HomeMy WebLinkAboutBLD2007-00319 MLA07-00332
tICILDING PERMIT APPLICATIPN Review Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD07-00319 Received Date: 6/14/2007
SITE ADDRESS: 630 GOSS RD
PORT TOWNSEND, 98368
OWNER: RICHARD A FLOYD PHONE: (919) 933-3619
CARLA S ELLIS
112 WOLFS TRL
CHAPEL HILL NC 27516-9060
SUBDIVISION: Block: Lot: TX17
PARCEL NUMBER: 002133007 Section: 13 Township: 30 N Range: 02 W
CONTRACTOR: LD RICHERT CONSTRUCTION PHONE: (360)379-5222
PO BOX 127
PORT TOWNSEND WA 98368
Contractor's License LDRICC*0E6L0 Expires 5/29/2009
REPRESENTATIVE: L D RICHERT PHONE: (360)379-0236
PO BOX 127
PORT TOWNSEND WA 98368
PROJECT DESCRIPTIOr NEW SFR W/ATTACHED HEATED GARAGE
ALSO A/G 250 GAL PROPANE TANK
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 1,340
VALUATION 300,000.00 ADD'L: 871 HEAT TYPE: RAD
CODE EDITION: 2003 HEAT BASE: 664 HEAT TYPE: PRO
OCCUPANCY: R-3 UNHEATED: # OF STORIES:
OCCUPANCY:
CONST TYPE: 5N OTHER: SHORELINE:
CONST TYPE: GARAGE: 350 SETBACK: 511
DECK: 240 BANK HEIGHT: 120
SEWAGE DISPOSAL: ALT
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: 3 Prop: 3
Total: 3 Total: 3
Routing Date:
8 /10—/G-)
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $2,113.75 KAS 06/14/07 91313 APPA OV E D
Plan Check $1,373.94 KAS 06/14/07 91313
State Building Code $4.50 KAS 06/14/07 91313 l Ir
Potable Water Application $58.00 KAS 06/14/07 91313
Jefferson County Planning
Total: $3,550.19 & Building Department
CERTIFICATE OF OCCUPANCY
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451 (800) 831-2678
PERMIT #: BLD07-00319
SITE ADDRESS: 630 GOSS RD Issue Date: 08/8/2007
PORT TOWNSEND, 98368 Final Date: 3/2/2009
APPLICANT: RICHARD A FLOYD PHONE: (919) 933-3619
CARLA S ELLIS
PO BOX 1071
PORT TOWNSEND WA 98368
SUBDIVISION: Block: Lot: TX 17
PARCEL NUMBER: 002133007 Section: 13 Township: 30 N Range: 02 W
PROJECT DESCRIPTION: NEW SFR W/ATTACHED HEATED GARAGE
ALSO A/G 250 GAL PROPANE 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 ("�
THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 3/2/2009
I:\F_BLD_Occupancy.rpt 10/29/19
Jefferson County Building Dilion Permit Num. BLD07-00319
Applicant: FLOYD
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
Erosion Control
Foundation Footing c.,a,i- i ire- (ft.-TS () 'o
Footing Drains I NT, Po o 1-Z `^'�'fJ
Foundation Stem Wall )2_IL _1
Underground Plumbing
Under Floor Framing
Straps(hold downs) A"
Ext. Shear Wall Nailing 8 _A0 06
Rough-in Plumbing g/z,/off � , t,1457 - V� -74.1tS h 4/4F
Framing
f}'�2U/O
Blocking /0® <
Airseal gjz f 5/ j
Insulation:Walls 3/748
Insulation: Floors g/' �/c Or
Insulation: Ceiling 8/77/re
Int. Shear Wall Nailing 0, zA 5 `
/
'P/Z% �/LZ EkCE-F'1 /D6 �ixED �HE�ka.),4c.03 4/
Wallboard Nailing 61/14/eC; �J�
Gas Line: Interior
Gas Line: Exterior
Propane Tank
Heat/Chimney Clearance
Drywell/Alt Drainage
Address Posted
hryn,,N,e kA., s z/i2/98 f ooL/
upp j'r18 l,USUL Z/12./6I
r:1'7Th'ePie 1//.a6Z e/At)/o fit -
FINAL INSPECTION ,)Zf 07
FINAL INSPECTIO4 MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
• •
CONDITIONS for Building Permit# :BLD07-00319
1.) PRIOR TO OCCUPANCY& BUILDING FINAL INSPECTION FINAL APPROVAL OF
SEPTIC SEP06-348 IS REQUIRED.
2.) ALL COMPONENTS OF THE SEPTIC SYSTEM ARE TO BE COMPLETELY
PROTECTED FROM VEHICULAR TRAFFIC OR MECHANICAL DISTURBANCE.
THERE SHALL BE NO EQUIPMENT, STOCKPILING OF MATERIALS, OR ANY
CONSTRUCTION ACTIVITIES ARE ALLOWED WITHIN 30' DOWNSLOPE OF THE
RESERVE ABSORPTION AREA.
3.) 10' SEPARATION REQUIRED BETWEEN A WATER LINE AND ALL PORTIONS OF
THE ONSITE SEWAGE SYSTEM; EFFLUENT TRANSPORT LINE, TANKS,
TREATMENT AND DISPOSAL COMPONENTS.
4.) The application was reviewed by the Jefferson County Department of Community
Development staff on July 19, 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:
conservancy shoreline designation; Type 5 stream; Category II wetland; landslide hazard
area 2 & 3; SUSC aquifer recharge area; coastal SIPZ.
5.) 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.
6.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions
that promote rapid infiltration of recharge waters to groundwater aquifers.
7.) Geologically Hazardous Areas in Jefferson County are characterized by slope, soil type,
geologic material, and groundwater that may combine to create problems with slope
stability, erosion, and water quality during and after construction or during natural events
such as earthquakes or severe rainstorms.
8.) A Type 5 Stream (Fish and Wildlife Habitat Area) has been identified on the subject
property. The stream will require a setback of 50-feet. The setback shall be measured
horizontally from the Ordinary High Water Mark (OHWM). Fish and Wildlife Habitat Areas
shall also have Buffers and Building Setbacks established.
9.) Stream and landslide hazard area 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.
10.) 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 (Salix lasiandra), and Scouler's Willow (Salix
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
(Sam bucus racemosa), Snowberry(Symphoricarpos albus), Evergreen Huckleberry
(Vaccinium ovatum), Red Huckleberry (Vaccinium parvifolium).
11.) Marine shorelines and islands arisceptible to a condition that is known as water
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.
12.) 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.
13.) 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.
14.) A Geotechnical Report prepared by NTI dated March 12, 2001 and an Addendum dated
September 7, 2004 was submitted in conjunction with the SPAAD application to address
the landslide hazard. The report addressed the stability of the geologic hazard area. The
Addendum recommended a setback of 120-feet be measured perpendicularly from the
top or toe of the geologic hazard to the proposed development due to the site constraints
and based upon a new site visit of the parcel.
15.) 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.
16.) 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."
17.) All construction activities shall not encroach upon the landslide hazard area and stream
buffers. This includes the storage or preparation of materials.
18.) 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.
19.) 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.
20.) 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.
21.) The identified Fish and Wildlife Habitat Area (Type 5 Stream), shall maintain a vegetative
buffer setback of 50-feet. The setback shall be measured horizontally from the Ordinary
High Water Mark (OHWM) to the proposed single family residence with attached garage.
22.) An additional setback of five (5) feet is required from the edge of the stream buffer area to
the proposed single family residence with attached garage.
23.) A permanent physical separation along the boundary of the stream 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.
24.) Stream buffer perimeters shall b rked with temporary signs at an interval �e per
parcel or every one hundred (100) feet, whichever is less. Signs shall be in place prior to
and during construction activities. The signs shall contain the following statement: "Buffer
- Do Not Remove or Alter Existing Vegetation."
25.) VOLUNTARY MEASURES OF COASTAL &AT RISK SIPZ:
Water conservation measures:
1. Roof and other intercepted precipitation shall be routed to on-site detention ponds
and/or other approved means and allowed to be released to the soil slowly.
2. Water collected from Storm water and roof catchments may be used for watering
lawns and gardens. Unless catchment water has been treated to meet drinking water
standards, there shall be no cross connections allowed between the potable supply and
impounded water.
3. Water withdrawn from wells on each property shall not be used for watering of lawns
and/or gardens.
4. Ground water withdrawn from each property shall be restricted to a rate of three (3)
gallons per minute.
5. Installation of water conserving fixtures such as low flow toilets, faucets and shower
restrictors and other water saving plumbing fixtures.
6. Landscaping plan (xeriscaping, native vegetation with minimal amounts of irrigation).
Please NOTE that the above listed measures are not intended to be exhaustive, but rather
is intended to be illustrative of the types of water conservation measures.
26.) VOLUNTARY MEASURES OF COASTAL &AT RISK SIPZ:
1. Installation of a flow meter.
2. On-going well monitoring for chloride concentration.
3. Submittal of monitoring data to County.
27.) MANDATORY MEASURES FOR COASTAL SIPZ:
1. For proof of potable water on a building permit application, applicant must utilize
DOH-approved public water system if available.
2. If public water is unavailable, a qualifying alternative system may be used as proof of
potable water or an individual well may be used as proof of potable water subject to the
following requirement:
a. Chloride concentration of a laboratory-certified well water sample submitted with
building permit application.
3. If public water is unavailable, a qualifying alternative system may be used as proof of
potable water.
28.) The property owner shall comply with Water Conservation Measures (per list maintained
by the UDC Administrator).
29.) The applicant is proposing to create or add 1645 square feet of impervious surface and
5073 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.
30.) 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.
31.) 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.
32.) 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).
33.) The site plan as submitted with tljilding permit application on June 14, 204103s 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 19, 2007 shall be resubmitted for review and
approval by Jefferson County Department of Community Development.
34.) This approval is for a single family residence with attached heated garage and 250 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.
35.) The parcel has been designated as RR 1:5 under the Jefferson County Comprehensive
Land Use Map effective August 28, 1998.
36.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
37.) 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.
38.) A minimum of two (2) on-site parking spaces shall be provided for the single family
residence.
39.) The building height is not to exceed 35 feet.
40.) Residential developers and individual builders shall be required to preserve shoreline
vegetation and reduce the associated risk of erosion during construction and any future
activity which may impact the stability of the shoreline.
41.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
42.) 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.
43.) 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.
44.) Minimum setback from Goss Road right-of-way shall be 20 feet. Minimum side yard
setbacks shall be 5 feet. Minimum setback from top of bank shall be 120 feet per letter
dated September 7, 2004 from NTI. Minimum setback from the Type 5 stream shall be 55
feet.
45.) An address of 630 Goss Road, Port Townsend has been assigned to the parcel. Goss
Road is a county local access (C620009).
46.) The site is served by an individual on-site well.
47.) Per letter dated January 24, 2005 from Ross Goodwin, DNR forester and based on his
site visit with Jeff Davis, WDFW wilidlife biologist on January 20, 2005, he determined that
the stream was a type 5.
48.) A road approach permit (RAP01-0093) was withdrawn as the portion of Goss Road is
private. A zoning permit (ZON01-0021) to operate a 7 bedroom bed and breakfast was
withdrawn due to lack of public water. A road approach permit(RAP04-0278) was
cancelled on November 10, 2004. A zoning permit(ZON04-0054) for a SPAAD was
approved on March 22, 2005. A wet season evaluation (OTH02-0003)was finaled on May
2, 2003. A well review (USR06-0061)was finaled on July 17, 2007. A septic permit
(SEP02-0161) expired and is now filed with SEP06-0348 that was approved on December
12, 2006.
49.) A setback of 100-feet, 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.
50.) Buffer perimeters shall be markeh temporary signs at an interval of one 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."
51.) 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.
52.) A Wetland Delineation prepared by Westech Company dated March 2003 was submitted
in conjunction with the SPAAD application to address the wetland. The report identified
the wetland as a category II wetland. A Habitat Management and Mitigation Plan prepared
by Westech Company dated August 2004 was submitted to address the wetland buffer
averaging proposal.
53.) The SPAAD application proposed wetland buffer averaging per UDC 3.6.9d(8). The
proposal shall comply with the Habitat Management and Mitication Plan dated August
2004 prepared by Westech Company.
54.) The proposal shall comply with the Habitat Management and Mitigation Plan dated August
2004 prepared by Westech Company.
55.) Washington State Department of Natural Resources (WSDNR) commented on the
SPAAD application in a letter dated January 24, 2005. WSDNR determined the stream is
a Type 5 Stream. WSDNR further stated removal of trees for this proposal will most likely
require a Forest Practice Permit and subject the proposal to the geo-technical report
requirements in the Forest Practice Rules.
56.) A Declaration of Restrictive Covenant has been recorded on July 24, 2007 under AFN
525699 due to limited septic capacity of three (3) bedrooms.
lv' ON c06. JEFFERSO fUNTY •
33 DEPARTMENT OF COMMUNITY DEVELOPMENT
~' ` `1 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
"Z www.co.jefferson.wa.us/commdevelopment
SIN
Master Permit Application MLA: D t-3J -
Project Description(include separate sheets as necessary):
Tax Parcel Property
Number: Size: (acres/square feet)
Site Address and/or Directions to Property: !f1E (a)Tf-t-V
EV )
Property Owner(s)of Record:
Telephone: Fax: _ emtki;s1 14 21119
Mailing Address:
Applicant/Agent(if different from owner): kfiggli$ i�ink It)
Telephone: Fax: mla( +
Mailing Address:
What kind of Permit?(Check each box that applies
❑Building ❑Variance(Minor, Major or Reasonable Economic Use)
❑ Demolition Permit 0 Conditional Use[C(a), C(d),or C]*"
❑ Single Family 0 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 ❑Short Plat**
❑ Address 0 Road Approach ❑ Binding Site Plan**
❑ Home Business 0 Cottagelndustry 0 Long Plat**
❑ Propane 0 Planned Rural Residential Development(PRRD)/Amendments**
❑Sign ❑ Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions**
❑ Stormwater Management ❑Shoreline Management Substantial Development**
❑Site Plan Approval Advance Determination(SPAAD)* ❑ 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 to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE Date:
By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of
his,her or it's knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet
may result in this permit being null and void.
I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and
expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit.
I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any required la -r-. ions. Staffs accPs,s_and right of entry will be assumed unless the applicant informs the County in writing at the
time of the appl ia4r• r •- or h• prior notice. �
Signature: _ W. Date: f- (a — ( 4-— O
The action or actions Apkant 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 v'• . e e • A. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)even if you ar j in co :is lia, - • • -: .:-:•.•. . .• •evelopment code.The Applicant acknowledges that he,she or it holds individual
and non-tran fera• = j"bilit .r ad•-ring to and complying with the ESA. The Applicant has read this i imer and s• ns and dates it below.
Signat •-��ref ` Date: I - ��
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc
C--
Cotet JEFFERS•ON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
M 621 Sheridan Street• Port Townsend •Washington 98368
360/379-4450. 360/379-4451 Fax
IN6�
Master Permit Application MLA: or1-33a
Project Description(include separate sheets as necessary):
S l- i tii/Arr d A fL.
Tax Parcel Property
Number: 002, 133 0 0 7 Size: 6 . 4,
.-quare feet)
Site Address and/or Directions to Property: 6. 3o Cr o s,r Rd
Property Owner(s)of Record: �i i s h a, A F!e 7 d C g r C A E L L S
Telephone: 919 - 9 33- 3 6 /9 Fax: email: el.; t k Cf.dvk�.t/p
Mailing Address: // 2 LM. C f's Tea; L.) Chaps ( !4 Jl,, NC Z 7$/(,
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
at kg d of Permit?(Check each PI) 11P4111k4�(�tr ,i h
ulldin ariance(Minor,Major or Reasonable Economic Use)
J�emolition Permit ❑Conditional Use[C(a),C(d),or C]**
Single Family ,�� ODiscretionary"D"or Unnamed Use Classification
El Garage Attached/Detached til' `I:a; I 4 2007 OSpecial Use(Essential Public Facilities)**
Q Manufactured Home [Boundary Line Adjustment
d Modular °Short Plat'"*
0 Commercial* ,IERIS101 .-Oil hi 1(I.j lBinding Site Plan**
Q Change of Use �i[JP 1 ( ]Long Plat
Q Address i Road Approach OPlanned Rural Residential Development(PRRD)/Amendments**
roP ane []Plat Vacation/Alteration**
OAllowed"Yes"Use Consistency Analysis shoreline Master Program Exemption/Permit Revisions**
OStormwater Management tiShoreline Management Substantial Development**
OSite Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Variance
OTemporary Use ❑Comprehensive Plan/UDC/Land Use District Map Amendment
OWireless Telecommunication* °Jefferson County Shoreline Master Program Amendment
❑Forest Practices Act/Release of Six-Year Moratorium
*May require a Pre Application Conference **Requires a Pre-Application Conference
Please identify any other local, state or federal permits required for this proposal, if known:
n, DESIGNATION OF AGENT
I hereby designate L. • i'C+ chept to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE 4,4 4 -( Date: 8 Fe t- O 1
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 applicatigr�that he or she want prior notice. �E£ � �Q� 7
Signature: "►�WJ, A Date: 6 _
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-transferable onsibility hering to and co lying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
.
Signature: A 2-e_ A-1- C ` J Date: 8 - re 4 - 07
D:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05-2.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 assuming the responsibility of the General Contractor for the proposed project.
Signature: Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
IA) Zici4 2 ( (12 L- Cow- ( ) 5'Iq-g2ZZ( ) .�
MAILING ADDRESS: 'PD '2 EMAIL: on c he,r-f tg (ON+1-1 c , (0)..-
CONTRACTOR'S LICENSE WAINS
NUMBER: (2iC& 0(VG L U NUMBER
ARCHITECT/ENGINEER: C�4.4w411/I.17 � �.X... PHONE ( Z09g,yiJAX:( )
MAILING ADDRESS: 3,1 cowoluxc!1..1._mf AintecAtrz.5 .EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
Er'New G'Wood ' Existing: , C 3-ewer
:❑ Addition. , 0 Steel Proposed: 3 Bank ❑Community System
❑ Alteration/Remodel , 0 Concrete • Total: 5 Hei ht:1 I I Individual System
❑ Repair ❑ Masonry SEP Permit#�1 pO G-120§f{8:
❑ Demolition 0 Other: Bedrooms: Water Supply:
Ex tin•: Setback: Private well 0 Two Party
T •• of Heat: °e. ' � )i# [ ublic
if4 irJ d A • :I: 3 Name of System:
7�ly ❑
If this is a Commercial Project you mud ftwIr4h rng:
Number of Parking Spaces: Current: _'Pfoposed: Number of ADA Parking Spaces:
Number of occupants(includes own op ants,employees,etc) Current Proposed Allis
IBC Occupancy: IB '- it 1 Will you have Food Service? '--'. No
If this is a Propane Tank and/or Ap i�,- et,mark all items below that apply:
d Underground Tank pr.4kbove ground Tank Size of Propane Tank: 'ZED
Heat Stove T Cook Stove ❑Woodstove ❑Fireplace Insert 0 Hot Water Tank 0 Pellet Stove p 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 t iildin•t;:11 pro
lines, tank location and size,distances from the propane tank to all property lines,buildings and septie stem — pone
including the reserve area. C
Square Footage Current Proposed For Office Use Only Amount Revision
Main Floor Heated i 10 i —°LiZO EH Bid App Review: y m
2na Floor Heated 5'89 523,43 I
g2 Consistency Review: i .�
Other Heated A-tTfC. ZS SI Base fee:
,Q113.-5
Mezzanine Additional Section:
Heated Basement 6,G 4 J°6I�•3 Plan Check fee: '12.91
Unheated Basement State Surcharge fee: o
Other Unheated Pot Water Review fee: � ;
Garage/Carport 3i31a•5b SUBTOTAL "{�J [�
14 -TE o '?J 5r7 ` _z- . r
Decks 2 0 3 $p 911/Rd Approach fee:,
�11Other _. TOTAL: $`�5(/�_ 1
Receipt Number: l' V`�13
J
Cash/Check Number: GI 5 I
0`g3►`4
ESTIMATED COST(REQUIRED) Date: �^
.Fair market value of all labor and materials foundation to finish Isrib')
e,yr7 a o Initials:
D:\PertnitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05-2.doc
• 110
ClIORCENTH
ON
4
ri, ,,, JEFFERSON COUNTY
kilo,'4 DEPARTMENT OF COMMUNITY DEVELOPMENT
4, ,0• 621 Sheridan Street • Port Townsend • Washington 98368 At 11 G�1U��I l�rr
�! OHO 360/379-4450 • 360/379-4451 Fax 1'
N http://www.co.jefferson.wa.us/commdevelopment/
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# Di - --a. PROJECT/APPLICANT NAME: rt.-DID ' 1
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.
'5 I ttZ S a>7/ e IOa' ar-.Sv O4''n. S7,-I RoNNlr)G ///a4hi y m/,90 i
( riptr- )• oar LAiD- �G2i5.77/2o ,,l&'Pb & Pr// GvpST/u.a- din'-L
/ -p JT Rei'r 110 Sr' a- d j10f -p 6.'•
Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map. argon-- -u. nt r
5-4e Pr i9i 7 S/77 P'--,4N1
3. Describe the existing vegetation. Indicate native vegetation areas on the site map.
K//1T L --tfle-4- r //4-G ,14 t-2 Ng7Z‘5:) -c /1465 iCT:4441 11,4UIYi I 11( ki
,'i 47pA ;0 / nkr ram«/7 )
4. Describe the existing soils. Indicate soil type on the site map.
J4x).a j 241,i q i7-//� / sz Jr.
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 activity:
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Stormwater DEPT.OF C . IT D• Et. PMENT
S SIGNATURE ,
Required
stormwater site plan template—rev.10/1/2003
5
4111 • •
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.
S4e 1 r 0
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.).
L.dG�+-j�E� ' O Q4� d� /7JLGr/ /✓ "�/ �Il�G1L'ni/,Ji
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.
s ,17 17c-a feeds
O`"1 t4'
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.]
NA-
11. Describe the performance goals and standards applicable to the project.
N4 RIEC1EIVET ))
12. Describe the flow control system. J U:iN Jai 4 2Util
N 4 IEff�-l�li�t4�IIIINIY�II;I�
stormwater site plan template—rev.10/1/2003 6
• 0
13. Describe the water quality system. '�� ��
A-4-'
jg ,,,., a:,.. 4:,....rA
14. Describe the conveyance system analysis and design. g
1I11 1111.1
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15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material.
N /9-
16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
/V f.
17. Describe the proposed surfacing material.
U(--' fi r//0 _S ,// /i/J4 ..5 avc
18. Describe methods for restoration of the site.
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.
/V4
20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
K4-
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.
b./6-7- L74/09 AEU/ Ai/J It m 1 647/c10 i' z/drt T
6/Nf _f Rredr-r- r- .. Soy-//
stomnvater site plan ten-plate—rev.10/12003
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. G r d o BM
p
2. Establish Construction Access.
3. Control Flow Rates.
4. Install Sediment Controls.
5. Stabilize Soils.
6. Protect Slopes.
R ,�\\�jt W1R1 ji
JJ
7. Protect Drain Inlets.
t
t�I�nEII�IN�r III!/
stormwater site plan template—rev.10/1/2003 8
12 Required Elements—Construction SWPPP(continued)
8. Stabilize Channels and Outlets. )CrA k q}�
,11
J'1 it 14 2447
9. Control Pollutants.
10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
11. Maintain Best Management Practices(BMPs).
12. Manage the Project.
2. Adjacent Areas.
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential
areas, roads).
Tfig: j r 04/3, i s 6-6 �Sf l re Nv ,e9ASr46
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/71
b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
yards).
E' Ao f (GiAe 467I4' /,co'
3. Environmentally Sensitive Areas.
a. Description of environmentally sensitive areas that are on or adjacent to the site.
S�>r' •/a" f3TTi f> G /-epu.c. a- vir__.1-'
stormwater site plan template-rev.10/1/2003 9
• •
b. Description of special requirements for working in or near environmentally sensitive areas.
—710' J7Va4 /Ail' /9Aly
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).
SS/t; S>(0/Mt/AC" F /11/1 v�J EGG 177
5. Construction Phasing.
a. Construction sequence
6T; -i \744-1/ O 1- fJi.1 ' 7 tj —i2 Off
b. Construction phasing(if proposed)
/%173
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
Provide a proposed construction schedule.
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��M „�y S t 2y ,a17 C -/' F51 ,( /�s ,� IJiIP5
II. Wet Season Construction Activities. i.J�f" Si4r4,CL)`')
a. Proposed wet season construction activities.
'L /N/2 ' Z- JJ/cS ity l j
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.
ti
8. Engineering Calculations. Provide Design Calculations on a separate sheet for the followin if applicable.
a. Sediment Ponds/Traps. IID RCETRP,i)
b. Diversions. / Al
c. Waterways.
d. Runoff/Stormwater Detention Calculations `11 J + ° 2007
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 so certify t at this application is being made with the full knowledge and consent of all
owners of the aff d property.
(LANDOWNER OR AUTHORIZED REPRESENTATIVE GNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES,IF NEEDED:
EICEW Ell )1
JUN 14 ZOO?
IEFFEHtiIh��;IIIINIr I1:1I
stormwater site plan template—rev.10/1/2003 12
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V 606 ROOSEVELT ST., PORT TOWNSEND,WA 96368
to PORT TOWNSEND.WA 98368
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—� Voice(360)379.8338 Fax(360)379.1327 henry9?designsbysouze,com
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DRAWN AR
DATE 611410-1
SHEET
A2.1