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HomeMy WebLinkAboutBLD2010-00007 •UILDING PERMIT APPLICAS)N MLA10-T Review Type:pe: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00007 Received Date: 1/6/2010 SITE ADDRESS: 211 MIDDLEPOINT RD PORT TOWNSEND, 98368 OWNER: DAVID F BARROWS PHONE: 361-729-0779 CAROL S BARROWS 131 HERON OAKS ROCKPORT TX 783824332 SUBDIVISION: Block: Lot: T 11+ PARCEL NUMBER: 001064001 Section: 6 Township: 30 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI NEW M/H - SER# PH2O-9984A&B TYPE OF WORK MOB SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 1,404 VALUATION ADD'L: HEAT TYPE: EEE CODE EDITION: 2006 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: SHORELINE: CONST TYPE: GARAGE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: PWELL BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 3 Prop: 2 Total: 3 Total: 2 Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Manufactured Homes $213.00 LYK 01/06/10 113610 Potable Water Application $62.00 LYK 01/06/10 113610 APPROVED Total: $275.00 FEB 5 ZUltl Jefferson County Planning & Building Department MANUFACSED/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 #: BLD10-00007 Received Date: 1/6/2010 SITE ADDRESS: 211 MIDDLEPOINT RD Issue Date: 2/3/2010 PORT TOWNSEND, 98368 APPLICANT: DAVID F BARROWS CAROL S BARROWS 131 HERON OAKS ROCKPORT TX 783824332 SUBDIVISION: Block: Lot: T 11+ PARCEL#: 001064001 Section: 6 Township: 30 N Range: 01 W CONTRACTOR/ OWNER/BUILDER PHONE: DEALER PROJECT DESCRIPTION: NEW M/H -SER# PH2O-9984A&B fycl RC r p q2.ci2(CJtY MAKE: PALM HARBO YEAR: 2010 SIZE: 63X28 Directions To Site: 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 FINAL INSPECTION FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR SPECIAL CONDITIONS APPLY- SEE REVERSE Inspection Item Date Approval Signature Notes SetbacksV( o `---- 2/ Drywell/Alt Drainage Erosion Control ii• SkirtingNentilation .S i t\k O 91, _ Pressure Test Propane Tank d 1 %) 1O Gas Line/Exterior 41) 1° Blocking & Tie Down `I/22[/0 ✓ M/H Foundation ���//� s91-- • Address Posted (0-1Q—(© 14' Final Inspection/C.O. '� "10 lIA5;6Ps 0(t i�ronfr ;,s ce)4e ec.ic 411 SPECIAL CONDITIONS CASE # BL•D10-00007 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.) CONSTRUCTION ENTRANCES SHALL BE STABILIZED 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.) The application was reviewed by the Jefferson County Department of Community Development staff on February 2, 2010 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: SUSC aquifer recharge area. 4.) 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. 5.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to groundwater aquifers. 6.) 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. 7.) The applicant is proposing to cre or add 3775 square feet of impervious sike and 1950 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. 8.) 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. 9.) 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). 10.) The site plan as submitted with the manufacture home installation application on January 6, 2010 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 February 3, 2010 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 11.) 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. 12.) The parcel has been designated as RR 1:5 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 13.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 14.) 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. 15.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 16.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 17.) The building height is not to exceed 35 feet. 18.) Minimum setback from Middle Point Road right-of-way shall be 20 feet. Minimum side and rear yard setbacks shall be 5 feet. 19.) 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. 20.) 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. 21.) An address of 211 Middlepoint Road, Port Townsend has been assigned to the parcel. Middlepoint Road is a county local access (C627509). 22.) The parcel is served by an on-site well. 23.) A road approach (RAP09-0068)was approved on November 5, 2009. A septic permit (SEP09-0030)was approved on April 10, 2009. A well review(USR09-0005)was finaled on January 25, 2010. 24.) The road approach permit(RAP09-0068) must be inspected and finaled by the Jefferson County Department of Public Works prior to the final inspection/certificate of occupancy of this residence. Contact Terry Duff, Department of Public Works at 360-385-9159 for the final road approach inspection. 25.) NOTICE: This permit does not Oase the proponent from complying with of ocal, state, and federal ordinances, regulations, or statutes applicable to the propos d 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. JACK WESTERMAN III Jefferson ConntSurthouse ASSESSOR 1'O Ilox 12.20. Port Townsend, 1111'A 98368 43601 :385-9105 MOBILE HOME INFORMATION FORM OWNER'S NAME /MAILING ADDRESS: NAME: Dc,0 N ct►n CO, C ( 6o'c- ' ADDRESS: i 3 i / Jr S) Roc i o>rT , 1x' 7g.) 3 ; PHONE NO. se/- Z 3 0 -- cj VS- 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. I)MOBILE HOME DATA: (A) MAKE PQ Ihn /TUN-i)O\r fI0wt•r S (B) MODEL_ `! P 3502S _(C)YEAR a 0 1 0 (D) LENGTH PH 2o-c L1 A I'5 (E)WIDTH )- S (F)SERIAL # cre (G) YOUR PURCHASE PRICE(Do not include sales taa 1 .2 0 I< PURCHASE DATE NcTe 2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO tt QUESTION 3) 1l (A) FROM WHOM DID YOU PURCHASE MOBILE DIM le`r - Pal , 1/ax- ew- f idled f T ADDRESS 1(r0i' �/ S Ave • Ftfc 1n/A ci FfA X`1 (B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR? Yes Nosy 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? Yes No (B►IF LOCATED IN MOBILE HOME PARK: NAME & ADDRESS OF PARK N/p Lot/Space # (C) IF NOT LOCATED IN MOBILE ROM PARK: NAME OF LAND OWNER: 10 cw d a+' Ccore ! 3 a' 1c- S LOCATION ADDRESS =2 // w.S T M J I.e pc) ) r1 t `i'o r 1 1 ow,t 5'en0), w sal REAL PROPERTY PARCEL #/DESCRIPTION 0010 (o 00 / Signature of applicant THANK YOU FOR YOUR HELP! VI 0 11 Lauralee Kiesel, Property Technician Do�'�''1 1 61 M PL, t v{ ° r,— �' (' Ct. Fj ►' u � >otl h r r1 Pc rS Sct�t,� , ,„... „ ieilvAL. . , t ir. ......0..i,z ............. . 6:4 a li I I I a a i 0 in 1 LC) LL. C•I ol I 17 LO Cv) IN gii ...1_ 74 ,,C sTop N\tyto/ricAsanco (6) 0 1 It - . — * (...1 J1_,J M ! ox CONVIR.M.AllbN ' -\) II 1111‘ 4111 .n AN 3 p.utu;WICKVICF: , _•„ (ill tjj% 0 CI rit 0 01.111114= tl:li A1:1 >7 2 n n z.."= \ • es. l..._J . • ----41 0 • C: Ank\ Eli G \mg 0 - 0 ; _......... .....____,„„. 0 0 V) • 0 - : _ --, 1 _ .,..„ i V V 6 It . : 4 OWMUM 14 Ininai !" C4k • V in I Ci .ri (2) 1 --AMMO 1 =..1" g o w } . 8 ... ,......,,\c, RECEIVED 11-18—'09 17:32 FROM— TO— P003/005 1 • • "SON 68 tww . JEFFERSON COUNTY 1 DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend•Washington 98368 O 360/379-4450 •360/379-4451 Fax -fiNG�' http://www.co.jefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPL. TE MLA# PROJECT/APPLICANT NAME: C QY o l 1-L o 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. � P 10.C r ir'Yl r K�t �` f ct, i y X a t 1 Gl a r A S t' Lu t t L A p Y ©cr C'.i Existing Conditions Summary r I 2. Describe the existin topography. Indicate contours on the site map. km e tt S.-d,r e ors 4 �-1 t Nr c(L"To I n[ ►Q rI. S;jr 7eingix sIalrt .10 A)w • A�` ro-iCI�"a`l(r tl.r-C I is ' per 100 '- Lq iS 4 c'lcc 0) ,A: :1, Tree S a.. a -7"1e v*5-estcIi IQ vt • 3. Describe the existing vegetation. Indicate native vegetation are/ais on the site map. T Na:vK 1- teY,C okrleii_sentA1 r Lk) 7'-i) s• Ira 7i ati (1 �Io'ca I k►1 t 0.� ie►( r'ov ev g .'u IN to E • 4. Describe the existing soils. Indicate s/oill tlyrp m e on the site ap. 0 } —to S c i I SO Nt'C C i Q+ i n wo Si l/1 (3 eev•P ry) Co LIT S ► 5d ncii• 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. IV SSll't 1rretwt b - Cu Nr` aCY wa P` - preSe Lk avt 5 t 1- leq d— on '�iItta'ti0✓1 OCCJ - S T Lvov 9ln oot sit? , N v- 0� c 7 T n►crgS• 6. Describe any excess levels of noise generated by the proposed use or activity: a., S i d r vt. j ct/ a NC t 0. IS sLirldrc) A SoN-fs -1T 1 aNcI' a • APPROVF1L STORMWATER PLAN stormwater site plan template.doc—rev.10/1 Is F E B - 3 2010 �/ StoroN Required JEFF RS UNT DEPT.OF CO, TV EVELO SIGNATURE: • 4111 7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams, steep slopes,etc.)on h jthe site. Indicate location on the site map.— Y t { O Q I O ) ` d r o 1 Ow YOAd ©V1 64 let -SO'rrS G • Cot- t � e t0Ccs.-ic 3 .S ' o rvk b-o a W. 8. Describe the general vicinity of the site, including adjacen land pses a d structu es, utilities, oads and sensitive/critical areas (streams,wetland1s lakes,steep slopes,etc.). at s 1 ,.IA . i�t I O S c i&.�T $O\c-e i le-Ct( dtfQ.S� WPS � (��IY 'Di � 7Q� t'ov S IY S Ceti> 7� ) a cl eaS 1 c-Cfel• Permanent Stormwater Control Plan This portion of the Stormwater Site Plan consists of the selection and installation of the appropriate storrnwater control BMPs and facilities to remain in place after constriction 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 nd differentiate proposed facilities from existing facilities. Lva s.ToY ry Us} I—{ 5- u/ 1. ell �rYS•r a S w { II Or I YN T rt t-d.q P C 0 rug l �r C C ', 10. If the project requires the use of stormwater treatment facilities, describe the types of storrnwater 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.] 11/4-1//9 11. Describe the performance goals and standards applicable to the project. Al/ 12. Describe the flow control system. N7/1 stormwater site plan template.doc-rev.10/12/2003 • • 13. Describe the water quality system. NM 14. Describe the conveyance system analysis and design. I /4 15. Describe the source of fill material,physical Oaracterislics of fill material,and deposition of excess material. N© n► r I-1 v1k< 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code.fl!O C ✓ t c L D}r S 0 f" i 1 1t r lore S pyo P O sP 04 17. Describe thy proposed surfacing material. r I /r / 3fq " /71 fI? V S C.IrvS kr c't YOC 1 Q,'S Off tyr c ,4OY (rNohrvoO`._i 18. Describe methods for re ratio of the site. �,C / On1� v.t5r-t�-ti 0A ch s Lvxc II< C! wt/ i /Y 4of dr%NJwway. ay.ay.ri ! Q•r S f • N r ur_r�SS t •r-}t a )rk 7�c r Y s 7'4 S 1'1-v kg w ►JI b-c p 1[a vN 4�r j Z-o 0 3"S 5� c tx S'L v�r Lr of 1 o 1-ov • 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.] tf included,list the Manuals here. N f/ l 20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan. AJf/ 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. -cTi ► c -arr, ro cct — Se 09— oo030 ff tt+.c1I c© r, r 'e?t1- wZI (19yL - Ui ►f ur tco10 i ) .THG- Ai'.q i29/ ftAP - 000L. R - a� r1-is r 00.51S wfil ctll lxs -%he QBObW rr uSr . cq - ooO3- - q 1re4tti Ati est zS P� slv Nstlf 1114- '�tr1 rr � stormwater site plan template.doc—rev.10/12/2003 7 O • • 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. ) I a-cey Q 5-e c Y e 0. t NV r�1 1 11{ tM ay f`Y (1 2. Establish Construction Access. /} CCCS S t S ► v‘ 1, jaCY 3. Co trol Flow Rates. r VU0. ter d N `tS 'revSrS' di," Ih4iItrc rS �It1tl. y Nof%t i(- vA O��s. 4. Install Sediment Controls. N/ii" 5. Stabilize Soils. N/r 6. Protect Sloes. O&/ C Ygrlvt QC tv\--t oNA S f 0 pe • 7. Protect Drain Inlets. N/A1 JAN - 6 261,O stormwater site plan template.eoc—rev.10I12/2003 • • 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. N`i9 9. Control pollutants. I 1 r 1--cis , s o% I t 04 cl Y v.v - j� v\ c)i l a+�J4t 5 ? a -c S iQ b1't • No 'r af'1(Jitm �n I v,,,'1) �� t►Tt o (1V t'e c! a n S j► 1/S w, 1 r h r C (keg,pi rl o i v►1 N?r d i el /1 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). IU/A 11. Main in B st Man gement Practices(BMPs). L'`t-a afr rf1 av-eas w�till l jj ro Sfc Di deli ) —Io ihsuvr vt5 't `fa 1 d,il , S .eS'tohit shr d • 12. Manage th Project L 0tA rV- O �?Nrct 0\-, LoNira(1O`f wtlJ rIe‘ci0+INN all S1�r WO�1� end C©h l \ve�tov , c leoYl►ts alkyl a d h•e,r to � 3 . 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). .}_ i r r /4 tf c w v, .N �r-o p t.- or S W%11 i.et h r a 14'r �r r/ A.j S r�r (�\ s"1u^�r hahcrS • 3 �, �' will Z, .1" a it t+ b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). N o Civa (ras ,o raZl 4 -1 iS S • 3. Environmentally Sensitive Areas. a. Description of nvironmen Ily sensitive areas at are on or adjacent to the si�,�aF. e Ill O a dq cx cr vcr eY oV1— S(Te fo v moll rm GOrrGO )f - SeR Stvy, 1 avraS stormwater site plan template.0oc—rev.10/12/2003 6 1 • s b. Description of special requi ements for orking in or near environmentally sensitive areas. IV p It' V t Y f /r e itT e-jC 1 S7S 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). As (orq as so- Wt r/VaIrv• tS sl0 ceY% CeF1�ra�eNl i"roCl & okit Il toor occuY- 5. Construction Phasing. a. Constructio sequence /r I Cjroc �►'�< and Cto -r s P . �s S 1h co4C`�flf i11 Q�ro v� (�( • Cohsl\vcy Cj(1 (O ) >oLY covtCYfir cs 0 ) b. Construction phas'hh,,g(if proposed) N !/y 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). Provide a proposed constructi n schedule. N c 9reei i c tv4A\ _TO Co,i^ Si-YVQ4IO►t l i1NY ti • II. Wet Season Construction Activities. a. Proposed wet season construction activities. N//4 b. Proposed wet season construction activities for environmentally sensitive areas. AVA 7. Financial/Ownership Responsibilities. a. Identify the property owner responsible for the initiation of bonds and/or other financial securities. N//) b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts/ N /i 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable. a. Sediment Ponds/Traps. N/A b. Diversions. c. Waterways. d. Runoff/Stormwater Detention Calculations I A N - ;;gin sh rmwater sfte plan templateAoc—rev.10/12/2003 • s 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 owner a aff cted�ruperty. pez. 20 bet in (LANDOWNER OR AUTHOR! ED REPRESENTATIVE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: stormvater she plan template.cbc—rev.10/12/2003 12 lk �' ON CO • • wow L� JEFFERSON COUNTY ' DEPARTMENT OF COMMUNITY DEVELOPMENT '' efi ` `4 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax g �N��O www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: tO-C9 Project Description(include separate sheets as necessary): 13 Q t ‘..c I,,L; S ge 0,e _____ ...1.0 VA Tax Parcel Number: 00/0 4 00/ Property Size: ;, 63A/y 37,),g(acr s/square feet) Site Address and/or Directions to Property: `1 1 ,_V// \A 1T P9L GI (1' ,C1 v i \di,St+ Cr, (I a S 1 i o STfi 0 0 ), I"(, 4ri (0 ? N C 7 - Property Owner(s)of Record: '1)#1\ i i 1) 4 yr C'a�.-e I ll CI-TV 1r 0%--t) S / Telephone: 3&/ a 3 0- 4 4/S L) Fax: email: t�►--fi 7 3(1'6 ct S (3 L&i c tic.), Na/ Mailing Address: 13 ( 14 P r-©✓t Oct k S , t' cc r p G t-t 1 TX 7? 3 a ea, Applica Agent .'f different from owner): jolt a l el 1I c f�t'e.c q I H,(JdJf f�O l n t id 9 8'3 Ice Telephone: Ip O — 7.7•-r "' 2 d q Fax: mail: Mailing Address: CrIA/ 'S M1 •P-©, t) PoY7 To Lon S e n J) w Fl Q' r3 L & What kind of Permit?(Check each box that applies 0 Lot or Road Segregation IXIBuilding 0 Critical Areas Stewardship Plan O Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) RI Single Family 0 Garage Attactiedl 9etgit@d 0 Conditional Use[C(a), C(d),or C]** �Manufactured-Marne,brne, . 0 Modular - 0 Discretionary"D"or Unnamed Use Classification ❑ f;ommeicta!-t----' 0 Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment O Address J Road Approach 0 Short Plat** ❑ Home Business 0 Cottage Industry 0 Binding Site Plan" O Propane 0 Long Plat** 0 Sign - 0 Planned Rural Residential Development(PRRD)/Amendments** 0 Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** ❑ Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions** i$'Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development** 0 Temporary Use 0 Shoreline Management Variance ❑Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendment O Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference ❑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 S to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE ! ja,'I'r-P.I , Date: //' //° 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.)nspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the appli i n thayt't or nts prior notice. Signature: t?/> c'-/ {E[[c V Date: /lc 7/` 0 9. 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-trans;.erable r / s for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: 11�C.tt�i d 44 1. '—K/ Date: /{/r /i' 0 0 BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be Turfiing the r Dopsibility the General Contractor for the proposed project. Signature: ',Wilt u-1,,r CCl0`"Q,, Date: //47/' C 9 GENERAL CONTRACTOR OR MANU ACTURED HOMEINSTALLER: PHONE: FAX: A T 14orne c U1C -S' ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: O 3 / NUMBER O 3 3 L/ ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: i ,c (,, 3-I Sr A''e- is) Fir, w1q creg1/ EMAIL &MaV4o pcti0k ' -bcli.. (..0rri Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: 'New ' Wood Existing: 0 ❑ Sewer ❑ Addition k Steel Proposed: Z Bank NiA ❑ Community System ❑ Alteration/Remodel 0 Concrete Total: 2_ Height: t Individual System O Repair 0 Masonry SEP Permit# S G P O q"d OCR 30 ❑ Demolition 0 Other: Bedrooms: Water Supply: Existing: 0 Setback: X Private well ❑ Two Party . Ty L of Heat: I ,I 1 Proposed: 0 Public i✓ C: CtKTCa r 1'tea"f Total: 3 1 Name of System: r A/G v' 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 i For Office Use Only Amount Revision Main Floor Heated EH Bid App Review: ��11-i0y 2nd Floor Heated Consistency Review: Other Heated Base fee: F- Mezzanine Additional Section: Heated Basement Plan Check fee: _._--__- Unheated Basement State Surcharge fee: _ _ _-_- Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL :D-.-' - Decks 911/Rd Approach fee: _�__— ——(`�' Other TOTAL: $ t) Receipt Number: ` 1 7 tb Cash/Check Number: Z 322_ ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish (—Li.it) Initials: -,., ..•J-_____,uu4tc'Dt4c4444\rnen cnDX C\r.,—....TIDTI G,.....,-\Ar,,...e.no....,:«A....t:,...«,..,c 10 na,a,..- >- . •-ta . glik4 co ::::4 - Oi 71). '47-, .x 1-- `�� w v) ,i) = H o d o tic n 41 Z w pVII coCD o� CM o o cn X •ii cc p Z _ o c c m Q I z �o v n E °' cco .a a� m C3 c w CO N N , .' ` 1 vi m c�i w U f� U c�i ii 0 v LL ;2 ao. 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