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HomeMy WebLinkAboutBLD2007-00278 to • MANUFACTURED/MOBILE HOME INSTALLATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD07-00278 Received Date: 5/30/2007 SITE ADDRESS: 1029 DABOB RD Issue Date: 7/16/2007 CHIMACUM, 98325 APPLICANT: ANNA L NEAL WILLIAM F NEAL 1219 188TH ST NE ARLINGTON WA 98223 SUBDIVISION: Block: Lot: TX18 PARCEL#: 801212011 Section: 21 Township: 28 N Range: 01 W CONTRACTOR/ PREFERRED HOME SERVICES PHONE: 360 808-1830 DEALER 61 HOUSE RD SEQUIM WA 98382 Contractor's License PREFEHS981RR Expires 12/19/2008 PROJECT DESCRIPTION: NEW MFH W/COVERED PORCH INSPECTED BY L & I MAKE: SKYLINE YEAR: 2007 SIZE: 60 X 40 THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 7/16/2008. CALL IN R3I EQUiD INSPECTIONS THATAPPLY.TO YOUR PROJECT. etback ooting (CONTINUOUS FOOTING, SLAB or PADS USED): Oik f/j/0j�� Stormwater FINAL Approval: Blocking/Plumbing: 10-(t-01 w\ Propane Tank/Lines /LA Zoning Final Approval: Septic System Final Approval (If not on sewer): Road Approach Final Approval: Final/Skirting/Vents/Porches/Steps: 6/K 1- .r„A,-/ 0-40/4,6 fr 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 REVERSE MLA07-00289 Review Type: I MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00278 Received Date: 5/30/2007 SITE ADDRESS: 1029 DABOB RD CHIMACUM, 98325 APPLICANT: ANNA L NEAL PHONE: (360)652-8018 WILLIAM F NEAL 1219 188TH ST NE ARLINGTON WA 98223 SUBDIVISION: Block: Lot: TX 18 PARCEL NUMBER: 801212011 Section: 21 Township: 28 N Range: 01 W CONTRACTOR/ PREFERRED HOME SERVICES PHONE: 360 808-1830 DEALER: 61 HOUSE RD SEQUIM WA 98382 Contractor's License PREFEHS931 RR Expires 12/19/2008 REPRESENTATIVE: HAROLD NEAL PHONE: (360) 732-4642 1029 DABOB RD QUILCENE WA 98376 PROJECT DESCRIPTION: NEW MFH W/COVERED PORCH INSPECTED BY L & I TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW MAKE: SKYLINE SETBACK: VALUATION 107,000.00 YEAR: 2007 LABOR & INDUSTRIES APPROVAL? SIZE: 60 X 40 BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: PWELL BEDROOMS: BATHROOMS: Exist: Exist: Prop: 3 Prop: 2 Total: 3 Total: 2 Routing Date: .)\ •.40.-1 Type Amount Paid Bv: Date: Receipt: APPROVED Manufactured Homes $163.00 KAS 05/30/07 91128 Add. Manufactured Home $34.00 KAS 05/30/07 91128 JUL 132007 Potable Water Application $58.00 KAS 05/30/07 91128 Jefferson County Planning Total: $255.00 & Building Department • S SPECIAL CONDITIONS CASE # BLD07-00278 1.) The application was reviewed by the Jefferson County Department of Community Development staff on July 11, 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: Level I Landslide Hazard Area, Susceptible Aquifer Recharge Area. 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.) Jefferson County has determined that the use of real property for agriculture and forestry operations is a high priority and favored use in the county. The county will not consider to be a nuisance those inconveniences or discomforts arising from such operations, if such operations are consistent with commonly accepted best management practices in compliance with local, state, and federal laws. If your real property includes or is within five hundred (500) feet of real property designated as Rural Residential 1:10 or 1:20, Rural Industrial, Rural Commercial, Agriculture, or Forestry, you may be subject to inconveniences or discomforts arising from such farming and forestry operations, including but not limited to noise, tree removal, odors, flies, fumes, dust, smoke, the operation of farm and forestry machinery during any 24-hour period, the storage and disposal or manure, and the application of permitted fertilizers and permitted pesticides. One or more of these inconveniences may occur as a result of agricultural and forestry operations which are in conformance with existing laws and regulations. 5.) Landslide Hazard 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. 6.) 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). 7.) A vegetative buffer of 30-feet shall be permanently maintained from the top or edge of the Landslide Hazard Area. All buffers shall be measured perpendicularly from the top of the Landslide Hazard Area. 8.) Landslide Hazard Areas and their associated buffers shall remain naturally vegetated. Should buffer disturbance occur during construction, the Unified Development Code (UDC)Administrator shall require replanting with native vegetation. No alterations shall be made to the Landslide Hazard Area or its associated buffer without prior authorization by the UDC Administrator. • • 9.) Prior to and during approved construction activities, the perimeter of the landslide hazard area buffer shall be marked with a temporary sign. The sign shall be placed in such a manner that it can be directly observed from the construction area. The sign shall contain the following statement: "Landslide Hazard Area and Buffer- Do not Remove or Alter Existing Vegetation." 10.) All construction activities shall not encroach upon the landslide hazard buffer. This includes the storage or preparation of materials. 11.) The applicant shall permanently separate the boundary of the Landslide Hazard Area Buffer from the remainder of the subject property through installing logs, trees, a hedge row, 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.) 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. 14.) The applicant is proposing to create or add 3046 square feet of impervious surface and 11578 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. 15.) A Stormwater Site Plan for a medium project has been submitted and approved by the Department of Community Development. Once the subject permit has been issued the applicant shall fully implement the provisions of the submitted plan and contact the Jefferson County Department of Community Development to arrange a schedule to inspect the property for plan compliance. A Certificate of Occupancy will not be issued until the Department verifies plan compliance. No clearing for roadways or utilities shall occur on the project site until clearing necessary for the installation of temporary sedimentation and erosion control measures have been completed. 16.) 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). 17.) The revised site plan as submitted on July 12, 2007has 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 13, 2007 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 18.) This approval is for a manufactured home with covered porch 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. 19.) The parcel has been designated as Rural Residential 1:5 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 20.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 21.) 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. 22.) A minimum of two (2) on-site parking spaces shall be provided for the manufactured home. 23.) The building height is not to exceed 35 feet. • 24.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 25.) 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. 26.) Minimum setback from Dabob Road right-of-way shall be 20 feet. Minimum north and south property line setbacks shall be 5 feet. Minimum rear(east) property line is abutting a commercial forest land parcel and the minimum setback shall be 250 feet. 27.) Dabob Road is a county minor collector road (C348808). The road approach was reviewed under RAP04-00257 and an address of 1029 Dabob Rd shall be assigned to the parcel. 28.) A septic permit (SEP04-00258) was approved on October 26, 2004 for a system of 480 gallons per day 29.) A building permit (BLD04-00645) was finaled on February 24, 2006 for a new pole building, 30.) PRIOR TO OCCUPANCY & BUILDING FINAL INSPECTION FINAL APPROVAL OF SEPTIC SEP04-258 IS REQUIRED. 31.) MUST COLLECT AND DIVERT ALL SOURCES OF DRAINAGE AWAY FROM SEPTIC TANK, RESERVE & DRAINFIELD. MUST COMPLY WITH ALL PERMIT CONDITIONS, STATE AND LOCAL CODE. 32.) ANY PORTION OF TRANSPORT LINE UNDER A DRIVEN WAY IS TO BE SLEEVED/CASED OR EQUIVALENT. 33.) 10' SEPARATION REQUIRED BETWEEN A WATER LINE AND ALL PORTIONS OF THE ONSITE SEWAGE SYSTEM; EFFLUENT TRANSPORT LINE, TANKS, TREATMENT AND DISPOSAL COMPONENTS. 34.) ALL COMPONENTS OF THE SEPTIC SYSTEM ARE 70 BE COMPLETELY PROTECTED FROM VEHICULAR TRAFFIC OR MECHANICAL DISTURBANCE. PROTECTIVE BARRIERS ARE REQUIRED AROUND DRAINFIELD-MUST BE INSPECTED BY HEALTH DEPARTMENT. • • £ R... • -0--.-F-C: \\,,, I � �b F II ;1flNI Nl' I (\ \jii....daj .„__aI ti ® u O. 43.T , . /----1 �,),, i, . I � l► • 6cc g. ..0, B _ _ ____ is ! o II , 0 . 9,. 1 t ./,' c_T, r. r\Y3 1"' H 1a ., :‘, S --- 'I P54wgg� tia ir o � g ili. :II u cc- .. ^ . ..: I- _ v -.%,..f,:-.'7', 0-.2.. . • -..,.....,. ., dpi ! , . 21_,:„ 6< 6 : ; 12" 6,tve el- l'AP J I 4 CO 1 Jill I i I 1 , . .. Y . r \ . . . J o Iitiliel 7M/7M -1N-1,.1 1I I7►JH7C bCP 7/t,NCT 9C:bT /R1;i7/FGi/CC1 4111. mc ('+� 28 Series ©C' ?co ^( (:: c_.-e_ C.L.' 1--1-(.4- (-A Z-b) •h • { i A ) u" r rigilli. I.' 1111111OM OPTION GARDEN TUB BATH OPTION CORNER SHOWER BATH OPTION CORNER TUB BATH 60'-0" ‘,I ii 1't r,">,.‘ -: , , . . . tr BEDROOM BEDROOM No.3 - No.2 A f2 LMNG ROOM ,t • . B{ 12' :,.. Y 18�" • c3,!is t 4 T , 1 [ ; n • -_ 1 a { I a.-;-1- i KITCHEN I 1B-8 ' ` BREAKFAST *r MASTER 1 + AREA +w DINING ROOM BEDROOM soll FOYER.'.. Vr i 1250CT/60.3042(1,984 SQ.FT.) FAMILY ROOM I. '.if 3BEDROOM-2BATHS 23.1" COVERED PORCH 5'-4" 30'-0" s -- 24'-8" -- of•' • ' ' ' -• \i IF 1\V N)1,Rki,( 4 f,„ 4;-4 FOYERi i. , . ...i JEfFEN 'OrotUUNIylII,II ALT ENTRY JACK WESTERMAN Ill Jefferson Ct. Courthouse ASSESSOR Po Btox 1220, '�°� i \ ,.: 'V (360)385-9105 MOBILE HOME INFORMATION FO ., 117 OWNER'S NAME/MAILING/ADDRESS: NAME: 14 1�L� e l\c4- ,tEFFEIiIi ,1MMM � 1 ,�1 ADDRESS: /OZ 9 T,gg06 QS) Qufc.c 6, Gis4_9637c, 9729 PHONE NO. 3 co.6-732-4/6 vZ. The purpose of this questionnaire is to obtain information regarding either the current location of a mobile home or the previous ownership and location of a mobile home. This will help our office determine whether the mobile home is already on the tax rolls in Jefferson County or if it has been moved to this county from another area. 1)IyIOBILE HOME DATA: (A) MAKE 5i y)-.)A I (II) MODEL (CO YEAR (1� (D) LENGTH (.1C( (E) WIDTH47/C) (F)SERIAL # 7/5,►" (G) YOUR PURCHASE PRICE (Do not include sales tax) f O`, 000.CPYRCHASE DATE (12//))0,7 2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3) VLYIOROM WHOM DID YOU PURCHASE MOBILE f0DDIRESS (B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR?Yeses% If Yes, Previous address of mobile. If No, What County was Mobile assessed in last year. / 3) HERE MOBILE HOME IS TO BE LOCATED: jI (A) WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes �No (B)IF LOCATED IN MOBILE HOME PARK: NAME &ADDRESS OF PARK Lot/Space# (C) IF NOT LOCATED IN MOBIL HOME PARK- NAME OF LAND OWNER: L f'CL f rt IV d)4c. LOCATION ADDRESS � Cf^" II Gi}a- ?0-_g76,-97j REAL PROPERTY PARCEL #/DESCRIPTION 5j Q5 l Zl2 O J //a,(04/ 2 . Signature of applicant THANK YOU FOR YOUR HELP! ss-F JO COSSELL, Property Technician -F4 )) �w¢sON o �o� JEFFERSON �NTY • I �� �] \� 1xr \ DEPARTMENT OF COMMUNITY DEVELOPMENT � `� 621 Sheridan Street • Port Townsend •Washington 98368 l ir1i� tt kd 4Uw t 360/379-4450 • 360/379-4451 Fax q"S, N� O www.co.jefferson.wa.us/commdevelopment JERR ii 1fIRIIY1I„� Master Permit Application MLA: O`1_a S ( f Project Description (include separate sheets as necessary): 1 i\i'C k' AA > .s.i 44 SAC i vi t2c—)) )--/zi YO(= Cii,'T)-1 _Lido-Orc-1) ? O t' 14 Tax Parcel Property /A'a' c�jcD is'd t.q" Number: tj Z/Z-0// Size: ,7(Q7L 11 Ck'c S (acres/square feet) Site Address and/or Directions to Property: /02q -Dr4Z66 jZT. u)Le�i AJc-, ())4• 9837 - 979 Property Owner(s)of Record: G_)1 LI—t,q y,., lY*L- T e I e p h o n e: 1—3 CP 0- Cn ' 2- 1p rjl 1 F x: email: Mailing Address: l 2 1 i 1JS/ Sf-. L , 4e t-/iv(.."R)s..,/ 1,0)4. 3`g 203 Applicant/Agent(if different from owner): / r ot.t L_.93` Telephone: e--..tau: /-3&0-73Z- V&Gtz email: Mailing Address:J Q 29 1)A a Q t . ( • QU IIL CE?-,kliZaII_ 9 ' -76.--9 779 What kind of Permit? (Check each box that applies ❑Building ❑Variance(Minor,Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use[C(a), C(d),or C]** ❑ Single Family ❑ Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification Manufactured Home ❑ Modular ❑ Special Use(Essential Public Facilities)** ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use 0 Short Plat** ❑ Address ❑ Road Approach ❑ Binding Site Plan** ❑ Home Business ❑ 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* ❑ 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 r9 'o' .-b r /Cl�L .J,j,. to act as my agent in matters relating to this application for permit(s). 1 OWNER SIGNATURE Date: .�o�7/0 7 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 applicat' n that he o she ants prior ce. Signature: �c6n�- i �;i` Date: 5/ 7/7 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-transfera le le r�ibility for erin to a complying with the ESA. The Applicant has read this disclaimer and igns and dates it below. Signature: Date: 2777a7 G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc • 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 assumin the responsibility of th General C tractor for the proposed project. Signature: Ci . Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: t FAX: --. j �r' ( `:) (., -1' :' - ) ?3 L , ( ) MAILIN &ADDRESS: Lt2, 1 ? iLA s ' 1 A EMAIL: g... TRACTORS LICENSE WAINS i t W I"Irt tciJi, NUMBER: NUMBER ` ��� ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: j ' New Wood Existing: 2. lit,Sewer O Addition 0 Steel Proposed: Bank ❑ Community System O Alteration/Remodel ❑ Concrete Total: Z Height: X Individual SysSystem O Repair 0 Masonry I A SEEP Permit# `!-� 5zSZ O Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: K Private well 0.Two Party Type of Heat: Proposed: 0 Public 4tECTQl C. Total: 0 ll Name of System:&ftrirsery 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 Bid App Review: 2nd Floor Heated Consistency Review: 155. car Other Heated R,„4 TAN fsfee n 3 [J Mezzanine I 't Additional Section: Heated Basement ii.k C 2 ,kl, Plan Check fee. Unheated Basement Surcharge fee: �� Other Unheated k�'��,u �gul ater Review fee: Garage/Carport : SUBTOTAL JI I co Decks 911/Rd Approach fee: FpS}-f nO) �y Other TtTAL: $ J l I 00 Receipt Number: 91 12 Cash/Check Number: is &— ESTIMATED COST(REQUIRED) Date: f 7 .Fair market value of all labor and materials foundation to finish l Initials: Y G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc • • c IRECED trki JEFFERSON COUNTY Kt DEPARTMENT OF COMMUNITY DEVELOPMENT MAY ^^Q' 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax NO http://www.co.jefferson.wa.us/comrndevelopment/ > f11p 013111 P 01 STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# O e - (OC c6C\ PROJECT/APPLICANT NAME: %t Awl/ VCrilL//.l FOANr f e7It` 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. s Ir. kipis C Lam,,) fA r•l tli naltr - ss . 7 t/6 l N4 c.44 Tin, 1a M to Nu r4 r{Z.v2v-N 4-oyn L- Stilywhr d a.i s/T' M4'i' . kJ 1T 6)62vpo Sam On4.1,6" a}i r4 LA•rex, 74T6,. Existing Conditions Summary 2. Describe the existing topography,. Indicate contours on the site map. 5 C0 'cE "r0 5 3. Describe the existing vegetation. Indicate native vegetation areas on th"77e site map. gop.- r L4j,4S G-'-0---) '—) i T 9j -Lam,41� P iF�= (2c-SO 0 )•+ ' T W4J . 4. Describe the existing soils. Indicate soil type on the site map. Ai., )f 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. APPROVED STORMWATER PLAN 6. Describe any excess levels of noise generated by the proposed use or activiy: JUL 1 3 MON JEFFERSON COUNTY . DEfT.-d SIGNATUR . stormwater site plan template—rev.10/1/2003 5 • S i 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. Ai 14 8. Describe the general vicinity of the site, including adjacent land uses and structures, utilities, roads, and sensitive/critical areas (streams,w nds,lakes,steep slopes,etc.). k�RL 0014 o�..� �j �6on5 6' - w iv 5,24 - glee o N fie QRf ' 1 40M-, 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 with.. - site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. o • ... - N ttrj ENO C 1 If th " wject requires the use of stormwater treatment facilities,describe the types of stormwater treatment facilities proposed for 0 i the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. [This is -_-� nor nr"lame"oroiects or projects that involve the potential for dispersion of cojtaminants.])4)__ 11. Describe the performance goals and standards applicable to the project. FAlev-No t 1 D s'�r�b�the.flow�on�rol systg.i � cop I�.tit� T/:1stio.t 4'.tii '✓trl )3 t*.r t.s:fZi stormwater site plan template—rev.10/1/2003 6 • • 13. Describe the water quality system. /0 )4 R, ECEWRif )) 14. Describe the conveyance system analysis and design. JFFHu ;ooNI in: /u/ 4- 15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material. NI n 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. rr Or 6%2rgss CH-ib aZvs6.07:i i c. ) G oAd c,g�i 4 u 1 TI-1 Pc.A,.TS ei 6 yht(C. 17. Describe the proposed surfacing material. (cc.c, Pats4% �fSTuaBci) 4iiGk. Zor Co2,acs Scyta ,& -v,.eAwe,- W I (^1 4 Pc ?3$ 4 IL 1i 1'4"1-N 6,09 V O 18. Describe methods for restoration of the site. S/9r1tr A f 71 I "7 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. V' \ A 20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan. KJ J y4 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. PIA 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. ,� U�'T C L-trite '- Si ►..(s IT tiJaS Y�(�2av���s c ,1 ierm? 6.44' 2. Establish Construction Access. C.c3- -oy x 1s7 3. Control Flow Rates. 4. Install Sediment Controls. NI 5. Stabilize Soils. ?J1 REcEiVFli 6. Protect Slopes. IE �E 5�1�I+;1111NI�11Iri 7. Protect Drain Inlets. Nl stormwater site plan template—rev.10/1/2003 8 • • 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. 1 'RECEIVED 9. Control Pollutants. �i u-�r _3 u �2aa ) I ,IEFF NU , OUP+ihl, 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). 0 11. Maintain B st Man ement Practices(BMPs). C �.. 1a ,ry s W > L P "i d ? /1 i)4G r-riK� C)1� + I 12. Manage the Project. I-i yce7----e_� 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). ,t) la 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. stormwater site plan template—rev.10/1/2003 9 • • b. Description of special requirements for working in or near environmentally sensitive areas. rU ) 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 S I r �eqP / st''�3 F'ooao- , Mvi c. . )J yr b' Ty4 cc b. Construction) tphasing(if proposed) 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Muua Provide a proposed construction schedule. hC (� '9��� 24U7 t�� ' 4T) II. Wet Season Construction Activities. PAY 3 1 2207 a. Proposed wet season construction activities. ' IEFFFHSUN+;UUNIM,lD b. Proposed wet season construction activities for environmentally sensitive areas. 1u4 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. ,) S /4- Sa s f6z,� 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable. a. Sediment Ponds/Traps. b. Diversions. ' c. Waterways. d. Runoff/Stormwater Detention Calculations stormwater site plan template—rev.10/12003 10 • • • Stormwater Site Plan Changes If the designer wishes to make changes or revisions to the originally approved Stormwater Site Plan,the proposed revisions shall be submitted to DCD prior to construction. The submittal shall include substitute pages that include all proposed changes, revised drawings showing any structural changes,and any other supporting information that explains and supports the reason for the change. Final Corrected Plan Submittal If the project included construction of conveyance systems,treatment facilities,flow control facilities, or structural source control BMPs (not standard on-site stormwater management BMPs), the applicant shall submit a final corrected plan ("as-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. 1-�G s I�7/U ( 7 LANDOWNER OR AUTHORIZED REPRESENTATIyE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: R C BANI VA 11 ,IEEF�I��UN�,UVNr�kW' 12 stormwater site plan template—rev.10/1/2003 t m n zc. z m 3s.3 Fv- --> • . 1 T t PO - ' 7" L ,44/ N 4 0 Q., 0 p_i PC. Ir N 4 d CI _ ...... \ ; a cP'IN6 ,°, 1 H •o c ,cam/ ci 50 a, Vf i _ �1 -, layCO _ m C',,. , m `r Z G G., V ,. V 'fie / )•' Co \\\ .1\?.11,t!et N. 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