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HomeMy WebLinkAboutBLD2010-00106 •UILDING PERMIT APPLICADON MLA Review Type: 32 I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00106 Received Date: 4/8/2010 SITE ADDRESS: OLD GARDINER RD PORT TOWNSEND, 98368 OWNER: RAMON F BRODERS PHONE: 360-385-3840 5571 OLD GARDINER RD PORT TOWNSEND WA 98368-8732 JUNCTION CITY SUBDIVISION: Block: 13 Lot: 1-4+ PARCEL NUMBER: 964501301 Section: 13 Township: 29 N Range: 02 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: RICHARD BRODERS PHONE: 360-797-7722 4503 OLD GARDINER ROAD PORT TOWNSEND WA 98368 PROJECT DESCRIPTION NEW M/H TYPE OF WORK MOB SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 1,512 VALUATION CODE EDITION: 2006 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: PUBLIC BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 3 Prop: 2 Total: 3 Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Manufactured Homes $213.00 LYK 04/08/10 117538 Potable Water Application $98.00 LYK 04/08/10 117538 APPROVE Total: $311.00 'l 5 201E1 Jefferson ;ounty Planning &Building ^artment o schedule inspections, call (3160 379-4455 no later than 7:00 AM the day of the inspection. Requests received after 7:00 AM will not be scheduled for that day's inspections. ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries. The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection Inspection Item Date Approval Signature Notes Setbacks Setbacks Building setback from Old Gardiner Road right-of-way is no less than 4.; 1:14-}R}R=HiFFI sk►areli to setback is 35 ft. from the top of the bank; Erosion Control side and rear setbacks are no less than 5 ft. SEE CONDITIONS 2 & 3 Erosion Control MH Foundation (O'"2 Blocking&Tie Down Skirting&Ventilation Gas Line: Exterior Propane Tank Pressure Test Drywell/Alt Drainage SEE CONDITION 1 FOR TRENCH Drywell/Alt Drainage Address Posted FINAL INSPECTION 0._s-yo c----eij FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR SPECIAL CONDITIONS APPLY- SEE REVERSE SPECIAL CONDITIONS CASE #•BLD10-00106 • 1.) THE FOLLOWING MINIMUM LENGTHS (LINEAR FEET) PER 1,000 SQUARE FEET OF ROOF AREA BASED ON SOIL TYPE MAY BE USED FOR SIZING DOWNSPOUT INFILTRATION TRENCHES: COARSE SANDS AND COBBLES 20 LF MEDIUM SAND 30 LF FINE SAND, LOAMY SAND 75 LF SANDY LOAM 125 LF LOAM 190 LF MAXIMUM LENGTH OF TRENCH MUST NOT EXCEED 100 FEET FROM THE INLET SUMP. MINIMUM SPACING BETWEEN TRENCH CENTERLINES MUST BE 6 FEET. FILTER FABRIC MUST BE PLACED OVER THE DRAIN ROCK PRIOR TO BACKFILLING. A VEGETATED FLOWPATH OF AT LEAST 25 FEET IN LENGTH MUST BE MAINTAINED BETWEEN THE OUTLET OF THE TRENCH AND ANY PROPERTY LINE, STRUCTURE, STREAM,WETLAND, OR IMPERVIOUS SURFACE. A SETBACK OF AT LEAST 5 FEET SHOULD BE MAINTAINED BETWEEN ANY EDGE OF THE TRENCH AND ANY STRUCTURE OR PROPERTY LINE. NO EROSION OR FLOODING OF DOWNSTREAM PROPERTIES MAY RESULT. 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.) IF NEEDED, A SILT FENCE LL BE INSTALLED AT THE EDGE OF 35 FOOT LANDSLIDE HAZARD AREA UFFER PRIOR TO ANY LAND DISTURBI ACTIVITY. APPLICANT/CONTRACTOR SHALL BE RESPONSIBLE TO MAKE SURE THAT SILT DOES NOT ENTER DISCOVERYBAY. THE MINIMUM HEIGHT OF THE TOP OF SILT FENCE SHALL BE 2 FEET AND THE MAXIMUM HEIGHT SHALL BE 2 1/2 FEET ABOVE THE ORIGINAL GROUND SURFACE. THE SILT FENCE SHALL BE BURIED IN A TRENCH TO A MINIMUM DEPTH OF 5 INCHES BELOW THE GROUND SURFACE. THE TRENCH SHALL BE BACKFILLED AND THE SOIL TAMPED IN PLACE OVER THE BURIED PORTION OF THE SILT FENCE, SUCH THAT NO FLOW CAN PASS BENEATH THE FENCE AND SCOURING CAN NOT OCCUR. ANY DAMAGE TO THE SILT FENCE SHALL BE REPAIRED IMMEDIATELY. SEDIMENT DEPOSITS SHALL EITHER BE REMOVED WHEN THE DEPOSIT REACHES APPROXIMATELY ONE-THIRD THE HEIGHT OF THE SILT FENCE, OR A SECOND SILT FENCE SHALL BE INSTALLED. 4.) The application was reviewed by the Jefferson County Department of Community Development staff on June 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: Conservancy Shoreline Designation; Unstable Shoreline Slope Stability; Slight Landslide Hazard Area; Seismic Hazard Area; Susceptible 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.) Geologically Hazardous Areas in Jefferson County are characterized by slope, soil type, geologic material, and groundwater that may combine to create problems with slope stability, erosion, and water quality during and after construction or during natural events such as earthquakes or severe rainstorms. 8.) Marine shorelines and islands are susceptible to a condition that is known as 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. 9.) 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. 10.) A vegetative buffer of 35-feet shall be permanently maintained from the top or edge of the Landslide Hazard Area. All buffers shall be measured perpendicularly from the top or toe of the Landslide Hazard Area. 11.) A Geotechnical Report was 4110nitted in conjunction with the SPAAD appleon (ZON08-00092). The report addressed the stability of the geologic hazard area. A setback of 35-feet shall be measured perpendicularly from the top or toe of the geologic hazard (shoreline bluff) to the proposed single family residence. the applicant shall comply with the recommendations contained in the Geotechnical Report. 12.) Landslide Hazard Areas and their associated buffers shall remain naturally vegetated. Should buffer disturbance occur during construction, the Unified Development Code (UDC)Administrator shall require replanting with native vegetation. No alterations shall be made to the Landslide Hazard Area or its associated buffer without prior authorization by the UDC Administrator. 13.) Prior to and during approved construction activities, the perimeter of the landslide hazard area buffer shall be marked with a temporary sign. The sign shall be placed in such a manner that it can be directly observed from the construction area. The sign shall contain the following statement: "Landslide Hazard Area and Buffer- Do not Remove or Alter Existing Vegetation." 14.) All construction activities shall not encroach upon the landslide hazard area buffer. This includes the storage or preparation of materials. 15.) The applicant shall permanently separate the boundary of the Landslide Hazard Area Buffer from the remainder of the subject property through installing logs, trees, a hedge row, or any other prominent physical marking approved by the UDC Administrator. 16.) The applicant is proposing to create or add 1894 square feet of impervious surface and 5250 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. 17.) 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. 18.) 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. 19.) 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). 20.) The site plan as submitted with the building permit application on April 8, 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 June 3, 2010 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 21.) This approval is for a manufactured home and shoreline exemption permit (SDP10-00045) 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. 22.) The parcel has been designated as RR 1:5 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 23.) A Declaration of Restrictive Covenant has been recorded on January 20, 2009 under AFN 540012 for the purpose of consolidating the lots to meet minimum land area requirements for on-site septic and to allow zero lot line setbacks. The Covenant is strictly for building and septic purposes only. 24.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 25.) Not more than 2 unlicensed les shall be stored on any lot unless tot�creened from view of neighboring dwel ings and rights-of-way. Such screening shal 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. 26.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 27.) The road approach permit (RAP10-0002) 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. 28.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 29.) The building height is not to exceed 35 feet. 30.) Building setback from Old Gardiner Road right-of-way is no less than 20 ft.; minimum shoreline setback is 35 ft. from the top of the bank; side and rear setbacks are no less than 5 ft. If an environmentally sensitive area (ESA) is present, then the more restrictive setback shall apply. 31.) 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. 32.) 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. 33.) Residential developers and individual builders shall be required to preserve shoreline vegetation and reduce the associated risk of erosion during construction and any future activity which may impact the stability of the shoreline. 34.) An address of 5503 Old Gardiner Road has been assigned to the parcel. Old Gardiner Road is a County local access (C501109). 35.) The parcel is served by the Discovery Bay Village public water system. 36.) The parcel was created through the Junction City Subdivision December 28, 1889 no AFN. The map was recorded again on March 5, 1891 and re-recorded on March 30, 1891 under AFN 7057. 37.) A septic permit (SEP08-0234) was approved on March 16, 2009. A road approach permit (RAP10-0002) was approved on February 4, 2010. A shoreline exemption (SDP10-0045) will be issued with the building permit (BLD10-0106). 38.) NOTICE: This permit does excuse the proponent from complying wither local, state, and federal ordinances, regulations, or statutes applicable to the proposed development, but consistent with ROW 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 Conn ourtlwnsr ASSESSOR PO Box 1220, Port Townsend, WA 98368 (360) 385-9105 MOBILE HOME INFORMATION FORM OWNER'S NAME/MAILING ADDRESS: NAME: LA "nor) F e ADDRESS: S ce I CD ct J av 1 �e r Rct PHONE NO. 3 s3 -3 D 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 ni!A21 e (B) MODEL % 9 _S (C) YEAII2_ L7/4 (D) LENGTH 5—is/ (E) WIDTH .._!- (F) SERIAL # -ro 8-e ci-.e Tt via (G) YOUR PURCHASE PRICE (Do not include sales tax) u���STtia�e� PURCHASE DATE 2DI6 2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (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)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 Lot/Space # (C) IF NOT LOCATED IN MOBILE HOME PARK: NAME OF LAND OWNER: %r a w pv-\ 1- y-t)d-er LOCATION ADDRESS CCY b 1 v\- i R A REAL PROPERTY PARCEL #/DESCRIPTION 9[PY SD/—30/ 9'rio c/—S b/—. D THANK YOU FOR YOUR HELP! Signature of applicant Lauralee Kiesel, Property Technician • 511, ON G,O�\1pl -41n_.. JEFFERSON COUNTY W4 ' \� DEPARTMENT OF COMMUNITY DEVELOPMENT 'n PC 621 Sheridan Street • Port Townsend •Washington 98368 l 360/379-4450 • 360/379-4451 Fax gS�N��p www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: (b-- ( __ Project Description(include separate sheets as necessary): //I ST4// /hjJe fCii'»Jy ressicketr\c e ( roanCkVCC•Tit €ci. VUvhE. . Tax Parcel Number: q���—� �>� — / 9�y-�� ,261_ Property Size.: =� d �'� �} (acres/square feet) Site Address and/or Directions to Property: 55-0 3 G/d GGArcJuner /Zd Property Owner(s)of Record: ( ,..4 rY) c V) F 1 k2 U d e r s Telephone: . 6© ^ 3 3 - 110 Fax: email: �< r t p Mailing Address: J ,� 7 r O and►y e 1�1, i `. I • u O c�. . Applicant/Agent(if different from owner): F'I,"YYY;-N f't K( I`j Telephone: yq 7- 7 Fax: email: Mailing Address:_-15 3 i c1 - 70. t(lam (7."---(_ , j What kind of Permit?(Check each box that applies 0 Lot or Road Segregation �Iding ❑Critical Areas Stewardship Plan . ❑ Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) .Single Family 0 Garage Attached/Detached ❑Conditional Use[C(a), C(d),or C]** ,1 Manufactured Home .0 Modular 0 Discretionary"D"or Unnamed Use Classification i ❑ Commercial* 0 Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment ❑ Address 0 Road Approach 0 Short Plat** ❑ Home Business 0 Cottage Industry ❑Binding Site Plan** ❑ Propane 0 Long Plat** ❑ Sign - 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** ❑ Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions** ❑ 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 ❑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 r2 ' C c-1-A- B c d A€a�r�- �s to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE L• -l/ 1 % '°�'r-' Date: 7 -3/ /O 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 applicatio t he or she wants prior not Signature: 4 i .n r Date: 3 —.29 -J D 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 tederal 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-transferaabb sponsibility for adhering to a omplying wit the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: i/ [v ��Lt 7 f �' 7--'t�-- Date: 3 - 2`i / C • • 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 assuming/the responsibility of the General Co actor for the proposed project. Signature: ` Yh1 i I Co Date: 3 —30— /U GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: 65 c-UV) er — C1 hov-e ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSEI. WAINS NUMBER: N/ NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: w 0 Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: 2 Bank (1 Community System ❑ Alteration/Remodel El Concrete Total: 2,, Height: / dividual System ❑ Repair ❑ Masonry .7-9. SEP Permit# 50008 `Ob 23'f 0 Demolition Other: Bedrooms: Water Supply: M A►.ArAeTurr'D Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: f-7;}nt) Proposed: 71 3 5ubiic E=/ec•rit.YNAC2 Total: 3 Name of System: • DJ o eYY BkY V i I/46-e 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: 1 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 BId App Review: Floor Heated !I X Consistency Review: (9 i5-- Other Heated (( Base fee: Mezzanine — 0 4Q1 —Z7) Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: _ Other Unheated Pot Water Review fee: l I Garage/Carport SUBTOTAL Ca33 Decks 911/Rd Approach fee: Other TOTAL: $ Receipt Number: i 1--Fs Cash/Check Number: ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish J Initials: • • • ��.w,sON 0 0 �� JEFFERSON COUNTY : 1 DEPARTMENT OF COMMUNITY DEVELOPMENT ,. 621 Sheridan Street • Port Townsend •Washington 98368 �S�`IINO�O 360/379-4450 . 360/379-4451 Fax http://www.co.jefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE I MLA# I 0- �5.'C�� PROJECT/APPLICANT NAME: R awl I., y\ 8 � 0 44 d-E'_. I 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. "/'J c T A ti nr\A to FA e T u re a Al t w o f /S'/O '21 �('e s'I A�+nc,e o h egg A & ac,er r- T COu h For- s l h a l e Fa w1 i l y d�tie way o Feer F r ctCC- - road bl d yard i►ne,c rdf S�,o rT-Tea.* s5 . Si rE So// is A!1 m )uwi coarser 9r/G v42l, Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. Sjmatl u l le `� Y '7"O In cA('T ar�d-ers pro terry ahi bwiIdihg sire 'ts riQT and , FI ccr 5 road rov ,er gar/ £oad tel'5Ar OF W 4-0 • They. 51 a p s 1'a ward 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. ,V ?V-e S eciet 1 Q,) d hock e berry br,./sl, t.u)7-4 occec5iona/ mod mule_ Tree a») rrna// Fir trees, 4. Describe the existing soils. Indicate soil type on the site map. Sol I 'is eK-trevv ekv dN-y t.4.474) 9ra vie( w i-4, Sa nci rev)X Q user- e rvt-1 re ib r down -re, ar least- (Q Fear As Pererr,,►1nre:d 6y '► n/craI//4 j Dora in Fie/d 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. pry — n c ware r 1r v v\ WGcter dv.ri_ a w.e — oFF nR STaHdI�f �Y S��s-c`� I rorr, yQ years or Obler-vwrions. APPROVED 6. Describe any excess levels of noise ger erateSMP r a�aNnp1•�Qy'���� /!1 p'T",/113 4 CG T Ii bY'mGi dur4n9 Con.5^ -ruCT/d✓) Stormwate' =jt,i JUN - 3 2010 Required/ /ifl►�P.i- JEFFERSO UN Y DEPT.OF C E . P E stormwater site plan template-rev.10/21/2008 SIGNATURE: 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. er-c're v'€l/ 8,ry n o ru oFP. frbID v►S 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.). Lo c_Gt r r$ Di el 5 a T1.1 a,d ere-17see41 v11y rc5,�Q,�.ce a:e\ ©-t`her iovt.5-eS '- cw"• D LTG o\1 '/ $4ty $brle1s 1rA� S t: prU_rer-ry Z-iAvr A-Ptnrc X. / SS Fee,- Fro tH E f3 c-)!ding sirE, o Lp g411 0A Gira To Tkp sw 4/ bn9 tbp F E3ANk, 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. '-j i -rt. Th- SoV Type 4 1 -ro_po9'rty.pJ y STorw, 1.4)4 Ter to/ 11 noT b-e a pro ve. . -ry pica! drains trovnck house will d15p.ers-0-- a/l coF W4.7" Y rroVv1 1 u rrerS Jege>a.i it G(-t,l Ie,r 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. -ro HAv-e m i4Iinn.4) )M PAC 7 o ti Ar4,e, 5i m) t Ao 70 M of o f itQr /© I an'l°gt tt.S_Q S .r N k AtS-42 r-P a . 12. Describe the flow control system. : ` • N t`' • stormwater site plan template—rev.10/21/2008 • ,L q ' l i i 13. Describe the water quality system. a-l1 r-c, d.:h1 e - rvvx DFF f)/ye(e� -rA'v t L 54.4i/y-ra,,e/ exZS'Trti Sot 1. 14. Describe the conveyance system analysis and design. d ot,r,1i Spo urs rb a -eci' ea-suety r.eYFt •F1-ex ?t't3,c '' / Frame �loccse i� ro woods . 15. Describe the source of fill material, physical characteristics of fill material,and deposition of excess material. v ,y aY\ S1 Te rnt1.T-ev-I a ( U S .c. Nd fi/l c rket-- T114�'J 1)_Oil- 3 raid E r /,e ve4 f,tvi . 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. 2rivewAy cvv\sisrs olc e'\rvske, )rock- wIrk I ity•er- br- 3/ 11yiu4- cbvhpetcre y eXcav4.7ar, Nor wore Tlna X to Fool wld� 3a Fool- joh1 17. Describe the proposed surfacing material. 'a rd cs vn pd n/41 TCA ref g ra mme/ So;! ;`^ way 1�ee bDvr + 16 C Yvs]~ed roeK, 18. Describe methods for restoration of the site. 11 In a T/ 1 A n h a77 ce G n ti D ,LA crJ.vs No l�'15i" V oh 5E wa r-er ma�n7-�r►;,�� as � Qcr.6�r�-- As i r s �1-/r��� planred and a MY 6, 4/a as-P 4.v4 by t'►'��' - SArne 9�>1erat leiY\as (le 5 in Th-e area .. Mi.v,Miu ytrci area 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. Al 4- 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. Se jo-r e ra i n F e i c1 Pe-r r i rs eel lied 6. 11( Oeci — Sy57e4A i,U Su-r tidT dkr) r'` f ► ah('d A r)d AAts�s41>,0/ eir,.te wu y . stormwater site plan template—rev.10/21/2008 7 i e CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN (SWPPP) on. e indicated by the in The that follows o l wsSWPPPmust addresses e installed onlment and the ground rosion dur during all trol during const construction phases of hehprojects The proponent sareslp responsible template that follows 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. 2. Establish Construction Access. 3. Control Flow Rates. 4. Install Sediment Controls. 5. Stabilize Soils. 6. Protect Slopes. 7. Protect Drain Inlets. 8 stormwater site plan template—rev.10/21/2008 • . 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. 9. Control Pollutants. 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. 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). il/v rki i kl c../o Se e o To b' a rfioc,7e q b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). dowh ;u 711. 5 u_1 -ey ct eSrrs 6rvs10y Ares. 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. No SCD r-y bay jg /Sa fear asv.4y w >ti tie ?Gc71ye 6u rCei, RI)r IN f Cea fro-CS I)) de 1 TAi/4-^r- G,g r 7 11 r01../4 -h rvs t't'r, stormwater site plan template—rev.10/21/2008 9 • b. Description of special requirements for working in or near environmentally sensitive areas. NO eis u l p m e>nT iv/1hrh /oo F- er or Sh ore l r ii'e and n a d 1 sckli"rf'e5 On or- aver The A40,e, NO 0•Selewir'rv-e COWf fl o y 4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site soils(eg.,erodibili seleabili permeability depth,texture, ruct e).ty ty, ND N--o5i OvN -- sln/ � Sae 4 � a Ory A , 5. Construction Phasing. a. Construction sequence I CvnSTY vcT-Lie gelid Qn m i kiSra/i tin a ywi FAc 7-6,vrot occs--e -rv.c ti Fur v1-.1 I't rr es b. Construction phasing(if proposed) 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). I. Provide a proposed construction schedule. ND AC0W-em5- No MUD ovc— _Tref v1t.ill cJGc7-Pr 0156erVe I YA A-N/ 7eu5o h P'1-`1 wseaT ke`s' r tv IT 411 Ai 1 a y1 p r-e f-e�(4..1.. II. Wet Season Construction Activities. a. Proposed wet season construction activities.it1DT A ArT)Ci paTea. S ir- S}1'FStr/ }5 cI'c/ Ju^r.'ny uxt SettSarMI, b. Proposed wet season construction activities for environmentally sensitive areas. Ai O Al C-- 7. Financial/Ownership Responsibilities. a. Identify the property owner responsible for the initiation of bonds and/or other financial securities. b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. 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 10 stormwater site plan template-rev.10/2112008 • • SECTION II—EROSION AND SEDIMENT CONTROL PLAN Sediment and erosion control measures may be depicted on the master land use application plot plan, a stormwater site plan, and/or a separate Construction SWPPP site plan. This is a checklist to ensure that the following are depicted on a site plan: 1. General. Vicinity Map b. Jefferson County Approval Block mac. Erosion and Sediment Control Notes 2. Site Plan. tea. Legal description of subject property. lb. North arrow. Indicate boundaries of existing vegetation(e.g.,tree lines,pasture areas, etc.). cd' Identify and label areas of potential erosion problems. <e' Identify FEMA base flood boundaries and Shoreline Management boundaries(if applicable). fr Show existing and proposed contours. /g. Indicate drainage basins and direction of flow for individual drainage areas. h. Label final grade contours and identify developed condition drainage basins. it Delineate areas that are to be cleared and graded. j. Show all cut and fill slopes indicating top and bottom of slope catch lines. 3. Conveyance Systems. A. Designate locations for swales, interceptor trenches,or ditches. _Ix Show all temporary and permanent drainage pipes,ditches, or cut-off trenches required for erosion&sediment control. c. Provide minimum slope and cover for all temporary pipes or call out pipe inverts. d. Shows grades, dimensions, and direction of flow in all ditches, swales,culverts and pipes. e. Provide details for bypassing off-site runoff around disturbed areas. f. Indicate locations and outlets of any dewatering systems. 4. Location of Detention Best Management Practices (BMPs). Identify location of detention BMPs. 5. Erosion and Sediment Control Facilities. a. Show the locations of sediment trap(s), pond(s), pipes and structures. b. Dimension pond berm widths and inside and outside pond slopes. c. Indicate the trap/pond storage required and the depth,length,and width dimensions. d. Provide typical section views through pond and outlet structure. e. Provide typical details of gravel cone and standpipe, and/or other filtering devices. f. Detail stabilization techniques for outlet/inlet. g. Detail control/restrictor device location and details. h. Specify mulch and/or recommended cover of berms and slopes. i. Provide rock specifications and detail for rock check dam(s), if applicable. j. Specify spacing for rock check dams as required. k. Provide front and side sections of typical rock check dams. I. Indicate the locations and provide details and specifications for silt fabric. m. Locate the construction entrance and provide a detail. 6. Detailed Drawings. Any structural practices used that are not referenced in the Ecology Manual should be explained and illustrated with detailed drawings. 7. Other Pollutant BMPs. Indicate on the site plan the locations of BMPs to be used for the control of pollutants other than sediment(e.g., concrete wash water). 8. Monitoring Locations. Indicate on the site plan the water quality sampling locations to be used for monitoring water quality on the construction site. Sampling stations should be located upstream and downstream of the project site. stormwater site plan template—rev.10/21/2008 11 • • Stormwater Site Plan Changes If the eigoer CD pri to aconstruction.es orTherevisions submittal) shal9includeinally pproved substitute pages thatlt include the proposed shall be rawngsubmitted to prior 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 inn-site stormwaterr management BMPs),on of conveyance the appems, licant shalltment lities,submit ow a finalt corrected plan (tas builts)when the project s (not standard on site 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 test that made with the informationfuil providedde and in is strueofad ll correct to the best of my knowledge. I also certify that this applicationbeing owners of the affected property. t!(/-4/2 3 3 e)-- /6 (LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: 12 stormwater site plan template—rev.10/21/2008 sx z q , — ,.., . •. , •,' ' • , . • , .. ,:. ,, ., * PRODUCTION 9598-S ;2' 0" 72 x 80 SLIDING 1374 SQ. FT. Ass°°°R 46 x 59 36 x 36 46": 59 .,�.„a.,- 36 x 80 46 x 40 ® b Oven il ii,-- Micro � t ( UTILITYr£=m C)' KITCHEN DINING RM. _s' 8" x • lin1 Y ��� � �I UNEN Pantry F.Il/ -MST_O �i a- ,40A t, —BATH - --(4. ,, ..n,,,,..,,,. ........-.. r.,-- ...... .....:..„,„„. .. LIVING ROOM - MST. 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