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HomeMy WebLinkAboutBLD2012-00292 CERTIFICATE OF OCCUPANCY Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 Carl Smith, Director/Building Official PERMIT#: BLD12-00292 SITE ADDRESS: 480 POND RD PORT TOWNSEND, 98368 Issue Date: 11/15/2012 Final Date: 8/1/2013 APPLICANT: SHERWIN M HARLICH PO BOX 1670 PHONE 360-531-1022 PORT TOWNSEND WA 98368-0139 SUBDIVISION: GAZEBO SHORT PLAT Block: Lot: 1+ PARCEL NUMBER: 002121025 Section: 12 Township: 30 N Range: 02 W PROJECT DESCRIPTION: NSFR W/ATT GARAGE in conjunction with a shorline exemption permit (SDP12-00052) 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 8/1/2013 \\tidemark\data\forms\F_BLD_Occupancy rpt 9/12/2013 Jefferson County Building Division Permit Num411 b BLD12-00292 Applicant: HARLICH BUILDING PERMIT INSPECTION APPROVALS Applicable Code: 2009 International Building 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 11/30/2012 Minimum setback from Pond Road right-of-way shall be 20 feet. Minimum side yard setbacks shall be 5 feet. Minimum setback from shoreline top of bank shall be 110 feet and 160 feet from OWHM. Erosion Control 11/30/2012 SEE CONDITIN 3 Foundation Footing 11/30/2012 6-*- •- Footing Drains Foundation Stem Wall It ' 3u—tz Underground Plumbing Under Floor Framing '1L\ - 13 Straps(hold downs) Ext. Shear Wall Nailing ✓2- !3 A;AA I 0 1 vv U'_- fhlucsc Rough-in Plumbing Framing ll �' � c.rr(oir4,o Blocking AirsealOu.ax1r Insulation:Walls fL' (LA `v"3 - Insulation: Floors ,. (( ( (A \O /1 Insulation: Ceiling Int. Shear Wall Nailing `� v Wallboard Nailing �Z//' Gas Line: Interior ((( Gas Line: Exterior Propane Tank Heat/Chimney Clearance Mechanical Systems Blower Airtight Test Smoke&CO2 Drywell/Alt Drainage SEE CONDITION 1 FOR DRYWELL Address Posted S (� O `e t !zj c 0/Q Water Meter Inspection i i FINAL INSPECTION te)iol, FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR M Review PERMIT APPLICA1IN R 00209 Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD12-00292 Received Date: 9/25/2012 SITE ADDRESS: 480 POND RD PORT TOWNSEND, 98368 OWNER: SHERWIN M HARLICH PHONE: 360-531-1022 PO BOX 1670 PORT TOWNSEND WA 98368-0139 GAZEBO SHORT PLAT SUBDIVISION: Block: Lot: 1+ PARCEL NUMBER: 002121025 Section: 12 Township: 30 N Range: 02 W CONTRACTOR: LEXAR HOMES PHONE: (360) 379-8600 94 KALA SQUARE PLACE PORT TOWNSEND WA 98368 Contractor's License HI LI N H*981 BT Expires 2/10/2013 REPRESENTATIVE: TIM GIBBS PHONE: 253-606-5210 94 KALA SQ PORT TOWNSEND WA 98368 PROJECT DESCRIPTION NSFR W/ATT GARAGE TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 1,478 VALUATION 148,000.00 ADD'L: HEAT TYPE: EEE CODE EDITION: 2009 HEAT BASE: HEAT TYPE: OCCUPANCY: R-3 UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: 5N GARAGE: 560 SHORELINE: CONST TYPE: DECK: 204 SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: 1 PWELL BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 3 Prop: 2 Total: 3 Total: 2 Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $1,262.55 LYK 09/25/12 135231 ._. E y A, Plan Check $820.66 LYK 09/25/12 135231 State Building Code $4.50 LYK 09/25/12 135231 NOV i5 ZU4'. Potable Water Application $64.00 LYK 09/25/12 135231 .>eife:con County Pfarm:ro�. Total: $2,151.71 & Building Dc ammo^+ \\fid.rnnr4\rinfn\fnrmo\F RI f1 Ann RId rnf 0/9a-.M(119 • • CONDITIONS for Building Permit# :BLD12-00292 1.) 2012 DOE STORMWATER MANUAL DRYWELL DESIGN CRITERIA ALL INFILTRATION SYSTEMS SHOULD BEAT 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.) 12/6/12: CONDITION MODIFIED A SILT FENCE IS NOT REQUIRED UNLESS THERE IS A STORM EVENT THAT CAUSES EROSION BETWEEN THE PROPOSED RESIDENCE AND THE SHORELINE BLUFF. IF A SILT FENCE IS NEEDED IT SHALL BE INSTALLED IN ACCORDANCE WITH THE REQUIREMENTS BELOW: A SILT FENCE SHALL BE INSTALLED AS CLOSE AS PRACTICABLE TO THE PROPOSED DEVELOPMENT AREA BETWEEN THE PROPOSED SINGLE FAMILY RESIDENCE AND THE SHORELINE PRIOR TO ANY LAND DISTURBING ACTIVITY. APPLICANT/CONTRACTOR SHALL BE RESPONSIBLE TO MAKE SURE THAT SILT DOES NOT FLOW ACROSS THE TOP OF THE SHORELINE BANK. 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 ENTRANCES On BE STABILIZED WHEREVER TRAFILL 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.) The project is located within WRIA 17 and thus is subject to compliance with the WA State Department of Ecology In- Stream Flow Rule for that region. The parcel is located within the Quimper sub-basin in a designated Coastal Management Area; as such, state regulations require the following: 1. 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; see Ecology web site at http://www.ecy.wa.gov/programs/wr/instream-flows/quilsnowbasin.html or contact Ecology at 360-407-6300. 5.) 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. 6.) 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. 7.) 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. 8.) 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. 9.) MANDATORY MEASURES FOR AN AT RISK SIPZ: 1. For proof of potable water on a building permit application, applicant must utilize DOH-approved public water system if available. 2. If public water is unavailable, a qualifying alternative system may be used as proof of potable water or an individual well may be used as proof of potable water subject to the following requirements: a. Chloride concentration of a laboratory-certified well water sample submitted with building permit application. b. Installation of a flow meter. c. On-going well monitoring for chloride concentration. d. Submittal of flow and chloride data to the County per monitoring program. 3. If public water is unavailable, a qualifying alternative system may be used as proof of potable water. • • 10.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 11.) A flow meter shall be installed prior to final sign off of the building permit. 12.) 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. 13.) 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. 14.) 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." 15.) All construction activities shall not encroach upon the landslide hazard area buffer. This includes the storage or preparation of materials. 16.) 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. 17.) 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. 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.) Lighting fixtures shall be designed* hooded to prevent the light source from lig 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. 23.) 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. 24.) Minimum setback from Pond Road right-of-way shall be 20 feet. Minimum side yard setbacks shall be 5 feet. Minimum setback from shoreline top of bank shall be 110 feet and 160 feet from OWHM. 25.) The building height is not to exceed 35 feet. 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. \\tiriamark\data\fnrmc\F RI f) Parmit Rldn rnt 19/F,/9(119 ����SON co� TY • ,w \ , �, DEPARTMENTJEFFERS OFOUN COMMUNITY DEVELOPMENT 1' 1-4 621 Sheridan Street • Port Townsend • Washington 98368 i 360/379-4450 • 360/379-4451 Fax q '� Q www.co.jefferson.wa.us/commdevelopment S41NGZ Master Permit Application MLA: I a -Q-0q Project Description(include separate sheets as necessary): kink; fricI-1 e Ceti` r121-1c7-T7 CO Tax Parcel CC, �, / 5 Property Number: Size: /- A( (fit `1)- (acres/square feet) Site Address and/or Directions to Property: '/>R) ROIN 0 1c.c n , R:Yr Otki&I.Sr&,l r Property Owner(s)of Record: 6 '1--1 E✓sR(A.' i (v (-} AK L I C {} Telephone: '3(C 5-3 I I r,7 2-- Fax: email: Mailing Address: P. D: Bo A 1 (c7 0' QC:C,T TOvv/t S EN) D (/J( 9 R. 3 L Applicant/Agent(if different from owner): L6x./Sl !-f0 h'l t S.- .T/f( L / £35 Telephone: 153 (3-C`(- -5 Z.l b Fax: 36.,,C 37 c L-I 17/ email: tci(bL 5 (e>Cc4'h Ca)kCS Mailing Address: qLi K fic/--+A 5 aoiv_e-- 12L-I-+C- eGi.'-TTcYc (QSt?V1) I,l.'I)-cig j(^ : L-e-'vl What kind of Permit?(Check each box that applies (Building ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit 0 Conditional Use[C(a),C(d), or C]** JS Single Family [ Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home 0 Modular ❑ Special Use(Essential Public Facilities)** ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use ❑Short Plat** ❑ Address 0 Road Approach 0 Binding Site Plan** ❑ Home Business 0 Cottagelndustry ❑ Long Plat** ❑ Propane 0 Planned Rural ResidOit[ [-eVel6 e'ritt(b l r dm,t ** ❑Sign 0 Plat Vacation/AlteratioN*v� i - '- t ``� ❑Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Progrrrl.Exemption/Permit Revisions?;+* l ❑Stormwater Management 0 Shoreline Managem¢rit1 u stantial Development** I;I 1: ❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Managem4rlt�Var ante ; I 0 Temporary Use 0 Comprehensive Plan/UDC/ and Use District Map Ameji�mpnt ❑Wireless Telecommunication* ❑Jefferson County Shorrliric Master Program Amendment I ❑Forest Practices Act/Release of Six-Year Moratorium 0 Tree Vegetaion Request — OUP TY *May require a Pre—Application Conference **Requires a Pre•LApplicatiop Conference n rl dot r�T Please identify any other local, state or federal permits required for this proposal, if .cl-nown:� �- /7, DESIGNATION OF AGENT I hereby designate '/,''2!7 / to a t as my agen in matters relating to this application for permit(s). OWNER SIGNATURE ,-- >,' " Date: e� ' ��' 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 it's 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 application that he or she wants prior notice. j Signature � �� 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 the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and nonsferabl responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: - Dafe: —7— / j2— C:ADocuments and Settings\caral\Local Settings\Temporary Internet Files\O1,K86\Master Permit Application 12-19-2006.doe ... . 111 • 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 Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: 6Exii 1-FoMc5 -- 9y KAct S )Prlee" PLAcc- et-0) 3 9- 17 i7 (36o _.3-'79-4li7/ MAILING ADDRESS: P6W--r--r--OtLIN j ,� /� tJ r� EMAIL: -t--q vi�� I e c r 1- ovi • C crYi CONTRACTOR'S LICENSE /) n � v r, WAINS NUMBER: t!.LXi�Ik I I* ?C,C a,7 NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: -14 New Wood Existing: 1 Sewer Addition __ Steel Proposed: 2 Bank 1 Community System Alteration/Remodel -- Concrete Total: 2 Height: AA Individual System _ Repair Masonry c< SEP Permit# I Demolition 1 Other: Bedrooms: Water Supply: Existing: Setback: X Private well = Two Party Type of at: Proposed: 3 , Public GjQ Cl-- Total: 3 /,� — Name of System: If this is a Commercial Project you nIust��ee th6 I0116Wit* Number of Parking Spaces: C rr r} PropGsedi Number of ADA ParkingSpaces: !� P Number of occupants(includes er ,tenants,employees, etc) •Current Proposed IBC Occupancy: IcapIBC,Type of construction: i : Will you «.... I / If this is a Propane Tank and/or'Appliance Installation permit,mark all items below th-t .p • �� ` 0 Underground Tank 0Above grojino,Tank Size of Propane Tank: I I,i J f I I 'ii ❑Heat Stove 0 Cook Stove 0 Woodsfove LI Fireplace Insert 0 Hotf Water Tank 0 '' It Stove,,0 Other I. Is this appliance being installed in arManufattured:FlVlobi`i'_�E1 me? es / No @ `III1 _ ,-, l' i JI When applying for a permit to install a propane tank you must also submit a site l tll shpwin all of the buildings, " roperty p�� g lines,tank location and size, distances from the propane tank to all property lines, ouildirly,drii I r a ct pon�nts, including the reserve are fs l DEPT.OF C:,:.;I,i,.';ii'f DEVI10';_TNT , Square Footage Current Proposed For Office Use Only Amount Revision Main Floor Heated /1-1-7 G t I ZD(,palEH Bld App Review: 7(49 2na Floor Heated �'jA Consistency Review: 222 Other Heated /4 Base fee: 55 Mezzanine I/ Additional S n• ti -- .r),i,e Section Heated Basement Plan Check fee: Unheated Basement i State Surcharge fee: Other Unheated t',/i+ Pot Water Review fee: I Garage/Carport `O3 — 5 L-C 153-17 Z° SUBTOTAL )-dP[CI I Decks 2vy --,k,olo5 911/Rd Approach fee: Other x\5 n n� TOTAL: $..3000 17E Receipt Number: (�Sz3 ---______- Cash/Check Number: QSTIMATED COST ll b randma) . Date: '�-��Fair market value of all labor and materi undation to finish --- --- ---- %`%U ee Initials: C TIi C:\Documents and Settings\caral\Local Settings\'l'emporary Internet Files\OLK8,\,Master Permit Application 12-19-2006.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 the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED 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: C New D Wood Existing: Sewer C Addition ❑ Steel Proposed: Bank C Community System IT Alteration/Remodel ❑ Concrete Total: Height: C Individual System C Repair C MasonrySEP Permit# _ Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Type of Heat: Proposed: Party Total: ❑ Public 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 lBC 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: 1 Underground Tank i Above ground Tank Size of Propane Tank: I Heat Stove 1 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: - 2`"'Floor Heated Consistency Review: Other Heated Base fee: J 5 Mezzanine /3/. Additional Section: Heated Basement Plan Check fee: 90• 5 Unheated Basement State Surcharge fee: Other Unheated y Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other ��� ZOO TOTAL: $ / -7 Receipt Number: / Cash/Check Number: ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc Stoll/at r 'S APPROVED Requir STORMWATER PLAN eifrA9°14 � �� JEFFERSON COUNTYNov 1 32012, ,�� DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend • Washington 98368 7EFF 0 COUN k' O� 360/379-4450 • 360/379-4451 Fax DEPT.O DE ►• •,,, , �`�81N0� http://www.co.jefferson.wa.us/commdevelopment/ SIGNATU ,L 4 / STORMWATER SITE PLAN SUBMITTAL TEMPLA MLA# '� v ci . PROJECT/APPLICANT NAME: I/m 6.LA CH- 1-Z L S ND L t C-e- 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. .Ec 5 t1L ft_0 rL, Fug L..Cc are CY'l. i3 /Lb 5//V6LC r, I4iLI? eE5/OFticc Lk: i T a vl Tt-A-c N O 6/112(24 c,�/ /''7 3 P Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. ,32Ac`r, 8 L/1 f t ) %G'�tzi�!r — 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. , 4. Describe the existing soils. Indicate soil type on the site map. ' iL; +4 I 5. Describe the existing site hydrology (i.e., drainage; behavior of water cin the site—ghqyp5(t t wN t,d on the ground). Indicate existing stormwater drainage to and from the site on the site map. , Dep tps ar(,q*I j+n.Pg?t(hra5flnt on the site map, if applicable, and indicate acreage of each. 6. Describe any excess levels of noise generated by the proposed use or activity: /L"<;(,)Lr1-e coA)S-7-k-cc-r/o&) /*Cr-f V i-ReF.5 stormwater site plan template.doc—rev.10/12/2003 5 • i 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. 8. Describe the general vicinity of the site, including adjacent land uses and structures, utilities, roads, and sensitive/critical areas (streams,wetlands, lakes, stee slopes,etch). �� Q/�• � Z �,'" 0 Y64 L�pb%tee ?e' r/%.��'�%"/ � i�.' i� ,od '/C ,fie''e-5'' 1,4 f/. -e 42,E c /fi 5/Ai'4 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. �/�/ ,4 G < A te" 'sue i ,4nOe-,C ''),",y _40050.4",- 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.] AZ, 11. Describe the performance goals and standards applicable to the project. { , !' ; / - `� G' ) .2-J!_yt �li� D.Q,C�EC-'� /,�/li' L' E RS911 COUNTY __DFPT.OF COMMUNUUY UciEWPMENT 12. Describe the flow control system. ,. ,, , ape/ ,.f/7_.s /V.% 1` 1,-/ii/ 6,4e'i C/-• Aa%W C'�.P -c-- stormwater site plan template.doc—rev.10/12/2003 6 . . • • 13. Describe the water quality system. ' A V 1 P7 ,Y� /� - a' A2 �� ,s-oT-- r 14. Describe the conveyance system analysis and design. /,14,4iv ),"Ou</ 7Z' /2.11 (:; i.✓ /!f7 /i.,,,%e /,i/�e" % 15. Describe the source of fill material, physical char fteristics of fill material, and deposition of excess material. ____ i ce- ,75-p D,i _..5. 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. ©A. 2 G GV/ e-77•', oi/?;;— o'` -4..f.,,- 17. Describe the proposed surfacing material. . ./ material., MA ''4� 1 fr / 18 Describe methods for restoration of the site. ,V%9-rkt // ' 74- ,� iy.�'3 in R:/4,� 19. An Operation and Maintenance Manual is required for each flow control and treatment facility. [This is normally required for "large"projects only and onlythose for which facilities are required to control flow or treat runoff.] If included, list the Manuals here. `�"/ . 1 --- r= r• EJI H 1 20. List here and include any special reports or studies conducted to prepare the Storm . if_ 1 1—) 21. List other necessary permits and approvals as required by other regulatory agenCies_'!fib � vas incl�de conditions that affect the drainage plan or contain more restrictive drainage-related requirements',de§C IA txpe conditions or restrictions here. — n stormwater site plan template.doc—rev.10/12/2003 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 section 2.5.2 of the Manual(beginning on page 2-15). 12 Required Elements—Construction SWPPP 1. Mark Clearing Limits. 2. Establish Construction Acce s. 3. Control Flow Rates. 1 11 _ oelfr.'"9-2 /—/e:i. ," .5.. 4. Install Sediment Controls. f_ 5. Stabilize Soils. �Z s14 .ram i��4,s� ' ""/Z 6. Protect Slopes. rcT S dC' Gz g-- • i 1 I i 7. Protect Drain Inlets. j 1 ihl i-LIISUN CO'INTY stormwater site plan template.doc-rev.10/12/2003 8 • • 12 Required Elements-Construction SWPPP(continued) 8. Stabilize Channels and Outlets. 4 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). . '/-4 eg: _t1wy� Cam. ' 5 �� •% /. e ti5 Qze. 5;T�' aG, , 12. Manage the Project. / _ _ Div -4"/ .1„1�'� "-- ..------ 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). s,X 7�' Vrv'� � i /� /- r /;2 A ,1',I U.i/;p G- f4,M i %,-- b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). /t/fr 4 3. Environmentally Sensitive Areas. :l i I a. Description of environmentally sensitive areas that are on or adjacentto the bite. it I 1 f 7.4it' 7 s' (^,- ,? -4't /2% ;<- stormwater site plan template.doc—rev.10/12/2003 9 • • b. Description� of special requirements for working in or near environmentally sensitive areas. frf 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). 5. Construction Phasing. a. Construction sequence - 5/7-A' ��p �ia�.✓�'��� `��c 1ery�sc-� b. Construction phasing(if proposed) / I Air* 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). Pro ide a proposed constructs^^.nhedule. 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` responsiblele for the initiation of bonds and/or other financial securities. _✓l� Lr/f✓ /7 /(// 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.tie following, if applicab el �Ij' s. Ponds/Tra a. Sediment p b. Diversions. c. Waterways. j d. Runoff/Stormwater Detention Calculations ; )i:,Fi stormwater site plan template.doc—rev.10/12/2003 t0 • • Stormwater Site Plan Changes If the designer wishes to make changes or revisions to the originally approved Stormwater Site Plan, the proposed revisions shall be submitted to DCD prior to construction. The submittal shall include substitute pages that include all proposed changes, revised drawings showing any structural changes, and any other supporting information that explains and supports the reason for the change. Final Corrected Plan Submittal If the project included construction of conveyance systems, treatment facilities, flow control facilities, or structural source control BMPs (not standard on-site stormwater management BMPs), the applicant shall submit a final corrected plan ("as-builts")when the project is completed. These should be engineering drawings (stamped by a licensed civil engineer) that accurately represent the project as constructed. APPLICANT SIGNATURE By signing the Construction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all owners of the affected property. AN WNE OR UTH RIZED REPRESENTATIVE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: L.)1y lli iI JEFFERS:'N COON"l' DEPT.OFCOMM iN T`l D_'r'ir.plrs�,ir 12 stormwater site plan template.doc-rev.10/12/2003 • 4036 s J L•-__-J -, REF [o)o REF ii I ,i) SINK ) m D I r i Cr) co O A elm i- 1 -D.r.* D\ r - Cn I-nx. C) N C D mc-,, o ➢ O ' rC O 1-D =N G'J A z O-nz)* NZ ' cknn g . N lir O irimm r `C -I • O D FURN. _ Z 5 P A0 m C 1 0< r A m < 0 0 Lm 8II f1 0< 0 I 0 Al OAJ Xi r1 r� / W r. / . . 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Sy m^p O m r z z P ® r D;.0 r mr --1 N Z N➢C7mO Z comG")r C' X N V) O kJ N -., a^o C m�1 Z 7 o z co �- m> N�m� p Z f+� ® p c-)r N r �m m `-)� ➢�Z Dr ZO cam)N�D G'orn m N W O r p x.D m-O - rn n ➢a D r z Z C) G.-i T.0 A N .TO]Z n Z=m m 00'�N �)O D r cn z X) X - 0 r m • 0 r 0 c' a N m p O p r m r 2 r T. O N O Z C' ON m O N z N z, D r(7 O 2 N I- Zp G7 AZ? Z M� �Z rSo m o p rl m fa Cl 77 0 V ' rn - `C T m • up INI• z Cl c' o Cl C) r -c Zrri O -O z N J ? o a o o Sheet Contents: Project Title: LExARI ,, ,., „,. .. P ' SHERWIN & MARTHA° ,..., MAIN NJ _ FLOOR HARLICH N N o a 480 POND RD. HOME S 0) N O -, Co PLAN PORT TOWNSEND, WA. 98368 co 4, cn ccc - 92 & 94 KALA SQ. PL., PORT TOWNSEND, WA. 98368 II J C C P n) (360) 379 8600 7711111111 �Nc�N d / P.L.212.00'V. F �,��---- / v / 1 g N 1 40 � a _ ` TOP OF BANK a�` ��,e T.O.BLUFF 187.OT l t ,,o,I ___ _-- f rpo� / /1 1 LDT1 1 GAZEBO SHORT PLAT LOT 2 ;' ;; p PROJECT SITE / GAZEBO SHORT PLAT '' t I W a T—SEPTIC TANK 3 �I 1 PUMP CHMBR N� a a i I 15'-0"MIN TO SEPTIC TA V.I.F. �% 100' BUFFER 8 1 1 I10'-0"MIN TO GRAINFIELD SCALE ; l' = 50. h 1tit ...., so. = r1 '-R - - r` 7 --_ .___.___..__._. _ m 1 HoSQ.ir---ri / i I it i 1 DRAINFIELD PER ' r ENGINEERING V.I.F. • I I it r 4 1 r U.G.PROPANE • ,�N ',,, , :\ .2 ,` i TANK i `\>rC� 100' WELL SETBACK / "' r rr / ` ,' i It I r sk.tfrit r / ' ..N ' I r a rr r r o' �r1 1 ' 4' / 40 �4 W I / �'PROP��3ED�RNEW � ' / \ / DT 12' / LEN,.THy r -,LF. / ( d cf 1 //// Cr/ Q AESS DRIVE �/ O'EASEMENT 1 A 1 , / ,,, N. c� aV / .......s . , /,/, II ...„ ,..,_ /// / SEP 2 5 2012 / % JEffERSON COUNTY , DEPT.Of COMMUNITY DEVELOPMENT i Stormv�a r 's ,''�� Require f-toME OW K1E-12 A \\,... ' au l (5710 APPROVED Po i s E�� v�� 836,8 SITE PLAN 1 (-3(c()) 3-79 - 3�� NOV 1 3 2012 JEF RS•' r DEPT.OF ••, i J,I10 r • �� • • 1,4 Ss_r E Tt�L rt,- o -4- ,r x,,\ f SIGNAT • 44,IV.//hip 4 N N R.0 . P PS42-C- t-- i#- OD 2 1 2 0ZS ,hi