Loading...
HomeMy WebLinkAboutBLD2007-00307 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 PERT #: BLD07-00307 SITE AMIDDRESS: 31 TOPSAIL LN Issue Date: 07/27/2007 PORT LUDLOW, 98365 Final Date: 2/14/2008 APPLICANT: CHARLES J HERMANN PHONE: (715)425-5375 MARY L HERMANN W 12480 832ND AVE RIVER FALLS WI 54022-4733 SUBDIVISION: PORT LUDLOW NO. 3 Block: Lot: 57 PARCEL NUMBER: 990700057 Section: 17 Township: 28 N Range: 01 E PROJECT DESCRIPTION: NEW SFR W/ATTACHED GARAGE ALSO A/G 125 GAL PORPANE 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 ? noJ THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 2/14/2008 I:\F_BLD_Occupancy.rpt 10/29/19 SJILDING PERMIT APPLICAITN MLA07-00317 Jefferson County Department of Community Development Review Type: l 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00307 Received Date: 6/11/2007 SITE ADDRESS: %', t TOPSAIL LN PORT LUDLOW, 98365 OWNER: CHARLES J HERMANN PHONE: (715)425-5375 MARY L HERMANN W 12480 832ND AVE RIVER FALLS WI 54022-4733 SUBDIVISION: PORT LUDLOW NO. 3 Block: Lot: 57 PARCEL NUMBER: 990700057 Section: 17 Township: 28 N Range: 01 E CONTRACTOR: TERHUNE CUSTOM HOMES INC PO BOX 97 PHONE: 360-681-8898 POULSBO WA 98370 Contractor's License TERHUCH984MA Expires 7/1/2008 REPRESENTATIVE: TERHUNE CUSTOM HOMES PHONE: (360)681-8898 PO BOX 3125 SEQUIM WA 98382 PROJECT DESCRIPTIOI NEW SFR W/ATTACHED GARAGE ALSO A/G 125 GAL PORPANIE TANK TYPE OF WORK RES SQUARE FOOTAGE. TYPE OF IMP NEW VALUATION 286,000.00 MAIN: 2,407 CODE EDITION: 2003 ADD'L: HEAT TYPE: HTP HEAT BASE: HEAT TYPE: PRO OCCUPANCY: R_3 OCCUPANCY: UNHEATED: # OF STORIES: CONST TYPE: 5N OTHER: CONST TYPE: GARAGE: 846 SHORELINE: DECK: 99 SETBACK: SEWAGE DISPOSAL: SEW BANK HEIGHT: WATER SYSTEM: LUDLOW BEDROOMS: BATHROOMS: Exist: Exist: Prop: 3 Prop: 3 Total: 3 Total: 3 Routing Date: ll� Type Amount Paid By: Date: Receipt: Approved/Date Permit $2,040.95 KAS 06/11/07 91301 APPRO'fEDPlan Check $1,326.62 KAS 06/11/07 91301 State Building Code $4.50 KAS 06/11/07 91301 Potable Water Application $58.00 KAS 06/11/07 91301 JUL 2007 Total: $3,430.07 Jefferson County Planning & Building Department • Jefferson County Building Dion Permit Number: BLD07-00307 Applicant: HERMANN BUILDING PERMIT INSPECTION APPROVALS applicable 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 / 4.4; 5-rAte-ED ay-r BY OwaEQ Erosion Control Foundation Footing �y� WI 1/07Al At_ drFFE. Au s-ra, _ `T'7/0fr Footing Drains g/3o/07 dK Foundation Stem Wall r0 Z`�`� RAP c1 MWALL AEA.® A1[OL4I D i..ivUuc AR54 4 a2 Underground Plumbing WA Under Floor Framing q/4 t 7 Li At Straps(hold downs) P GA9 Ext. Shear Wall Nailing it 15--61 tv11M/-{ ( (le ,/Rough-in Plumbing Dc S'ctc idir e'-t- 01L ll/b�'Irt�/G/d1 D2AiliS Y\)As? 4 IFNITS P1 �fr9i Framing j1/4/0 K Blocking O Aft 7 Airseal lo/;//c7 # 6 Insulation:Walls ///9/07 Insulation: Floors PAO Insulation: Ceiling 2Jss/d$ I ✓/96LT P ee'L'A. OR- /i — Int. Shear Wall Nailing 1")`1 a—° Wt. -((i.Gti tip✓ PI- to -I,0- ,,1 ok' iez/d7 f G3C (46.8) Wallboard Nailing 07/6I p/ OK Gas Line: Interior /G/5//� ,�`" ,� Gas Line: Exterior u/3o/O S AI / l` Propane Tank 1/3o/OS AG Heat/Chimney Clearance Drywell/Alt Drainage AO/31 U7iii- ? / dK iD 07 Address Posted 4 f r 0360/07 v- FINAL INSPECTION Z/14/Ce fri OK ro— G/js 2/j47/0- FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR • • CONDITIONS for Building Permit# :BLD07-00307 1.) The application was reviewed by the Jefferson County Department of Community Development staff on July 18, 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: coastal SIPZ. 2.) 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. 3.) 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. 4.) 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. 5.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 6.) The applicant is proposing to create or add 4742 square feet of impervious surface and 8140 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. 7.) 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. 8.) 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). 9.) The site plan as submitted with the building permit application on June 11, 2007 has been reviewed for consistency under the UDC, and has been approved by Jefferson County Department of Community Development. Any modifications, changes, and/or additions to the stamped, approved site plan dated July 25, 2007 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 10.) This approval is for a single family residence with attached garage and 125 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. 11.) The parcel has been designatecOMPR SF4:1 under the Jefferson County I Comprehensive Land Use Map effective August 28, 1998. 12.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 13.) 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. 14.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 15.) The road approach permit(RAP07-0096) must be inspected and finaled by the Jefferson County Department of Public Works prior to the final inspection/certificate of occupancy of this residence. Contact Terry Duff, Department of Public Works at 360-385-9159 for the final road approach inspection. 16.) Per MPR Code Section 3.17, accessory dwelling units (ADUs) shall not be allowed in the MPR-SF zone. 17.) The building height is not to exceed 35 feet. 18.) Maximum lot coverage is not to exceed 45%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 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.) Minimum setback from Topsail Lane right-of-way shall be 20 feet. Mimimum side and rear yard setbacks shall be 5 feet. 22.) An address of 31 Topsail Lane, Port Ludlow has been assigned to the parcel. Topsail Lane is a county local access (C511209). 23.) The lot was created through the Port Ludlow#3 Subdivision on February 25, 1974 under AFN 221956. 24.) The parcel is served by Olympic Water& Sewer Inc. 25.) A road approach permit(RAP07-0096)will be issued with the building permit. al APPROVED ö PERMIT # BID STORMWATER PLAN 0 i . 0 .-- Dt'1 J U L 2 5 2007 ELEV. JailCOUNTY rr�� 261 84.12' 1, ELEV. U�I �F32 c:a oc� � � 2f8 JEFFERSON COUNTY s` SETBACK (TO FAVES)�—� DEPT.OF COMMUNITY DEVELOPMENT • „""1 SIGNATURE: t ‘ \ \ \ t t \o T °.\C7I\ -- 1-...heal Grain t t tot r, tf• 1 lakiaAtlhALAA 1 If O1 Flo t� n Rebel ad e nv i y. l` g 0cs,1a 0..". 6gF;tle6 .1, ---1 \ 1 Via, o A ` t k. ..__ r�t� b IFFS b z nft °, 21,F:ntl:nrr. tentam dn,.n (Lade flat ti,anal dam) ,�' t I-rid. Drainage DeLiil �'- `p��o '� �s Fl F v�` ' ''‘ i N Fouling ctrnirl rirC;IIrK1s. 256 CI ,. t entire perimeter of ` a� �� t�� - I house w/(2)4" PVC 4) N. lta pipe: from tooting v. / `4\ 0 drain & roof downspouts 1x / '` f, to ditch on topsail Ln. \� `r 0.n %u: d C� ` << % 7 ...'- /� -- _ �. S '}ice... _ p 'a `- 4� l Expose culvert•neighbor's c LLL VS i• • ,, r �IP 7 O praprrty and tightlinc all r 4s Ip' 'p 1 j" Jrunwye3 to Culvert. J 253 QO TT °t `-`f 1'1 (` •.-4 X. cfl' .11P - Heat Pump —4� �.1 r �\ ` .v. w/riot veg. O % ta Q , hr screening ttn Slupe drivnwuy to \O., ,} Z. Culvert/ditch on . l„T, a. !1 dr 125 CaL Propunc to` NW comer' pia, / l tank w/natural � 1 vegetation screening 05' _ 5' SETBACK (TO EAFFS) REVISED s ?LAN ELEV. l03•37r NR7 20r32,�yy ELEV. z�}71//f0 7 58 Has been dated APPROVED 7/ 4 7 A SITE PI AN by JEFFERS•(i CO ,j SCALE: 1" - 2O•-0" DEPT.OF CO " t �j D; RI ,tNI JAY & MARY HERMANN SIGNATURE; • ARE0/I te,,,► PORT f MI OW A; I OT 57 TOPSAIL LANE SEC 17 TWP 28'J RC 1E 7TThll1NI" C.l1EIAM-14441Ar---_ 6/8/07 LR' Rev. 7/10/07.,} PARCEL 1 990700057 Stormwat rDL-r�d 6 0 �Q�1 Require J -) ,1=, ti 'd 0S00 '0N bM 'WIHb3S : S3110H WOIS0a 3N0H131 Wdlb:ZL L006 'LIMP III •RECEWR)J ii JEFFERSON COUNTY f EVELOPMENT `.3 • '\ ^'• 621PSher Sheridan StT trree F COMMUNITY Townsend"Washington 98368 360/379-4450• 360/379-4451 Fax ,q www.co.jefferson.wa.us/commdevelopment It1lJJ s11'i1IM 91I iffiNi Master Permit Application MLA: n e1 5 Pro'ect Description(include separate sheets as necessary): Cc1Y\ t1'LA -t- CA. `3bedXccm c F-12-. /Cit{-aCAeLt 3 cw� E-x,r• Tax Parcel Property Number: �9 0 -1 Q C 0�^] Size: I �z . (acres/sq tare e) Site Address and/or Directions to Property: —rpP _,L,] (�VJ Fe-1Y f LLCM,60.) From oa.lc.. Wes- p,n Property Owner(s)of Record:',\{3„c..� 11 rne_A,y t� '.0 V VY\tX tr!h Telephone!T 1$ - 1-}-ZS '-5"1S Fax:Nye email: Mailing Address: (Z4 8 C S 2 d v\J Q . W V •-646, Lt"i( S 4 C Z 7. Applicant/Agent(if different from owner):Ta-v KU... _ c:Lk S" O V'V\ 1rY e c, Telephone:3,O (oCrl-1DOO Fax:; > (f,'4A'1—"l Op email: Mailing Address:?. 0• X �`T k-tuAE,bet, u6 pt " �Q 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]** 1 Single Family I+1Garage CPlache Detached ❑Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home 0 Modular ❑Special Use(Essential Public Facilities)** ❑ Commercial* ❑Boundary Line Adjustment ❑ Change of Use ❑Short Plat** A Address R/Road Approach ❑Binding Site Plan*" ❑Home Business ❑Cottagelndustry ❑Long Plat** ,I Propane ❑Planned Rural Residential Development(PRRD)/Amendments** ❑Sign ❑Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisions** ❑Stormwater Management ❑Shoreline Management Substantial Development** ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Variance ❑Temporary Use [3 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 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 attomey'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 ins ctions. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the appl - or.she nts rior notice. `� Signature: A. Date: "'- 1 The action or ac • s 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 ar J co pliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-I (es nsi lity for adhering to and complying with the ESA. The Applicant has read this disc imer/annd signs and dates it below. Signatu r - Date: "'( <51 C:\Documents and Settings\caral\Local Settings\Temporary Internet Files\OLKB6\Master Permit Application 12-19-2006.doc • i• May. 25. 2007 2: 05PV Terhune Custom Homes No. 9414 P. 1 ■© 05/ 4.�, GVUI .co.ZIJ oo037Sti 3EFFf- CO PERMITCF FN� 03/04 ■ n May, 25. 2007 1 : .11 PM •UNE CUSTOM HOMES : SEQU;M, WA No. 91.14 P. 3 . 111: ,rin • CI 1 QUD.DE]2 STATimeirf; /� The.lord does . •.. ... i Urey�eta• . ,pal .. . ��� � ' ��1'I''��'f�I''',• �Y� of tlx+• _ ... .. . . ,�thry are not twitted , C9raM.CrtNTRAciQR No FA. - • Now a)( -7—Y , Sri) 45t(Z-1 Son 'PA. 'r' .1 e o"ram' luA c rz3'7i ARC!Itf4crlENolt t4ien ( ) Roc j MnutG AIXSZsze t . � ` Pett1YPe2 . Frsoo'NM reornst — ttrotiithe Typo of 8.wagd tIVI )11t W 0 Od Acf�Sart9' id Seaver .1 AttratIoMRemodel u Concrete 'Nit Height u Intrarklual 7 Resew El my SEP pvst/ -IDerho lon U Ott Or ®edoones Exisem ' Water St Setback u PrivsteWes u We PArty or H Froposeek 3 u p Tote: 3 New of Syrsiem: • N In e — Ptatl4e A `tl A! Eli) of S c t C Qcou - tIn )f visit a Propene Tx&sidlnr Ap o stAllF lan Servtx7 007 I Tank I llbave antra.met Ail awn�{O�g_ t R!?dl/� : get of Promo Tark I H!knave e I Cook • 1I Insert I Hot V MN( I Pellet t She t MI& b tht9 apP&we hop}p 411.4100,it hignitiZt4tO(Mo[,an Warm? Yes / No II1h��11 11 1 1 E AP><,e/r Ib!'0peIfrQDl1fe�11apltgp.NfgLziflryDuI1axCaelsa�71�tds ,plansbwvkga!fof$t(,prg �}LW 11 . OM,etItit IdefleOP and Silt,distances,*nor ate pry rank to am'p oportyfi es,bt&ne mg eepticsystcm pompe Comet �!A K�i.' �Y!'::T�iLS• ���ial.��ir,:�ykti` 1� ,, N. Main FOOT §;l •v:i!c�s,,� :. 4.4,,.�I�7.44,,t..4�.., 1.4:. Tr.•�w.p. Ftoor �'r.=cr' e�. a. �11vrJ>+ti�.CQ.r... w. "�,`46 Y: tit' - �r.V.►t'� :�, —LY177i 2F„1 r�,� .�. t 's" t-•,;,,,, �1,s.,.n,-•l, _ a {fie'✓. ..., ,' New ^R 1.4.':.:6:•.7..:�4`. :;Y l''.:0i" 4 I"Yil'ri.. :Q�fiS~ .�Z' n'Y-'.C�.•-rr�y�'w`rJ:��,.':��':i4Y1Ci�::ww.�.i�+tH!.f•Lliw'?.M�;nr'�y.1•'�7.',:�' f�`••, P. I► rde I:a�Ct.',`N�'l r,: 1 `�f�rr:7: c v.•.,r. .�54.;,•"..;,:- 1• a \. ` ^:, Heated easement • ♦'lY��'.:y/,:C,,`�•1: :.1. .n......:'�...` �- _���!e_"C,'�`•`,ip��l, Tl.1y • w`y .is Si:.+�Iy." Y 1:i'i,, . .1`:-., A ,�_ .. : �'.•L::_1:,N••!. ` A ��^ i1•,lam �. - �T^�-Yr'-YiN;' •%i�':.CAtiL. I/:�....^:.,AIPAZZ...Sl tali wy :,L: .n 4 r.. ye- 0ltt0r Uryte� c .r-• -�....•: ,.;.,...,-w.i.;•n«px_' r,-. ..:.�. 1.:�•, ri✓!e7t E rAw; 4� e..-s..:.,-... " mo , tie 1.�,..r+.•ti .�+< « �+,pv, lli. ill• ,.. .F ~' ,. L' .'ti +r, -'-i� •� �.�f' �.�''��,,,,�.�!!�� +�px]�fC 4+t�ypr,(.J•S�r ���•�,[ 7 y`• • ';i%i ..�c.s,r.:..e1 '••aL?.•nsi�. .,;,:.,`;.�!t:�` s`.-. �=%a�i1.•`.^.,s., : Docks .. '. -'I• :1.:•�~�'r;�} .. ��!!;�.�r,,,,.w1C;Yr„yhrw..,Y y�•, ,�.�,�y„;, K n. �6� ai�{ i:_\"Itir al )x••y; "�°`:7F ✓ k]'" `i i"c�/� m i11 +W. '.i,: .�, J W w.'� atrn.6�:-.•'='i;>-,`../;YizR' '• .'',Ur'.:.•n✓.%'• r•. .r C •: , i i!2J 4 .R` . y.A rT Katie attifkto>•SWIffstrfafc•r. . s4u7tr p^t -;i�3( ,i.<�.` n�r`•wI'{' i.,1'r l.: �'� �j ` �' - ��rC��L c:.'r,�+�;�.•v�".t,Ls„' h��`•',�'h�yc�yf ;�,'�� ij���,•' .'�,7, CIDoaameenold IIiuArna,ted1Dm±er\MFter Pared Ap re474-DI.±r , P 05May. 25.0 2007:� 2 : 05PMe��s elhune Custom Homes JEFF CO PERl4ITC R No. 9414 F AUL 04/04 RUILDER STATEMENT The signer of!hi&Ittitehtent does hereby certify that they are the OwMrr Of the parcel raiotenced herein,that they are not[leaned contractors and that they will be Deeming the rotponslblllty of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER; PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: • CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONIC ( ) FAx:( ) MAILING ADDRESS: EIw►IL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: O New n Wood Existing: C Sewer U Addition 0 Steel Proposed: Bank ❑ Community System t1 Alteration/Rembdet 0 Concrete Total: Height: ❑ Individual System ❑ Repair CI Masonry SEP Permit# n Demolition ❑ Other Bedrooms: Water Supply: ExiStIng: Setback: ❑ Private well 0 Two Party Typo of Heat: Proposed: ❑ Public Total: Name of System: If this is a Commenial Projeot you must answer the followlnc; ( Number of Parking Spades: Current- ulh9 Proposed: Number of A F t rLL li Number of occupants (includes owners.tenants,employees,eto) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? If Otitis a Propane Tank and/or Appllknoo Installation permit, mark all items below that apply: ' I Underground Tank I Above ground Tank Size of Propane Tank: I Heat Steve I Cook Stove I Woodstove I Fireplace Insert I Hot Water Tank I Pellet Sto + Is thisippNonce being installed in a ManufaeturedJ Moblte_Home? Yes / No 11r1E '., �' When applying for 3 permit to install a propane tank you must a/so submit a site plan showing dime the buildings,all property linos,rank location and size, distances from the propane tank to all properly lines,buildings and septic system components,• Including the raservo area. . G'i• - �: e /, '� ,r•t t•'141 6' �I P .;;G^,i�F' r a:,.._. , �... ;;ur�i'' t',I r,�,• '� q' d .'i'''�•.,r-.,;ii;.iR�7••'� •C�2'i1g�C�fe�.,.����: w Proposed _ f.,l r,r, i:�� W ��. ,! I� �.:.; Square Footage , CurrentI•,I ,b' '. •t. :s ,_.,,,. . y�t , `•.1 }tt� .. '% !•' , .r s�i'.� >:.'s:��r,�74�. �:� Kir1IICr' ,j.,air.�ri.lti �1'.��'="� Main Floor Heated tij" j:,tlr EH Bid App Review: '�' `:w ,,.H,:•_, 2"°Floor Heated k,:ce;� F.�_ Consistency Review: eD Other Heated . Base fee: t90 fly Mezzanine -':;',• Addhl,inal Section: Healed Basement :.:-.r:,.: • Plan Check fee: / 2 Unheated Sasetnent <.,;`,,.. State Surcharge fee: r ,- �t.;•,`;tint . . y Other Unheated :i? Pot Water Review fee: Garage/Carport _: SUBTOTAL 0-7 Docks .C9f9 ,2 ? Rd Approach fee: 1 6 Other •2 `*•' TOTAL: S -7"1Q.0-1 ?c, ' ,- :'r Receipt Number; �' .} „,„....,, qHOI _ s .: Cash/Check Number: ESTIMATED COST(REQUIRED) '3 Date: r • •Fair mantel value of all labor and materials foundation to Olen l� initials: (") G:\PermitCrntc+\31ff#rORMSO4 \DIM FORMS\Master Permit notticatinn tn.19_2Mvr.dw, ,/,<-00,r, "., JEFFER ' � eSON F ))COUNTYA 1 DEPARTMENT OF COMMUNITY DEVELOPMENT s."._"' I 1 2rtr 4. 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax Ikff�tiaU ��U IY I U('I http://www.co.Jefferson.wa.us/commdevelopment/ U I U STORMWATER SITE PLAN SUBMITTAL TEMPLATE IMLA# D - 31 PROJECT/APPLICANT NAME: Please answer all of the following questions to the best of your ability. Where the question calls for depiction on a site map, the applicant may choose to either incorporate the elements into the general plot plan for the Master Land Use Application or to submit a separate stormwater site plan map. Project Overview 1. Describe the proposed developed conditions of the site. Indicate position and relative size of proposed improvements on the site map. V a-CC-i/\.-{- 2(d v+11 SP. ' 1 4-e p 1 ) Existing Conditions Summary 2. Describe the existing topography. Indicate contours n the kite m . aR 3. Describe the existing vegetation. Indicate native ve.etation areas on the site map UMtit. 1. _ _ J QU a�0 1A ■ 4. Describe the existing soils. Indicate soil type on the site map. 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. N o Y\-e- LS-h 1F 6. Describe any excess levels of noise generated by the proposed use or actirty. oVW__ APPROVED STORMWATER PLAN Stormwate is JUL 2 5 2007 stomnvater site plan template—rev.10/1/2003 Required 1EFFERS C u TY 5 DEPT.OFC IIf 0 .1.5; mr. SIGNATU I J • • 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. 1 A 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.). 1v l 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. -hAIA k- ra a c- --O c ep lid .vc Y ck_ct-e_ c -F- 10. If the project requires the use of stormwater treatment facilities, describe the types of stormwater treatment facilities proposed for use on the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. [This is normally for large"projects or projects that involve the potential for dispersion of contaminants.] 11. Describe the performance goals and standards applicable to the project. RFCEWElf )) 4,,,, 47 • 12. Describe the flow control system. • � � 3 777 , ! gtg I y stornwaterstte clanteraolate—red 1 0/1/2003 • • w 13. Describe the water quality system. 14. Describe the conveyance system analysis and design. _ • .11 _ Di�� _ _ I . 15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material.Sa rcSYir 16. Proposed methods of placement and compaction consistent with the applicable standards on AppendixChapter 33 p of the Uniform Building Code. a y 'lb, zI l ►r' p i - a 17. Describe the proposed surfacing material. `p -}- 18. Describe methods for restoration of the site. V G ( L.011) awv).e�r 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. / Pr _. y I 1 . 20. List here and include any special reports or studies conducted to prepare the Stomiwater Site PIO.:'." 1 1 2007 / IA- . . 21. List other necessary permits and approvals as required by other regulatory agencies. If those permits • I ' r' I r p conditions that affect the drainage plan or contain more restrictive drainage-related requirements,describe tho eaconddo s or restrictions here. 11V stormwater site plan template—rev.1 O/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. See_ 1-� ✓l / C�P�V 1 Ir] I 1v1 1�� CLA in 2. Establish Construction Access. tctr____p1 cyov-ei ( Y o 6Yl CT\V Lv�.LiCL U j ✓\ 3. Control Flow Rates. pt- tywu 1-1,1 -h8 -1 r ii CJ' 4. Install Sediment Controls. Cc -c V I SI v\(, dry OsQ aocl 1 (wail r e tav >,iNUJ 5. Stabilize Soils. S l 6. Protect Slopes. " F 7. Protect Drain Inlets. 11! NMI (A.), mil, iV \ 8 storrmvater site plan template—rev.1 Or1/2003 • • 12 Required Elements—Construction SWPPP(a9ntinued) 8. Stabilize Channels and Outlets. 9. Control Pollutants. Y1 � 10. Control De-Watering(the act of pumping groundwater or stormwater away from a n active construction site). 11. Maintain Best Management Practices(BMPs). 12. Manage the Project. 1- 11 ;CIEWIF Y � j • 2. Adjacent Areas. a. Description of the adjacent areas that maybe affected by ( I �� p 1 areas, roons), site disturbance (e.g., streams, lakes, wetlands, residential b. Des cription of the downstream drainage path leading from the site to the receivings). body of water(minimum distance of 400 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site, stomnvater site plan template—rev.10/12003 9 • • b. Description of special requirements for working in or near environmentally sensitive areas. N3 OA— - . • 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). N-\ (PV 5. Construction Phasing. a. Construction sequence b. Construction h ing(if prop/ ecA 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). I. Provide proposed construction schedule. b 4 -IA-my A- ���A b-1 't.rN.k5, o II. Wet Season Construction Activities. ", V a. Proposed wet season construction activities. JJL�, ~ 1+� . n`s�n wCY k, I Q 4 . r(MC � Q2 R!.�'� AOFT )) b. Proposed wet season construction activities for environmentally sensitive are0..;�,l I I 217 f ( , 1�IIIIIII�I�V�111► 7. Financial/Ownership Responsibilities. a. Identify the property owner responsible for the initiation of bonds and/or other financial securities. A nna Y WCI n✓). b. De cribe bonds and/orer evidence of financial responsibility for liability associated with erosion and sedimentation impacts. M f1 - 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable. a. Sediment Ponds/Traps. b. Diversions. I 1\ c. Waterways. d. Runoff/Storrnwater Detention Calculations 10 stormwater site plan template—rev.10/12003 • 0 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 stomiwater 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. -- • ta j I (LAND W ER OR AUTHORIZED REPRESENTAINE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: . R 1�;,A'an l 11 )i '....., , 112 ? titliSONIAIINrilihlV 12 storrnwater site plan template—rev.10/12003 65'-0' 12'-2" r-Cr ,6'-,0' ,e'-o. z -- 'S�-0' 8'-10' S'-2• a o Z 1,r-6' 2'_4'� 3'-5' 3'-5' 1E O 4 r-r > g_ o � GV m 1. �iC` t l��{� �+ .3 1 °i •I I K,.T. -, f I i N o 1 ail sb � I IL)? I I _ ♦ • o o f + O u I I ram+ I 2 + '� p q r t3 I I sp `° I I o u u e J 4 14 N O 4 \ / Nf .Q < Yp N \ / / Ai el IF. - 00 Q >< g 4_ ''>:)4 § Q ' ttOdm : �� IT 1i s. I 0 R a. r it y 5•-10' S' 3: r r_r e — 'us a o T (;) i- Qa X ¢ `d — fear T.; GI vii 1 � t o a S._ • IP +z'-40' 9'HI i. di e•mout6bnd�� 0 Flat o MIS , 1. 6. 1 0 RR�. I µ Q trio-,o- I -{ - r-e' f 5'-,0' f z'-ice I r_2- I 0 r I N t ` N 00 ▪ 1 a 8- P Q : i R o O .- o o+ �:� gas. - S v K 0o 7Q - 4.I! 1 -: �1of a t1.3, O SSati S x �• o O 4 U Co II pa clr2 Y gV7� -1 .+- 9.1 Y xc1 � . 3 sa a c ; i.j O 5' ♦' a I▪ S g 4'-e' , s'--5 1'1'-2 1/2' e-7 V/Ve• o N. t 24-0' Storage a —1 \"'d,! 8 � o Meet o ..•• I �' `c�s�j o, N - -�(/ o N + bf, -- R ' Tali 45d11t o.• it A a o a Fl. Ging ' 4 .e *1 Granite 4 u to v \ / 1 i n 3e i I s • • D.1). a xu O i 6 qr \ / I. S s N w" N c N O Q 1 \ / 4X ^j 1 ♦ {9 1� i7 : a N a ��` \/ o f- Q >N !♦� 3 1 o Y /\ b '"4 a �`' Q / \ E \ \ im ®o Granite / \ O Fa 4 N $r I = a p J / \ tD !U 1 �- ♦ Q Q 3 C p �. cn N / \ BP Pantry Shelves • h ,Si 3 ••' g it___. _. *, z: O a o a j�u........ c 44 ;. 3 a O i O :Y 10 0 q 4 s I. t '. J110cfrn P. /41*. . -. ? 0!. 4 a \ / xI Q r�A` 43 ^t K X p I 1�'' L� ek4�ao 356'.h �7, •• �N-T 10 / \ x a! u 1 1 1 /' \\ I Q o 3 'ItI \ 11/ _,j p N P1 4114 O c u M \ \ \ P, P1 i 6'-Cr I 5-5 1S-2 2'-a'3'--0' C'au24'-e' 4 1•I. iii 26'-70` 5'-e' S-Y 65--0' t 4 III*8#yQppq (i) NgNV1 3F • _ _� 7 i Q Vnq_ St 1111 _ Q A • '�* CD Ci g - Q 1 ,�. �n ra>•�rt t,,, id v ss�ae� _ i $gg S $ ^:R (D W�• ga -_--- it-= Q(AD O is 4nP. O c. is VIZ • ---- ---- -- - aO a ,t N D t 475 s; PMPartY °t T E R H Ulf N t Date' 6/7/07 Nee Residence For. custom homes Re o�: �T a y 8c Mary Hermann_ Poulebo (380)897-7000 • 800-772- • Fax (3e0)697-7500 _ segnim (a eai-889e • e77-837-4e83 • Fax (380) 8>_-rs99 By. Contractor NumberhuCHn84Hti ns www.terhnnecu•tombaeanet: Brawn �-Ritter rTh Floor Plan SECRET: 3 OF 5