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HomeMy WebLinkAboutBLD2008-00193 • 0 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 Al Scalf, Building Official PERMIT #: BLD08-00193 SITE ADDRESS: 33 SANDSTONE LN Issue Date: 08/28/2008 PORT TOWNSEND, 98368 Final Date: 3/10/2010 APPLICANT: LLOYD BELVILL PHONE: 360-697-3456 REGINA BELVILL JTWROS 2023 E SIMS WAY PORT TOWNSEND WA 98368-6905 SUBDIVISION: EISENBEIS BAY VIEW Block: 27 Lot: 4-6 PARCEL NUMBER: 948602702 Section: 16 Township: 30 N Range: 01 W PROJECT DESCRIPTION: NEW M/H 1216WR 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 3/10/2010 I:\F_BLD_Occupancy.rpt 10/29/19 MANUFAGfURED/MOBILE HOME INSTA!LATIO N PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD08-00193 Received Date: 5/8/2008 SITE ADDRESS: 33 SANDSTONE LN Issue Date: 8/28/2008 PORT TOWNSEND, 98368 APPLICANT: LLOYD BELVILL REGINA BELVILL JTWROS 2023 E SIMS WAY PORT TOWNSEND WA 98368 SUBDIVISION: EISENBEIS BAY VIEW Block: 27 Lot: 4-6 PARCEL#: 948602702 Section: 16 Township: 30 N Range: 01 W CONTRACTOR/ GOLDEN HOMES OF POULSBO PHONE: 360-697-3456 DEALER 19647 VIKING AVE NW POULSBO WA 98370 360-697-4606 Contractor's License GOLDEHP950KB Expires 5/18/2009 PROJECT DESCRIPTION: NEW M/H 1216WR MAKE: SKYLINE YEAR: 2008 SIZE: 60X28 Directions SEE MAP& DIRECTIONS To Site: THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPcIRATION DATE IS 8/28/2009. CALL IN FOR THE REQUIRED INSPECTIONS THATAPLY TO YOUR PROJECT. Setbacks/Footing (CONTINUOUS FOOTING, SLAB or PAQS USED): /L. ( - Z(:, •I: `i Stormwater FINAL Approval: jb q1�'1�13 k., /A1\i�' ( � (•�..� v y .�104 Blocking/Plumbing: l L!(f4 Propane Tank/Lines/ Zoning Final Approval: Septic System Final Approval (If not on sewer): Road Approach Final Approval: /� Final/Skirting/Vents/Porches/Steps: F6 - IQ - HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:00 a.m. -4:30 p.m. HOT-LINE AVAILABLE 24 HOURS A DAY SPECIAL CONDITIONS APPLY- SEE REVERSE MLA08-00224 iltILDING PERMIT APPLICATI Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD08-00193 Received Date: 5/8/2008 SITE ADDRESS: LOUISA ST ?jam SCCOr 1.` t)(\Cc._ PORT TOWNSEND, 98368 OWNER: LLOYD BELVILL PHONE: 360-697-3456 REGINA BELVILL JTWROS 2023 E SIMS WAY PORT TOWNSEND WA 98368 EISENBEIS BAY VIEW SUBDIVISION: Block: 27 Lot: 4-6 PARCEL NUMBER: 948602702 Section: 16 .township: 30 N Range: 01 W CONTRACTOR: GOLDEN HOMES OF POULSBO PHONE: 360-697-3456 19647 VIKING AVE NW POULSBO WA 98370 Contractor's License GOLDEHP950KB Expires 5/18/2009 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr NEW M/H 1216WR TYPE OF WORK MOB SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: 1,680 CODE EDITION: 2006 ADD'L: HEAT TYPE: EEE OCCUPANCY: R-3 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OTHER: CONST TYPE: 5N GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: CITY BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 2 Prop: 2 Total: 2 Total: 2 Routing Date: ) 105 Q -j Type Amount Paid By: Date: Receipt: Approved/Date Plan Check $168.00 AMS 05/08/08 97246 APPROVED Potable Water Application $59.00 AMS 05/08/08 97246 Total: $227.00 AUG 2008 Jefferson County Planning & Building Department • • SPECIAL CONDITIONS CASE # BLD08-00193 1.) 2005 DOE STORMWATER MANUAL DRYWELL DESIGN CRITERIA ALL INFILTRATION SYSTEMS SHOULD BE AT LEAST 10 FEET FROM ANY STRUCTURE, PROPERTY LINE, OR SENSITIVE AREA. FOR SITE WITH SEPTIC SYSTEMS, INFILTRATION SYSTEMS MUST BE DOWNGRADIENT OF THE DRAINFIELD UNLESS THE SITE TOPOGRAPHY CLEARLY PROHIBITS SUBSURFACE FLOWS FROM INTERSECTING THE DRAINFIELD. DRYWELL BOTTOMS MUST BE A MINIMUM OF 1 FOOT ABOVE SEASONAL HIGH GROUNDWATER LEVEL OR IMPERMEABLE SOIL LAYERS. EACH DRYWELL MAY SERVE UP TO 1000 SQUARE FEET OF IMPERVIOUS SURFACE FOR EITHER MEDIUM SANDS OR COURSE SANDS. TYPICALLY DRYWELLS ARE 48 INCHES IN DIAMETER (MINIMUM)AND HAVE A DEPTH OF 5 FEET (4 FEET OF GRAVEL AND 1 FOOT OF SUITABLE COVER MATERIAL). FILTER FABRIC (GEOTEXTILE) MUST BE PLACED ON TOP OF THE DRAIN ROCK AND ON TRENCH OR DRYWELL SIDES PRIOR TO BACKFILLING. SPACING BETWEEN DRYWELLS MUST BE A MINIMUM OF 4 FEET. 2.) PRIOR TO OCCUPANCY& BUILDING FINAL - FINAL APPROVAL OF SEPTIC SEP08-00193 IS REQUIRED. MUST MEET ALL CONDITIONS OF SEPTIC PERMIT, STATE AND LOCAL CODES. 3.) 10' SEPARATION REQUIRED BETWEEN A WATER LINE AND ALL PORTIONS OF THE ONSITE SEWAGE SYSTEM; EFFLUENT TRANSPORT LINE, TANKS, TREATMENT AND DISPOSAL COMPONENTS. 4.) The application was reviewed by the Jefferson County Department of Community Development staff on July 8, 2008 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: SARPA & SUSC aquifer recharge area. 5.) Aquifer Recharge Areas in Jefferson County are characterized by porous geological formations that allow percolation of the surface water into the soils and the underlying zone of saturation. Aquifers are geologic formations that contain sufficient saturated permeable material to yield significant quantities of water to wells and springs. Aquifers serve as the source of drinking water within most of the rural portions of Jefferson County. 6.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to groundwater aquifers. 7.) Critical Aquifer Recharge Areas are defined as Seawater Intrusion Areas, and Special Aquifer Recharge Protection Areas and the following land uses located within Susceptible Aquifer Recharge Areas (1)All Industrial Land Uses (2)All Commercial Uses (3)All Rural Residential Land Uses requiring a Discretionary Use or Conditional Use Permit(4)All Rural Residential Land Uses with nonconforming uses that would otherwise require a Discretionary Use or Conditional Use Permit (5) Unsewered Planned Rural Residential Developments (6) Unsewered residential development with gross densities greater than one unit per acre. All of the above listed uses shall be subject to the applicable requirements and standards of the Jefferson County Unified Development Code. 8.) 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. 9.) The applicant is proposing tolate or add 1680 square feet of impervious face and 4100 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. 10.) 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. 11.) 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). 12.) The site plan as submitted with the manufactured home application on May 8, 2008 has been reviewed for consistency under the UDC, and has been approved by Jefferson County Department of Community Development. Any modifications, changes, and/or additions to the stamped, approved site plan dated July 8, 2008 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 13.) This approval is for a manufactured home 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. 14.) The parcel has been designated as RR 1:5 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 15.) A Declaration of Restrictive Covenant has been recorded on March 28, 2008 under AFN 532528 for the purpose of consolidating the lots to meet minimum land area requirements for on-site septic ad to allow zero lot line setbacks. The Covenant is strictly for building and septic purposes only. 16 ) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 17.) 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. 18.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 19.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 20.) Mininum setbacks from Louisa Street right-of-way and Bay View Avenue right-of-way shall be 20 feet. Minimum side and rear(south and west) setbacks shall be 5 feet. 21.) 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. 22.) 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. 23.) The building height is not to exceed 35 feet. 24.) An address of 33 Sandstone Lane, Port Townsend has been assigned to the parcel. Sandstone Lane is private (P669). 25.) The parcel was created through the Eisenbeis Vay View Addition Subdivision on April 3, 1890. 26.) The parcel is served by the City of Port Townsend public water system. 27.) A septic permit (SEP08-0046) was approved on April 14, 2008. `• Lou, t Si�e • 14,... t •}s nsIno) I m - c�1IldrZ Ir1 '� N g12 1 O cv 1 m ; o= r U) c JEfFE0d0N COUNTY 000 0 a - c ...I CIZ.2 ) I c •is C7 li - r\I a oo � 3h 3 (It';) i r..E. J r '' w':1• - I _ _ Z ' (1' * C((j\IN . — 1 a°ii 0 \ ...., .‘.4. : ! lik.710.ii, ,) io _. ki ;. 4- ca 1141* x '1, \ O i cx.. ' --.0-- if \ tJ i ., . .E § ::, - \C " � � ma's - _„ 4. \ C � 0 i . •.74 vii* - 1-)1 '',Th : 0 .• . .. .. •• . .• 1- \ 0 kik- Illib• . i °. • 7e :. - - • - 6 ,,,' I- - - *- . sr . ::. , • .1-- . .• . it f - • • • -- - co\ si t /kilo */ 0—E ,.. NV 2 02 .1 \u' a.:_/-\— -\t V--\---1 p .1caldd OC I0© � / - - JACK WESTERMAN IIe Jefferson('oueCourtbouse ASSESSOR 1'O llos 1220. Port Townsend, WA 90368 (360)385-910:5 MOBILE HOME INFORMATION FORM OWNER'S NAME/MAILING ADDRESS: is,' ECM/ If ) NAME: L\0[4 'getV)I t ADDRESS: \4l.0-1 1 VIVIVI Ave ROu1SOO WA- 403'70 MAY — 8 2008 PHONE NO. E-2,t/U-Le9'1- '��} 1p JEFFERSON COUNTY OCR The purpose of this questionnaire is to obtain information regarding either the current location of a mobile hone or the previous ownership and location of a mobile home. This will help our office determine whether the mobile home is already on the tax rolls in Jefferson County or if it has been moved to this county from another area. 'MOBILE HOME DATA: (A) MAKES 1 I VI.Q, (B) MODEL C1.f=- (C) YEAR 0 g (D) LENGTH Leo (E) WIDTH 2 (F) SERIAL # ;5D (G)YOUR PURCHASE PRICE (Do not include sales tax) i 3G PURCHASE DATE ►/24013 2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3) (A) FROM WHOM DID YOU PURCHASE MOBILE til4' ADDRESS (B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR? Yes No If Yes, Previous address of mobile. If No, What County was Mobile assessed in last year. 3)WHERE MOBILE HOME IS TO BE LOCATED: (A) WILL THE MOBILE HOME BE IN MOBILE HOME PARK? (B)IF LOCATED IN MOBILE HOME PARK: 1-15? , NAME dz.ADDRESS OF PARK 1_bLl tSO t QuiZt �'+' � Lot/Space# ?Ut-- a1 (C) IF NOT LOCATED IN MOBILE HOME PARK: NAME OF LAND OWNER: LOO SA -Pov2A- Tbu,r eY c' LOCATION ADDRESS LOAAS 4- e 60 EiSeh►)etS 'gaj Vte-� REAL PROPERTY PARCEL #/DESCRIPTION q L BLe©z')c�Z' SeC 1 1p TUUC) I\J \2\\X tkwNi\ c'K 11/0/4 Signat4ire of applicant THANK YOU FOR YOUR HELP! • II el) JO I I COSSELL, Property Technician A�¢so Cob. JEFFERSON C NTY ' _A DEPARTMENT OF COMMUNITY DEVELOPMENT *C1 621 Sheridan Street • Port Townsend •Washington 98368 MAY - 8 2008 360/379-4450 • 360/379-4451 Fax .4,.. Gip wv vw.co.jefferson.wa.us/commdevelopment ww.co.jefferson.wa.us/commdevelopment ,IEffMMSON COONII OH Master Permit Application MLA: OS-a . Project Description(include separate sheets as necessary): New W\tivt A {Li t t1,tt 4 aV OYY1 - tY tV Li)4" Tax Parcel Property q Number: L1L-I9 LW 2 1° Z- Size: )14 I 1 1 (acres/square feet) Site Address and/or Directions to Property: l-CkAiSCA S1 - PU 2A -h ,k,k)v m c c i cy / t'1v`v t,y2 C, 'tv Fti er.i.Yl l c_,k:"a A-t C.CAA I S 6 O t-n u& S r oA e., Property Owner(s)of Record: Ita •4 110;I Telephone: : 60 Gg7-'3HS-w dveFax:=(36e) G;9'7•-y lic2q email: Mailing Address: j q4,.o r 1l:k.,�?j. " fP— ,t" , . _ /9i'Zs,y4.�7; �j�.. 9V 7�l Applicant/Agent(if different from owner): C:Dldei 1 k-\i.'t'Yt F'S Telephone:kl.(L) I t(41-=3�1`SLp Fax: ':31. .,- tj Th l- Li t(Cif erne ii:4 L ICtIt rli t, .trVq SC:,,f pout SO O Mailing Address:VIlp4'1 V1' lvt0 Dot'_. 9ckklSb..;i1,1.:A `ilt, c7C e 1"otnt'ta(t 0csVv--) What kind of Permit?(Check each box that applies .BS'uilding 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit 0 Conditional Use[C(a), C(d),or CI** 'Single Family 0 Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification LManufactured Home 0 Modular 0 Special Use(Essential Public Facilities)** ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use 0 Short Plat** ❑ Address 0 Road Approach ❑ Binding Site Plan'"' ❑ Home Business 0 Cottagelndustry 0 Long Plat** ❑ Propane 0 Planned Rural Residential Development(PRRD)/Amendments** ❑ Sign 0 Plat Vacation/Alteration** ❑Allowed"Yes" Use Consistency Analysis 0 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: DESIGNATION OF AGENT I hereby designate C Dk 6V N lefk t?S D4 POMX�aY1)to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE /^-+S- -.- .-- Date: 4/4''/ 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 acre and right of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application review and re 'red late inspections. Staffs access and right of entry will be assumed unless the applicant informs t County in vvyyriting at the tipe-cIfthe application a. e or she wants prior notice. Sture: Date: 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."Jeffersop County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not viola ,he SA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in co ith the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferable res sl ' y adtSering to and complying with the ESA. The Applicant has read this disclaimer��.,_ sig and dates it below. Signature: Date: �'/G-`7"lJ "` G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc • • BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assumin -t e responsibility of the General Contractor for the proposed project. Signature: VDate: �j 1 /�./ r51 d /GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: c�7� FAX: `1 C_.�`tx eV\ MI n eS U-( PokA. �'.x' ( t C)L 'i.?y�_c.( � tr ( Q c)(/ 1,C}(PV(. MAILING ADDRESS: ,CI(,pll'"1 V l kkyu L\ti,e_ EMAIL:got Cie hvl0, .10I ixt:lll,V koilirlat/I 'C61'Y' CONTRACTORS LICENSE R-)u`l j r)L i a.A i-,7 C.y WAINS 2 1 Q)`? NUMBER: u'(;,2 Z,C1 2--c6 2-c NUMBER ARCHITECT/ENGINEER: PHONE ( j)213E'2i.`4aFAX: ( Z)..-t12—firs` S k��1�VU( 4�r:jrn;t.I t�. t11. MAILING ADDRESS:G3jC?z�.. 1CJjt o(i MC`'yLC,$iU,'1vtILc C>IZ.. EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ,a'-"New ..e-Wood - Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: 2- Bank 0 Community System ❑ Alteration/Remodel ❑ Concrete Total: 2 Height: -Individual System ❑ Repair ❑ Masonry SEP Permit# C75 t-(6 ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: _ _ Setback: ❑ Private well ❑ Two Party Type of Heat. Proposed: _x. _ Public „t-,, ' A.t o( Total: 2. _ 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 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. Square Footage Current Proposed For Office Use Only Amount Revision Main Floor Heated EH Bld App Review: 0. W 2na Floor Heated Consistency Review: Other Heated 1,' 1Leic ' It _s 4 1i..✓ Base fee: 110 0 p ,D(//� Mezzanine Additional Section: � — 8 Zaas Heated Basement Plan Check fee: ______._, Unheated Basement "`1 State Surcharge fee: Other Unheated "�; Pot Water Review fee: Garage/Carport SUBTOTAL q CIO, cc Decks 91111)Rd Approach fee: ' / Other TOTAL: $ ((At?.. Receipt Number: (� ^1 1-1-6 Cash/Check Number: _` O� ESTIMATED COST(REQUIRED) Date: ��Cp •Fair market value of all labor and materials foundation to finish O Initials: 5) G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc I • • li,Sozv 0o RECEIVED JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT MAY - 8 2008 \A . 4J 621 Sheridan Street • Port Townsend • Washington 98368 llksztiNO�O http:/3/7www co.jeffe s/on wa4 us/commdevelopment/ 379-451 Fax JEFFERSON COUNTY BCD STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# O$- a aci-- PROJECT/APPLICANT NAME: 10\ \ 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. cacndw Wmk.6 So'l \ 2.0 -sto tvtctr- tv (Se. toca, -u- is cevv+ev-eol tvr IPatsckaLk oc ca.2 c e i Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. l\._1 s ►- ce\-\\,(ek, kr--l0.-r ei evo v-) a .c Fe v-eif-ICI) 0\--ek2 Zoo -1- IS t o s S -E-tf1 a ) 3-C=4- . 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. G-2c&ss ,sorne bvzs1/4,(s1,1 a.Vtck -Sovyle tv-e 4. Describe the existing soils. Indicate soil type on the site map.. 2CLvdt.3 U6 VYll., 'of 1 up cj t 11\GV1Q.S 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. r? posed s t 12 hornQ, T,vta9.a V-De. o_k Qva.kea 2 1. -3,,?e:t_ot OLWCLA -f-2/vrn tr\o t . 0 YCULY aS� 5 * L\ L..,e_, cl R [t,t I- S eel 0'vz t\e, G cnd c a Vie sno ak _ APPROVED 6. Describe any excess levels of noise generated by the proposed use or activity: STORMWATER PLAN YY ock v-rl '► o\se / Ino IntsV) lQ t-e,l ho ISe w6 l\, b-c Ipti c c-e►Z JUL - 8 2008 tF1F[I1 J N COUNTY On DEPT.OF C' 1 JEFFE/ Y •U Lp �f �, . �.?ON stormwater site pantemplate—rev.1d1/2003 SIGNATIURE(�, • 1 / 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. Ck apeo xZS s1 fie. VAC(s acken Okaie, s\.ov� avla kyo poy\cl.lv\ oc suv2XO CO L *€f - rs iL J NO u--k-- a1�Zsz. cUt -e C Ql>Q 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.). Frl c)r-\ s c e-t- i c l�u i CC-1 S\- vce,214_.. 1s l D ewed access av‘ v,-e sk s t d.-Q Vl (3a vv e LO G J eve emu-. no Sev�i�tic ( eat`-\- c a cu-ecac avz4 pveseirv-k- 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. iY\k) ve.c iD r cvvy o1O. -Y> wowlott toe (') k�� �t vl� ru to v f c w� Qs awn_L f CW`s v1ovr Z, 1 CA_O e We s a.ncA rig vaIv)fl.e ldc a)--eq. (,(..)1- -vt tow tY v c c-l- z) WA h i lNe-0. 1L3Y-1 e vuo iy' i'- iY )\og(3 c vyi k vka ve.. se v-i c c- l-sy Sot 1 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. EXcavak-tsy-) is -t\ he vy-vw vtQ l aaa SD i t-1rtak s ovk dikk -eu:aLj chid c \e Lc pvno--vt SVIA.P of 1,\ toe, d t.► t t -1-V1 I'c 020 ec-f- c r�l.e P i v C1 r� F c pryi Is avid .Felnc k ad w will he (iced a c nucted -12:._ Describe the flow control system:. { ?MAP 'AA 17e \A ed : ( to i2m f aid S. w w I I)�) u r-ed c� c l c�(.,Qd i t MAY - 8 2008 JEf f LRSON COUNTY He stormwater site plan template—rev.10/1/2003 • 6 • . 13. Describe the water quality system. n • d-r\ ----v t 5'C UY o-c s► O \ be� ,ink wA.Uvv . --1-tri R lUuu \VY`Jpctc 14. Describe the conveyance system analysis and design. fit-WI\Je C- C \ sl lc \CVy- sep v pfai rVl.l9c V O C to-PIS) h ape v2.0 ve_cl 15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material. ca-hd t or) 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. r tmvq c-t-u_sn co-e as Ldk e, d 17. Describe the proposed surfacing material. w c n a -cA a t t.Gt.i2.hex' 1M l rl us u>t v\ A,uoj 4e. - .v.c k rY1 l v.U C,vIASV WcJc_ 18. Describe methods for restoration of the site. spa w -sF e c V C hC, savkat-L r -1-e-v tCO a c sLa oL-2 �U Y2 rvO,Q.r duv ct.vkay_, 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. Nil Pc 20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan. jti'Pc 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-relateq[r�gE e Eaeiib h Jconditions or restrictions here. �ll1�� `��, �y fVI lR MAY - 8 2008 JEE:: SUk ,_LN^Y rc JEFFERSON COUNTY DO 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. iAeS 2. Establish Construction Access. 3. Control Flow Rates. 11�v l v C 62 l-LIcQ 4. Install Sediment Controls. use P 5. Stabilize Soils. 15Q 6. Protect Slopes.un� RECEIVE)[ l MAY - 8 2008 7. Protect Drain Inlets. r1(tA k-r :l a DO stormwater site plan template—rev.10/1/2003 8 S s 12 Required Elements—Construction SWPPP(continued) tq 8. Stabilize Channels and Outlets. 9. Control Pollutants. tAA 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). 11. Maintain Best Management Practices (BMPs). 12. Manage the Project. Old 1 eon. COY tt01 LCLVA i 2 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). Nil A- , b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). A. 3. Environmentally Sensitive Areas. RECEIVE., a. Description of environmentally sensitive areas that are on or adjacent to the site. MAY — 8 2008 JEEEE ICON CDUNJ1' BCD stormwater site plan template—rev.10/1/2003 9 • • 1 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). N 5. Construction Phasing. a. Construction sequence A CIA,* kV\ f-o,rz Fr)V3r1600"10Y-) , t►-IcA 0.l.\ \no YW2.. , v�i S1, fi e i�Get l►'t a1 d i(2.AARLtst1 y C tat ii via- -120.oke__ b. Construction nstruction phasing(if proposed) IN 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). Provide a proposed construction schedule. mQy 5u II. Wet Season Construction Activities. a. Proposed wet season construction activities. NI k b. Proposed wet season construction activities for environmentally sensitive areas. NI(� 7. Financial/Ownership Responsibilities. a. Identify the property owner responsible for the initiation of bonds and/or other financial securities. t\l`)LACE P,e\\A \ b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. G-L*d e m YvornsQ. O-E tit Cbu R CEIVED 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable. a. Sediment Ponds/Traps. 14A- MAY - g ZUUS b. Diversions. c. Waterways. d. Runoff/Stormwater Detention Calculations J ARSON COUNT' DCD stormwater site plan template—rev.10/1/2003 t0 • • 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 o y knowledge. I also certify that this application is being made with the full knowledge and consent of all owners of the prope ,5/9 7 9p (LANDO R OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DAT ) i THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: RECEIVED MAY - 8 2008 JEFFERSON COUNTY OCO stormwater site plan template-rev.10/1/2003 12 • • ...., wan T. .........., • , :i. 0. •ffig a ..,,, . meat j I „.,...._, - , , F...7._ •.- , rr- I i .-6-•-_-- CO 1 I I ' "I ---._. ,).. c:. 1 I 1 f 1 3f b. ' 5.• ...._., c.,, . . los I . I 1 j / Cgr: I I I IN i alla wai '.• Ca; I I ,'-',,•,' WI Z L.r..4 .• • Lle 1.4...8 iv... is: 111k • gin) _am .4.,, . .. . . . . . .... . . . 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