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HomeMy WebLinkAboutBLD2010-00160 • • CERTIFICATE OF OCCUPANCY Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 (800) 831-2678 Al Scalf, Building Official PERMIT #: BLD10-00160 SITE ADDRESS: 6503 CENTER RD Issue Date: 08/4/2010 CHIMACUM, 98325 Final Date: 10/21/2010 APPLICANT: KURT T WAGGONER PHONE: 360-340-5723 PO BOX 248 PORT GAMBLE WA 98364-0248 SUBDIVISION: Block: Lot TX 2+ PARCEL NUMBER: 801161003 Section: 16 Township: 28 N Range: 01 W PROJECT DESCRIPTION: NEW M/H - (OAK GROVE 4563A) 031-17522) 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 10/21/2010 I:\F_BLD_Occupancy.rpt 10/29/19 MANUFA•URED/MOBILE HOME INSTILLATION PER MIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD10-00160 Received Date: 5/17/2010 SITE ADDRESS: 6503 CENTER RD Issue Date: CHIMACUM, 98325 8/4/2010 APPLICANT: KURT T WAGGONER PO BOX 248 PORT GAMBLE WA 98364-0248 SUBDIVISION: Block: Lot: TX 2+ PARCEL#: 801161003 Section: 16 Township: 28 N Range: 01 W CONTRACTOR/ OWNER/BUILDER DEALER PHONE: PROJECT DESCRIPTION: NEW M/H - (OAK GROVE 4563A) 031-17522) MAKE: FLEETWOOD YEAR: 2001 SIZE: 54X24 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 Setbacks 1-) - tv /, Erosion Control MH Foundation c - Blocking&Tie Down 9—'-'p Skirting&Ventilation Gas Line: Exterior Propane Tank Pressure Test Drywell/Alt Drainage Drywell/Alt Drainage splashblocks see condition 2 Address Posted Vex t IYU l ti6,1 A1,1,F.L1 FINAL INSPECTION rO_Z1- 10 FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR SPECIAL CONDITIONS APPLY- SEE REVERSE ItUILDING PERMIT APPLICADN ML 188 Revv iew iew T Tyype: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00160 Received Date: 5/17/2010 SITE ADDRESS: CHIMACUM, 98325 OWNER: KURT T WAGGONER PHONE: 360-340-5723 PO BOX 248 PORT GAMBLE WA 98364-0248 SUBDIVISION: Block: Lot: TX 2+ PARCEL NUMBER: 801161003 Section: 16 Township: 28 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: KATHERINE MORGAN PHONE: 360-930-0537 22461 MILLER LANE POULSBO WA 98370 PROJECT DESCRIPTIOt NEW M/H - (OAK GROVE 4563A) 031-17522) TYPE OF WORK MOB SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: 1,242 CODE EDITION: 2006 ADD'L: HEAT TYPE: EEE OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: OTHER: GARAGE: SHORELINE: CONST TYPE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: 2WELL BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 3 Prop: 2 Total: 3 Total: Routing Date: —10 Type Amount Paid By: Date: Receipt: Approved/Date Manufactured Homes $213.00 LYK 05/17/10 117704 APPROVED Potable Water Application $98.00 LYK 05/17/10 117704 Total: $311.00 AUG .4 2010 Jefferson County Planning & Building Department • SPECIAL CONDITIONS CASE # BLD10-00160 1.) THE PROJECT IS SUBJECT TO COMPLIANCE WITH THE DEPARTMENT OF ECOLOGY IN STREAM FLOW RULE OF WRIA 17. THE PARCEL IS LOCATED WITHIN THE CHIMACUM SUB-BASIN; AS SUCH, THE FOLLOWS IS REQUIRED: 1. WATER USE SHALL BE LIMITED TO DOMESTIC USE ONLY, AND SUCH USE SHALL NOT INCLUDE OUTDOOR IRRIGATION. "DOMESTIC USE" MEANS USE OF WATER ASSOCIATED WITH HUMAN HEALTH AND WELFARE REQUIREMENTS, INCLUDING WATER USED FOR DRINKING, BATHING, SANITARY REQUIREMENTS, COOKING, LAUNDERING AND OTHER INCIDENTAL HOUSEHOLD USES, INCLUDING POTABLE DOMESTIC WATER REQUIREMENTS ASSOCIATED WITH COMMERCIAL AND INDUSTRIAL PURPOSES. (WAC 173-517-150(8)) 2. INSTALLATION OF A WATER METER, MEETING DEPARTMENT OF ECOLOGY SPECIFICATIONS, IS REQUIRED FOR ALL NEW USES THROUGHOUT THE WATERSHED. (WAC 173-517-180) BROCHURES WITH SPECIFICATIONS ARE ENCLOSED WITH THE PERMIT. REFER TO ENCLOSED DOCUMENTS FOR MORE INFORMATION OR CONTACT ECOLOGY AT 360-407-6300. 2.) DESIGN CRITERIA FOR SPLASH BLOCKS: 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. 3.) The application was reviewed by the Jefferson County Department of Community Development staff on July 29, 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, the following ESAs were confirmed to be present on the subject property: Two Type N Streams, Wetlands. 4.) A letter dated May 1, 2009 and a critical area study dated November 13, 2008 prepared by Loggy Soil an Wetland Consulting were submitted to address the wetlands and the streams on the subject parcel. Originals of the letter and special report are filed in MLA08-00494. 5.) Jefferson County has determined that the use of real property for agriculture and forestry operations is a high priority and favored use in the county. The county will not consider to be a nuisance those inconveniences or discomforts arising from such operations, if such operations are consistent with commonly accepted best management practices in compliance with local, state, and federal laws. If your real property includes or is within five hundred (500) feet of real property designated as Rural Residential 1:10 or 1:20, Rural Industrial, Rural Commercial, Agriculture, or Forestry, you may be subject to inconveniences or discomforts arising from such farming and forestry operations, including but not limited to noise, tree removal, odors, flies, fumes, dust, smoke, the operation of farm and forestry machinery during any 24-hour period, the storage and disposal or manure, and the application of permitted fertilizers and permitted pesticides. One or more of these inconveniences may occur as a result of agricultural and forestry operations which are in conformance with existing laws and regulations. 6.) Two Type N Streams (Fish Wildlife Habitat Conservation Area) haven identified on the subject property. The reams will require a buffer of 75-feet. The er shall be measured horizontally from the Ordinary High Water Mark (OHWM). Fish and Wildlife Habitat Areas shall also have Buffers and Building Setbacks established. 7.) Stream and wetland buffers are areas that shall be maintained in their natural condition, however, minor pruning or alteration of vegetation may be permitted as long as the function and character of the buffer are not diminished. 8.) Among the native conifer species which may be used in buffers or for re-vegetation include, but are not limited to: Grand Fir(Aibes grandis), Sitka Spruce (Picea sitchensis), Shore Pine (Pinus contorta), Douglas Fir(Pseudotsuga menziesii), Western Red Cedar (Thuja plicata), and Western Hemlock (Tsuga heterophylla). Among native tree species which may be used includes: Vine Maple (Acer circinatum), Big-Leaf Maple (Acer macrophyllum), Red Alder(Alnus rubra), Pacific Madrone (Arbutus menziesii), Quaking Aspen (Populus tremula), Black Cottonwood (Populus trichocarpa), Bitter Cherry (Prunus emarginata), Oregon White Oak (Quercus garryana), Cascara (Rhamnus purshiana), Pacific Willow (Salix lasiandra), and Scouler's Willow (Salix scouleriana). Among the native shrub species which may be used are: Sevice-Berry (Amalanchier alnifolia), Red Osier Dogwood (Cornus stolonifera) Salal (Gaultheria shallon), Ocean Spray (Holodiscus discolor), Indian Plum (Oemlaria cerasiformis), Pacific Ninebark (Physocarpus capitus), Red Flowering Currant(Ribes sanguineum), Wild Rose (Rosa nutkana), Swamp Rose (Rosa pisocarpa), Willows (Salix ssp.), Red Elderberry (Sambucus racemosa), Snowberry (Symphoricarpos albus), Evergreen Huckleberry (Vaccinium ovatum), Red Huckleberry (Vaccinium parvifolium). 9.) All construction activities shall not encroach upon the stream and wetland buffers. This includes the storage or preparation of materials. 10.) A setback of 60-feet, measured perpendicularly from the wetland edge, shall be permanently maintained as a buffer. No filling, grading, clearing, or other alteration of the wetland or its buffer is allowed. 11.) Buffer perimeters shall be marked with temporary signs at an interval of one per parcel or every one hundred (100) feet, whichever is less. Signs shall contain the following statement: "Wetland & Buffer- Do Not Remove or Alter Existing Vegetation." 12.) A permanent physical separation along the upland boundary of the wetland buffer area shall be installed and permanently maintained. Such separation can include installing logs, trees, a hedgerow, or any other prominent physical marking approved by the UDC Administrator. 13.) The identified Fish and Wildlife Habitat Areas (Two Type N Streams), shall maintain a vegetative buffer setback of 75-feet. The setback shall be measured horizontally from the Ordinary High Water Mark (OHWM) to the proposed residential development including driveways. 14.) An additional setback of five (5) feet is required from the edge of the buffer area to the proposed residential development. 15.) A permanent physical separation along the boundary of the buffer area shall be installed and permanently maintained. Such separation can include installing logs, trees, a hedgerow, or any other prominent physical marking approved by the UDC Administrator. 16.) Buffer perimeters shall be marked with temporary signs at an interval of one per parcel or every one hundred (100) feet, whichever is less. Signs shall be in place prior to and during construction activities. The signs shall contain the following statement: "Buffer- Do Not Remove or Alter Existing Vegetation." 17.) The applicant is proposing to create or add 4,226 square feet of impervious surface and 8,836 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. 18.) A Stormwater Plan has beelibmitted and approved by the Department�ommunity Development. Once the subject permit has been issued the applicant shalTfully 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 on May 17, 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 July 29, 2010 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 21.) This approval is for a new manufactured home, deck and detached garage 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 1:20 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 23.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 24.) 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. 25.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 26.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 27.) The building height is not to exceed 35 feet. 28.) The setback from the ingress/egress easement is no less than 20 ft., the setback from Center Rd.right-of-way is no less than 30 ft., the setback from SR 104 right-of-way is no less than 50 ft., 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. 29.) 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. 30.) 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. 31.) Access is off an ingress/egress easement(AFN 547404) that connects to Center Road. An address of 6503 Center Rd, has been assigned to the parcel. 32.) NOTICE: This permit does 41kxcuse 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. 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(7S. 0g. di „ oN..„e,m, JACK WESTERMAN 40 Jeifrrwrn C+,t'oorth.udr. ASSESSOR INS Boo 1220, Port Townsend, NA 98368 (3 0 393-9105 MOBILE HOME INFORMATION FORM OWNER'S NAME/MAILING ADDRESS: NAME: KU( UCf,� �L> ADDRESS: PO -BINA Z, ov-t C ee.rri ble. A cl`536f PHONE NO. 3620 Aj-7 Z3 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: `-t5C�3Pt (A) MAKE_ I e_.ekwo a d (B)MODEL V ci-ki (Drove. <16(C)YEAR (D)LENGTH (E)WIDTH - (F)SERIAL# 031 - ( 1 4G)YOUR PURCHASE PRICE(Do not iwdode sales taxf tOt Cuba PURCHASE DATE 7(2 ' 20 PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 30 (A)FROM WHOM DID YOU PURCHASE MOBILE ADDRESS (B)WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR?Yes l"�J If Yes, Previous address of mobile. If No, What County was Mobile assessed in last year. K i{'S G.-e 3)WHERE MOBILE HOME IS TO BE LOCATED: (A)WILL THE MOBILE HOME HE IN MOBILE HOME PARK? Yes (H)IF LOCATED IN MOBILE HOME PARK: NAME O ADDRESS OF PARK Let/Space# (C) IF NOT LOCATED IN MOBILE HOME PARK: NAME OF LAND OWNER: ‘h(p Q Ct-J SO�1�tr' LOCATION ADDRESS ��� u ' C F L� F-A C k l.!Y1Gcc_JW\ REAL PROPERTY PARCEL#/DESCRIPTION ft 1 I (a% o O'3 //all Signature of applicant THANK YOU FOR YOUR HELP! eJODI COSSELL. Property Technician MAY 1 7 2010 c10 �, JEFFERSO(�OUNTY • ( �' DEPARTMENT OF �-.r� COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 ,,......, joeth-gby 360/379-4450 . 360/379-4451 Fax -P'441-ztrt7c6c71- www.cojefferson.wa.us/commdevelopment us/commdevelopment Master Permit Application MLA: I O- I gR Project Description(include separate sheets as necessary): , A_f ) V(�-,Y.t. , VI U 1-Y) e Tax Parcel Number. 60 I ( (Q [ 00 3 Property party Size: I(1?:5 4 cC'L (acres/square feet) Site Address and/or Directions to Property: (OS X k k--e� R..�c Ca--kyet Ace north b 1 pk-t l n ,e.c__\. �C , OO �� Property Owner(s)of Record: VV rk Or, - p 3lUO . 3(-{c �Telephone: 5•7 Z.3 Fax: emaft: k_u r++.i ?az-+c+D) Mailing Address: Ft)TN?)X 2.-4$ -Pb rrk (.. a.,ry-1 b le. IAj f2t- CtE3s(oil Applicant/Agent(if different from owner): l4 t-h0x c,41-e IL.(a.C-y C:,r Telephone: 7p 0 . C(3 0 . 0 S 3'l Fax: email: MO r e a.n.( k 1{--6� efllkt.1, Mailing Address: 224 to t & t.(.e-r Ln tvt (�.-vu l'S V.xj t N ck ,�Z p cJ ei,,,, What kind of Permit?(Check each box that applies ( uilding 0 Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use) ❑Single Family {�rage Attached/Detached 0 Conditional Use[C(a),C(d),or C)** D'Manufactured Home 0 Modular 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* 0 Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment Er Address 0 Road Approach 0 Short Plat** ❑Home Business 0 Cottage Industry 0 Binding Site Plan•'* ❑Propane 0 Long Plat** ❑Sign 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed`Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** E 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 0 Tree Vegetation Request *'*Requires a Pre-Application Conference Please Identify any other local,state or federal permits required for this proposal, if known: p, i DESIGNATION OF AGENT I hereby designate t\& c to act as my agent in matters relating to ap lication for permit(s). OWNER SIGNATURE ^� Date: l )2-l By signing this application form,the owner/a ttests that the information provided herein,and in any attachments,is true and correct to the best of his,her or its knowledge. Any material false 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 attomey'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 applicatipnpia or she wants prior n ice. Signature: ((//��,,f -''2---T�- �`r-. 4:5L Date: / • / / i C 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-transfera sibility for adheri and mplying with the ESA. The Applicant has read this discla" r and signs and dates it below. Sig nature: <'^' Date: 1/it / i G A • BUILDER STATEMENT • The signer of this state nt oe' hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assu in re risibility of the General Contractor for the proposed pro Signature: /A `l"i /, fp.4-^', Date: l I7- 1 GENERAL CONTRACTOR OR MA TtACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: )4' New ' -Wood Existing: _ [1 Sewer 0 Addition CI Steel Proposed: Z. Bank ❑ Community System 0 Alteration/Remodel ❑ Concrete Total: 2- Height: IZIAndividual System ❑ Repair 0 Masonry SEP Permit# ❑ Demolition 0 Other: Bedrooms: Water Supply: Existing: icif Setback: 0 Private well ;Two Party Type of Heat Proposed: 0 Public 72 f ;L r Total: _ Name of System: If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes I No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: I Underground Tank 1 Above ground Tank Size of Propane Tank: 1 Heat Stove 1 Cook Stove I Woodstove 1 Fireplace Insert 1 Hot Water Tank 1 Pellet Stove 1 Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / No When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. itr c , 4,k t 4 4 ;-sc Square Footage Current Proposed �„ , I i• �',`-',, P :: .` ,J' n_. Main Floor Heated lxw EH Bld App Review: 2 it'1- 12`t 2- r= ' >�� 2M Floor Heated '' R,rxr Consistency Review: J�- Other Heated Base fee: . (9 1 5 o Mezzanine ; Additional Section: — I ? �� Heated Basement Plan Check fee: i-74,. .,,.1 Unheated Basement , r r° ', State Surcharge fee: -- Other Unheated r ' 4".••"c Pot Water Review fee: I Garage/Carport `r SUBTOTAL ;N § kS Decks ,74F i t-4 911 :. Approach fee: Y ° :�. Other .4ka,. TOTAL: $ C'5R 1. �. .,` rk Receipt Number: 1 11'1 ,-t " ' Cash/Check Number ESTIMATED COST(REQUIRED) Date: �,,—i .Fair market value of all labor and materials foundation to finish Initials: APPROVED STORMWATER PLAN ,¢SON c JUL 2 9 20a OG JEFFERSON COUNTY rzi DEPARTMENT OF COMMUNITY DEVELOPMENT JEFFERSON COUNTY DEPT.OF COMMUNITY DEVELOPMENT IOW 621 Sheridan Street • Port Townsend • Washington 98368 SIGNATURE: O 360/379-4450 • 360/379-4451 Fax �'SIINO� http://www.co.jefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# r +�V PROJECT/APPLICANT NAME: 1!( ��t��er ('(cc,t, L 11`J 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 positipn and relative size of proposed improveJnents on the site map. �r1Z.i w,t I1� fib•- a_ j�►Y4Lt1 tl _j'v"ez.* 1-tom LJe.rt ck c e C'�IefCCG6)eL' C -e- 11 r 1 41'1 j i €Q (�(-_f(E),�(n e bit at:h �. �-J c�S t.D r 11 be tv .Stl'i ii.LI ct--i` J�!�( "tke h rr G 12. ✓e..i-u _ I es `/'/ H /C b e ,_ Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map." 3. Describe the existing vegetation. Indicate native vegetation areas on the site map.j t./6- Yb Le .-L7\ ✓ /4 ''l• , ! ' 4C`. ��t%L� �.�L DLJ ki ice ('LG( )t. r'' I.S 1►1 Li L 1 Alt Ci ✓2 c<-S CL re- n1i fi r vec- •t-1f Z)I 4. Describe the existing soils. Indicate soil type on the site map. l(' r' - r, h rt-(' cet' r.i:�i`'1 �� _,`.3'� e-/ ( tY?_ LF Y i L/ _ •-• j� ( J ►% I. �'�l�� �f ,; J� fit' 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. :;1 i f c-i)er Iy ,/dr( L�2 t / �'7 ;1-.L�c�� r / i/ , �t>'TL e LS h,i , �L✓1✓C� l GCt�/ (C r.:_i�R'd , e.J�"/( (U0� �G t c1 ! h 6. Describe any excess levels of noise generated by the proposed use or activity: stormwater site plan template.doc—rev.10/12/2003 • isIi... i.. r; ' #'i' 1 4 7 `i (r 3 OM AL 7. Describe significant geo aphic fejtures and critical areas (i.e., environmentally sensitive areas such as wetlands, streams, steep slopes, etc.) on the ite. Indi ;ate location on the site map. )c tyra i mwip�rt4+ =(l- , >L�ru-.t . ei. V �- ---4 1--'-Ha i ti5 TA i.S01 Vitt fI✓.)„la.rn!u; fii yu.i,i t d-pew, Uii / L 1j 13 _be 8. Describe the general vi Li site, including adjacent land uses and structures, utilities, roads, and sensitive/critical areas (streams,wetlands, lakes, steep slopes, etc.). t ecrrti'i 7r �! r oz�-i� fie. n -t►ems « 7i= 1 Permanent Stormwater Control Plan This portion of the Stormwater Site Plan consists of the selection and installation of the appropriate stormwater control BMPs and facilities to remain in place after construction of the project is completed. "Medium" size projects are required to have the totals calculated of all impervious surfaces, pollution-generating impervious surfaces, and pollution-generating pervious surfaces to verify that the thresholds for treatment facilities and flow control facilities are not exceeded. 9. Describe the developed site hydrology, as proposed. Indicate whether stormwater will be fully dispersed (i.e., per BMP T5.30 in the Manual) or, if not, what types of stormwater flow control will be utilized for the site or specific threshold discharge areas within the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. 'r1� ecvi co rue- 4- �GZ Gott! IL, C is ck PeAr- -1— . / U y t t c 0cymia�ci` � yg4� i L%�1 flet4N.� ►j bl-rA rh.PelrVI v 0-s GP►%t t. — ,.Pee--1-• ki 4 c CL,tic. 1-'1 .` -'L• k i l a-('.-. a L` -k . ve 10. If the project requires the use of stormwater treatment fac7 ties, 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. (Witt Z '.-. Lt-t�, ;fir .i'`C-� L,, lt)l.Yfl v V -l'., 1 i' )i---1 ,- ,{ ;r"S e-''� S, to v 1 12. Describe the flow control syst m. CI_ c(6 wit( ems. Ier:_s& ov . rlcz+t_LA c:.1 .rc t, -1--icfire-.0 t' Or 1w' .((7/_11 stormwater site plan template.doc—rev.10/12/2003 6 • • 13. Describe the water quality system. \\ D _ L/��,�;.�F� �j 8,. �•l 1 �V��7 �f l ��.-- �r�r-'1�rC - --c- •- _— . - c 14. Describe the conveyance system analysis and design. ►1/(t 04 0 .urn 7 b wcl i lok i p&vS-e4 v n& k 15. Describe the source of fill material, physical charractef istics of fill material, and deposition of excess material. no Ail wi l I be. i,-r,p�-1 cl 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. /U 18. Describe methods for restoration of the,site. - ( h.)( ire E=c il (L )c i nc_ < :,() 5-�r-��C f-1 e)-� L A 1( be. 'edJJ <tz.v14. l' '! 0 ! &d1�(k 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. nic` 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. ti/CL_ stormwater site plan template.doc—rev.10/12/2003 • • 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 BM Ps 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. . 2. Establish Construction Access. 3. Control FFlow� Rates. F�C-^rr)1�!^ I�rLrytai1 I�/ ' �:1- c— .—. •�T"'a�'/�� L./- r Cr C,heC� Vo(tz c ne 4. Install Sediment Controls. ,,r, 6 c--k-ck �- � sue(ps wit( x' (F f- a Cl 5 5. Stabilize Soils. r, L ( L ( cam it; c� L ,t-�l� 114.A.l�(c ) Cj'rc 6. Protect Slopes. 7. Protect Dr in Inlets. Y2�= (1 ilea/1 In (6' sto rmwa ter site plan template.doc-rev.10/12/2003 8 • • 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. n/t. fits 4hc4,0,n e,1> ttAii L t i zte> 9. Control Pollutants I fc1 Foil V L et f Q. nGa �L� - (1 �1 e-S ' ine, !W F t si -eetc.u_p . - recur ' needed 10. Control De-Waterint (the act of pumping groundwater or stormwater away from an active construction site). 11. Maintain st Management P actices(BMPs). tt i 1 t( Practices CtA‹c (e_.pai r ac__s 12. Manage the Project. � -� CL&tk Wl.Q.vr C..:itil�-v- c,vLtk � � OY� —S1 CS C'CVt�(r(i) t� (,UOr'V 4;L1 G« ' n Svm no e%:Ar__ 2 Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). !! } (� 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. C; cat l c� .C% { -� :.moom przDie i- sl site„ stormwater site plan template.doc—rev.10/12/2003 9 i i b. Description, of special requirements for working in or near environmentally sensitive areas. 46,11. 1 1�v`� L2,v-C� GAY—x Ct LVL S l?rtCC S _ (. 'j (4,Y lic k 1 rbI 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). . C, t-t u-4 t� C.eX`e_ek_s �,i; • ' nect\'v e ve�(� `c�'T cry j S i- ��l e . �i G - SeC r1 c i ti .� `t.�IAA fTh 1 -E� 5. Construction Phasing. L � a. Construction sequence ex 5 hear 4- C o rIS.--kYVL* \b/ Lovn c Di - C.1 r�n�' b c us k �ar b r. ne1 stf�s ( C lnC� �>�ble�} It htt12, !. fir"IUD K b. Construction phasing (if proposed) .p&i5 6. Construction Schedule. Wet season is October 1 through April 30 (page 2-21 of the Manual). I. Provide a proposed construction schedule. 1V — Jun II. Wet Season Construction Activities. a. Proposed wet season construction activities. 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. b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. Lk 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.doc—rev.10/12/2003 I0 • • Stormwater Site Plan Changes If the dealer 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 Const uction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and correct to t : best of y knowledge. I also certify that this application is being made with the full knowledge and consent of all owne s of t: affe ed roperty. .,/ (LAN!OWNE- ,' THORI EPRESENTATIVE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: 12 stormwater site plan template.doc—rev.10/12/2003 l� Jo o cn °' cjj C� MI m o amc n y m- w a Jn a D5-0 o v j° ao n FP' X2 O.oy 07 a) 0 4, •,:-.., -Li i i T CD .1. n I �l I --I Cr, C ^v 119'11.88" w rri _ 255'9.96 w ro m 0,, A < n o rn rD o m.► < w El co - I0 N eb O.a W= to ` A) OG, ,v 3.. o p°av o ti ,N ,q 1 OD0'W4, , rn O " < W trn 0 , V a� c ° o _ r— , Ct _.. 2 ' till O ro 4 ` O 1. O CM i 2- X p rn ' co , oo ' O ...A....A.fD Q �t —a O O �. • CO N QQ O • - O J �_ _ Y N rD N ', w O O ; �1 O 'r1 Q" ! ' ! \ ' O CD1 I i 0, el ‘ s \ , \ .--- _ ,,,. 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