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HomeMy WebLinkAboutBLD2013-00115 • ,'BUILDING PERMIT APPLIC N LDiew 00115 Jefferson County Department of Community eIopment 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD13-00115 Received Date: 4/11/2013 SITE ADDRESS: OWNER: MARK R JOHNSON PHONE: ANNETTE JOHNSON 10 CUTTER LANE PORT LUDLOW WA 983659722 PORT LUDLOW NO. 2 SUBDIVISION: Block: Lot: PARCEL NUMBER: 990600252 Section: 9 Township: 28 N Range: 01 E CONTRACTOR: WHITEY JOHNSON GENERAL CONTR PHONE: (360)779-9884 PO BOX 1110 SUQUAMISH WA 98392 Contractor's License WHITEJG952DN Expires 3/15/2015 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION NSFR WITH ATTACHED GARAGE TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 2,343 VALUATION 271,714.00 ADD'L: HEAT TYPE: HTP CODE EDITION: 2009 HEAT BASE: HEAT TYPE: WOD OCCUPANCY: R-3 UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: 5N GARAGE: 843 SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: SEW WATER SYSTEM: 68700 BEDROOMS: BATHROOMS: Exist: Exist: Prop: 3 Prop: 2 Total: 3 Total: 2 Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $0.00 ZAL 04/11/13 Plan Check $0.00 ZAL 04/11/13 State Building Code $0.00 ZAL 04/11/13 kS\Sel \\1/44/ '\\c*, )3\\\•5"\\: Potable Water Application $0.00 ZAL 04/11/13 Total: $0.00 \\firlomrL\rlofo\fnrmo\R RI fl An RI.J rnf 411x,/')/11'2 • 0-5ON r" , DEPARTMENT OF COMMUNITY DEVELOPMENT I,;; 621 Sheridan Street,Port Townsend,WA 98368 Tel:360.379.4450 I Fax:360.379.4451 Web:www.co.jefferson.wa.us/cornmunitydevelopment g f1 s 6c° E-mail:dcdaco.jefferson.wa.us CERTIFICATE OF OCCUPANCY PERMIT#: BLD13-00115 APPLICANT: MARK R JOHNSON PHONE: ANNETTE JOHNSON PO BOX 65335 PORT LUDLOW WA 983659722 SITE ADDRESS: 72 RESOLUTE LN Issue Date: 05/14/2013 Final Date: 10/27/2014 SUBDIVISION: 9906 Block: Lot: PARCEL NUMBER: 990600252 Section: 9 Township: 28 N Range: 1 E PROJECT DESCRIPTION: NSFR WITH ATTACHED GARAGE THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2009 EDITION. OCCUPANCY GROUP: R-3 TYPE OF CONSTRUCTION: 5N SPRINKLER SYSTEM yes no THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 10/27/2014 \\tidemark\data\forms\F_BLD_Occupancy.rpt 10/28/2014 • Jefferson County Building Division Permit Number: BLD13-00115 Applicant: JOHNSON BUILDING PERMIT INSPECTION APPROVALS Applicable Code: 2009 International Building Codes To schedule inspections, call (360)379-4455 no later than 3:00PM the day before the inspection is needed. Requests received after 3:00 PM will not be scheduled for the next 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 9'1 S\1 Erosion Control Foundation Footing CA 51 I 9—V / Footing Drains •,r hi// /;. .' Foundation Stem Wall wi7/13 ( 7 Underground Plumbing Under Floor Framing t I �3 Straps(hold downs) 3/27 4A/ Ext. Shear Wall Nailing //r i4 Rough-in Plumbing 3/ 7//q Framing 3/2-7/ /t Blocking 3/2-7/-II. Airseal --/Z7/( C Insulation:Walls Insulation: Floors r .2,7' Insulation: Ceiling o . V/Lf r Int. Shear Wall Nailing !a 5 3 Ci.08 Wallboard Nailing /o4,-/(/ Gas Line: Interior Gas Line: Exterior Propane Tank Heat/Chimney Clearance )�{, 1,4 Mechanical Systems /L Duct Test Cert jD y ))1-- Blower Airtight Test ��h64/ Smoke&CO2 SDI . 1 Drywell/Alt Drainage Address Posted /0 /a II • • FINAL INSPECTION /r/i.2-4/-i FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR • • CONDITIONS for Building Permit# :BLD13-00115 1.) The project shall adhere to the Best Management Practices (BMPs) 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. 2.) The site plan as submitted with the Building Permit application on April 11, 2013 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 April 16, 2013 shall be resubmitted for review and approval by Jefferson County Department of Community Development. Wiriamark\data\fnrmc\F RI fl Permit RIrin rnt /14/7(111 • • co�YZA JEFFERSON COUNTY R kry DEPARTMENT OF COMMUNITY DEVELOPMENT -r`' ,; t. titi 621 Sheridan Street • Port Townsend • Washington 98368 MAR 1 1 2013 O 360/379-4450 • 360/379-4451 Fax`�$ING�S http://www.co.jefferson.wa.us/commdevelopment/ ,lEffEilSON mot up Stormwater Calculation Worksheet MLA# PROJECT/APPLICANT NAME: DETERMINING STORMWATER MANAGEMENT REQUIREMENTS: This stormwater calculation worksheet should be completed first to classify the proposal as "small,""medium," or"large." The size determines whether a Stormwater Site Plan is required in conjunction with a stand-alone stormwater management permit application, building permit application, or other land use approval application that involves stormwater review. The basic information will also be helpful for completing a Stormwater Site Plan, if required. PARCEL SIZE(I.E., SITE) Size of parcel , Zg acres An acre contains 43,560 square feet. Multiply the acreage by this figure. Size of parcel in square feet I Zl NO sq/ft Land-disturbing activity is any activity that results in movement of earth, or a change in the existing soil cover (both vegetative and non-vegetative) and/or the existing soil topography. Land disturbing activities include, but are not limited to clearing, grading, filling, excavation, and compaction associated with stabilization of structures and road construction. Native vegetation is vegetation comprised on plant species, other than noxious weeds, that are indigenous to the coastal region of the Pacific Northwest and which reasonably could have been expected to naturally occur on the site. Examples include species such as Douglas fir,western hemlock,western red cedar, alder, big-leaf maple, and vine maple; shrubs such as willow, elderberry, salmonberry, and salal; herbaceous plants such as sword fern, foam flower, and fireweed. LAND DISTURBING ACTIVITY, CONVERSION OF NATIVE VEGETATION, AND VOLUME OF CUT/FILL Calculate the total area to be cleared, graded,filled, Answer the following two questions related to excavated, and/or compacted for proposed development conversion of native vegetation: project. Include in this calculation the area to be cleared for: Does the project convert 3/4 acres or more of Construction site for structures Z sq/ft native vegetation to lawn or landscaped areas? Drainfield, septic tank, etc. rJ/lL sq/ft Circle: Yes No Well, utilities, etc. ->'- sq/ft Does the project convert 2 1/2 acres or more of native vegetation to pasture? Driveway, parking,roads, etc. ! 1 ? sq/ft Circle: Yes No Lawn, landscaping, etc. L.)4-r-i sq/ft Other compacted surface, etc. sq/ft Indicate Total Volumes of Proposed: Total Land Disturbance 5-41i U sq/ft Cut `� Fill + (cu/yd) [over] stormwater calc worksheet Rev 9-9-2010—REV 9/9/2010 1 • • Impervious surface is a hard surface that either prevents or retards the entry of water into the soil mantle as under natural conditions prior to development. A hard surface area which causes water to run off the surface in greater quantities or at an increased rate of flow from the flow present under natural conditions prior to development. Common impervious surfaces include, but are not limited to roof tops, walkways, patios, driveways, parking lots or storage areas, concrete or asphalt paving, gravel roads, packed earthen materials, and oiled, macadam or other surfaces which similarly impede the natural infiltration of stormwater. STORMWATER CALULATIONS—IMPERVIOUS SURFACE NEW EXISTING Structures (all roof area) ; I sq/ft Structures (all roof area) sq/ft Sidewalks sq/ft Sidewalks sq/ft Patios sq/ft Patios sq/ft Solid Decks sq/ft Solid Decks sq/ft (without infiltration below) (without infiltration below) Driveway, parking, roads, etc I S-7 ei sq/ft Driveway, parking, roads, etc sq/ft Other sq/ft Other sq/ft Total New 5-4-01 U _sq/ft Total Existing -�' sq/ft TOTAL NEW+TOTAL EXISTING* 94-c o sq/ft *This amount will be used BY STAFF to check total lot coverage. The following questions will help determine whether the proposed project is considered development or redevelopment. DEVELOPMENT v. REDEVELOPMENT Divide the total existing impervious surface above by the size of the parcel and convert to a percentage: •446,% Does the site have 35% or more of existing impervious surface? Circle: Yes FURTHER INSTRUCTIONS: If the answer is yes, the proposal is considered redevelopment and the attached Figure 2 should be used to determine the applicable Minimum Requirements. If the answer is no, the proposal is considered new development and the attached Figure 1 should be used. At this juncture, the applicant should refer to the applicable Flow Chart to determine the Minimum Requirements for stormwater management. DCD staff will help verify the classification of the project and the application requirements. For proponents of "small" projects who must comply only with Minimum Requirement #2—Construction Stormwater Pollution Prevention—an additional submittal is not required. The proponent is responsible for employing the 12 Elements to control erosion and prevent sediment and other pollutants from leaving the site during the construction phase of the project. Pick up the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet. Proponents of"medium" projects—those that must meet only Minimum Requirements #1 through #5—and for "large" projects—those that must meet all 10 Minimum Requirements—are required to submit a Stormwater Site Plan. DCD has prepared a submittal template of a Stormwater Site Plan, principally for rural residential projects. Complete the template in the Stormwater Site Plan Instructions and Submittal Template or prepare a Stormwater Site Plan using the step-by-step guidance in the Stormwater Management Manual. APPLICANT SIGNATURE By signing the Stormwater Calculation 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. (LANDO E OR AUTHO IZE E RP ESENTATIVE SIGNATURE) (DATE) / FOR OFFICE USE ONLY SMALL MEDIUM LARGE REDEVELOPMENT Stormwater Site Plan: Yes No stormwater calc worksheet Rev 9-9-2010—REV 9/9/2010 2 • w JEFFERSON COUNTY t-, ►q DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend • Washington 98368 �.qs O� 360/379-4450 . 360/379-4451 Fax �37N0 http://www.co.jefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# PROJECT/APPLICANT NAME: 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. &0n15 T J L z-- 2 34 5 4' hI)f;-L -�A-6*LY 2s�/D0Nig w/&el-. .LT' /s T' 14it. > -ram Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. `(' t el- — r3/4-/->K- s7-xl-rzi- o Ore./v R- y(S c-i en -r r' c Lrr' > A- / 4-/,c, ,� 'I - 2 -so L-e-, re L. -it ) Lo7-S/. /DES g2— rzcr To r-7 GV/f71-r4- -E57" Phi,.>T- C:3 NKi eA0C-,vC-nL laPzce -i-s[, 2/ '?/5e- 6 /55' 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. 7/4 -11'/L40 c---,G- 6&1.7/ 72 Oo u C=-J/2 IL I' NI # S C G Z7 D v L-a-r-- (/i- ei 7-�•Y r it-)� ciarPig--7',€ dr ies ,,ci--A/o ,b0-) v-tvf . ofr+-7 c SN (_ -L j I,V/C--D t3Ct,><./ . 4 ","/ ��-rZ iL 7"Z- 4. Describe the existing soils. Indicate soil type on the site map. // ,, Describe the existingsite hydrology r ' — 5. esc be (i.e., drainage; behavior of water on the site above, below, and on the ground). Indicate existing stormwater drainage to and from the site on the site map. Depict separate drainage basins on the site map, if applicable, and indicate acreage of each. Z-or /5 ��4-r�-�� J2� 17Izi ex.e T 6 A€,a:'T, 4-;(2'c-i- Ol rz/f v/ o �-:13 43 Si.03 0/v/5 j ev it-) O5 o l'roi� 1-o SAgou o , 4v i 7-2-1 itJLL-'e n-fre--1 a t er ID A Pp/e&L'4- v2 S r ,(2. 1 (4,t Z 2_ /-,./-1 0/,.r.q-Cr - 6. Describe any excess levels of noise generated by the proposed use or activity: tiru i. 11 stormwater site plan template—rev.10/21/2008 5 • • • 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. ,coo rvt te1rP4'LLr S iV/ 7 7 11/ , s -re3 e K /D '�r-��/i 7 1 -,��oa s":„,ar le-VA-a-- 'i- , Pr 12-7 / 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.). GD C1Q- 0 /tJ r D CTs1 r7 /(�.zi _ > 'D Vi - /2 mac— o J IL30 2 -r-i-/ ,-'p !/,4 A -'T L.407- 0A- So6'7 - L ,v A-c-e_z? Sri 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. Fo'-rZ L-- t7Q_Ac -J L-i IL) F i...42t' T r L uu G {..4- t `c) '��-�i 1>G— � G -G," -t C-f f L r Ct�rt�-I-6 isyst 4..2 5 •w)i trj'mow o C7 t ccA-hsc r � -r C) .-rt- 'r$ 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. Describe the performance goals and standards applicable to the project. -� CL-0A<L, -t- c.�-r�-c c v�,-�� S s c.� Pe4,r4► s- �tvt,12G r t Al2 P ---b S a rvl A uD D(c ck�-t�(I ''vC, Z"t-c-= P� N 12. Describe the flow control system. r till r.> f S 'to Ltitit r-b T'0 b n16 c' , _LA S! N P V L''-ru ►v�S , 4,'< (1).M LA , /4'` c i L - r `-1 E-- 5 f stormwater site plan template-rev.10/21/2008 6 • • 13. Describe the water quality system. t a-t c— Le B I pc k-S- av w 1 LL 8 tT 5C'1 US w/; -- L L 11- - E—N?t.15r L4JH IJts-—r 'Ct CAA 2.1 tiC.1:" ColuS .1,kC, 1 14. Describe the conveyance system analysis and design. 15. Describe the source of fill material, physical characteristics of fill material, and deposition of excess material. -1 a P .S a t L. W t LL_ r�� P t L z' � D r a— p1/4-0viD 1 L L✓ p7 u-S 1�-(J AcS �-SS A(12.Y 1 L) I7 V"l ouk 71-- S. w 13E 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. f- kv-)c) rc9 LA-1%-)1::>&12- CL-"Pc12-Ace-c-" / < ? c 95 • 17. Describe the proposed surfacing material. A-LS c(Z zr t' (3� W1.l IU ILO C ft4,1 18. Describe methods for restoration of the site. cb12xwr35 Lci— n7ot-c c trt5-f2 t w/(�c i t iv.I�vr olio pc_1 v U 1 a• 1 ����r�-P C--� �''� �a�-, 1/t=- ✓C--Cr-r�T-1 r� o O S P R.1 t)V 1 r1-F i X.L.-L(I 'r L., `rr S 5 tr 19. An Operation and Maintenance Manual is required for each flow control and treatment facility. [This is normally required for "large"projects only and only those for which facilities are required to control flow or treat runoff.] If included, list the Manuals here. n' 20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan. Oelkite 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. �P7 e L L/ ( )kt-t' ApP Ik t_,LA { 'Lb LC� stormwater site plan template—rev.10/21/2008 7 • • CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN (SWPPP) The Construction SWPPP addresses sediment and erosion control during construction. The BMPs indicated by the applicant in the template that follows must be installed on the ground during all construction phases of the project. The proponent is responsible for preventing sediment and erosion impacts to environmentally sensitive areas and off-site areas. Consult the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet for guidance, particularly with rural residential development. SECTION I-CONSTRUCTION SWPPP NARRATIVE 1. Construction Stormwater Pollution Plan Elements. Describe how each of the Construction SWPPP elements has been or will be addressed. Identify the type and location of BMPs used to satisfy the required element. If an element is not applicable to the proposal,justify in writing. Descriptions of the 12 Elements are found at Volume II Section 3.2.3 of the Manual (beginning on page 3-7). 12 Required Elements-Construction SWPPP 1. Mark Clearing Limits. 47t2 a A-Q_`-r - S't' 1 5 L)(.s- w I L-L, 35- ,k, P t�ArC�G IA)t g.) c! - ., -�11)(z P.rt Pr11719 _✓ _ b PLC 2. Establish Construction Access. 1.74 c; t kJ 121 Cat A ) A. -1 a_) GO o t2,1L 3. Control Flow Rates. cvc.I✓ '1 Uo-wt5 t'7Gra✓r o `t-r 4. Install Sediment Controls. 3 bc.) Ac-12p 5. Stabilize Soils. b k 4 IP `t- A arte..K L O.113 Q- r'fZ -Q,q(0 t C-- 6. Protect Slopes. tl,F-' �- c-c eG �iTtc� �7 -�=- �6(31 IC1 l 7. Protect Drain Inlets. C',taerc-A+ F3 Ih__) S u,►mil p f" ,271 vry s Pc,vvr5 s ter- 1►� I�1 2 t tj. 4 / d3 LASS- 1=4 I-)rc.l--Y C.tQ A t'e w t Lc, u5 t✓ 5 �.- 1:111-1 L)C (0 5 i 4" stormwater site plan template-rev.10/21/2008 8 • . I 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. w/ f LL v t S co tv 9. Control Pollutants. t_-t ►.� Lt n G c- -P tL.,tsr w 12. N c2c7 LL. i '3 10. Control De-Watering (the act of pumping groundwater or stormwater away from an active construction site). (.. N --- GU('I--t+ C--Ac4.-p 11. Maintain Best Management Practices(BMPs). __ err- (.vrQ 1� w t SFr S pG-2.tJ r-E t1,�✓ 'fl-}� Ltt 1UL-1p�,� CAD TT> - P- a(-- -L -.-t Tt4 1 ir{a c 12. Manage the Project. ( PPLL 2:$ 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). I LL F-12-4) t+o LA.S L, NI J AA-C-ram a Ku 11-1, -l..)n 4/ ►V €1, C L+rrie ►,J uu 1 ti la-►�r2 TH-tr" S r a r/Q ITLll '-r<2 Q,nab o lam- b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). . j�. 64II LC-- ,- J'p L A.ct- ,-tv 12b may/ 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. (V// stormwater site plan template—rev.10/21/2008 9 � • . b. Description of special requirements for working in or near environmentally sensitive areas. 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 d> U�/5 4r. Ltd }=t s W n121► c SF ter _ 'E PIMA IN-r-trre - . 4 Nth b. Construction phasing(if proposed) IA/t5"' 6. Construction Schedule. Wet season is October 1 through April 30 (page 2-21 of the Manual). Provide a proposed construction schedule. t St (JcSA C- J!AftJ■'— II. Wet Season Construction Activitie . V uLY a. Proposed wet season construction activities. IJD "- b. Proposed wet season construction activities for environmentally sensitive areas. 7. Financial/Ownership Responsibilities. a. Identify the property owner responsible for the initiation tf bonds and/or other financial securities. INI p Q.41 4 ,p�t� � c b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. �7 J 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following, if applicable. a. Sediment Ponds/Traps. k b. Diversions. c. Waterways. d. Runoff/Stormwater Detention Calculations 10 stormwater site plan template—rev.10/21/2008 • • SECTION II—EROSION AND SEDIMENT CONTROL PLAN Sediment and erosion control measures may be depicted on the master land use application plot plan, a stormwater site plan, and/or a separate Construction SWPPP site plan. This is a checklist to ensure that the following are depicted on a site plan: 1. General. a. Vicinity Map b. Jefferson County Approval Block c. Erosion and Sediment Control Notes 2. Site Plan. a. Legal description of subject property. b. North arrow. c. Indicate boundaries of existing vegetation (e.g., tree lines, pasture areas, etc.). d. Identify and label areas of potential erosion problems. e. Identify FEMA base flood boundaries and Shoreline Management boundaries(if applicable). f. Show existing and proposed contours. g. Indicate drainage basins and direction of flow for individual drainage areas. h. Label final grade contours and identify developed condition drainage basins. i. Delineate areas that are to be cleared and graded. j. Show all cut and fill slopes indicating top and bottom of slope catch lines. 3. Conveyance Systems. a. Designate locations for swales, interceptor trenches, or ditches. b. Show all temporary and permanent drainage pipes, ditches, or cut-off trenches required for erosion&sediment control. c. Provide minimum slope and cover for all temporary pipes or call out pipe inverts. d. Shows grades, dimensions, and direction of flow in all ditches, swales, culverts and pipes. e. Provide details for bypassing off-site runoff around disturbed areas. f. Indicate locations and outlets of any dewatering systems. 4. Location of Detention Best Management Practices (BMPs). Identify location of detention BMPs. 5. Erosion and Sediment Control Facilities. a. Show the locations of sediment trap(s), pond(s), pipes and structures. b. Dimension pond berm widths and inside and outside pond slopes. c. Indicate the trap/pond storage required and the depth, length, and width dimensions. d. Provide typical section views through pond and outlet structure. e. Provide typical details of gravel cone and standpipe, and/or other filtering devices. f. Detail stabilization techniques for outlet/inlet. g. Detail control/restrictor device location and details. h. Specify mulch and/or recommended cover of berms and slopes. i. Provide rock specifications and detail for rock check dam(s), if applicable. j. Specify spacing for rock check dams as required. k. Provide front and side sections of typical rock check dams. I. Indicate the locations and provide details and specifications for silt fabric. m. Locate the construction entrance and provide a detail. 6. Detailed Drawings. Any structural practices used that are not referenced in the Ecology Manual should be explained and illustrated with detailed drawings. 7. Other Pollutant BMPs. Indicate on the site plan the locations of BMPs to be used for the control of pollutants other than sediment(e.g., concrete wash water). 8. Monitoring Locations. Indicate on the site plan the water quality sampling locations to be used for monitoring water quality on the construction site. Sampling stations should be located upstream and downstream of the project site. stormwater site plan template—rev.10/21/2008 11 • • Stormwater Site Plan Changes 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 G % G ////3 ( D NER OR AU.HO 1 REPRESENTATIVE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: 12 stormwater site plan template-rev.10/21/2008 ci iiv E 1-al- Cb JEFFERSO COUNTY D Lo ti • ' \� rA DEPARTMENT OF COMMUNITY DEVELOPMENT APR 1 1 2013 "'( = 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax cgs N��O$ www.co.jefferson.wa.us/commdevelopment DEPT.OF EF ERSON COUNTY NITY DEVELOPMENT Master Permit Application MLA: Project Description(include separate sheets as necessary): L.0.1-=:7J Tax Parcel Number: eiclo (000 ZsZ Property Size: 12,290411 (acres/square feet) Site Address and/or Directions to Property: L-0-r 52 12-S( -r•e 1.41,-u.)az P[>ar l.--(A L4 Property Owner(s)of Record: M PC(L{L Telephone: ' (0‘31 7 7+ 2:727 Fax: mail:Mlaa,�e�-a3L •ea ,yirt,i.t ,ten€ Mailing Address: IG C ur[-E tZ., L. Pet r l tiwu2 LVA- 18 1o'2 Applicant/Agent(if different from owner)): (,.b,.i-rr - r t 4.yv &i Cr—es t, Telephone: Gp 'LC-`i 06,4 Fax: email:/ _ rtv• Mailing Address: I 0 L,(" ' What kind of Permit?(Check each box that applies 0 Lot or Road Segregation ❑Building 0 Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) ©-Single Family lit-Garage i; -.A/Detached 0 Conditional Use[C(a), C(d),or C]** ❑ Manufactured Home .0 Modular - • - 0 Discretionary"D"or Unnamed Use Classification 0 Commercial* 0 Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment ❑ Address 0 Road Approach 0 Short Plat** ❑ Home Business 0 Cottage Industry 0 Binding Site Plan** 0 Propane 0 Long Plat** 0 Sign 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes" Use Consistency Analysis 0 Plat Vacation/Alteration** ❑Stormwater Management ❑ Shoreline Master Program Exemption/Permit Revisions** ❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development** ❑Temporary Use 0 Shoreline Management Variance ❑Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendment i�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 ( t.+ to act as my agent in matters relating to this application for permit(s). • OWNER SIGNATUREZ Date: 4110 J 13 By signing this application form,the ow er/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 in cti ns. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the appli io hat e r he ants prior notice. Signature: Date: 4) f((Ij The action or actions Applicant II 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-trans a responsi i for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: `-) ^ Date: 1 / i 3 _ill ili 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: P'C) 7K a t I D Su�fes4 6{4 c��QZEMAIL: , I , ,7 �y-i -t.ii�i CONTRACTORS LICENSE `1r"` " WAINS e 5( ' G NUMBER: �b4-ftgiiCxCiS2.b1.� NUMBERIK/S(O2753O i Nt 27J-3a_13 ARCHITECT/ENGINEER: dstom? y i-I-i.r•r=_-se �_ ,1VSb�� PHONE ( ) F ( ) MAILING ADDRESS: Ni;,o V`Ga. EMAIL Pr9ject Type: Fra a Type: Bathrooms: Shoreline: Type of Sewage Disposal: r New Wood Existing: wer C Addition C: Steel Proposed: 2l� Bank Community System C Alteration/Remodel 0 Concrete Total: Height: ❑ Individual System 0 Repair 0 Masonry SEP Permit# o Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: 0 Private well 0 Two Party Type of Heat: Proposed: 7j N-"Public u,o�oI Weller- 04mP Total: Name of System: 12crt1.ti.oU !/ If this is a Commercial Project you must answer the following: r4._ 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: 1 Heat Stove i Cook Stove j Woodstove i Fireplace Insert 1 Hot Water Tank i Pellet Stove 1 Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / No . When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines, tank location and size, distances from the propane tank to all property lines, buildings and septic system components, including the reserve area. • S.uare Footage Current Proposed For Office Use OM Amount Revision Main Floor Heated Z3 43 `&/9z, 'f H Bld App Review: A,. 2"°Floor Heated Consistency Review: .;a?, ? 00 Other Heated Base fee: /9 C , 9 Mezzanine Additional Section: --a"- Heated Basement Plan Check fee: f; 70?, ooZ Unheated Basement State Surcharge fee: q So Other Unheated Pot Water Review fee: /O 0° Garage/Carport e7 4-3 5M 70 SUBTOTAL 3519 7! q7 Decks 911/Rd Approach fee: ‘72 op Other _ �� TOTAL: $ 3795,y7 . 1. 1 1 I Receipt Number: ILIOQ3 Cash/Check Number: 010(rz.5 ESTIMATED COST(REQUIRED) Date: --( (, 13 .Fair market value of all labor and materials foundation to finish Initials: • 188 ,5az1 ,` 0 NI NI pb08 lS1I { ' 115 I J B` ,0/;6G F a- e\ tip\ laI �� d1 0' 3 VC 4- I00 o / O n.c tt, aII I gx.E. 1 J g II) I M I 4i s ‘1, 011 F(0:41:Al � . 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