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HomeMy WebLinkAboutBLD2009-00311 I CERTIFICATE OF OCCUPANCY Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 (800) 831-2678 PERMIT #: BLD09-00311110 RANDOLPH ST Issue Date: 10/15/2009 SITE ADDRESS: PORTHADLOCK, 98339 Final Date: 2/10/2010 APPLICANT: T W DUKELOW PHONE: 360-531-1373 2023 E SIMS WAY #125 PORT TOWNSEND WA 98368-6905 Block: 5 Lot: 3-4 SUBDIVISION: PORT HADLOCK PARCEL NUMBER: 989400502 Section: 2 Township: 29 N Range: 01 W PROJECT DESCRIPTION: NEW MIH REPLACEMENT GREENBRIAR(SER#0561-U) 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 2/10/2010 10/29/19 I:\F_BLD_Occupancy.rpt MANUFAc,`TURED/MOBILE HOME INSTALLATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD09-00311 Received Date: 9/16/2009 SITE ADDRESS: 110 RANDOLPH ST Issue Date: 10/15/2009 PORT HADLOCK, 98339 APPLICANT: T W DUKELOW 2023 E SIMS WAY #125 PORT TOWNSEND WA 98368-6905 SUBDIVISION: PORT HADLOCK Block: 5 Lot: 3-4 PARCEL#: 989400502 Section: 2 Township: 29 N Range: 01 W CONTRACTOR/ MCCLANE CONSTRUCTION INC PHONE: 360-379-8245 DEALER PO BOX 7 PORT HADLOCK WA 98339 Contractor's License MCCLACI93 1KJ Expires 9/10/2011 PROJECT DESCRIPTION: NEW M/H REPLACEMENT GREENBRIAR(SER#0561-U) MAKE: SKYLINE YEAR: 2009 SIZE: 62X28 THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. Setbacks/Footing (CONTINUOUS FOOTING, SLAB or PADS USED): Stormwater FINAL Approval: Blocking/Plumbing: .��1-?I h4X.-- Propane Tank/Lines Zoning Final Approval: Septic System Final Approval (If not on sewer): Road Approach Final Approval: FinalSkirtingNents/Porches/Steps: v • 0 1 HEALTH DEPARTMENT AND PUBLIC WORK APPROVAL REQUIRED PRIOR TO FINAL INSPECTION THIS PERMIT IS VALID FOR ONE YEAR BUILDING INSPECTION HOT-LINE 379-4455. Office Hours 9:00 a.m. -4:30 p.m. HOT-LINE AVAILABLE 24 HOURS A DAY SPECIAL CONDITIONS APPLY-SEE REVERSE To Schedule inspections, call (360)379-4455 by 3:00 PM prior day. • NOTE: Monday inspections by • 3:00 PM prior Thursday. MLA09-00303 •ILDING PERMIT APPLICATION' Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD09-00311 Received Date: 9/16/2009 SITE ADDRESS 110 RANDOLPH ST PORTHADLOCK, 98339 OWNER: T W DUKELOW PHONE: 360-531-1373 2023 E SIMS WAY PORT TOWNSEND WA 98368-6905 PORT HADLOCK SUBDIVISION: Block: 5 Lot: 3-4 PARCEL NUMBER: 989400502 Section: 2 Township: 29 N Range: 01 CONTRACTOR: MCCLANE CONSTRUCTION INC PHONE: 360-379-8245 PO BOX 7 PORT HADLOCK WA 98339 Contractor's License MCCLACI931 KJ Expires 9/10/2011 REPRESENTATIVE: JnOHN MCCLACONSTRUCTION INC PHONE: 360-379-8245 PO BOX 7 PROJECT DESCRIPTIOI' NEW M/H REPLACEMENT TYPE OF WORK MOB SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: '1,484 VALUATION ADD'L: HEAT TYPE: EEE CODE EDITION: 2006 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: CONST TYPE: DECK: BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: PUD BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 2 Prop: 2 Total: 2 Total:,-----2--- Routing Date: LI( t 031 Type Amount Paid By: Date: Receipt: Approved/Date Manufactured Homes $213.00 LYK 09/16/09 110919 APPRQJ, r Potable Water Application $62.00 LYK 09/16/09 110919 OCT �� g Total: $275.00 Jefferson County Planning &Building Department SPECIAL CONDITIONS CASE •LD09-00311 • 1.) DESIGN CRITERIA FOR SPLASHBLOCKS: A VEGETATED FLOWPATH OF AT LEAST 50 FEET SHOULD BE MAINTAINED BETWEEN THE DISCHARGE POINT AND ANY PROPERTY 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 SPLASHBLOCK OR A PAD OF CRUSHED ROCK (2 FEET 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.) CONSTRUCTION ENTRANCES SHALL BE STABILIZE[) WHEREVER TRAFFIC WILL BE LEAVING A CONSTRUCTION SITE AND TRAVELING ON PAVED ROADS OR OTHER PAVED AREAS WITHIN 1,000 FEET OF THE SITE. THE ENTRANCE SHALL BE CONSTRUCTED ON A FIRM COMPACTED SUBGRADE. QUARRY SPALLS (OR HOG FUEL) SHALL BE ADDED IF THE PAD IS NO LONGER IN ACCORDANCE WITH THE SPECIFICATIONS. (BMP C105, 2005 DOE STORMWATER MANUAL). ANY SEDIMENT THAT IS TRACKED ONTO PAVEMENT SHALL BE REMOVED BY SHOVELING OR STREET SWEEPING. THE SEDIMENT COLLECTED BY SWEEPING SHALL BE REMOVED OR STABILIZED ON STIE. ANY QUARRY SPALLS THAT ARE LOOSENED FROM THE PAD, WHICH END UP ON THE ROADWAY SHALL BE REMOVED IMMEDIATELY. UPON PROJECT COMPLETION AND SITE STABILIZATION, ALL CONSTRUCTION ACCESSES INTENDED AS PERMANENT ACCESS FOR MAINTENANCE SHALL BE PERMANENTLY STABILIZED. 3.) Final approval of SEP09-114 required. 4.) The application was reviewed by the Jefferson County Department of Community Development staff on October 8, 2009 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 followingESAs were confirmed to be present on the subjectproperty: P 1 SUSC aquifer recharge area; coastal SIPZ. 5.) Aquifer Recharge Areas in Jefferson County are characterized by porous geological formations that allow percolation of the surface water into the soils and the underlying zone of saturation. Aquifers are geologic formations that contain sufficient saturated permeable material to yield significant quantities of water to wells and springs. Aquifers serve as the source of drinking water within most of the rural portions of Jefferson County. 6.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to groundwater aquifers. 7.) Marine shorelines and islan•re susceptible to a condition that is knows seawater intrusion. Seawater intrusion is a condition in which the saltwater/freshwater interface in an aquifer moves inland so that wells drilled on upland areas cannot obtain freshwater suitable for public consumption without significant additional treatment and cost. Maintaining a stable balance in the saltwater/freshwater interface is primarily a function of the rate of aquifer recharge (primarily through rainfall) and the rate of groundwater withdrawals (primarily through wells). The Washington Department of Ecology is the agency with statutory authority to regulate groundwater withdrawal for individual wells in Jefferson County. New development, redevelopment, and land use activities on islands and in close proximity to marine shorelines in particular should be developed in such a manner to maximize aquifer recharge and maintain the saltwater/freshwater balance to the maximum extent possible by infiltrating stormwater runoff so that it recharges the aquifer. 8.) The parcel is located within a coastal SIPZ (seawater intrusion protection zone) according to the County GIS map. There are voluntary and mandatory measures identified in the Jefferson County Seawater Intrusion Policy (Resolution 44-22, effective September 23, 2002) that apply to well drilling proposals and building permit applications on existing lots of record. A Coastal SIPZ is defined as: all islands and area within one-quarter mile of marine shoreline, but no history of chloride concentration above 100 mg/L in groundwater sources within 1000 feet. 9.) 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. 10.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 11.) 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. 12.) The applicant is proposing to create or add 1484 square feet of impervious surface and 2500 square feet of land disturbing activities. JCC 18.30.060 and 18.30.070 require your proposal comply with Minimum Requirement#2 (Construction Stormwater Pollution Prevention) of the Department of Ecology Stormwater Management Manual for Western Washington to control stormwater, erosion and sediment during construction. BMPs shall address permanent measures to stabilize soil exposed during construction, and in the design and operation of stormwater and drainage control systems. 13.) 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. 14.) 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. 15.) 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). 16.) The site plan as submitted with the manufactured home and deck permit applications on September 16, 2009 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 October 15, 2009 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 17.) This approval is for a manufactured home and deck permits 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. 18.) The parcel has been design.as interim zoning of RR 1:5 under the Ikon County Comprehensive Land Use Map effective August 28, 1998. Current zoning designation is Moderate Density Residential. 19.) A Restrictive Covenant for Irondale/Hadlock Sanitary Sewer System No Protest Agreement was recorded on October 14, 2009 under AFN 547213 with the Jefferson County Auditor. 20.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 21.) Not more than 2 unlicensed 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 automobile 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 requirements of JCC 18.20.100, Automobile wrecking yards and junk (or salvage) yards. In no case, shall any such junk motor vehicles be stored in a critical area. 22.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 23.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 24.) The building height is not to exceed 35 feet. 25.) Minimum setback from Randloph Street right-of-way shall be 20 feet. Minimum side yard setback shall be 5 feet. Minimum setback from platted alley right-of-way shall be 20 feet. 26.) 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. 27.) 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. 28.) An address of 110 Randolph Street, Port Hadlock has been assigned to the parcel. Randolph Street is a county local access (C650109). 29.) The parcel is served by the Quimper public water system. 30.) The lot was created through the Port Hadlock Subdivision on January 20, 1887; no AFN. 31.) A septic permit(SEP82-0102)was finaled on April 23, 1982. A septic permit (SEP09-0114)was approved on October 7, 2009. A building permit(BLD91-0839) for a detached garage was finaled on December 17, 1991. .32.) .NOTICE: This permit does rixcuse the proponent from complying wither local, state, and federal ordinances, regulations, or statutes applicable to the proposed development, but consistent with RCW 90.58. Development pursuant to this permit shall be undertaken subject to the applicable policies and performance standards of the Jefferson County Shoreline Management Master Program and the Jefferson County Unified Development Code. If during excavation or development of the site an area of potential archaeological significance is uncovered, all activity in the immediate area shall be halted, and the Administrator shall be notified at once. The Federal Endangered Species Act rules to protect threatened Chinook and Summer-run Chum salmon became effective on January 8, 2001. Bull trout have been listed as threatened since early 2000. Under the ESA, any person may bring lawsuit against any individual or agency that"takes" listed species (defined as causing harm, harassing, or damaging habitat for the listed species). In addition, the National Marine Fisheries Service can levy penalties. All areas in Jefferson County are included as "critical habitat"for a listed species. Development of property along any marine shoreline, freshwater shoreline, or floodplains could harm habitat if protective measures are not taken. To minimize the potential to damage habitat, all property owners developing adjacent to marine shoreline, freshwater shoreline, or floodplains are advised to do the following: -All development activities should avoid unstable slopes, wetlands, and forested areas near surface waters - Remove minimal vegetation for site development, especially large trees -Allow trees that have fallen into surface waters to remain there - Infiltrate stormwater from buildings and driveways onsite through drywells rather than discharging directly into surface waters or roadside ditches Any individual, group, or agency can bring suit for a listed species "taking", even if you are in compliance with Jefferson County development codes. The risk of a lawsuit against you can be reduced by consulting with a professional fisheries habitat biologist, and following the recommendations for site development provided by the biologist. For more information, contact the National Marine Fisheries Service in Seattle, or the U.S. Fish and Wildlife Service. /f JACK WESTERMAN III • Jefferson County tehonsc ASSESSOR PO Box 1220, Port Townsend, WA 98368 (360) 385-9105 MOBILE HOME INFORMATION FORM OWNER'S NAME/MAILING ADDRESS: NAME: I - -DO -aLoc-.-J ADDRESS: P 1 u -R 4Jb0(-P K S i: e . c.c PHONE NO. 5 3 I 1313 The purpose of this questionnaire is to obtain information regarding either the current location of a mobile home 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. 1)MOBILE HOME DATA: (A) MAKE S Ky(_/ iU a (B) MODEL CO V'_ AT (ca--(C)YEAR 2-4)a9 (D) LENGTH &Z (E) WIDTH "a (F) SERIAL# 33 b I - IL (G) YOUR PURCHASE PRICE (Do not include sales tax)/0,7v COO K-ITIICRASE DATE Yl3/(y9 2) PREVIOUS OWNER/LOCATION OF MOBILE ROME: (IF NEW MOVE TO QUESTION 3) /// (A) FROM WHOM DID YOU PURCHASE MOBILE 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)WRERE MOBILE HOME IS TO BE LOCATED: (A) WILL THE MOBILE DOME BE IN MOBILE ROME PARK? Yes 0 (II)IF LOCATED IN MOBILE HOME PARK: NAME & ADDRESS OF PARK Lot/Space # (C) IF NOT LOCATED IN MOBILE HOME PARK: NAME OF LAND OWNER: TE iD -Dv 1 L CL) LOCATION ADDRESS II 0 -KA-1.11 c P tk ST Pr t{i lbLock- REAL PROPERTY PARCEL #/DESCRIPTION ! b i y"OD 5 OZ. •'IX S2aapi/ Signature of applicant THANK YOU FOR YOUR HELP! Lauralee Kiesel, Property Technician • • CDa-> CD 0 W CD me 7-7 . EIV (p O . 0 c i ......, ,,--- ? Ts ch C 03 Q u /4) I I a i. >Tr i !I C r"'-' coii Si cr ai Iz M a) 1 itd;" .. O fi co c4 cfl W �N. ` E ' I( 5 c . oI* i c °� �# of cU d�V `� Z CO 01 1 cn 01(il ... ei, • • . • /6 1 \ \ -44 • C/D C.) ..°:,. 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(acres/square feet) a0a �l� 4 Site Address and/or Directions to Property: I' 0 t3<tJ1�OL-4:,r{ j; Pi . '-Id{bL0L Property Owner(s)of Record: j .. Dot C_ o e_ Telephone: 3 3/ r 3-7 3 Fax: email: Mailing Address: Applicant/Agent(if different from owner): #446._6 Ljq-,J ( , A)c-j. Telephone: 3 -1 ' 2-y S Fax: email: Mailing Address: 4 7 i HA Z c/; What kind of Permit?(Check each box that applies 0 Lot or Road Segregation Auilding 0 Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use) ❑ Single Family ❑Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]** '1Manufactured Home .0 Modular 0 Discretionary"D"or Unnamed Use Classification ❑ mmercia!* ❑Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment ❑ Address 0 Road Approach ❑Short Plat** ❑ Home Business ❑Cottage Industry 0 Binding Site Plan** t 6 r-; El Propane ❑Long Plat** J ❑Sign -• 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration** ❑Stormwater Management ❑Shoreline Master Program Exemption/Permit Revisions*" 0 Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development** ❑Temporary Use 0 Shoreline Management Variance ❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference 0 Tree Vegetation Request "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 1L '0 NA-1 1i k-1--c�o._A Lie_ to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE ' - - I _ Date: 9/li/0) 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 its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any required later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applicaygnthatt he/ors wants pr r n ice. • Signature: ! • / `✓ _ ..G f i Date: y/i /09 The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferable ress�ponse ili fo adhere g o and co/mplying with the ESA. The Applicant has read this discla/Fyne,and signs and dates it below. Sianati,re //I 11_ / AZ . /' IIia.1� n...... c //I/n 0 • • BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contradors and that they will be a uming the resp ility of he eneral Contractor for the proposed proje Signature:T— ,E,t, Date: 1f<</o9 GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: M 1. CD,Q-4- (1,-))3-FI FLL-Is ( ) d1-1 -- MAILING ADDRESS: .b —1 t 1 rrrl-(�U Cie— EMAIL: rkE )S oZ-9 PEJI/, Co o-t CONTRACTOR'S LICENSE WAINS _ 7� 1 0 NUMBER: MEC(,4 I93 j 'K.A NUMBER L U GA!J ©5S k 2. ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ANew ❑ Wood Existing: — ❑ Sewer ❑ Addition Cl Steel Proposed: `9- Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ,Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other. Bedrooms: 95 Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Z Proposed: . Public Type of Heat: Total: V LIE�rLI Ct - Name of System: RAl 0 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 I Mobile Home? Yes I 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 Foote Current Proposed �. Office Us .� ` i �-> '� ' Main Floor Heated �`Tb EH Bld App Review: �� Consistency Review: 2nQ Floor Heated `)t 3 Other Heated Base fee: 1 Mezzanine - Additional Section: �_. Plan Checkfee: Heated Basement ---" Unheated Basement State Surcharge fee: ___—__ . Other Unheated Pot Water Review fee: I Garage/Carport SUBTOTAL ,5--rr 6'"(e, - S " - —Decks 911/Rd Approach fee: �j - ed i Other .. TOTAL: $ Receipt Number: 1 ( 09 tQ - Cash/Check Number: l ESTIMATED COST(REQUIRED) Date: Di J! .Fair market value of all labor and materials foundation to finish Initials: • • ij,sON O�� JEFFERSON COUNTY ti DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend • Washington 98368 �S �O 360/379-4450 • 360/379-4451 Fax b1ING http://www.co.jefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# V r30 3 PROJECT/APPLICANT NAME: -1)3 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. den wv4 ST/A1 b M f N RAP L> trc KlQw I (-t, N SA..nA.. Lp C '►-7 6)—. Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. S[P 1 2009 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. L4 ► IL)144 OF 6 E 7cr 4. Describe the existing soils. Indicate soil type on the site map. V EIZ-y Rc y J .3 u Ef S A.„ !, 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. A/13 Z?c°t/1--(1 C_E (cu G-1 / i Vs-2 ►sT -)ul605Po u7-s 'to i T S/aGritil AgZzxx 77-) APPROVED ,,ttyv��.ttV 6. Describe any excess levels of noise gerErateasb�� }�r tH /1/7 St© - ' r,1, ►� I OtT 1 5 2009 S E P 1 6 1EFFERSO �C� ��FMkDEPT.OFC'O ` � DE:V .►ri ' EN i 1 1111 JIJNIY uciistormwatersiteplantemplate—rev.10/21/2008 SIGNATti'E: 11ilOUN /t . t • • 1 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. A//A 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.). AD POL44 ..n 19-it- 1 u3ci 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. iA A4 bU_ri t-c D v� /� / - Jit-y ��n u $PL 4 c/t 4 /0 c-K S. r✓ t l t FuA.t I y pts r�d.s s 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.] A.J/4. 11. Describe the performance goals and standards applicable to the project. 7€ 60/gc 14)0 11 L-i 72) ,6G4->h/7 >A/ ac77A14? crYl , 4s- 12. Describe the flow control system. 'kL N 3l vc s • • stormwater site plan template—rev.10/21/2008 "+ ' '" 6 • • 13. Describe the water quality system. tan- is TeSsi TAMA/SW A?- L E 0E1_. , auL' i ti/it/ - �s�v4-v�P-i7o�►-. ZoZv t -7Z) i ST/N( til ( 14-. 14. Describe the conveyance system analysis and design. j:.�t Ai LULL.TE.44- Sc?,ft--g4ee 4 Ker1PT S - 15. Describe the source of fill material, physical characteristics of fill material,and deposition of excess material. /VUGU� 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. 17. Describe the proposed surfacing material. ) t 18. Describe methods for restoration of the site. 4,[. TJ� 61Tafe 7? s I lb LA-I,1b 11/Lib 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. 11/ 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. N/4 SEP 1 6 2009 2EFFERSUN CUUNIY V1; stormwater site plan template—rev.10/21/2008 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 Volume II Section 3.2.3 of the Manual (beginning on page 3-7). 12 Required Elements-Construction SWPPP 1. Mark Clearing Limits. Arb Cc u PC, 2. Establish Construction Access. IC,'c -'- ,1-4)c-w 3. Control Flow Rates. �7aa �r w ti ( Ahtrze X./fez X./fez y /5X 1)tt ev...5 T1 4. Install Sediment Controls. A�AT-i ( )►tA Ta 3 (, P P L 3 w Luc& �IL0 PtiQN v E4 `st 4C3 5u A-it_oo AA ) t,k Lc- 5. Stabilize Soils. 6. Protect Slopes. Lo7" Fl ( �J o 56 o i S 7. Protect Drain Inlets. 01///4 stormwater site plan template—rev.10/21/2008 8 • • 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. Ai 1 k. 9. Control Pollutants. No Po L I L T,9- im c) O /w Pie_ckj E-c-7`. 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). tr/A'7 1L. W ILL A/O T. a GLs C% Air 4'/ S'r 11. Maintain Best Management Practices(BMPs). c1..4 u 1/r/w J`jTjLR c✓N-yc.L ?O AU--©FF .o nd 71 tale. D & , p. issoc ma's /RAILc- 12. Manage the Project. d f�11.aj c�-- 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). 774ri $ Pita ,Ty is l n CA-c D I' tiAbLt ( E_ YN JULL i z Q P: G• Na A b f 1 &ur zo b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). ��� ►� 2L S C 0>_!LA L S 1-rt L E_T5 Li-q D Mra Tc� 4,u-u*C.0 ( E.(C NA-4LE A y ©A.Tb Low tif. H->4-b L D c_K- I (IAA E= 04 frt. 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. /Vl A/E 5EN 1 6 2009 stormwater site plan template—rev.10/21/2008 F R S�� ��� O C 9 • for workingin or near environmentallysensitive areas. b. Description of special requirements MO a/2- 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). NO Ai - 5 ( %2 rS P—LIA l 1 G") €LL �AA-,rv/iU SeiC 5. Construction Phasing. a. Construction sequence HMO sr) )tt-O 3► L_ tk 61.4c 17'c)0 it_ 5c iti 10 A- J•J i Ht)4-£ Jr-)s 1'j G /V t<c:a..> 4-CrriAl5 Ks Yt 1 1 C.} -173�Cf� b. Construction phasing(if pro,osed) G 1410 scA-PE 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). Provide a proposed construction schedule. tin-o.,I er- GUL LL o c.L z 'i /0PPk Vie' 7)1 y ISS�4,0&F II. Wet Season Construction Activities. a. Pro osed wet season construction activities. Kivt.o J� "-/ hf Po S c 4 4 PUS 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. .ice �v� � Lvw b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. fLs L 1\7Ls PO e---, i t i l`I O f 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following, if applicable. a. Sediment Ponds/Traps. b. Diversions. c. Waterways. — d. Runoff/Stormwater Detention Calculations stormwater site plan template—rev.10/21/2008 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 of the affected property. --nteee.„ 47/11 ( •"'DOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: storrnwater site plan template—rev.10/21/2008 12