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HomeMy WebLinkAboutBLD2010-00344 • • 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 #: BLD10-00344 SITE ADDRESS: 7074 CAPE GEORGE RD Issue Date: 12/6/2010 PORT TOWNSEND, 98368 Final Date: 5/27/2011 APPLICANT: SUZANNE L CARLSON PHONE: 360-379-3005 7074 CAPE GEORGE RD PORT TOWNSEND WA 98368-8857 SUBDIVISION: BAYVIEW AT CHEVY CHASE Block: Lot: 4+ PARCEL NUMBER: 001305003 Section: 30 Township: 30 N Range: 01 W PROJECT DESCRIPTION: NSFR W ATT GARAGE THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2009 EDITION. OCCUPANCY GROUP: R-3 TYPE OF CONSTRUCTION: 5N SPRINKLER SYSTEM yes , no ' THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 5/27/2011 I:\F_BLD_Occu pancy.rpt 10/29/19 Jefferson County Building •sion Permit NuOr: BLD10-00344 Applicant: CARLSON BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2009 International Build'-ig Codes 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 1J'y7•(C (( 7 Minimum setback from Cape George Road right-of-way shall be 20 (.s r( feet. Minimum side yard setbacks shall be 5 feet. Minimum setback to the OWHM is approximately 330 feet. Erosion Control SEE CONDITIONS 2& 3 Foundation Footing /0 7 E-My 1/%0( Footing Drains -tc '' Foundation Stem Wall t -2, ,— Underground Plumbing Under Floor Framing Straps(hold downs) •1 / I( 7i-.1Ext. Shear Wall Nailing ) / 61/ Rough-in Plumbing _3( -7 ` 1[ Framing Blocking 31 1, _ 'mac-K 1� ;cT f c Ts) -5-7-l I Airseal 317 Insulation: Walls Aq( L( Insulation: Floors ( Insulation: Ceiling "1 Int. Shear Wall Nailing l / Wallboard Nailing Gas Line: Interior Gas Line: Exterior Propane Tank Heat/Chimney Clearance Drywell/Alt Drainage > / SEE CONDITION 1 Address Posted /1 7l c FINAL INSPECTION . - `7/7 71-75 FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR •UILDING PERMIT APPLICAAN ML Ty 357 Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00344 Received Date: 9/28/2010 SITE ADDRESS: 7074 CAPE GEORGE RD PORT TOWNSEND, 98368 OWNER: SUZANNE L CARLSON PHONE: 360-379-3005 7074 CAPE GEORGE RD PORT TOWNSEND WA 98368-8857 BAYVIEW AT CHEVY CHASE SUBDIVISION: Block: Lot: 4+ PARCEL NUMBER: 001305003 Section: 30 Township: 30 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE REPRESENTATIVE PHONE: PROJECT DESCRIPTIOt NSFR W ATT GARAGE TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION 70,000.00 MAIN: CODE EDITION: 2009 ADD'L: 614 HEAT TYPE: EEE OCCUPANCY: R-3 HEAT BASE: HEAT TYPE: WOD OCCUPANCY: UNHEATED: #OF STORIES: CONST TYPE: 5N OTHER: GARAGE: 480 SHORELINE CONST TYPE: SETBACK: DECK: 288 BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: CAPE GEO BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 1 Prop: ---1 Total: 1 T al: 1 Routing Date: � __ 0 — Type Amount Paid By: Date: Receipt:Permit $783.75 LYK 09/28/10 120133 APb°c7 E r Plan Check $509.44 LYK 09/28/10 120133 State Building Code $4.50 LYK 09/28/10 120133 DEC Co 2010 Potable Water Application $98.00 LYK 09/28/10 120133 Jefferson County Planninc Total: $1,395.69 & Building Department • • CONDITIONS for Building Permit# :BLD10-00344 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.) A SILT FENCE SHALL BE INSTALLED LANDWARD OF THE LANDSLIDE HAZARD AREA BUFFER PRIOR TO ANY LAND DISTURBING ACTIVITY. APPLICANT/CONTRACTOR SHALL BE RESPONSIBLE TO MAKE SURE THAT SILT DOES NOT ENTER THE STREAM. IF NECESSARY A SILT FENCE SHALL ALSO BE INSTALLED SOUTH OF THE 55 FOOT STREAM BUFFER. 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. 3.) CONSTRUCTION ENTRANCE•ALL BE STABILIZED WHEREVER TRAI. 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. 4.) Silt fences or other sediment control devices may be needed during construction such that sedimentation off site does not significantly exceed predevelopment conditions. Standard erosion control best management practices (BMP's) should be utilized as necessary to prevent erosion and off-site runoff. Temporary stabilization might include silt fences and/or hay bails or straw waddles staked with rebar. Permanent stabilization might include replanting, mulching or gravel. 5.) Maintaining ground cover will help reduce erosion from surface runoff. Any bare areas that develop should be revegetated. Native low growing vegetation that requires little or no irrigation would be the most beneficial 6.) Tree limbs, lawn clippings, etc. should not be thrown over the bluff because these piles have a tendency to damage/kill the underlying vegetation which in turn increases the erosion potential of the bluff soils. These piles also add unnecessary weight to the bluff soils, especially when saturated with water. 7.) To help prevent seawater from intruding landward into underground aquifers, all new development activity on Marrowstone Island, Indian Island and within 1/4 mile of any marine shoreline shall be required to infiltrate all stormwater runoff onsite. 8.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 9.) A vegetative buffer of 30-feet shall be permanently maintained from the top or edge of the Landslide Hazard Area. All buffers shall be measured perpendicularly from the top of the Landslide Hazard Area. 10.) A Geotechnical Report prepared by Stratum Group dated May 14, 2009 was submitted in conjunction with this application. The report addressed the stability of the geologic hazard area. A setback of 30-feet shall be measured perpendicularly from the top or toe of the geologic hazard to the proposed single family residence. 11.) 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. 12.) 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." • • 13.) All construction activities shall not encroach upon the landslide hazard area buffer. This includes the storage or preparation of materials. 14.) 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. 15.) 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. 16.) The applicant shall fully adhere to all conditions and requirements of the eagle habitat management plan as signed by Suzanne Carlson on September 22, 2010 and WDFW on September 15, 2009. 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.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 20.) 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. 21.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 22.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 23.) The building height is not to exceed 35 feet. 24.) Minimum setback from Cape George Road right-of-way shall be 20 feet. Minimum side yard setbacks shall be 5 feet. Minimum setback (as depicted on the revised site plan dated October 19, 2010) to the OWHM is approximately 330 feet. 25.) 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. 26.) Lighting fixtures shall be designSd hooded to prevent the light source fror ing 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. 27.) 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. • • STRATUM GROUP P.O. Box 2546, Bellingham, WA 98227 Phone(360)714-9409 May 14, 2009 Becky Whit sA3 a,w 2 C Nit S� P.O. B 757 70 7 C• eo rsie.- R—o�d J son, WY 83002-9757 - W A B36 B Re: Geology Hazard Assessment Parcel 001305003, Cape George Road Port Townsend, WA Dear Ms White: Stratum Group is pleased to present the results of our geology hazard evaluation of the above referenced property. The purpose of this geology evaluation was to evaluate the risk of slope failures impacting the proposed residential development area on the subject-property and provide general site development and maintenance recommendations. This evaluation included a visual inspection of the property and vicinity, a visual inspection of the slopes on the property and vicinity, review of available geologic mapping in the area, and inspection of the shoreline conditions in the vicinity of the property. The property is located on an approximately 220-foot high bluff on the east side of Discovery Bay. The location of the property is indicated on Figure 1. The upland area of the property is located on the west side of Cape George Road and the steep west facing bluff. SEP 28 Z010 SCOPE OF SERVICES The scope of our services included the following: 1) Conducted a site visit to visually inspect the subject property including the slope conditions, shoreline conditions, and relevant conditions in the vicinity of the property. 2) Observed surface soil conditions on the slope and on the uplands above the slope. 3) Prepared this report summarizing our findings, including an evaluation of the slope stability in regards to potential development on the property, recommendations for site development, and recommendations for further investigation, if necessary. • . May 15,2009 Parcel 001305003,Cape George Road,Jefferson County, WA Geology Hazard Assessment GENERAL GEOLOGY Northwestern Washington has been occupied by continental glaciers at least four times during the Pleistocene Epoch (1.6 million to 10,000 years ago). During these glacial and accompanying interglacial periods, a relatively thick layer of glacial related and interglacial fluvial sediments were deposited in the vicinity of the subject property. The Geologic Map of the Port Townsend South and Part of the Port Townsend North 7.5-minute Quadrangles, Jefferson County, Washington (Schasse and Slaughter, 2005) indicates the bluff is underlain by Olympic age glacial and non glacial deposits with Vashon glacial advance outwash deposits overlying the upper part of the bluff and the upland area of the property. The Olympic age deposits consists of sands and gravels deposited by rivers and streams and silts deposited as overbank deposits along the rivers. A carbon date on the bluff face just north of the subject property indicates an age of approximately 34,000 years. These deposits were laid down prior to the last glacial period. The advance outwash deposits consist of sand and gravel deposited by melt water streams from the advancing glacial ice approximately 18,000 years ago. Observations on the subject property, slopes in the vicinity of the property and upland areas above the subject property are consistent with the mapping described above. However, glacial till is present on portions of the upland. The till consists of poorly sorted silt, sand and gravel with occasional boulders. The till was deposited directly by glacial ice during the last glacial period approximately 15,000 years ago. The steep slope on the subject property is underlain by very compact sand and gravel consistent with advance outwash on the upper portion of the bluff. The sediments on the mid section of the steep slope consist of very compact silts and the lower half of the bluff slope is underlain by very compact sand and gravel. Looser material raveled from the upper slope is present as a thin veneer of soil over the underlying geology. SPECIFIC SITE OBSERVATIONS The subject property is located on a high shoreline bluff on the northwest shore of Discovery Bay. The property is accessed via a gravel driveway from Cape George Road from the southeast • of the lot. The location of the property is shown on Figure 1. A sketch map of the property with pertinent features indicated is provided in Figure 2. The upland portion of the property slopes gently towards the west. A very old road cuts across the upper portion of the upland area and extends to the north of the property. Low cut slopes on this road show the uppermost portions of the property are underlain by sandy to gravely glacial till and outwash sand and gravel. The upland area between Cape George Road and the top of the steep bluff slope is mostly tree covered with a mix of Douglas fir and madrone. A grass-covered clearing is located on the gentle sloping area just above the bluff. Stratum Group File:4.22.09 2 • • May 15,2009 Parcel 001305003,Cape George Road,Jefferson County, WA Geology Hazard Assessment The steep bluff slope slopes down to the base'of the bluff at an overall slope of approximately 35 degrees. However, portions of the slope are steeper with sections of the upper bluff having slopes of up to 60 degrees but generally around 45 degrees. The bluff slope is tree-covered with straight second growth mature Douglas fir and madrone with a thick brush understory. Soils underlying the slope consist of a veneer of loose raveled sand and gravel overlying very compact sand and gravel with some silt layers. The colluvium becomes thicker towards the base of the bluff and the slope becomes less steep as well. The base of the bluff is located at a wide accretionary shore form that has built out over 100 feet from the base of the bluff The area is grass-covered with a few scattered trees. Scattered drift wood indicates that on a very rare basis water covers this area during a combination of very high tide and storm surge. As such there is no indication of erosion at the toe of the steep slope as it is well protected from shoreline processes. The beach conditions at the edge of the accretionary shore form suggest that accretion is continuing at this shoreline reach. Hence, no erosion should be expected for many years. The steep slope on the subject property is the result of the site being a former shoreline bluff The slope has eroded back to a fairly stable angle through root throw and raveling of soils on the slope. CONCLUSIONS AND RECOMMENDATIONS Based on my visual inspection of the subject property and vicinity, I conclude that the steep slope on the subject is a potential landslide hazard area. However, the primary source of slope movement on the slope appears to be root throw from occasional toppling trees and raveling associated with deer and thaw freeze. However, the upper slope is steep enough that shallow landslides should be expected on a periodic basis. If slides do take place, I anticipate that they would involve only a few feet at most of the upper soil horizon. S E?' 2 8 Lv() A residence can be located on the gentle sloping upland area without being at risk from landsliding as indicated in the site plan sketch. The building should be setback from the top of the steep west slope a minimum of 30 feet. A deck may be constructed within the setback from the top of the steep slope as long as it is not an integral part of the structure of the'residence. That is if a slope failure occurs, the deck will detach from the house. No debris should be placed on the top of the bluff or on the steep slope. Thinning and trimming of trees on the bluff slope and within the setback area should be limited to topping and limbing for view corridors. Thinning should leave at least one tree on a 30-foof center. Any debris from thinning on the steep slope itself should be removed from the slope. Stratum Group File:4.22.09 3 O May 15,2009 Parcel 001305003,Cape George Road,Jefferson County,WA Geology Hazard Assessment Soils on the upland portion of the property appear to be well drained. Storm water run off from the roof gutters should not be routed towards the bluff and should be infiltrated into the ground in a dispersed manner. I recommend that any storm water drainage be directed into a level spreader and site tree clearing of the upland area be limited to the area necessary for construction of the home site. The septic drain field should be located at least 30 feet back from the top edge of the bluff. The addition of water at this location does not pose a risk of causing slope stability problems. CLOSURE Please note that there are inherent risks associated with lots near or adjacent to steep slopes. These are risks that the building owner should recognize and be willing to accept. If conditions appear different than those described in this report, or other concerns arise, we request that we be notified so we can review those areas and modify our recommendations as required. We appreciate the opportunity to be of service to you. Should you have any questions regarding please contact our office at (360) 714-9409. Sincerely yours, 8. Stratum Group %FY' Dan McShane, M.Sc., L.E.G. 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',.„. kb.) •%\ \ %... \ ‘ \ \ .g.,...---- \ cla -4c-- \IN \ 1 . i .....____ \ _.....---- -)<.. cs ...4 -.. — .c......r s2<- 1.• _ .---..?•A . ._ ...._.__— Y 7-+%A / . ,") .),,... • 74- ..-----V �� ON c�G JEFFERSON uNTY • �' �' DEPARTMENT OF COMMUNITY DEVELOPMENT � ''4 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax <ys, �,�0$ www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: )0 3) / Project Description(include separate sheets as necessary): `eka<i k�c.: 17c- --� of ��"i kyle �-'n-, I l y 12e s r 'd e_ki c &, Tax Parcel Number: U(- / 0 S 00.E Property Size: i q finzr c;'(acres/square feet) Site Address and/or Directions to Property: Property Owner(s)of Record: ,---51L z, 2a.i--I r-Q , ,3 4 -1----e 6,:_,-( - .--- Telephone: 367 =� - 7L�-c->' Fax: email:c nn..C, (I7 e_ co�-I4gi46il Mailing Address: 70'7'� CCa,I ( -P�.e1Y—c�e_ ci a of P. A ,cf . e., VVCOyn Applicant/Agent(if different from owner): cJ Telephone: -. ---_____..._„m mil Mailing Address: "' What kind of Permit?(Check each box that applies $Building 0 Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use) yl Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a),C(d),or CI** ❑ Manufactured Home 0 Modular ❑ Discretionary"D"or Unnamed Use Classification ❑ Commercial* 0 Special Use(Essential Public Facilities)** I k ❑ Chi of Use 0 Boundary Line Adjustment 1,/ , ddress /O 1•1 ❑ Road Approach 0 Short Plat** ❑Home Business 0 Cottage Industry 0 Binding Site Plan** ❑Propane 0 Long Plat** ❑Sign ❑Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis ❑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 ❑Shoreline Management Variance ❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference 0 Tree Vegetation Request **Requires a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal, if known: DESIGNATION OF AGENT I hereby designate t7------ to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: C{ 2-1 Ito, 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 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 application that heAr she want prior notice. / Signature: l '/ 'L_� Date: 2 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 th Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferable responsibili for adheri to and complying with the ESA. The Applicant has read this disclaimer 4nd signs arjd dates it below. Signature: C+ _ - Date: GI/ /lO _ G:\PemutCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc • BUILDER STATEMENT • The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming fie responsi ility of the General Contractor for the proposed project. Signature: q r vvi, Date: l 2-1 ; 't 0 GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: MAILING ADDRESS: 7 Cj i y C' ff e (—r. e ,,rote 1'� EMAIL`. A3 1(1Ae vie*'� e V,1 `�l °c_Cy 1 CONTRACTOR'S LICENSE r ,..J WAINS J NUMBER: NUMBER ARCHITECT/ENGINEER: Ldoh(k r S�ewaA✓-E- V/ AY� \r ,PHONE (4 3i'-i .- IZ FAX:( -)-- MAILING ADDRESS: 16CA Vt N.4:i\1i �e •?T. wfA q 7 EMAIL Project Type: 1p Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: '(New X Wood Existing: i 7 Sewer ❑ Addition [I Steel Proposed: 1 Bank ❑ Community System ii Alteration/Remodel ❑ Concrete Total: ___L__ Height: Individual Syst m [7 Repair 0 Masonry -.7.7---0 'SEP Permit#`O L9_n f7 Demolition ❑ Other: Bzdroeryrs: 0V—E Water Supply: Existing: Setback: Li Private well 0 Two Party Type of Heat: Proposed: i , Public Woc>>I IPi:--ir vG- Total: t `fib Name of System:1 Ub 3 If this is a Commercial Project you must answer the following: KJ 1 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: t.JI Pc- 1 Underground Tank 1 Above ground Tank Size of Propane Tank: 1 Heat Stove 1 Cook Stove yWoodstove 1 Fireplace Insert 1 Hot Water Tank 1 Pellet Stove 1 Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / No (S At- 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 dbAlt Propose For S�ffiC �lle'3nhv .;M r s Amount =- .3 tOvision Main Floor H'-`1d �J s EH Bld App Review. r� 2n0 Floor Heated I'j .4 Consistency Review: o = - _ ..,„.,,,,: Other Heated "` Base fee: /Ql Mezzanine Additional Section: ___ Y -Heated-Basement Plan Check fee: t.._+ I �- State Surcharge fee: Other Unheated f it), , .j-11 Pot Water Review fee: r 3G Garage/Carport ��l l ' L `,Li.1 i SUBTOTAL I. 1 l I• �� 911/Rd Approach fee: �� - Decks `- j'-st tT7 I\, Other 1(,4, j LLI TOTAL $ `1 101 .(D --- = Receipt Number: �7�1 xr ' Cash/Check Number: Iq /' cvlUv_ `` � ' i 1 E TIMATED COST(REQUIRED) Date: _ it market value of all la at a erials foUT datiCn to finish — Initials: G:\PermitCcnter\###FORMS###\DR1)FORMS\Master Permit Application 5-29-08.doc 0 • APPROVED STORMWATER PLAN w���"- bi..?6 JEFFERSON COUNTY DEC 3 2010 .4 DEPARTMENT OF COMMUNITY DEVELOPMENT 4, ,1 621360/379 Sheridan4450 Street • Port Townsend • Washington 98%8 JEFFERS C U Y•� gS, NG�O . 360/379-4451 Fax DEP1 OF Y VE o 4.http://www.co.jefferson.wa.us/commdevelopment/ SIGNATUR STORMWATER SITE PLAN SUBMITTAL TEMPLATE I MLA# I,Q 35 PROJECT/APPLICANT NAME: .3‘4 ?hYvQ� CarLSc:Nr1.-- 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. II C4�/\SIYKC1�l� Q÷ -i tY1I6 E ,, -e �_i -4-__ vvk a. v�I �P C�2v�Gs2__ . Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. S. `Z ' ^ �_ . o -1.• - . .��3 ev_k . -Vea ". t- vL�1 W C . w ZT ( b L: b u . l+- • , Y� - vO,k* k1 1_ W ✓e �\ e c�v.V• -�O- T Ti„ `` 17� .�41/L\��/1 3. Describe the exls ing vegetation. Indicate native vegetation areas on the site map. l-I— l a --P aiv.,-r;1,3 W\a Are,' -v,d 4 r -1-,,,, 4. Describe the existing soils. Indicate soil type on the site map. ,a v\d nr.\i'e-1_�� l o vvl • 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. .711.ere ‘ S YLa S drvxcL ,,,Z �' N0 5 PE' A i . t . J I e 5 . �n,� . 6. Describe any excess levels of noise generated by the proposed use or activity: J ;No c�1 5 C=. (-)e- ..,L� r � c� tr i ray7v1 ClY�tG G� . Stormw ' Required stormwater site plan template—rev.10/21/2008 5 i ! I j } 1 71 Describe significant geographic-features nd critical areas (i.e., environmentally sensitive areas such as wetlands, streams, steep`slopes, etc)on the site. Indicate to ation on the site map. G ri �G� I a , . .� C, 6...e)_ wig-+ \ s a ' PIO e- 4 s . 7 Yl o - v, t y-i / I- c PI ref- "E 1 e-.b &I - . -� o Y/1L k t.,Gi 1 g. Describe the general vicinity ottfie site, including adjacent land uses and structures, utilities, roads, and sensitive/critical areas (streams,wetlands, lakes, steep slopes,etc.). • `f `,\ r� .i i s p cal �J� D i,5 r ,4 a e o D I�,y�rs aGi r j n� c�fS --% Nt � i�� (,,� 5� ~ate` t i L# - Ol ltie -s _ ►� (�-� . Le _c. .v eiy Al�ti � p'I(,�r_rs Vie_ w rrc•��" {'� z -t�-�,-� fi l�a-t ar� �-o � ��'�-�!�I �sS oG i a-1l�✓] D vJ�S vt ac�c�I h� ( Z w S h�� tC Nt S. "�" v� Permanent Stormwater Control Plan->cw�Sl 4�v v� p � ve_I (eon[b e(.S . �--E joy � � UU This portion of the Stormwater Site Plan consists of the selection and installation of the app opriate 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. 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.] N 1 A- li. Describe the performance goals and standards applicable to the project. 1 oss°Ibie u, ,`t-\ lMi v. vn�\ 1 c_\ea-vi ►-ti `to c s e-hcV\ 12. Describe the flow coral system. --T-v\e_ l is is ar-� . wIA- 6 stormwater site plan template-rev.10/21/2008 i • 13. Describe the water quality system. iq I A— i, Describe the conveyance system analysis and design. NI IPC— 15. Describe the source of fill material,physical characteristics of fill material, and deposition of excess material. NSA- 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. Awk.. CO AA? 4 n_ ?a cti 0 _n �,t,j k. v ovu< O 1`� -}z� I I-c_ 2nO(e n i IN,AA im COvvy 14.}-)`cAn 1C e y yam+ rQ ,ivNe rrc+-S 1 I e- 17. Describe the proposet#Surfacing material. C -a 4 P 1 4( i V'e w-z 1 18. Describe methods for restoration of the site. P 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. N{ I C-- 20. List here and include any pecial� 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. U P6t- stormwater site plan template—rev.10/21/2008 7 • • CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN (SWPPP) The Construction SWPPP addresses sediment and erosion control during construction. The BMPs indicated by the applicant in the template that follows must be installed on the ground during all construction phases of the project. The proponent is responsible for preventing sediment and erosion impacts to environmentally sensitive areas and off-site areas. Consult the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet for guidance, particularly with rural residential development. SECTION I—CONSTRUCTION SWPPP NARRATIVE 1. Construction Stormwater Pollution Plan Elements. Describe how each of the Construction SWPPP elements has been or will be addressed. Identify the type and location of BMPs used to satisfy the required element. If an element is not applicable to the proposal,justify in writing. Descriptions of the 12 Elements are found at Volume II Section 3.2.3 of the Manual (beginning on page 3-7). /� N n 12 Required Elements—Construction SWPPP /� '� ���� '`�`evtejeet 1. Mark Clearing Limits. tra_ctjcs 2. Establish Construction Access. 3. Control Flow Rates. 4. Install Sediment Controls. 5. Stabilize Soils. 6. Protect Slopes. 7. Protect Drain Inlets. stormwater site plan template—rev.10/21/2008 8 • 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). Nil 1-61 a ✓�—� 51 S w tr 1 1 kw 4 b € b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). kJ I l s 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. -' A a 2 prover, p�rdXI h'1c+e( 220 -fit a b o•r e_ -fits e ac l� stormwater site plan template—rev.10/21/2008 9 • • b. Description of special requirements for working in or near environmentally sensitive areas. See e_ a t 1 aiye a s `j'v c 5`-i1i v € a 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). y, 5. Construction Phasing. a. Construction sequence J(�1 V\ `4AC\ CAA I f a W\.iha 1rop-Pi f I �yt ✓1d1�� -�1✓�l t 11 c� Y�P Zv��G a? b. Construction phastrr�(if proposed) JJ 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). I. Provide a proposed construction schedule n 0'4- din whet► bk.,l my pGrrnr`-is are.odai i fit(/ S1r t cn cvi �vt .: ''gip .°0 - '✓ .fin) /C v1 /h-�/�rvY', 7cnv xc,av 'fioVl �4cisc 11..l II. Wet Season Construction A ivities. p(e?L?c1/t..— i a. Proposed wet season construction activities. b. Proposed wet season construction activities for environmentally sensitive areas. I A- 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. reseonsi bi 1 ► 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable. a. Sediment Ponds/Traps. Ni\A— b. Diversions. NIPC c. Waterways. 1•(d. Runoff/Stormwater Detention Calculations N 1 n A stormwater site plan template—rev.10/21/2008 10 • • 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. a. Vicinity Map b. Jefferson County Approval Block c. Erosion and Sediment Control Notes 2. Site Plan. a. Legal description of subject property. b. North arrow. c. Indicate boundaries of existing vegetation (e.g.,tree lines, pasture areas, etc.). d. Identify and label areas of potential erosion problems. e. Identify FEMA base flood boundaries and Shoreline Management boundaries (if applicable). f. 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. i. 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. b. 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 ch^nges or revisions to the originally approved Stormwater Site Plan, the proposed revisions shall be ...onstruction. The submittal shall include substitute pages that include all proposed changes, revised drawings snowing 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 a should be engineering drawings (stamped by a licensed civil engineer) that accurately represent the project as cui I,,.ructeu. APPLICANT SIGNATURE By signing the Construction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all owners of the affected property. .j1"/ 47/Z2,/ (LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: stormwater site plan template—rev.10/21/2008 12 • • - 1• • (,. ." a s, A › ..1., .4-• z- x X X' 11 .1;.. ,-- R 7-= •'. — )1 ' r,l) • 01 C• Z. 7C) Z. (‘‘ '1 <.. ''''- .P tl 0\ -C‘ C' • \--.<- \-- q1 3 '-i-, -' ,• 73 A \--- -11 \.. /2/-0 " 1.. /2. ..-C2 ."- --7( • 1 1 . s . , • V 444' V . /4P P6'0 " .., ...._: .••-...L..... — --.- - -,\,, - • — — --r-- -=.--)-':-.;::-:;:-..-, i . ! -<- O •,.. S‘‘i•A1 •, I " .:,--' • 1 1 ..;; 6 4 1 1 ; 1 , - • -0 > Y' Y• 01 0_ 4- .•, • P i 1 ,.--z. ,.._ • (r)." ‘-'‘ cj I.-.1\ - . f0 :• c, r, • •, % J\ ii d k 1 , ..• t- AI 7;)f • ,.'-•i ,i i _< I I 6, : .,.. 's\r'%4 ,'• Q.' - . I 1 • ..•1-- 1 -I • ,‘, ,,/ .......\_ 0 i \. ._ C5 ! 4ZSA 7---). '.,:" • 0, , - -- -4 —4(3-k V.' I i izt, k-, • 7_. 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