HomeMy WebLinkAboutBLD2007-00184 B1ING PERMIT APPLICATIO• MLA07-00211
Review Type:I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD07-00184 Received Date: 4/30/2007
SITE ADDRESS: 3756 W VALLEY RD
CHIMACUM, 98325
OWNER: CHARLOTTE SUMMERS PHONE: 206-335-8621
PO BOX 654
CHIMACUM WA 983250654
SUBDIVISION: Block: Lot: TX10-1
PARCEL NUMBER: 901342009 Section: 34 Township: 29 N Range: 01 W
CONTRACTOR: KOZELISKY'S HOME SERVICE INC PHONE: (360)385-3215
1112 S JACOB MILLER RD
PORT TOWNSEND WA 98368
Contractor's License KOZELHS027C3 Expires 1/6/2009
REPRESENTATIVE: PHONE:
41 -,E Aries b K t2-1
PROJECT DESCRIPTIOI NEW M/H -CORONADO (SER#0321073) � 500 '7 t IArt
TYPE OF WORK MOB SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION ADD'L: HEAT TYPE: PRO
CODE EDITION: 2003 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: SHORELINE:
GARAGE: SETBACK:
CONST TYPE: DECK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 1 Prop: 1
Total: 1 Total: 1 _
Rou inq Date: Ji_—�
t I I0'7 (--___ '
Type CAnwuritfrali-jBv: Date: Receipt: Approved/Date
Manufactured Homes $163.00 LYK 04/30/07 89920 APPROVED
Potable Water Application $58.00 LYK 04/30/07 89920
Total: $221.00 MAY 15 rj
Jefferson County Planning
&Building Department
40)14 ea JEFFERSON COU tnr 111/
irNott DEPARTMENT OF COMMUNITY DEVELOPMENT �� `>
621 Sheridan Street• Port Townsend Wash ngtorn ‘,'*14 :"1c•■ A ,/
360/379-4450. 360/379-4451 Fax
9' ' www.co.jefferson.wa.us/commdevelopment
Master Permit Application
Project Description(include separate sheets as necessary):
NeW MAN UFAciu Ho.nng'
Tax Parcel Property 800�'o Z (acres/square feet)
Number: q01 3`{Z OE7q
Size: lure` 7
Site Address and/or Directions to Property: 3750 W
VALLEY 9WAP MierC.uM,W Pt' 9g3zS
Property Owner(s)of Record: C4 f aR Lorre 3ufr^A't ERA email: MM `lo�/� t
Telephone: 2Q4' 335 &6 Z I Fax:
Mailing Address: 3t& IA), OLYMPIC 9/. #`F 5E-4T Ze (AM. 9E3((ef
Applicant/Agent(if different from owner): email:
Telephone: Fax:
Mailing Address:
What kind of Permit?(Check each box that applies) i Variance(Minor,Major or Reasonable Economic Use)
B I Demolition I Conditional Use[C(a),C(d),or C]**
i iglFamily Permit I Discretionary"0"or Unnamed Use Classification
I Garage Family i Special Use(Essential Public Facilities)**
I Garage Attached/Detached i Boundary Line Adjustment
Ai Manufactured Home i Short Plat'"""
Modular i Binding Site Plan**
i Commercial*
i Change of Use i Long Plat**I Planned Rural Residential Development(PRRD)/Amendments**
i Address i Road Approach 1 Plat Vacation/Alteration**
yl owed"Y I Shoreline Master Program Exemption/Permit Revisions**
I Allowed ter Management Use Consistency Analysis I Shoreline Management Substantial Development**
I Stormwa A Management I Shoreline Management Variance
I I Site Plan Approval Advance Determination(SPAAD)* I Comprehensive Plan/UDC/Land Use District Map Amendment
I Temporary Use i Jefferson County Shoreline Master Program Amendment
i Wireless Telecommunication
I Forest Practices Act/Release of Six-Year Moratorium **Requires aPre-Applicatio Conference
*May require a Pre-Application Conference
Please identify any other local,state or federal permits required for this proposal,if known:
DESIGNATION OF AGENT application for permit(s).
I hereby designate to act as my agent in matters relating to this app Pe ( )•
Date:
OWNER SIGNATURE
By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the of
his,her or Ws knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this app' packet
may result in this permit being null and void.
I further agree to save,indemnify and hold
against Jefferson County as a result of orI in consequence of the granceting of this permit.attorney's fees and
expenses which may in any way accrue 9
rI eview further agree required provide access andi right ns.oStaf s aoccess and right of entry wil be lasseumed unless the appl cant informs the County in writ ng at heon
review and any required later inspe
time of t the application that
. P or she wants prior notice. %P.-P C.1 c .t.KO Date: - /
Signature: .5f'fi/YI/�I"S `
n one or more threatened or
The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upo
endangered species and could lead to a potential"take"of an endangered species as those nt that the defined r actions that will federal ral law knob asu the
e this
'Endangered Species Act"or"ESA."Jefferson County makes no assurances to the app' c regarding your
permit has been issued o re will i compliance p tet�h individual,group or agency can file a lawsuit on behalf of an
development code.The Applicant acknowledges that he endangered or it holdsindividual
action(s)even if you a
and non-transferable responsibility for adhering to and corply ing with the Ee Applicant has read this disclaimer and signs and dates it below.
Signature: �( �� 3�' CAN � DDate:
G:\PennitCenter\FORMS\DRD FORMS\Master Permit Application 07-142000.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:
L��js I` (i PHONE: FAX:
r� 1� fiOAt. SERvfc (moo) 3e9 3215- ( )
MAILING ADDRESS:
CONTRACTOR'S LICENSE EMAIL:
NUMBER: WAINS
ARCHITECT/ENGINEER: NUMBER
MAILING ADDRESS: PHONE ( ) FAX:( )
EMAIL
Project Type:
Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
A New ,Wood Existing:
❑ Addition ❑ Steel Proposed: ❑ Sewer
❑ Alteration/Remodel ❑ Steel a Bank Community System
❑ Repair Total: _ l Hei htt:
❑ Masonry „_( ndi ermit System
❑ Demolition ❑ Other. Bedrooms. -f�--- SEP Permit l
Type of Heat: Existing: Setback: Water Supply:
pro Proposed: 9 Private well ❑ Two Party
parle. Total: -�_ Ala_ ❑ Public
�- Name of System:
If this is a Commercial Pro ect ou must answer the followin :
Number of Parking Spaces: Current:
Number of occupants(includes owners,tenants,employees, Current Number of A op Parking Spaces:
IBC Occupancy: IBC Type of construction: Proposed
If this is a Pro•-ne Tank and/or A• •liance Installation •-rmit mark all items below t at a••I :.Service? Yes / No
I Underground Tank Above ground Tank
1 Heat Stove j Size of Propane Tank: DO C7,�-�
Cook Stove I Woodstove I Fireplace Insert I Hot W. er Tank I Pellet Stove I
Is this appliance being installed in a Manufactured/Mobile Home? *1 z Others
When applying fora ���./l
permit to install a propane tank you must also submit a site plan showing all of the buildings,
lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system components,
includin• the reserve area.
S•uare Foote, :: �
e Current Pro••sect z e` .:
Main Floor Heated u • NOMifidl
`zEH Bld App Review:
2''Floor Heated � "� �
Onirellimmomm......111111111111111
Consistency Review:
Other _g
ther Heated Base fee:a °. ; ��
P
Mezzanine ,t
ALTO
.;: Additional Section: MILIV
Heated Basement `—---
Plan Check fee:
IIIIIIIII
Unheated Basement - �e,
State Surcharge fee:
, „ ,,,,,,,,, ,O
MIIIIIII
ther Unheated ________,
,_ Pot Water Review fee:
Garage/Carport °:',, �I .CO
SUBTOTAL
• Q r j
O�Decks ` 911/Rd A'pro.ch fee:
Other F 7,a -. lb i T i,
�$ a IM P killffiWill
" Receipt Number:
1112N111 c4�Cash/Check Number: //�
ESTIMATED COST(REQUIRED) '`1� `may
Date:
•Fairmariret value of all labor and materials foundation to finish .1
Initials:
G:\PennitCenter\FORMS\DRD FORMS
"IlleirallIMP
Waster Permit Application 07-4-2006.doc
JACK WESTERMAN III , Jefferson t'ow.t�urtl.ou
ASSESSOR P0 BOA 12.20, Port Townsend,W A 98368
(360)385-9105 t N r t} 2177
MOBILE HOME INFORMATION FORM p ff�
as' U O�t1
OWNER'S NAME/MAILING ADDRESS:
NAME: CHI}R l arTZ 5 c ERS
ADDRESS: 31 ' W. OLYMPIC P1. 4 5 t7TLe 1 w,c• `743/17.
PHONE NO. 204, 335 156.2.1
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:
(A) MAKE MTrvuuNE (B)MODEL eoRo ) Dto (C)YEAR 20014
(D) LENGTH 3(i / (E)WIDTH 1`f (F)SERIAL # 0321073
(G)YOUR PURCHASE PRICE (Do not indude sales tax) 21 SO O PURCHASE DATE 1/12/07
07
2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3)
(A) FROM WHOM DID YOU PURCHASE MOBILE WILL SAM k(NOC1
ADDRESS 17dc C LA y 57REEr P oR t TU wN5EAJD ,w4 q e3 613
(B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR e✓s No
If Yes, Previous address of mobile. 3 C' p ALDER LDS POiW W NSEJVZ'� WA
If No, What County was Mobile assessed in last year.
3)WHERE MOBILE HOME IS TO BE LOCATED:
(A) WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes No
(B)IF LOCATED IN MOBILE HOME PARK:
NAME &ADDRESS OF PARK Lot/Spate#
(C) IF NOT LOCATED IN MOBILE HOME PARK:
NAME OF LAND OWNER:, C RUITTE 5 ta.M MFRS
LOCATION ADDRESS 375h We5T V/ LE`/ ¢Zoh4 C14 wtActt t w '/&3z5
PA-R cE�
REAL PROPERTY PARCEL#/DESCRIPTION 53't T29N 341.2 oo
a/aYtvrt Sunners /x/e 7
Signature of applicant
THANK YOU FOR YOUR HELP!
n
JO COSSELL, Property Technician
0 0
(S6o \ 3M - 33S7
<lp,(1 NI
Pea,
-,
3614, A(der S4. 1
. --
o ‹.
el Z .LTh
le .4 1
if'.
(Th
r OtA r& •---------- ---,1
\ \ -1C
%.:-.., 1 ---\''
og C-,1 kl
--- ' ‘-.-
1 I
RECEIVE
•,:--,,. ,,,
.FR111111, 1101i1)
74...
. ------
0
F
•
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
PERMIT #: BLD07-00184
SITE ADDRESS: 3756 W VALLEY RD Issue Date: 05/15/2007
Final Date: 9/13/2007
APPLICANT: CHARLOTTE SUMMERS PHONE: 206-335-8621
PO BOX 654
CHIMACUM WA 983250654
SUBDIVISION: Block: Lot: TR 3
PARCEL NUMBER: 901342009 Section: 34 Township: 29 N Range: 01 W
PROJECT DESCRIPTION: NEW M/H -CORONADO (SER#0321073) &A/G 500 GAL PROP TANK
THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING
CODE 2003 EDITION.
OCCUPANCY GROUP: r-
1 A n Lt. CGt-C.kt Y ho me,— bad O lr 314'e,
TYPE OF CONSTRUCTION: 717. 5 p_C b L
SYSTEM yes no
THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 9/13/2007
9i
JI3 / Q1
Building Official Signature ac "" e-ief Dat
I:\F_BLD_Occupancy.rpt 10/29/19
.
U . .
3 . •
ElliiiiiiiiIIP.11111111011111111111111111101iiiii ,--1.- Mil - MIMI __ Mil M
m 11111111111EINIMPIIIIIIIIIIMINIIIIIIN • 111=11.111111101111111111110111111111M111
IIIIIIIIINEEK2E110111111111I
;11111111111111E111Willit - 1111=111:•7 imminitirsmontia
lommoinsmnomm- kiiiiiii111115111111E11111
111.11111111P11111111111111111111 1 011=11111141111111111111111E1111111111H1111
=413 31,4111111111.4111111111111,111E1111111111111111111• 111111111EMENiithMEIRL1111-7
c);
o 11111111111 MMIJES1411111111111PAIIIIIIIIIMIN
111111111.11, MilltERIMIENFIRIMPAIMM '
1111EliMMIERMITIMERIMMEINIFF L 11
:111111134,1111111ENIRMIIIIIIFEE1111141 1111MILLIONEWINIMININNIII u\r,
'41 rl 1.1111111igiliLSIP.19111111111Utill 1111111.1Mili -1411111
1 . I (I- I MEM n
F 11111111111451111511111:1111111111!mi ' M. .
11111Blikilliiilleth:11111111P*1111--1 • pi_ NEE
111 ME
11111011:Y11111111111111111111111=111 7" I -1 . • I I 111111111111
IN
, -- • -
' . 1111111111 1I I ' 1111111111
.11111111111111111111111111111 -. t -->
sommomsminaiiiiimit a ammilmmuummulm
N I
itommisommitimmmiumilinmpiliiii mum •
MEM
- 111111111111111111
i
, Ell IMIIIIMIIIMII
.■11.___11111111111111111111111
t?z, -11111111111111111111111111111111111111111111111 • ! E1111111 • E•R
ff, -1111111111MTIIIIIIIIIIIIIIIIPNIEII I ! 11111Milli
z V1111111111111111111111111111 .`. ' 11111•
41111111111111111111111111111' ' • - III
; •H:Lt:
• 111111111111111111111111111PUNI1111111.111 I .1 • q,pisiminui •
'1• ,_smarim
vommis_Ammimasionimppmmi " 1111111111111■2
I 111111111111UMNIIPMENII: wit limmomitawagmo
so moon Epp =Ammo- - -• Est - --mormintiummo .
tottomm-AmniNguimmommituj- :-. 744Ammitomammuomminim (/
IMMENEMEMMEPTAMORMEMERIO I I r;:
liaMENEINNMERIONMEMBr . I - . 111111111111111110111
Li ! 1111111111111111111
111M1111
I ,IlgIIIIIIIIIMIMEIMINIIIIIIIII \-p•
EW _ -1 •
M 1111111
r41 111111111111111111111111111111111111111111111101111111111111111 EMIR
511) , III II II II 11111111111K H • NUR
vogommommillutumminiammemilon ammummamm
t I rmommmamilmosiammiumogiabiammumn • 1111111111111=111113
111111M11111111111111111.1A1111111111110111111610.1111111111111111111111 11111 111111101111E
sommmoRraffirangtommoramisiiiiiniimem An,
Al1111111111111111111111111111 UUUUU
jP4111111111111111111111EVINNISMONTAllillimemillia11 1101111111111111111111
G) I1UUi.UUiUUUUUIUUUUU
1'4 kilIMIMMINNIMINMEIMPLINFORM itAtlifinemoinintilaratekla.••••••••11
FESIMINIINIMMNIIIIENNERINCE
mmmitimanommomministimontwormonsatromossernom
el
111111B111111111111111111111111111101111111E1 MINSIVAINIMMENINI=12.111111111
II IIIIMEM111111111.1111111111111111111111INNIMINIVAIIIINNIBMIIII11111111111111111111111110
_ Cc
A4Esr- v.41-LEy Ro4r,
• ECE1VED
7.,____,..,,\
, *son
.,..* JEFFERSON COUNTY APR 3 0 2007
DEPARTMENT OF COMMUNITY DEVELOPMENT
4. poe:tgab. 4,, 621 Sheridan Street• Port Townsend •Washington 98368 , ttrtn3uF J(Jf DCII
360/379-4450 .360/379-4451 Fax
http://www.cojefferson.wa.us/commdevelopment/
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MLA# Q'l GR 1 k PROJECT/APPLICANT NAME: G/-IAR.Lo777 5'1J%p1
Please answer all of the following questions to the best of your ability. Where the question I 7• , .4 ply;in •• site map, the
applicant may choose to either incorporate the elements into the general plot plan for the Mast= + e ',I• j or to submit a
separate stormwater site plan map.
7 - 184
Project Overview
1. Describe the proposed developed conditions of the site Indicate position and relas10 An the
site map.
4 Hoare a s tie -Pal- a in,a4 cerct rAred Gib oa s 2 o n a 6-acre Jaree4
- jro xe_plarr vetAimet w6<(!ac G f po>ci 257 'X/2' ►.v tote
Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map. /����
erran-1 is vGN'I`e0( �-ie 147= 5 ./ a lid/ _ "S •Yb'o 4✓T 6 tev'e I i1JAL
i Ciminimemomipiwnmormor-- --
3. Describe the exis mg vegetation. Indicate native vegetation areas on the site map. • • P • i
P e c� _ ee lack zerry.e • •• .
4. Describe the existing soils. Indicate soil type on the site map. MAY 1 4 XV
.0
rn GLi v►� - irl S vw.P.0
JFFgER$ON COUNTY'
DEPT.OF _N IF r
5. Describe the existing site hydrology(i.e.,drainage;behavior of water on the site—ain :6: 111441114
existing stormwater drainage to and from the site on the site map. Depict separate drainage basins on t ►
applicable,and indicate acreage of each.
u�
poi (h 4114 &O/lli pies Cflr7"tes'- Hag-
. : % _-% :ii .
i
6. Describe any excess levels of noise generated by the proposed use or activity:
4 b e€SS noise 1 e c e� 4 . S4ne s E ft`.yon.1n t
'Wiwi rrt f a t cr
stormwater site plan template—rev.10/1/2003 5
III
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.
pm-1004 i /►^r',r1-11 We-Si L? flu pr y-1 ,,
8. Describe the general vicinity of the site,including adjacent land uses and structures,utilities,roads,and sensitive/critical areas
(streams,wetlands,lakes,steep slopes,etc.).
11/1 0/4140-6 ,tre-pr G►,o e- (41/1 f izt on WI, V' /' k'k'( �Iyn Chf�,K.,g� .c
GIJ ..y calliN�t,40/l�tr -- kv 611 riS Al tic ) h vi 1 I cp lgii�2
G
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.
41.4. 157DRA.f kermrt LA'/ U- 60 ,D1sPE7Cs'>jA• _a& r7'ETAS W l'114 ()OWNS/QOLc7S
62.07NO 7' tam y Wa'u-S t 1/L c. DispEX $77cW 6f Li a-rr-ie F!e.cW
films M-4it)Lt 1� -cruR eD sq-a✓ACi' -
4 rt
Llit ',Atha project re1u res 1,... e stormwater treatment facilities,describe the types of stormwater treatment facilities proposed
r jse•-rr>�ttN tifb , !`_. the facilities on the site plan and differentiate proposed facilities from existing facilities. [This is
- L.r r ally=far-"large"p*acts or p ojects that involve the potential for dispersion of contaminants.]
. N/4 x
n).1av iii f'i' ' r.,? LI
uescnbe.fha femlance goatrand standards applicable to the project.
I-hiAWr ?ro ly.srUe Ilfts" LAND /4-S G-177 ice`•-s Pass 1 g32.6 Mi
'r7N£7 11'-E 44NGf C-r-Gf c4,-r AA E.
12. Describe the flow control system.
A.C74 $u,2eliGtA brn16 S W f Le- o t% PaRsE A-LLANA 0/z.
stormwater site plan template—rev.10/1/2003 6
• .
•�iECEIVEt)
13. Describe the water quality system.
14. Describe the conveyance system analysis and design. RENE I Kb
�3es /us7 tz1J 1v/LC, fjD1W 42POV,7s eat®tNCa f 1aR,Sewas
Pb-12_ 5TD te..K WArE--2 Eve, a,t,tz
MAAI C -oose "Fu2eNc+ DAZAteoc4 -cent' 361 tor).—,i c s+ s o f-
ihAM urAcnh >A>✓ iNSTE—k0 o f i Irt t/> � t W
15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material.
AN' ' ARf1)EW✓ Y Ovt SITS G(04AJ& W7 LL ,fie I.J /fl4-
/S 1"7IivCG► 7)1124-
Okcerr ft5rr2 Gi k A-v LG?N 7 D 2 I tlE Y 2 D'X IZ '
16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
PilitetAiver t1/4/1 L-1- /Se e 12Ks N-6D P..cc44.
mMP W1t.L 6E ?LACED QA) A- SLA$ .( covorez- -)
17. Describe the proposed surfacing material.
Gt tt11,pp. I N 114- .'/it'll'•[)
18. Describe`methods for restoration of the site.
Rte-P1 Wr C Fs G�72-7-- "i h - ii-s
GG� 1 Al uP CO✓vSr cr7t • 73e�g.
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.
N1tr u.
20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
Nlff-
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.
5t-P1 VS-Mut 5f bk74-NQVIE-7.-A
stormwater site plan template—rev.10/1/2003
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.
AAAJDonn -TREEs tVl LL, 6IT- MOVgD To t/i-C(C 4T
2. Establish Construction Access.
•
. 05&/Lt&7Vr ROA10 e)'5--
3. Control Flow Rates.
1/iky Avis o,v 4,w
4. Install Sediment Controls.
g 1-y 4411-5
5. Stabilize Soils.
IQ'EPtANT /W/EE, G0 7e?ucT/o) T 6,6)-55,GCoyza 7 (o v -c )
6. Protect Slopes.
5,7. - IS 120t-[-MJG 1-1-iU-
Lv r- s pi .c r P
f emnF_ (Arts Nvr-TA-tc€ (-Le R-4/11/ RagA4 S
7. Protect Drain Inlets.
tocr k. Go nit-es wry Pt b t 071 R gteal2'. s.
/V'P tN (•4-► - zs
stormwater site plan template—rev.101/2003 a
•
12 Required Elements-Construction SWPPP(continued)
8. Stabilize Channels and Outlets.
A'/A- 22I vmD
9. Control Pollutants.
j ti sA E31-E 1Af rat tcll LL 436 ON S c
1771Ar Fri a�` s
fl.. r)i d��v
10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
I With- /SE A-pte o/6
11. Maintain Best Management Practices(BMPs).
12. Manage the Project.
1 W/Lc. 8e 000 SITE ND/
-14A41 IC07-e2-lsk,Y 1/01-L 4e bi• S l Tn bate.t NG i `Ecr-,
2. Adjacent Areas.
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential
areas,roads).
f ibLCj 6r i MAST SIV E ROJA-Cartfr to PAD P 'tiyr 77-fe- 2
rt2A t¢O ?Z eS A-CALftfil3.0AA f 4 C4/ O11#E42. tb-f-gre r
b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
yards).
MY Y Weer 7. (NDu Lb Lew * 771` wes r V 714e i3 Leit.4 ink S ITO
i ikf>Q. 4 itm-ru P.. t. s wpa-c�e sons Aro RAM-1-1-4/ p,t.,y,
3. Environmentally Sensitive Areas.
a. Description of environmentally sensitive areas that are on or adjacent to the site.
pa/V'fl 64u' -�'i9-� �1 oQarFt tT coeAr 2. o- FR45-Ps72 r
stomnvater site pan template—rev.10/1/2003 9
b. Description of special requirements for working in or near environmentally sensitive areas.
/Vf
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).
4/e A. r Fo 5 / 50/LS TheE VIC y
5. Construction Phasing. •
a. Construction sequence
S'!7- p-R ? � 1O1n 12.1 tN die SST A ikvu FA-crukz2,
b. Construction phasing(if proposed)
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
I. Provide a proposed construction schedule.
R°_OJ fir' •On/a t /My ¢{j UAIC. 9iDa7 PA1 PL-Or; i3 t4 Gt1E3 0•
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.
Lf,N1NV7'-3
b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation
impacts.
8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable.
a. Sediment Ponds/Traps.
b. Diversions.
c. Waterways.
d. Runoff/Stormwater Detention Calculations
stormwater site plan template—rev.1 W1/2003 10
• S
Stormwater Site Plan Changes
If the designer wishes to make changes or revisions to the originally approved Stormwater Site Plan,the proposed revisions shall be
submitted to DCD prior to construction. The submittal shall include substitute pages that include all proposed changes, revised
drawings showing any structural changes,and any other supporting information that explains and supports the reason for the change.
Final Corrected Plan Submittal
If the project included construction of conveyance systems,treatment facilities,flow control facilities,or structural source control BMPs
(not standard on-site stormwater management BMPs),the applicant shall submit a final corrected plan ("as-builts")when the project is
completed. These should be engineering drawings (stamped by a licensed civil engineer) that accurately represent the project as
constructed.
APPLICANT SIGNATURE
By signing the Construction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and
correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all
owners of the affected property.
_6(4arr,Ota el,e/Y1.01gPS Wte/o7
(LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES,IF NEEDED:
r--
stormwater site plan template—rev.10/1/2003 12
1110 4
MANUFACTURED/MOBILE HOME INSTALLATION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT#: BLD07-00184 Received Date: 4/30/2007
SITE ADDRESS: 3756 W VALLEY RD Issue Date: 5/15/2007
CHIMACUM, 98325
APPLICANT: CHARLOTTE SUMMERS
PO BOX 654
CHIMACUM WA 983250654
SUBDIVISION: Block: Lot: TX10-
PARCEL#: 901342009 Section: 34 Township: 29 N Range: 01 W
CONTRACTOR/ KOZELISKY'S HOME SERVICE INC PHONE: (360)385-3215
DEALER 1112 S JACOB MILLER RD
PORT TOWNSEND WA 98368
Contractor's License KOZELHS027C3 Expires 1/6/2009
PROJECT DESCRIPTION: NEW M/H -CORONADO (SER#0321073) it iI"1 co qat... Carliint.
MAKE: MODULINE
YEAR: 2004
SIZE: 36X14
THIS PERMIT IS VAUD FOR ONE YEAR.
THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR.
THE EXPIRATION DATE IS 5/15/2008.
CALL IN FOR THE REQUIRED INSPECTIONS THAT APPL OUR PROJECT.
Setbacks/Footing (CONTINUOUS FOOTING, LAa r PADS USED): 5I l in
Stormwater FINAL Approval:
(giL"-Matra) MOOD)
Blocking/Plumbing: RtocKtwc '-Ti6-bauu OK 01107A (-RAMEut6Elt Cot. Skte1E& dkOA!
Atto, lj Propane Tank/Lines A^6- TiO Tit K ._u-19 LINE -a-7)7
Zoning Final Approval:
Septic System Final Approval (If not on sewer):
Road Approach Final Approval:
Final/Skirting/Vents/Porches/Steps. C-- 1.1 sio7
HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION
THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:00 a.m. -4:30 p.m.
HOT-LINE AVAILABLE 24 HOURS A DAY
SPECIAL CONDITIONS APPLY-SEE REVERSE
• •
SPECIAL CONDITIONS CASE # BLD07-00184
1.) Building application will utilize a minimum of 240 gallons per day for the septic system.
Existing septic permit SEP94-29 is for three bedroom, there is no additional capacity for
an ADU on this septic system.
2.) The application was reviewed by the Jefferson County Department of Community
Development for the presence of Environmentally Sensitive Areas (ESAs). The
Department conducted a review and has concluded that the property DOES NOT contain
Environmentally Sensitive Areas. However, future proposals will be subject to a new ESA
review and conditions may be added if new ESAs are found on the property.
3.) 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.
4.) The applicant is proposing to create or add 3624 square feet of impervious surface and
4000 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.
5.) A Stormwater Site Plan for a medium project 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.
6.) 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).
7.) The site plan as submitted with the building permit application on April 30, 2007 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 May 14, 2007 shall be resubmitted for review and
approval by Jefferson County Department of Community Development.
8.) This approval is for installation of a manufactured home only. Any future permits on this
site are subject to review for consistency with applicable codes and ordinances and does
not preclude review and conditions which may be placed on future permits.
9.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
10.) 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 autormobile 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 requriements 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.
11.) Minimum setbcak from the edge of the ingress/egress easement is 20 ft. Minimum side
and rear setbacks are 5 ft.
12.) 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.
13.) 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.
1
14.) Maximum lot coverage is not toltceed 25%. Lot coverage is defined as arint of
impervious surface which includes roof tops, driveways, concrete, etc.
15.) The building height is not to exceed 35 feet.
16.) 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.
17.) This parcel has been designated as Rural Residential 1:10 under the Jefferson County
Comprehensive Plan Land Use Map effective August 28, 1998.
18.) A septic permit(SEP94-00029)was finaled on March 3, 1995 for a 3 bedroom system.
19.) W Valley Rd (C514109) is a local access road. The road approach is existing and an
address of 3756 W Valley Rd has been assigned to the parcel.
20.) Development Review staff conducted a site visit of the parcel April 13, 2007. The site visit
confirmed the wetland as identify on the GIS mapping system is a manmade pond and
there is no stream on site.
21.) A minimum of two (2) on-site parking spaces are required for the single family residence.