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Home My WebLink AboutBLD2014-00109 • MOLDING PERMIT APPLICATIC BLD14-00109 Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00109 Received Date: 3/21/2014 SITE ADDRESS: 450 ROBBINS RD NORDLAND, 98358 OWNER: MICHAEL P COFFEEN PHONE: 360-385-3342 PAMELA L COFFEEN 450 ROBBINS RD NORDLAND WA 98358-9671 SUBDIVISION: Block: Lot: TX 62 PARCEL NUMBER: 921093005 Section: 9 Township: 29 N Range: 01 E CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP DETACHED GARAGE - NO HEAT, NO PLUMBING TYPE OF WORK GAR SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 50,000.00 ADD'L: • HEAT TYPE: CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: 1,200 SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: OSS WATER SYSTEM: 05783 BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: 0 Total: Total: 0 Routing Date:V, ( Type Amount Paid By: Date: Receipt: Approved/Date Permit $577.00 JLA 03/19/14 148490 Plan Check $375.05 JLA 03/19/14 148490 State Building Code $4.50 JLA 03/19/14 148490 "1 • x v� Total: $956.55 Jefferson: Utirlomork\rlofo\fnrme\G P1 11 Ann RIr1 rn4 AHA/9MA JEFFERSON COUIDY 411 I 4 3 4 '7,3 17; DATE -A RECEIVED FROM DESCRIPTION BARS# AMOUNT CURRENCY COIN CHECKS ..";7 7 z 73 171 ) c /RECEIVED BY TOTAL / Jx - TE.00 nraLLTalattlir T W - nüoLs BRITY•FE 11/ EV, 0062962 11-24 Office AU# 1210(8) CASHIER'S CHECK 6296200323 Operator I.D.: u326209 PAY TO THE ORDER OF ***JEFFERSON COUNTY*** March 19,2014 ***One thousand two hundred eighty-two dollars and 55 cents*** **$1,282.55** WELLS FARGO BANK,N.A. 2101 WASHINGTON ST VOID IF OVER US$ 1,282.55 PORT TOWNSEND,WA 98368 FOR INQUIRIES CALL(480)394-3122 714;14•J Z"7-- CONTROLLER 11•6 296 2003 2 3Ile 1: L i000 2481:1186 L Pi 3 ?flu „.4ON C, 4i Oe) JEFFERSONNUNTY / rzi CS, 1: DEPARTMENT COMMUNITY DEVELOPMENT '' ` '4 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax q p� www.co.jefferson.wa.us/commdevelopment TIN0 Master Permit Application MLA: Project Description (include separate sheets as necessary): $u.t 1 e 'DiAAc.1\ed eatrolg. Tax Parcel Number: q 2,1 0 9 '. bd S Property Size: (acres/square feet) Site Address and/or Directions to Property: Li JO R s\o\3 s F.d , l∎l o rd l o-1 of \lM 9$3S S Property Owner(s)of Record: 1-A1 d e 1 di w.Q\o. C...1•E'-fee.. Telephone: 3 ra O — 38 S —339 .. Fax: S�w.e email: t'Q core¢�n�J w.s„•c o Mailing Address: M 5 o Z ,W. i2� y t l ord Ia..� w A 0191 S Applicant/Agent(if different from owner): ,.i A Telephone: Fax: email: _ Mailing Address:_ What kind of Permit?(Check each box that applies 0 Lot or Road Segregation email: ❑Critical Areas Stewardship PI ❑ Demolition Permit ❑Variance(Minor,Major or R alp ❑Single Family ®Garage Attached/ etac ❑Conditional Use[C(a),C(d), C t� ( �� ❑ Manufactured Home .❑ Modular - ❑ Discretionary"D”or Unnam C as n.,• ❑ Commercial* ❑Special Use(Essential Pub' ities)** ❑ Change of Use ❑ Boundary Line Adjustment ❑ Address ❑ Road Approach_ ❑Short Plat** f 11 P 1 .0 2014 ❑ Home Business ❑ Cottage Industry ❑Binding Site Plan** ❑ Propane ❑Long Plat** ❑syn ❑ Planned Rural Residents ev�tp[a F fI 1,- -- • * ❑Allowed"Yes”Use Consistency Analysis ❑ Plat Vacation/Alteration** 0MMUN!Jy DUE ❑Stormwater Management ❑Shoreline Master Program Exemption/Permit 1' ❑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 ❑Forest Practices Act/Release 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: DESIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: 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 application that he or she wants pri.r notice. Signature: _ ____I _ _ Date: OS/ 13 101 y 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 res onsibility or adherin to and complying with the ESA. The Applicant has read this disclaimer and siins and dates it below. Signature: 4 — Date: 61 /0) !t Lf G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc 0 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: i... . ) .. Date: 03 / 13 ! 1 4 GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) 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: K New g Wood Existing: ❑ Sewer 9 Addition 0 Steel Proposed: Bank 0 Community System ❑ Alteration/Remodel 0 Concrete Total: ` m_ Height: Individual System 0 Repair ❑ Masonry SEP Permit# _ 9 Demolition 0 Other: Bedrooms: Water Supply: Existing: 0 Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: 0 ig Public Total: 0 Name of System: P u'D 44 04 JQgt.rso� Co . 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: Underground Tank i Above ground Tank Size of Propane Tank: i Heat Stove 1 Cook Stove i Woodstove i Fireplace Insert 1 Hot Water Tank 1 Pellet Stove i Other Is this appliance being installed in a Manufactured/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. 1 Square Footage Current Proposed For Office Use Only Amount Revision Main Floor Heated EH Bld App Review: 2"d Floor Heated Consistency Review: Other Heated Base fee: 577-,'0 Mezzanine Additional S ion: 11 Heated Basement Plan Check fee: J? c OS Unheated Basement State Surcharge fee: 7 Other Unheated ' Pot Water Review fee Garage/Carport SUBTOTAL t7,0_0 314 it-10 l2_8 2. 55 Decks 91"1/Rd Approach fee: Other TOTAL: $ Receipt Number: /L`g y'Q Cash/Check Number: ESTIMATED COST(REQUIRED) 4j S0 000 Date: 'Fair market value of all labor and materials foundation fo finish 1 3)-11- 1f/ Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\'faster Permit Application 5-29-08.doc • • BLD14-00109 BUILDING PERMIT APPLICAT Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00109 Received Date: 3/21/2014 SITE ADDRESS: 450 ROBBINS RD NORDLAND, 98358 OWNER: MICHAEL P COFFEEN PHONE: 360-385-3342 PAMELA L COFFEEN 450 ROBBINS RD NORDLAND WA 98358-9671 SUBDIVISION: Block: Lot: TX 62 PARCEL NUMBER: 921093005 Section: 9 Township: 29 N Range: 01 E CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP DETACHED GARAGE - NO HEAT, WI LUMBING TYPE OF WORK GAR SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 50,000.00 ADD'L: HEAT TYPE: CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: SHORELINE: GARAGE: 1,200 CONST TYPE: DECK SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: 1 Total: Total: 1 Routing Date: ,, Type Amount Paid By: Date: Receipt: Approved/Date Plan Check $375.05 JLA 03/21/14 148490 State Building Code $4.50 JLA 03/21/14 148490 Permit $577.00 JLA 03/21/14 148490 Total: $956.55 \1+irlomer4\rlo+a\fnrrne RI P1 Ann Rlr+rn+ 2/'J1/7l11A Op Front Parcel Review • Parcel 921093005 Printed: April 3, 2014 MICHAEL P COFFEEN Site Address: PAMELA L COFFEEN 450 ROBBINS RD 450 ROBBINS RD NORDLAND, WA 983589671 NORDLAND WA, 98358 Parcel Number: 921093005 S-T-R: 9-29N-01E Total Acreage 10 Legal Description S9 T29 RIE TAX 62 Land Use: 1100 Flood District: Fire District: 1 Planning Area: 3 Flood Map(FIRM)Panel No: School District 49 Zoning:' :1 C COMP PLAN DESIGNATION: COMUNITY PLAN: UGA: UGA Trans [ ,/] M Plot plan states "property line" [ / Assessor's Map (Property lines on submitted plot plan must match the pnperty lines as identified on theAssessor's 1/4 map) [A Legal Access to Property �� NO S b+1 ,, Parcel Scanned m ESAarc's:Tags Special or Reports Nearby Docu ents YES YES tO [' ] Design A Y Shoreline ated Designatg ES ion:) E s [ [i Shoreline Slope Stability NO SUP le Stream Type:YES FWHCA: YES W aiii etlands: YES G, Rare Plants:YES irt Seismic: YES d• Landslide: YES Al Flood: YES A Erosion: YES jo Aquifer Recharge Area NO 5 pr P SIPZ: At Risk High Risk ,Coastal, CMZ: d e : High Risk Moderate Risk Disconnected CMZ Stormwater site plan submitted: YesNo VI Forest Lands: YES -L Adjoining Forest Lands: Commercial/ Rural/ Inholding [A Mineral Lands: YES [A Agricultural Lands: YES [A Archaeology: YES 0 [4 No Shooting Zone: YES 6 O llll�� "'' v. Stormwater: New Impervious Surface ' 00 Land Disturbing Activity 1 ESA's Stormwater Req's:Min Req#2 Min Req#1 thru#5 Min Req#1 thru#10 Engineering Vr Notice Provisions/Disclosure:Ai sort YES 0 MRL YES FO Forest Lands YES No [A dscaping Required: Yes No king Spaces Required NO 2 Other Buildinn Height: 5' UBC Standard .),..--]' Impervious Surface covera ercenta_e: 1, Resource Lands&Public: 10% -milt . '- •• : 2 'o Rural Indus- . Per UDC Sec 6.7 Rural Commercial: 60% Area of Building Coverage:60%in Rural Industrial Lands only Total Building (s) Size: f< c&OO 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: - Left Side: 5 Right Side: J Rear: Shoreline Setback: LSHA Setback: A __ _ VI- o� ' ' Q-0o\ -- I 4 . Road Classification: .,bloLn.c> C Road Approach:4EL ISTINGJOT REQ'D RAP y]--- SEPA Required: YES XEMPT J., ]---"flood Certificate: L,...}---- Existing Case(s)&Condition(s): pI..Q.Q aeL0-1.4) /Violations: Yes [/J Recorded Date of Subdivision: 1y j\- AFN Over 5yrs=UDC / Plat Conditions: <5yrs=Plat Conditions on plat or Old Ordinance 7r<Lots/Require Declaration of Restrictive Covenant YESSO, submitted: YES____„, Pd 6j UGA No Protest Agreement YE O .ubmitted: YE NO ] Site Visit conducted YES 4151-__ � [,ir- Require Final Zoning Approval YE�O [ ] 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 921093005 Cases Name Review Type Status Planner BLD11-00333 COFFEEN F Application Received: 12/13/2011 Permit Issued/Case closed: 12/13/2011 Case Finaled: 1/30/2012 A/G 120 GAL PROP lANK, COOK STOVE & LINES BLD11-00333 COFFEEN F Application Received: 12/13/2011 Permit Issued/Case closed: 12/13/2011 Case Finaled: 1/30/2012 A/G 120 GAL PROP lANK, COOK STOVE & LINES BLD14-00109 COFFEEN P Application Received: 3/21/2014 Permit Issued/Case closed: Case Finaled: DETACHED GARAGE- NU HEAL, WITH PLUMBING BLD14-00109 COFFEEN P Application Received: 3/21/2014 Permit Issued/Case closed: Case Finaled: DETACHED GARAGE- NO HEAP, WITH PLUMBING BLD88-00035 MATSON F Application Received: 8/1/1991 Permit Issued/Case closed: 8/4/1988 Case Finaled: single family addition BLD88-00035 MATSON F Application Received: 8/1/1991 Permit Issued/Case closed: 8/4/1988 Case Finaled: single family addition BLD91-00701 MATSON F Application Received: 10/3/1991 Permit Issued/Case closed: 10/3/1991 Case Finaled: woodstove installations: iviT ng room and family room BLD91-00701 MATSON F Application Received: 10/3/1991 Permit Issued/Case closed: 10/3/1991 Case Finaled: woodstove installations: iviT ng room and family room SEP72-00089 MATSON N Application Received: 7/12/1972 Permit Issued/Case closed: 7/12/1972 Case Finaled: 7/12/1972 all info now filed to SEPU6-120. SEP72-00089 MATSON N Application Received: 7/12/1972 Permit Issued/Case closed: 7/12/1972 Case Finaled: 7/12/1972 all info now filed to SEP06-120. \\tidemark\data\forms\R_ParceLCRMLA.rpt 4/3/2014 Page 2 of 3 • •CAM14-00152 COFFEEN • NA M Application Received: 3/10/2014 Permit Issued/Case closed: 3/5/2014 Case Finaled: Well protection area for new garage CAM14-00152 COFFEEN NA M Application Received: 3/10/2014 Permit Issued/Case closed: 3/5/2014 Case Finaled: Well protection area for new garage M LA07-00474 BLD07-00457 MLA07-00474 COFFEEN I F Application Received: 8/15/2007 Permit Issued/Case closed: 9/11/2007 Case Finaled: 7/25/2008 NEW ADDITION & REMODEL TO EXISTING SFR BLD07-00457 MLA07-00474 COFFEEN I F Application Received: 8/15/2007 Permit Issued/Case closed: 9/11/2007 Case Finaled: 7/25/2008 NEW ADDITION & REMODEL-TO EXISTING SFR SEP04-00311 MATSON TRSTEE F Application Received: 12/28/2004 Permit Issued/Case closed: 1/6/2005 Case Finaled: 1/26/2005 all info now filed to SEP06-120 REPLACE"D" BOX, info from SEP/2-89-filed to this case. SEP04-00311 MATSON TRSTEE F Application Received: 12/28/2004 Permit Issued/Case closed: 1/6/2005 Case Finaled: 1/26/2005 all info now filed to SEPUo-120 REPLACE "D" BOX, info from SEP/2-89 tiled to this case. SEP06-00120 COFFEEN F Application Received: 4/26/2006 Permit Issued/Case closed: 6/15/2006 Case Finaled: 7/10/2007 info from SEP04-311 andSEP72$9 are filed to this case. SEP06-00120 COFFEEN F Application Received: 4/26/2006 Permit Issued/Case closed: 6/15/2006 Case Finaled: 7/10/2007 info from SEP04-311 and SEP/2-89 are filed to this case. SOM06-00120 COFFEEN RCR Application Received: 7/10/2007 Permit Issued/Case closed: 3/12/2014 Case Finaled: SOM06-00120 COFFEEN RCR Application Received: 7/10/2007 Permit Issued/Case closed: 3/12/2014 Case Finaled: \\tidemark\data\forms\R_Parcel_CRMLA.rpt 4/3/2014 Page 3 of 3 5 g C1:. ar,. JEFFERSON SUNTY • if ' �j DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax ' p� www.co.jefferson.wa.us/commdevelopment �`SBIlid Master Permit Application MLA: _- Project Description(include separate sheets as necessary): �Y $u.1 1A 'Dm4Jed Erode Tax. Parcel Number: 3.2.1 0 9 •• DO C Property Size: (acres/square feet) Site Address and/or Directions to Property: ' 150 R.N.\;,ns R c , i•,o rcL1 o.'nc W IP'. 9S9 Property Owner(s)of Record: t-it;01,,2e 1 1 tMQ\a Ca --ape Telephone: ( 0 - SS S -339 Z Fax: 5�n.e email: 1'Q comae¢ @ w,s h•c o Mailing Address: 4 S 'R.pb\o;"s R.�t 1.1ordtah� wt� GS33SS Applicant/Agent(if different from owner): J A Telephone: Fax: email Mailing Address: What kind of Permit?(Check each box that applies ❑Lot or Road Segregation email: ❑Critical Areas Stewardship PI:- CI Demolition Permit ❑Variance(Minor, Major or R:---. • a r,�• - ❑ Single Family =i Garage Attached/ etac ❑Conditional Use[C(a),C(d), •kiC V ❑ Manufactured Home ❑ Modular ❑ Discretionary"D"or Unnam: C as n' e, ❑ Commercial* ❑ Special Use(Essential Pub - l ities)** ❑ Change of Use ❑ Boundary Line Adjustment ` I 1,, , ❑ Address ❑ Road Approach_ ❑Short Plat** u 'H 1 ' ` 1 "' _)1f ❑ Home Business ❑Cottage Industry ❑Binding Site Plan** ❑ Propane ❑ Long Plat** ❑3ign ❑Plannea Rural Residenti- DevOpp F[ )i'1 T;T- • * ❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration** O011MUNl)y oEVF ❑Stormwater Management ❑Shoreline Master Program Exemption/Permit -- =•r T ❑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 ❑ Forest Practices Act/Release 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: DESIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of his,her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any required later inspections. 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 pri r notice. Signature: �1 ry,,._A kL 4_ oL Date: 0 / l 3 i t y 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 res•onsibility`or adherin• to and complying with the ESA. The Applicant has read this disclaimer and sips and dates it below. kr Signature: '—?e. • - it Date: Cl Z ICS !i q G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc • BUILDER STATEMENT • The signer of this statement does hereby certify that they are the Owners of the parce;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: ► , .. l Date: 0 3 / i 3 I `i GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PFICNE: FAx: ( ) ( ) MAILING ADDRESS: EMAIL.: CONTRACTORS LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL • Project Type: 1 Frame Type: Bathrooms: 1 Shoreline: Type of Sewage Disposal: §C New g Wood Existing: i Sewer 0 Addition 0 Steel Proposed: 12• I Bank G Community System C Alteration/Remodel 0 Concrete Total: '/zHeight: tg Individual System 0 Repair 0 Masonry -A SEP Permit# _ Demolition 0 Other: Bedrooms: Water Supply: Existing: O _ Setback: 0 Private well 0 Two Party Type of Heat: Proposed: 0 g Public Total: D Name of System: P U D +I' I 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: 1 Underground Tank i Above ground Tank Size of Propane Tank: I Heat Stove i Cook Stove i Woodstove i Fireplace Insert 1 Hot Water Tank 1 Pellet Stove i Other Is this appliance being installed in a Manufactured/Mobile Home? Yes /L"% 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, includin• the reserve area. S•uare Foota•e Current Proposed For Office Use Only _ Amount Revision Main Floor Heated EH Bld App Review: •"�G_�r 2nd Floor Heated Consistency Review: 22,-;I —' Other Heated - � - Base fee: Si 7- Mezzanine Additional S .ction: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated - Pot Water Review fee: Garage/Carport 3i.-1 SUBTOTAL — I WO-0 _ Ho /Z ' 2. 55 1 Decks 911/Rd Approach fee: Other TOTAL: $ Receipt Number: /11 S 1' j CI) Cash/Check Number: ESTIMATED COST(REQUIRED) J S0 ooc'• Date: 'Fair market value of all labor and materials foundation fo finish 3 /1- Ill Initials: I G:,Pe:mitCenterr\ =#FORMSr;--,#\DRD FORMS\Current DRD For^.;s\\fas:er Permit Application 5-29-08 doc • o°c JEFFERSON COUNTY ;. DEPARTMENT OF COMMUNITY DEVELOPMENT 4 ,p<•",,_ "-,A. 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax �s$INO http://www.co.jefferson.wa.us/commdevelopment/ Stormwater Calculation Worksheet MLA# PROJECT/APPLICANT NAME: VA t(, J (Pay Apt_ acree V. 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 1 0 acres An acre contains 43,560 square feet. Multiply the acreage by this figure. Size of parcel in square feet 43 5 , (o00 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%acres or more of Construction site for structures 1'ZOO sq/ft native vegetation to lawn or landscaped areas? Drainfield, septic tank,etc. sq/ft Circle: Yes Well, utilities,etc. sq/ft Does the project convert 21/2 acres or more of native vegetation to pasture? Driveway, parking,roads,etc. sq/ft Circle: Yes No Lawn, landscaping, etc. sq/ft Otl ler c,u t ted. ut face etc. sq/ft Indicate Total Volumes of Proposed: r1 " - 7.• • l.n sq/ft Cut < I S Y ds Fill L \(C (cu/yd) VAR 1 0 2014 J 11 [over] JEFFERSON COUNTY L._ DEPT.OF COMIMUNITY DEVELOPMENT stormwater talc worksheet Rev 9-9-2010—REV.9/9/2010 1 S Impervious surface is a hard surface that either prevents or retards the entry of water into the soil mantle as under natural conditions prior to development. A hard surface area which causes water to run off the surface in greater quantities or at an increased rate of flow from the flow present under natural conditions prior to development. Common impervious surfaces include, but are not limited to roof tops, walkways, patios, driveways, parking lots or storage areas, concrete or asphalt paving, gravel roads, packed earthen materials, and oiled, macadam or other surfaces which similarly impede the natural infiltration of stormwater. STORMWATER CALULATIONS-IMPERVIOUS SURFACE NEW EXISTING Structures(all roof area) 1 2..oo sq/ft Structures(all roof area) 16?Z. s 4/ft Sidewalks sq/ft Sidewalks I Sc' sq/ft Patios sq/ft Patios G07 sq/ft Solid Decks sq/ft Solid Decks ( Z 0 sq/ft (without infiltration below) (without infiltration below) Driveway, parking, roads, etc raucl sq/ft �riveway, parking, roads,etc 2 O o O sq/ft Other sq/ft Other sq/ft Total New 1206. sq/ft Total Existing 4 S"( q s 4/ft TOTAL NEW+TOTAL EXISTING* 519 9 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: 1.3 % Does the site have 35%or more of existing impervious surface? Circle: Yes ()No FURTHER INSTRUCTIONS: If the answer is yes, the proposal is considered redevelopment and the attached Figure 2 should be used to determine the applicable Minimum Requirements. If the answer is no, the proposal is considered new development and the attached Figure 1 should be used. At this juncture, the applicant should refer to the applicable Flow Chart to determine the Minimum Requirements for stormwater management. DCD staff will help verify the classification of the project and the application requirements. For proponents of "small" projects who must comply only with Minimum Requirement #2—Construction Stormwater Pollution Prevention—an additional submittal is not required. The proponent is responsible for employing the 12 Elements to control erosion and prevent sediment and other pollutants from leaving the site during the construction phase of the project. Pick up the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet. Proponents of"medium" projects—those that must meet only Minimum Requirements #1 through #5—and for "large" projects—those that must meet all 10 Minimum Requirements—are required to submit a Stormwater Site Plan. DCD has prepared a submittal template of a Stormwater Site Plan, principally for rural residential projects. Complete the template in the Stormwater Site Plan Instructions and Submittal Template or prepare a Stormwater Site Plan using the step-by-step guidance in the Stormwater Management Manual. APPLICANT SIGNATURE By signing the Stormwater Calculation Worksheet, I as the applicant/owner attest that the information provided herein is true and correct to the best of my knowledge. 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'""'n=^a• ncanrree+u.,anv,.nn,..,.v„,..�.rn.,. +,:rmlg141in•.,7,su r,.ara+,:F;TmY^aa:-M..tivaast,wo..r-r,n,•.---rr-.+-•«--Ta<+c ! 5rv^Mma�'c>•r,,:c= IN3141d073A30 A1IN111/011O0 701d30 AlN000 NOS2133.131. 1OZ p - ddd 3A112103 GI ,7071,4.v.v.. .6...____ f .. • F° • h o I{ ........... Roof downspout serves up to 700 sf. Of roof 50' min. I .. Vegetated flow path MftIJIIIIIIIJ c7- Splash If 't block Downspout extension NTS Splash / block 74t1:17.11 c " Figure 3.1.7-Typical Downspout Splashblock Dispersion ti'ne III—Hydrologic Analysis and Flow Control BMPs—August 2012 3-16 • • Design Criteria for Splashblocks A typical downspout splashblock is shown in Figure 3.1.77. 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 stoum 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 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 as causing harm, harassing, or damaging habitat for the listed species). In addition, the National Marine 2013-03-07_SFR_StdConditions 3/7/2013 1 Fisheries Service can levy peTtalties. 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 SFR StdConditions 9/6/2013 2 1 eO` coo JEFFERSON COU• 2` DEPARTMENT OF COMMUNITY DEVELOPMENT l'SHt NGl Date: Time Time Received: :07 ,�ar�Jypm Mon. Tue. Wed. Thur. 0 Date: Q/ /T BLD: l 4- DO/D9 Contact Name: Owner: Contact Number: 360 385- 330_ Address: 4t$d 4Lo 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 Setbacks Floor Final Inspection Foundation Wall Address Posted Block&Tile Ceiling Q�'_SON coo • • JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT ,gslfLNG,c2 69 Date: e114 Time Received: n :We pm Mon. Tue. Wed. Thur. Fri. Date: _ i BLD: 141 - U p 1 p q Contact Name: Owner: Contact Number: 360 33 - 33,'L Address: 450 I0133i►OS 'Pb 206 Notes: Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Under ground Furance Footing Rough Intl 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?-- C, ° w °, , JEFFERSON COUNIL DEPARTME F COMMUNITY DEVELOPWNT 7 1 N`pHl o� Date: %3 Time Received: Z. Z% am/ ir Mon. Tue. Wed. a Fri. Date: „ it BLD: ---(' COI Contact Name: Owner: C C Contact Number: 360 34-Z Address: ` '` III a 1 �0 206 Notes: Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing t Under ground Furance Footing Rough In Air Seal r Above ground Gas Stemwall Hydronic Exterior shear V 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 c .. °°y,, JEFFERSON COU 4. ate DEPARTMEN OF COMMUNITY DEVELOPMENT isti/1' 3 Date: -'j Time Received: 2 3 am/ . Tue. Wed. Thur. Fri. Date: '-* BLD: /Ll- /(j 9 Contact Name: Owner: Contact Number: 360 --7y Z q q Address: 115-0 /eoMirt-J 206 Notes: Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Under ground Furance Footing Rough In Air Seal Above ground Gas Stemwall S 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 C- er (3°j JE FFERSON COUNTY 4 DEPARTMEN•F COMMUNITY DEVELOPIVIT 7 N 6 i- Date: 5-- 7 Time Received: /7L a pm Mon. Tue. Wed Thur. Fri. Date: BLD: /4—/Z9 Contact Name: Owner: Contact Number: 360 Cis-0 CZ r2ciaw% 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 Address Posted Block&Tile Ceiling 0 S V �k4SON °oG JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT )ate: Time Received: g:Z4 6-?pm Mon Tue. Wed. Thur. Fri. �— Date: /76V/ 41 3LD: 14- 00:07 Contact Name: )wner: ee)PP)Ne Contact Number: 360 3S5 3342 \ddress: 46o eciYsi+u 206 Notes: £ L)$ Framing Foundation Plumbing g Propane Tank Mechanical g d Furance Framing Under ground Setbacks Under ground Gas Footing Rough In Air Seal Above ground 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 S S.. Jefferson County Building Division Permit Number: BLD14-00109 Applicant: COFFEEN 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 5720 r Erosion Control T 5/ , Foundation Footing 5/463/61 d 4.PPet Ins'ea.Cled Footing Drains Foundation Stem Wall (oil. / Straps(hold downs) /.`i Ext.Shear Wall Nailing g 1,11) fze) Framing / Blocking 0005/i4 ge Wallboard Nailing \ Drywell/Alt Drainage N.4/1 y Address Posted V/4/i4 (#1/ System Finaled 4/29/v' 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) tel FINAL INSPECTION 4/41/)1 FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR • CONDITIONS for Building Permit# :BLD14-00109 1.) The project shall adhere to the Best Management Practices(BMPs)to control stormwater, erosion and sediment during construction. BMPs shall address permanent measures to stabilize soil exposed during construction, and in the design and operation of stormwater and drainage control systems. 2.) The site plan as submitted with the building permit application on March 19, 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 April 15, 2014 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 3.) This approval is for a detached garage no heat and no plumbing 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. 4.) CJZ 5.) No plumbing has been reviewed or approved for this project by Jefferson County Public Health. Additional requirements may apply if plumbing is proposed. \\tidemark\data\forms\F_BLD_Permit_BIdg.rpt 4/18/2014 • • BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD14-00109 Received Date: 3/21/2014 SITE ADDRESS: 450 ROBBINS RD Issue Date 4/18/2014 NORDLAND, 98358 Expiration Date 4/18/2015 OWNER: MICHAEL P COFFEEN PHONE: 360-385-3342 PAMELA L COFFEEN 450 ROBBINS RD NORDLAND WA 98358-9671 SUBDIVISION: Block: Lot: TX 62 PARCEL NUMBER: 921093005 Section: 9 Township: 29 N Range: 01 E CONTRACTOR: OWNER/BUILDER PHONE: PROJECT DESCRIPTION: DETACHED GARAGE - NO HEAT, NO PLUMBING TYPE OF WORK GAR SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 50,000.00 ADD'L: HEAT TYPE CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: 1,200 SHORELINE: CONST TYPE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: OSS WATER SYSTEM: 05783 Type Amount Paid By: Date: Receipt: BEDROOMS: BATHROOMS: Permit $577.00 JLA 03/19/14 148490 Exist: Exist: Plan Check $375.05 JLA 03/19/14 148490 Prop: Prop: 0 State Building Code $4.50 JLA 03/19/14 148490 Total: Total: 0 Total: $956.55 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