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BLD2014-00133
I .13UILDING PERMIT APPLIC•ON BLD14-00133 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00133 Received Date: 4/16/2014 SITE ADDRESS: 1772 ANDERSON LAKE RD OWNER: ROBERT L QUINN PHONE: 360-393-5959 1209 37TH ST BELLINGHAM WA 98229-3236 SUBDIVISION: Block: Lot: TX 26 PARCEL NUMBER: 901152001 Section: 15 Township: 29 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP NSFR with attached garage, no heat, no plumb TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 2,048 VALUATION 300,000.00 ADD'L: HEAT TYPE: HTP CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: 720 SHORELINE: CONST TYPE: DECK: 1,440 SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: OSS WATER SYSTEM: 1PWELL BEDROOMS: BATHROOMS: Exist: Exist: Prop: 2 Prop: 2 Total: 2 Total: 2 Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $2,427.00 MEB 04/16/14 148602 Plan Check $1,577.55 MEB 04/16/14 148602 APPROVED State Building Code $4.50 MEB 04/16/14 148602 Potable Water Application $67.00 MEB 04/16/14 148602 MAY 15 2014 Total: $4,076.05 Jefferson County DCD 114irinmor41r1a1�lfnm.elG ni n nrn RI. rn+ ANAI)n1A eS°" co f DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street,Port Townsend,WA 98368 Tel:360.379.4450 Fax:360379.4451 Web:www.co.iefferson.wa.us/communitvdevclopment qsf/1" lp` E-mail:dcd @co.jefferson.wa.us CERTIFICATE OF OCCUPANCY PERMIT#: BLD14-00133 APPLICANT: ROBERT L QUINN PHONE: 360-393-5959 1209 37TH ST BELLINGHAM WA 98229-3236 SITE ADDRESS: 1772 ANDERSON LAKE RD Issue Date: 05/15/2014 Final Date: 8/11/2015 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901152001 Section: 15 Township: 29 N Range: 1W PROJECT DESCRIPTION: NSFR with attached garage, no heat, no plumb THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2012 EDITION. OCCUPANCY GROUP: TYPE OF CONSTRUCTION: SPRINKLER SYSTEM yes 0 THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 8/11/2015 11tidemark1data 1forms\F_BLD_Occupancy.rpt 8/12/2015 I 5� o c o JEFFER:I COUNTY • W' uEP A KT;�cnT ur CulviUFiTr DEVELOPMENT y 621 Sheridan Street • Port Townsend • Washington 98368 ,it• ma, 360/379-4459 • 360/379-4451 Fax vgs:tim 6) www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Project Description(include separate sheets as necessary): -- Tax Parcel Number: �� % ��� I �- t (,, Property Size: • ,0 2 (acres/-quare feet) monow Site Address and/or Directions to Property: I ��=--,-V'lam- !3 k9 �U r n Property Owner(s)of Record: L. � `^�� /7 3 s i t N N Telephone: 3 F O `�y 3 ti c —� Fax:—.tl/OA/r Mailing Address:J_ Cc - 'rx, •7— — -- email: rb L , tiC0 Applicant/Agent(it different from owner)• e Telephone: Addre _ Fax. Mailing ss:--=--____ email: What kind of Permit?(Check each box that applies IRIBuilding ❑ Lot or Road Segregation G Demolition Permit ❑ Critical Areas Stewardship Plan Single Family .)Garage Attache�.i/Detached ❑Conditional Use[C(a),rC(d)),,or C]Reasonable Economic Use) ❑ Manufactured-Horne ❑ Modular ❑ Commercial* ❑Discretionary"D"or Unnamed Use Classification G Change of Use ❑Special Use(Essential Public Facilities)** ❑ Address 0 Road Approach ❑ Boundary Line Adjustment ❑ Home Business ❑Cottage Industry 0 Short Plat Site** ❑ Propane ❑ Binding Site Plan** G Cign • 0 Long Plat** ❑Allowed"Yes"Use Consistency Analysis ❑ Planned Rural Residential Development(PRRD)/Amenaments** ❑Allowed ater Management 0 Plat Vacation/Alteration"* ❑ Site Plan Approval Aovance Determination SPAAD ❑Shoreline Master Program Exemption/permit Revisions** ❑Temporary Use ( ) 0 Shoreline Management Substantial Development** ❑Wireless Telecommunication ❑Shoreline Management Variance ion* ❑ Forest Practices Act/Release ion of Six-Year Moratorium ❑ Comprehensive Plan/UDC/Land Use District Map Amendment *May require a Pre—Application Conference ❑Jefferson County Shoreline Master Program Amendment ❑Tree a Vegetation Request Please identify any other local, state or federal permits required for th saproposlal, if known:Conference -_ © I hereby designate /V0 A/ DESIGNATION OF AGENT to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE - — Date: -_12(_:21__ ____ 1 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 applicatiei t .t he or she wants i.r notice. Signature: , — _ 1 Date: 3-3/ -zo �r�! 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-transfers JJ rer.onsi•ility for n! to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: , Date:_ 3— '! 2U1y G:\PemvtCenter\###FORMS###\DRD FORMS\Current DRD Forms Master Permit Annlimt,,,,,e en no _ • BUILDER STATEMENT • 1 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 assu ' �nsibility of General Contractor for the proposed project. Signature: ,L/ ,.rte rn.,..v Date: __ 3 -31 -2-014/ GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: O I/vA/C K ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: I Shoreline: Type of Sewage Disposal: i( New Wood Existing: ❑ Sewer O Addition ❑ Steel Proposed: 2. Bank ❑ Community System O Alteration/Remodel ❑ Concrete Total: 2 _ Height: Individual System O Repair 0 Masonry - ✓9 SEP Permit# Ste/2--0080 o Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: X Private well C Two Party Type of Heat�:/ Proposed:Total: '2 // ❑ Public r:kc-ir` h�L4 f e�f A Name of System: If this is a Commercial Project you must answer the following: i'/, 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 f No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: •/A 1 Underground Tank t Above ground Tank Size of Propane Tank: 1 Heat Stove i Cook Stove 1 Woodstove i Fireplace Insert 1 Hot Water Tank 1 Pellet Stove 1 Other Is this appliance being installed in a Manufactured I Mobile Home? Yes 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 I Current Proposed For Office Use Only. Amount Revision Main Floor Heated EH Bld App Review: • , a 0'/? 225 81 S. .2.. 2n°Floor Heated Consistency Review: �7 Other Heated I'� Base fee: �/ 7 (/ 2 cv —Mezzanine Additional Section: 1 o J Heated Basement N Plan Check fee: 1 S-- �1 s� Unheated Basement N,, Sat to Surcharge fee: l ^u Other Unheated �/� Pot Water Review fee: I 0 - ,UJ_ • Garage/Carport .___ SUBTOTAL 77.0 __ -__ Ali 02� Decks � / • 911/Rd Approa ee: Other TOTAL: $ Cow<�<� Pa�t't? lyS/O Y�`I �?��" Receipt Number: )(,Q6 U 2 . Cash/Check Number: C 2 'O 2-v-:32-512- O ESTIMATED COST{REQUIRED) Date: (-1•Fair m e value of all latorerials foundation to finish %.1� Initials: TIT. s i • '''''.4 ''') \ \ 7i.7":S ` DWI ' r11 \� .• k...,,.•)' I ' s S �° ,, .�...- .dy a,. -r C� + r%, . .., .7.7,•-•x%141 L¢I%SI ' '* S 1 L �C I•'I �rl q H 4;I r� _R^ �'�NiYW a v �a 1e O S1 Ell v ( ... r» e, O`l 5S -.r. /V \n S� v,ii� h1 1,p •'.' Le—,.`Sea4;; �/ ;Jr,T` `r � ��; s - '''^'�� 4rl .f, C t Y` ��1) t� n (A) > I v P 1 ' a t,ti 11 1 Z.-- '''''' 01 ‘ g ' s J11:. r r ' m H� lTrc.ss� t'"Icldl �a < rpcj S = O I o a- ac „G IMI 4Z. Z .C, X C 7 �\ -�c • i A' ..c, I\ 0 -4 71 r 1 `^ Q 2. s � s h rn •■ A, A 1 ._P 4 . r. s A y' (< A' ti :••■ '7-1°'--- V-4- — 16/ v.) ,.._, —. \ ,_ t % ,„ r S }� \ \ ),I .;', r- ' I 5) • {_ f : XJ s I I V o — is‘i V I . / s 4. o s wA s ; x a I I h 1 sj `, N '. i 1 rot F .:: . , ) --r. c--N r I N -.-.il\ '(t: k . AI ] 3 fit , �� 1 : y1 Ce C w n -^� S ^1s . d , x_II�b ` .-C n 1661 / t' t Fri (ii/ t.,vM .n1,A0 4.., I.4.snt_ °C1 .J --- I s , S.54 1 -C ,.1 S CS m ,+ A V 0 < 4 . • 3.1.2 Downspout Dispersion Systems (BMP T5.10B) Downspout dispersion systems are splash blocks or gravel-filled trenches, which serve to spread roof runoff over vegetated pervious areas. Dispersion attenuates peak flows by slowing the runoff entering into the conveyance system, allowing some infiltration, and providing some water quality benefits. Applications & Downspout dispersion may be used in all subdivision lots where Limitations downspout full infiltration, full dispersion, and bioretention/rain gardens are not feasible. Flow Credit for In WWIIM3, roof areas may be modeled as grassed surfaces if roof runoff Roof Downspout is dispersed according to the requirements of this section on lots greater Dispersion than 22,000 square feet, and the vegetative flow' path is 50 feet or larger through undisturbed native landscape or lawn/landscape area that meets BMP T5.13. This is done in WWHM on the Mitigated Scenario screen by entering the roof area into one of the entry options for dispersal of impervious area runoff. For WWHM 2012, see Appendix III-C in this Volume. Design Criteria 1. Use downspout trenches designed as shown in Figures 3.1.5 and 3.1.6 for all downspout dispersion applications except where splash blocks are allowed below. 2. Splash blocks shown in Figure 3.1.7 may be used for downspouts discharging to a vegetated flowpath at least 50 feet in length as measured from the downspout to the downstream property line, structure, slope over 15%, stream, wetland, or other impervious surface. Sensitive area buffers may count toward flowpath lengths. 3. Cover the vegetated flowpath with well-established lawn or pasture, landscaping with well-established groundcover, or native vegetation with natural groundcover. The groundcover shall be dense enough to help disperse and infiltrate flows and to prevent erosion. 4. If the vegetated flowpath(measured as defined above)is less than 25 feet, a perforated stub-out connection per Section 3.1.3 may be used in lieu of downspout dispersion. A perforated stub-out may also be used where implementation of downspout dispersion might cause erosion or flooding problems, either on site or on adjacent lots. For example,this provision might be appropriate for lots constructed on steep hills where downspout discharge could culminate and might pose a potential hazard for lower lying lots, or where dispersed flows could create problems for adjacent off-site lots. This provision does not apply to situations where lots are flat and on-site downspout dispersal would result in saturated Vegetative flow path is measured from the downspout or dispersion system discharge point to the downstream property line,stream,wetland,or other impervious surface. Volume III—Hydrologic Analysis and Flow Control BMPs—August 2012 3-11 • yards. Perforated stub-outs are not appropriate when seasonal water table is<1 foot below trench bottom. Note:For all other types of projects, the use of a perforated stub-out in lieu of downspout dispersion shall be as determined by the Local Plan Approval Authority. 5. For sites with septic systems,the discharge point of all dispersion systems must be downgradient of the drainfield. This requirement may be waived if site topography clearly prohibits flows from intersecting the drainfield. Design Criteria for Dispersion Trenches 1. 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 vegetated flowpath of at least 50 feet in length must be maintained between the outlet of the trench and any slope steeper than 15%. Sensitive area buffers may count towards flowpath lengths. 2. Trenches serving up to 700 square feet of roof area may be simple 10- foot-long by 2-foot wide gravel filled trenches as shown in Figure 3.1.5. For roof areas larger than 700 square feet, a dispersion trench with notched grade board as shown in Figure 3.1.6 or alternative material approved by the Local Plan Approval Authority may be used. The total length of this design must not exceed 50 feet and must provide at least 10 feet of trench per 700 square feet of roof area. 3. Maintain a setback of at least 5 feet between any edge of the trench and any structure or property line. 4. No erosion or flooding of downstream properties may result. 5. Have a geotechnical engineer or a licensed geologist, hydrogeologist, or engineering geologist evaluate runoff discharged towards landslide hazard areas. Don not place the discharge point on or above slopes greater than 15%or above erosion hazard areas without evaluation by a geotechnical engineer or qualified geologist and jurisdiction approval. 6. For purposes of maintaining adequate separation of flows discharged from adjacent dispersion devices,the outer edge of the vegetated flowpath segment for the dispersion trench must not overlap with other flowpath segments, except those associated with sheet flow from a non- native pervious surface. Volume III—Hydrologic Analysis and Flow Control BMPs—August 2012 3-12 • • °. 0 °y' level outlet .� edod °Q0 00 • d d °D vd bp d °0°° 7D a .0;.1,,° t� v v40°v40 ° v `_ 04° a Ov4,a a p4 .v,,• .00 • 0 va °aovaao �~ 6'min ',o p°a aoo od e oa,oa .,. • D d a do °p 4' rf pipe °°d E,:‹�vv doo4 18'min a 0vaaoeDO°DV° °° v o°a °e eO -0 a e°°o 1 l2 -3 W2 Sted rock Oo ap°v p e°°° °oa 00 vO °p o a° 011000101100'50o.o o 0 . a e Ih -- 24'min—+1 TRENCH X-SECTION NTS slope - smal catch basin or yard drain 2'x10 _ level trenches 5700 sq.ft. Type I CB >700 sq.ft. — standard dispersion trench WI notched grade board length 10'per 700 sq.ft. of roof area. J PLAN VIEW OF ROOF LITC Figure 3.1.5 -Typical Downspout Dispersion Trench Source: King County Volume III—Hydrologic Analysis and Flow Control BMPs—August 2012 3-13 pipe O.D. r1'-0 1'-0I rrun end cap or plug flaN to seoond !+� d ispersal Ue r h ■ "O clean out wye from pipe if necessary ��1 �o,ao 4"or6"perioreed pipe lad flatllevel iii notched =111' ° 4° grade board e 2'X2"notches +1 . :46V type I C B w/so lid cover(locking) I type I CB 18'0.C. A � ° ' w/snld offer t a a�I '� IIIIIIIIIIIIIII -da- b I L1 e) a influent pipe (max design _ Qpye fbw40.5CFSpertrench} _ • : oa clean outwee from pipe 1u 0.4. flow to other PLAN branching CB's as necessary NTS pipe O.D. I 18'O.G. galvanized bolts -0.1 jot—2" l'-0 1'0 2"x12" . tfl° j>✓„�i,+ • n ,s�rk , ' 2.,grade :?rx �'�; . y f " board notches 2", pressure "vt�z.E'�.e mg `a ep �u 'y^' ,E;x 6a, treated grade '� 0 • g• >"; 4•ore?'perforated a4 Jf P . r board ' v ` pipe laid flat +!::::' ' ;• ° 1 t<: NOTES: c a / 4"x 4'support post it 44 clear)(e5%Ires) 1.This trench shall be constructd so 'n° 1+t2"•311"washed rtck as b prevent point discharge andbr 6 ' aigip erosion. ��`iI 2.Trenches may be placed no cbser fitter fabric than 50 feet b one another.(100 feet %1596 max tcrflouccntrolfwaterquality abrgfbwline) tre8tll'lerfi in rural areas. 3.Trench and grade board must be 'axe!.A lig n to fol bw co nto urs of site. SECTION A-A 4,Support post spacing as required by NTS so a co rd itbns to ensure grade board remains level. Figure 3.1.6 - Standard Dispersion Trench with Notched Grade Board Volume III—Hydrologic Analysis and Flow Control BMPs—August 2012 3-14 • 41 Design Criteria for Splashblocks A typical downspout splashblock is shown in Figure 3.1.7. In general, if the ground is sloped away from the foundation and there is adequate vegetation and area for effective dispersion, splashblocks will adequately disperse storm runoff. If the ground is fairly level, if the structure includes a basement, or if foundation drains are proposed, splashblocks with downspout extensions may be a better choice because the discharge point is moved away from the foundation. Downspout extensions can include piping to a splashblock/discharge point a considerable distance from the downspout, as long as the runoff can travel through a well-vegetated area as described below. The following apply to the use of splashblocks: 1. Maintain a vegetated flowpath of at least 50 feet between the discharge point and any property line, structure, slope steeper than 15%, stream, wetland, lake, or other impervious surface. Sensitive area buffers may count toward flowpath lengths. 2. A maximum of 700 square feet of roof area may drain to each splashblock. 3. For purposes of maintaining adequate separation of flows discharged from adjacent dispersion devices,the vegetated flowpath segment for the splashblock must not overlap with other flowpath segments, except those associated with sheet flow from a non-native pervious surface. 4. Place a splashblock or a pad of crushed rock (2 feet wide by 3 feet long by 6 inches deep) at each downspout discharge point. 5. No erosion or flooding of downstream properties may result. 6. Have a geotechnical engineer or a licensed geologist, hydrogeologist, or engineering geologist evaluate runoff discharged towards landslide hazard areas. Do not place Splashblocks on or above slopes greater than 15%or above erosion hazard areas without evaluation by a professional engineer with geotechnical expertise or a licensed geologist, hydrogeologist, or engineering geologist, and approval by the Local Plan Approval Authority. 7. For sites with septic systems, the discharge point must be downslope of the primary and reserve drainfield areas. This requirement may be waived if site topography clearly prohibits flows from intersecting the drainfield or where site conditions (soil permeability, distance between systems, etc)indicate that this is unnecessary. Volume III—Hydrologic Analysis and Flow Control BMPs—August 2012 3-15 • house € il Roof Ir I .I € i downspout :: :�^ serves up to 700 sf. Of roof .... E 50' min. 17' .....I J L Vegetated flow path ::: ".""I Splash .m. € €€i block i. y :• -r * Downspout extension NTS Splash block Figure 3.1.7 -Typical Downspout Splashblock Dispersion Vc vine III—Hydrologic Analysis and Flow Control BMPs—August 2012 3-16 • • • Standard Conditions for Residential Development in Jefferson County 1. LIGHTING: 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. 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. 2. BUILDING HEIGHT: The building height is not to exceed 35 feet. 3. OUTDOOR STORAGE: Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 4. UNLICENSED VEHICLES: 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. 5. PARKING: A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 6. This permit has been reviewed consistent with JCC 18.40.130 & 140. Notice: this permit does not excuse the applicant from complying with other local, state and federal ordinances, regulations or statues, applicable to the proposed development, but consistent with RCW 90.58. Future development beyond that specified in this permit shall require further review. 7. BMPs: 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. 8. NOTICE: This permit does not excuse the proponent from complying with other local, state, and federal ordinances, regulations, or statutes applicable to the proposed development, but consistent with RCW 90.58. Development pursuant to this permit shall be undertaken subject to the applicable policies and performance standards of the Jefferson County Shoreline Management Master Program and the Jefferson County Unified Development Code. If during excavation or development of the site an area of potential archaeological significance is uncovered, all activity in the immediate area shall be halted, and the Administrator shall be notified at once. The Federal Endangered Species Act rules to protect threatened Chinook and Summer-run Chum salmon became effective on January 8, 2001. Bull trout have been listed as threatened since early 2000. Under the ESA, any person may bring lawsuit against any individual or agency that "takes" listed species (defined 2013-03-07 SFR StdConditions 3/7/2013 1 • • • as causing harm, harassing, or damaging habitat for the listed species). In addition, the National Marine Fisheries Service can levy penalties. Portions of Jefferson County, including marine waters, are included as "critical habitat" for a listed species. Development of property along any marine shoreline, freshwater shoreline, or floodplains could harm habitat if protective measures are not taken. To minimize the potential to damage habitat, all property owners developing adjacent to marine shoreline, freshwater shoreline, or floodplains are advised to do the following: All development activities should avoid unstable slopes, wetlands, and forested areas near surface waters Remove minimal vegetation for site development, especially large trees Allow trees that have fallen into surface waters to remain there Infiltrate stormwater from buildings and driveways onsite through drywells rather than discharging directly into surface waters or roadside ditches The Federal Bald and Golden Eagle Protection Act requires landowners within 660 feet (1/8th of a mile) of an eagle nest to consult with the US Fish and Wildlife Service. This Eagle Act prohibits anyone from "taking" bald eagles. This federal law defines the term "take" and describes the possible legal consequences when a "take" occurs. Among other actions, "take" includes a disturbance of bald eagles or their habitat. Under federal law a permit may still be required for activities that impact bald eagles or their habitat. Contact the US Fish and Wildlife Service (http://www.fws.gov/pacific/eagle/) to learn more about how this law affects your project. Any individual, group, or agency can bring suit for a listed species "taking", even if you are in compliance with Jefferson County development codes. The risk of a lawsuit against you can be reduced by consulting with a professional fisheries habitat biologist, and following the recommendations for site development provided by the biologist. For more information, contact the National Marine Fisheries Service in Seattle, or the U.S. Fish and Wildlife Service. 2013-09-06 5FR Std Conditions 9/6/2013 2 4JEFFERSON COUNTY K DEPARTMENT OF COMMUNITY DEVELOPMENT gSING`c° Date: 7//S"fime Received: am/ r0 Mon. Tue. ed. Thur. Fri. Date: 9-J BLD: fY � ?' Contact Name: Owner: ! Contact Number: 360 S' — 12.E Address: I-77A no,u,1 ou 1_4 206 Notes: Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Underground Furance Footing Rough In Air Seal Above ground Gas Stemwall Hydronic Exterior shear Exterior lines Oil Straps Hot Water Htr Interior shear Interior lines Ducts Post Hole Ventilation Appliance Underfloor Gas/Wood stove Man-Homes Insulation Final Inspection Setbacks Floor Foundation Wall Address Posted Block&Tile Ceiling _', JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT Date: r 0 ime Received: L am/61) Mon. MP Wed. Thur. Fri. . I Date: 1L—i BLD: N. 193 Contact Name: Y Owner: I Contact Number: 360'30 I c.fu Address: 17'7Z /boat �'�J (At- 206 Notes: �'�+� Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Underground Furance Footing Rough In Air Seal Above ground Gas Stemwall Hydronic Exterior shear Exterior lines Oil Straps Hot Water Htr Interior shear Interior lines Ducts Post Hole Ventilation Appliance Underfloor Gas/Wood stove Man-Homes Insulation Final Inspection Setbacks Floor Foundation Wall Address Posted Block &Tile Ceiling 7 • ��eQ-5O\ `o� JEFFERSON COUNTY � ` DEPARTMENT OF COMMUNITY DEVELOPMENT S`T!/:tiG59 7 Date: C?—/O Time Received: a2afk am457 Mon. Tue. Wed. 'AD Fri. Date: �/'—/7 BLD: 1 9 — 133 Contact Name: Cit.)c-(C Owner: Contact Number: 360 _70/ b'7133 Address: j 77 L X1/✓n'J"✓ LIC 206 Notes: Foundation Plumbing Framing Propane Tank Mechanical Setbacks pc Under-ground Framing Underground Furance Footing '( Rough In Air Seal Above ground Gas Stemwall Hydronic Exterior shear Exterior lines Oil Straps Hot Water Htr Interior shear Interior lines Ducts Post Hole Ventilation Appliance Underfloor Gas/Wood stove Man-Homes Insulation Final Inspection Setbacks Floor Foundation Wall Address Posted Block&Tile Ceiling r.:1 JEFFERSON COUNTY 4. DEPARTMENT OF COMMUNITY DEVELOPMENT 49,0q,,, cr.__ i 7SylNG�p I Date: Time Received: _____f_a__j.X.Y Mon. 4150. Wed. Thur. Fri. Date: BLD: Owner: J 133 Contact Name: Address: 17 Contact Number: 360 01 3/ 206 Notes: Foundat Plumbing Fr a_ng Propane Tank Mechanical Setbacks Under-ground Framing Under ground Footing Rough In Air Seal Furance Stemwall Above ground Gas Hydronic Exterior shear Exterior lines Straps Hot Water Htr Interior shear Oil Post Hole Interior lines Ducts Ventilation Underfloor Appliance Man-Homes Gas/Wood stove Insulation Setbacks Final Inspection Foundation Floor Block& Tile Wall Address Posted Ceiling 1N ��w�s moo\ JEFFERSON COUNTY ��` DEPARTMENT OF COMMUNITY DEVELOPMENT �sN Wed. Thur. Fri. �7 am 4: Mon. ate: 7 •Zi Time Received: z ' Date: 7 Contact Name: gQ — LD: 14- 00i Contact Number: 360_Gi - 4� L$- 4 �$ inner: 206 ,ddress: 7 L -,-.,- - Lk. ED Dotes: Plumbing Framing Propane Tank Mechanical Foundation Under ground Furance Under-ground Framing Gas Setbacks Air Seal Above ground Rough In Oil Footing Exterior shear Exterior lines Stemwall Straps Hater Htr c Interior lines Ducts Hot Water H Interior shear appliance Strape Ventilation Post Hole Gas/Wood stove Underfloor Insulation Final Inspection Man-Homes Setbacks Floor Address Posted Wall Foundation Ceiling ., -s`''' `o,. JEFFERSON COUNTY � 2" DEPARTMENT OF COMMUNITY DEVELOPMENT Date: (—Z(0 Time Received: 21,g am/ke Mon. ue Wed. Thur. Fri. Date: ( --2) BLD: I-- 133 Contact Name: 1:11ci1.--- Owner: Contact Number: 360 i 143/ Address: n1 Z. ftl mo E-K RD 206 Notes: Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Under ground Furance Footing Rough In Air Seal Above ground Gas Stemwall Hydronic Exterior shear Exterior lines Oil Straps Hot Water Htr Interior shear Interior lines Ducts Post Hole Ventilation Appliance Underfloor Gas/Wood stove Man-Homes Insulation Final Inspection Setbacks Floor Foundation Wall 'X Address Posted Block &Tile Ceiling env \ 50\ CO Gam, JEFFERSON COUNTY �AK DEPARTMENT OF COMMUNITY DEVELOPMENT g• IN GS9' Date: 03 Time Received: f/ 3'� v%/pm on. Tue. Wed. Thur. Fri. Date: BLD: N- 63 Contact Name: Owner: Contact Number: 360 34 (,V3., Address: 177 2.. 1.6J02/50,3 206 Notes: I Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Under ground Furance Footing Rough In Air Seal Above ground Gas Stemwall Hydronic Exterior shear Exterior lines Oil Straps Hot Water Htr Interior shear Interior lines Ducts Post Hole Ventilation Appliance Underfloor Gas/Wood stove Man-Homes Insulation Final Inspection Setbacks Floor Foundation Wall Address Posted Block&Tile Ceiling `, G wFyON NN2 JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 't(„„,NG,,o-? / J l Date: '7 3 ( Time Received: ; • 13 am/ on Tue. Wed. Thur. Fri. Date: BLD: /`/ 13 3 Contact Name: Owner: Contact Number: 360 '30/ ' V5 Address: / 1 72 ! PciSctJ LIc 206 Notes: `-'-- I Pip-AStjA/lt Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Under ground Furance Footing Rough In Air Seal Above ground Gas Stemwall Hydronic Exterior shear Exterior lines Oil Straps Hot Water Htr Interior shear Interior lines Ducts Post Hole Ventilation Appliance Underfloor Gas/Wood stove Man-Homes Insulation Final Inspection Setbacks Floor Foundation Wall Address Posted Block &Tile Ceiling SON rU .. 4w 1K JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 9sHfrGjO C. — Date: -7 7 2Time Received: / Z 341 at En) Mon. Tue. , Wed. Thur. Fri. Date: a-- BLD: / " /33 Contact Name: Owner: Contact Number: 360 �j p / (, X13 Address: /777_ ,1424s;r9.✓ t-/C 206 Notes: Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Under ground Furance Footing Rough In Air Seal Above ground Gas Stemwall Hydronic Exterior shear Exterior lines Oil Straps Hot Water Htr Interior shear Interior lines Ducts Post Hole Ventilation Appliance 1 Underfloor Gas/Wood stove Man-Homes Insulation Final Inspection Setbacks Floor Foundation Wall Address Posted Block &Tile Ceiling 4/c�'FyV` ` JEFFERSON COUNTY �0 RX \ SglZ cao - DEPARTMENT OF COMMUNITY DEVELOPMENT I OT F (NAL �s'rH1 sG1-G Date: OS Time Received: 7 ° ¢# a pm Mon. Tue. ed. Thur. OP Date: 4I2 BLD: q-- ()Oi33 Contact Name: oc i oZ,o € �Nn �AY i � Owner: Contact Number: 360 .30( - 48a Address: 1777_ A NbmP_Sot..) Lte._ eu 206 Notes: Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Under ground Furance Footing Rough In Air Seal Above ground Gas Stemwall Hydronic Exterior shear Exterior lines Oil Straps Hot Water Htr Interior shear Interior lines Ducts Post Hole Ventilation Appliance Underfloor Gas/Wood stove Man-Homes Insulation \ ' Final Inspection �( Setbacks Floor /v Foundation Wall Address Posted Block &Tile Ceiling JEFFERSON COUNTY `DCZ NO 156017 /; DATE 44/22/I 5 RECEIVED FROM d i1 l iot }1 DESCRIPTION BARS# AMOUNT CURRENCY COIN C H Q� ;� ,L ( E C, F-- phew,teal p g T 0LEL `1b*j 1. 1.47 /4- 0013s m XI 0 0 RECEIVED BY +Q TOTAL 237"" /�yO `moo JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT S'S'H N�.SO Date: Time Time Received: a 5ef am, rr Mon. Tue. Wed. Thur. O' Date: 'Z-( BLD: it-t-- I Contact Name: Owner: Contact Number: 360 Address: i 1-1 Z /kpJ Cii2. .,) 206 Notes: C -■3-)7› Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Under ground Furance Footing Rough In Air Seal Above ground Gas Stemwall Hydronic Exterior shear Exterior lines Oil Straps Hot Water Htr Interior shear Interior lines Ducts Post Hole Ventilation Appliance Underfloor Gas/Wood stove Man-Homes Insulation Final Inspection Setbacks Floor Foundation Wall Address Posted Block &Tile Ceiling .;' ` % JEFFERSON COUNTY ( �$` DEPARTMENT OF COMMUNITY DEVELOPMENT 9SHIr�� 1%i7 )ate: 111-2,4, Time Received: 3 am pm Mon. fue_ Wed. Thur. Fri. , Date: ///z5/►y ILD: 14/ t/33 Contact Name: owner. Contact Number: 360 301- i$s$ address: /77Z kie Ersc0 LK _ED 206 Notes: Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Underground Furance Footing Rough In Air Seal Above ground Gas Stemwall Hydronic Exterior shear 'Y Exterior lines Oil Straps Hot Water Htr Interior shear Interior lines Ducts Post Hole Ventilation Appliance Underfloor Gas/Wood stove Man-Homes Insulation Final Inspection Setbacks Floor Foundation Wall Address Posted Block&Tile Ceiling .,go cb°i JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT N/ SHt Date: X_/ ,Time Received: /737 6/pm Mon. Tue. Wed. Thur. iJ v Date: /0'1-7 BLD: /S-133 Contact Name: Owner: Contact Number: 360 361,f - Address: 1771 ,,JZ1126p,) ZK 206 Notes: Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Under ground Furance Footing Rough In Air Seal Above ground Gas Stemwall Hydronic Exterior shear X Exterior lines Oil Straps Hot Water Htr Interior shear Interior lines Ducts Post Hole Ventilation Appliance Underfloor Gas/Wood stove Man-Homes Insulation Final Inspection - Setbacks Floor Foundation Wall Address Posted Block &Tile Ceiling o� _`A c��i 0 JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT -cSHrNo i Date: Qit_Time Received: 6.2L0) am,? Mon. Tue. Wed. Fri. Date: /0—.2- BLD: Mt— /33 Contact Name: ReY Owner: Contact Number: 360 3e/ "teal Address: /772 11:00,fi,J 206 Notes: S Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Under ground Furance Footing Rough In Air Seal Above ground Gas Stemwall Hydronic Exterior shear Exterior lines Oil Straps Hot Water Htr Interior shear Interior lines Ducts Post Hole Ventilation Appliance Underfloor Gas/Wood stove Man-Homes Insulation Final Inspection - Setbacks Floor Foundation Wall Address Posted Block&Tile Ceiling 4, SO ,---,% JEFFERSON COUNTY -` DEPARTMENT OF COMMUNITY DEVELOPMENT S's(/:,GAO= Date: 7. /8 Time Received: /7'/7 &pm Mon. Tue. Wed. Thur. Date: /Q BLD: /4 — f5) Contact Name: Owner: Contact Number: 360 ,'O// `?33 Address: '?7Z 5o J L-14, 206 2 Notes: /5' ›r2)<"( et' Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Under ground Furance Footing Rough In Air Seal Above ground Gas Stemwall Hydronic Exterior shear Exterior lines Oil Straps Hot Water Htr Interior shear Interior lines Ducts Post Hole Ventilation Appliance Underfloor Gas/Wood stove Man-Homes Insulation Final Inspection Setbacks Floor Foundation Wall Address Posted Block&Tile Ceiling 1 ,,,0-'° c° JEFFERSON JEFFERSON COUNTY C(3. VO DEPARTMENT OF COMMUNITY DEVELOPMENT l- 2-\ 9,. o$ --1 Time Received: CZ. `'t ( am/pm Mon. Tue. Wed. Thur. Fri. >ate: �n Date: _ ` te 1 1 '- 2I 3LD: '3a Contact Name: )wner: �r? 1/L IA" Contact Number: 3 address: - a .... I �i ,-t 206 Notes: 11 01110/+ [akj2., ! w 4. C�� �1 # k. < i ■y ~; Foundation ��Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing L/. /� Under ground Furance Footing Rough In Air Seal LAbove ground Gas Stemwall Hydronic Exterior shear Exterior lines Oil Straps Hot Water Htr Interior shear Interior lines Ducts Post Hole Ventilation Appliance Underfloor Gas/Wood stove Man-Homes Insulation Final Inspection Setbacks Floor Foundation Wall Address Posted Block&Tile Ceiling alp Front Parcel Review • t`b I Y ( 33-- 3 Parcel 901152001 Printed: April 29, 2014 ROBERT L QUINN Site Address(es): 1209 37TH ST 1772 ANDERSON LAKE RD , WA BELLINGHAM, WA 982293236 Parcel Number: 901152001 S-T-R: 15-29N-01W Total Acreage 90 Legal Description S15 T29N RI W TAX 26 PARCELA SURVEY V25/P58 Land Use: 8300 Flood District: Fire District: 1 Planning Area: 4 Flood Map(FIRM) Panel No: School District 49 Zoning: e�c ( �� COMP PLAN DESIGNATION: CON5MUNITY PLAN: UGA: UGA Trans [ ,��1! Plot plan states "property line" [ ] Assessor's Map (Property lines on submitted plot plan must match the property lines as identified on the Assessor's 1/4 map) [ ] Legal Access to Property 410 NO AricLer,/elk- Fell [ ] Parcel Tags or Scanned Documents YES [ ] ESA's: Special Reports Nearby YES NO [ ] Designated Ag YES [ ] Shoreline Designation: YES g [ ] Shoreline Slo.- tability: YES le Stream Typ 401 NO t 0,te.ewh, . etS FWHCA: NO 05(9 i Wetlands: NYE'S NO Rare Plants:YES fi►' Seismic: YES •O Landslide NO /tOd a I —` Flood: YES Uyra Erosion: YES Aquifer Rec•• :- rea:YES SIPZ: At Risk High Risk Coastal CMZ: non- High Risk Mod •to Risk Disconnected CMZ Stormwater site . submitted: er o [ ] Forest Lands: OP NO Adjoining Forest Lands: Commercial/ Rural/ Inholding [ ] Mineral Lands: YES • [ ] Agricultural Lands: YES [ ] Archaeology: YES ,I J [ ] No Shooting Zone: YES () p/ [ ] Stormwater: New Impervious Surface ,5,5 DD Land Disturbing Activity / ( /6� ESA's Stormwater Req's:Min Req#2 Min Req#1 thru#5 Min Req#1 thru#10 Engineering [. ] Notice Provisions/Disclosure:Airport vss MRL YES C 0 Forest Lands 'Es NO [ ] Landscaping Required: Yes e [ ] Parking Spaces Rewired NO Q Other f 1 Buildin2 Heitht:/3S' ) UBC Standard [ ] Impervious Surface coverageeercentage: ' Resource Lands&Public: 10% Rural Residential: 25% Rural IndustiPer UDC Sec 6.7 Rural Commercial: 60% Area of Building Coverage:60%in Rural Indus only [ ] 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/None specified [ ] Setbacks: Front: 29 Left Side: 5 - 260 Right Side: 2S0 Rear: Z50 Shoreline Setback: LSHA Setback: [ ] Road Classification: . , ' Road Approach: EXISTING I 0' REQ.9RAP R.6-i9 I I- z-3 [ ] SEPA Required: YES -.-67-1\4P [ ] Flood Certificate: [ ] Existing Case(s) &Condition(s): Violations: Yes No [ ] Recorded Date of Subdivision: AFN Over 5yrs=UDC Plat Conditions: <5yrs=Plat Conditions on plat or Old Ordinance [ ] Lots/Require Declaration of Restrictive Covenant YES NO, submitted: YES NO [ ] UGA No Protest Agreement WO, submitted: YES NO [ ] Site Visit conducted YES [ ] Require Final Zoning Approval YES [ ] ADMIN: Setbacks entered in Permit Plan case N/A YES New Parcel Tags entered in Permit Plan N/A YES Special Reports Scanned N/A YES No parcel tags found for parcel Cases Associated with APN 901152001 Cases Name Review Type Status Planner BLD14-00133 QUINN I P Application Received: 4/16/2014 Permit Issued/Case closed: Case Finaled: NSFR with attached garage, no heat, no plumb FPA2605158 NISBET F Application Received: 4/16/2003 Permit Issued/Case closed: 2/11/2003 Case Finaled: 4/16/2003 Uneven Aged Harvest& Road Maintenance FPA2607100 NISBET F Application Received: 8/8/2005 Permit Issued/Case closed: Case Finaled: 9/6/2005 70 acre timber harvest. RAP71-00023 QUINN C Application Received: 5/4/2011 Permit Issued/Case closed: Case Finaled: 5/10/2011 No Rd Approach Required-Already Existing. Assigned Address only. SEP12-00080 QUINN A Application Received: .7/17/2012 Permit Issued/Case closed: 9/13/2012 Case Finaled: • \\tidemark\data\forms\R_ParceLCRMLA.rpt 4/29/2014 Page 2 of 2 BLD14-00133 BUILDING PERMIT APPLICA ON Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00133 Received Date: 4/16/2014 SITE ADDRESS: 1772 ANDERSON LAKE RD OWNER: ROBERT L QUINN PHONE: 360-393-5959 1209 37TH ST BELLINGHAM WA 98229-3236 SUBDIVISION: Block: Lot: TX 26 PARCEL NUMBER: 901152001 Section: 15 Township: 29 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTION NSFR with attached garage, no heat, no plumb TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 2,048 VALUATION 300,000.00 ADD'L: HEAT TYPE: HTP CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: OCCUPANCY: OTHER: CONST TYPE: SHORELINE: GARAGE: 720 CONST TYPE: SETBACK: DECK: 1,440 BANK HEIGHT: SEWAGE DISPOSAL: OSS WATER SYSTEM: 1PWELL BEDROOMS: BATHROOMS: Exist: Exist: Prop: 2 Prop: 2 Total: 2 Total: 2 Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $2,427.00 MEB 04/16/14 148602 Plan Check $1,577.55 MEB 04/16/14 148602 State Building Code $4.50 MEB 04/16/14 148602 Potable Water Application $67.00 MEB 04/16/14 148602 Total: $4,076.05 \lhlrinm orlArinhnkfnrmclL RI n Ann RH rnh AHR/9/HA soN e • 4� be, JEFFERSON COUNTY • ti ' \� .� DEPARTMENT OF COMMUNITY DEVELOPMENT � 4 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax �'gS, G�c5 www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: _ Project Description(include separate sheets as necessary): I_ S, y I r Jl' PP S CI e•In L (�� c^�[ OLEw e e i . _ �e.e 4-- pfd-S. Tax Parcel Number. 6/o/ i ca_o0 ' Property Size: - • ,0 2 J at quare feet) Site Address and/or Directions to Property: » 72 4_ .� 1 - ke- a -. c■I . . . I•✓ - . , Property Owner(s)of Record: 44 12(6-'1" L Q ,, Telephone: 3 6 o 3e)3 5"c7 5-9 Fax: A/On/a email: gob L y1,,“,,., L*-11 44,J0(0k, Mailing Address: /.']09 ,3'7 n" 57 / 9el/,%4 j,®,,.,,, in/A- G),Q22,9 Applicant/Agent(if different from owner): /'.JM J Telephone: -- Fax: email: -- Mailing Address: — What kind of Permit?(Check each box that applies ❑Lot or Road Segregation Building ❑Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) 'Single Family EGarage Attache /Detached ❑Conditional Use[C(a), C(d),or C]`* 1 I ❑ Manufactured Home .❑ Modular ❑ Discretionary"D"or Unnamed Use Classification 0 Commercial* ❑Special Use(Essential Public Facilities)** ❑ Change of Use ❑ Boundary Line Adjustment ❑ Address ❑Road Approach ❑Short Plat** ❑ Home Business A❑Cottage Industry ❑Binding Site Plan** ❑ Propane ❑Long Plat** ❑Sign ❑Planned Rural Residential Development(PRRD)lAmenaments** ❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration** ❑Stormwater Management ❑ Shoreline Master Program Exemption/Permit Revisions*" ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development** ❑Temporary Use ❑Shoreline Management Variance ❑Wireless Telecommunication* ❑ Comprehensive Plan/UDC/Land Use District Map Amendment o Forest Practices AcURelease of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment *May require a Pre-Application Conference ❑Tree Vegetation Request **Requires a Pre-Application Conference Please identify any other local, state or federal permits required for this proposal, if known: ____ALCAth DESIGNATION OF AGENT I hereby designate `�y�/V O AJ� to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE (/1 1 /f �,,4,�, Date: 3-31 -2©I J By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and caner)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 attorneys 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 applit t hT she w}rrts per notice. c Signature: �l. `ntr Date: 3-31 -20P/ 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-transfers re onsi ility f,orAdhe in to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: �u-vt c,�J c444,-,,,,,.-- Date: 3-31 -201 V G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc .-D i . , 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 assu ' the responsibility of th¢General Contractor for the proposed project. Signature: ( "r,.4,,,,,,,, Date: 3 -3 / -3-0/// GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: Pi-IGNE: FAX: 0 1/t//(/e/ ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ' New ,%Wood Existing: C Sewer 0 Addition El Steel Proposed: 2. Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: 2 _ Height: Individual System ❑ Repair ❑ Masonry Ai/4 SEP Permit# Ste/2-01220 D Demolition o Other: Bedrooms: Water Supply: Existing: — - Setback: X Private well U Two Party Type of Heat: Proposed: U Public E-it 6-,1 Ale Ai ie741„1 Total: 2.. _([g_ Name of System: If this is a Commercial Project you must answer the following: qtr/4 Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed ;BC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No If this is a Propane Tank andlor Appliance Installation permit,mark all items below that apply: NSA t Underground Tank i Above ground Tank Size of Propane Tank: 1 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 I Mobile Home? Yes 0 When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines,tank location and size, distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. • Square Footage Current Proposed For Office Use Only Amount Revision Main Floor Heated EH Bld App Review: p avy? 22-C6+S.R2- 01,c 2"°Floor Heated - Consistency Review: .- Q,,, Other Heated Base fee: / 2yMezzanine Nl i� Additional Section: , -4-,,ad Heated Basement Plan Check fee: `-.-, Unheated Basement N� - - r sr —N/ ' I State Surcharge fee: v Other Unheated Pot Water Review fee: G , Garage/Carport c,, SUBTOTAL .``7x0 ,_-:_n__, 4/IIL12 , " - . Decks 911/Rd Approa ee: Other / N ,u gy.•C 0v tv—e of t2 -i- O I L/Lb tj 4 K.e,c-. TOTAL: $ ' Receipt Number: 1(,f V/ 0 2 / Cash/Check Number: o(4 2-2-4-.32-5:1 Z _ S 2 �� ESTIMATED COST_ REQUIRED) Date: r I /� •Fair m et value of all labor materials foundation to finish l� 300.) 000 , _• Initials: ' G\PemitCenter\###FORMS###\DRD FORMS\Current DM Forms\Master Permit Application 5-29-08.doc Map Output Pagc 1 of 1 ArcIMS HTML Viewer Map O I } i �� w. ,; 11 \ y Cherryyay ' s..._______„. e, \r f1 .c....j, ir..,.\ \.}.i (,. i, ,. �� ( l 41 yss1 4 °° Rd , �. J -„,..._3 6 nLTke { ,+� ,/ �' l l Legend 'I` " L` _ Selected Features •_ T .i _/? I JC Roads fl SSS l ' lr r Parcels-H\ i �' r -I, ) Contours ir\ ,.,, Y J ' ..." to Fpbt Como a ti a . \ '') )'. ,; "�y • I I SD Foot Contour j°$ ONR FP Stream• \\\_ ✓/ Classification '�� y ° y, �C..=--�'-{ �i F-F"kYh Haber ♦4\l r--1}J { (r '� s_� °i j � � N•Non-irsh Ilabbal 7-) Np-Non fish Ilabeal Poronnui .CC--- { n 4 p 1\ -..,�,r ji/ Ns-Nan•fish Habitat-Seasonal -- se S•Inventory Shoreline __ r. �. u V' -�� " ° 10M Hillshade Lt pp n Ifi .1/ 11 `mac );' 5 x (J rl W cl U. 1 G 1/a:,Ta:ikday-c• ..::.I Cua'Ire c:or4.—... U 1 Q.. {y-p_l , FOR INFORMATIONAL PURPOSES ONLY- Jefferson County does not attest to the accuracy of the data contained herein and makes no warranty with respect to its correctness or validity. Data contained in this map is limited by the method and accuracy of its collection. Thu May 01 08:48:58 2014 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientV ersion=4.0&Form=True... 5/1/2014 Map Output, • Page 1 of 1 Osprey - Features Not Surveyed lit _ ' AIMIL ,,, 1 I ' Bor:41 liral- '''' . - 1 - ( I - Prdnv f `•1 Legend I '� `-- - Selected Features I ' r f,, Township Lines I JC Roads 29N''∎N ti Parcels•H I Heritage Points - I 71 re"ee 1 i 3 '"---TLE d a tOt a \i:rn..rv.dcd at.ci"%.ri Cum.{C r'J:.K!vtts Gib 0 iiiLMN gigh FOR INFORMATIONAL PURPOSES ONLY- Jefferson County does not attest to the accuracy of the data contained herein and makes no warranty with respect to its correctness or validity. Data contained in this map is limited by the method and accuracy of its collection. Thu May 01 08:49:46 2014 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientVersion=4.0&Form=True... 5/1/2014 Map Output. • • Page 1 of 1 ArcIMS HTML Viewer Map fr ,0 i Lj ' .Ch..rry Av i. 11'''-----: 1 ' -- --._-_L__,:_: ...dti,'.ti;4 i, F F5r P LP. ( J !r °J Prd ef — 1 +- Legend ' Selected Features �* � JC_Roads , �... Parcels-H is. Landslide Hazard ink &Nees -1 1 i the II t` Macerate �ISig m FA r 'el— — A jl G V� f 1 Man rrvndoi ti«'-"run Corey cants Smnos.= 0MMNIMI■100111 N FOR INFORMATIONAL PURPOSES ONLY- Jefferson County does not attest to the accuracy of the data contained herein and makes no warranty with respect to its correctness or validity. Data contained in this map is limited by the method and accuracy of its collection. Thu May 01 08:50 55 2014 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientVersion=4.0&Form=True... 5/1/2014 Map Output• • • Page 1 of 2 ArcIMS HTML Viewer Map c'; orcsoo. 2Kg en f I ji i[ mam •d:n. .i c•.k•J:.._.. . ,,'.:,.,rt- -a,:-, yr,...:GS _•dfl http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientVersion=4.0&Form—True... 5/1/2014 Map Output. IP • Page 2 of 2 Legend 73 Selected Features Township Lines JC_Roads Parcels-H County Zoning MPR•SF Tracts Rural Resident 121 1:5 Rural Resldanl of 1:10 Rural Resident ul 1:20 M PR-Sing Family ■ MPR•M uN damlry M PR-Resort Ce,ne klk Parks and Recreation ■ MPR-Open Space ■ Ra♦al Forest Convnorcit Ferrst In holding Forest I loavy Ind last rut Airport CPF ■ NPR Vnlaga Con tar si AP 1:20 Ru rat Village Center ■ Reset]roe Based Ind. Log 111 Ind ustrul M PR-Recreation Waste Mgmt CPF LIMI Lite ■ Crossroads-GC ■ Cr roads CC ■ Crossroads-NC ■ AL 1:20 UGA•Urban C emmorctat UGA•Urban Light Ind um rul UGA•M DR UGA-Ii DR UGA-Pia bhc UGA-LDR UGA-Vrsdor Oriented Commercial MPR•DRN Grinnen CF-&IMRLO Commercial Forest- M ineral Resource Overlay FOR INFORMATIONAL PURPOSES ONLY- Jefferson County does not attest to the accuracy of the data contained herein and makes no warranty with respect to its correctness or validity. Data contained in this map is limited by the method and accuracy of its collection. Thu May 01 08:52:14 2014 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientVersion=4.0&Form=True... 5/1/2014 Map Output, Page 1 of 1 ArcIMS}}HTML Viewer Ma. r I ' -. 1 ii iii 1 41: 44t#1;•' a _ r. .—..rte .. ...... irlierm. I s S Legend -- Selected Features a ' JC_Roads 11 i-14: - 2011 Aerial Photos ■ IN 4 rr — �. -- 1 i Maw wooded by JeAsam Canty Goan.Samoa G49 FOR INFORMATIONAL PURPOSES ONLY- efferson County does not attest to the accuracy of the data contained herein and makes no warranty with respect to its orrectness or validity. Data contained in this map is limited by the method and accuracy of its collection. Thu May 01 08:53:11 2014 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientVersion=4.0&Form=True... 5/1/2014 III III \ \ \\ «\ B \ \ / \ \ ) \ ] w $ / �- � . . , . . . : _ _ z G e 3 ( • / e / §} a_ , z c wv+ ) \x n z 3 9 § �. ._._. ._._._._.� )I w @ > - 0§ / ^ \ / 070,0 1 NI* ■ § \ x1 : \ \ _. ƒ \ 0 § / { z �— — — — — ,1, w g, u ; ! 1 0 CC NM \ glIg n O ( , G() |. , ,e > _ ! • ; � ;§ \ ] , - §. : / ! ! / \ \ / \g 2� \ /!\ ! 5| !>/ & a.pl 2| - : 5"g 8; / • k \�§ §� \ \ #, \ /1/ : ` U !, ;q4 x (/ | 1 \ 9,p2b 6; • \•|d c! 2 ,/ !\ ) \ \;/.1 g/; \ (}2|£ , ! rXng M 5= ! �j \ ( . • ��wON coy JEFFERSON COUNTY I L-4 r3 DEPARTMENT OF COMMUNITY DEVELOPMENT $ 621 Sheridan Street • Port Townsend • Washington 98368 Y O 360/379-4450 • 360/379-4451 Fax �s$ING(C. http://www.co.jefferson.wa.us/commdevelopment/ 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 'y0,o L acres An acre contains 43,560 square feet. Multiply the acreage by this figure. Size of parcel in square feet '3,9'2./ , 27/ 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/.acres or more of Construction site for structures 10, Sl 2 sq/ft native vegetation to lawn or landscaped areas? Drainfield, septic tank, etc. q 00 sq/ft Circle: Yes No Well, utilities,etc. 5-O0 sq/ft Does the project convert 2%acres or more of native vegetation to pasture? Driveway, parking,roads,etc. -50 sq/ft Circle: Yes No Lawn, landscaping,etc. sq/ft Other compacted surface, etc. sq/ft Indicate Total Volumes of Proposed: Total Land Disturbance j � y (a:Z sq/ft Cut Sv Fill :5-0 (cu/yd) t ,-E�Si»etr) Sped [over] 5 0170 k �.s C.)‘}3 Qf J a-1 y!" 1 Pijij slormwater talc worksheet Rev 9-9-2010-REV 9/9/2010 1 • I 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 infiltra ii0n e STORMWATER CALULATION • —IMPE- ! SURFACE NEW EXISTING Structures(all roof area) ii 9SC7 sq/ft Structures(all roof area) '2,"2/0 sq/ft Sidewalks _ sq/ft Sidewalks — I �1 sq/ft Patios L kd1„ Bost sq/ft Patios sq/ft Solid Decks sq/ft Solid Decks (without infiltration below) sq/ft (without infiltration below) Driveway, parking, roads, etc $TcO sq/ft Driveway, parkin• roads etc 7` ) 00 sq/ft Other sq/ft Other — sq/ft Total New ,S—3—O 0 sq/ft Total Existing '7 6 7/0 sq/ft TOTAL NEW+TOTAL EXISTING` 8 2,d2/0 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: 2./0 % Does the site have 35%or more of existing impervious surface? Circle: Yes 0 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. ww•,.1 , 3- 3/-zo/Y (LANDOWNER OR AUTHORIZED PRESENTATIVE SIGNATURE) (DATE) IFOR OFFICE USE ONLY SMALL MEDIUM LARGE REDEVELOPMENT Stormwater Site Plan: Yes No I stormwater calc worksheet Rev 9-9-2010—REV 9/912010 • • ; -o'` pet g \L r n r,esOIST C S W ikq, JEFFERSON COUNTY ti DEPARTMENT OF COMMUNITY DEVELOPMENT Ki I/ 621 Sheridan Street • Port Townsend • Washington 98368 4... ty FIINO O$ 360/379-4450 . 360/379-4451 Fax http://www.co.jefferson.waus/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. r X/0S�'yr^/titer ) 2 61 Gve. ov--..�J� (/Yrc��s•S ''j/ `I,.1 J 5- -, ' 77,....k 0 al h CA V NAA,IA �i-G/!/l Yr f I.O}./14-(/1. I ,J CIO 4 %C. e)-e v V't I¢-v, W-G�'1,,�0.4- Po 4.. p..- Q,.-. t.✓a+<r -172 S'•T-G • Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. . :. . 4,e S , e 7- C . .. . 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. r4.ss� =,.e.1 a( 4. Describe the existing soils. Indicate soil type on the site map. S'e –J7 L L . p!f S{�,-1-1 L, S ;J L�J 5. Describe the existing site hydrology (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. .5")..)e- Flow -A P A/ 1 z- I i4.- ) p-� .rM --: I ftr41-1-104.-1 6. Describe any excess levels of noise generated by the proposed use or activity: Nod; stormwater site plan template—rev.10/21/2008 5 I . 4 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. a • er f0 '1.t �sJ U s,4.e P%u� - o S 4.-/o,-.1at I 527'7^-e a..... Loci.. 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.). 4 I I.e So." 1_e- RoHJ vl /4;I, Paf 2 , SOV ,c a d CC Jkc �., f— Res a /) s7" �utioff l Or{ 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. O;s �e wk .- 8� Fwd 3-0 -Pe ,Y't+ �... �fV'a7''-�Irc V o., 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.] A107- Rec7 �.,r� � 11. Describe the performance goals and standards applicable to the project. .,.'f- t�eL7 M s...w-,..,.i 7"r.c7'!!'.11 .,Act .S7` "ra1..Aw p 086-1 s.1(t—}a l ,i 14-J1! jn o,j S,I'1 i1 a S -e s S7'r4,c7' , a 12. Describe the flow control system. Pe�1., stormwater site plan template—rev.10/21/2008 6 • • • 13. Describe the water quality system. IVU+fnV dr I .27-. Po I+r4.4 he') 14. Describe the conveyance system analysis and design. yto 15. Describe the source of fill material, physical characteristics of fill material,and deposition of excess material. PIJI1,1 e gsr�v;ir 7M.-. etH� S Femur .1 lNyt 1 .1 �N1I J 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform � QBuilding Code. Pee- / ) Qr~ Utn���f l�.,y P1 . �n )I., Q eV.t. Re? LA he-G rn-e 17. Describe the proposed surfacing material. J G✓hVLI c0 In 0YIVK. &lery Clv't Lo in. A' PG,te-k vv. 4, O/ 18. Describe methods for restoration of the site. B k Pr 1/ 0. Rest G>J 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/,/4 20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan. /1/49 0-1 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. stormwater site plan template-rev.10/21/2008 7 0 • 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. 5,*- c..; e 51-2.k J -P - •rf 7"r In 4.-47 c."'L • 2. Establish Construction Access. Oki X.i *it..y O It L e, 3. Control Flow Rates. AJc v ca ) L7 e v- v P r..f To "P1 /tv *I U 6-1 4. Install Sediment Controls. S,`I1 Few t 1 rte'- 1 $Tvur✓ /e.c 5. Stabilize Soils. Fr/at , S ruw 6. Protect Slopes. /li D s/ 7. Protect Drain Inlets. A10/11&-: stormwater site plan template—rev.10/21/2008 8 • • 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. 9. Control Pollutants. �^t 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). A//4 11. Maintain Best M•anage�ment Practices(BM Ps). J A P 5 11 / 1 c b J I V, COt., yV'6 c. /(.d/' 12. Manage the Project. 1I c0a-d),..q-fc 411 En, 4.41 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas,roads). f1lo Areas I t. B,.otCr,.,,, ,---,3 ; 1..J) b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. storrvwater site plan template—rev.10/21/2008 0 • • 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 _y Pei ri6"-e ivc, f✓�lf� / �p7 tc ins/.l/ei.( t..✓ .-1-e , c,r,ot 7�Werr I e /� 4 1 ,y �o /)n,! r%.� l�-•t . �E'«441 -PO r 1CPi 1af rn! /cr 1 Cr r b. Construction phasing(if proposed) S �c``^G1GVlf Ph,.!y� 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). Provide a proposed construction schedule. MGM ���dl j � 5 f2±1 v1{9{r II. Wet Season Construction Activities. a. Proposed wet season construction activities. Altri b. Proposed wet season construction activities for environmentally sensitive areas. 7. Financial/Ownership Responsibilities. a. Identify the property owner responsible for the initiation of bonds and/or other financial securities. b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following, if applicable. a. Sediment Ponds/Traps. /Vf,Q b. Diversions. N/4 c. Waterways. fit//Q d. Runoff/Stormwater Detention Calculations Stormwater site plan template—rev.10/21/2008 10 • • • 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. _ 3 / ' (LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) _�� THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: stormwater site plan template—rev.10/21/2008 12 • • • 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. 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WA 98.525 �462-J2 CREWE;R'° 618 S QbN St Pat M18W V,161 96792 aE£i: OF g Jefferson County Building Division Permit Number: BLD14-00133 Applicant: QUINN BUILDING PERMIT INSPECTION APPROVALS Applicable Code: 2012 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 i iL fp Erosion Control 114, /t� P v a 4K ' °1/f Foundation Footing ! J � 7 /NG l �„ ,f.K dui«g s I 105r#1 r 7/ti F• ooting Drains Q1 Iii I� Foundation Stem Wall /�1 ��nl► ¶"AT10 5-r&RApALL vim 911 G 11 Underground Plumbing Under Floor Framing � �� S• traps(hold downs) Ext. Shear Wall Nailing 1)- t! J ii,Rough-in Plumbing (, I F• raming �S11f Jy� Q B• locking ( / A• irseal /ii/ - Insulation:Walls t5 Insulation: Floors It Insulation: Ceiling p 1 t Int. Shear Wall Nailing 1s Wallboard Nailing Gas Line: Interior Gas Line: Exterior Propane Tank Heat/Chimney Clearance 9 II J' Drywell/Alt Drainage Address Posted V (III I S� Water Meter Inspection 11 j5 i Septic System Finaled • • A final inspection will not be scheduled until all of the following are completed and signed off by the applicable Department: • Building Permit Conditions are met • Septic Permit Final/Complete for any building containing plumbing • Land Use Conditions met and signed off • Public Works Permit Final(where applicable) FINAL INSPECTION c\I \17 Cy FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR • • CONDITIONS for Building Permit# :BLD14-00133 1.) 10' minimum separation required between the water line and any onsite sewage system components including sewage transport lines. 2.) The project is located within WRIA 17 and thus is subject to compliance with the WA State Department of Ecology In Stream Flow Rule for that region. The parcel is located within the Chimacum sub-basin; as such, state regulations require the following: 1. Water use shall be limited to domestic use only, and such use shall not include outdoor irrigation. "Domestic use" means use of water associated with human health and welfare requirements, including water used for drinking, bathing, sanitary requirements, cooking, laundering and other incidental household uses, including potable domestic water requirements associated with commercial and industrial purposes. (WAC 173-517-150(8)) 2. INSTALLATION OF A WATER METER, MEETING DEPARTMENT OF ECOLOGY SPECIFICATIONS, IS REQUIRED FOR ALL NEW USES THROUGHOUT THE WATERSHED. (WAC 173-517-180) BROCHURES WITH SPECIFICATIONS ARE ENCLOSED WITH THE PERMIT. Refer to enclosed documents for more information, see Ecology web site at http://www.ecy.wa.gov/programs/wr/instream-flows/quilsnowbasin.html or contact Ecology at 360-407-6300. 3.) Jefferson County has determined that the use of real property for agriculture and forestry operations is a high priority and favored use in the county. The county will not consider to be a nuisance those inconveniences or discomforts arising from such operations, if such operations are consistent with commonly accepted best management practices in compliance with local, state, and federal laws. If your real property includes or is within five hundred (500)feet of real property designated as Rural Residential 1:10 or 1:20, Rural Industrial, Rural Commercial, Agriculture, or Forestry, you may be subject to inconveniences or discomforts arising from such farming and forestry operations, including but not limited to noise, tree removal, odors, flies, fumes, dust, smoke, the operation of farm and forestry machinery during any 24-hour period, the storage and disposal or manure, and the application of permitted fertilizers and permitted pesticides. One or more of these inconveniences may occur as a result of agricultural and forestry operations which are in conformance with existing laws and regulations. 4.) zal 5.) 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. 6.) The site plan as submitted on April 16, 2014 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 1, 2014 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 7.) This approval is for a new Single-family residence only. Any future permits on this site are subject to review for consistency with applicable codes and ordinances and does not preclude review and conditions which may be placed on future permits. \\tidemark\datalforms1F_BLD_Permit_Bldg.rpt 5/15/2014 BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD14-00133 Received Date: 4/16/2014 SITE ADDRESS: 1772 ANDERSON LAKE RD Issue Date 5/15/2014 Expiration Date 5/15/2015 OWNER: ROBERT L QUINN PHONE: 360-393-5959 1209 37TH ST BELLINGHAM WA 98229-3236 SUBDIVISION: Block: Lot: TX 26 PARCEL NUMBER: 901152001 Section: 15 Township: 29 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: PROJECT DESCRIPTION: NSFR with attached garage, no heat, no plumb TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 2,048 VALUATION 300,000.00 ADD'L: HEAT TYPE HTP CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE 720 SHORELINE: CONST TYPE: SETBACK: DECK: 1,440 BANK HEIGHT: SEWAGE DISPOSAL: OSS WATER SYSTEM: 1PWELL Type Amount Paid By: Date: Receipt: BEDROOMS: BATHROOMS: Permit $2,427.00 MEB 04/16/14 148602 Exist: Exist: Plan Check $1,577.55 MEB 04/16/14 148602 Prop: 2 Prop: 2 State Building Code $4.50 MEB 04/16/14 148602 Total: 2 Total: 2 Potable Water Application $67.00 MEB 04/16/14 148602 Total: $4,076.05 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