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HomeMy WebLinkAboutBLD2007-00193 AIDING PERMIT APPLICATA" MLA07-00220 Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00193 Received Date: 5/7/2007 SITE ADDRESS: 1094 BLUE SKY DR PORT TOWNSEND, 98368 OWNER: ANDREW J MC GREGOR PHONE: 907-586-3353 SUSAN B MC GREGOR PO BOX 240945 DOUGLAS AK 998240945 DISCOVERY RIDGE PRESERVE SUBDIVISION: Block: Lot: 2+ PARCEL NUMBER: 947200002 Section: 19 Township: 30 N Range: 01 W CONTRACTOR: BISHOP CONSTRUCTION INC PHONE: (360) 676-1293 1217 POWELL ST BELLINGHAM WA 98229 Contractor's License BISHOCI000QB Expires 1/21/2009 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION NEW BOAT/STORGE - UNHEATED, NO PLUMBING TYPE OF WORK GAR SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION 15,179.00 MAIN: CODE EDITION: 2003 ADD'L: HEAT TYPE: UH OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: CONST TYPE: OTHER: GARAGE: 644 SHORELINE: CONST TYPE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: 0 Prop: 0 Total: 0 Total: 0 Routing Date: b l 01 ey--- Type Amount Paid By: Date: Receipt: A proved/Date Permit $363.25 CJZ 05/04/07 39744 APPROVED Plan Check $236.11 CJZ 05/04/07 89744 State Building Code $4.50 CJZ 05/04/07 89744 JUN Z007 Total: $603.86 Jefferson County Planning &Building Department • Jefferson County Building Dillon Permit Numl. BLD07-00193 Applicant: MC GREGOR 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-T-C7 Erosion Control Post Holes t 7 P-r itbLrvvMlt ,' - Foundation Footing Footing Drains Foundation Stem Wall Straps(hold downs) Ext. Shear Wall Nailing Framing Blocking Wallboard Nailing Drywell/Alt Drainage Address Posted FINAL INSPECTION /4J`I A FINAL INSPE TION MUST :: ' PPROVED PRIOR TO BUILDING BEING OCCUPIED T ' PERMIT IS VALID FOR ONE YEAR A • S CONDITIONS for Building Permit# :BLD07-00193 1.) No plumbing has been reviewed or approved for this project by Jefferson County Public Health. Additional requirements may apply if plumbing is proposed. 2.) The application was reviewed by the Jefferson County Department of Community Development staff on June 8, 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: wetlands. 3.) A setback of 100-feet from Wetland PX measured perpendicularly from the wetland edge, shall be permanently maintained as a buffer. No filling, grading, clearing, or other alteration of the wetland or its buffer is allowed. 4.) Wetland 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." 5.) 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. 6.) The applicant is proposing to create or add 700 square feet of impervious surface and 700 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. 7 ) 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. 8.) 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. 9.) 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. 10.) 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). 11.) The site plan as submitted with the building permit application on May 4, 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 June 8, 2007 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 12.) This approval is for a private boat storage building 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. 13.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 14.) Not more than 2 unlicensed vehicshall be stored on any lot unless totally sc ed 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. 15.) 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. 16.) 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. 17.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 18.) The building height is not to exceed 35 feet. 19.) Minimum setback from Blue Sky Drive right-of-way shall be 20 feet. Minimum side and rear yard setbacks shall be 5 feet. If an ESA is present, then the more stricter setbacks shall apply. 20.) The parcel has been designated as RR 1:10 under the Jefferson County Comprhensive Land Use Map effective August 28, 1998. 21.) An address of 1094 Blue Sky Drive, Port Townsend has been assigned to the parcel. Blue Sky Drive is private (P278). 22.) The lot was created through the Discovery Ridge Preserve Subdivision on November 1, 2004 under AFN 491110. The plat is subject to Notice to Potential Purchasers. 23.) The parcel is served by PUD#1 public water. 24.) A septic permit (SEP06-0310)was approved on December 26, 2006. A building permit (BLD07-0041) for a single family residence was finaled on February 13, 2007. :-....1 [,-; re- o vis L rm MAY - 4 2007 .r N c° JEFFERSON C ' O r O 1 �UNTY DEPARTMENT OF COMiVIEINITY DEVELO - - fEHiSD ,j COUNTY I••j „, 4,.. ips.6„,4,7, ,, 621 Sheridan Street • Port Townsend • Washington 98368 19N0 360/379-4450 . 360/379-4451 Fax http://www.co.jefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE jM # - V\"'� PROJECT t; J i6 CN T. IS)1�� 6,,,,,,,, c s, manic. 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. 711 i5 4N tX► 5%i,rJ a R.cRc , Lram} bi'Vc- � R 36o `)S 300 t ilitm r114 i . 1,,,,Ai c_ Li 1Zrp \1 Eli--Rs G 0 , i., w t`Lt_. v S /1-Alo r'tin ifZ.0Vc L—` t 5 t-1 fu Ro t-c . iv iljrLL 3 v i C.p 4- iv C• w S.,?✓/L. 3 3 5-0 [ 'IN 1 1f e L +N� Ar1b lel C. yy SQ. FT, 3 o67- SioRAc $ `/I LbH ' 6 . Existing Conditions Summary 2. Describe� l�the existingtopography. Indicate contours on the she map. • i iiC UrLI)IeVG 117 SL0P0 V02.'1' 5L. (61�1"L 4 ToL&i 1znS T1fr� i-".. iutT Pr'fz- of 5 , -- : T Ittz SLQ(C c t 'NG rN Fa04'ti o ti 2 8v.i Li,I iv(._ 5 i , Ttte cor >/tz--)v L / -r5 ova 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. —r 1 o,5 ft0Z I -0 7` t S A r 1 X O F Do uc F/12 f N/I)Vt. pL.tivn E-x c --PT J iv k Ni > FY'r N d i 'b a N 11th s , TZ P(A-iv. r 4. Describe the existing soils. Indicate soil type on the site map. k.( O w ti La H-rh ` `f i�`;,v 6- s.'f--ivfl S S>ry C o &IA r 0-�,1- G-►2A v e-L . 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. —We- 5 I TF /Zh c i.-v S tA✓iiT 1�gdAA 47" 12 5 I Tc3�,i94.i if wt-sr xiv b G E P R O P t� -y LINE-- , �tT I-0}- S L 0 pig To Lu ii-K o > > ,5 4- . . ! . • I Ilia..r:i 1 i..1.. 6. Describe any excess levels of noise generated by the proposed use or a• ivi : '•a t — P T y P 1 c rc-L 6 W►o Ni j 1 s o f N o 1 s e'. �—SrT-E3—STORM i'IjA�E R RE .l41 too ILA— aI; iv-6() �/zL w1DRNtN6-5 0 (2 / tv, Criy L., O • S41i6 J dUN - 8 2007 Require 4 JEFFER I SO"i • v� stormwater site pan template—rev.11Y71t003 DE PT OF CO t , - t _ 51GNAJ_URE'. ! A U_FYEn I PME� • • 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. yY l N o ( i Ji 1 t 5 £s; s r- o ry 77 w 0T W' PvPek rY 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.). rills silk IS , N jt1i m, U1 1t 0h bE`(C LorMOv% : 3'v1osj COTS ft ID f}ci s , TTj" Roil s P/4q m 77t'S Lo? tvirN t,/..577 `rc PL w ,4,v( w1 i> • 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. wF wI L- h4-49 il-E-"( .S DA/7-1' U ,NG it y " T 6rf1*- L NES . 11Z�' T16it7 LlNEI w4L.L Ark/4-iry iNTO Fo/1& J&/ jRusl¢ I S ►1 i SLOPE Few t j 0 11A ri /y-tl Nl t f P AM N F/1=L 0. j v( E 1?o'ff S7UR6Gt KAT (.-J,LC[ Yf Z ,-) TPt ('O u Ts R A ,N , iu To 71t(-� Imo,C S )1/v Cr JE&ET°rT/0� 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.] t 7Ih s rTt '-" �� ECrS, _ �lr �dv� /N JsuLL_y L ISet'Yt5t?5 J k o 6 f F-0 R s )'o Ren L Il i 2`f& c 0 N 7'g.o L • I 11. Describe the performance goals and standards applicable to the project. u, tic, fur P, ►- GZur0 (3 ea,PA! \ of" h1 E-Ais )5-v ' SiN6- I Nib b flu biN G S i TF • TtbS to � 'vs LL � N o7 D j v ��7( ►Sr S o I c C oNAITidrvS bug.,R, G c o,JS i-� ULrio' 4: WkLl_ LO ENg. f fjCK , L_L SofLS bU1etn/G 1 t/NDlYi7UN LAJc)/eX • 12. Describe the flow control system. C L it l rV it I/4 NOT 13 C a LR`-`2E1). SO WA" Mr1 tF awS wI LL r'io r )6' f Y) Lik rir-Fr --_ eats! i f v v r stormwa r site lir0.Qt<?#3 rer:fO/i/$QOiir,r{�.; ) it .1 VI a r .=.r. y � r I MAY AY - 4 2007 13. Describe the water quality system. _ f I I 71 b &iLOrn.) c- S I re S /Co' "i) boo ' ,may F2o�-, ��L K Ta �t vt e12 �/�-,�i s il�� c�cL v(Z q u`rci>v G� J24-�v Kr- P A S 28eb �� � w �"1+ S7Y6 - o F �� S i 1� �o t tl/f�� r=ti b w S y r c L ����v ,9-,�,t. �'`� u ` 14. Describe the conveyance system analysis and design. w.N Sea J I S W i t_L b 1 � jr,t>13 rv(,, � t N �-j v opr C �tST c L � c r 6 l r rill.— y °' p fz/9-JN w_ t K.)eS ir'i7j 2 '' GRhv0.... So �� L LL 17 I S P(-) SC ry L o LA-) )` v `v N/� <1 v�' �}L t,,J I " 15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material. istte 0 a Li 1 L (,a( l.L lg>2 i ni G i ro W i L (s R u c K G R V l`t Fore R,0 d 8v i b ti fv G . 2 ��,21i i`>v 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. I�ielvl; ON Exrs7YvG fL00-p ''��72 G-R �l c`L 1 S i N P C/j---CF i�S kJ,'Li_ rtfC IV C�v coMrod-c.T aucl2 7?yl:—o u R e- o l+t) yv)t` (3o i L f ,%J L %) •^ G/9--AA C F S V} 6-42/7✓c~L tel: <L 17. Describe theL proposed surfacing material. fi r•,Pi9-CT e� 43,1 6-41-S c O vim►.4"c I-n 7 !7- /y ° D}eI YN Lj' w, c` j3 , Z " cRUs 11-F� �K,4-vl�t / 18. Describe methods for restoration of the site. t X IS ►) ,xi G; R d /}-o i) s Ii G t t_ c n/ `�% G fvr`t L cL ,C�fZfNlr 0-1 ; s ,);Lr 7�F 2c37- F w f r` t+ 4 V S o r-► G /0 s S /4-Al ,v 7- r Do nr d �9 7.i >r PC�4 S 7' (Z �Q U t2 F U c It c-t r'i-i'��2 t j,`L L t3 C P - 19. An Operation and Maintenance Manual is required for each flow control and treatment facil' . i I ec aifor large"projects only and only those for which facilities are required to control flow or treat ruhere. lu ;}`ist"thg Muals N/i9= i1 ab 17 20. List here and include any special reports or studies conducted to prepare the StormWater Site \ si 11'1, hi o 2�Po r2T s 0-R e /}v f-/`c.y-is t a u S/ 30i. 'I � 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. S EV7-7 c P N)e.r- 1 r t F)--L 2 c-yvo , 13 0 Q sv . k '? `L N off— a re r ,v s—b uilfkb S 4-it- stormwater site plan template—rev.10/1/2003 • • • 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. w-tLL /36 Vt -'( F C S o1,2 us(>t T C th S 13 E- C t_l`�9 2��() Y C1912S /1-G d .. 2. Establish Construction Access. ; ' ay ( ILL I rr P R v 1 > X i ST?I\J G. (Zo a 7- F'f S I t HOr S . 3. Control Flow Rates.- U J G A 1—d6z2 1- j Bkvs N-, 4. Install Sediment Controls. SNP` 5 J 1 / '-U oN 1 r1._ P0SN`P Soi . Z [ -LI 84LC S TO 5 E-6 w Con, S ��i v� ONO— -r 0 t m ri,JT" i N to JJ 1 Fj.i T. 5. Stabilize Soils. C Sin f�,g^�r" Cr M-s s ��9,�c. r i-Dm Q R,oct5S Ta cetu 7R.e, 1o;v 6. Protect Slopes. We- kiiLL IJ j et- I t_Q G. oij s- 0 P . 7. Protect Drain Inlets. c • rP ;op.- Jlli. stormwater site plan template—rev.10/1/2003 • • 12 Required Elements-Construction SWPPP(continued) tJ 8. Stabilize Channels and Outlets. ', ? �t t Al .t NJ r• 4_ MAY - 4 2007 ry _:VE.OP.lEr_r 9. Control Pollutants. WILL f3F ON TO P20Tcr /1 PRd,�-cr 44u0 Phionit 0La NNL5 Morn orn ca1v Ntuio crYUS 5PiI(L_5, 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). Tt j s i P w 1 L L C+1 Y C` r4-r1 o Ptry i>v G- 1-6 w/3-R.0 - w€,3 7' .S o NI t P mP+tv_6 Li 1.J , 11. Maintain Best Management Practices(BMPs). WiLL lit ory S i 7b ove1. coro5I'ROc)-1on! 4- u 11-4-N 6 S o N ,. T1 PC OF 00 Li) w t Tv- At y O(u-A) ot-t oL d y a"S. 12. Manage the Project. EA" F-130 01-ScD T ,%--v f3v1LojN G -7 1-S f'R-0JEc I=a,e ;f cs4,(u Cr-4 t,(0 0 P- !Arlin) ) S p W 1 7l 6 R 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas,roads). cs c-Cfi0s op <r u k Loci}-,"teary it .lh-o TrtN; f -(T S L i.s tT' SCt T1, 13v+ L,Dlti.t•Cr w t O- 6-1 �, ‘A.)t L� TT}- "t-i- ?Nl� N �1-4-ary N r-t 1`l'L 0 R 10 t rYk C't -<: ON S u ig.0 LR�✓1t1i/r9(r' pFLoPt r1 aIL c Its lTicPr S b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). C� G�t L> i ' -Ti", G p Kfik�' >- M` S o F-(1-!L �1-' moo.n,� I B C/)t9 S 1, - _ 3. Environmentally Sensitive Areas. , — .i c a. Description of environmentally sensitive areas that are on or adjacent to the site. II !27-11 t �� �S A)t� �-- S rv1 � S OF -nD 5t7 - PLj J - stormwater site plan template-rev.10✓1/2003 ;c • • b. Description of special requirements for working in or near environmentally sensitive areas. 10/4 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). SITr P/z%lANS uj e,-Lcn0 &ifs JMI Li i jLE SLoPt , 5. Construction Phasing. a. Construction sequence %G- tt rtrs Po j (.K t-)mot_ 4' 1 t 5Ia2E 5) T 1f� 5'N1Cr Fed r c ) slO+rvc= , ItuO r P r,U7 7;,N ;s It �i\t U L AMs t b. Construction phasing(if proposed) 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). Provide a proposed construction schedule. II. Wet Season Construction Activities. a. Proposed wet season construction activities. V6Wi L-rn LE . b. Proposed wet season construction activities for environmentally sensitive areas. 7. Financial/Ownership Responsibilities. a. Identify the property owner responsible for the initiation of bonds and/or other financial securities. b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. t - 0' N'.'R.s 0 63 v t L D 8. Engineering Calculations. Provide Design Calculation on a separate sheet for l Ic�`vf�ng,10airpljdai 1& a. Sediment Ponds/Traps. V � • - b. Diversions. — — —' c. Waterways. r - d. Runoff/Stormwater Detention Calculations -� „- 4.0 stormwater site plan template-rev.10/1/2003 1#4 1111 • 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. [so certify that this application is being made with the full knowledge and consent of all owners of the affected prop Lil' . / (-- - - 3--- 9/ 0 7 _ RE) ,g4t , -:;f I THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: D ` k IA A`( s� ,,, i-rV tiENA - \._-- pEVEtOPti It „imp.- - -:" 12 stormwater site plan template—rev.10/112003 V w�i 06. JEFFERSON cowry DEPARTMENT OF COMMUNITY DEVELOPMENT 1-' '4 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax � t5 www.cojefferson.wa.us/commdevelopment "r87NO� Master Permit Application �0 14' -i iv° pc V Vv\66 i iJ,.MLA: 01 a ao Project Description (include separate sheets as necessary): 6 q c) S 4 f•T, TO 1`A l OPEN 8o i - f;A/ }, Jo Jo' icici ' c LOS s� sieAAi3C t B ',u23iii Tax Parcel t, Property Number: 9—1 ' - '2() 0- 0 0 Z. Size: / p C2 '�- � cS (acres/square feet) Site Address and/or Directions to Property: 1J AA) Rt t.- 0-r % k A I t-F� ri75S G-Ul F CO u R 5 I099 EiLv (-- SKy 1)g-i • Tft-K t DtrS<4ve`!Zt-1 A 9AKe• RI601-e6-co, coRr'psl; Property Owner(s)of Record: W- /V Q l e" S' V' l; /Y1 c ( 2 6-6-e A Telephone: q e'i -- 5 e (7 3 j 5 3 Fax: email: — Mailing Address: P ,0 . ea x 2 r-( 0 9 y S Dt, j o G�,,j s 1A 9 9 •Z(i Applicant/Agent(if different from owner): Is .M g t S itet P ($ v ;LP Ot) I �,Telephone: 3(p 6 &7 (C I z ci 3 Fax: S itr i email: h).5 1,1 i IAA} p1 04.CG- Mailing Address: I Z 1., PO L•L cZL. 5 t�. f3 i_, 1, , ice .,.,,, t t._ y lr Z ci. ' A; CI-- What kind of Permit? (Check each box that applies &Building 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit L,q-0,Pc. iz i 0 Conditional Use[C(a), C(d),or C)** ❑ Single Family el Garage Attached Detached 0 Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home 0 Modular 0 Special Use(Essential Public Facilities)** ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use 0 Short Plat** ❑ Address 0 Road Approach 0 Binding Site Plan** 0 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 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* 0 Jefferson County Shoreline Master Program Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium 0 Tree Vegetaion Request *May require a Pre—Application Conference **Requires a Pre-Application Conference Please ide tify any other local, state or federal.permita required for this proposal, if known: iv 4 DESIGNATION OF AGENT I hereby designate qq to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE T1NNc L (11 Date: '1 1 C ) By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of his,her or it's knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application review and any required later/inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the application that De or she w) prior .otice. Signature: r"' cam. L% J3 D 7Date: t / The action or actiops Applicant will undertake as a r'uft 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 com 'ante with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferable respons' i ity for hering to and complying with the ESA. The Applicant has read this disclaimer arid signs/and dates it below. Signature: C_ t 1 Date: L f //3 /v 7 G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc V ' • BUILDER STATEMENT e The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: (1,L 3)1 el)31 FAX: � I S tf-�4° c cr . -I- N C ; ( 3 Go) b 7( I Li ( ) 5'n.-,vl(- MAILING ADDRESS: t Z 1 l P o w t1 L 5/ . EMAIL: b i Sr l",c. r. /Al(Q.0 ' N E1 CONTRACTOR'S LICENSE WAINS NUMBER: 1 S' {-j-o (_.- 006 Q 5NUMBER ARCHITECT/ENGINEER: t PHONE ( ) FAX: ( ) MAILING ADDRESS: f Z-i- PO 11-1 ELF \ -t i G i-Fr)--M EMAIL Project Type: 1 Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: i l New N Wood Existing: /J i7 Sewer ❑ Addition I-7 Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: _ Height: ❑ Individual System ❑ Repair Cl Masonry SEP Permit# Q(D-�I U ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: ❑ Public l 1 �A Total: Name of System: 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: I Underground Tank I Above ground Tank Size of Propane Tank: i Heat Stove i Cook Stove i Woodstove i Fireplace Insert i Hot Water Tank i Pellet Stove i Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / No When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines, tank location and size, distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. Square Footage Current Proposed For Office Use Only Amount Revision Main Floor Heated EH Bld App Review: c,) co 2' Floor Heated Consistency Review: 155 Other Heated Base fee: 95 Mezzanine Additional Section: ^_______ Heated Basement Plan Check fee: ,93(0.1 Unheated Basement State Surcharge fee: "4, Z Other Unheated Pot Water Review fee: No fit`r•-ij3 Garag arpo-DI C,t t� 0 LjI lC�C SUBTOTAL p/ -t 1 `` C OHO Decks 11/Rd Approach feed -------r Other TOTAL: $ yl :2(+' Receipt Number: 8Cti - _ Cash/Check Number: 1 �.= 1 • ; I ESTIMATED COST Date: ��� A: i • t1 , .Fair market va materia undation to finish 1 NY 4 �1�u7 " ' e@ Initials: i i LI t 7 0_0 ` ,.dlY __Opt1ENT G:\PermitCcnter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc - — ____„.............i. 71 C) CD rn 'r. CD a 7 . a • —1, m Pa • C) O _.....,__ 71 . . 1 i < l (D { ,z.-.‘t\-5—: 1 ''S3''''S-' ' ; --lemeev.. 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