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HomeMy WebLinkAboutBLD2008-00054T--- • • 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 #: BLD08-00054 Issue Date: 07/21/2008 SITE ADDRESS: 183 WAMPUM POINT RD QUILCENE, 98376 Final Date: 1/20/2009 APPLICANT: CLAUDIA G SHERMAN PHONE: 206-276-6220 LAWRENCE D SHERMAN 18544 NE 19TH PL BELLEVUE WA 980083324 SUBDIVISION: Block: Lot: T 45+ PARCEL NUMBER: 701194027 Section: 19 Township: 27 N Range: 01 W PROJECT DESCRIPTION: NEW MODULAR HOME THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2006 EDITION. OCCUPANCY GROUP: R-3 TYPE OF CONSTRUCTION: 5N SPRINKLER SYSTEM yes no THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 1/20/2009 I:\F_BLD_Occupancy.rpt 10/29/19 V Jefferson County Building Division Permit Nu,: BLD08-00054 Applicant: SHERMAN 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 Erosion Control SEE CONDITION 2 FOR SILT FENCE CRITERIAAt ok 0015,0 Foundation Footing 41/23/4 Footing Drains ! �V Foundation Stem Wall �q/ /4 Under Floor Framing '1/ Straps(hold downs) 6 filz eb�=7r?E�Z,v�Z 4f IZg�5 Rough-in Plumbing Framing L&I puch list HA2)21R4; 1..14;6" t3c:.TEn It:eRma Airseal M Insulation: Walls Insulation: Floors Insulation: Ceiling Propane Tank Heat/Chimney Clearance Drywell/Alt Drainage SEE CONDITION 1 FOR SPLASHBLOCK CRITERIA Address Posted FINAL INSPECTION • 4 FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR •LDING PERMIT APPLICATJ MR 08-00Ty0 52 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD08-00054 Received Date: 2/11/2008 SITE ADDRESS: 183 WAMPUM POINT RD QUILCENE, 98376 OWNER: CLAUDIA G SHERMAN PHONE: 206-276-6220 LAWRENCE D SHERMAN 18544 NE 19TH PL BELLEVUE WA 980083324 SUBDIVISION: Block: Lot: PARCEL NUMBER: 701194027 Section: 19 Township: 27 N Range: 01 W CONTRACTOR: GIFFORD CONSTRUCTION COMPANY PHONE: 253-405-7994 PO BOX 2744 GIG HARBOR WA 98335 Contractor's License GIFFOOC977KF Expires 5/6/2009 REPRESENTATIVE: GRETCHEN REYNOLDS PHONE: 206-592-1824 3058 S 200TH SEATAC WA 98198 PROJECT DESCRIPTION NEW MODULAR HOME TYPE OF WORK MOD SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 1,512 VALUATION 43,654.00 ADD'L: HEAT TYPE: EEE CODE EDITION: 2006 HEAT BASE: HEAT TYPE: OCCUPANCY: R-3 UNHEATED: #OF STORIES: OCCUPANCY: CONST TYPE: 5N OTHER: SHORELINE: GARA CONST TYPE: DECKLE 80 SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: PWELL BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 2 Prop: 2 Total: 2 Total: 2 Routing Date: ___ Type omit.Paid Bv: Date: Receipt: Approved/Date Permit $583.15 LYK 02/11/08 95914 q�P R®1J��°State Building Code $4.50 LYK 02/11/08 95914 Potable Water Application $59.00 LYK 02/11/08 95914 Plan Check $371.05 LYK 02/11/08 95914 JUL Plan Check $8.00 LYK 02/11/08 95915 Jefferson County Piannint Total: $1,025.70 &Building Department • • CONDITIONS for Building Permit# :BLD08-00054 1.) DESIGN CRITERIA FOR SPLASHBLOCKS: A VEGETATED FLOWPATH OF AT LEAST 50 FEET SHOULD BE MAINTAINED BETWEEN THE DISCHARGE POINT AND ANY PROPER--Y LINE, STRUCTURE, STEEP SLOPE, STREAM, WETLAND, LAKE, OR OTHER IMPERVIOUS SURFACE. SENSITIVE AREA BUFFERS MAY COUNT TOWARD FLOWPATH LENGTHS. A MAXIMUM OF 700 SQUARE FEET OF ROOF AREA MAY DRAIN TO EACH SPLASHBLOCK. A SPLASH BLOCK OR A PAD OF CRUSHED ROCK (2 FEEE--WIDE BY 3 FEET LONG BY 6 INCHES DEEP) SHOULD BE PLACED AT EACH DOWNSPOUT DISCHARGE POINT. NO EROSION OR FLOODING OF DOWNSTREAM PROPERTIES MAY RESULT. FOR SITES WITH SEPTIC SYSTEMS, THE DISCHARGE POINT MUST BE DOWNSLOPE OF THE PRIMARY AND RESERVE DRAINFILED AREAS. 2.) A SILT FENCE SHALL BE INSTALLED 30 FEET LANDWARD OF THE TOP OF THE SHORELINE BANK PRIOR TO ANY LAND DISTURBING ACTIVITY. THE MINIMUM HEIGHT OF THE TOP OF SILT FENCE SHALL BE 2 FEET AND THE MAXIMUM HEIGHT SHALL BE 2 1/2 FEET ABOVE THE ORIGINAL GROUND SURFACE. THE SILT FENCE SHALL BE BURIED IN A TRENCH TO A MINIMUM DEPTH OF 5 INCHES BELOW THE GROUND SURFACE. THE TRENCH SHALL BE BACKFILLED AND THE SOIL TAMPED IN PLACE OVER THE BURIED PORTION OF THE SILT FENCE, SUCH THAT NO FLOW CAN PASS BENEATH THE FENCE AND SCOURING CAN NOT OCCUR. ANY DAMAGE TO THE SILT FENCE SHALL BE REPAIRED IMMEDIATELY. SEDIMENT DEPOSITS SHALL EITHER BE REMOVED WHEN THE DEPOSIT REACHES APPROXIMATELY ONE-THIRD THE HEIGHT OF THE SILT FENCE, OR A SECOND SILT FENCE SHALL BE INSTALLED. 3.) PRIOR TO OCCUPANCY & BUILDING FINAL - FINAL APPROVAL OF SEPTIC SEP07-265 & SEP99-60 IS REQUIRED. MUST MEET ALL CONDITIONS OF SEPTIC PERMIT. 4.) ANY PORTION OF A TRANSPORT LINE UNDER A DRIVEN WAY IS TO BE SLEEVED/CASED OR EQUIVALENT. 5.) 10' SEPARATION REQUIRED BETWEEN A WATER LINE AND ALL PORTIONS OF THE ONSITE SEWAGE SYSTEM; EFFLUENT TRANSPORT LINE, TANKS, TREATMENT AND DISPOSAL COMPONENTS. 6.) 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. 7.) VOLUNTARY MEASURES OF CTAL &AT RISK SIPZ: i 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. 8.) 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. 9.) 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. 10.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 11.) All construction activities shall not encroach upon the shoreline 30-foot buffer. This includes the storage or preparation of materials. 12.) Critical Aquifer Recharge Areas may require special protection measures to mitigate water quality degradation. The submitted proposal does not require additional aquifer protection measures. However, during construction the project shall follow the Best Management Practices (BMPs) and facility design standards as identified and defined in the Stormwater Management Manual for the Puget Sound Basin. 13.) 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. 14.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 15.) Not more than 2 unlicensed vehi•shall be stored on any lot unless totally scOned 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. 16.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 17.) 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. 18.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 19.) Minimum setback from Wampum Point Road right-of-way shall be 20 feet. Minimum north and south property setbacks shall be 5 feet. Minimum setback from shoreline top of bank shall be 30 feet. 20.) 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. 21.) 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. 22.) The building height is not to exceed 35 feet. ' . • • Qom• .ec �- 'if-1 L CEPWE � ip " JEFFERSON COUNTY �' ;`" .ry DEPARTMENT OF i JUL 1 4 2008 L..) . p, COMMUNITY DEVELOPMENT - 621 Sheridan Street• Port Townsend •Washington 98368 t (p 360/379-4450 • 360/379-4451 Fax JEFFERSON COUNTY ' `(\ ...„.,, NG httpa/www.co.Jefferson.wa.us/commdevelopment/ DEPT.OF COMMUNITY DEVELOPMENT STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# e -c PROJECT/APPLICANT NAME: k (v- Vii r'i y'( 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. l OL.C..e. 0 e iJ ili O oI cU /a V 11 a vl-1 e (1� `5 1 � w r t +k ItV G,t.S Pok a a e'R�h 1 Siz d � W y j V IA Ve0.v ou t owte a'd c 0 k t fv'ckC_+- f.6 ' X 2-St 5f-Ict -F tithe i5I-ora,-is IOU kirk` a1+4- LiOVV-4•ot• 7 Existing Conditions Summary 2. Describe the existing topograph ; Indicate contours on the site map. 3 (a t e1a4-avetY (a a - ak'eAt o eo S vEtct- 16 ay - d P bar lc ... l�0ptit 'fly ec b4t ock ►re-M1 1l (-,k, L(, /Q bock ( et' i`�c2h ,C.. v o w '- " 7, 0 ✓-o pi w 3. Describe the existing vegetation. Indicate native vegetatiorfareas on the`site map. CC F �✓o.tt 4,1 f i5 Vl S be v, O / o' re , -J i'i ill..j 5` - rit IOeke< f4a L.td pi k-4,45 0L� ei-Ot fcr4- lie- Lt7 Ge ll 1:Ca1-,rtL F� , IQO0 atJ 10 / b 1�e i-a r1I j 1-Y�. CJ a 1I H . 4. Describe the ek(sting soils. Indicate soil type on the site map. rAe frafePf ' is /gym a 5c-aitevec ►avel , (Ail ei( tr-ecovSs eti. o r� Ko+ �i-,e_ ctk'f-e✓ b fC dvex 1n JVIllt.,,, 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. 5 / `t $' tF' is VL.ty / -t w ; -{fit o vt lY a / �`i '611° -1' Pi6e ,!a-c Gtboct"f' I .po -fr ; kt &VPa fa i-e_c Icektev 0 1 0f bc+tor,ak PrOPa52� . h0US� and 5 .lv-G A- ti,c; l-.I.I � vA,� raLI, s. .. C'_ a kSe trvlL14-6C e./I(Lec-�'/aViS 4' wa r eit f--Vt'4- '1(de W14-tC cl Val NS t'v‘ 6. Describe any excess levels of noise generated by the proposed use or activity: /-2- -y5 T 1s c 116 Ct_6 Z t 5 _Mil citi (4 ` 4 n-d tr.K Gd' 4 ti ` -re. G tt L y ..r a 4 h cI -t 0 In r1 ,..... rovED C 6 4 0- rtfc4'/0!A not 5( _AO if Ci 544 P.- P.x( et-t ;, ERM1T # BLS STORMWATER PLAN stormwater site plan templat.doc—rev.10/12/2003 0 8 - 0 0 5 ' J U L 1 4 2008 5 } Stormwater '� �l► JEFFERSON COUNTY JEFFERS O Y . Require 1 ,. ' • DEPT.OF C'O RT E E SIGNATURE: • • 7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams, steep slopes,etc.)on the site. Indicate location on the site map. 1 :3 0 56 4-h al e t b�t�' o- `I o fx1517119 k )'L4 n/lie i, rt ct.vt j�l ett /6. 15_ 40 ©u %1c to bar tc tekfecl by Ore k ae, d- Oki e11c a LA ( wet 14..19 20qd t'4 S+- ,p 5/of�� w6t/c A is 11(A vl /y covevvj 4-ti '-j Yees a veey4rt o a ti 1.J i [1 be I¢4t a 5 `t 1 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.). OuttCeoC Aar vo kJ, 5i14j1ecgoii(if vest e Ptees �z &\-4 ( -1-- s ► s. (-Ja 10 ttw. rate a� tr-t&h.S Tt v�a tt 5 L, Na ��-1-1ve�1�s ©� t. -f`ta h�`j c 5[ Qi& lceKe Re Permanent Stormwater Control Plan This portion of the Stormwater Site Plan consists of the selection and installation of the appropriate stormwater control BMPs and facilities to remain in place after construction of the project is completed. "Medium" size projects are required to have the totals calculated of all impervious surfaces, pollution-generating impervious surfaces, and pollution-generating pervious surfaces to verify that the thresholds for treatment facilities and flow control facilities are not exceeded. 9. Describe the developed site hydrology, as proposed. Indicate whether stormwater will be fully dispersed (i.e., per BMP T5.30 in the Manual)or, if not,what types of stormwater flow control will be utilized for the site or specific threshold discharge areas within the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. 7'h e 19 ro/oeci It o c,5C /ZWS / So' p vbCs. co~, ik 5 o ret S r' S/' ( ha 5 /c55 /kQt� zzo� oF > d0�. 7'�f fI ha_v 5eitzl biaciLs co Sol tie je+ated.clo1.J et-fG1s k_ � *i ttic5t-u-k 4- 2- ke. (An, r ck s af= 4-Ile 1iO4.64= L,PZ ac.-3 pa` ? k 't"`j wdti� 4-o 4-Le tje5ta.5 �jhn�rvl CK site P/ati• (Ile Ifer45e shcd It Vtavc a Sj'IaSit bock_ +. elet41 p +tt 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 gpals and standards applicable to the project. tt t i 5 G Go rt►n,4 y ? + S°��P_ "VI? �-�ry � S�a t�wk c�a�e► - ,,c 'lrt b,cii 1 elha:. ✓05/6 H c i 11 t-r0/ ,c MCI G1t 01� r, P �1b1 j J-r4cl /6f^ 12. Describe the flow control system. las h mo c/c cd f.);`-"t v �.o w to tf o r,,4-S d t veL'fr J 4-p foot v e r l✓e ..c k e eet, 7,- „;a✓4 G‘7f 7" a cr° 04 1 a-1-. -rifC" aYe. LA., in en in_ S ; tr P/at.1. PERMIT # BIB stormwater site plan template.doe—rev.10/12/2003 08 -- 0054 JEFFERSON COUNTY OCO • • 13. Describe the water.quality system. 1—Ile Oki las it,i `>i -1-e S . (ei.4-- A y ct.kA. hi l vt0k-- q ci- 1 it. elC15flt'tj 4=/r. 4.,i 0%f_ 1-64-0-� WQk-e✓. The kottse welt be emit.Sfl-kcfec 05 i to ate ik.5 fee I Le 4 nK-sr 1-cf over 2"311 eg.,l og -.1,,t,k sc w t I b" direted 41- ve c 4-et f t v e to t3 c7 L'kid 0 Qe-Z r>, th+. t^�it s i-tcch or. o 5 Lc re e)e .5lied/ 1dtJ wilt 1t{� l&.iee1c AtC- i-et, e1C14 s-i .+- o -- 14. Describe the conveyance system analysis and design. OcJk ZSpole'0,' r .7--h e t-/ u/n 5/0 a ta.7�d( io_ r(iv-cc r e � '--e) c /o c„ ec +-t j,t e,C-¢- , ci Csfi riiot- 4,0 p/etc t.4-,t'k1- oc 5 f- v q e_fiAles The s ckV ez 5 kit L I v ewt..at L4 r vk L7l e L S -tl i s et re. rAe- 9 y4 1 tmci d c c,45.1 c4--i 0 51 fe cd t 1/ /Pia* q..-� Co ir't$ ftC Jc Q 5 fit dvtvc wty. 15. Describe the source of fill material, ph sical characteristics of fill material,anc deposition of excess material. i 4--e t 5 (c v L: I a(.._ vo r.vc, < <. t tot t 14,4 Cr ►tit D it iLj— r43,(': +T y SO l / f'Ltn y be Pia Ced a 5 4 PeJPr „a►' M I izd V l ;id So1101 tic ec I tt e 1 vei ,5/g ,� tvC I '.(iv- d v 1 ve aR. t c4.d tc yid vat 5 a tA. L I( e tt 10,1 c 6i v4 41,V (A,►•ek A-0 o vk e a d w'e p ct L a +l A 4 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. Gra.oz I w;i.l 6e lac d as ceCV1 \,e1 it tS Se yreyek ( (OaCA ..gelr c_e nciaC�l0 a h regcL free' Er,5d'iticr uCLC55 t5 10y ,10-1-11va t<1 ...048 cat►+� “.w„ e f. y ,S) et 1-,AL. c ke 1..18, vt e i- be a .ecf, 17. DescnbVthe proposed surfacing material. c& r ii i l Q, Ye, u le Ne 1 4-0i+5 p y t I tAq �-, 5 t a a-ky Croce/6vt 0 &kV (vaVE( ci1(t✓ tARy e0i'tvtec1i1i 'k 6)ar4%.f�.►.- pI-, goad at1i 4.,1 lekLOLt. 18. Describe methods for restoration a site. , ff t M/a/ret q t lei ttofSca�fl vt 5 a No(.1n�c� ko k Sc 4 VreS -o tre 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 dies conducted to prepare the Stormwater Site Plan. // 1) 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. t ,kJO K C k 4 a (Ai PI 1tl f ‘ Q-1c- 1 t d l 1^,,. IC Lc( r- stormwater site plan template-dot-rev.10112/2003 0 8 - 0 0 5 JEFFERSON COUNTY OCD • • 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 Claring Limits. tJP etre AolI- cleat ►'iho) , fVCJec,'1" is ok exi�t� Ptl C. jtA v ell -1-. tin 7rvCe5 t bo c-(-1:k—. 2. Establish Construction Access / /' e y el i s Access/ . GJ a vvt ✓c 1�t-t P°l ki-t- d /s ma,sc`fa[he cI O� vet.%L'ci 4'O4l..c1 a t..a, ai( rr�1S�vic4-to.A. s44taC[g.s w, l( ac6c55 5/re V h y th, s er/6' i-;Lt) kz,'i. 3. Control Flow Rates. • �1 a Uvntc�s hi/p l/ 4 / Sc5 0f froJeC�''J .Kci, -L. hee.,4?ada v4. (Ali t! Iv nlewA _het r/C e&,os 0ir)1.4 he 5i11-r' eh 5 17r2z fcretly SaP: tci? covet,4. Install Sediment ontrols. G a.r V- L. /S a ' '' -. a2 V e •► • - • ' A AIIIIMMIE I[ . O. , • k ,. • 5. Stabilize Soils. i)� 1 13 a Y k- c t1-'(-(/�/5 AIN 5 a V-i"o 14 4 J 5 i 1r}/ V Ct letj / L/ / ��n •,.. ' i - 1 a'v- •.. e — t.tYl &K. t • 6. Protect Slopes. 516i0e DK. GJesI S1Jc 7 e� Or1/4f74-At b I "" ‹.-ii £4.c1 i u t I c,?tne 6 , o -+ Wt eCt C'�. r6i II -t— V044. oat U be )c..c ri- rt k d l;1--(4_r cic'd. 7. Protect Drain Inlets. • r rc rs i t-_ I - N•. PERMIT # RIB stormwater site plan template the-rev-10/12/2003 0 8 — 0 0 8 JEFFERSON COUNTY DCD • i 12 Required Elements-Construction SWPPP(continued) 8. Stabilize Channels and Outlets. o C. kc2. VL NC S. (1Y rat; '���5 (N t be i u n , . t h C 4 1-v-ui^ (f-i et-L _ Ke a w i voile-- ivAJ1( &4-- to i 1\ he re ,prt o✓ e-s,frk S-I`r-L.k.o 4--"r 9. Control pollutants. ttiL eihvi..si vl NG golf Cfc. LA 5 t I Ltte i&u `� /ac'�l. f�,avK A e r��� l to used Ot. (`a tti oP. v-e,/ [.�'�_ et f�e.er�.�'.�, 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). Ja1-- iiiguti,'e,r c j-t- 15 Vkv / 6 ✓el a L1 I� k"-. 3T 11Ltr�s� 1-� �,/��"a 5�rvtt tJ&f'e✓ e a-h �e 10d of e t &4 L<(5 e Tr/i v-1 at, et t ct t1 J-e it few 711 toL&t 1-‘ alt-5iJc 04- /ob 11. Maintain Best Management Practices(BMPs).� C 4- G i ( � -i d �t I Z i9 c.e)(k ►�-'� t inch vdS r- ey-o !n c1+IA irl1 ; /1 p pnc/k .. &', t Sk bcOK4-yc-r Fr et : I( v e�c, V� �ti� � rc�� 5, e ita hacje,u e t.. 12. Manage the Project. ( o r ►ty era J (°es vv4 �1,, Q col ( ( to Prest e '1- a a f1 4-I vLt e.5 d V i t� H 51-► 14. >� e. S.q t-c erc�rs�c ert ekt a�• q t' / aspec 1-c sj 711 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). TA e Oct r (Ceti C P3c:Y /s 1t/05 c �S `�C tc 4,4 P c v d'"t. +- S d c A. /." v-C r S/ e n.+7 4 f. hcr 4e. k-e v'-d S 1 / e4/.,5w ` I Cr 1/ J�/ / fb" s-r/l+ £S'� be ' Ira 4 5 as 'lc rui /.1 � f -- et.n�t6i-14 b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). L - apt. S • ' ;4,- 10 s ve, txi 11 a " /i • - 3. Environmentally Sensitive Areas. a. Description of environmentally se sitive areas that are ion or adjacent to the site. cAC'e 4ae ay J j' 'ERMI dl: sthrmwater site plan template.doc—rev.10/12112093 0 8 - Qi 0 5 4 9 JEFFERSON COUNTY OCO • • b. Description of special requirerents for workingin or near environmentally sensitive area . g6'oS/oN Cover, / 5eI/-1.2_ertc/r! 00-•25i t;' �- /-tom f 3Q` t., FF� n c k -1,4 1- rtied field owt G s ifs aid 7// s pit t 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 tructure). ISO e-111/ r . Q fr-d id( G rtS ve',c 3 ire /S Jevil level ..LI1( d' (.J 1 Lo c t-k--- r f tt 5. Construction Phasing. a. Construction sequence , � r e e (A.+ off c��J, p kicz f t c,ja ✓ vti e cah S v u cficd- ci s e) , I um o� o�.K s�w� c�c o� b. Construction phasing(if proposed) S 4-e ra Sc c-,; o 1 K 5ko f 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). Provide a proposed construction scIrdule. i c ok 5 u c_tl oset /51 j ✓Ct --Feet vicIc.`k-1 or-IA d P/ac P I k fic.. t, (6 b` 11 n r-i e r'L- /�Ct�, II. Wet Season Construction Activities. G O h.5+V CC- e Y ► Sk or (Se-PTC�g� a. Proposed wet season construction activities. I-' le p/�c,�.tze/L c Me DIei Ia v k.o w�cOckolacy 00 Neele. b. Proposed wet season construction activities for environmentally sensitive areas. A1e'+`2wofos� 7. Financial/Ownership Responsibilities. a. Identify the property owner responsible for the initiation oporids and/or other financial securities. QtUKenee ah 0ar/ t �✓N�ld t 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. b. Diversions. c. Waterways. r d. Runoff/Stormwater Detention Calculations urj f 4t ry&1,' ' j2/a cJ Pcc silt 5j.G] rifte 91-6 r t't r stormwater site plan template dos-rev.10/12/2003 0 8 - �, J 10 JEFFERSON COUNTY DCD L • • Stormwater Site Plan Changes If the designer wishes to make changes or revisions to the originally approved Storrnwater 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 ownerss of the affected property. 7`� / 7 -c6 (LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: PERMIT # RIB stormtiieter site plan template.doc—rev 10/12/2003 0 8 0 0 12 JEFFERSON C6LJi iY OCR A .---SON c0C� JEFFERSON'AUNTY • DEPARTMENT OF COMMUNITY DEVELOPMENT ` 621 Sheridan Street • Port T seaid--aV,/asktj gt� 368 360/379-4450 • 360/379-44$1 X�,,�,_ ,l •.,- % JI A ), 4; NO �0� www.co.jefferson.wa.us/commdevelopment IfIMaster Permit Application FEB 1 20Q� M .�j-� MLA: Pro'ect Description (includ separat sheets as necessary uf i rim i r�rn Tax Parcel Property Number: 70 (_ «'k O i-7 Size: 1 -01 (f (acres/square feet) Site Address and/or Directions to Property: • Property Owner(s)of Record. LauX<A de `�, Telephone: _ - email: Mailing Address: ' ' 5y l` ' �(,�c—�' ,�' ,Lk �' � Applicant/Agent(if different from owner):'� tic 4 �/� Telephone:�(Q (Z iq C Fax:L'� L Z lla email: Ct m ni i f S ! i vII' i(60 Mailing Address: 3D S. 2Q - •��..tkcc. ll//�� ( --lL ,J f ' ,y Whit kind of Permit?(Check each box that applies *giBuilding 0 Variance (Minor, Major or Reasonable Economic Use) ❑ Demolition Permit 0 Conditional Use[C(a), C(d), or C]** la'Single Family 0 Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home 41 Modular ❑ Special Use(Essential Public Facilities)** ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use 0 Short Plat** 0 Address ❑ Road Approach 0 Binding Site Plan** ❑ Home Business El Cottagelndustry ❑ Long Plat** ❑ Propane 0 Planned Rural Residential Development(PRRD)/Amendments** ❑ Sign 0 Plat Vacation/Alteration** ❑Allowed "Yes" Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management 0 Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination (SPAAD)* 0 Shoreline Management Variance ❑Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* 0 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, state or federal permits required for this proposal, if known: �r��L,t- „ ^ i�,- - C� DESIGNATION OF AGENT I hereby designate 1��v(,��1 C �•�— to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE 1--•—- - )/\A- f Ad' /t�(�...-- 1 Date: Ia/ZO 1 7 By signing this application form,the owner/agent attests that the information prov ded 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 fac: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 application ghat he s e wants prior notice. Signature: /J �.�✓� Date: II •� ,�-t.l&._-t 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-transf e res on ibility for adhering to and complying with the ESA. The Applicant has read this disclaim T a sr�dates it below. Signature �c Date: G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc po..... — • BUILDER STATEMENT • The signer of this statement does e ify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be ass in the rasp I ili o e General Contractor for the proposed proltc I� Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: C s1cc --1 O� 1 CCYI r�Cfi an ( -- x651 D-"7 _ ) i-351-A-5 MAILING ADDRESS: POfboc. ��L4-y EMAIL: �f. 'IS ittt e)rnSI,, e Parh CONTRACTOR'S LICENSE / __ WAINS V NUMBER: I t `Ooco�7 7 Ki- NUMBER ARCHITECT/ENGINEER: i+im II2tr icvic F-f-y�t i PHONE ( ) FAX: ( ) MAILING ADDRESS: ° �'j""' EMAIL c�5'S s`?"35��'� Prpject Type: Fra pe Type: Bathrooms: Shoreline: Type of Sewage Disposal: New Wood Existing: v3/A ❑ Sewer ❑ Addition ❑ Steel Proposed: 'Z.. Bank a ❑ Community System O Alteration/Remodel ❑ Concrete Total: 'L Height:kg ❑ Individual System -,� c O Repair ❑ Masonry SEP Permit#P6�4O2S ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: cl etback: '®C Private well ❑ Two Party Type of Heat: Proposed: _ _ r {c ❑ Public .iZ�RLk-( L., Total: 2— _ (,., VJ 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: f. ' 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 1 Above ground Tank)c ei-k9ki 1N5ize of Propane Tank: 'lot �n ') 1 Heat Stove 1 Cook Stove 1 Woodstove 1 Fireplace Insert 1 Hot Water Tank 1 Pellet Sie 1 Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / No When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines, tank location and size, distances from the propane tank to all property lines, buildings and septic system components, including the reserve area. Square Footage Current Proposed For Office Use Only Amount Revision Main Floor Heated 15 C 1 Zy{ .1 ►G EH Bld App Review: e-r,� 4o 2"°Floor Heated J l ' Consistency Review: 100 Other Heated Base fee: D53. ►e) Mezzanine Additional Sectior(HHNDi 3W� f a Heated Basement Plan Check fee: ,I Unheated Basement State Surcharge fee: 5° Other Unheated Pot Water Review fee: CI 5 t R) Garage/Carport SUBTOTAL / Decks IS04 1q01 LI 911/Rd Approach fee: Lv i3r or, Other TOTAL: $ f `-/O) Receipt Number: Q`-5.j*►IV -- sh/Check Number: ink ED COST REQUIRED ' 7- l�_. ESTIMATED (REQUIRED) 0. 9\ .Fair marke value of all labor and materials found ion to finish .(-1--- 'Fair 121^O 0 1 - 1 Initials. 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