HomeMy WebLinkAboutBLD2010-00081 L
•LDING PERMIT APPLICATIAN ""Review O°p:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD10-00081 Received Date: 3/24/2010
SITE ADDRESS: 581 BACHELOR RD
SEQUIM, 98382
OWNER: HOUSTON D CHEN TRUSTEE PHONE:
H D CHEN REV LIVING TRUST
42 ORCAS VIEW TRL
PORT TOWNSEND WA 98368-8738
SUBDIVISION: Block: Lot: TX 6+
PARCEL NUMBER: 002352005 Section: 35 Township: 30 N Range: 02 W
CONTRACTOR: PHONE:
`•W, Expires
REPRESENTATIVE: KEVIN COKER PHONE: 360-385-2739
814 GARFIELD ST
PORT TOWNSEND WA 98368
PROJECT DESCRIPTIOI NSFR W/ATT GARAGE
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 2,984
VALUATION 450,000.00 ADD'L: 1,181 HEAT TYPE: EEE
CODE EDITION: 2006 HEAT BASE: HEAT TYPE:
OCCUPANCY: R-3 UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: 5N GARAGE: 490 SHORELINE:
CONST TYPE: DECK: 200 SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: PUD
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 3 Prop: 4
Total: 3 To
Routing Date: L
Type AmotturFrila By: Date: Receipt: Approved/Date
Permit ' $2,953.75 LYK 03/24/10 117453
Plan Check $1,919.94 LYK 03/24/10 117453 APPROVED
State Building Code $4.50 LYK 03/24/10 117453
Potable Water Application $98.00 LYK 03/24/10 117453 JUN 23 201U
Total: $4,976.19 Jefferson County Plannin1
&Building Department
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"~" ,b DEPARTMENT OF COMMUNITY DEVELOPMENT
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,'...4 621 Sheridan Street,Port Townsend,WA 98368
Tel:360.379.4450 I Fax:360.379.4451
Web:www.co.jefferson.wa.us/communitydevelopment
�t ,.c.0" E-mail:dcd n,co.jefferson.wa.us
CERTIFICATE OF OCCUPANCY
PERMIT#: BLD10-00081
APPLICANT: HOUSTON D CHEN TRUSTEE PHONE:
H D CHEN REV LIVING TRUST
42 ORCAS VIEW TRL
PORT TOWNSEND WA 98368-8738
SITE ADDRESS: 581 BACHELOR RD Issue Date: 06/23/2010
SEQUIM, 98382 Final Date: 10/8/2014
SUBDIVISION: Block: Lot: TX 6+
PARCEL NUMBER: 002352005 Section: 35 Township: 30 N Range: 2W
PROJECT DESCRIPTION: NSFR W/ATT GARAGE and shoreline exemption permit(SDP10-00037)
THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2006
EDITION.
OCCUPANCY GROUP: R-3
TYPE OF CONSTRUCTION: 5N
SPRINKLER SYSTEM yes nd
THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 10/8/2014
\\tidemark\data\forms\F_BLD_Occupancy.rpt 10/8/2014
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1! Jefferson County Building Division Permit Number: BLD10-00081
Applicant: CHEN TRUSTEE
BUILDING PERMIT INSPECTION APPROVALS \pplicable Code: 2006 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 q.-I _i` Minimum setback from Bachelor Road right-of-way shall be 20 feet.
s144 be 5 feet. Minimum setback from
shoreline top of bank shall be no less than 50 feet
Erosion Control SEE CONDITIONS 2,3,&4- SILT FENCE SHALL BE
INSTA-LL16 AT LEAST 44 FEET FROM THE TOP OF
SHORELINE BANK. PRIOR TO ANY GROUND-DISTURBING
ACTIVITIES, PROJECT PROPONENT SHALL CONTACT
JEFFERSON COUNTY DRD TO REVIEW THE SILT FENCE
LOCATION AND INSTALLATION (360-379-4450).
Foundation Footing ( —(
Footing Drains _6-19
);8(
Foundation Stem Wall . y b!6 -P6
Underground Plumbing A
Under Floor Framing /4
Straps(hold downs) 1--40113
Ext. Shear Wall Nailing 3740 _2 vet.
Rough-in Plumbing 2 l Pa�,
ot� cl-�- 1 3
/ 1 Framing
F l ram,
Bleckmg '` AAirsealInsulation:Walls 1,00
uLa- A-0 miss_ S__c, w n u. t2N%u.t LAI s--,i
Insulation: Floors
Insulation: Ceiling � 3Ck 1.602, 0
pittl
Int. Shear Wall Nailing — k
Wallboard Nailing
Gas Line: Interior / __1&
Gas Line: Exterior £ 12)
Propane Tank Q/•,1/i q
Heat/Chimney Clearance
Drywell/Alt Drainage SEE CONDITION I FOR TRENCH
Address Posted -_ 3 t /:
FINAL INSPECTION &)...?
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
CONDITIONS for Building Permit# :BLD10-00081
1 ) THE FOLLOWING MINIMUM LENGTHS (LINEAR FEET) PER 1,000 SQUARE FEET OF
ROOF AREA BASED ON SOIL TYPE MAY BE USED FOR SIZING DOWNSPOUT
INFILTRATION TRENCHES:
COARSE SANDS AND COBBLES 20 LF
MEDIUM SAND 30 LF
FINE SAND, LOAMY SAND 75 LF
SANDY LOAM 125 LF
LOAM 190 LF
MAXIMUM LENGTH OF TRENCH MUST NOT EXCEED 100 FEET FROM THE INLET
SUMP.
MINIMUM SPACING BETWEEN TRENCH CENTERLINES MUST BE 6 FEET.
FILTER FABRIC MUST BE PLACED OVER THE DRAIN ROCK PRIOR TO
BACKFILLING.
A VEGETATED FLOWPATH OF AT LEAST 25 FEET IN LENGTH MUST BE
MAINTAINED BETWEEN THE OUTLET OF THE TRENCH AND ANY PROPERTY LINE,
STRUCTURE, STREAM,WETLAND, OR IMPERVIOUS SURFACE.
A SETBACK OF AT LEAST 5 FEET SHOULD BE MAINTAINED BETWEEN ANY EDGE
OF THE TRENCH AND ANY STRUCTURE OR PROPERTY LINE.
NO EROSION OR FLOODING OF DOWNSTREAM PROPERTIES MAY RESULT.
2 ) CONSTRUCTION ENTRANCES SHALL BE STABILIZED WHEREVER TRAFFIC WILL
BE LEAVING A CONSTRUCTION SITE AND TRAVELING ON PAVED ROADS OR
OTHER PAVED AREAS WITHIN 1,000 FEET OF THE SITE.
THE ENTRANCE SHALL BE CONSTRUCTED ON A FIRM COMPACTED SUBGRADE.
QUARRY SPALLS (OR HOG FUEL) SHALL BE ADDED IF THE PAD IS NO LONGER IN
ACCORDANCE WITH THE SPECIFICATIONS. (BMP C105, 2005 DOE STORMWATER
MANUAL).
ANY SEDIMENT THAT IS TRACKED ONTO PAVEMENT SHALL BE REMOVED BY
SHOVELING OR STREET SWEEPING. THE SEDIMENT COLLECTED BY SWEEPING
SHALL BE REMOVED OR STABILIZED ON STIE.
ANY QUARRY SPALLS THAT ARE LOOSENED FROM THE PAD, WHICH END UP ON
THE ROADWAY SHALL BE REMOVED IMMEDIATELY.
UPON PROJECT COMPLETION AND SITE STABILIZATION, ALL CONSTRUCTION
ACCESSES INTENDED AS PERMANENT ACCESS FOR MAINTENANCE SHALL BE
PERMANENTLY STABILIZED.
3.) A SILT FENCE SHALL BE INOLLED AT LEAST 44 FEET FROM THE T F THE
STEEP SHORELINE SLOPE IOR TO ANY LAND DISTURBING ACTIVI
THE MINIMUM HEIGHT OF THE TOP OF SILT FENCE SHALL BE 2 FEET AND THE
MAXIMUM HEIGHT SHALL BE 2 1/2 FEET ABOVE THE ORIGINAL GROUND
SURFACE.
THE SILT FENCE SHALL BE BURIED IN A TRENCH TO A MINIMUM DEPTH OF 5
INCHES BELOW THE GROUND SURFACE. THE TRENCH SHALL BE BACKFILLED
AND THE SOIL TAMPED IN PLACE OVER THE BURIED PORTION OF THE SILT
FENCE, SUCH THAT NO FLOW CAN PASS BENEATH THE FENCE AND SCOURING
CAN NOT OCCUR.
ANY DAMAGE TO THE SILT FENCE SHALL BE REPAIRED IMMEDIATELY.
SEDIMENT DEPOSITS SHALL EITHER BE REMOVED WHEN THE DEPOSIT
REACHES APPROXIMATELY ONE-THIRD THE HEIGHT OF THE SILT FENCE, OR A
SECOND SILT FENCE SHALL BE INSTALLED.
4.) Silt fencing shall be installed along the outer edge of the house to protect the reduced fish
and wildlife habitat conservation area buffer during construction. Silt fencing shall be
located at least 44 feet from the top of the steep slope.
PRIOR TO BEGINNING ANY GROUND-DISTURBING ACTIVITIES, PROJECT
PROPONENT SHALL CONTACT JEFFERSON COUNTY DRD TO REVIEW THE SILT
FENCE LOCATION AND INSTALLATION (360-379-4450). NO EARTH WORK OR
OTHER GROUND-DISTURBING ACTIVITIES SHALL BEGIN UNTIL THE SILT FENCE
INSTALLATION AND LOCATION HAVE BEEN APPROVED BY JEFFERSON COUNTY
DRD.
5.) The project proponent shall implement the Critical Areas Stewardship Plan (dated May 26,
2010; received May 27, 2010) except as follows:
a. Monitoring of the mitigation areas shall be conducted for five years (instead of the three
years specified in the CASP), with percent cover of installed plants at 40% in Year 4 and
at 50% in Year 5.
b. Any revisions to the planting plan shall be approved by Jefferson County DRD prior to
plant installation. Substitutions shall be not approved for non-native species or for species
that are not appropriate for the habitat type. Ornamentals and landscaping varieties shall
not be considered acceptable substitutions.
c. The project biologist shall be on-site to review plant health and plant locations prior to
installation of plants.
d. AN AS-BUILT PREPARED BY THE PROJECT BIOLOGIST SHALL BE SUBMITTED
AND APPROVED BY JEFFERSON COUNTY DEVELOPMENT REVIEW DIVISION
PRIOR TO ISSUING A BUILDING FINAL.
e. Annual monitoring reports shall be submitted to Jefferson County DRD by October 31
for each monitoring year.
6.) SITE GRADING SOILS OR DEBRIS, LANDSCAPE DEBRIS, OR ANY OTHER
MATERIAL SHOULD NOT BE DISPOSED OF OVER THE BLUFF FACE OR PLACED
AT THE TOP OF THE STEEP BLUFF.
7.) 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
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.) VOLUNTARY MEASURES 0 •ASTAL &AT RISK SIPZ:
Water conservation measures:
1. Roof and other intercepted precipitation shall be routed to on-site detention ponds
and/or other approved means and allowed to be released to the soil slowly.
2. Water collected from Storm water and roof catchments may be used for watering
lawns and gardens. Unless catchment water has been treated to meet drinking water
standards, there shall be no cross connections allowed between the potable supply and
impounded water.
3. Water withdrawn from wells on each property shall not be used for watering of lawns
and/or gardens.
4. Ground water withdrawn from each property shall be restricted to a rate of three (3)
gallons per minute.
5. Installation of water conserving fixtures such as low flow toilets, faucets and shower
restrictors and other water saving plumbing fixtures.
6. Landscaping plan (xeriscaping, native vegetation with minimal amounts of irrigation).
Please NOTE that the above listed measures are not intended to be exhaustive, but rather
is intended to be illustrative of the types of water conservation measures.
10.) VOLUNTARY MEASURES OF COASTAL &AT RISK SIPZ:
1. Installation of a flow meter.
2. On-going well monitoring for chloride concentration.
3. Submittal of monitoring data to County.
11.) MANDATORY MEASURES FOR COASTAL 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 requirement:
a. Chloride concentration of a laboratory-certified well water sample submitted with
building permit application.
3. If public water is unavailable, a qualifying alternative system may be used as proof of
potable water.
12.) The property owner shall comply with Water Conservation Measures (per list maintained
by the UDC Administrator).
13.) 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.
14.) A Geotechnical Report dated November 25, 2002 prepared by Stratum Group was
submitted in conjunction with this application. The report addressed the stability of the
geologic hazard area.
15.) 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.
16.) 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."
17.) All construction activities shall not encroach upon the landslide hazard area or the fish and
wildlife habitat buffers. This includes the storage or preparation of materials.
18.) 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.
19.) Critical Aquifer may a Areas 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.
20.) The applicant shall fully adhere to all conditions and requirements of the eagle habitat
management plan as signed by the applicant on June 15, 2010 and signed by the county
on June 21, 2010.
21.) 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.
22.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
23.) 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.
24.) A minimum of two (2) on-site parking spaces shall be provided for the single family
residence.
25.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
26.) The building height is not to exceed 35 feet.
27.) Minimum setback from Bachelor Road right-of-way shall be 20 feet. Minimum side yard
setbcks shall be 5 feet. Minimum setback from shoreline top of bank shall be no less than
50 feet
28.) 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.
29.) 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.
30.) 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.
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Sample Planting Plans •
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Garden 1: Shade Garden
ZONE 1 Emergents: Slough sedge (Carex obnupta) and small-fruited bulrush (Scirpus microcarpus). w
Ferns: Lady fern (Athyrium filix-femina) and deer fern (Blechnum spicant).
Deciduous shrubs: Stink currant (Ribes bracteosum). If the garden is large add black twinberry (Lonicera t
involucrata).
ZONE 2 Deciduous shrubs: Snowberries (Symphoricarpos albus). ti
Evergreen shrubs: Evergreen huckleberry (Vaccinium ovatum). .
Ferns: Sword fern (Polystichum munitum) and lady fern.
IN
ZONE 3 Evergreen shrubs: Evergreen huckleberry, low Oregon-grape (Berberis nervosa).
Ferns: Sword fern. t
Herbaceous perennials: Wild ginger (Asarum caudatum), inside-out flower (Vancouveria hexandra), and t
western bleeding heart(Dicentra formosa).
- - .. In-flow pipe t
Zone 3,-- V, Emergents
' .� • ' Ferns
r yam' trxio-'-?� \�f .., ,
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''g• `'` *) Usin a soil excavated from th .ain garden ��
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If the soil that is excavated does not have too much clay set it aside for mixing kq
Build with compost and refilling the rain garden. The rain garden soil mix should be: tY
'' ' „,/ ._, . . „ . _ ,
• About 65% excavated soil and 35% compost by volume V
" Compost should be stable and mature and made from organic waste materials such Ct
as yard debris or wood wastes.A simple way to judge compost quality is to smell and
examine the finished product which should have the following characteristics: qh
il
• Earthy smell that is not sour, sweet or ammonia like.
• Brown to black in color. ti
o Mixed particle size.
f ' Stable temperature that doesn't get hot when re-wetted.
1/4 Crumbly texture.
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q` ? or sawdust for cot lost.
Placing the rain garden soil mix ,. : : y$, -. af.- t
Rain gardens have some area above ground � � so s Si
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to allow water to pond. Six to 12 inches is ',..??•-� ,* by _.,. 1._.
recommended. So, replace the soil in the rain n- "`� Y• -t �,
garden about 6 inches at a time and walk on t_ �,, 4 r
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each layer to lightly compact. Fill the soil up � f�-;: k� �.� '4, -
to a level that provides the desired ponding ,7 f . .,,ems r,= r e.
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w��i 06, JEFFERSON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
; ` ''4 621 Sheridan Street• Port Townsend •Washington 98368
0 360/379-4450 • 360/379-4451 Fax
�`S`BIN� www.co.jefferson.wa.us/commdevelopment
Master Permit Application MAi-i 2 4 2010 MLA: L " I 0
Project Description(include separate sheets as necessary):
Tax Parcel Number: 00? 35.-2,S- Property Size: 7 32Q.-is (acres/square feet)
Site Address and/or Directions to Property:
Property Owner(s)of Record: hiefs-42,1 AdoChP�
Telephone: .� Fax: email:
Mailing Address: 5 3 j
Applicant/Agent(if different from owner): ,N
Telephone: SSS 2 7 3? r, Fax: email:
Mailing Address: S"/1 £ )— 4,0
What kind of Permit?(Check each box that applies 0 Lot or Road Segregation
IOBuilding ❑Critical Areas Stewardship Plan
❑ Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
Single Family .Qarage ached/ etached ❑❑Conditional Use[C(a),C(d),or C]*"
❑ Manufactured Home ❑❑ Modula 0 Discretionary"D"or Unnamed Use Classification
❑ Commercial* 0 Special Use(Essential Public Facilities)**
❑ Change of Use 0 Boundary Line Adjustment
❑ Address 0 Road Approach 0 Short Plat**
❑ Home Business ❑Cottage Industry ❑Binding Site Plan**
0 Propane ❑Long Plat**
❑Sign - 0 Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration**
❑ Stormwater Management ❑Shoreline Master Program ExemptioNPermit Revisions**
❑ Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development**
❑Temporary Use 0 Shoreline Management Variance
❑Wireless Telecommunication* 0 Comprehensive PIaNUDC/Land Use District Map Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium ❑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 to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE Date:
By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of
his,her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet
may result in this permit being null and void.
I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and
expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit.
I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any required later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the ap li tion that e r she wants prior notice.
�ignature: Date:
The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or
endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the
"Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this
permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-tran gable res n ibility adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: (��-- Date:
0 •
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:
GENERA,CON TRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
Cter, e-Ce ( ) 77l77? ( )
MAILING ADDRESS: To 2i (`u , _ lial f$25 EMAIL:
CONTRACTOR'S LICENSE l I WAINS
NUMBER: t''�"'' {, G, 1 2-1"LE NUMBER
ARCHITECT/ENGINEER: E,l` rat/4 PHONE ( ) S- j( -O FAX:( )
MAILING ADDRESS: � EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
New ja Wood Existing: ❑ Sewer
Addition ❑ Steel Proposed: Bank ❑ Community System
Total: H ht:� ❑ Individual System
❑ Alteration/Remodel ❑ Concrete — � y
❑ Repair ❑ Masonry SEP Permit# 63-196/4
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: _ Setback: [1 Private well ❑ Two Party
Typef Heat: ,. Proposed: ;- o f Public
` r Total: `1) Name of System: -
If this is a Commercial Project you must answer the following:
Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces:
Number of occupants(includes owners,tenants,employees,etc) Current Proposed
IBC Occupancy: IBC Type of construction: Will you have Food'Service? Yes / No
If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply:
i Underground Tank 1 Above ground Tank Size of Propane Tank:
i Heat Stove i Cook Stove i Woodstove i Fireplace Insert i Hot Water Tank i Pellet Stove i Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No
When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property
lines, tank location and size,distances from the propane tank to all property lines,buildings and septic system components,
including the reserve area.
Square Footage Current Proposed Fqr Office Use Only _ Amount Revision
Main Floor Heated g4 LZEH Bld App Review:(9:1 r13 —
4 ` ConsistencyReview:
2fd Floor Heated C ig` j t(1' ` �— 2(3
Other Heated Base fee:
ZQ53 ?5
Mezzanine Addtt I ect bfl ,t-Cfl-
Heated Basement Plan Check fee: 1 9 1 c
Unheated Basement State Surcharge fee: 1 ^ so
Other Unheated Pot Water Review fee: 15
P
Garage/Carport i2:76t4so SUBTOTAL � 9
Decks 52A00° _pop ac fee: r
Other TOTAL: $5 /I
Receipt Number: 1 "�9
- Cash/Check Number:
43D10 .i._= 1 I
ESTIMATED COST(REQUIRED) Date:
Fair market v etif elttabor�nd materials foundation to finish t
t / Initials: f
1� c�<�0 %7 <
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JEFFERSON COUNTY
4 ,. 1 DEPARTMENT OF COMMUNITY DEVELOPMENT •
621 Sheridan Street • Port Townsend • Washington 98368 ''"' 2 4 2010
�O� 360/379-4450 . 360/379-4451 Fax
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http://www.co.jefferson.wa.us/commdevelopment/
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
I MLA# 1 D - ' 10 PROJECT/APPLICANT NAME: Qcts�-u
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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.
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Existing Conditions Summary
2. Describe the existinc topography. Indicate contours onttiae site map.
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3. Describe the existing vegetation. Indicate native vegetafon areas on the site map.
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4. Describe the existing soils. Indicate soil type on the ite map.
5. Describe the existing site hydrology(i.e., drainage; behavior of water on the site—above, below, and on the ground). Indicate
' e ' Ling stormwater drainage to and from the site on the site map. Depict separate drainage basins on the site map, if
, .pplicable,and indicate acreage of each. '
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6. scribe any excess levels of noise generated by the propo ed use or activity: STORMWATER PLAN
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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 themap._ tstitte ----A-4at. (F1-- ) (944COO
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8. Describe the general vicinity of the site, including adjacent land uses and structures, utilities, roads, and sensitive/critical areas
(streams,wetlands,lakes, steep lopes, t). �/
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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 th site. Locat?these facili s,on the site plan andñv
diffqriate proposed facilities from ex' 'ng facili ' s.
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10. If the project requires the use of stormwater treatment facilities, describe the types of stormwater treatment facilities proposed
for use on the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. [This is
normally for"large"projects or projects that involve the potential for dispersion of contaminants.]
11. Desk'be the pgrfo mance goals and standards applicable to the roject. )Q M no - n\
Describe he w ntrol system. 6 t
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13. Describe the water quality ystem.
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5 N.14. lescribe th-4 onveyance system analysis and desi i n. i
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15. Describe thesource of fil material, physical c aracteristics of fill material,and deposition of excess material.
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16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code. f
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17. Describe the proposed surfacing materia
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18. Desc ibe m thods for restor tion of the site. ,,...a ,
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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. S r 4-
20.4
t h e and include any s ecial report or studies con.ucted to prepare the Stormwater Site Plan.
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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.
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stom,.eater site plan template—rev 10121/2008
•
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).
1 "Required Elements-Construction SWPPP
1. Mark Clearing Limits. Si (a„ (Is
2. Establishconstruction Access. .....t
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Control Flow Rates.
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4. Install ediment Control I /] e 4 A _
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5. Stabile e Soils.
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1 6. Protect Slops.
7. Protect Drain Inlets.
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stormwater site plan template—rev.10/21/2008
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12 Required Elements—Construction SWPPP(continued)
8. Stabilize Channels and Outlets.
9. Cont of Pollutants.
10. Control Watering (the act of pu ing groundwa -r or s�rmwater away from
a/�active construction site).
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11. Maintain Best Margement Practices(BM2s).
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12. Manage the Project.
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2. Adjacent Areas.
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential
areas, roads))PM
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b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
yards).
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3. Environmentally Sensitive Areas.
a. Description�Cn-v�l��environmentally sensitive areas that are on or a5djace to the site.
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stormwater site plan template—rev.10/21/2008
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b. Description of special requirements for working in or near environmentally sensitive areas.
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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).
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5. Construction Phasing. :40-123 1 11-4- f L--f ....k.,„..0
a. C struction uence , �r4V-.1"Q"--i ..P.,
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b. Construction phasing (if proposed)
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
I. Providf a proposed c nstruction schedule.
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II. Wet Season Construction Activities.
a Prop sed wet season cstr ctignactivities. r
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b. Proposed wet season construction activities for environmentally sensitive areas.
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7. Financial/Ownership Responsibilities.
a. Identify t property ovgier responsible for the initiation of bonds and/or other financial securities.
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b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation
impacts.
47,4
8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following, if applicable.
a. Sediment Ponds/Traps.
b. Diversions. 7/4
c. Waterways.
d. Runoff/Stormwater Detention Calculations
10
stormwater site plan template—rev.10/21/2008
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• •
SECTION li—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.
r,O i„n 4 L
stormwater site plan template—rev.10/21/2008
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1 r
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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.
i_ ` 2 -z4-(D
(LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE)
(DATE)
THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
•
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stormwater site plan template—rev.10/21/2008