HomeMy WebLinkAboutBLD2007-00489 JILDING PERMIT APPLICAAN MLA07-00507
Review Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD07-00489 Received Date: 9/4/2007
SITE ADDRESS: 51 HERBERT ST
QUILCENE, 98376
OWNER: ARNIE E FINLEY PHONE: 360-302-0163
DANNY M FINLEY
PO BOX 126
QUILCENE WA 98376-0126 CAMPBELL'S H.W. ADDITION
SUBDIVISION: Block: 10 Lot: TX 7+
PARCEL NUMBER: 937201054 Section: 24 Township: 27 N Range: 02 W
CONTRACTOR: OWNER/BUILDER PHONE
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION NEW HEATED SHOP - NO PLUMBING
FOR PERSONAL USE ONLY - ALSO A/G 750 GAL PROPANE TANK
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION 156,853.00 ADD'L: HEAT TYPE: PRO
CODE EDITION: 2006 HEAT BASE: HEAT TYPE:
OCCUPANCY:
OCCUPANCY: UNHEATED: # OF STORIES:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: 1,750 SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 0 Prop: 0
Total: 0 Total: 0
Routing Date:
Li 1 4 in--1 &—
Type Amount Paid Bv: Date: Receipt: A roved/Date
Permit $1,312.95 KAS 09/04/07 93130 gPPR®VED
Plan Check $853.42 KAS 09/04/07 93130
State Building Code $4.50 KAS 09/04/07 93130 JAN ? + 2Cf)
Total: $2,170.87 Jefferson County Planning
&Building Department
flountYBuiIdingojt Num BLD07 00489
Applican : FINLEY
BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2006 International
To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection. tional Building Code.
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 111111111111111111111
Erosion Control
cUFrr2 iti f�� p� 7 6 ce 8/
Foundation Footing /3 09
WINE , 16 ,
r r
Footing Drains
Straps(hold downs)
NA
Ext. Shear Wall Nailing
Framing
MENVAIIII
Airseal ..m.11111111111 ' 6, ' r.,
111111
Insulation:Walls
6
Insulation: Floors ELM ^
Insulation: Ceiling
Wallboard Nailing MI /
b A
Drywell/Alt Drainage
Address Posted
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PQaPAue- ?.oNK tt/7/41 �
ld/�iM�- PRov,p6 Preen-e- ?iaa
45c7 PPoPA& 1.44JE u`Z B
/ken ReOP,Aug L,at i4' 08
P PAS 4', '
FINAL INSPECTION MEM.
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
•
CONDITIONS for Building Permit# :BLD07-00489
1.) 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.
2.) 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.
3.) A Stormwater Site Plan for a medium project has been submitted and approved by the
Department of Community Development. Once the subject permit has been issued the
applicant shall fully implement the provisions of the submitted plan and contact the
Jefferson County Department of Community Development to arrange a schedule to
inspect the property for plan compliance. A Certificate of Occupancy will not be issued
until the Department verifies plan compliance. No clearing for roadways or utilities shall
occur on the project site until clearing necessary for the installation of temporary
sedimentation and erosion control measures have been completed.
4.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
5.) 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.
6.) The building height is not to exceed 35 feet.
7.) Maximum lot coverage is not to exceed 60%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
8.) 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.
9.) Minimum setbcak from the edge of Herbert St right-of-way shall be 20 ft. Minimum side
and rear setbacks are 5 ft.
10.) Exterior lighting for commercial and industrial uses shall not exceed thirty feet(30') in
height from the finished excepting when such lighting is an integral part of a building or
structure. Ground level lighting is encouraged.
11.) All noise emitting machinery that cannot in any other way operate below the maximum
permitted noise level shall be housed in a sound-attenuating structure.
12.) The storage and handling of inflammable liquids, liquified petroleum, gases and
explosives shall comply with rules and regulations falling under the jurisdiction of the fire
marshal, the laws of the state and other local ordinances. Bulk storage of inflammable
liquids below ground shall be located no closer to the property line than the greatest
dimension (diameter, length, or height) of the tank.
13.) Loading and unloading must occur on site (off-street). •
FILE COPY
�S O N �,
4� G
��SH JEFFERSON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street
Port Townsend, WA 98368
Al Scalf, Director
PLAN REVIEW FINDINGS AND DETERMINATIONS
ARNIE E. FINLEY 1-16-08
DANNY M. FINLEY
P.O. BOX 126
QUILCENE, WA. 98376 0126
PERMIT # BLD07-00489 PROJECT SCOPE:
NEW HEATED SHOP
PARCEL # 937201054
SITE ADDRESS 51 HERBERT ST.
QUILCENE, WA. 98376
This department is in receipt of the set of building plans (pages lthrul8) dated
5-31-07 by United Steel Building, Jalal Ketabi engineer. Site plan by Arnie Finley,
owner, dated 11-13-07. Structural and Lateral Force Calculations by United Steel
Factory by Jalal Ketabi engineer, dated 5-24-07. Foundation Design by Jalal
Ketabi engineer dated 5-31-07. Fire Code Review dated 12-21-07 by Tom Aumock,
Consulting Fire Code Official.
The above code referenced construction drawings and engineering have been
reviewed for code compliance by this department relative to the 2006
International building Code, 2006 UPC Plumbing code, 2006 WA. State Building
Code Amendments, 2006 International Mechanical Code, ICC117.1 Barrier Free
Construction Code, 2006 Washington State Energy and Ventilation Code, and
other related and adopted codes. This Building Plan Review shall become a part of
the approved plan set approval.
Michael Hoskins11(4., Plans Examiner
Page 1 of 4
Building Permits/Inspections Development Review Division Long Range Planning
(360) 379-4450 e-mail: ascalf@co.jefferson.wa.us FAX: (360) 379-4451
FILE Copy Page2
PLAN REVIEW FINDINGS AND DETERMINATIONS;
1. The proposed building is a one story heated 1,750 SF type II-B non-combustible
construction building. The approved use for this structure is an S-1 motor vehicle repair
shop. 2006 IBC sec 602, 302
2. Exterior walls of this structure shall be set--back not less than 10 feet from the
property line, structures less than a 10 foot set back require fire-rated exterior wall
assemblies. IBC T-602.
3. Plumbing. This building have been approved with no plumbing systems.
4. An automatic sprinkler system is not required for this building/occupancy.
IBC/IFC 903
5. A fire alarm system is not required for this building/occupancy. IBC/IFC 907
6. Egress occupancy loads for this building/use are 1,750sf/200= 9 occupants.
2006 IBC Sec.1004.
7. Egress Lighting. The means of egress, including the exit discharge, shall be
illuminated at all times the building space served by the means of egress is occupied.
IBC 1106
The power supply for the means of egress illumination shall normally be provided for by
the premises primary electrical supply. In the event of a power failure, a back-up
emergency electrical power source shall automatically illuminate the means of egress
area for a duration not less than 90 minutes. IBC 1106
8. Illuminated exit signs with back-up power are not required for this space. Installed
exit signs shall be installed as required by IBC 1011.
9. This building is permitted for 1,750 SF of heated space and shall be insulated per
the 2006 WA. State Energy Code. Refer to the WA. State Nonresidential Energy
Code Form.
- Ceiling R-21 (combined)
- Walls R-19 (combined)
- Heated slab R-10 (under entire slab)
- Slab perimeter R-10
-Vertical glazing U-0.55
- Exterior doors, U-0.60
Page 3
10. This building is required to be accessible. At least one accessible route shall
connect accessible buildings, accessible facilities, accessible elements, and accessible
spaces that are on the site per IBC Chapter 11. Accessible buildings and site elements
shall have accessible maneuvering clearances, door width, door hardware, pulls,
latches, and locks installed per IBC chapter 11 and 2003 ANSI 117.1
11. Thresholds at accessible exit doorways shall not exceed 0.50 inches in height.
Raised thresholds and floor level changes greater than 0.25 inches at doorways shall
be beveled at not more than 45 degrees. 2003 ANSI 117.1 303.3
12. Landings at man-doors shall have a width not less than the width of the door. (36")
Landings shall have a length measured in the direction of travel of not less than 44
inches. IBC 1008.1.5 Accessible doors shall have landings and clearances as set forth
in 2003 ANSI 117.1 (see attached)
13. Mechanical ventilation shall be installed with controllable exhaust fans w/ system
controls located at the entrance of the garage/shop to exhaust a minimum of 0.050
cfm/sq ft. Mechanical ventilation shall normally operate continuously in automotive
repair garages. 2006 WSVAIAQC, 2006 IBC 406.6.3, 1203.4, 2006 IMC, 2006 IFC
2211
14. Boilers/Heating Equipment shall be installed per 2006 International
Mechanical Code. Boilers over 15 psi and 10 hp shall be located within a separate
mechanical room constructed with a 1 hr. fire-separation IBC T-508.2 All boilers shall
be ventilated per IMC or per manufacture installation instructions. Direct venting
propane heater/ boilers shall be installed per manufacture and may not require
additional fresh air venting or fire separation. All boilers/heaters shall be protected from
impact by the use of bollards or curbs. All sources of ignition shall be not located
within 18 inches of the floor. 2006 IBC, IFC Sec. 2211
15. Heating systems shall be equipped with automatic controls capable of
accomplishing a reduction of energy use through control set-back or equipment shut-
down during periods of non-use or alternate use of the spaces served by the system.
WSEC 1412.4 (see attached)
16. The main shop overhead lighting shall be limited to 1,600 watts total. Lighting
control shall be located near the entrance door and divided into three (3) switched
bays/zones. Per 2006 WSEC
Page 4
17. Special Inspections for Seismic Resistance as set forth in IBC 1707 shall be
required by the Building Official for all commercial structures in Seismic Design
Category D-1. The following Special Inspections shall be required;
a. Soils and soil compaction for fill material and disturbed areas only
b. Structural steel (including welds over 5/16")
c. Cold-formed steel (bolting, attachment, anchoring, struts, braces, and hold-downs)
d. Mechanical and electrical components as specified in IBC 1717.7
18. Structural Observation is required by the Building Official up through structural.
2006 IBC Chapter 17
19. For onsite fire-flow requirements, road, and building requirements see attached
Fire Code Official Plan Review dated 12-21-07
20. Install two 2A-10BC fire extinguishers. One mounted in a conspicuous location
near each exit door not more than 60 inches or less than 4 inches from the floor.
2006 IFC sec 906
21. Repair garages shall meet the minimum requirement of 2006 International Fire
Code sec 2211 for operation and storage of flammable and combustible liquids.
(see attached)
22 A key box (Knox Box) access to, or within the structure for emergency services is
required to be installed at the main entry, to contain key(s) to gain access to the
structure in its entirety. Product information/purchase forms are available from the Port
Townsend Fire Dept.
23. This approval is subject to the Findings and Determinations requirements by
Consulting Fire Code Official, Tom Aumock, and dated 12-21 07.
24. Any other applicable or relevant code requirement not covered herein shall
nonetheless apply to this approval.
If you should have any questions regarding this review, please feel free to contact me at
360-379-4450
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Thomas L. Aumock
Consulting Fire Code Official
2303 Hendricks Street,Port Townsend,WA 98368
(360)385-3938 Email:taumock@co.jefferson.wa.us Fax:(360)344-4604
PLAN REVIEW MEMORANDUM
TO: Wade Priddy,Plans Examiner,Jefferson County B.C.D. j
FR: Tom Aumock,Consulting Fire Code Official to Jefferson County
DT: 21 December 2007
RE: BLD07-489 Finley Proposed 1,750 Square Foot Shop,Quilcene
CC: Bob Wilson, Fire Chief,Jeff. Co. Fire District No.2
This plans examiner is in receipt of the set of plans dated for the above-referenced proposal from
your office, and have reviewed the proposal with the International Fire Code [I.F.C.], 2006
Edition, and N.F.P.A. 1142. The following constitutes this consulting Fire Code Official's
findings and determinations based upon the plans of record submitted.
I do not have the fire flow data, or proximity of fire hydrants for this proposal. Please consult
Jeff. Co. PUD No. 1 and let me know. Below, I have calculated the fire flow, and have included
the Fire District reservoir as a credit, however, if fire hydrants are closer to the project, then the
required fire flow will likely be a lower number.
Based upon a proposed construction of a single largest structure of approximately 11,150 square
feet, with,this consulting fire code official provides the following fire flow determination:
International Building Code Type II-B construction classification With ISO Fire Flow Formula: 18 C IAl o.s
=Flow IF]—H%
• 18[0.8 Construction Factor][1,750Sq.Ft.of Fire Area]°5=Fire Flow in GPM @ 20 psi residual
14.4[41.8]=602 gpm @ 20 psi residual
=692 gpm after surcharge is added for exposure proximity of other structures[existing shop].
International Building Code Type V-B construction classification With ISO Fire Flow Formula: 18 C IAI o.5
=Flow IFI—H%
• 18[1.5 Construction Factor][1,750 Sq.Ft.of Fire Areal05=Fire Flow in GPM @ 20 psi residual
27[41.8]= 1,128 gpm @ 20 psi residual
= 1,298 gpm after surcharge is added for exposure proximity of other structures[existing shop].
Fire Hydrant Availability and Proximity:Undetermined--Please consult Jefferson County PUD
• 600 gpm @ 20 psi residual assumed
Fire Reservoir Capacity and Duration:Fire Protection District No.2 Headquarters
• NFPA 1142 Tender allowance
• Tender capacity credit per NFPA 1142= 125 gpm
• 20,000 gallon static capacity/ 124 gallon per minute[7,440 p/hour]demand=2.6 hour static duration
• 25 gallon per minute[1,500 p/hour]gpm rechge rate increases duration to a 3.3 hours
C:\Documents and Settings\Tom\My Documents\Business\County Contract\PIN Riejav&CorrespondenceUefferson Co.Plan Review Il\Plan Reviews\BLD07-489
Finley Shop.doc 12/21/07
It is the administrative determination of this plans examiner that the proposed project, with an
assumed fire flow support of 725 gallons per minute would qualify the proposed development as meeting
the required fire flow for Type II-B construction method only.
1.0 hours time was consumed in the review of this proposal.
It is the administrative determination of this department that the proposal be approved subject to the
aforesaid stipulations of the International Fire Code and NFPA standards.
C.\Documents and Settings\Tom\My Documents\Business\County Contract\Plan Review&CorrespondenceUefferson Co.Plan Review ll\Plan Reviews\BLDo7-489
Finley Shop.doc 12/21/(Yr'•
I.S.O. FIRE FLOW CALCULATION WORKSHEET
Building Permit Number BLD 07-
Proponent f/NL EY 4Q I"
Fire District& Tender Credit GPM
Parcel Number
Fire Area Calculation [Al
Base 17� �� SF
Exterior Overhangs, Etc. 13' SF Square Ft. Total
-.��--
I.B.C. Construction Type , ' 6 [Type A factored as 1-hour below]
I.S.O. Construction Coefficient [Cl Q, 8
Total Fire Flow from ISO Formula: 18 C/A/0.5=[F]-/+ 11%
181.PJ I I l�'re 10.5=Base Fire Flow GPM IFI Base Fire Flow GPM boy
r/w�9 r4i.8' i= Zooy
Debits or Credits Pi]'I.S.O. Occupancy Hazard [ ] Low[-25%] High [+25%] Adj. GPM
Q I.S.O. Exposures Debit or Credit Distance/Type Debit(or Credit]%
<30'add 20% North
31-60'add 15% South fli _ t/,S%
61-100 add 10% East
101-150 add 5% West
> 150'subtract 25% Other
Adusted Base
Largest Single Debit, or Credit % Fire Flow GPM "r! Z
Sprinklers Credit deduct 0.75% [Multiply by 0.25] Adj. GPM ..Y
One-Hour Construction Credit deduct 0.25% [Multiply by 0.75] Adj. GPM
Required Total Fire Flow Requrement [But not less than 500 GPM] Required GPM &f
Design Change Credits
Type Adjustment
Change in Exposure Rating
Sprinklers
One-Hour Construction
Area Separation Calculation
Largest Structure Fire Area:Adjusted Base Fire Flow ::
Factored to SF:Dist.Fire Flow Capacity X
Equals Maximum Fire Area Separation Allowed Square Feet Max.
Largest Proposed Area Separation in SF Pass! I Fail
Other
Adj. Required GPM
Q Plans Examiner
Date
Cir, Clem..%A/r.rLches�+ U/i.rLc srlr 1')Y)1/')(117
I.S.O. FIRE FLOW CALCULATION WORKSHEET
Building Permit Number BLD 07- ,
Proponent ,J/VLty VIC"
Fire District& Tender Credit GPM
Parcel Number
Fire Area Calculation [A]
Base / •17) SF
Exterior Overhangs, Etc. t°J" SF Square Ft. Total 7 S )
I.B.C. Construction Type V 76 [Type A factored as 1-hour below]
I.S.O. Construction Coefficient [C]
c •Total Fire Flow from ISO Formula: 18 C/A]0.5 -11 j--- 11%
1s1/ 1 1 I .5=Base Fire Flow GPM IFI Base Fire Flow GPM / /24(
141 • ]=
Debits or Credits[H]
4I.S.O. Occupancy Hazard [ ] Low[-25°%] High [+25%] Adj. GPM
I.S.O. Exposures Debit or Credit Distance/T pe Debit(orCredit]%
<30'add 20% North
31-60'add 15% South
61-100 add 10% East
101-150 add 5% West
> 150'subtract 25% Other
Adusted Base
Largest Single Debit, or Credit % Fire Flow GPM
Sprinklers Credit deduct 0.75% [Multiply by 0.25] Adj. GPM
One-Hour Construction Credit deduct 0.25% [Multiply by 0.75] Adj. GPM
Required Total Fire Flow Requrement [But not less than 500 GPM] Required GPM /`/i)
Design Change Credits
Type Adjustment
Change in Exposure Rating
Sprinklers
One-Hour Construction
Area Separation Calculation,
Largest Structure Fire Area:Adjusted Base Fire Flow : ::
Factored to SF:Dist.Fire Flow Capacity X
Equals Maximum Fire Area Separation Allowed Square Feet Max.
Largest Proposed Area Separation in SF Pass Fail
Other
Adj. Required GPM
Plans Examiner
Date
Cinn 1A/"rLe.he-Aes+ 1A/e,rLo sfIr 10/01 remr17
1 f
The ISO Fire Flow Formula
18 C [A] 0.5=Flow [F] —H%
[but not less than 500 gpm for SFR less than 3,200 SF and not less than 1000 gpm for mixed use areas/
C=A co-efficient based upon UBC Construction type
• 0.6 for Type I fire resistive construction
• 0.8 for Type II non-combustible construction
• 1.0 for Type III ordinary construction
• 0.9 for Type IV heavy timber construction
• 1.5 for Type V wood frame construction
• Notes: 1. One-Hour construction[Type "-A"Construction]has no coefficient, but rather, is a credit
2. Proponent can change the type of construction materials to more fire resistive I.B.C.
construction classification
A=Area of construction in square feet of the largest structure,excluding basement
The variable"A" is computed as the largest two successive floors in buildings with unprotected
vertical openings and three successive floors when openings are protected. "Area Separation"credit
can be applied—see definition below.
F=Base Fire Flow Determination
The base fire flow is compared to the area's available fire flow. The proponent then must determine
what design changes are necessary, if any,to reduce the fire flow requirement, using design credits.
H=Hazard Adiustmentfsl at %
• Up to 25%credit for"low fire hazard"[churches, dwellings, hospitals, schools, hotels and
facilities where the fuel load is light and the rate of heat release is likely to be low]
• Up to 25%surcharge for"high fire hazard"[high piled storage, warehouse,paint shop, wood
working using flammable liquids, and the like]
• Building setbacks for exposure control result in credit or surcharge percentage--Setback new
construction from others at greater distances to reduce the exposure hazard or include at least
one-hour construction on the exterior.
• Fire protection system credits with a variable reduction from 50-75% for the installation of
approved fire sprinkler systems, with the highest reduction for facilities of lower fire hazard risk.
Other Adjustment Credits
• Area Separation Credit: The firewall separation [2-hour] reduces the fire area calculation to the
largest single occupancy at the fire separation area, under the allowable fire area separation
provisions of I.F.C. Section B 104. Installation of approved area separation wall[s] and/or floor[s]
interior and/or exterior
• Installation of wet or dry hydrant[s] associated with an approved lake,reservoir,or well source
• I.B.C. compliant one-hour [minimum] construction method for interior andlor exterior
walls andlor floors
C:\Documents and Settings\Tom\My Documents\Business\County Contract\Fire Flow\The ISO formula.doc 12/21/07
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s o JEFFERSC OUNTY �'L' `�4,5)'
DEPARTMEN t OF COMMUNITY DEVELOPMENT
(." 621 Sheridan Street • Port Townsend Washington 9836841° SEP — 4 2007
4,116p360/379-4450 • 360/379-4451 Fax
, N��p"� www.co.jefferson.wa.us/commdevelopment
JEEEEHSON Y ACC •
Master Permit Application MLA: 01
Project Description(include separate sheets as necessary): shop i't, ��=2sc. O-" cE:t Li
1/9.,3 7 .c/- e syl. pig rk ic'i -T 7(. -tL), • : 9C_� 1c,,
Property
Tax Parcel Number: , 9(3-7_ .9-tI_ b,S ' Size: 0,j (acres/square feet)
Site Address and/or Directions to Property: 51 / .Q,e - ;5 0 .)-‘=
Property Owner(s)of Record: Vy-tt,,)t� at u tJxi 146 1
Telephone: `�LO—.302_-v%U Fax: email:
Mailing Address: '7 t) c c;tzC i L.
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies)
L'tuilding ❑ Variance(Minor,Major or Reasonable Economic Use)
❑ Demolition Permit ❑ Conditional Use[C(a),C(d),or C]**
❑ Ingle Family ❑ Discretionary"D"or Unnamed Use Classification
Garage Attached I -• ❑ Special Use(Essential Public Facilities)**
❑ Manufactured Home ❑ Boundary Line Adjustment
n Modular ❑ Short Plat**
Commercial* ❑ Binding Site Plan**
❑ Change of Use ❑ Long Plat**
❑ Address H Road Approach 0 Planned Rural Residential Development(PRRD)/Amendments**
❑ Propane ❑ 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 ❑ Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless 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:
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 later i ections.Access d ri ht of entry to this property shall be requested and shall occur only during regular business
hours. �r- `
Signature: ��� L L ltik�"tt lb l C.i)) Date: c - '�
g
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 t 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 w' he Jefferson Cou development code.The Applicant acknowledges that he,she or it holds individual and non-
transferable responsibility for ring to pad comp in . the ESA. The Applicant has read thi disclaimer and si ns and datesat it below.
Signature: t L C;,„t Vt.(11 e 0� Date: tY.�c r�1 °—C,)
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc
0 BUILDER STATEMENT • ill ,
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 ;/responsibility 7the eral Contractor for the proposed project.
Signature: . ��.,G� Date:
. t
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX: ( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
V New [I Wood Existing: ❑ Sewer
❑ Addition [Jr Steel Proposed: Bank Height: ❑ Community System
❑ Alteration/Remodel i i Concrete Total: -" X.,Individual System
❑ Repair LI Masonry SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: pe Private well ❑ Two Party
Type of Heat: Proposed: ❑ Public
Total: s 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:
i i Underground Tank l:7 Above ground Tank Size of Propane Tank: 7,42)
`'Heat Stove ❑ Cook Stove ❑ Woodstove ❑ Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove LI 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. *E-'R2Uc -tt,cs,„,
Square Footage Current Proposed For Office Use Only Amount Revision
Main Floor Heated f, c EH_ Bld App Review:
\::sue I .. 5 .,-)C ice---- .r;�s-t1& L:U
2n°Floor Heated C Consistency Review: F _
l.)5. c �
Other Heated Base fee:
��� , 613 jig. 15
Mezzanine Additional Section:
L.y \,( iPlorG*1
Heated1l3�selnrtr Plan Check fee: �G, - t°'"
Ur fie fed Basement State Surcharge fee: �. 31$,
(-J o
r
Other Ut.:L.:)ed y , Pot Water Review fee: 1tJ i��6u)t.Fire
�.: - 4 2007 6 wc' -
Garage/Carport
SUBTOTAL
rl Srl
DecrFEi; J WIMP ppe 911/Rd Approach fee:4''Ll>a t n(.rj
Other TOTAL: $ ay- , ri
— Receipt Number: q 313
1
Cash/Check Number: I I 5
ESTIMATED COST(REQUIRED) Date: 9, 14
'1
.Fair market value of all labor and materials foundation faiinish\ g ,I L „c�
l ,�-- \ Initials: r----\
G:\PermitCertter\FORMS\DRD FIRMS\Master Permit Application 12345.doc
•
• •
C RECEIVED
°k& JEFFERSON COUNTY
kiii, DEPARTMENT OF COMMUNITY DEVELOPMENTSEP - 4 2m07
.4, 621 Sheridan Street• Port Townsend •Washington 98368 . NO'�� http:////www.co.jefferrson wa.s/ommdevelopment/ (ILl 1 L e � C0��1 I BCD
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# 0 L—5 0'7 PROJECT/APPLICANT NAME: 4210/r� --7/3 Lai
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.
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Existing Conditions Summary fi
2. Describe the existing topography. Indicate contours on the site map. � �` "
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3. Describe the existing�vegetation. Indicate native vegetation areas on the site map. �i fE�+�+'
No tie J e i-4-'w6,v Ci 12-a-u�t. SeR *I.-L.
4. Describe the existing soils. Indicate soil type on the site map.
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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. I /�`_T.\ rf ►-5 dJ v w ' �,,Ae 2 1 ti1 0.-2 t Rt6 F m kl3 Ac°p.:_/-44.. _
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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
• •
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.
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
/siite/plan and differentiate proposed facilities from existing facilities.
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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.
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12. Describe the flow control system.we' cii2N�� ��f37� o",„ A NeQ l-1 5 ysv7 E X,S1'rl-.) c
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J{FFE '9 EJCD
stormwater site plan template—rev.10/1/2003 6
••
13. Describe the water quality system. /
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14. Describe the conveyance system analysis and des nn. !U
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15. Describe the so rce 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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17. Describe the proposed surfacing material.
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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.
20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
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. r
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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. Control Flow Rates._ ( I
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4. Install Sediment Controls. p
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5. Stabilize S�`oils. r
6. Protect Slopes.
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7. Protect Drain Inlets. R E C T1' T�D
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SEP - 4 2007
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stormwater site plan template—rev.10/1/2003 8
•
12 Required Elements—Construction SWPPP(continued)
8. Stabilize Channels and Outlets.
/0/A -1-10EIVED
9. Control Pollutants. SEP 2007
JEFFERSON CIIINI E..
10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
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).
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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).
3. Environmentally Sensitive Areas.
a. Description of environmentally sensitive areas that are on or adjacent to the site.
stormwater site plan template—rev.10/1/2003 9
•
b. Description of special requirements for working in or near environmentally sensitive areas.
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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.
a. Construction sequence
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b. Construction phasing(if proposed)
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
Provide a proposed construction schedule.
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II. Wet Season Construction Activities.
a. Proposed wet season construction activities.
b. Proposed wet season construction activities for environmentally sensitive areas.
7. Financial/Ownership Responsibilities.
a. Identify the property owner responsible for the initiation of bonds and/or other financial securities.
b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation
impacts. t
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.
8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if app licable
a. Sediment Ponds/Traps. EIV
e)
b. Diversions.
c. Waterways.
d. Runoff/Stormwater Detention Calculations SEP - 4 2007
stormwater site plan template—rev.10/1/2003 10
• •
Stormwater Site Plan Changes
If the designer wishes to make changes or revisions to the originally approved Stormwater Site Plan,the proposed revisions shall be
submitted to DCD prior to construction. The submittal shall include substitute pages that include all proposed changes, revised
drawings showing any structural changes,and any other supporting information that explains and supports the reason for the change.
Final Corrected Plan Submittal
If the project included construction of conveyance systems,treatment facilities,flow control facilities, or structural source control BMPs
(not standard on-site stormwater management BMPs),the applicant shall submit a final corrected plan ("as-builts")when the project is
completed. These should be engineering drawings (stamped by a licensed civil engineer) that accurately represent the project as
constructed.
APPLICANT SIGNATURE
By signing the Construction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and
correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all
owners the affected property.
( WNER OR AUTHORIZED REP ESE TIVE SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
RECEIVED
SEP d 4 2007
MUSH COUNTY DCD
stormwater site plan template—rev.10/1/2003 12
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