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HomeMy WebLinkAboutBLD2013-00145 • BUILDING PERMIT S Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD13-00145 Received Date: 5/14/2013 SITE ADDRESS: 260 MC MINN RD Issue Date 7/11/2013 PORT TOWNSEND, 98368 Expiration Date 7/11/2014 OWNER: RONALD STRANGE PHONE: 360-379-4908 JUDITH A KING 260 MCMINN RD PORT TOWNSEND WA 983689646 SUBDIVISION: Block: Lot PARCEL NUMBER: 001072014 Section: 7 Township: 30 N Range: 01 W CONTRACTOR: COXEN DESIGN & CONSTRUCTION PHONE: (360)379-1585 6401 CAPE GEORGE ROAD PORT TOWNSEND WA 98368 Contractor's License COXENDC005QN Expires 11/29/2014 PROJECT DESCRIPTION: New SFR TYPE OF WORK f RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 1,439 VALUATION 220,000.00 ADD'L: HEAT TYPE: EEE CODE EDITION: 2009 HEAT BASE: HEAT TYPE: OCCUPANCY: R 3 UNHEATED: #OF STORIES: OCCUPANCY: OTHER: 48 CONST TYPE: 5N GARAGE: SHORELINE: CONST TYPE: DECK: 200 SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: 1PWELL Type Amount Paid By: Date: Receipt: BEDROOMS: BATHROOMS: Permit $1,665.75 CJZ 05/14/13 142080 Exist: 1 Exist: 2 Plan Check $1,082.74 CJZ 05/14/13 142080 Prop: 1 Prop: 1 State Building Code $4.50 CJZ 05/14/13 142080 Total: 2 Total: 3 Potable Water Application $66.00 CJZ 05/14/13 142080 Total: $2,818.99 Directions to Site: 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. Request must be received by 3pm the day before the inspection is needed. Office Hours 9:00 am -4:30 pm MONDAY - THURSDAY HOT LINE AVAILABLE 24 HOURS A DAY SPECIAL CONDITIONS APPLY-SEE ATTATCHED `:~tfN (r DEPARTMEROF COMMUNITY DEVELO•ENT 621 Sheridan Street,Port Townsend,WA 98368 — Tel:360.379.4450 I Fax:360.379.4451 Web:www.co.jefferson.wa.us/communitydevelopment '.1,5,f,1 N N`.\0` E-mail:dcd(uico.jefferson.wa.us CERTIFICATE OF OCCUPANCY PERMIT#: BLD13-00145 APPLICANT: RONALD STRANGE PHONE: 360-379-4908 JUDITH A KING 260 MCMINN RD PORT TOWNSEND WA 983689646 SITE ADDRESS: 260 MC MINN RD Issue Date: 07/11/2013 PORT TOWNSEND, 98368 Final Date: 12/24/2014 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001072014 Section: 7 Township: 30 N Range: 1W PROJECT DESCRIPTION: New SFR 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 . THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 12/24/2014 • \\tidemark\data\forms\F_BLD_Occupancy.rpt 12/29/2014 03 UILDING PERMIT APPLICA )N BLD13-00145 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD13-00145 Received Date: 5/14/2013 SITE ADDRESS: 260 MC MINN RD PORT TOWNSEND, 98368 OWNER: RONALD STRANGE PHONE: 360-379-4908 JUDITH A KING 260 MCMINN RD PORT TOWNSEND WA 983689646 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001072014 Section: 7 Township: 30 N Range: 01 W CONTRACTOR: COXEN DESIGN & CONSTRUCTION PHONE: (360)379-1585 6401 CAPE GEORGE ROAD PORT TOWNSEND WA 98368 Contractor's License COXENDC005QN Expires 11/29/2014 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr New SFR TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 1,439 VALUATION 220,000.00 ADD'L: HEAT TYPE: EEE CODE EDITION: 2009 HEAT BASE: HEAT TYPE: OCCUPANCY: R-3 UNHEATED: #OF STORIES: OCCUPANCY: CONST TYPE: 5N OTHER: 48 SHORELINE: GARAGE: CONST TYPE: DECK: 200 SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: 2 Exist: Prop: I Prop: ( Total: 3 Total: 2- Routing Date: 5_ - / Type Amount Paid Bv: Date: Receipt: Approved/Date Permit $1,665.75 CJZ 05/14/13 142080 APPROVED Plan Check $1,082.74 CJZ 05/14/13 142080 State Building Code $4.50 CJZ 05/14/13 142080 JUL 1 1 2013 Potable Water Application $66.00 CJZ 05/14/13 142080 Total: $2,818.99 Jefferson County DCD rlornnrL\rlo4o\fnr, \C Rl n nnr, Ri,+rn4 gi1�i0n1z Up Front Parcel Review. Parcel 001072014 Printed: May 15, 2013 RONALD STRANGE Site Address: JUDITH A KING 260 MC MINN RD 260 MCMINN RD PORT TOWNSEND, WA 983( PORT TOWNSEND WA, 98368 Parcel Number: 001072014 S-T-R: 7-30N-01W Total Acreage 4 Legal Description S7 T30 R1 W TAX 10(LESS CO RD R/W) Land Use: 1100 Flood District: Fire District: 1 Planning Area: 2 Flood Map(FIRM) Panel No: School District 50 Zoning: COMP PLAN DESIGNATION: COMMUNITY PLAN: UGA: UGA Trans [ iA Plot plan states "property line" [ vrAssessor's Map (Property lines on submitted plot plan must match the property lines as identified on the Assessor's 1/4 map) [ (4 Legal Access to Property- J NO [ V] Parcel Tags or Scanned Documents YES NO [ V ESA's: Special Reports Nearby YES NO [ Designated Ag YES NO [ �/j" Shoreline Designation: YES NO [ Vr Shoreline Slope Stability: YES 0 Stream Type:YES NO Fish & Wildlife:YES NO Wetlands: YES NO Rare Plants:YES NO 20 Seismic: YES NO tad1/49 Landslide: YES NO Flood: YES NO Erosion: YES NO Aquifer Recharge Ar YES NO (LS SIPZ: none At High Risk Coastal CMZ: none High Risk Moderate RiskDisc nnected CMZ Stormwater site plan submitted: YesNo [VT Forest Lands: YES Adjoining Forest Lan s: Commercial/ Rural/ Inholding [ Mineral Lands: YES 4.19 [ kr Agricultural Lands: i • [fir Archaeology: YES rCc 3v [ fjj— Stormwater: New I u•- '• Surface ( L8RLand Disturbing Activity l Sv t) ESA's Stormwater R=! s:Min Re. # Min Weg#1 thru#5 Min Reg#1 thru#10' Engineering [ f/J Notice Provisions II isclosure:A ort YES NO MRL YES NO Forest Lands YES NO [ pY Landscaping Required: Yes [v( Parking Spaces Re ed NO CD Other f c/l� Building Height: 35' UBC Standard [ f Impervious Surface covera e percentage: ----- Resource Lands&Public: 1 Rural Residential 25°/ i Rural Inc al: Per UDC Sec 6.7 Rural Commercial: 60% Area of Building Coverage:60%in Rural Inrial Lands only [ t)-- Total Building (s) Size: RVC:20,000 SF CC: 5 000 SF NC: 7,500 SF GC: 10,000 SF All others:subject to septic&water constraints/Non specified [ kr Setbacks: Front:ILt"7 Left Side: '5 Right Side: _ Rear: 7, Shoreline Setback: LSHA Setback: [✓r Road Classification: Road Approach: EXISTING EQ'D RAP [ ' J SEPA Required: YES XEMP [ . Flood Certificate: [ ttj'- Existing Case(s) & Condition(s): Violations: Yes No [ (.1' / Recorded Date of Subdivision: AFN Over 5yrs—UDC Plat Conditions: <5yrs=Plat Conditions on plat or Old Ordinance [1/r Lots/Require Declaration of Restrict ve Covenant YE 0 submitted: YES NO [ irr UGA No Protest Agreement YES(N� submitted: Y S NO [1v Site Visit conducted YES NO [I/r Require Final Zoning Approval YES6S [ 1,1' ADMIN: Setbacks entered in Permit Plan case YES New Parcel Tags entered in Permit Plan / YES Special Reports Scanned& YES INo parcel tags found for parcel I Cases Associated with APN 001072014 Cases Name Review Type Status Planner BLD01-00017 CARSON F Application Received: 1/9/2001 Permit Issued/Case closed: 1/11/2001 Case Finaled: 2/13/2001 PROPANE TANK INS IALLATION BLD13-00145 STRANGE P Application Received: 5/14/2013 Permit Issued/Case closed: Case Finaled: New SFR BLD90-00643 CARSON F Application Received: 9/18/1990 Permit Issued/Case closed: 9/19/1990 Case Finaled: pole building MLA06-00278 BLD06-00305 MLA06-00278 STRANGE I C M FARFAN Application Received: 5/31/2006 Permit Issued/Case closed: 7/19/2006 Case Finaled: CONVERTING EXIS1 ING POLE BLDG TO SFR W/ATT GARAGE CONVERTING 177 SQ FT TO HTD SPACE, ADDING 590SQ FT HTD LOFT, 70SQ FT DECK& 172 SQ FT COVERED WALK, DELETING 960SQ FT GARAGE SEP90-00700 CARSON F Application Received: 5/7/1990 Permit Issued/Case closed: 5/22/1990 Case Finaled: 8/31/1990 EES BY ENVIROCHE R SOM90-00700 STRANGE RCR Application Received: 8/31/1990 Permit Issued/Case closed: 5/8/2013 Case Finaled: \\tidemark\data\forms\R_Parcel_CRMLA.rpt 5/15/2013 Page 2 of 2 m N n` r iii Rio --(..0 ' o � � � m Ca V ,_ cfl a CO in %o O in ti LJ E c-a) iil ON op a0 ,- a007' CD I� O ,- UO (D (0u) T� r N II II 11 II 11 II II II II II II II II 11 II II 11 �J Z , v=i m ) OWu 02 - J 02UWtLC92 - J › = '5 v RI 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 LL y ----Z ,...g, _ / . . 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W C N II- i' Cr) a) Z (� J '� O '' _ O o a w N@ Z -J Z U O O O , Q N J a a) - -r; tl�OZ _' I- C c' X-. ›� ��] chi ZQo a) WU) mo a z aO (Wi) -a 0 0 a 4:2 Le I Jefferson County Building •sion Permit NA,: BLD13-00145 Applicant: STRANGE 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 9/24 3 Erosion Control Foundation Footing 9 .?„(4 3 Footing Drains Foundation Stem Wall _16_13 -1 A)1" FT(..,— /1—/ / 3„„9_- Underground Plumbing �: ... Under Floor Framing Straps(hold downs) T'y// Ext. Shear Wall Nailing rZ_2,_ Rough-in Plumbing J, I�ct) ( Framing `11-21ifitt (L Blocking Jam` Airseal ' Z4II f Insulation:Walls 511:4 Insulation: Floors Insulation: Ceiling BIZ I'I t Lt ;L— int. Shear Wall Nailing _/ 1// Wallboard Nailing b 51 H Gas Line: Interior Gas Line: Exterior Propane Tank Heat/Chimney Clearance I._ 14�f Mechanical Systems y Duct Test Cert Blower Airtight Test Smoke&CO2 III I (17 'f Drywell/Alt Drainage � Address Posted Id 17 1`f ci/ • • FINAL INSPECTION 1.2�/7 / FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR • • CONDITIONS for Building Permit# :BLD13-00145 1.) Prior to final approval of this building permit, BOTH septic system permits must be finalled; SEP13-65 and SEP13-67 2.) The existing well for this development lies within the WRIA 17. The proposal is a replacement residence built before the in-stream flow rule, per the assessors information. Therefore, we have determined that the well is exempted and not subject to the in-stream flow rule for domestic use, metering, and exempt well irrigation. 3.) 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. 4.) The site plan as submitted with the Building Permit application on May 14, 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 May 15, 2013 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 5.) 10' minimum separation required between the water line and any onsite sewage system components including sewage transport lines. 6.) THE EXISTING DRAINFIELD IS BEING PARTIALLY MOVED TO ACCOMMODATE THE NEW HOME LOCATION. A 10' SEPARATION IS REQUIRED. THE SEPTIC INSTALLER AND THE HOME BUILDER MUST COORDINATE TO ASSURE THE 10' SETBACK CAN BE MET. \\tiriamark\riata\fnrmc\F RI Il Permit Rlrin rnt 7/11/2(11R al w •5�N co JEFFERSOIv" OUNTY t". ' vA DEPARTMENT OF COMMUNITY DEVELOPMENT _ "w' ` `� 621 Sheridan Street • Port Townsend • Washington 98368 ilOp360/379-4450 • 360/379-4451 Fax p� www.co.jefferson.wa.us/commdevelopment �`9$INC . Master Permit Application MLA: Project Description(include separate sheets as necessary): • til e w hp wee- con 54-va.c 11 o-n) Tax Parcel Number: °o(w 7 p f y Property Size: 5 d cve-- (acres/square feet) Site Address and/or Directions to Property: Z cov Mt, M l h r p: Po 2-T TU LUU1S )p k)i QK 3LP? Property Orer(s of Record: f-()Al C Id S*rdi-' e /41v D :UD 1 ► -f- A. IL! IVGf Telephone:(3t00 ) 3 7q-4g'O Fax: email: C her_ J U(f g.(4) , �D v� Mailing Address:_ -? (.e 0 �-i!C- l VI 12-7, Po 7- 7 Lf- ,)5 (.'(7I t.T - qg j Applicant/Agent(if different from owner): Telephone: Fax: email: _ Mailing Address: A ❑at kind of Permit?(Check each box that applies Lot or Road Segregation wilding 0 Critical Arease Stewardship PI \` ,i . ❑ Demolition Permit ❑Variance(Minor, Major or Re it conomic Use) Single Family ❑Garage Attached/Detached ❑ Conditional Use[C(a), C(d),or C]** ❑ Manufactured Home . 0 Moduli; 0 Discretionary"D"or Unnamed Use( ificlti4t ;till' ❑ Commercial* 0 Special Use(Essential Public Facilities)** • Change of Use 0 Boundary Line Adjustment ' ❑ Address 0 Road Approach_ 0 Short Plat** II j[ 'CiltI ; ((}}r''��tt ❑ Home Business ❑Cottage Industry 0 Binding Site Plan** W !1 � �.�.iJ t�lu ❑ Propane ❑ Long Plat** • El Sign ❑ Planned Rural Residential Development(PRRD)/Amenaments** ❑Allowed"Yes" Use Consistency Analysis El Plat Vacation/Alteration** ❑ Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions** ❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development** ❑ Temporary Use 0 Shoreline Management Variance ❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/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 El 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 cation that he o he""g�ants prior noti r"j Signature 'r` 2 /Gcei ec Date: 5—_./— a.0)3 The action or actions Applicant will underta e as 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- ble responsjbility for adherij /f/(T / and complyinth the ESA. The Applicant has read this disclaimer and signs and dates it below. Signatur : 1 /Lts• Date: 5 / /33 0 o 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: t-cf c&\4e,l Caxe& (c ( 36d ..53) -1 q (Mc ) j7e( - /5P5 (36a) 37`7-)5 8.� MAILING ADDRESS: dye/ Ca/n 4e o f • , EMAIL.: c d py�� 512„` /1 e 0 rK4f d-Z.\ CONTRACTORS LICENSE `'` WAINS ,--<= 6 NUMBER: C k.PiQI .U Q S't AI NUMBER 5E A.U/ Z z 3eL3 ARCHITECT/ENGINEER: I` rk VU 1 Ke//7(, PHONE (31Qo) 3 gS--(,ILO FAX:( ) rr ►� II( ,�, I W�,r g;�y MAILING ADDRESS: " 0 1 I a 50-1 SI-, (�,yro1,(.,)Lr .kip EMAIL 5-.2(Q1 Kai) a--PCf'@ ff-frY) .I l,a Vv\ Project Type: Frame Type: Bathrooms: Shoreline: Type of-Sewage Disposal: X New X Wood Existing: 1 ,, 5 Sewer El Addition U Steel Proposed: 1 Bank o Community System Alteration/Remodel ❑ Concrete Total: p?. S_ Height: X Individual System ❑ Repair ❑ Masonry — SEP Permit# 610-ZOd _ C Demolition li Other: Bedrooms: Water Supply: Existing: 4___- Setback: X Private well C Two Party Type of Heat: Proposed: ❑ Public Total: 2- 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 i Above ground Tank Size of Propane Tank: Heat Stove i Cook Stove i Woodstove 1 Fireplace Insert I Hot Water Tank i Pellet Stove I Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / No When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines, tank location and size,distances from the propane tank to all property lines, buildings and septic system components, including the reserve area. Square Footage Current Proposed For Office Use Only Amount Revision Main Floor Heated u f �L� I_. A EH Bld App Review: r18 oO I. 2' Floor Heated / I Consistency Review: 2x ao Other Heated Base fee: l 1 /l7(Q 6 9 5 Mezzanine Additional Section: Heated Basement Plan Check fee: ` 10 JD 11 Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: / GO Garage/Carport SUBTOTAL GQ .19 • Decks .2_00 %10 911/Rd Approach fee: Other GD v ec'P D e/{_df(/y 4/1 �ID 7A.9- - TOTAL: $ 3 ,1 4,g,`Ici _____________ Le Receipt Number: /Lf a 09(3 I 10� Cash/Check Number: 0 &5? ESTIMATED COST(REQUIRED) Date: /�, '� •Fair market value of all labor and materials\oundation to finish ` _ —(--,.________ i 2 Z(� 0 doU Initials: -/,i ..,.. •—..._,Maur,11%1CJJ+++i\1-101\orNon(c\r.... ...,nnll C,...�.,-\r(,,...,,_n,,.._.:. .1....1:,..,4-:,...C 70(IA,7,.,- • • P 6( i'V NeC15-2 ` 7c,4.-- -30N 1 oo�� JEFFERSON COUNTY -+ , +a DEPARTMENT OF COMMUNITY DEVELOPMENT I-, ,y.fti ) ti 621 Sheridan Street • Port Townsend • Washington 9836 xqs OHO 360/379-4450 • 360/379-4451 Fax J` il'IN http://www.co.jefferson.wa.us/commdevelopment/ MAY 1 4 2013 Stormwater Calculation Worksheet ilia SON COUNTY DCD 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 acres An acre contains 43,560 square feet. Multiply the acreage by this figure. Size of parcel in square feet i 7 Dt'v 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. it oLAND DISTURBING ACTIVITY, C8NVERSION OF NATIVE VEGETATION, AND VOLUME OF CUT/FILL Calculate theetbta7 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: COoes the project convert%acres or more of Construction site for structures I l. sq/ft native vegetation to lawn or landscaped areas? Drainfield, septic tank, etc. sq/ft Circle: Yes ,No 2 Well, utilities, etc. - sq/ft Does the project convert 21/2 acres or more of native vegetation to pasture? Driveway, parking,roads, etc. sq/ft -, Circle: Yes ,/No Lawn, landscaping, etc. sq/ft Other compacted surface, etc. �v sq/ft Indicate Total Volumes of Proposed: Total Land Disturbance ���� sq/ft Cut Fill (cu/yd) [over] stormwater talc 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) p . 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 sq/ft Driveway, parking, roads, etc ! "`0r7 sq/ft Other —7 sq/ft Other sq/ft Total New I (o ! _sglft Total Existing 3(PO0 sq/ft TOTAL NEW+TOTAL EXISTING* S -7 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 (CP2.1/ Divide the total existing impervious surface above by the size of the parcel and convert to a percentage: 7:4 % Does the site have 35% or more of existing impervious surface? Circle: Yes No ' 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. )--t,ekt./(7 q //14 —/ —c E / ? (LANDOWNER OR AUTHORIZED REPRESENTAIJE 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 a 0 0 1 5 / • / // / 1 f sr 6 0(R 0 70 70 x bU ZN Z fr1 n . I 6 0 r .7 r <'A c, z /nz / / A n o i / nP�. ��, a-, . r rr 7 ------------ ....-----..1..„...._qot" 0 \\\ s V \ / 1 f 1 R P f 3 F ' /6,— bi -----7/ zs- * C\ 't C. m z T y D 7o -0 m m N a 5� c 's fn ° L 3Nf I C �' • N o >, 319.01 U Z7 oarA. ?.-Z- C --c Li E Tt z H Z . o , o{ ti n o r r r Z b Z O -S o Z c Z p 3 v N v a v t,1 I' Oa W 3 O a m a p Z. F f z Z Z o z n z } U 1; m (` m S H In i4 -."' • RJ Ia r. • 2 —--4-_—— , • I co c', 71 3 : I1 d C° [a D p 00 c---. ut - - w N - O '1,.... -o "i I- J L I 1 I 0 o 8 2 0 0 f tG' pi O� - ' u O --\ I I N 1 I . o o S - .z m$� -r. 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