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BLD2005-00540
SUILDING PERMIT APPLICA N MRAOW00500 Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00540 Received Date: 8/18/2005 SITE ADDRESS: 306998 HWY 101 BRINNON, 98320 OWNER: JEFFERSON COUNTY PHONE: COURTHOUSE PO BOX 1220 PORT TOWNSEND WA 98368-0920 SUBDIVISION: Block: Lot: T 50 PARCEL NUMBER: 602343014 Section: 34 Township: 26 N Range: 02 W CONTRACTOR: TO BE DETERMINED PHONE: REPRESENTATIVE: TAMI POKORNY PHONE: (360) 379-4498 615 SHERIDAN ST PORT TOWNSEND WA 98368 PROJECT DESCRIPTIOI DEMOLITION - DOSEWALLIPS RIVER ENHANCEMENT PROJECT - JEFFCO NR POLE BARN - 576 SQ FT AND DECKS - 636 SQ FT TYPE OF WORK GAR SQUARE FOOTAGE: TYPE OF IMP DEM VALUATION MAIN: CODE EDITION: 2003 ADD'L: HEAT TYPE OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: \ Type Amount Paid Bv: Date: Receipt: Approved/Date Permit $0.00 KAS 08/22/05 APPROVED State Building Code $0.00 KAS 08/22/05 Total: $0.00 OCT 10 2005 Jefferson County Planning &Building Department • DEMOLITION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD05-00540 Received Date 8/18/2005 SITE ADDRESS: 306998 HWY 101 Issue Date 10/10/2005 BRINNON, 98320 APPLICANT: JEFFERSON COUNTY PHONE: COURTHOUSE PO BOX 1220 PORT TOWNSEND WA 98368-0920 T 50 SUBDIVISION: Block: Lot: PARCEL NUMBER: 602343014 Section: 34 Township: 26N Range: 02W CONTRACTOR: REEVES EXVTNG & LAND CLRNG INC PHONE: (360)765-3633 PO BOX 185 QUILCENE WA 98376 Contractor's License REEVEEL016DE Expires 3/1/2006 OWNER, JEFFERSON COUNTY PHONE: if different: COURTHOUSE PO BOX 1220 PORT TOWNSEND WA 98368-0920 PROJECT DESCRIPTION: DEMOLITION - DOSEWALLIPS RIVER ENHANCEMENT PROJECT- JEFFCO NR POLE BARN -576 SQ FT AND DECKS -636 SQ FT THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 10/10/2006. REQUIRED INSPECTION: FinalApproval: ql 6- BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:00 a.m. -4:30 p.m. SPECIAL CONDITIONS APPLY - SEE REVERSE HOT LINE AVAILABLE 24 HOURS A DAY • • SPECIAL CONDITIONS FOR CASE#BLD05-00540: 1.) ABANDONMENT OF ANY SEPTIC COMPONENT MUST BE VERRIFIED BY COUNTY PERSONEL 2.) The application was reviewed by the Jefferson County Department of Community Development staff on 9/16/05 for the potential presence of Environmentally Sensitive Areas (ESAs) under the provisions of the Unified Development Code (UDC). After an initial Geographic Information Systems mapping review and an investigative site inspection, the following ESAs were confirmed to be present on the subject property: fresh water shoreline (Conservancy), Priority Habitat Species (Harlequin duck& Elk winter range), wetlands, slight& moderate landslide hazard, floodplain, aquifer recharge (Susceptible& SARPA), and stormwater. 3.) This proposal from Jefferson County Natural Resources Department for the removal of old dilapidated structures located near the Dosewallip River. The removal of these structures located in environmentally sensitive areas associate with the Dosewallip River will be a benefit to the functioning of the river. Because the structures &facility was established prior to the adoption of the UDC it is exempt from review of Environmentally Sensitive Areas under Section 3.6.4(g) of the Jefferson County Unified Development Code. The removal of a structure in this case would have less impact than if the existing structures and facilities were repaired or maintained. The applicant is required to obtain a HPA from the WA State Dept. of Fish &Wildlife that will ensure that the removal of the structures &facilities and the access to these sites will not impact fish or fish habitat. 4.) The removal of the structures near the Dosewallip River would restore these sites to a similar condition to prior to the establishment of these structures. Therefore, the proposed demolish activity for the WA State Dept. of Fish &Wildlife is exempt under Section 3.402(6) County Shoreline Management Master Plan (SMMP), which is normal repair and maintenance. The processing of a shoreline exemption still requires compliance with the SMMP. This activity is also not considered development as defined by the Jefferson County SMMP. 5.) This project entails removal of structures and facilities located in the vicinity of the Dosewallip River, and this activity has been determine to have less impact that minor repair and maintenance of the existing structures. Therefore, this project is exempt from SEPA under Section 197-11-800(3). Structures covered by water may be repaired provided that they are not specifically listed as non-exempted activities under WAC 197-11-800(3). The proposal is not considered dredging, a shoreline protection facility, or utility cables, dam, dike, or reservoir facility, which are all specifically not exempt under 197-11-800(3). • • 6.) Among the native conifer species which may be used in buffers or for re-vegetation include, but are not limited to: Grand Fir(Aibes grandis), Sitka Spruce (Picea Sitchensis), Shore Pine (Pinus Contorta), Douglas Fir(Pseudotsuga Menziesii), Western Red Cedar (Thuja Plicata), and Western Hemlock (Tsuga Heterophylla). Among native tree species which may be used includes: Vine Maple (Acer Circinatum), Big-Leaf Maple (Acer Macrophyllum), Red Alder(Alnus Rubra), Pacific Madrone (Arbutus Menziesii), Quaking Aspen (Populus Tremula), Black Cottonwood (Populus Trichocarpa), Bitter Cherry (Prunus Emarginata), Oregon White Oak (Quercus Garryana), Cascara (Rhamnus Purshiana), Pacific Willow (Saliz Lasiandra), and Scouler's Willow(Saliz Scouleriana). Among the native shrub species which may be used are: Sevice-Berry(Amalanchier Alnifolia), Red Osier Dogwood (Cornus Stolonifera)Salal (Gaultheria Shallon), Ocean Spray(Holodiscus Discolor), Indian Plum (Oemlaria Cerasiformis), Pacific Ninebark (Physocarpus Capitus), Red Flowering Currant(Ribes Sanguineum), Wild Rose (Rosa Nutkana), Swamp Rose (Rosa Pisocarpa), Willows (Salix ssp.), Red Elderberry (Sambucus Racemosa), Snowberry (Symphoricarpos Albus), Evergreen Huckleberry (Vaccinium Ovatum), Red Huckleberry (Vaccinium Parvifolium). 7.) The removal of the exsiting structures would not create or add over 2,000 square feet of impervious surface and would not result in over 7,000 square feet of land disturbing activities. Sections 6.6 and 6.7 of the Jefferson County Unified Development Code requires that your proposal submit a Stormwater Plan for a Small Project, which are construction best management practices (attached). 8.) 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. 9.) A Stormwater Plan has been submitted and approved by the Department of Community Development. Once the subject permit has been issued the applicant shall fully implement the provisions of the submitted plan and contact the Jefferson County Department of Community Development to arrange a schedule to inspect the property for plan compliance. A Certificate of Occupancy will not be issued until the Department verifies plan compliance. No clearing for roadways or utilities shall occur on the project site until clearing necessary for the installation of temporary sedimentation and erosion control measures have been completed. 10.) Prior to commencing development activity, proponent is responsible for informing the Washington Department of Fish and Wildlife (WDFW) in order for WDFW to determine whether this action is subject to the Washington State Hydraulic Code (Chapter 220-10 WAC). Hydraulic Project Approval (HPA) is required for all hydraulic projects, which are defined as construction or performance of other work that will use, divert, obstruct, or change the natural flow or bed of any of the salt or fresh waters of the state. 11.) In addition to Jefferson County permit conditions, the project proponent shall comply with all conditions set forth by the Washington Department of Fish and Wildlife through Hydraulic Project Approval. 12.) All disturbed areas including areas where structures are removed shall at a minimum be re-seedinng with native grass and straw spread over the areas. 13.) The site plan as submitted with the demolition permit application (BLD 05-537) on August 18, 2005 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 September 16, 2005 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 14.) This approval is for demolition of structures and removal of debris 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. 15.) The applicant shall contact Terry Duff at the Jefferson County Public Works Department at(360) 385-9159 to see if a Road Approach Permit is needed to bring equipment to the site. I:\F_BLD_Permit_Propane.rpt 10/29/19 08/24.2005 15:10 FAX 360 491 6308 ORCAA Z 0 0 1 Iorf PERM(T# 3 r sG r APPRQVEl dol__ 05 ,540 L. © t ~.ii t k��11 CONDITIONALLY APPROVED , Ot 0- D`�' .50D iiiM�. , • �1 NOT APP r1 f P up * 1i�1 AA FOR COMPLIANCE WITH mar Awn - -woo,-111 , ORCAA REGULATION 1 Notification of Demolition Permit It is unlawful for any person to cause or allow the demolition(or major renovation) of any structure unless all asbestos- containing materials have been removed from the area to be demolished. Work shall not commence on an asbestos project or demolition unless the owner or operator has obtained written approval from ORCAA. A written application for a demolition shall include a certification that there is no known asbestos-containing material remaining in the area of the struchtre, ell cv-ba_ j s Project Site Address: /n! eps7?_3 4 30 15/P a -31-I 3 C0 1)County: �T e-ka-M City: , r nrt-o r7 State: L1iM Zip: ge320 Starting Date: A el- r' 9 z f P Completion Date: I f 6 Co *(There is a 10 working day advance notification period from receipt of permit application) Property Owner:_crell.arseyyi dr *1 , Telephone: - `t Fax: p1.0 ,-R e ` 74�d/ Mailing Address: LQIs 6'Zu e-L. ,' -,e.1- City: f r-.'i-- To cu its eft State: 09- Zip: `78 ea g Demolition Contractoe.r n.SI State License#: __ - Mailing Address: _ City: State: - Zip: Contact Person: - Telephone: Fax:_ YES NO X Demolition by Wrecking or Dismantling? ($25.00 fee) check# Training Fire Demolition? (If yes, attach fire department request for training fire) Renovation,Alteration, Remodeling, Maintenance,or other Construction? . Asbestos found or suspected* *An ORCAA"Notice of Intent to Remove or Encapsulate Asbestos"form and appropriate fee must be submitted prior to any asbestos removal work. Asbestos removal rrojects involving demolition must be preformed by a Certified Asbestos Contractor and all friable or potentially friable asbestos must be removed before any demolition begins. Refer to ORCAA Regulation 1 Article 14 for additional requirements that may apply. Asbestos Survey Completed by AHERA Certified Inspector Z)m ea gdziir e - ( - a _r J Certification# l p/ Q In 34, - This approved permit must Enclose S25 Certification of the Asbestos Survey must be available at the job site Processing Fee accompany this form 117 - E2940 2 Limited Lane NW,Olympia,Washington 98502 �— l Pr F.') 360.586-1044 * 800422-5623 • fax 360-491-6308 RAU( 2_4 Lvu5 homepage:www.orcaa_org * email:jpfoaorcaaorfi A U G 12005 ��gsorr co�� JEFFERSONOUNTY '44 ,a DEPARTMENT OF COMMUNITY DEVELOPMENT ` 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax ',/,& www.cojefferson.wa.us/connmdevelopmerit us/commdevelopment ��-.�' f C Master Permit Application MLA: C - - Project Description(include separate sheets as necessary): > i? o 11'h a r) co see a, . R1 V er"'Filiki.p)(e 177 et7f eO ec— - Tax Parcel Property 3. / e 1:e • - Number: •C' 3 'l 3 0 / L] :.� 6/2.3 ?3 UG5 4-3 Size: /,3/0 /S ,/ (acres/square feet) -4 c�;t1(/ m /G/ / Site Address and/or Directions to Property: /�jee-es - l?yr tt I') 4 7),,S-c ir1/27//,.c p -13;-/f-7f,cf-? Property Owner(s)of Record: 1%e r r-co r-i ('?e)cfii f�lt Telephone: 36,0 2) 7/ Nye,. Fax: (FCJ 3 -- q ye,f email: 1-poi<orn, i (��e0 J d Crerscf»•vzt;. Mailing Address: /5- 91t-‘.-/ie'cr/ 5J f Y-tT/cii-r56.1 1 II/A 'lc';>G6_ I ids" Applicant/Agent(if different from owner): T 04i F kc;^h`/ Telephone: Fax: _/ email: Mailing Address: What kind of Permit?(Check each box that applies) ❑ Building ❑Variance(Minor,Major or Reasonable Economic Use) Demolition Permit ❑ Conditional Use[C(a),C(d),or Cl** ❑ Single Family ❑ Discretionary"D"or Unnamed Use Classification ❑ Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** Manufactured Home ❑ Boundary Line Adjustment ❑Modular ❑ Short Plat** 1_1 Commercial* H") 1-El-BiridingiSile'Plan** ❑ Change of Use l q Lor)g Plaf ` I ❑Address ❑ Road Approa I ❑Planned R'(4I Residential Development(PRRD)/Amendments** CI Propane I C`\, 1 ❑ Plat Vacati�prr/Alteration** ❑Allowed"Yes"Use Consistency Analysis :• ' g yn oreline tt1a!ster Program Exemption/Permit Revisions** Stormwater Management `t oreline IVjahagement Substantial Development*" ❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance ❑Temporary Use ------0-Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium - - - *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: /1 DESIGNATION OF AGENT I hereby designate I tt "'hi /'3�/�t y f'/ //- to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE 4- �1 w �r /G 4-4': e"C 7 Date: 8//1/1 C 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 attomey'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.Access and right of entry to this property shall be requested and shall occur only during regular business hours. / /1 p �} jf Si nature: � � �G` �� O /Q 1,s 9 Date: The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferabl responsibility pp adhering gtto�and com ing with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: �� � G�r�=e! Date: ,p/a4 6- G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc • OWNER 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: /c) G;c t1le 1't/h2r /1 wee ( ) ( ) 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 X Wood Existing: I ❑ Sewer Li Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: / Height: Vi.Individual System ❑ Repair ❑ Masonry SEP Permit# X Demolition ❑ Other: Bedrooms: Water Supply: Existing: / Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: ❑ Public tvocel Total: - / Name of System: i/pe ft - / >-zi i-k7 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: u Underground Tank ❑ Above ground Tank Size of Propane Tank: ❑ Heat Stove ❑ Cook Stove ❑ Woodstove ❑ Fireplace Insert Li Hot Water Tank ❑ Pellet Stove ❑ 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 For Office Use Only Current Proposed Amount Main Floor Consistency Review: 3-7(c c L-i g ( ) 2""Floor Base fee: Li ! 00 3f°Floor Additional Section: �(. Mezzanine: Plan Check fee: Heated Basement State Surcharge fee: LI /: c-,,, Unheated Basement Pot Water Review fee: Other Unheated .91a/Rd.: Garage/Carport �' - ,� � ; Decks c ({�Jium :!e 63 " � ' AUG 1 Other Cash/Check lumber: ESTIMATED COST(REQUIRED) ! Date: •Fair market value of all labor and materials foundation to finish Initials: G:\PemutCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc i z (6 rn ■■■■■i4 4. _ I I ■ ■■■■■ o IIIII illiti _, l- ' 1 ■ ■ ■■.■ ■■■ �v apr ,i- • ...N.. ii ■■■■■II IE� I■..I�■■ �■■■ 'p • __ !IP!'ii! too ■■■■■IIru mili_ ■ ! ■■■■■■IIa �� _ ■ 1 ■I ■■ _ __; ■ I _ _■ ■__ _ _ii :..... . - -_a---■■ ■_ ; ■ A ■ .- _ ' _ 11111111111111111111111 i l- --- • ■ ---_ ■/ _7 IlliniiiiiM 1 1 _ _1 _ + L __j_ . 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