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HomeMy WebLinkAboutBLD2007-00151 96ILDING PERMIT APPLICAT t ML ReviewTy 176 Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00151 Received Date: 4/6/2007 SITE ADDRESS: 111 RIVERDALE DR QUILCENE, 98376 OWNER: ALBERT T AUDETTE JR PHONE: 360-765-3715 PO BOX 372 QUILCENE WA 983760372 HIDDENDALE TRACTS ADDITION SUBDIVISION: Block: 3 Lot: 6 PARCEL NUMBER: 959400306 Section: 27 Township: 27 N Range: 02 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI` ADDITION TO EXISITING SFR -ADDING 1 BATHROOM & 1 BEDROOM TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP ADD MAIN: 833 VALUATION 102,996.00 ADD'L: 136 HEAT TYPE: PRO CODE EDITION: 2003 HEAT BASE: HEAT TYPE: EEE OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: SHORELINE: GARACONST TYPE: DECKLE 68� SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: 1 Exist: 1 Prop: 1 Prop: 1 Total: 2 Total: 2 Routing Date: 11R/a1 Type Amount Paid Bv: Date: Receipt: Approved/Date Permit $1,010.55 CJZ 04/06/07 89712 Plan Check $656.86 CJZ 04/06/07 89712 APPROVED State Building Code $4.50 CJZ 04/06/07 89712 Potable Water Application $58.00 CJZ 04/06/07 89712 MAY al 2007 Total: $1,729.91 Jefferson County Planning &Building Department • BUILDING PERMIT • Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD07-00151 Received Date: 4/6/2007 SITE ADDRESS: 111 RIVERDALE DR Issue Date 5/21/2007 QUILCENE, 98376 Expiration Date 5/21/2008 OWNER: ALBERT T AUDETTE JR PHONE: 360-765-3715 PO BOX 372 QUILCENE WA 983760372 HIDDEN DALE TRACTS ADDITION SUBDIVISION: Block: Lot: PARCEL NUMBER: 959400306 Section: 27 Township: 27 N Range: 02 W CONTRACTOR: OWNER/BUILDER PHONE: PROJECT DESCRIPTION: ADDITION TO EXISITING SFR -ADDING 1 BATHROOM & 1 BEDROOM TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP ADD MAIN: 833 VALUATION 102,996.00 ADD'L: 136 HEAT TYPE: PRO CODE EDITION: 2003 HEAT BASE: HEAT TYPE: EEE OCCUPANCY: OCCUPANCY: UNHEATED: # OF STORIES: OTHER: CONST TYPE: SHORELINE: GARA0 CONST TYPE: DECKLE 685 SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: PUBLIC Type Amount Paid By: Date: Receipt: BEDROOMS: BATHROOMS: Permit $1,010.55 CJZ 04/06/07 89712 Exist: 1 Exist: 1 Plan Check $656.86 CJZ 04/06/07 89712 Prop: 1 Prop: 1 State Building Code $4.50 CJZ 04/06/07 89712 Total: 2 Total: 2 Potable Water Application $58.00 CJZ 04/06/07 89712 Total: $1,729.91 Directions to Site: SEE ATTACHED HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:00 a.m. -4:30 p.m. HOT LINE AVAILABLE 24 HOURS A DAY SPECIAL CONDITIONS APPLY -SEE ATTATCHED 0 Jefferson County Building Divvon Permit Nu BLD07-00151 Applicant: AUDETTE JR BUILDING PERMIT INSPECTION APPROVALS \pplicable 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 (,//1/67 Erosion Control Foundation Footing 4/�y/0 bZ Footing Drains Foundation Stem Wall 7 Pp Underground Plumbing /'" Under Floor Framing IND 7 Of- ',Az IdA/Dsrrthcie- ,194/07,V Straps(hold downs) Fo/A.uvvrio)/liDcc /LLD PAntme OK � � o7.044 Ext. Shear Wall Nailing Q,2- -{r Rough-in Plumbing Framing 0-_15-07 Blocking Airseal 0 _15--t'1 / Insulation:Walls Insulation: Floors Insulation: Ceiling =11-del n' ' Int. Shear Wall Nailing /VA Wallboard Nailing11// / Gas Line: Interior Gas Line: Exterior Propane Tank Heat/Chimney Clearance Drywell/Alt Drainage Address Posted //3o/os � FINAL INSPECTION 6/fC',E-� U ecm FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR • CONDITIONS for Building Permit# :BLD07-00151 1.) PRIOR TO OCCUPANCY: FINAL APPROVAL OF SEPTIC SEP06-321 IS REQUIRED. 2.) ALL COMPONENTS OF THE SEPTIC SYSTEM, INCLUDING RESERVE AREA, ARE TO BE COMPLETELY PROTECTED FROM VEHICULAR TRAFFIC OR MECHANICAL DISTURBANCE. 3.) The application was reviewed by the Jefferson County Department of Community Development staff on May 21, 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: conservancy shoreline designation; spotted owl/harlequin duck; seismic; erosion; SUSC aquifer recharge area. 4.) 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. 5.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to groundwater aquifers. 6.) Geologically Hazardous Areas in Jefferson County are characterized by slope, soil type, geologic material, and groundwater that may combine to create problems with slope stability, erosion, and water quality during and after construction or during natural events such as earthquakes or severe rainstorms. 7.) A Type 1 Stream (Fish and Wildlife Habitat Area) has been identified on the subject property. The stream will require a setback of 150-feet. The setback shall be measured horizontally from the Ordinary High Water Mark (OHWM). Fish and Wildlife Habitat Areas shall also have Buffers and Building Setbacks established. 8.) Stream buffers are areas that shall be maintained in their natural condition, however, minor pruning or alteration of vegetation may be permitted as long as the function and character of the buffer are not diminished. 9.) 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). 10.) 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. 11.) The identified Fish and Wildlife Habitat Area (Type 1 Stream), shall maintain a vegetative buffer setback of 150-feet. The setback shall be measured horizontally from the Ordinary High Water Mark (OHWM) to proposed development. 12.) An additional setback of five (5) feet is required from the edge of the stream buffer area to the proposed development. 13.) A permanent physical separation leg the boundary of the stream buffer areal 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. 14.) Stream 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 be in place prior to and during construction activities. The signs shall contain the following statement: "Buffer - Do Not Remove or Alter Existing Vegetation." 15.) 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. 16.) The applicant is proposing to create or add 1518 square feet of impervious surface and 850 square feet of land disturbing activities. JCC 18.30.060 and 18.30.070 require your proposal comply with Minimum Requirement#2 (Construction Stormwater Pollution Prevention) of the Department of Ecology 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. 17.) 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. 18.) 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). 19.) The revised site plan dated April 26, 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 21, 2007 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 20.) This approval is for an addition of a bedroom, bathroom and deck to an existing single family residence 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. 21.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 22.) 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. 23.) 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. 24.) 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. 25.) Residential developers and individual builders shall be required to preserve shoreline vegetation and reduce the associated risk of erosion during construction and any future activity which may impact the stability of the shoreline. 26.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 27.) The building height is not to exceed 35 feet. 28.) Minimum setback from Riverdale Drive right-of-way shall be 20 feet. Minimum side yard setbacks shall be 5 feet. Minimum setback from rear property line (river side) to the existing residence is 105 feet. Setback from OHWM is greater than 150 feet. 29.) The parcel has been designated aR 1:5 under the Jefferson County Compri"sive Land Use Map effective August 28, 1998. 30.) An address of 111 Riverdale Drive, Quilcene has been assigned to the parcel. Riverdale Drive is a county local access (C300109). 31.) The lot was created through the Hiddendale Tracts Addition on July 6, 1965 under AFN 121017. 32.) A septic permit (SEP71-0048) is now filed with SEP06-0321. An EES was approved on April 10, 2006. A building permit (BLD99-0514) for a propane tank and has heating stove was finaled on August 22, 2000. The existing two-story residence was constructed in 1971 according to Jefferson County assessor records. 33.) Per email dated October 3, 2006 from Jeff Davis, WDFW biologist, the proposal will not have an impact on spotted owl and if shoreline vegetation is restored along the rivers edge, then there will likely not be an impact to Harlequin duck. 34.) A Declaration of Restrictive Covenant was recorded on October 10, 2006 under AFN 516375 to consolidate parcels 959400306 & 959400305 to meet minimum land area for septic purposes only. • S f`. 0rill4,� JEFFERSON COUNTY it AP U tu Ki DEPARTMENT OF COMMUNITY DEVELOPMENT ! _ 621 Sheridan Street • Port Townsend •Washington 98368 I r tQ 360/379-4450 • 360/379-4451 Fax _ r` _1 t i http://www.co.jefferson.wa.us/comrndevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# 0-1- \1)0 PROJECT/APPLICANT NAME: 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. • .4PDisr/,6 . 14/717/Tfu7 7—el , X,S'-if sv(C ifirg',a/w,.✓-t— Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. f=t--4--T.' 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. te.XI S,S f i 2 T/�-/r✓s3 4. D cribe the existing soils. Indicate soil type on the site map. ioC e_ k Sy-x/D p l rz 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 appli able,and indicate acreage of each. ®-n rL APPROVED 6. •Describe any excess levels of noise generated by the proposed use or activity: STORM WATER PLAN ff,4- MAY 2 1 2007 Stormwater B ri r JEFFERSON, , I UN 1 DEPT.OF C � � I Y Df:V PMEN stormwater site plan template-rev.10/1/2003 Require. 1', 0j_4I SIGNATIJR : , • • • 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. /'re0 r✓lS etc. Qu tt-c-a 4,✓� , 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 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. Pi 5 f rr-ta r:c %oo lVALT 1 tom'-. -L- or-6 r-(7"'1-Ti o-i-L o t.✓ 5 /T/a. 10. If the project requires the use of stormwater treatment facilities, describe the types of stormwater treatment facilities proposed for use on the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. [This is norm II for large"projects or projects that involve the potential for dispersion of contaminants.] 11. Describe the performance goals and standards applicable to the project. 4--77P r?'TThre— 5 7 2 tP,H. LAJ A- -_ O A/ 12. ,Descri the flow control system. stormwater site plan template—rev.10✓1/2003 _ r.. 6 • • 1 1 fit.i .�:1 I 13. Describe the water quality system. I ` S 7"� -r. �� 5 tC �O4 E' e� 5 s �� ,R - 6 1 i 1 1 ,. L.h .1L` 14. Describe the conveyance system analysis and design. 06-w .c,,G u A c p.iy 64 ` 75c-CSC(c S % A/AT!-1 ?-C_ 1.4=-6,27-427-bzC 15. Descri e the------ hhee 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. ,/ 17. Describe the proposed surfacing material. /rorl7,D 2 t S i//44; 18. Describe methods for restoration of the site. /iis•-S/-g-D 4 a'1 si-e co t-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. VA4_ 20. List e e and include any special reports or studies conducted to prepare the Stormwater Site Plan. l 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 restric' s here. 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. 2. Establish Construction Access. X iS ft✓�' 3. _Cp�trol Flow Rates. 4. Install Sediment Controls. 7) S rY:. t t) e' (A.) h t ps .43 A 1s ©I2 5. Stabilize Soils. 6. Protect Slopes. 7. Protect Drain Inlets. stormwater site plan template—rev.10/1/2003 8 • • 12 Required Elements—Construction SWPPP(continued) !7,-.7� r ('`) C ,' } '•' —+ , 8. Stabilize Channels and Outlets. f,j j . — -- -- J 1 i 1 � - 9. Control Pollutants. r!r\ f,' '•l't.? 'w7 QIAfLIC C i-Fi p S -_,...„.A0.1 ntrol De-Watering(the act of pumping groundwater or stormwater away from an active construction site). 11. Maintain Best Management Practices(BMPs). ,CJ-z 2 L c, . t i-'r 2-- 441/z---t-- is-t .,a /rc/ a' Pl. j i T iP- WO UJt 77"t— 7 O /Fi 1/A...'+_ 12.14nage the P ject. 2. Adjacent Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). 3o i/4-c_c__ p cc ' -t-- Cry 7 O tv ty'p Q 1�{ /►_'l y`S _ 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 on or adjacent to the site. 0tC-i QleI C ru0,0 Ir?tc0 __ stomiwater site plan template—rev.10/1/2003 9 • • b. Description of special requireme for workin 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 soil (e.g.,erodibilit� settleability,permeability,depth,texture,soil structure). Akr i lc /rLK-S - 1-r_4 -- 4-A✓0 0oS u,iv-1- 17 - i.J .To J -D t'l vet--ft , 5. Construction Phasing. a. Construction se uence f� i jl-/-g I-re r ei/-c j yea /4, el-4 ,1 c i ,,,,--n-ti` a ry= 4A''f b e-2 e'l 77 clY1.- 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 schedule. _ 5T -r <'a2 r f c_^/$' 'zt 1 ' -. -- - t NI 1til l4c 1 �ot T-ftJRS .fir 4.. a M ---(e4 Alft /' irG '—(eA 2-4' I If ,pc_ -cAPt- ►Ju'-Y 4.4 II. Wet Season Construction Activities. a. Proposed wet season construction activities. b 1. roposed wet season construction activities for environmentally sensitive areas. 7. Financial/Ownership Responsibilities. a.1 Pntify the property owner responsible for the initiation of bonds and/or other financial securities. /d/ " b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation e7p/r. 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable. a. Sediment Ponds/Traps. b. Diversions. c. Waterways. d. Runoff/Stormwater Detention Calculations storrnwater site plan template—rev.10/12003 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-bunts")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 signinrt e Cons ction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and corr to th best of my knowled . so certify that this application is being made with the full knowledge and consent of all o ers o e affect property. ...7 a//0�% 7 DOWNER OR AUTHORIZED EPRESENTATIVE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: l I`-� if" 9 c� ; :e t La li i ��6 A 1 iOFVfl OPMENT stormwater site plan template—rev.10/1/2003 12 ON C • l o� JEFFERSON COUNTY W ' \ DEPARTMENT OF COMMUNITY DEVELOPMENT ti 621 Sheridan Street• Port Townsend •Washington 98368 411 360/379-4450. 360/379-4451 Fax " www.co.efferson.wa.us/commdevelopment �`r$I'NC�� Master Permit Application MLA: n r'l _ t --q, Pr •ect Description(include separate sheets as necessary): A'` 1 G�l� ! "7'/ U�/1 j c> > ; v F; (_ / _ i4-t,--. , L — /C i ei.e o,L,e' ; Tax Parcel G q Property Number: / S / — ao - 3o . _ _ Si—•• _ _ - (acres/square feet) Site Address and/or Directions to Property: _\\\ �`�y,ec6\0.�Q.. t cvl e �Q,:%\LtrZZIT, Property Owner(s)of Record: It, i??'.r �II7i 76 � i� Telephone: 360 76 S-37/S Fax: email: Mailing Address: PO 37 Z. qu l t_c¢N e (Ain 57,.376 Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) ❑Building IDVariance(Minor, Major or Reasonable Economic Use) Ej Demolition Permit ❑Conditional Use[C(a),C(d),or Cj** ,j'Single Family (❑Discretionary"D"or Unnamed Use Classification El Garage Attached/Detached I:Special Use(Essential Public Facilities)** II Manufactured Home [1Boundary Line Adjustment El Modular °Short Plat** El Commercial* °Binding Site Plan** El Change of Use °Long Plat** El Address i Road Approach °Planned Rural Residential Development(PRRD)/Amendments** I 1 Propane ❑Plat Vacation/Alteration*" ❑Allowed"Yes"Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisions** ❑Stormwater Management ❑Shoreline Management Substantial Development** ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Variance ❑Temporary Use °Comprehensive Plan/UDC/Land Use District Map Amendment 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: p�SIGNATION OF AGENT I hereby designate A-3 T I to act as my agent in matters relating to this application for permit(s). i OWNER SIGNATURE ,___„t- / i� Date: /OA//OL By signing this application orm,the owner/age t 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,ind-.••ify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and expenses which ma ' any w..y accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree t. pro *de- "ess and right ry to Jefferson County and i:s employees,representatives or agents for the sole purpose of application review and an re.,�red ':ter inspection . ff's a s and right of entry will be assumed unless the applicant informs the County in writing at the time of the a.•li• : A-the r s pri Signature: - Date: /o//i /e,( The action or actions Applicant wi ndertake 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" "ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been iss will n violate the " •. •ny individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if ou e in mplian - ' ith the aefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-trans ra re s• II •, adh- ' • t -...'d complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: i / / Date: /O////Q"1( D:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05-2.doc • BUILDER STATEMENT The signer of thi men does hereby rti that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be as m. t r p ibili f t Gene I ntractor for the proposed project. Signature: Date: /0//4/ez . GENERAL CO TRACTOR OR MAN FACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New Wood Existing: / 0 Sewer ,Addition 0 Steel Proposed: — r _ Bank ❑Community System & _3 Z / o Alteration/Remodel El Concrete Total: _ ? Height: individual Sy ❑ Repair 0 Masonry SEP Permit# fro ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: I Setback: ❑ Private well 0 Two Party T pe of Heat: Proposed: / 0 Public Total: cOe Name of System:gratliworm--64.-a e acce_f ❑ CO P►IN4N a T;• 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 I No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: [] nderground Tank 0 Above ground Tank Size of Propane Tank: �„�-- Heat Stove ❑Cook Stove 0 Woodstove ❑Fireplace Insert 0 Hot Water Tank 0 Pellet Stove p Other 064 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 ^ D 4333 ill 1-r, EH Bld App Review: 1QB 2"0 Floor Heated o3 136. Q I Consistency Review: r L J 3 -Other Heated Base fee: 1 Mezzanine Additional Section: Heated Basement Plan Check fee: Co N/ p§6 Unheated Basement State Surcharge fee: � j0 Other Unheated Pot Water Review fee: 93 Garage/Carport SUBTOTAL 1 /985.1 r Decks l_�0 v M (096 I(0/1 4b 911/Rd Approach fee: Other TOTAL: $ Loa o Gi1(7. Re ipt Number: of ash/Check Number p ESTIMATED COST(REQUIRED) Date: `D .Fair market value of all labor and materials foundation to finish 9 4� 1 Initials: •-, CY 00 000 APR - AGO i 7 D:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05-2.doc I —_ V • AW AN O s E' ? E'E i1y r it o oir " R Rf(p • ov tyv cilieDittA Rp gg li c-; p 1 i q., • 1 0 • • w /' . e mph` !� u4 D � � I 8 i \�3 -.-___ F. J — it �. ii 1 q i . -1 , 2g a ,kir 'A ,. ..,0, zr. ..... • . • . , \ \ 11 a ,a `II41 NEW GUARDRAIL �C 1 I- (l> 1 1 i rn B Q7 p b'-e• / e,,4. / / / x,.•t xume.. se..t c.,t.•t. N0rNumb*, Upper Floor Flan / & ry� Nil ep RAKE 2 Numb*, Repel a ��� ��� Fos t e r W i I l i a m s N ARCHITECT 1 Addition/Remodel to Residence for: //////� 4 Al & StarlaAudette AI Architects STATE �wIT W Ne. R•J�en e•t• 6 Quilcene,Washington P.O. Box 102 Shelton,Washington 98584 0^�• dem by ow.by 9 (360)426-0511 FAX(360)426-2926 E-Mail: IwObctc.com 4-04-01 Reproduction or re-use of these drawings without written permission of the Architect is prohibited K.T. LAW. A w p r., 0 0 F is PVgg �Q t y n p(� N +\ Q - n IF1 CD e '' ;O. 17T q i R , mi • I rn t 11 r G pp i] g \ \ it 0p X m $ 1{ i m L / 6 p.msl-/ ®1. ill IP 22 Er ym a R a I NE J Z a o W � _ b O rig N co NEW GUARDRAIL is It i 1 L J C> qP a C iii m i-n S (D x T C 6 0 � / 6,e" / D , / pr..,xM.w, u.•I ce�i«�• 20CW:1e Upper Floor Plan / �� R gSTERED Sheaf Number ae�,nn• ������� Foster & Williams A��iTE�T Addition/Remodel to Residence for: ///j//) A I A Architects C h I t e C t S sLaDa A wWqT gRt 4 Al & Starla AudetteOf P.O. Box 102 Shelton, Washin ton 98584 360 426-0511 FAX 360 426-2926 E—Mail: fw®hctc.com °'a.•br �ichia br 6 Quilcene,Washington 9 � � � � 0e 4-04-01 K.T. LAM. Reproduction or re—use of these drawings without written permission of the Architect is prohibited 04/04/2007 09:31 am . le'.10' 20'-0"/ / 10'Q• / / / 14'•6' / - / e 10• / 4 0• /2 0"/ / 6• / 3.0• / / W A A, —A, r 7 a D0 1 1 i if T Tng@ T 2 72 ° ° ET • 4 ~ D P g" U, m r 1 1 1 •111414P j it V}`RV o � I \\ • [ Zy ; LP(p W 6 1' r 24•x96'I I 74"x!6•i V {Y �I ,`I,i 7 ( dCYLITE i e4 YLITC i T 0 p �9 it t 1 l 1 in,_ If ® It 2 "to I,n- J 31 G pp. — L $ p . COA10 C4ThJG BAR 6 �-^ 4 a „ r J 4� Q. . I_I I@ M j 24•r+J6' I 24•x36•j p i i KKK 0KYLIT!i SKYLITE 1 1 �� L i t J /I I I i q \ \ \ 1 i CEILING LINE NI / 1 �� s 1 El �LLI 73 -1 x t ®! ):(f.; ,,, .. '? DRY. WA614 M1"'l, O _ e CD ; g El '� ;:it rr 3 4� m • Nal 3 w g E 1r, ill 6 : ik9 i ei.,0_ ., Ip I'I �4 L^' I 7 rej c tun. \ 60 40 .••- -••;.- WINDOW REPLACED ' t__ N6. 1 IN EXISTING L J OPENING T X O E 0P ZF O 1 I T m T 7 O Q cep (• Pf9 e , C Q a c� - i rn i pc--' =I Q / ''-m" / 6'•6• / �.� CO / /22'-0" 24'-0"e-EXISTING / v Ve 2006018 SMain Floor P►�is 7 pp W m 1��O97l RERGO- REO %��/�/�� F S G r & •• I I fYl S I\/ ARCHITECT Addition/Remodel to Residence for: �������� A I A Architects c h I t e c t 8 LI«N AMA. 3 Al & Starla Audette STATE°`""_"'"�'°" Ne. MMNm o....,er Quilcene,Washington P.O. Box 102 Shelton, Washington 98584 (360)426-0511 FAX(360)426-2926 E-Mail: fw®hctc.com 4-04-01 KT. cneLy"eyL.A.W. Reproductionor or re-use 6 of these drawings without written permission of the Architect ie prohibited oai• °VS%Olga clk A(kLiekt • !! ) , ! I. i • t "V -.•' • �1 N 11 , e�Q`// Pi `` t�t -pl r �s�co • I,CS) g rm- • U ii ( /P` / O NI �n "'_ �/' a Nam` 1 — ff. 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