefferson County Public Health. Additional requirements may apply if plumbing is proposed. • • o ° JEFFERSON COUNTY IRECEWED #f"#44' DEPARTMENT OF COMMUNITY DEVELOPMENT bc 621 Sheridan Street • Port Townsend •Washington 98368 '' fiQ 360/379-4450 • 360/379-4451 Fax l' N� http.//www.co.Jeffersonwa.us/commdevelopment/ JEf fEIIJUIV 5OHN I r ii CI STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# b 1- `JI PROJECT/APPLICANT NAME: r► t clog q L/ 2ibH g 'i�� 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 ma . 5/iv 4'i z->' , $i D tv/r/f 4- Existing Conditions Summary r n JrrrrpenN /11ri�kTh Y '1 '► 2. Descri a the existing topography. Indicate contours on the site map. ,,r ifL /j' Li 16.DIN 4 L.b 7" l l D 1/-.q$ /alb $L.e/ $, APPROVED 3. Describe the exislms vegetation. Indicate native vegetation areas on the site map. STORMWATER PLAN dN'-)-). MAR 2 7 2007 4. Describe the existing soils. Indicate soil type on the site map. 4 2O C> JEFFERSON COUNTY DEPT.OF CON:MUNflClll�[Nr;� SIB\n. gC;\ J J JJ 5. Describe the existing site hydrology(i.e., drainage;behavior of water on the site—above, below, and on the ground). Indicate existing stormwater drainage to and from the site on the site map. Depict separate drainage basins on the site map, if applicable,and indicate acreage of each. Ao vi5//31 T _At/A/ 6. Describe any excess levels of noise generated by the proposed use or activity: i2�51 D lei Aft) =?c s.$ No/ 5 e, stormwater site plan template—rev.10/1/2003 5 0 • . 7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams, steep sl es,etc.)on the site. Indicate location on the site map. �te0P r r t 5 -Ln r 'V0 51 4/if /re e 4/7- C/2-11-/ -#4-L it/< ---14-S., 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.). fftee.V&WrY rs AS( / s'e)` /q rill C litleE� 014 7 c=mietLi OF- 2- C 7 le 017:4s. 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.. 9. 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. NO hi >1 PR 0 Lo 40-I, DR GvEGG,5 l a'/4-Cr /SE ei-c p Pv/2 Dic! St 7'6 gP/iI S/OK O/- <c7- nih r1/4-7-E- ("i p •• i ' Ip•A1- f e r project rA requires' use df stormwater treatment facilities,describe the types of stormwater treatment facilities proposed jfor use on the site. ate these facilities on the site plan and differentiate proposed facilities from existing facilities. [This is normally for large"pr ects or projects that involve the potential for dispersion of contaminants.] 1'r1s: , it ^.1 } u//14 Del 7). >1 E-v LZ-, . 1A3 f.St)JlV:( Vir,'.''1,.,rAi t+'► 4"i:rr1 d 11. Describe the performance goals and standards applicable to the project. L 6 /1-l- /A 1 /G7/e/4-7 E _- t,' 1 kifi ? OK SI'1.--e: 12. Describe the flow control system. ./(/.01(/ RECETVED . of IEffftftlIII 1I11nl l i In stormwater site plan template—rev.10/1/2003 6 • • 13. Describe the water quality system. if///4 14. Describe the conveyance system analysis and design. alie--t- pa Pi V CO Etc- 41 d'u rrE�s 4-14 D 1>txei v_/Oric.r T_ 5, 15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material. 4/c.7 -/Lc, AfitiD No E(cE5S G,I"z-` .etAf e-,S 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. / 17. Describe the proposed surfacing material. i L tl 5t:% i .( /90 Ci-fj ids PP 1 ✓E-w44-}-, b t-1/2 i N 4 coS7"/t,'11 z 77 O he , 18. Describe methods for restoration of the site. I(%/L I. €E5EED C, ss ,s. 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�'/� 20. List here and include any special reports r 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,descriibe Q�conditions or restrictions here. �/ RECEI\� I► l) ` 1 ,,, , r-E-1;4 , 1 ,....,J1 r Po iiiMB MIVI 10 t stormwater site plan template—rev.10/1/2003 7 • • CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN(SWPPP) The Construction SWPPP addresses sediment and erosion control during construction. The BMPs indicated by the applicant in the template that follows must be installed on the ground during all construction phases of the project. The proponent is responsible for preventing sediment and erosion impacts to environmentally sensitive areas and off-site areas. Consult the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet for guidance, particularly with rural residential development. SECTION I—CONSTRUCTION SWPPP NARRATIVE 1. Construction Stormwater Pollution Plan Elements. Describe how each of the Construction SWPPP elements has been or will.be addressed. Identify the type and location of BMPs used to satisfy the required element. If an element is not applicable to the proposal,justify in writing. Descriptions of the 12 Elements are found at section 2.5.2 of the Manual(beginning on page 2-15). 12 Required Elements—Construction SWPPP 1. Mark Clearing Limits. itili L /J1/t1 K GW0ie 7'15 al f ttf SSei/e 1/-1'1 /0 2. Establish Construction Access. LifdIG 1/5. c, xtee- sS )'b/N-- Iry S/T- . Lc, ir-Att GM lE C,is i D /2ack i/ DXav cd/ -> -c. r -, Ctxl At7 )' go ill:),. dz�-Af- 3. Control Flow Rates. �1� 4. Install Sediment Controls. -------__a-L 4'SE /L ! ,i E. /, ___ L=35s Ji . 5. Stabilize Soils. .%gyp A/ C g ssl A ' 'vtt-L, ue— .57 coy' Di-57?,t,Sc0 4"A'oaAiU • XI —5 , D Z) ,l l ASS �`i \+F4 -FI) 6. Protect Slopes. \ Tj FL c 2 :r 7. Protect Drain Inlets. H-Mali\ c1UIIN1' i11,1} i1-" GAS S ,--,$.1 ilvG d g- s'77r LGJ /C/&-ote-,S stormwater site plan template—rev.10/1/2003 8 • . 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. 9. Control Pollutants. 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). Ou 7Z7 D,4-lr4/EtL5 /,G e 11. Maintain Best Management Practices(BMPs). 12. Manage the Project. 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). 41tc cle!i t GJ L 47:2 5; Co/CH- 72 Lo< 0./t?t>t Z COw O of-DS &t/1 . coatsz'ikft.-Tt0eV t.V Z Aec,7 p,sTt!`e a crr1€iZ iSk vloeeTr ES o.= J<'c»`t©S b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). 4 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. ���a j(\��F1) .//ems I� �� J�p stormwater site plan template—rev.1 CV7/2003 9 • • • b. Description of special requirements for working in or near environmentally sensitive areas. PR EC-r e/ri/b1.vas ,Yo 7 e". /11a e7 S 4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site soils(e.g.,erodibility,settleability,permeability,depth,texture,soil structure). .A O ,/Y'0e1-&-v41 l L D/e..T-1/1 II' '1 IN z• Dig 5. Construction Phasing. a. Construction sequence e-04 int ri a! Fr3.1-1 t`.4LQ4.'2-t Oetl 4 //va$ E b. Construction phasing(if proposed) 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). I. Provide a proposed construction sched't e._ IV-Me90 �tfr-TZ 1' / 7,n c., yl/.-? 2- o`7 II. Wet Season Construction Activities. TD eon fie�Tk►!.!. a. Proposed wet season construction activities. /b14C 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. /14 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable. a. Sediment Ponds/Traps. n� ������y�f�� b. Diversions. R c. Waterways. /l / d. Runoff/Stormwater Detention Calculations /L it .1EFFOSII , +.(ItV 110 stormwater site plan template—rev.10/1/2003 10 • • 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 applicantowner 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. 2//"L?/o7 DOWNER OR 0 ED REPRESENTATIVE SIGNATURE) (DATE) tt THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: RR(( ` i ICJ/71, j]") aft , 1E16 ill stormwater site plan template—rev.10/1/2003 12 I • 0 Fi,(,( t (I .�r If ai)J (--, oN C06 JEFFERSON COUNTY i`� ` DEPARTMENT OF COMMUNITY DEVELOPMENT ,- 621 Sheridan Street • Port Townsend •Washington 98368 / i 360/379-4450 • 360/379-4451 Fax '46. ktING $ www.co.jefferson.wa.us/commdevelopment t I Master Permit Application MLA: 0"7-69' Project Description(include separ e sheets as necessary): Tax Parcel r �. Property / Number: 7�' 2— IV7 Z 0 7 Size: /00 X l 3$ /4.5 --S+"(a cres/square feet) Site Address and/or Directions to Property: /.5Z. �`/ (;n /tiN e C 16 4��' Ave /r T ,•Ns p73s' Property Owner(s)of Record: PE De.24rf AZ t7 421 erenw0 itsfr,j•,4: Telephone: )4,O '311-- eel W'Z— Fax: email: GeyJG>ZCCO e * v!' cc.Ll Mailing Address: LY/0 hi( ili,`9 4Q-4 4 '- r,I/ I T/f ,4,4=r 7;1.-- ,(Se/7 e 0/L.Pz/'f: '7g3 t. Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) !trading ❑Variance(Minor, Major or Reasonable Economic Use) -Demolition Permit ❑Conditional Use[C(a),C(d),or C]** d Single Family ]Discretionary"D"or Unnamed Use Classification 'arage Attached C6etache ]Special Use(Essential Public Facilities)** Q Manufactured Home °Boundary Line Adjustment C7 Modular °Short Plat"* El Commercial* °Binding Site Plan** Q Change of Use °Long Plat** El Address i Road Approach °Planned Rural Residential Development(PRRD)/Amendments** Et Propane ❑Plat Vacation/Alteration** OAllowed"Yes"Use Consistency Analysis C]Shoreline Master Program Exemption/Permit Revisions** OStormwater Management ❑Shoreline Management Substantial Development** OSite Plan Approval Advance Determination(SPAAD)* CDShoreline Management Variance OTemporary Use °Comprehensive Plan/UDC/Land Use District Map Amendment OWireless 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 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 SIGNATURE Date: By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of his,her or it's knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable 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 re ired I ter ins ections. taffs ccess and right of entry will be assumed unless the applicant informs the County in writing at the time of the appli n he or he wa prior tice. Signature: Date: 2.-/Z7,6 7 The action or actions Applicant will undertake as a result of the issuance of the 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 re in mpliance ith the J fferson ounty development code.The Applicant acknowledges that he,she or it holds individual and non-transfer 25p ibility for dherin and m lyin with the ESA. The Applicant has read this disclaimer a signs aped dates it below. Signature: Date: Z /L? O 7 l/ ` D:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05-2.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 assu " th espo ibility, the eral Contractor for the proposed project. l Signature: Date: 2 27 67 GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE:: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Fr me Type: Bathrooms: Shoreline: Type of Sewage Disposal: 52(New Wood Existing: © 0 Sewer ❑ Addition 0 teel Proposed: C Bank Community System ❑ Alteration/Remodel 0 Concrete Total: Q Hejgh 4Individual System ❑ Repair ID Masonry I'll// SEP Permit# dio"Ot)i33 ❑ Demolition ❑ Other: Bedrooms: a Water Supply: Existing: Setback: 0 Private well ❑Two Party Type� of Heat: Proposed: C? /✓ p�gPublic U w i•-/E 4 TED Total: Name of System: ! p- i 0 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: I1 Underground Tank 0 Above ground Tank Size of Propane Tank: ❑Heat Stove ❑Cook Stove ❑Woodstove OFireplace Insert ❑Hot Water Tank 0 Pellet Stove p 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 For Office Use Only Amount Revision Main Floor Heated EH Bld App Review: 2n0 Floor Heated �j •., Consistency Review: _ II Other Heated Base fee: 4a1.35 Mezzanine :� ' Additional Section: t .1 , Heated Basement i( Plan Check fee: ��, b Unheated Basement i.°11S il;, :� 111'1 111,I� State Surcharge fee: e '•so Other Unheated ! Pot Water Review fee: y,____ _V Garage/Carport TVS11 `5 SUBTOTAL 8142 to �� .4-13 Decks 911/Rd Approach fee: e A54-i 4 Other 2Iti. p�Q LtWNi MTEb .3 ri() ctil 485.as TOTAL: $ 64/. ate_ e-� Receipt Number: i- L1,5a Q` ^ ` Cash/Check Number: ESTIMATED COST(REQUIRED) (� 41) . /6 j Date: -1� I �1' of all labor aterials foundation to U` I of 1d .Fair market value bo 'i f 7 �i O �� f7 Initials: 6- D:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05-2.doc -----.444.4 I- I . .. , — - — _ _ . . "•10........1.41. 11 1 I • 1 ! I i \ / / . V' \ -11 / 8 V.- \ , 70. ,, ___I I .• ...,. .s, \ N 1 1 1 — 1 . 1 i-------i • , I I 1 / \\ / \ / \ / • — \. .• .,, • , .. •.• '' .. •.. 1.]• •, \ p‘ 1 1 • ______;___I„,,. . _ \ i c___ 1.1-1 CD . C.-0'D •—cy c---z cn VI' r...:----. . •......... =.:. CC = . C.. = i , i t i i I V.1 0 1 , t.,4 i .._...,. I 1 1 Vr ' j, Zfri, --_,--..a.----.-„------------„---- ...,- --- ----- , 1 1 i4- r ......... . .......... .....,........._ ,......*.asaaommiewo,a., i I ' 0 . 1 1 i S I I I 1 C i t al 3> . It. • i M Cr ILI1 !-- J--- 1 1 -I or i -et Lc41 1 •IS• 7'j , 1 - • I • I ,1 trl i I • :1 1 1 .., _ •1 Imo, �1�P(irr 1 [-4 r- �SC I?VE�- ?70 ` I 1� �A I N r, h�F'Tlli Dl�rll��IEI.I7 II Vr� I sGi�1'I�TpNK IO'x'70' �r r-'941 H l;IGLt2 Miy.IIH Iq,IW Io'x?ia' I MIN-I01 Rp wet 2q v� F i !o' tv 1 — IS' cog �A GLv 44G M ID N N I to t ho I { ,o N i Lor•IG, THO14E / E Ibo t a l 4 �p+°la 5 L. __. \V /x'I r Iz 13 rlfrrf� �I _ Gr IhI �G1 l ,.vim -1I_� " I �GIiS L = I��LOGK I �Z I �dl l pit✓ 1JI /. (P I � Val,. Z �h I ?j� Joints in filter fabric shall be spliced at �G• 3 10\\+'F-I Lj l—) I �70 N �� f`^V7' ) ,t/ posts. Use staples, wire rings or - '— _ t equivalent to attach fabric to posts 2"x2" by 14 Ga. wire or .- equivalent if standard Ii0 I G/ Z'_ � — z q strength fabric used "rh.X L.GU I I(>Z Imo% ZQ61 I I I Filter fabric �i�P(IC� �rlh/PI I �f O E ^Z 1 l�of�{ IG\VFI=��'IJf7 -7r---s'maz-_-�Tti - E J Minimum 4"x4'trench.. E '9 O N 17 �� � BacMill trench with native soil Past spacing may be Increased or 3/4"-1.5" washed gravel to 8' if wire backing is used - ... - 2CI I 2"x2" wood posts, steel fence IO I� I h(Ivlr posts, or equivalent r;'r7�f'r 1aW1-4 `7[F,:14t2 Figure 4.20-Silt Fence OVA_ f`7.7(o�3 I��TrZ 2- 2a- r,? 'Roof areas larger than w 40U square feet use 10 feet of soakage trench per 400 square feet - (or part thereof) of roof area, to be installed on contour. - _ 36• 'r Z12" 10' min. - Trench shall be / / / 12 / a 10' from buildings and �,o"oc / / /•h 5' from property lines. �0 ca°°tea rat �•, � �/ / 10" min. / / -' x 7 above groin �u / i% / with filter fabric h / 12" min.' y, j� below / ground 3" ABS SCH40_ ' erfo ated - 3" C.I. or - 3" PVC SCH40 pipe smooth wall �} (4'pipe required plastic pipe lorroo/areas N over 1500square feet) Mclean gravel fill 2 3/4' to 2 1 /2" �i I K M \v�'r i•Z /� �i%� � r a IJ 1��2 GaU N T�' �'�• ' � APPROVED SITE PLAN MAR 2 7 20U7 JE FFE R SON ('n i. NTY DEPT.OF14 b Ul`'r'C'( SIGNATURE:Y M407- 0008� %l �v1 S/0nq S ADDED D 2Y40E(L 1�0c47_/0NS