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HomeMy WebLinkAboutBLD2008-00016 4,> ctt JEFFERSO•OUNTY I W DEPARTMENT OF COMMON TX DEV.j�l�O' PMENT ~' ,ii ` `''4 621 Sheridan Street • Port 4kiv s� d,•1AA/isti �dan11968 360/379-4450 S. 360/379-4451 Fax kgS�� N00� www.co.jefferson.wa.us/commdevelopment JAN 16 2008 Master Permit Application MLA: °S - KO Project Description(include separate sheets as necess (-�HSHN COUNTY BCD -� Tax Parcel A Property Number: 3 " 273 ` 00Z, Size: ZO tom-. /8 1O,coo t(acres/square feet) Site Address and/or Directions to Property: Property Owner(s)of Record: SEA CRC:s- Lao.,0De-Vc—Lo'PN10.1.3T / ILic. Telephone: (3 ir0) 457 -542.7_ Fax: Kl/& email: t••3/A Mailing Address: Z23 1-1A4?- )wic)c i 011 .>-r Rut.-0 < E4„t,,;,, W 4.4.,.,,c1Tc4,4 gb38Z Applicant/Agent(if different from owner): Jn.c lc: Gt.du 13t74 z - Telephone:(31o0) 457- 542.Z Fax: N/A email: N/4 Mailing Address: 223 4.4A07�nwicrc tRD1 .)•r Rc .c - s5s9u>",,t, i& s s oc,„TON cfS382. Wjhat kind of Permit?(Check each box that applies Building 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit 0 Conditional Use[C(a), C(d),or C]** @Single Family 0 Garage Attached/Detached ❑ Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home 0 Modular ❑Special Use(Essential Public Facilities)** ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use 0 Short Plat** ❑ Address 0 Road Approach 0 Binding Site Plan** ❑ Home Business 0 Cottagelndustry 0 Long Plat** 0 Propane 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Sign 0 Plat Vacation/Alteration** ❑Allowed "Yes" Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** ❑Stormwater Management 0 Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination (SPAAD)* ❑Shoreline Management Variance ❑Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* 0 Jefferson County Shoreline Master Program Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium 0 Tree Vegetaion Request *May require a Pre-Application Conference _**Requires a Pre-Application Conference Please identify any other local, state or federal permits required for this proposal, if known: DESIGNATION OF AGENT I hereby designate --)t-G'- �i-o-> -- to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE • -k-ce S., C' s r Lcxt,c DAL ('r40NT 1 I&..X._. Date: 1/is iz«,g 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 it's 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. Staff's access and right of entry will be assumed unless the applicant informs the County in writing at the time of the application that he or she wants prior notice. Signature: .,,j..pct—_ t,tAc tg -T-- e_oAs cz1LYpr,-T- Date: 1/5/�0(2€, 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-transferable responsibility for adhering to and complying with the ESA. The Applicant has read this discla' er a signs and dates it below. Signature^- � t ,,t �-•9-� _ ,USuc- A./T Date: laps G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-20(16 r1,-.- )110 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: IKCJ—�-AL) 1' CN Ap t i=->e_3 l I-C . (31.-6) 4-6:4,_ 145-U ( ) NlA MAILING ADDRESS: 24-3 'E3 yam,,` 6i2 c; (2 -..^.,p EMAIL: CONTRACTOR'S LICENSE `,_ ,,,,,,,,,,( Ut_7 r. si-- i N..,T r .— ` i.-,r"4'"L WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: Z New X Wood Existing: v ❑ Sewer ❑ Addition 0 Steel Proposed: Z Bank ❑ Community System O Alteration/Remodel ❑ Concrete Total: Z Height: ❑ Individual System ❑ Repair 0 Masonry SEP Permit# ❑ Demolition 0 Other: Bedrooms: Water Supply: Existing: 0 Setback: 0 Private well 0 Two Party Type of Heat: Proposed: 3 ❑ Public CrA. -/Pt� u„ Total: 3 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( Above ground Tank Size of Propane Tank: Z.`0- (Du_ -feat Stove)(i Cook Stove I Woodstove i Fireplace Insert xi 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 t''- aiy.' ter. p- -44, 17, .,g � 'A1'l` rb1 W, ;a 37 it, . ... ' Main Floor Heated '}' EH Bld App Review: rip '7 0•2, i- 2n0 Floor Heated .. k Aar" �a$, Consistency Review: a! 4 J' Other Heated r aR Wit; Base fee: Q,z r 2 ow,i ,•, A f U -1 Mezzanine , . ,) L` Additional Section:Kil"i __� ' -( Plan Check fee: Z, (M �j Heated Basement ,r 622 5r1 �J' ' (DQ Unheated Basement State Surcharge fete: Other Unheated ."� ' -.x ' Pot Water Review fee: �} . CO Garage/Carport 4 r r� - SUBTOTAL Decks 3-"LT pt.:14,7„,,,";:,'' 911/Rd Approach fee: f.Z4 • I..—�. A pine. Ck l_f--51-1 TOTAL: $ ! . I l .(00 Other s � � � • �- �: s` le � �c� � �� ' Y. „ (6, Receipt Number: CI 3IGL_ ��5 \ "e,,V74,0 4 ash/Check Number: I(. ESTIMATED COST(REQUIRED) Date: I_ I�, •Fair mfcet value of all labor and materials foundation to finish 3� «' -r Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc • • oN c° JEFFERSON COUNTY RECE1IvED DEPARTMENT OF COMMUNITY DEVELOPMENT JAN 1 6 2008 621 Sheridan Street • Port Townsend •Washington 98368 �1 1 9 360/379-4450 • 360/379-4451 Fax "ANC` http://www.co.jefferson.wa.us/commdevelopment/ JEFFERSON CORP' CCil STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# - W PROJECT/APPLICANT NAME: 5EL `_ae r LALIDDsoecovmear luc 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. P. CL 2to AL'A *R)k A SMALL -700 e4alti .A Ioo a' w Ek,u5` s-rs c 'rat` pn > TY Existing Conditions Summary 2. Describe the existing topography. Indicate contours on the site map. _.ram Lat i s F A.-r w I rw A• 1-11 A A,P-co4[TZ`:5) Apo �. 1021 s b r eo Pi,�r Lorna_ - -��erzt� Ta As 'rite •tom=-ate Awls,=Deb Sam ►ke.A 3. Describe the existing vegetation. Indicate native vegetation areas on the site map. 1 -The AA14W Att`i4 IS cc9Inv c=IJ 1.prrtt qi)xe. oL. S ctca Avo 410+nw4K, t 04--AL 34 _fl $tYNGGt IS Ccx, 4JI1%4 Sceu( SQQc.cc 4. Describe the existing soils. Indicate soil type on the site map. -1-rl6,44 A2,e-A - LoA.t_ Top 2-3' - SP.i+� A-..a C•.r> v T►41. Ri sT LuAi .1 C--'1G(7p San-Ls 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. ` it-m i-A-t►► A02-41..--rt �LLas ' 1 s - lao Si6,0, s aP t •rk�rr_ Lypv1 'I..) s-Y- T C c--s I►.2Tr lr'1= SOIL - Is A,gsv ro He 4.4 6. Describe any excess levels of noise generated by the proposed use or hctwRy: t)o ADOrrwAvAer TO Geer C42elotTL=o - 141C-1Nw PRIWYNEh6G- T'Lsi f•b' el• 89 c:�48.0 STO MWATER PLAN_ AUG 2 1 2008 stormwater site plan template-rev.10/1/2003 iEFFE O,, Y 5 DE'i OF CO. yn'ty=emENY • • • 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. Two k`�otu�s t_">cr Low A .-e4 (DPI sr•) .,e t3efu64 -- Lob LC A.-r ti')c Acyr Lt7Ctd.TLo,l7 ou Pno�D Qa - C-J6.-auJ eRi nN 141C u A11-erk 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.). Atl,cta is FLAT U.'IT H CG 21 1 I ! 6010 pIoro - LAST- .5j,oe et /0/ Cs A c,G,t A-u o 1ZoG4=b PA214.,,uG, 4- -e A - W i—r l e n i s fle›.e,o r3o w«-, O2 L V lauv. s / 2-u ouT Il&H 42.L A A 2 ems A D_9oi,v i►��-, I-/,c►v L. B L' J LoC-,cz 13b A/01227 I - 1)v 517 1-,e2 Q (r i 8d--Corr auvrc l r acc.ue s w t sr of/-{i‘14 Aacat 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. Al.t� SrrE�z.nA �o t cQ . w1 IL'T O A�uO r_e 77 h l ya --/ - 42Gx► (eT S /00 ir) ,¢ o f SToEni+..'a?tom 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.] P/A - SMPLC-. S f IL-0 62 A -CA3a0 11. Describe the performance goals and standards applicable to the project. +--40 4 LL. 700 U- . c14t3,1U /U1 AEc,Ot_ ST7L-e 12. Describe the flow control system. AJD oGJ ce,x, eoz-. 7 stormwater a plan terrpli lb iev:1117%?2i)63 6 • • RECEIVED 13. Describe the water quality system. NSA JAN 16 20s IrFFfRSON CO�INY OCD 14. Describe the conveyance system analysis and design. CuTr s /t oGu,L) pocer-s -- it turn �L- ssiorus I L. Aossoe 8 -- _D2 r yta_Vc 15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material. 1►3/q 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. /A — 17. Describe the proposed surfacing material. P/A 18. Describe methods for restoration of the site. fjaA P jec, b" m t N- L) C QASS .L?t f i 1.JC' .D is1244Btr10 Atelc Qs Tp►e- 'FLA I-1 a ci Y•d ,duy 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. P/14 20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan. N�fC4 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. PAA storrnwater site plan template—rev.1 W1/2003 7 • CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN(SWPPP) The Construction SWPPP.addresses sediment and erosion control during construction. The BMPs indicated by the applicant in the template that follows must be'installed on the ground during all construction phases of the project. The proponent is responsible for preventing sediment and erosion impacts to environmentally sensitive areas and off-site areas. Consult the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet for guidance, particularly with rural residential development. SECTION I—CONSTRUCTION SWPPP NARRATIVE • 1. Construction Stormwater Pollution Plan Elements. Describe how each of the Construction SWPPP elements has been or will be addressed. Identify the type and location of BMPs used to satisfy the required element. If an element is not applicable to the proposal,justify in writing. Descriptions of the 12 Elements are found at section 2.5.2 of the Manual(beginning on page 2-15). 12 Required Elements--Construction SWPPP 1. Mark Clearing Limits. Asseic. Li t -t rrs C3 t'x�, GGtiRcW 2. Establish Construction Access. +�GGCSs H-As sore.) G.dr-IsT c 7---x) 3. Control Flow Rates. 'a $r"r ..pt)#J — 6 T)-f AasvaBS Ou et_ 10b t V<.ei e-s/ 12. /— IV D S'r79NDi Ad L.,,,t rem is) AL1 Dina f v ' 4. Install Sediment Controls. Ni a • 5. Stabilize Soils. -we!L.r Ae i„ 5Tr4sfiit G — R..qr 04,2 eV) 6. Protect Slopes. 1-9/Q 7. Protect Drain Inlets. /VA stormwater site plan template—rev.10/1/2003 8 • • 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. N/ RECEIVE D 9. Control Pollutants. g q @ r�}} Lu 6 t� 'GO Nb Pol t...t 1 At,,rS a3 1 U L638 tF OSON C011N1 OC 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). N114 11. Maintain Best Management Practices(BMPs). 12. Manage the Project. 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). IJo AWA/ T--,�o0.% c,A,e663 51TL c,u$ C3e; rptut.'b b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). tUATEC. CAeOLJ —nt 5 641.01.4043 s -Pie % De aim iv lZc.4ws I N evt tot311L c1. 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. T t-'b o t-+t0.5 t sT I N Tfti SA'-o /44.elk 0 P Orre a el4e44 Zeno! of Twit= 444 Rio 1 bo 7. ,o .. stormwater site plan template—rev.10/1/2003 9 • b. Description of special requirements for working in or near environmentally sensitive areas. 444 A4.4-+41 'rio,i.' **1 Ass'r1.c 1s tc3+45 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). I-7/ -6-4.Ctt t ru+0 15 5. Construction Phasing. a. Construction sequence b. Construction phasing(if proposed) 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). Provide a proposed construction schedule. All6ttGT �-2.00? — Z II. Wet Season Construction Activities. a. Proposed wet season construction activities. wrLirV�„t 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. IJ1 a 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable. a. Sediment Ponds/Traps. 0/14 b. Diversions. a . c. Waterways. d. Runoff/Stormwater Detention Calculations M stormwater site plan template-rev.10V12003 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 signiiip,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.C < J :4.� Z.] Zoo 7 (LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: stormwater site plan template—rev.10/1/2003 12 PROVED 1111P AP . . • SITE PLAN II - ...,,,,;..,:',.. • Z,I 6 11' 140' V\ 1 AUG 2 1 2008 .\ 2, Z. I---] .2:,. ,;,.4,-7,,,,,,TT. ar ,,i ------- JE ERSO •• ,• 0 -'... i; DEPT.OF C. y j I i. -------- . SIGNATURE: _:-.../.41LV.,;• i PMENT — T -51 ' is o -,,,r.i.o' , co 15'0, ' in 1)1 ..------ ,? -,-. , 0 o [, . . .., ,. . ... 0 A e D ,1 / k Z -..... --. -,...,....... 0... tl . 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C7�-� r Kot"t '_,.../ It5� / / v\ 0 2�,is D 4-2►_Zoos TdF _._ �/ — \ \ Sea Crest Queets LL C. ��� � \ 223 Hardwick Point Rd. 6� .' � 3 - 'Segim Bay,WA 98882 �1 I!'� A. TOP\BANK d NO •TE: ESTATE SITE SURVEY // ( 7_. .) )) r- BOOK 20, PAGE 7, 1998 Cr 153573 SCALE: 1":100' FEET r\ -' _ _ � r HIGHWAY 101 SO. �� a.3 ,,, `� ARc,-<t. 1D 4.r3- 2-f3-ooZ 576 . 29 ' -'" + 222 . 60 ' ttr� ,)----- i'258°-? t .---. ;:� , ,.1 b 18 / Po Ate ,8 N., � p \- > JACK GLAUBERT GOV' T LOT 7 i 1 Z 223 HARDWICK PT RD SECTION 27 .0 SEA CREST LAND SEQUIM, WA 98382 T24N; R1'S W. W.M. DEVELOPMENT SLAT 360-683-5459 JEFERSON COUNTY, WA M • , . • , , ,e1. ,....__ T (2) 2x6 d SW6 \ 1 / r SW6 /- K. / O w Z \ d i \ �0 CP 7:1I O _ x T ICI Oco CO M H c W d IZy H �.�y d tiJ-1 I Htom, 1-++ l O / co x y2 Y k O H C+1 Ilul 1 rn y 7 H; OA vi 1 _ ] zi (;) . -----*,/ .......„ C7 0 H r r CO J rt.7 CA I 4x8 DF$2 I f-s' H CA �� i CJ W H CO C7 r\. 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