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HomeMy WebLinkAboutBLD2007-00156 • BUILDING PERMIT • Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD07-00156 Received Date: 4/16/2007 SITE ADDRESS: 6943 FLAGLER RD Issue Date 7/19/2007 NORDLAND, 98358 Expiration Date 7/19/2008 OWNER: JEFFREY REYNOLDS PHONE: 360-621-8822 BOBBI REYNOLDS PO BOX 1190 ENUMCLAW WA 98022-1190 NORDLAND SUBDIVISION: Block: 10 Lot: 10+ PARCEL NUMBER: 976201001 Section: 32 Township: 30 N Range: 01 E CONTRACTOR: OWNER/BUILDER PHONE: d� 3(ii 0$ti tsi i' ? .t%.ett • No-�. ti m.t,w+- 6° PROJECT DESCRIPTION: NEW SFR W (CRAFT RM & STORAGE IN BSMNT) (ATTACHED GARAGE) & (1160 SQ FT BASEMENT ADU (1 BED) (1 BATH) ) ALSO A/G 1000 GAL PROPANE TANK TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 2,061 VALUATION 374,207.00 ADD'L: HEAT TYPE EEE CODE EDITION: 2003 HEAT BASE: 901 HEAT TYPE: HTP OCCUPANCY. R-3 UNHEATED: # OF STORIES: OCCUPANCY: OTHER: 1,160 CONST TYPE: 5N GARAGE: 720 SHORELINE: CONST TYPE: DECK: 680 SETBACK: 270 BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: 2WELL Type Amount Paid By: Date: Receipt: BEDROOMS: BATHROOMS: Permit $1,693.75 KAS 04/16/07 89782 Exist: Exist: Plan Check $1,100.94 KAS 04/16/07 89782 Prop: 3 Prop: 3 State Building Code $4.50 KAS 04/16/07 89782 Total: 3 Total: 3 Potable Water Application $58.00 KAS 04/16/07 89782 Plan Check $51.00 LYK 05/29/07 91090 Permit $840.00 KAS 07/10/07 91504 Plan Check $546.00 KAS 07/10/07 91504 State Building Code $4.50 KAS 07/10/07 91504 Potable Water Application $58.00 KAS 07/10/07 91504 Total: $4,356.69 Directions to Site: SEE MAP QUEST DIRECTIONS AND MAP 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 • • CONDITIONS for Building Permit# :BLD07-00156 1.) The application was reviewed by the Jefferson County Department of Community Development staff on June 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: Eagle Habitat Area, Wetlands, Special Aquifer Recharge Protection Area and At Risk Seawater Intrusion Protection Zones (SIPZ). 2.) 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. 3.) 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. 4.) 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. 5.) 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). 6.) The project components are more than 250' from the mapped/identified wetland. The requirement for a wetland delineation and report is waived based on maintenance of a 225' buffer from the wetland per UDC Table 3-3. 7.) 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. 8.) The parcel is located within an Pk SIPZ (seawater intrusion protection zo. 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. An At Risk SIPZ is defined as: areas within 1,000 feet of a groundwater source with a history of chloride analyses between 100 mg/L and 200 mg/L (milligrams per liter). 9.) The project is located in close proximity to an identified wetland and is subject to the delineation provisions of Section 3.6.9 of the Jefferson County Unified Development Code. Based upon the proposed location of the project in relation to the identified wetland, the applicant has agreed to maintain a buffer(setback) that exceeds the standard buffer requirements by fifty(50) percent. The applicant acknowledges the additional setback and agrees to maintain the extra 50 percent buffer, therefore, waiving the wetland delineation requirements of the Unified Development Code. 10.) 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." 11.) 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. 12.) 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. 13.) 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. 14.) The applicant shall fully adhere to all conditions and requirements of the eagle habitat management plan. 15.) 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. 16.) 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. 17.) MANDATORY MEASURES FO4,I AT RISK 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 requirements: a. Chloride concentration of a laboratory-certified well water sample submitted with building permit application. b. Installation of a flow meter. c. On-going well monitoring for chloride concentration. d. Submittal of flow and chloride data to the County per monitoring program. 3. If public water is unavailable, a qualifying alternative system may be used as proof of potable water. 18.) 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. 19.) The applicant is proposing to create or add 5776 square feet of impervious surface and 6200 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. 20.) A Stormwater Slte Plan has been submitted and approved by the Department of Community Development. Once the subject permit has been issued the applicant shall fully implement the provisions of the submitted plan and contact the Jefferson County Department of Community Development to arrange a schedule to inspect the property for plan compliance. A Certificate of Occupancy will not be issued until the Department verifies plan compliance. No clearing for roadways or utilities shall occur on the project site until clearing necessary for the installation of temporary sedimentation and erosion control measures have been completed. 21.) 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). 22.) The revised site plan as submitted on July 10, 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 July 18, 2007 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 23.) This approval is for a 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. 24.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 25.) 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. 26.) 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. 27.) 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. 28.) Maximum lot coverage is not to Ike 25%. Lot coverage is defined as amc of impervious surface which includes roof tops, driveways, concrete, etc. 29.) The building height is not to exceed 35 feet. 30.) Minimum setbcak from the edge of the ingress/egress and utility easement shall be 20 ft. Minimum side and rear setbacks shall be 5 ft. Minimum setback from the edge of the wetlands shall be 225 ft. Environmentally Sensitive Areas further impact setback. 31.) This parcel has been designated as Rural Residential 1:5 under the Jefferson County Comprehensive Plan Land Use Map effective August 28, 1998. 32.) A septic permit (SEP07-00098) was approved on May 3, 2007 for a system of 480 gallons per day 33.) The parcel is being accessed through an existing approach. DOT reviewed and issued Access Connection Permit Number 46418 in conjuction to the proposed Single Family Residence applictaion.. 34.) A minimum of two (2) on-site parking spaces are required for the single family residence. 35.) PRIOR TO FINAL BUILDING INSPECTION MUST SUBMIT RECORDED NOTICE TO TITLE REGARDING THE SQUARE FOOTAGE OF HOME AND LIMITED CAPACITY OF DRAINFIELD. 36.) 10' SEPARATION REQUIRED BETWEEN A WATER LINE AND ALL PORTIONS OF THE ONSITE SEWAGE SYSTEM; EFFLUENT TRANSPORT LINE, TANKS, TREATMENT AND DISPOSAL COMPONENTS. 37.) ANY PORTION OF TRANSPORT LINE UNDER A DRIVEN WAY IS TO BE SLEEVED/CASED OR EQUIVALENT. 38.) PRIOR TO OCCUPANCY & BUILDING FINAL INSPECTION FINAL APPROVAL OF SEPTIC SEP07-98 IS REQUIRED. !UILDING PERM IT APPLICAT KAI Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00156 Received Date: 4/16/2007 SITE ADDRESS: 6943 FLAGLER RD NORDLAND, 98358 OWNER: JEFFREY REYNOLDS PHONE 360-621-8822 BOBBI REYNOLDS PO BOX 1190 ENUMCLAW WA 98022-1190 NORDLAND SUBDIVISION: Block: 10 Lot: PARCEL NUMBER: 976201001 Section: 32 Township: 30 N Range: 01 E CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: —Roxki Se k ln O Na Pax t-'F�asefoM to Naecleti i of (Z-- I. 1, ✓'Dorn 4 Sl'Orde e I n /Bc43.- a,,0(0-44(-40 c1 A'r4.9 e-.) PROJECT DESCRIPTIOP NEW SFR(W/ATTACHED GARAGE 0 11Gob .il N5E/nen+ t.h) ALSO A/G 1000 GAL PROPANE TANK RLmS,.D 'L 1 Ig1014 TYPE OF WORK RES SQUARE FOOTAGE:.., TYPE OF IMP NEW toefec+lvh A"' VALUATION 225,000.00 MAIN: 20 . CODE EDITION: 2003 ADD'L: HEAT TYPE: EEE OCCUPANCY: R-3 HEAT BASE: q01 HEAT TYPE: HTP OCCUPANCY: UNHEATED: '�D # OF STORIES: CONST TYPE: 5N OTHER: SHORELINE: CONST TYPE: GARAGE: 720 DECK: 680 SETBACK: 270 SEWAGE DISPOSAL:( ALT BANK HEIGHT: WATER SYSTE L-�2WELL gk v 6c,p t 1 1 7 /I BEDROOMS: BATHROOMS: RI.VtSt 0 ''III4o7 Exist: Exist: et Prop. -3 % 3 Prop: a 3 Total: 3- 3 Total: 2 ., Routing Date: 1 I ( (c, 1 U'I .‘) J Type Amount Paid By: Date: Receipt: Approved/Date Permit $1,693.75 KAS 04/16/07 89 782 I PPR OV E C Plan Check $1,100.94 KAS 04/16/07 89782 State Building Code $4.50 KAS 04/16/07 89782 JUL 1ci 2007 Potable Water Application $58.00 KAS 04/16/07 89782 Total: Jefferson County PIanninf $2,857.19 & Building Department Jefferson County Building D iision Permit Nu �.;r: BLD07-00156 Applicant: REYNOLDS 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 it Erosion Control /Z/Uii" dt i peat FrzD GK 3/21/4 l Foundation Footing /�/�/a? R46e Foor,ic o!G . /y/i 6,L1FFEe / LZEP #47 7I Q Footing Drains //14/09 / GA 24/4 At Foundation Stem Wall i1-I3-7 9. ,,4 7N flOAc.c,S OK- l 2/4L/o7 tegae 011 2,//Q', Underground Plumbing c t - Under Floor Framing lick Straps(hold downs) 0_14� GA.P,46 C 54,e2e ,Ole3/t0)13 Ext. Shear Wall Nailing 3/ 10 t, pg. Rough-in Plumbing .2/2/0a /1 4''t& Ok 1J Framing / J l L'(� fie,►`►, 171f Ell -5c.?- ,Russ a►- 7/1.14% Blocking -/ I� Airseal 011, ,9/_— Insulation. * O r1 Walls 7/6/68 bi IC 7�,�� Insulation: Floors 7 /0/68 by IC:, Insulation: Ceiling /s/ Sc. Int. Shear Wall Nailing 7/7 Dg n, Wallboard Nailing c'. // ,,,,,e Gas Line: Interior I/4,6 ( I�`/ Gas Line: Exterior .7/y/b8 4/ r)�S Propane Tank /4 `i • )4. Heat/Chimney Clearance 7/7i/OFS ec,� 04, Drywell/Alt Drainage `� -7;4prn.tJoe- DE_ I/r448 ,c/ availe.g , " � /24/QAA Address Posted �T 5Nawaiz... PIMA 9/i�/oft 4/ FINAL INSPECTION 10-2..3- / FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR .1 A EIR) 71-441 ) ,��y C'o JEFFERSON COUNTY 4k4„..,_ 11 DEPARTMENT OF COMMUNITY DEVELOPMENT AP 12G 621 Sheridan Street• Port Townsend •Washington 98368 Uif 360/379-4450 • 360/379-4451 Fax 4.g` $ www.co.jefferson.wa.us/commdevelopment [ff }Jjnl t[ J I�f f Master Permit Application MLA: 01- I S 4Project Description(include separe e sheets as necessary): /� T�/�',r� !.�t�t f� iit`- it A( [1(t,t ±Atop+-• C �-S��1, AI SF k 1, + l �►�5. t t c-, i r-(f- pl,it Tax Parcel 4 roperty / Number: +--� , Size: 2_ A-LYtd.__+ (acres/square feet) Site Address and/or Directions to Perty: (p 1 4 3 ,,/" e via ,w.,,I ,,$3$-8 Property Owner(s)of Record: o �i a, a?4 Telephone: 0— ' — 2- i)ax: email: ]Vfu i1d COI" \ Mailing Address: • (�. ( Q •wv A-w • C( 0 22.-. ?e evtvolr) Applicant/Agent(i`f different from owner): Telephone: bp'f)UTOY �'�.Q�- at • _ a! �,�, email: ,���t.��CO�'�,,a '`. �,• ..i.{ ,,- Mailing Addre s: C. r-:'• What kind of Permit?(Check each box that applies) °Building ❑Variance(Minor,Major or Reasonable Economic Use) iDemolition Permit ❑Conditional Use[C(a),C(d),or C]** Single Famil °Discretionary"D"or Unnamed Use Classification Garage ched Detached ❑Special Use(Essential Public Facilities)** El Manufactured Home [JBoundary Line Adjustment d Modular [ IShort Plat** 0 Commercial* C IBinding Site Plan** El Change of Use -- ❑Long Plat** El Address i Road Approach E IPlanned Rural Residential Davt.Jopment(PRRD)/Amendments** 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 OTemporary Use ❑Comprehensive Plan/UDC/Land Use District Map Amendment ['Wireless Telecommunication* OJefferson County Shoreline Master Program Amendment • °Forrest 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,resuft 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 cpnsequence 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 applica io t at he orAsfle w nts prior notice. Signature: !J ' Date:%- .)-7 ' The action or a f ns Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in compliance with the Jefferson Co development code.The Applicant acknowledges that he,she or it holds individual and non-transfe res sibili r eeng to and com ing�gvth the ESA T Applicant hps read this disclaimer and signs and dates it below. Signature: Q� Date: ^� —04 D:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05-2.doc 0 lil . 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 th responsibility of the General Contractor for the proposed project. Signature: i � YJ Date: /r2-'9-7`dk 'P' GENERAL CO TRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: VIC J TJ � /_ MO) 7 l Nc /#9o� 8ti- 3Uz- MAILING ADDRESS 1`7 Ud-r D(tiE.4,4., , •f p r- EMAIL: pro -613 tek, uj(erai,CDAA CONTRACTOR'S LICENSE p•V? W A • GT ° WAINS NUMBER: / 25p't I(SLI,$' NUMBER ARCHITECT/ENGINEER: pp h 4y&)Ii K M K I I 1 +.� 1_ PHONE ( ) ^ FAX:( ) MAILING ADDRESS: t 9 0 Z fool U CUL. a i ,C/5Ti F1.re WAE,MAIL d ra41t r i L vt .. . cop" Project Type: Frame Type: Bathrooms: tig4 at) Shoreline: Type of Se age Disposal: ..New Wood Existing: ❑Sewer ❑ Addition 0 Steel Proposed: IR '514., Bank 0 Community System ❑ Alteration/Remodel 0 Concrete tc,�� Total: "3 '2i Height: Ipdividual System ❑ Repair 0 Masonry 14..P.11to 101 SEP Permit# ❑ Demolition 0 Other. Bedrooms: Water Supply: Existing: .4,3 C) Setback: 0 Private well titTwo Party Type of Heat: A.. 0 Public 'P„[op}os�edTotal: 3 ?0 , Name of System: Ire If this is a Commekial 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 rite? Yes / No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply:�'J� C]Underground Tank I(Abov- •round Tank Size of Propane Tank: peat Stove v/ - =4 i eplace Insert J Hot Water Tank 0 Pellet Stove 6 Other (bl.wt_Fu.yn�c Is this applian i'be F sfa e.`Ii " l> '. wired/Mobile Home? Yes I No tt When applying for a permit to install a propane tank you must also submit a site plan showing all of the building¢,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 tForr OffcelUse Only Amount Revision '//b(d1C Main Floor Heated '} E .0s-� 1Sq a7q.a Bld App Review: -!8.0() t 3(. oa _ 2nd Floor rleptotd2,,i 1 'Tr 7-11 Consistency Review: 00 Other Heated Base feea533_15 1 0/_ q , 7 84c :J .JJ vl Mezzanine i f r r i � ' 7 Additional Section: �_ • I Heated Basement Pan Check fit goi 80..156•(�, Chita4, !, /oo,q _ c : f i hh �}�}� �O Unheated 11!y I�I11IIV1 '�r` State Surcharge fee: . •SI) 4.Sb r /; Ot Ar Gaa?_ + i t/ '` (� 7c,�A? of Water Review fee: �l "t 3. cO Garage/Carport to V / � ) SUBTOTAL �J 1 ZU llot �' O 3 i i ( f - Decks 911/Rd Approach fee: Ems, C� 30 UP%oa'l•(nD c\CI Sk yn `A- I S.00 Other TOTAL: $ 3 !13 . /ct I 'Dil.50 Receipt Number: 50Ct1 g a Cd i 5o4. Cash/Check Number: I.0 lD Fp ESTIMATED COST(REQUIRED) al' p^1r� ate: ) ( f.�''( n.Fair market value of all labor nd material"foundbfion to finis ?` at —T `� V 1V � � O� CO 1 �m"tials: t .1_. f-` -�-5 oo( 3/4%206. 8G D:\PermitCenter\FORMS\DRD FORMS\Master Permit Application I2-30-05-2.doc ` • 9 v.st)N RECEWED ,r44/4q, JEFFERSON COUNTY APR 16107 iiik. KI DEPARTMENT OF COMMUNITY DEVELOPMENT „ „ 621 Sheridan Street • Port Townsend • Washington 98368,1ir.tHMU W; UNI 1 IIF;I! `� 6 3 0/379-4450 • 360/379-4451 Fax `i'IN 0 http://www.co.jefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# O 1 t -- PROJECT/APPLIC/JJT NAME: ,le,r1"a 5,k'b ti3O us 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. Rib Project Overview I r- 1. Describe the proposed developed conditions of the site. Indicate position and relative size of proposed improvements on the site map. i ,» � �� u � rP ►1- Zo5 SCE Pt- frum-42. 9-rt Q�C� t ikp (sepry pr no.c 1 '24 ed pg& ) Existing Conditions Summary 2. Describe the existing topography. Indicate contours 9n the site map. ./ t' rnb11.4., I-C J t P It s, . _ 1 s , m a f eA. I? .5:e-f— D ' a Q.7 O f e .l- rra-c k `--f - hck i , s, (mys-i-et-y i^'raji' `!,Ars a el _sil iL. 3. Describ the existing vegetation. Indicate native Neget I n reas on the site p. I�c. 1 s P s t e r lrs$ . d a -E'��... z t ` .a_. (� Ae ,k .f, 'rot:A.44_4A) e4-0--P...44,461,...-, k.),IL a.4.4..—,-1-ryiki *ILO 1.e-ewe_ 4:4-- nikhtly At .5* 4. Describe the existi soils. Indicate soil type on the site mapf r 110 r i° 8 i,Q 1_rmyn -- f ftilf 116(64 . I -r-e, e,F-ic tv 4I rtwed mr . ma() 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. 4 )1ithqr-ai etu-a • I : # , -77vt no,414/12, 41- br cbor" .f` t . WaJ4t." lA. 4. Wt t I a t Ns>f t�t it r..0 ,.e .4 a...r ‘,/i 0_, rn, t:td 4""`� :a.- _ +� 1�!iP .�1..tj��.�+s.rr.rii'� 6. Describe any excess levels of noise generated by the proposed use • .ctivity: V ' 1 .0/A- ( (10ri ait A JA.ST4tiei,TER PLAN JUN - 4 Zorn JEFFERSON COUNTY stormwater site an template—rev.10/1/2003 DEPT.OF O. UNI7 DEVELOP 5 5 SIGNATUR ! 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. teb$24Lii6:4-/- 1A-f ..r lrtt..►'"1.L. .-A a, r0- it.- . 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.). , , A ` (-1-ram- h= iie ,T . 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, a ollution-generating pervious surfaces to verify that the thresholds for treatment facilities and flow control ''tie 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 f cilities on the site plan and differentiate proposed facilities from existin3�facAilities. 1,0„ ii.,,,,:g2..., 444,2_ ,,,,,ti stwerea. w a., K2-4.),-t. tts-1 1.0 14-+A v_ v 'mn. -I-6a6 so v u.-r► w � 4 .ti t j.. . ,,, ,�r v x.J, to Ott Ottelli c od 10. If the project requires the use of stormwater treatment facilities,describe the types of stormwater treatment facilities proposed for use on the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. [This is normally for large"projects or projects that involve the potential for dispersion of contaminants.] 11. Describe theorna ce goals and standards applicable tothe project. I° t 21(kr r,S 4't - '�� J- �Jt9S23Ctn^,� sz oa..� t s 1-e= �-t� ,a_ % CcbQ�. u) iNsre. a4)(p + 1 1 12. Describe the flow control system. i . :,:4 y S 10 / i, a ,e,.r IA03 a n r 1 I r' Q\141 FANIVISV6 t k stornictissillateioat,l itar-iW:lotfi2003 ;,)T9::tt! } ORKS110 AND klf.t/ 6 • • • 13. Describe the water quality system. FCEIVEI ) APR 1f' ZOO? 14. Describe the conveyance system analysis and design. 't'/A- IHtth llllf 1 1N11 iJ1I1 15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material. /W/A- 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. N /A 17. Describe the proposed surfacing mat ' I. AVA- n�L0 V 18. Describe methods for r oration of the e. evcs.� 19. An Operation and Maintenance Manual is required for each flow control and treatment facility. [This is normally required for "large"projects only and only those for which facilities are required to control flow or treat runoff.] If included,list the Manuals here. 20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan. NPI- 1 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. 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. trwt- A-s 1 pocsi R\FAc EI D 2. Establish Constructio Access. �� ZOD7 grw€ rand 6 etiiUT t:UNIY LI U 3. Control Flow Rates. net.+14.ra Q ,s t o tie. re Q' S'c r /A. 4. Install Sediment Controls. N (4„S‘ neeeittA t W it/ S ur Qom,) 5. Stabilize Soils. • 0 C 1911--e (,./i ,c-trrirh.o."Y‘ 01) I 41N 166d14--ra Sinpe 6. Protect Slopes. r , h9-titi-edt(o. A-4 I-Lve-A-fi hek 7. Protect Drain Inlets. / �a,6 s e i - , 5 s ►M 8 stormwater site plan template—rev.10/1/2003 • • 12 Required Elements-Construction SWPPP(continued) 8. Stabilize Channels and Outlets. 01)/ Aeuluk224 v4. t4a44): GA5a-A-C) 9. Control Pollutants. (CO veic c_o n. ill +) N/� (d-o it p ly+ a c.,�. . LA.). W v f e ra r C'�,n .�� tie ems. I o r r 0144, e cto ig.t., o atir r i la ,e i / 10. Control De-Watering(the act of pumping grgundVater or stormwater away from an active construction site). /A 11. Maintain Best Management Practices (BMPs). R \vc \\,� AN 1 6 2 O t 12. Manage the Project. y.e0 ���fkN�U�V�,UUN�y uCU 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). / � b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). ti / Pt 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. CLei&AA 5 at-4_ a170 Reef- 0,c c S CELA-J -gY m C-9 n i' rt a , etALAYA stormwater site plan template—rev.10/1/2003 9 • • b. Description of special requirements for working in or near environmentally sensitive areas. /A 4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site soils(e.g.,erodibility,settleability,permeability,depth,texture,soil structure). 5. Construction Phasing. a. Construction sequence n0� YbCe4-44• ft- hope -� ► be,�; t wk F0_,A4 r .J 07 idu 1`4-+• �' ��ti ' , b. Construction P haling(if proposed) 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). 77 fi -x.e I. Provide a proposed construction schedule. MQ " r wc. kadtre J Ac.L I�t 5 3, II. Wet Season Construction Activities. t$p e.rS u e 4 etAN w 1/ Ith Cf ck l a. Proposed wet season construction activities. id.t r.t q(Xi rt4 !' w 'I k b. Proposed season construction activities for environmentally sensitive areas. 7. Financial/Ownership Responsibilities. a. Identify the property_o_w ner responsible for the initiation of bond and/or other financial securities. Jerric czA,1 130b (CLC b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. 5 /4 4-e.. 1 Car L oh A%CYO ek/C Ca OA d'r tCJVIZ T S sl ti f(C- (1Y1 gi+11C6.4,t)DosSttilt( 5eeathe t ri4 ) 0i. ? rkmpt t 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if ap5icable.` h91 '4''s a. Sediment Ponds/Traps. /A/� b. Diversions. N A RECEN‘) c. Waterways. d. Runoff/Stormwater Detention Calculations N/4-S OR 2V7 WO\ th0 t" 10 stormwater site plan template—rev.10/1/2003 • . 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. 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