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HomeMy WebLinkAboutBLD2007-00118 BUILDING PERMIT APPLICA JN ML vy 147 Review T Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00118 Received Date: 3/22/2007 SITE ADDRESS: 132 S OLD FLAGLER RD PORT HADLOCK, 98339 OWNER: CHAPPELL J BROWN PHONE: MARY/HAROLD/FRANK BROWN 55 FREDERICK ST PORT TOWNSEND WA 98368-9350 PORTAGE BAY PARK SUBDIVISION: Block: Lot: 47 PARCEL NUMBER: 989100031 Section: 1 Township: 29 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE PROJECT DESCRIPTIOF NEW SFR W/ATTACHED GARAGE TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 1,886 VALUATION 184,881.00 ADD'L: HEAT TYPE: EEE CODE EDITION: 2003 HEAT BASE: HEAT TYPE: OCCUPANCY: R-3 UNHEATED: # OF STORIES: OCCUPANCY: OTHER: CONST TYPE: 5N GARAGE: 576 SHORELINE: CONST TYPE: DECK: 96 SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: PUD BEDROOMS: BATHROOMS: Exist: Exist: Prop: 3 Prop: 2 Total: 3 Total: 2 Routing Date: � 7 3ia3 6 Cam- Type Amount Paid By: Date: Receipt: Approved/Date Permit $1,469.75 KAS 03/22/07 89480 APPROVEr Plan Check $955.34 KAS 03/22/07 89480 State Building Code $4.50 KAS 03/22/07 89480 MAY a4 2007 State Building Code $0.00 KAS 03/22/07 Potable Water Application $58.00 KAS 03/22/07 89480 Jefferson County Planning Total: $2,487.59 & Building Department Jefferson County Building Div,sion Permit Num. BLD07-00118 Applicant: BROWN 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 62,,4 `;`7 • Erosion Control i/i/nq Foundation Footing �(,"__ •- 7 �1 Footing Drains ti �•� (_ N >�t �,:;..i Foundation Stem Wall [J 1 (Ng Underground Plumbing tJ A Under Floor Framing G/Nien Straps(hold downs) C/_(Cf`3-7 Ext. Shear Wall Nailing 7,1c( �77 ` ' e Rough-in Plumbing Z_� V, . ,/0 Framing 2/zzief- �1 Blocking z,/zs/eg Airseal Z—(C_ Insulation:Walls ZP O L ��zlav natstAk-c j1EPtH s`neKs ic"-n e;;►ue•t Insulation: Floors /;/o Insulation: Ceiling ?�/Dg Int. Shear Wall Nailing 3/5./0, D� Wallboard Nailing f,S/e 311 b� Gas Line: Interior iU�i4 Gas Line: Exterior ��� Propane Tank Heat/Chimney Clearance AO- DrywelllAlt Drainage 7/..1/08 Address Posted / a FINAL INSPECTION 74//i j tj( -Q r el) 7/2/% FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR • . CONDITIONS for Building Permit# :BLD07-00118 1.) A setback of 100-feet, measured perpendicularly from the wetland edge, shall be permanently maintained as a buffer. No filling, grading, clearing, or other alteration of the wetland or its buffer is allowed. 2.) 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." 3.) 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. 4.) Perform grading operations on the driveway extension during the dry season (April 1 to October 15). Graded areas should be covered with non-eroding materials such as gravel or be re-vegetated within seven days of construction during the dry season. Completion of gravelling of the access driveway in and near the buffer zone should be prior to November 1 or else it should be re-vegetated or covered with straw and/or jute netting to stabilize these graded areas during the wet season. 5.) Install all erosion control measures prior to beginning grading or other ground disturbing construction activities. Silt fences should be placed between the access driveway and the buffer/wetland. Silt fences should be placed on the downhill edge of construction zones. Straw bales, jute netting or other appropriate materials should be used to stabilize sloped areas following grading. 6.) Two culverts shall be placed under the proposed driveway extension as shown in Figure 5 of the Revised Wetland Delineation & Mitigation Report. A small seep occurs along the northern edge of the property, which drains into the wetland. Although the amount of water coming from the seep is not significant, if it is not allowed to flow naturally, the proposed road may provide a barrier for the water and accumulation may occur There should be a six inch fall from one end of the culvert to the other, with the culverts angled toward the wetland. Through emplacement of culverts, natural drainage from the upland of the wetland will be maintained and possible road failure will be avoided. The culverts should match those recommended by Jefferson County(12 inch culverts should be adequate). 7.) The driveway width should be no greater than 12 feet, plus necessary sideslopes (sideslopes not to exceed 2.0 foot footprint each). Total footprint of the driveway where sideslopes are necessary should thus be no more than 16 feet. Areas where no sideslope is necessary should have a footprint of 12 feet or less. In either case, the footprint should be staked in the field prior to construction and equipment operators should be instructed not to deposit materials or to operate machinery outside of this footprint within the buffer zone. The height of fill should be less than 18 inches above the current grade, although more may be required at culvert locations. Sideslopes should conform to standard engineering practices and Jefferson County Code requirements. 8.) New shrubs and trees will be planted within the buffer zone as per the planting plan described in Chapter 5.0 of the Revised Wetland Delineation and Mitgiation Report dated August 2006. 9.) Planting success will be monitored and will conform to performance standards as described in Section 4.6 of the Revised Wetland Delineation and Mitgiation Report dated August 2006. If performance standards are not met, additional plantings or other remedial actions will be taken to meet the standards. 10.) Silt fencing will be placed downslope of the construction site, and exessive clearing of the area around the home-site should be avoided to the extent possible. The vegetation that currently occurs between the proposed homesite and the wetland will also help to reduce the risk of silt pollution. 11.) Erosion control measures discussed above should be implemented as necessary. 12.) Construction of the driveway extern, building of the home and placement of.septic system should be conducted between the period of April 1 through October 15, if feasible, in order to avoid carrying out ground disturbing activities during the rainy season (for minimization of erosion). Any construction work during the rainy season should have all erosion control measures in place prior to beginning work. Additional erosion control measures as necessary may be incorporated to prevent erosion of soils and sediments into the wetland. New plantings to be established in the buffer zone should be carried out during early fall if possible (September-October) to avoid the necessity of supplemental watering. Plantings can be placed during the winter or early spring if necessary. If plantings occur during summer months, supplemental watering with a drip irrigation system or equivalent method may be necessary. 13.) Monitoring success of erosion control measures will be carried out daily during the construction period. Any evidence of significant erosion or sedimentation entering the buffer zone or wetland will result in immediate action to block erosion and sediments. Such siltation can best be blocked by additional silt fences, straw bales, or temporary berms. The two recommended culverts should be maintained annually to ensure that water flows freely from north to south across the property. This may require periodic removal of leaves, brush, or other material from the culverts. Maintenance of the driveway should be performed as needed. Maintenance gravels should be compacted to limit erosion into the wetland. Monitoring success of new plants will be carried out according to the following schedule: 1) Following construction, plant new plantings and check soils conditions. Holes should be of appropriate size, generally 2-3 times the size of the container, filled with topsoil. New plantings should be adequately watered immediately upon placement in the ground. Mulch should be used as necessary. 2) Prepare an initial monitoring report at the end of the first growing season following plantings (within one year of the completion of construction). This report should address the success of the plantings. Any plant mortality should be noted and corrected if plant survival falls below 100 percent during the first year and 85 percent during successive years. 3) Prepare follow-up monitoring reports at the end of the next four years following construction and restoration. Monitoring needs to be conducted for a total of five years, with a monitoring report submitted annually to Jefferson County. Note any corrective actions which are necesary, including additional supplemental planting to compensate for plant mortality and the apparent reasons for such mortality. 14.) A Contingency Plan should be prepared in the event that the mitigation measures appear to be unsuccessful, particularly in terms of erosion and sediment control. The Plan should also address any significant lack of success with new plantings, particularly failure to meet the performance standards of 100 percent survival during the first year and 85 percent survival during the second and subsequent years. The percent cover of non-native species in the buffer enhancement area should not exceed 10 percent. If monitoring indicates that more than 10 percent of the enhanced buffer area consists of non-native or invasive species, contingency measures must be implemented. The Contingency Plan should include actions which will be taken to correct any defects and accomplish the intended purposes of the project. 15.) Revegetation is to occur along bides of the access road but only for the p411/n which passes through the buffer zone. The driveway itself and sideslopes will be made of compacted fill material and will thus not be suitable for revegetation. The existing forested upland, of which the buffer zone is comprised, appears to be very healthy. Revegetation and planting to mitigate for improvements to the existing drive and filling of the existing roadbed will not be excessive in an effort to avoid impacting the already healthy forest ecosystem. Accordingly, only shrubs and small trees which currently occur on the property will be planted. The likelihood of future road maintenance issues influenced the selection of the kinds of vegetation to be planted because of the location of the planting areas adjacent to the driveway. Planting areas are shown on Figure 5 of the Revised Wetland Delineation & Mitigation Report dated August 2006. The number of small trees and shrubs planted should correlate directly with the amount of vegetation removed, destroyed or harmed during the process of road construction, grading, and culvert installation as per Table 3 of the Revised Wetland Delineation & Mitigation Report dated August 2006. One-gallon pots of salal and sward fern with four foot centers, and three-gallon pots of salmonberry, oceanspray, and red elderberry with eight foot centers should be planted near the base of the sideslope, approximately ten feet from the road. The western hemlock trees can be planted along the southern edge of the buffer enhancement area. Placement of these plants should be staggered so that they are offset from one another to provide growing room. By alternating them in this semi-random fashion, it will give them a more natural appearing configuration. To increase the potential for the planted species to survive, four inches of mulch should be placed around the installed plants. Mulch should be held back two inches away from the stem of the plants. The landowner should be assisted with the plantings by a landscaping firm, arborist, or registered nursery person. Monitoring should be performed by use of these persons or a qualified biologist. 16.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 17.) 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. 18.) Minimum setback from South Old Flagler Road right-of-way shall be 20 feet. Minimum side and rear yard setbacks shall be 5 feet. If a critical area is present, then the more stricter setback(s) shall apply. 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.) 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. 21.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 22.) The building height is not to exceed 35 feet. 23.) The application was reviewed by the Jefferson County Department of Community Development staff on May 4, 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: Category II Wetlands and Coastal Seawater Intrusion Protection Zones (SIPZ). 24.) A Revised Wetland Delineation and Mitigation report dated August 2006 prepared by Westech Company was submitted in conjunction with the application to address the wetalnds. 25.) Buffers are areas that shall be miined in their natural condition, however, 4 pruning or alteration of vegetation may be permitted as long as the function and character of the buffer are not diminished. 26.) Among the native conifer species which may be used in buffers or for re-vegetation include, but are not limited to: Grand Fir (Aibes grandis), Sitka Spruce (Picea Sitchensis), Shore Pine (Pinus Contorta), Douglas Fir(Pseudotsuga Menziesii), Western Red Cedar (Thuja Plicata), and Western Hemlock (Tsuga Heterophylla). Among native tree species which may be used includes: Vine Maple (Acer Circinatum), Big-Leaf Maple (Acer Macrophyllum), Red Alder (Alnus Rubra), Pacific Madrone (Arbutus Menziesii), Quaking Aspen (Populus Tremula), Black Cottonwood (Populus Trichocarpa), Bitter Cherry (Prunus Emarginata), Oregon White Oak (Quercus Garryana), Cascara (Rhamnus Purshiana), Pacific Willow (Saliz Lasiandra), and Scouler's Willow (Saliz Scouleriana). Among the native shrub species which may be used are: Sevice-Berry (Amalanchier Alnifolia), Red Osier Dogwood (Cornus Stolonifera) Salal (Gaultheria Shallon), Ocean Spray (Holodiscus Discolor), Indian Plum (Oemlaria Cerasiformis), Pacific Ninebark (Physocarpus Capitus), Red Flowering Currant(Ribes Sanguineum), Wild Rose (Rosa Nutkana), Swamp Rose (Rosa Pisocarpa), Willows (Salix ssp.), Red Elderberry (Sambucus Racemosa), Snowberry (Symphoricarpos Albus), Evergreen Huckleberry (Vaccinium Ovatum), Red Huckleberry (Vaccinium Parvifolium). 27.) 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. 28.) 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. 29.) 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. 30.) 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. 31.) VOLUNTARY MEASURES OF CSTAL &AT RISK SIPZ: • 1. Installation of a flow meter. 2. On-going well monitoring for chloride concentration. 3. Submittal of monitoring data to County. 32.) 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. 33.) 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. 34.) The applicant is proposing to create or add 7918 square feet of impervious surface and 15,400 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. 35.) 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. 36.) 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). 37.) The site plan as submitted with the building permit application on March 22, 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 May 4, 2007 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 38.) This approval is for a single family residence with attached 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. 39.) This parcel is a legal nonconforming parcel designated as Rural Residential 1:5 under the Jefferson County Comprehensive Plan Land Use Map effective August 28, 1998. 40.) A septic permit (SEP07-00105) was approved on May 22, 2007 for a system of 360 gallons per day. 41.) South Old Flagler Road (C578409) is a county local access road. The road approach was reviewed under RAP06-00028 and an address of 132 South Old Flagler Road has been assigned to the parcel. 42.) The lot was created throught the Portage Bay Park Subdivision, filed of record on February 5, 1948 under AFN 112767. 43.) Development Review staff conducted a site visit in June 2006. The driveway was constructed through the northern portion of the wetland buffer. k����::. :,o�� vEFFEf�S01'�!OUNTY -�::;•//,,.... � _ rtiDEPARTMENT OF COMMUNITY DEVELOPMENT kilt A (-` o 621 Sheridan Street • Po nisgndi hi 918368 �y 360/379-4450 • 360/379 51 Fax ' ;)) 1`3,4 7NGO www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: or - i 1-1'1 Project De cription(include separate sheets as neces , . (0 i4 ,,.T,-ti 6-, � �, II IY�1�[ Tax Parcel r Number: I C G V Property /, 7 j c`,• I :5 (acres/square feet) Site Address and/o directions to Property: 1 aD coo \ c 4)) . Po r oo�" �-° F Property Owner(s)of Record' da/h.t✓ 13i"d,e,- J7�`�t W„ ,) Telephone: (X 0) Jc'I p 3 5,.a Fax: ,N$zi email: 7/7/ Mailing Address: qc? f4 .- lei /►e, % c44,, t,. ((if!. 961i j Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit? (Check each box that applies Building 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit 0 Conditional Use[C(a), C(d),or C]** SI Single Family I Garage Attache Detached ❑ Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home 0 Modular ❑ Special Use(Essential Public Facilities)** 0 Commercial* 0 Boundary Line Adjustment 0 Change of Use 0 Short Plat** ❑ Address 0 Road Approach ❑ Binding Site Plan** ❑ Home Business 0 Cottagelndustry 0 Lcng Plat** ❑ Propane ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑ Sign 0 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)* 0 Shoreline Management Variance ❑ Temporary Use 0 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 ❑ Tree Vegetaion Request *May require a Pre—Application Conference **Requires a Pre-Application Conference Please identify an_y.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 required later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the application that he or she wants prior n Signature: .----7-- "•- �� -�/ AV\�J ----, Date: : 3 - .2/-cr i The—an or act icant will undertake as a resQ#'of the issuance oft s •-rfnit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered s,,cies;as those terms are defined in the federal law known as the "Endangered Species Act"or"ESA."Jefferson County makes no assuran • to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in compliance with the Jefferson County development cote,The Applicant acknowledges that he,she or it holds individual and non-transferable responsibility for adhering to complyin with the ES -h¢Applicant has read this disclaimer and signs and dates it below. Signature: /`—�' n / Date: 3`2/ —c7 h G:\PermitCenter\###FORMS###\ORD FORMS\Master Permit Application 12-19-200dd BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed project. Signature: -•'.: Date: C.),C.),` GrNIRAL CONTRACTOR O12 MANUFACTURED HOME INSTALLER: PHONE: FAX: tXt".11.ec /1 L4.v Glii.3en t ,4;ty r-Ct t s. k-CCt v�.�'('t�., o ) 30/ .- /3 5''] ( ) AA MAILING ADDRESS: GA) /Celli .�L "�„, 11/ LG/� (2 4 EMAIL: 4jtA CONTRACTOR'S LICENSE 9 33.3`j WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type:` Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: II New % Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: 2 Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: ct Height: ', Individual System ❑ Repair ❑ Masonry SEP Permit# o1- [L5 ❑ Demolition ❑ Other: Bedrooms:' Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat Proposed: COY Public .4 r It j c Total: /.'fr Name of System: I ic?./.2 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: : vi tt e, ood Service? Yes / No If this is a Propane Tank and/or Appliance Installation permit,in(a�kall it ms b l*tht pply: i Underground Tank i Above ground Tank Size of Propane Tank: 1 Heat Stove 1 Cook Stove i Woodstove i Fireplace Insert i Hot Water Tank i Pellet Stove i Other Is this appliance being installed in a Manufactured/Mobile Home? Yes 'I 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 tan l {.t 'i gyti(rllings and septic system components, including the reserve area. . , , i l ii 1 Square Footage Current Proposed For Office Use Only Amount Revision Main Floor Heated EH Bid App Review: 2"d Floor Heated Consistency Review: f Cif. CT- Other Heated Base fee: 1 4,q, Mezzanine Additional Section: _ _ Heated Basement Plan Check fee: 955,O4 Unheated Basement State Surcharge fee: t_I c,Q Other Unheated Pot Water Review fee: CI Garage/Carport `) I (35-1/03a SUBTOTAL a '143.59 Decks 911/Rd Approach fee: , -f_I Other 0 L 'v' c'r'c.D 1 e; ('\ 9& Caba.12 TOTAL: $ a 1 43 ,5 I Receipt Number: 0(14C) Cash/Check Number: al ESTIMATED COST(REQUIRED) Date: ) ^t )r •Fair market value of all labor and materials fou dafion-,te finish- - 11 •S !(i o /0 ldo. t!B`t,sllo .l t73s: ()2 G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc • • 41T C' ECEIV IF)) g " , • ° , JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT �;f�lt 2 Kr 4621 Sheridan Street • Port Townsend •Washington 98368 JERBOA '.(�(1 p' 360/379-4450 • 360/379-4451 FaxIV '���� http://www.co.jefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# _ O I " L`I� �".' PROJECT/ ~,,; 0. 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. Existing Conditions Summary 2. 'Describe the existing topography. Indicate contours on the site map. �_., �• ` •— -rz E1 .5..--• -7 - c�`i - -.. i r 3. Describe the existing vegetation. Indicate native vegetation areas on the site ap. , , , �� �- II� S , s ko STORMWATER PLAN a 4. Describe the existing soils. Indicate soil IIIIIMMP �M;�► MI type on the site map. III III III IIII II I JEFFERSON COUNTY . lektffitA 5. Describe the existing site hydrology(i.e.,drainage;behavior of water on the site—above,v a e `w,a` /n�'oun.`'�'+■ existing stormwater drainage to and from the site on the site reun• �1 ate gmap. Depict separate drainage basins on the site map, if aPPIiCle,and indicate acreage of each. 6. Describe any excess levels of noise generated by the proposed use or activity: licrrcn)Uni L'UUN1Y On stormwater site plan template—rev.10/1/2003 34 4, 4 • 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.S op ropecht vs ® eth 0 . U� ec��d s l V cutul itt y'P'�Lta l M . 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.). W-t-k"\ICkV6 S t(*1?-e5 1 here ci S Permanent Stormwater Control Plan This portion of the Stormwater Site Plan consists of the selection and installation.of the appropriate stormwater control BMPs and facilities to remain in place after construction of the project is completed. "Medium" size projects are required to have the totals calculated of all impervious surfaces, pollution-generating impervious surfaces, and pollution-generating pervious surfaces to verify that the thresholds for treatment facilities and flow control facilities are not exceeded. g. Describe the developed site hydrology, as proposed. Indicate whether stormwater will be fully dispersed(i.e., per BMP T5.30 in the Manual)or,if not,what types of stormwater flow control will be utilized for the site or specific threshold discharge areas withi the site: Locate these facilitie on the site plan and differentiate proposed facilities from existing facilities. ` 11-) rkkS ecsQr -, , t ' '}A.z t', i 10. .Jf th 4 rgip requirg4 they pp qt sto water treatment facilities,describe the types of stormwater treatment facilities proposed �, . 0.sita. Locala_Mte facilities on the site plan and differentiate proposed facilities from existing facilities. [This is n rmally for"large"projects r projecth that involve the potential for dispersion of contaminants. Lf t t; T U, VkAttA E' er l k'P S A3 1.s,I YN WWV_) V.Oi;"0;._,-i' :i1 T �,+(11_ i:'i t:it Y1 iZ ji:1,:V l 10 x i:i l -t :perfoirnancergOatt tiltritandards applicable to the project. to a- V\Fa82, RVA- 'ID:CV:A) 12. Describe the flow contro ystem. I �u a ROVINV a JEFFERSON COUNTY OD stormwater site plan template—rev.10/1/2003 • • RECETFT) P 1'ir r t. 13. Descri the water quality, ystem. itijakAAL\ IAA 431 MI' 14. Describe the conveyance system analysis and design. L 15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material. -�a-;4e" . 1 A+vKZsr.nf 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. Al 6.." 17. Descr e the proposed surfacing,material. 18. D ri e tho r rest ration oRhesisite. I r cokpe 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 req Jired to control flow or treat runoff.] If included,list the Manuals here. Nilik • 20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan. ,Q•D 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. G-u,Tt2 . OLta Clc O ‘AN, 'I Pr JEEheii•w1tt uu►llY UCb stormwater site plan template-rev.10/1/2003 • • • 4 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. 2. Establish Construction Access. 3. Control Flow Rates. 1�a ^a V.c^_ . 177 �,gr_r t_,�.� J� �� +- Sys-t -c- 4. Install Sediment Controls. A / • C-+ri r.i SC..a•-,----.m r r (JYC 4 �.x r�J✓sac--+cam..► S�TZ - • 5. Stabilize Soils. ECEWET tt' t 1 Aillf1I10 11111%1, ,�,► 6. Protect Slopes. C -<-4-aN1.L.-, 1c) j�}C . L�T-� ��- `I�l+% -«3r_t� V�L�';Y-ra-t— i 7.. Protect Drain Inlets. ,.3`, i•cj ��'+;4.'�y I'd"�� - , . �Ifa.,� E�'L ` u/t�T"� '- \ .et�y �- -- -Tp a 't� -S Ne-C Qc:-�. -1 _ Z� c a% 21 •- Gam-..-acT- Wiz..- va-1,--E- kel. C i.�cftT-i o f3GS }- `^ -A•.! J-=3 t v f-1"::i.€ra1NrA stormwater site plan template-rev.10/1/2003 9-11.t` f • • 12 Required Elements-Construction SWPPP(continued) 8. Stabilize Channels and Outlets. 1.3427--z.c_. '-r----i,v�Go__S ion . 44i-+-*5� R Efi C t,1111ED 9. Control Pollutants. c� C) ,.���;.. 1`flA, MAR P, taut IMO 1IIIP11:0 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). �o'er rcv.t-e.°'iv Tr-, �� <=4:�-r-A 'l A l �x,w/ t-...-sr,.-1-_-.Ez, +- -R "'C-C:1- —.L-1= '9=2 -i ! . • Aws+`" 'r%yvc-- 11. aiW Best Management Practices(BMPs). . I Me c OVV C I\C_I c, ��; t ?) .01,0v-e, 1 S.ivcri+ vA- 1l. .e, Lr 41 IP ni OIAS 12. Manage the Project- a set if-) j�.r �� c r,4-cQ o r n a c c --t" cti. au 1 �'�C. j GLic krt P®'v,,c-t i 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). ■ v\J�-`".._R.+�.i.,r�,j - 1jiV'© C�On0,.. ,-=f^t-1-1Q.f r�+a.l,l ('� 'YT"c i�+7 ` —-T'.131'-., 'T?s<;,MLr _1At..- b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are n or adjacen e site. VOl c C!/•2 3 Me 12 t,1X-7tk .kA oc e cam. IlhIT JEFFERSON COUNTY RCE stormwater site plan template-rev.10/1/2003 • . A b. Description of special requirements for working in or near environmentally sensitive areas. (—C- 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)QrG +✓+,cl Co rt)�3L f. � Whoa L )--I rv--�_. © ��C Csi�Y IT'S , . G-���1`� t 4..11 ( J T 1} i L-1' LyL�',L3-- 5. Construction Phasing. a. construction sequenc • f.e9 �l�V'i t ��It. kt tm C I Vypo 1 m r to c I b. Construction phasing(if proposed) 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). I. Prov a proposed constructs schedule. �l -e V- `%l\ndct,-+(o\k RctY`/vic� oD-vitt, L ) r� �'eClo(' < J k-e C' -CC`�- 1 �i I i��n •J� �1 II. Wet Season Construction Activities. ' �q��f �'� a. Proposed wet season construction activities. REk b. Proposed wet season construction activities for environmentally sensitive areas. r,u DOW AS 7. Financial/Ownership Responsibilities. a. Identi the property owneKesponsible for the initiation of bondsand/or other financial securiti a-60 cav\1c'l t .� eu Uk , } cc Lv I - b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. . Q 3hS \O hi 8. Engineering Calculations. Provide Design Calcula ions on a separate sheet for the following,if applicable.W ''``' a. Sediment Ponds/Traps. ti A b. Diversions. c. Waterways. d. Runoff/Stormwater Detention Calculations stormwater site plan template-rev.10/1/2003 04 �'Y 111 • 4 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. 32/--Q7 tZED.REPREEENTA IVE SIGNA7U_ ) 490, is( THIS SPACE MAY BE USED FOR ADDITIONAL NOTES,IF NEEDED: RE CA E "19n 1JtS 6 • MB\118\113D PERMIT # Rhi nl 0118 JEFFERSON COUNTY 005 stormwater site plan template—rev.10/1/2003 O.. • 0. 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