HomeMy WebLinkAboutBLD2007-00386 • I
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 #: BLD07-00386
SITE ADDRESS: 130 SUNNY SLOPE Issue Date: 09/19/2007
BRINNON, 98320 Final Date: 9/22/2008
APPLICANT: JACK C KILMER PHONE: 503-731-9200
THERESA M KILMER
1746 SE 26TH CT
GRESHAM OR 97080-7264
SUBDIVISION: SUNNY SLOPE Block: Lot: 21
PARCEL NUMBER: 997200018 Section: 11 Township: 25 N Range: 02 W
PROJECT DESCRIPTION: NEW SINGLE-FAMILY RESIDENCE TO REPLACE EXISTING RESIDENCE
ADD 40 SQ FT HTD BATHROOM & 156 SQ FT HTD ENTRY TO BASEMENT
THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2006
EDITION.
OCCUPANCY GROUP:
TYPE OF CONSTRUCTION:
SPRINKLER SYSTEM yes ``(no )
THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 9/22/2008
I\F_BLD_Occupancy.rpt 10/29/19
Jefferson County Building Dion Permit Nun.: BLD07-00386
Applicant: KILMER
BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2006 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
01 r3/C/ Zba Pee_ eeJKa)St'[E PLAN It 13 07
Erosion Control $ ,� I Wsr
,�►ALE (///46
Foundation Footing 1"1 i efiGr S gv� pu.NNi, e_'h eaviL7
Footing Drains 3/11/08 b7 F$
Foundation Stem Wall t_\L,-v�b �c��;-+' Y'��
Underground Plumbing
Under Floor Framing
Straps(hold downs) s/�/�
Ext. Shear Wall Nailing 3 /�4/oa ix
Rough-in Plumbing ;/ (;)s _ .
l'N 1,J • D IS( Fig ci (s6. iM* 1?! I: u(Z
Framing
Blocking 4//3/68e"K /VpFDS JErree— MomAJLQ S 2-BfrA
0d/DS A:/ 11K
Airseal 4/30g 4)e-
Insulation:Walls ��t-2 , l
Insulation: Floors
Insulation: Ceiling
Int. Shear Wall Nailing (._v'
Wallboard Nailing � -D6
Gas Line: Interior -06 1g
Gas Line: Exterior / �Y
Propane Tank
Heat/Chimney Clearance S/34/4B QK
Drywell/Alt Drainage
Address Posted
FINAL INSPECTION
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
•UILDING PERMIT APPLICA•N MR 409
eviewiew Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD07-00386 Received Date: 7/18/2007
SITE ADDRESS: 130 SUNNY SLOPE
BRINNON, 98320
OWNER: JACK C KILMER PHONE: 503-731-9200
THERESA M KILMER
1746 SE 26TH CT
GRESHAM OR 970807264 SUNNY SLOPE
SUBDIVISION: Block: Lot: 21
PARCEL NUMBER: 997200018 Section: 11 Township: 25 N Range: 02 W
CONTRACTOR: WINDHORSE INC PHONE: 360-681-0796
1017 CHICKEN COOP RD
SEQUIM WA 98382
Contractor's License WINDHI*961BG Expires 1/2/2008
REPRESENTATIVE: WINDHORSE INC PHONE: 360-681-0796
1075 CHICKEN COOP RD
SEQUIM WA 98382
PROJECT DESCRIPTIOr NSFR TO REPLACE EXISTING SFR RQV\'_5eA)
A I ) ► tJ A-h< ;Orr k, UL, Vr..0-Y,V" A n 4 1,2(61 _
TYPE OF WORK RES Ac1)13 ,F45U E11TO A y (-Aft6
TYPE OF IMP NEW
VALUATION 200,000.00 MAIN: 728
CODE EDITION: 2006 ADD'L: 513 HEAT TYPE:
OCCUPANCY: zi,H EAT BASE: ?1NOr j 40 HEAT TYPE: EEE
OCCUPANCY: ,R�v0 UNHEATED: 653 # OF STORIES:
CONST TYPE: `\Z OTHER: �-{� 4� /y t.�;` SHORELINE:
CONST TYPE: (a GARAGE:
DECK: 384 SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: OTHER
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0 Q.`v 1-)t9
Prop: 2 Prop: ` 3 `` r40)�2,
Total: 2 T :--- :`
Routing Date: Y�
Type Amount Paid By: Date: Receipt:
Permit $1,553.75 LYK 07/18/07 91386 ANilit)V E D
Plan Check $1,009.94 LYK 07/18/07 91386
State Building Code $4.50 LYK 07/18/07 91386 SEP lq 2007
Potable Water Application $58.00 LYK 07/18/07 91386 Jefferson County Planning
Total: $2,626.19 &Building Department
• •
CONDITIONS for Building Permit# :BLD07-00386
1.) The application was reviewed by the Jefferson County Department of Community
Development staff on September 4, 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:
Suburban Shoreline Designation, Shoreline Slope Stability- Intermediate and Unstable,
Bald Eagle Habitat Area, Wetlands along shoreline, Seismic Hazard Area, Coastal
Seawater Intrusion Protection Zone (SIPZ).
2.) 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.
3.) 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.
4.) 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.
5.) 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.
6.) 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.
7.) 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."
8.) All construction activities shall not encroach upon the landslide hazard buffer. This
includes the storage or preparation of materials.
9.) 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.
10.) 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.
11.) VOLUNTARY MEASURES OF •STAL &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.
12.) 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.
13.) The project shall adhere to the Best Management Practices (BMPs) to control stormwater,
erosion and sediment during construction. BMPs shall address permanent measures to
stabilize soil exposed during construction, and in the design and operation of stormwater
and drainage control systems.
14.) The applicant is proposing to create or add 289 square feet of impervious surface and
1,509 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 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.
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 site plan as submitted with the application on July 18, 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 September 17, 2007 shall be resubmitted for review and
approval by Jefferson County Department of Community Development.
18.) This approval is for the demolition of the existing residence and building a new
single-family residence 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 vehill shall be stored on any lot unless totally signed
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 single family
residence.
23.) The building height is not to exceed 35 feet.
24.) Pre-existing legal lots of record less than one acre in size in rural residential districts are
subject to the stormwater requirements in Chapter 18.30 JCC and must meet the"Area of
Impervious Surface Coverage"to the maximum extent practicable as determined by the
administrator. Lot coverage is defined as amount of impervious surface, which includes
rooftops, 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.) Setback from Sunny Slope Rd. right-of-way is no less than 20 ft., side and rear setbacks
are no less than 5 ft. If an environmentally sensitive area (ESA) is present, then the more
restrictive setback shall apply.
27.) Sunny Slope Rd. (P164) is a private local access road. A road approach is not required.
An address of 130 Sunny Slope Rd. has been assigned to the parcel.
28.) A septic permit(SEP98-00067) was approved June 18, 1998 for a capacity of 240 gallons
per day. This permit was finalled September 29, 1998.
29.) Stormwater shall be retained and infiltrated on site. The owner shall control all
sedimentation and erosion on the property.
30.) 10' SEPARATION REQUIRED BETWEEN A WATER LINE AND ALL PORTIONS OF
THE ONSITE SEWAGE SYSTEM; EFFLUENT TRANSPORT LINE, TANKS,
TREATMENT AND DISPOSAL COMPONENTS.
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.) This project meets or exceeds all performance standards listed under the Shoreline
Management Master Program (JCC 18.25.410) with the exception of the shoreline
setback which has been addressed in the finding above.
33.) The proposal was reviewed for consistency with the Shoreline Management Master
Program Section (JCC 18.25.090 (5)) and found to be consistent. The proposal is (1) a
single family residence, (2) does not exceed 35 feet in height, (3) does not involve
over-water construction and is located landward of the OHWM, and (4) meets or exceeds
all required setbacks as set forth in said SMMP.
34.) The proponent shall notify the Jefferson County Department of Community Development
at(360) 379-4450 forty-eight(48) hours prior to commencing construction in order to allow
monitoring and ensure compliance with permit conditions.
35.) Work within the jurisdiction of the Shoreline Master Program other than as described
above shall receive separate review from this Department.
36.) The Development Review Division finds that this proposal is consistent with Shoreline
Master Program Section 3.402.5, which exempts the"construction by an owner, lessee, or
contract purchaser of a single-family residence [in shoreline jurisdiction] for the owner's or
owner's family's use..."from the substantial development permit (SDP) requirements
under certain provisions. Exemptions from the substantial development permit
requirements do not exempt a proposed development from compliance with the applicable
policies and standards of the Shoreline Master Program or other applicable Federal,
State, or local permit or license requirements.
37.) Construction shall be in substantial compliance with the site plan submitted on July 18,
2007 as it exists now or is hereafter amended by Jefferson County and/or the Washington
Department of Ecology.
38.) No fill or other material may bed in the waters or intertidal areas of Jeff
County.
39.) SPLASH BLOCKS MAY BE USED FOR DOWNSPOUTS DISCHARGING TO A
VEGETATED FLOWPATH AT LEAST 50 FEET IN LENGTH AS MEASURED FROM THE
DOWNSPOUT TO THE DOWNSTREAM PROPERTY LINE, STRUCTURE, STEEP
SLOPE, STREAM, WETLAND, OR OTHER IMPERVIOUS SURFACE. SENSITIVE
AREA BUFFERS MAY COUNT TOWARD FLOWPATH LENGTHS.
FOR SITES WITH SEPTIC SYSTEMS, THE DISCHARGE POINT OF ALL DISPERSION
SYSTEMS MUST BE DOWNGRADIENT OF THE DRAINFIELD.
40.) EXCAVATION, GRADING AND EARTHWORK CONSTRUCTION SHALL ONLY BE
ALLOWED FROM APRIL 1ST TO NOVEMBER 1ST, UNLESS THE APPLICANT
DEMONSTRATES THAT SUCH ACTIVITIES WOULD NOT RESULT IN IMPACTS OT
THE STEEP SLOPE.
41.) On September 13, 2007 the administrator determined this project complies with the
geohazard performance standards and no geotechnical report would be required.
• •
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FILE COPY
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6
L'C ►N O . JEFFERSONOUNTY
-- DEPARTMENT OF COMMUNITY DEVELTNIEN
`'q 621 Sheridan Street • Port Townsend atb 36 II
360/379-4450 • 360/379-4451 Fax
�qs, l5 www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: -7-- ( '
Project escription(include separate sheets as necessary): 41:0Sk
1 € 5.L..` .w,1 l,7 0e5,'01e4.,�� btA. '�3 '6 '* b, r `'f-
Tax Parcel '" Property
Number: C1 9 7 10t;0 16 Size: (acres/square feet)
Site Address and/or Directions to Property:�
� J.nV�v\y�, (
t)( -- `D6ywN.43v1
Property Owner(s)of Record: ;Scx, (;. sr..;\vvve_.,r
Telephone: l ']'73(� ���0 Fax: 503-2_33-\`6'71 email: )kilvvte_a--P t-<:.ne[t.;5a,cvrh
Mailing Address: t 7416 S C C Ct,r f (..ar�SI.c:.✓r.. J 0(1 CI 7Ot'v
Applicant/Agent(if different from owner): L.)tn4kci'5c- LW(� .
Telephone: 360 ( [-0.7 ct 6 Fax: 36U oe i 0 7 el 6 email:
Mailing Address: I C) 7 S CPI 1'c' 4, Car i cA
What kind of Permit? (Check each box that applies
[Mudding ❑Variance(Minor,Major or Reasonable Economic Use)
emolition 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 ❑ Special Use(Essential Public Facilities)**
❑ Commercial* 0 Boundary Line Adjustment
❑ Change of Use ❑ Short Plat**
❑ Address 0 Road Approach 0 Binding Site Plan**
Cl Home Business ❑ Cottagelndustry 0 Long Plat**
❑ Propane 0 Planned Rural Residential Development(PRRD)/Amendments**
Cl Sign 0 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 El Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment
❑Forest Practices Act/Release of Six-Year Moratorium 0 Tree Vegetaion Request
*May require a Pre—Application Conference **Requires a Pre-Application Conference
Please identify any other local, s to/or federal perm' s required for this proposal, if known: t
(--
I hereby desi n 4 Li �� f�iaESIG ATION�F AGEN�
y ate k.(r e(0.5 Ito act as my agent in matters relating to this a plication fo permit(s).
OWNER SIGNATUR_ `a� ,, Date:4 J
By signing this app tion form,t owner/agent attests that the information provided herein,and in any attachments,is true d 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 ins ctions. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the applic ti lilt o s a s rio jce. 1
Signature: Date: (Q/ q 07
The action or actions licant 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 complian i th the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transfe abf es ' srbili a ip t mplying with the ESA. The Applicant has read this "and disclaims signs and dates it below.
Signature: / Date: <�,l. /0'7
i
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc
0 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:
(..iliVAal-t0r3 e INC-. ( (,) ) (Si-07w 6 (360 )6&( O7g6
MAILING ADDRESS: (075 (Arkit,t:C OcrDRAI SGtt4,wt l9/R' 41E)36,kEMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX: ( )
MAILING ADDRESS: EMAIL
Pr91ect Type: F�f me Type: Bathrooms: Shoreline: Type of Sewage Disposal:
New l ' Wood Existing: =s ❑ Sewer
❑ Addition ❑�/Steel Proposed: Bank ❑ Community System
L"�'
❑ Alteration/Remodel Concrete t-,,.' Total: 3,- - Height: Bz Individual System
❑ Repair 0 Masonry II' `i' ,. � 30 SEPPermit# - `ft
pr Demolition ❑ Other: Bedrooms: v Water Supply:
Existing: Setback: 0 Private well ❑ Two Party
Type of Heat: Proposed: 6✓Public
Total: Name of System:
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:
1 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.
r y a } # a arm y ram;, .g:i
F
Square Footage Current Proposed Fpl` ee-iU.�O '-un� '� :. n * 4ygpi i r
Main Floor Heated x L, EH Bid App Review: (�
7 •
2"°Floor Heated S t 3 , `*}.; Consistency Review: j t--� vi;
i s r4„f4;
Other Heated r Base fee: 'rii
Mezzanine ",°x Additional.Section: ��� ]
� j 14tu -__.) /
u �vg =tom""'`� �,+'��t .�`� �'"(� (7c c�E.-j� ,;�..
Heate as ent 5 `•tII Plan Check fee:40 cy.9
Unheated Basement G 53 t - 4,(p State Surcharge fee:
Other S -�'�� ` Pot Water Review fee:c (0 i riiia:C q ,
Garage/Carport J SUBTOTAL i) A 5611. V l✓hA
Decks lsM 911/Rd Approach fee:
Other 9 �ck'r TOTAL: $3a3 oa
,.fi t S1 `xJ I�/:.T� J
,P -:��4� � Receipt Number: Ci tom,, .,, -
, Cash/Check Number: —75q
ESTIMATED COST(REQUIRED) S Li Date:
•Fair&ark•t value of all labor and materials fo n tion to finish I U
,yA� U � i F :Initials: t •
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc -
•
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STORMWATER PLAN
t • SEP 1 ;7 2007
.= ; °f.0 4 , JEFFE a SO 1DE •, aeli o - IRE( ;Ed VEi
14*4DEPARTM fma. . : ,,,LI -, 3 ' M: T
�j 621 Sheridan Street • Po►.i�wnsend • ashington •:368 JUL � ,�
360/379-4450 • 360/379-4451 Fax
,g NC http://www.co.jefferson.wa.us/commdevelopment/
Jf fffigSUaUUNItUa
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
r u -7(,,ac, ..c.
J MLA# 09 PROJECT/APPLICANT NAME: ` \\LA°L,,c n
i`,c._ CIJV\jir
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.
1 /`i is/-1 l
Existing Conditions Summary
2. Describ9 the existing topography. Indicate contours on the site map.
Oft D { 60 _ ki 1\` '-Afci 1 j1 4
�Ci � �< i`�'Cis"'^ e..c,,,,`C-
3. Describe the existing vegetation. Indicate native vegetation areas on the site map.
r
- ‘,,/6-eote.4.- 4-r-cc_s So-IcA:4- L Cyl-TA53
4. Describe the existing soils. dicate soil type on the site map. V
,S \I � Acc i- S( I
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.
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6. Describe any excess levels of noise generated by the proposed use or activity:
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stormwater site plan template—rev.10/1/2003
5
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7. Describe significant geographic features an titic 1areas (I.e., envyonmentallMltsensitive areas such as wetlands, streams,
steep slopes,etc.)on the site. Indic to location1oli tJe'siteFrtiaft4F } : r - ti '
i IT-kr.v•i.. aif
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.).
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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.
.
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.]
/QA •
11. Describe the performance goals and standards applicable to the project. (( (_
12. Describe the flow control system.
6
stormwater site plan template—rev.10/1/2003
• •
13. Describ9 the water quality system.
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14. Describe the conveyance system analysis and design.
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ors tca ,r:- i6•Sv\ ��`,OC . v,!1 .F, ex`rS 1im ., , Oat' ,�
15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material'.
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16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix�Chapter 33 of the
Uniform Building Code.
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, 777 I/
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17. D scribe the proposed surfacing material. r•
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18. Describe methods for restoration of the site. w �
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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.
20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
/VA
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.
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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.
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2. Establish Construction Access.
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3. Sontrol Flow Rates. ,
4. Install Sediment Controls.
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11.
5. Stabilize Soils.
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6. Protect Slopes.
7. Protect Drain Inlets.
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8
stormwater site plan template—rev.10/1/2003
• •
12 Required Elements-Construction SWPPP(continued)
8. Stabilize Channels and Outlets.
9. Control Pollutants.
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10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
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11. Maintain Best Management Practices(BMPs).
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12. Manage the Project.
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2. Adjacent Areas.
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential
areas,roads).�q
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b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
yards
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3. Environmentally Sensitive Areas.
a. Description of environmentally sensitive areas that are on or adjacent to the site.
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stormwater site plan template—rev.10/1/2003
9
• •
b. Description of special requirements for working in or near environmentally sensitive areas.
-`
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).
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5. Construction Phasing. ,•, , �,t1` ,,s e
a. Construction sequenc [
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b. Construction phasing(if proposed)
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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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II. Wet Season Construction Activities.
a. Proposed wet season construction activities.
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b. Proposed wet season construction activities for environmentally sensitive areas.
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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.
•
8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable.
a. Sediment Ponds/Traps. ! J /
b. Diversions. �J
c. Waterways.
d. Runoff/Stormwater Detention Calculations
10
stormwater site plan template—rev.10/12003
• •
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
own rs of the affected property.
•
;OLs (0 07/°7
(L DOWN OR AUTHORIZ D REPRESENTATIVE SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES,IF NEEDED:
12
stormwater site plan template—rev.10/1/2003
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