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Home My WebLink AboutBLD2007-00171 BU•ING PERMIT APPLICATIOF MLLA07N002203 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00171 Received Date: 4/24/2007 SITE ADDRESS: _;( ';,CEDARVIEW LN PORT TOWNSEND, 98368 OWNER: JOHN D ANDERSON PHONE: 360-385-7156 J NORMANDIE PHELPS JTWROS 469 243RD PL SE SAMMAMISH WA 980743453 KALA POINT#9 SUBDIVISION: Block: Lot: 194 PARCEL NUMBER: 965000334 Section: 27 Township: 30 N Range: 01 W CONTRACTOR: KELLEY SHIELDS INC PHONE: (360) 385-7156 260 KALA POINT DR PORT TOWNSEND WA 98368 Contractor's License KELLES1150LF Expires 6/6/2007 REPRESENTATIVE: KELLEY SHIELDS INC PHONE: (360) 385-7156 DENNIS KELLEY 260 KALA POINT DR PROJECT DESCRIPTIOP NSFR W/ ATT GARAGE & A/G 120 GAL PROP TANK TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 1,730 VALUATION 232,037.00 ADD'L: HEAT TYPE: HTP CODE EDITION: 2003 HEAT BASE: 683 HEAT TYPE: PRO OCCUPANCY: R-3 UNHEATED: 315 # OF STORIES: OCCUPANCY: OTHER: CONST TYPE: 5N SHORELINE: GARAGE: 480 CONST TYPE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: KALA PT BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 3 Prop: 3 Total: 3 Total: 3 Routin Date: A .c. .,)5 hu-1 Type Amount Paid By: Date: Receipt: Approved/Date Permit $1,738.55 LYK 04/24/07 89902 A 'PROV Plan Check $1,130.06 LYK 04/24/07 89902 State Building Code $4.50 LYK 04/24/07 89902 '! / 2007 Potable Water Application $58.00 LYK 04/24/07 89902 Jietl 'nty Planning Total: $2,931.11 a at' ' .. , *nem CERTIFICATE OF OCCUPANCY Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 (800) 831-2678 PERMIT #: BLD07-00171 SITE ADDRESS: 23 CEDARVIEW LN Issue Date: 06/1/2007 Final Date: 1/15/2008 APPLICANT: JOHN D ANDERSON PHONE: 360-385-7156 J NORMANDIE PHELPS JTWROS 469 243RD PL SE SAMMAMISH WA 980743453 SUBDIVISION: KALA POINT#9 Block: Lot: 194 PARCEL NUMBER: 965000334 Section: 27 Township: 30 N Range: 01 W PROJECT DESCRIPTION: NSFR W/ATT GARAGE & A/G 120 GAL PROP TANK THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2003 EDITION. OCCUPANCY GROUP: R-3 TYPE OF CONSTRUCTION: 5N SPRINKLER SYSTEM yes no THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 1/15/2008 I:\F_BLD_Occupancy.rpt 10/29/19 Jefferson County Building Divion Permit Numb! BLD07-00171 Applicant: ANDERSON 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 i Erosion Control Foundation Footing (z„ `7//r1c2 Footing Drains Foundation Stem Wall Underground Plumbing 6•-749--01 Under Floor Framing Straps(hold downs) qtom Ext. Shear Wall Nailing o") Rough in Plumbing R/4I67 Framing 0/49err D� Blocking Airseal n �� • Insulation: Walls `j �� Co/Zrcc'-c77 '-) Insulation: Floors 9 / 9 ram,Lcv-y Insulation: Ceiling /t f� Int. Shear Wall Nailing Wallboard Nailing 2:510-1 Gas Line: Interior 414'ar a Gas Line: Exterior a Q Propane Tank 05/4 Heat/Chimney Clearance Drywell/Alt Drainage Osiog Q/ �Y d.AISPAI Address Posted OS/4 FINAL INSPECTION 05/48 E 4t carVO FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR • BUILDING PERMIT • Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD07-00171 Received Date: 4/24/2007 SITE ADDRESS: 23 CEDARVIEW LN Issue Date 6/1/2007 Expiration Date 6/1/2008 OWNER: JOHN D ANDERSON PHONE: 360-385-7156 J NORMANDIE PHELPS JTWROS 469 243RD PL SE SAMMAMISH WA 980743453 KALA POINT#9 SUBDIVISION: Block: Lot: PARCEL NUMBER: 965000334 Section: 27 Township: 30 N Range: 01 W CONTRACTOR: KELLEY SHIELDS INC PHONE: (360) 385-7156 260 KALA POINT DR PORT TOWNSEND WA 98368 Contractor's License KELLES1150LF Expires 6/6/2007 PROJECT DESCRIPTION: NSFR W/ ATT GARAGE & A/G 120 GAL PROP TANK TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 1,730 VALUATION 232,037.00 ADD'L: HEAT TYPE: HTP CODE EDITION: 2003 HEAT BASE: 683 HEAT TYPE: PRO OCCUPANCY: R-3 UNHEATED: 315 # OF STORIES: OCCUPANCY: OTHER: CONST TYPE: 5N GARAGE: 480 SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: KALA PT Type Amount Paid By: Date: Receipt: BEDROOMS: BATHROOMS: Permit $1,738.55 LYK 04/24/07 89902 Exist: 0 Exist: 0 Plan Check $1,130.06 LYK 04/24/07 89902 Prop: 3 Prop: 3 State Building Code $4.50 LYK 04/24/07 89902 Total: 3 Total: 3 Potable Water Application $58.00 LYK 04/24/07 89902 Total: $2,931.11 Directions to Site: SEE DIRECTIONS & MAP IN FILE 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# :BLD07-00171 1.) The application was reviewed by the Jefferson County Department of Community Development staff on May 31, 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: rare plants (Vancouver ground cone); intermediate shoreline slope stability; Eagle; SARPA aquifer recharge area; coastal 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.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to groundwater aquifers. 4.) Critical Aquifer Recharge Areas are defined as Seawater Intrusion Areas, and Special Aquifer Recharge Protection Areas and the following land uses located within Susceptible Aquifer Recharge Areas (1) All Industrial Land Uses (2) All Commercial Uses (3)All Rural Residential Land Uses requiring a Discretionary Use or Conditional Use Permit (4)All Rural Residential Land Uses with nonconforming uses that would otherwise require a Discretionary Use or Conditional Use Permit (5) Unsewered Planned Rural Residential Developments (6) Unsewered residential development with gross densities greater than one unit per acre. All of the above listed uses shall be subject to the applicable requirements and standards of the Jefferson County Unified Development Code. 5.) 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. 6.) 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. 7.) 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. 8.) 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. 9.) 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. 10.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 11.) The applicant is proposing to crear add 3100 square feet of impervious sure and 4100 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. 12.) The project shall adhere to the Best Management Practices (BMPs) to control stormwater, erosion and sediment during construction. BMPs shall address permanent measures to stabilize soil exposed during construction, and in the design and operation of stormwater and drainage control systems. 13.) A Stormwater Site Plan has been submitted and approved by the Department of Community Development. Once the subject permit has been issued the applicant shall fully implement the provisions of the submitted plan and contact the Jefferson County Department of Community Development to arrange a schedule to inspect the property for plan compliance. A Certificate of Occupancy will not be issued until the Department verifies plan compliance. No clearing for roadways or utilities shall occur on the project site until clearing necessary for the installation of temporary sedimentation and erosion control measures have been completed. 14.) 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). 15.) The site plan as submitted with the building permit application on April 24, 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 31, 2007 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 16.) This approval is for a single family residence with attached garage and 120 gallon above-ground propane tank 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. 17.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 18.) 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. 19.) 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. 20.) 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. 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.) Minimum setback from Cedar View Lane, Cedar View Drive, and Kala Point Drive rights-of-ways shall be 20 feet. Minimum rear yard setback shall be 5 feet. 24.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 25.) The parcel has been designated as RR 1:5 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 26.) An address of 23 Cedar View Lanipprt Townsend has been assigned to the Ideedar View Lane is private (P215). 27.) The lot is served by the Kala Point public water system. 28.) A septic permit (SEP07-00140) was issued on May 3, 2007. 29.) The lot was created through the Kala Point#9 Subdivision on February 14, 1984 under AFN 287957. 0 �, i ' I t 14;, I �gON CO �� JEFFERSON COUNTY A: :; Ai / '.' .„ DEPARTMENT OF COMMUNITY DEVELOPMENT ,,,, 621 Sheridan Street•• Port Townsend••Washington 98368 O� 360/379-4450 • 360/379-4451 Fax $IN http://www.cojefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# 0'A-ac)3 PROJECT/APPLICANT NAME: A.y,,,>l ,, 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. 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. 4. Describe the existing soils. Indicate soil type on the site map. S nY wti . 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. cCir••.q..Lrt -✓T Rixtot / f../ FT- c) If cow 6. Describe any excess levels of noise generated by the proposed use or activity: )00 ex a ass /tv / o 1 -. _ APPRQv1 J 1 STORMWATER PLAN stormwater site plan template.doc—rev.10/12/2003 Storrnwa r Require MAY 3 1 2007 5 JEFFERSON UN DEPT.OF C , EVE ME SIGNATURE: • • 7. Describe significant geographic features and critical areas (i.e., environmentally sensitive ar a such a ,wet ric -- a steep slopes,etc.)on the site. Indicate location on the site map. - ,r'? r 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.). r3ellAi t 1 ) 11-1''-A- boor w-r 0/24 vas c G4.40/ tdt c J PK., Permanent Stormwater Control Plan This portion of the Stormwater Site Plan consists of the selection and installation of the appropriate stormwater control BMPs and facilities to remain in place after construction of the project is completed. "Medium" size projects are required to have the totals calculated of all impervious surfaces, pollution-generating impervious surfaces, and pollution-generating pervious surfaces to verify that the thresholds for treatment facilities and flow control facilities are not exceeded. 9. Describe the developed site hydrology,as proposed. Indicate whether stormwater will be fully dispersed (i.e., per BMP T5.30 in the Manual)or, if not, what types of stormwater flow control will be utilized for the site or specific threshold discharge areas within the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. Di n 'T'' , N Arc tJ1:.` 1l CZ-64 411 tit-..' Ca kJ tot c= Slit . 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.] A)zy �2 el)7,4 eN71 6 Cif///eS 4)e c esfAR y. 11. Describe the performance goals and standards applicable to the project. /i/441/1.01 CA1 i.r 1P4 C?'3 CON7Ra/ -747 it et rvAPCW 6Rove/ s/v,ni. sos .4 .r/, ifcA",eve peRfeC74 vJ 12. Describe the flow control system. li CI OTrtirlie— 'D/200 ,‘/.41 c ( stormwater site plan template.doc—rev.10/122003 6 • 13. Describe the water quality system.• 5itt ./,s akt{> SBNdy (PAT , ' II 1 14. Describe the conveyance system analysis and design. d60.,)NS)0 oo/t( f o ,ud ffRA 15. Describe the source of fill material,physical characteristics of fill material, and deposition of excess material. /00 F/// Re��Rem,��s Ave c es..r41 7 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. / 1 dRivewA /fookeZ /fait/ , 0 e catic Re l € °Al cciy 4 crcc/ A.9?v0P4 w//( 7/fii e. 17. Describe the proposed surfacing material. - C-4•U%tt � i 20 CA. 0$14 i trtsdideriat 18. Describe methods for restoration of the site. Nib v1/43- toOtroA QCir et M1 ti i NI- ST7/7.06 ; 19. An Operation and Maintenance Manual is required for each flow control and treatment facility. [This is normally required for "large"projects only and only those for which facilities are required to control flow or treat runoff.] If included,list the Manuals here. n)A 20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan. /(/ON t 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. /t-)OAV e stormwater site plan template.doc—rev.10/12/2003 7 III III . CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN (SWPPP) v ,,, 1 D The Construction SWPPP addresses sediment and erosion control during construction. The BMPs indicated by the applicant in tfie ` 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 8WPPP 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. DN� 2. Establish Construction Access. N-Z-- - -1►,vie Xz,R Ui4-7Z 0p., . 3. Control Flow Rates. y A T st taa�" 4 e x "T� �/� Lb-, Vi 4 7) ,/ ci A.. 4. Install Sediment Controls. S C-- --- 3 5. Stabilize Soils. 1.9... L. ) 4-44 4 ( -Ti. 144 ke 4 G c.,.,A,.,.a 1 6. Protect Slopes. 7. Protect Drain Inlets. — G lk'" iJ 1 d2A i dlid a 5 C J t401 ( -77,44 g stom water site plan template.doc—rev.10/12/2003 8 • • • 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. 1 •r`^7 Sc23 .. /j J 9. Control Pollutants. tiA 7 /jA/i°S nv C A4 e of 10. Control De Watering(the act of pumping groundwater or stormwater away from an active construction site). ffAy &/es fo ca hgo/ ekeos,a")' 11. Maintain Best Management Practices(BMPs). v,A.c;v k 5--1 1..4.. 41 0 f Vri) (4 W+`) ) ' • 12. Manage the Project. l CQNfRAC7aft an �/ /y A/8g2 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). /00 N fi b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). A)a J 74?eR.e. 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. NoitJe . stormwater site plan template doc—rev.10/12/2003 9 • • ,. . , , ,. . ... _ .. b. Description of special requirements for working in or near environmentally sensitive areas. tuA . ..... _ . _, . .: 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). iJON e, ,c6itQ y8e 5. Construction Phasing. a. Construction sequence tc.�ca4v AYj as- 4 CL r i *del J u..0 .c t3SS, 0! 2` Ar) 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. —C e4A. t hFL \ / 2) II. Wet Season Construction Activities. a. Proposed wet season construction activities. b. Proposed wet season construction activities for environmentally sensitive areas. 7. Financial/Ownership Responsibilities. a. Identify the property owner responsible for the initiation of bonds and/or other financial securitigs. .. v er1-1 A-N DaZ-,.n..,/ Ow,../ L — t a 441,e a w. , `S i 04 Sv b. Destribe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. Sa 1L V'l S 1,4-t tr- s I . — ' ` 4.,— «rt- . 21cx oct) 1 aSC -40'c.,"--- 8. Engineering Calculations. Provide Design Calculations on parate sheet for the following,if applicable. a. Sediment Ponds/Traps. b. Diversions. c. Waterways. d. Runoff/Stormwater Detention Calculations stormwater site plan template.doc—rev.10/12/2003 10 111 I Stormwater Site Plan Changes If the designer wishes to make changes or revisions to the originally approved Stormwater Site Plan, the proposed revisions shall be submitted to DCD prior to construction. The submittal shall include substitute pages that include all proposed changes, revised drawings showing any structural changes,and any other supporting information that explains and supports the reason for the change. Final Corrected Plan Submittal If the project included construction of conveyance systems, treatment facilities,flow control facilities, or structural source control BMPs (not standard on-site stormwater management BMPs),the applicant shall submit a final corrected plan('as-builts")when the project is completed. These should be engineering drawings (stamped by a licensed civil engineer) that accurately represent the project as constructed. APPLICANT SIGNATURE By signing the Construction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all owners of the affected property. 9 ///24t) (LANDOWNER OR AUTHORIZED REPR ENTATIVE SIGNA RE) (D E) r THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: stormwater site plan template.doc—rev.10/12/2003 12 4 �4�¢gON cp6� JEFFERSON CO�fY11110 rt7 , DEPARTMENT OF COMMUNITY DEVELOPMENT ,-' ` '4 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax 1`9&IN0r p� www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: 01— t Project Description (include separate sheets as necessary): Tax Parcel Property Number: Size: (acres/square feet) Site Address and/or Directions to Property: Property Owner(s)of Record: Telephone: Fax: email: Mailing Address: Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies ❑Building ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit 0 Conditional Use[C(a),C(d),or CJ** ❑ Single Family 0 Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home 0 Modular ❑ Special Use(Essential Public Facilities)** ❑ Commercial* ❑ Boundary Line Adjustment ❑ Change of Use ❑ Short Plat** ❑ Address 0 Road Approach 0 Binding Site Plan** ❑ Home Business 0 Cottagelndustry 0 Long Plat** ❑ Propane 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Sign 0 Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis 0 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 ❑ 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 any other local, state or federal permits required for this proposal, if known: DESIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of his,her or it's knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save, indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any 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 appl ;o that he ors an pr otice. / / Signature: �1'7 Date: �� a— i The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transfer,Welesponsibility for adheri o and complying with the ESA. The Applicant has read this disclaimr aryi signs and dates it below. Signature: /E 4i' ) /7 / D</ Date: X/7, C7 G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc • I >. 51-', I,A\ , ,, , , ,,[,, ,, ,,, t —..-- North p] r //, \� p0 64'2"I + !�':� ts t 25'Pad, 1 a . , Posh Fel-0N PERMIT # BED S?�R,''t�AT.�R �c� JEFFERSON COu NTY 9CII Property; o ` Primary and reserve Prainfields Lot #19�, Kala Point biv, 9 ),_. Parcel #96500054 A Owner: John and Normandie Anderson / fi 469 245rd Mace 5F r-� 5ammamish, WA 98074 A 5e �rank 560-585-7156 ,S W , - Stormwa i�3o r Require — a Contractor; i----25'-0"' ) 0 Maur Bedroom House �� Kelley Shields Inc, ___! 3.1 260 Kala Point br, Port Townsend, WA 9868 Two Car ' 1'0�..,�rn. 560-565-1156 cG crushed k'cek L2rroewal Lie, #Kf L -51150LF ./ plioi). e ,p, 47 _ iq_, APPROVED (? o o ) fi </°° SITE PLAN . \ 7 41 MAY 3 1 2007 25'Pad. JE E 0Q DEPT.OF C �— • 77'-4" SIGNATURE: • J °N c ,,, , oL� JEFFERSON C UNTY q, ,, DEPARTMENT OF COMMUNITY • DEVELOPMENT t' '-� '.4 M 621 Sheridan Street• Port Townsend•Washington 98368 $ 360/379-4450 • 360/379-4451 Fax `S� kIG�° www.co.jefferson.wa.us/commdevelopment Master Permit Application M(�q: '�` 365 Project Description(include separate sheets as necessary): jJZ,L—$ 4jf+^1Gj t i4.f (2ei( t)t;;-A.cie. Tax Parcel Property Number: CI(oS 0DO 334- Size: 11'L pe.....e. ;, (acres/square feet) Site Address and/or Directions to Property: •►kX err rrr.-t. tJ j i C.1--- tik 4.e p l.,t i' 02, Property Owner(s)of Record: *,C)At', ft f,J n 1,41 e e.d V l e 4 Ad D ') 0<-41 Telephone: 7°7 tvQ " Vt3 5' .' 1 t ,y Co Fax: email: Mailing Address: 4l2 1 2 4 ! 1.0 {aL , S(e g**i41,ry) 4 y I i S i*i( 441 A /R C 7+- Applicant/Agent(if different from owner): 144 *4..t,.40 M l 4c: +a I A.C. , � Telephone: 72E64 - 385" 1‘ 64a Fax: 355— 3 l l 5 email:a)5A 1 pJtiS P obi wpic,. A++r,,e__ Mailing Address: 2-i0 0 V-141.A Pr. biz , x'p r` 14,e—5 a,f.y4 `...4d 71/4 �i L What kind of Permit?(Check each box that applies) U Building J Variance(Minor,Major or Reasonable Economic Use) U Demolition Permit J Conditional Use[C(a),C(d),or CI** Single F J Discretionary"D"or Unnamed Use Classification Q Garage Attache Detached J Special Use(Essential Public Facilities)*` ❑ ManufacturedTiome 7 Boundary Line Adjustment U Modular J Short Plat** U Commercial* J Binding Site Plan** U Change of Use J Long Plat** U Address i Road Approach J Planned Rural Residential Development(PRRD)/Amendments** 11,eropane J Plat Vacation/Alteration** U Allowed"Yes"Use Consistency Analysis J Shoreline Master Program Exemption/Permit Revisions** U Stormwater Management J Shoreline Management Substantial Development** U Site Plan Approval Advance Determination(SPAAD)* J Shoreline Management Variance U Temporary Use J Comprehensive Plan/UDC/Land Use District Map Amendment U Wireless Telecommunication* J Jefferson County Shoreline Master Program Amendment LI Forest Practices Act/Release of Six-Year Moratorium •May require a Pre—Application Conference **Requires a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal, if known: DESIGNATION OF AGENT I hereby designate lL 1 .S#1E( , I w+C. to act as my agent in matters relating to this ap lication for permit(s). OWNER SIGNATURE Date: % O'O By signing this applicatio rm,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.Access and right of entry to this property shall be requested and shall ccur only wring regular business hours. /� Signature: / \ Date: �\ The action or actions cant 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 County development code.The Applicant acknowledge that he,she or it holds individual and non-transferable responsib'lity for adhec• g to n d complying with the ESA. The Applicant has read this discla r and igns and dates it below. Signature: . Date: 414, ik -LOAM C:\Documents and Settings\mochil\Desktop\Master Permit Application 7-8-04.doc • • OWNER 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 Gener ontractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTAI I FR: PHONE: FAX: r, `°c St+1 5 NC-. (360 ) 3455- 'll,i ( 3o) 3$ 5 --11;� MAILING ADDRESS: 2(db J k ,e'..' r,�� `/� Y EMAIL: C-ri f _ d ' • ,,,,• tt ?'r` CONTRACTOR'S LICENSE WAINS NUMBER: t/ � . . tO t NUMBER ARCHITECT/ENGINEER: !� ) ) L�S= ,4(J►'�.t�to — cot i iT f PHONE ( FAX:( MAILING ADDRESS: 261) lei P. EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New to;,Wood Existing: LI Sewer LI Addition Li Steel Proposed: 2'/2_ Bank LI Community Systern LI Alteration/Remodel L Concrete Total: Height: LI Individual System LI Repair Li Masonry SEP Permit# LI Demolition LI Other. Bedrooms: Water Supply: Existing: Setba k: LI Private well Li Two Party Type of Heat Proposed: � L)Public (uw ' Total: 3 Name of S em:_ i y#4 /Pfb` ri4!1 6 If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: _ Number of occupants(includes owners,tenants,employees,etc) Current Proposed _ IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No If this is a Propane Tank and/or Appliance Installation permit, mark all items below that apply: j Underground Tank i Above ground Tan Size of Propane Tank /2 4/ ,Heat Stove i Cook Stove j Woodstove i Fireplace Insert i Hot Water Tank -I. Pellet Sto<e j Other _ Is this appliance being installed in a Manufactured/Mobile Home? Yes / No When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. Square Footage For Office Use Only pY co Current Proposed (Dal Main Floor C� Consistency RevieLw 2"U Floor Base fee: 5 3fa Floor Additional Section: Mezzanine: Plan Check fee: ' 130. r.t Heated Basement ' 1 _t a(1 State Surcharge fee: 5• �$ �O l0 � - Unheated Basement ^ Pot Water Review fee: (1 L}%24 3a) Other Unheated 11 fRR_Approach fee: 2--r{) Garage/Carport 4So TOTAL: $ -t 13►3. Decks (�� Receipt Number. C '(lc) C r Other / 232o a sh/Check Number. c,' I P,4 i ESTIMATED COST(REQUIRED} ��+�'/.-Date: I • i �G , .Fair market value of all labor and materials found tfon to m f !1( Initials: 1\ C:\Davments and Settings\mochil\Desktop\Master Permit Application 7-8-04.doc /---- l''6''., ____j it5'-0'' / a / 22'6" / I' ICY/ a :1- 1 0 •—• OPY \ \ *: ,.. \ \ \\"----.1 (!) •:.: -vs-- •:,: , • t., c? k _ V , 2" / ,a. g I I I I a. R-, I Ij 1 ii ( I I I I :: ,g 1 ..4* •-.... K: i:i: ci• :•:. iii: 0-'- iz I , •$:, il / 12, XI .• 0(1) 1 2' 1 111 ID `3"I .ra -..,- K., 1 a . / i'l. 01 rifl 1 ,11 yi 1 ,--- -, „. '4 , byysneelf."1-7/ \ 61iNnOt \ ci. 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