HomeMy WebLinkAboutBLD2013-00325•_ 1
ft BUILDING• • BLD13-00325
PERMIT APPLIAION Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD13-00325 Received Date: 10/14/2013
SITE ADDRESS: 305 GIFFORD HILL DR
CHIMACUM, 98325
OWNER: RICHARD L GIFFORD PHONE:
PO BOX 1001
CHIMACUM WA 983251001
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901104019 Section: 10 Township: 29 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr ADU to existing primary residence
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ADU MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 2012 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY:
OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: OSS
WATER SYSTEM: 1 PWELL
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: 3 Prop: 2
Total: 3 Total: 2
Routing Date:
Type Amount Paid By: Date: Receipt: Approved/Date
State Building Code $4.50 MEB 10/14/13 145456 APPROVED
Manufactured Homes $228.00 MEB 10/14/13 145456
PAN ?, 2.01';
Potable Water Application $66.00 MEB 10/14/13 145456
Total: $298.50 Jefferson County DCD
\firlcmmrlArhfo\fnrmc\C RI Il Ann PIA rn+ 111/1R/9(114
ON rbc DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street,Port Townsend,WA 98368
-< Tel:360.379.4450 Fax:360.379.4451
Web:www.co.jefferson.wa.us/communitydevelopment
-1/1 E-mail:dcd@co.jefferson.wa.us
CERTIFICATE OF OCCUPANCY
PERMIT#: BLD13-00325
APPLICANT: RICHARD L GIFFORD PHONE:
PO BOX 1001
CHIMACUM WA 983251001
SITE ADDRESS: 305 GIFFORD HILL DR Issue Date: 01/29/2014
CHIMACUM, 98325 Final Date: 1/20/2015
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901104019 Section: 10 Township: 29 N Range: 1 W
PROJECT DESCRIPTION:ADU to existing primary residence (detached)
THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2012
EDITION.
OCCUPANCY GROUP:
TYPE OF CONSTRUCTION:
SPRINKLER SYSTEM yes no
THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 1/20/2015
\\tidemark\data\forms\F_BLD_Occupancy.rpt 1/23/2015
Standard Conditions for Resideal 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
20 13-03-07 SFR StdConditions 3/7/2013 1
Fisheries Service can levy peies. Portions of Jefferson County, incling 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
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JACK WESTERMAN IIe Jefferson Con rthonse
ASSESSOR PO Box 1220, Port Townsend, WA 98368
(360)385-9105
MOBILE HOME INFORMATION FORM
NAME/MAILING AILINGG ADDRESS:
NAME: ROtta/4
ADDRESS: / %x- /c9D/ J .' ■ 7 i! ' C Gv/4 .:323
PHONE NO. 31/40-r-6(13-01141b
The purpose of this questionnaire is to obtain information regarding either the
current location of a mobile home or the previous ownership and location of a mobile
home. This will help our office determine whether the mobile home is already on the
tax rolls in Jefferson County or if it has been moved to this county from another area.
1)MOBILE ROME DATA:
J t
(A) MAKE O�o :l i f� (B)MODEL /4/440/e--/4/440/e-- ( (C)YEAR /29(
(D) LENGTH tie (E)WIDTH 2P- (F)SERIAL# -— /2/24
(G) YOUR PURCHASE PRICE(Do not include sales tax) ���
PURCHASE DATE g,/-/3
2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3)
(A) FROM WHOM DID YOU PURCHASE MOBILE /,'Lam-° ( ''NC`
ADDRESS - 9- ) [ !/Lt- !z° ��
(B) WAS MOBILE HOME ASSESSED IN JEFF o ' SON COUNTY LAST YEA ''/
H Yes, Previous address of mobile. ?2e) ' v' -4/,
If No, What County was Mobile assessed in last year.
3)WHERE MOBILE HOME IS TO BE LOCATED:
(A)WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes GQ
(B)IF LOCATED IN MOBILE HOME PARK:
NAME &ADDRESS OF PARK Lot/Space #
(C) IF NOT LOCATED IN MOBILE HOME PARK: r(^r
NAME OF LAND OWNER: C• A
LOCATION ADDRESS 45� &, l� J 4Z4 i `1 4 ��`'t` do'"
REAL PROPERTY PARCEL #/DESCRIPTION 9 /1 /01( 6/2
Signature of applicant
THANK YOU FOR YOUR HELP!
Lauralee Kiesel, Property Technician
i • rage i 01 L IP
,r POST ON JOBSITE PRIOR TO BEGINNING OF WORK
'!�`�r= Department of Labor and Industries
. FAS ALTERATION PERMIT #FP2287902
Contractor Name License Number Installation Description:
INSTALLING EXTERIOR DOOR AND INT
Purchaser's mailing address ERIOR/EXTERIOR WALL
720 WEST VALLEY RD
CHIMICUM WA 98325 Services to inspect:
Telephone number FAX Number
(360) 643-0400 ( ) - Description Quantity Amount
Structural"-OTHER
Premises owner's name STRUCTURAL CHANGES 11 161.90
GIFFORD, RICHARD Inspection fee: $161.90
Address of inspection Additional Fees May Be Assessed Upon Field
720 WEST VALLEY RD
CHIMACUM Inspection
WA 98325 (360) 643-0400
This permit expires one (1) year after the date of purchase.
Applied: 9/26/2013 Expiration: 9/26/2014
Date Approved By Date Approved By
MECHANICAL PLUMBING
Type Type
ELECTRICAL STRUCTURAL
Type Type
OTHER OTHER
Type Type
Inspection Date Area, Building or Equipment Inspected Action Taken Inspector
Property Owner: This is your permanent record of inspection
FAILURE TO POST PRIOR TO BEGINNING WORK WILL RESULT IN CIVIL PENALTIES
Attention Applicant! The Department will not conduct this inspection if there are unrestrained
animals on the premises. Failure to comply with this requirement may result in additional
inspection service fees and delay in service.
Jo% ' 4i 'iy 1-A ✓ i✓«W(Fsao)
fi'l 047114/ " Zaa s' M - 5) c7 /4/1/74/-7-,--0 ,
http://field-services.apps-inside.lni.wa.gov/pairspermit/rptFASPermit.aspx?AppID=115 9/26/2013
• rage z or,t
DO NOT POST THIS AT THE WORKSITE
You have purchased a Manufactured Home Alteration permit.
SUBSCRIBERS of the EPIS system do not need to use this code to request or view inspections
through Secure Access Washington.
This is your permit number: FP2287902
Use this authorization code: 17498
The authorization code enables customers who are not subscribed to our online permitting
system (EPIS) to request inspections and view their inspection results online through the
"Request an Inspection" website.
Note: You must speak with an inspector to schedule an actual inspection date.
Use your authorization code and permit number at:
The Department of Labor and Industries FAS Homepage: www.lni.wa.gov/tradeslicensing/fas
Close
http://field-services.apps-inside.lni.wa.gov/pairspermit/rptFASPermit.aspx?AppID=115 9/26/2013
• e
•
Receipt
Washington State Department of Labor and Industries
Customer: RICHARD GIFFORD
Address: 720 WEST VALLEY RD
City: CHIMICUM State: WA Zip: 98325
--.Fiscal Transaction Receipt --
Fiscal Transaction: 104082441
Created: 9/26/2013
Payments: $161.90
-- Payments --
Type Amount Payer Reference
Credit Card $161.90 RICHARD L GIFFORD 495378673
-- Services --
FP2287902
Description Reference Quantity Price
Structural* - OTHER STRUCTURA FP2287902 1 $161.90
NOTE:All refund requests must be made in writing. Refunds may require processing through
central office and we cannot guarantee immediate refunding of services.
http://field-services.apps-inside.lni.wa.gov/FrontCounter/FCRevRecWeb/ReceiptPrint.asp... 9/26/2013
Department of Labor& Industries FAIDORY ASSEMBLED , A
Factory Assembled Structures Section 9
im,v
fit
w .Lni.wia gov/TradesLieensing/FAS ' . .t-' STRUCTURES ALTERATION
4STi...1(2,1T!ONS. APPLICATION
1 Cornplete at!l spaces tna!app;" :ric,11.1,- :he..;r-z.-,p::,, ba: fj-:-...yi“3,s1.,,,,.;,:,,.;-• x
2 R-ovide ..vritten diTecten3 to the home belna a:tafeti c.e.ins:reversa
Forward completed application and fees to this neari--,7-AL&;off:GE Permit number
'.;ontact and scheduls tne inspe.ttice-s:,:\••,!.n::,•por 5;•:.all.&!office
P2,g •77
I authorize payment foi- this permit to :-.:e taken from rri,.., ;--,critfactor's deposit account
Ste Address m.;i......j " 1-fe-i • )76f3-4)Yee) `7-17--/3
4- Jed_ , I,illet..caiv,—
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installenContact:::r1Dea!er ! 11;:-•z,s. - l Errall addre=is ff. Ocr*-,,,I-,t;-S
OW'Let, !
._,_
Add,ess of Contrastpr cr iristalier : C,ly ! 3ate
! :
:- Uesh-Inated Fic, ii-joal 0,-rs.rta•.:-,-..-al c.,-.''',-,:T.7' I ,
; EfrP,a"ecirri.s•s
Manufactured Mobile Home
_1,l55 :s.a ,::- .3. ELECTRICAL
,7tSped;ryTi. .
El Heal puniplAir Haildieffuniace 5:151.6C: Di Ele:).-;trio1iiiater I beater Fteplacement $ii 01 00
El Air conditioning 60 llj Electric Water He,atei-reptac5-q4 Gas–' ‘,V;ilt.er Lea te.) 5101.01:1
i...-: ErS'ich added or modified 120 volt circuits tiry la 4)
1 j Ai: coatiltionin Wilia I epla•:;ea neot l`wc,ace 5 161i:30 5101 00
circuits$202.00)
Each added 240 volt circuit (tor other than Heat
fue'bitcs instEititior: r:•-:iiii•licil= liiiliis PTn-.) `t'. '•:'1 ',i 't._. Prop:. lir Cr;ftPJ:7m':;rs: 1 l'rria 1Alat€,1- ,-.3a.,:: F
Ranges: Hid Tabs or Spas)
! l-iiro safety in?,p,m-tioft Hot 'Tub ::::., Sp.?: (power from home e!erfir::3: pe::fli: S101 00
, _.; Repleee main ele:::tri.:;a1 panet,ipeinlanenti::: ir:stahed
Note: Mechanical and Electrical tees CannOt . " S101.00
-- transfer hriiiipirent
be separated, one permit only. Permit
.'l Low voltage firefintrtrin Fila;m Si 01 00
purchaser nitist designate Electrical ot
,----• Ai iy combination of F-ureace, Raiiipii Fiiii.,:i •\/•-„ii,,,,,- i.::::,;-,i,:-,,
Mechanical contracAor performing work if ...,, , , .,:. ,. ‘ , „--_,.., 5101.c)0
,-3Igli ij yi::, ,!e..:entn:., :if f-.1,3::, t:11..-"ri
separate from purchaser,
PLUMBING
MECHANICAL. il 1 FI:e sprinkle:-system $22;0 90
. _..,..
I] Gast''' 121ping rs:;80 7 1._:1 Each added fixture 560 50
Ili Replacement of water piping system tthis includes twci 202 j;17.1
Si Wood Stove s 30 70
nspections)
pi Pellet Stove .ac 70 ' STRUCTURAL.
Ti Inspection as part of a mechanical/fire safety
El Gas**-Room Heater (add yes pq.-&y..1 fee, Sf30 7c.i $90 60
installation :' id triissitloor joist Sheet rockinol
r.-1. Gas—Dec,orati•,-)i il,p!-)l=2)i i.rp:: l e-l-T.; odn
- • Re:upfC y-tia-rf !e(3,,ire ;:,,, :,:.,an c.,----.)v,,,,,,,,,) 6161 -:,J,,:,
ii-7 Changes to home when additions bear loads on home
.! Range ...corn from:plec;1:-ih. tc-,
ft:E. the p!afeSSiOT'a; ..a-lt!-;0 regoiies a ti,i;-.ri S Hsii l,iti•
gas—iartir.ii gas pnt-c fee;
: i:
, Gas—Water Heater Pepe:;,e,::,er:t:,:,:io T: : -,,A otr.„-.-r st_::::,t.:,(:,.= Clancjer:i ihn...mn :equire a plall re'll'ew0 .
-.' gas pining fee •
Note: Add Gas Piping Fee to Room Heatiar
Decorative appliance. Rande, and Gas Watar
Heater Replacement unless gas lines
are existing and previously approved
Other Inspections and Fees
in Home owner requested inspection 5161 80 U Demolition $161 80 11 Plan Revie.w $166.20
Variance(F622-054-000 Homeowners Man:;facrrea 5161 80 7 Decertification $161 80
---' Mobile Home Variance Request roust be con,■,,.•,; eL-,1
".;:-a3e-0e1:12 7-2012
• •
Structural Inspection Request Questionnaire
Please fax this questionnaire to Plan Review at (360) 902-5229 or email to
John.Harvev@lni.wa.gov
YOU MUST HAVE A FAS ALTERATION PERMIT PRIOR TO FAXING TO PLAN
REVIEW
You also may want to contact plan review at (360) 902-5218 to discuss your structural
alteration and to expedite the process.
July 1, 2011
Name: Ac.v/I-e2J0 L7/1-7-02-0
(The contractor or person doing the work)
Site Address: 7 it/ 7— Vd//4 j afii/ic/ tifr 7s7f -3-----
(The physical address where the alteration is beink done) (Also include the city)
Daytime Phone#: (3b6) �3 6 — 62.7
(The contractor or person ing the work)
FAS Alteration Permit #: FP ZV 770
(You will find this #on the permit that you are to post on jobsi e prior to beginning work)
Who is the Manufacturer of the Manufactured Home? /�Q,0u4� /a/
/�/r'10m. -- .pa/
(You will find this on the compliance certificate in the manufactured home)
What year was the home manufactured? / 9 /
(You will find this on the compliance certificate in the manufactured home)
What is the roof load of your home? /4
(You will find this on the compliance certificate in the manufactured home)
What is the structural alteration you want to perform? (Be very specific)
//t/f i/'GG/,.1) n-- 3°6? , `' -L �, T vod- poo/2 j?6,e /►1/4r✓✓Y-�` s
,V ouf<c/?-r70r✓S TVA Oa i i rie-f7 O,L,-,4iL S. ..k' A-77-gef/F 77/' OaO,2
jia f 4i) O✓Tf t✓r, ,9,oi2 W, r—vr fl Z66-4, r'f 4, kji_.
What other types of alterations are you making? (Be very specific)
iM4ilAt_uni9 ,4 f2 w ZKG w/bvfv4, v„> ,2 /L F2,mi/Nf /p ia-/L
'7{t S Lou- LALA.- 03 C. N on3 ,vryr 9 K/ 3e,a-2r r✓f ia-NO earn L 77 6 Truju2
<.✓41-i- or' iF lWonr F_ , pie A-44a /33ifir/0 r sr 0.1i(--1-- $E. A- tJanr ifEATS
SroaAt t AneA. S v.eAwtricl -r t�- o l.o L ��c 0 o- nti 4.41,rc.c_
THC-- E,051``y`‘. c_*T 4 1u wcc_c_ snc.L Ge. -nw-- sip.a..4,,. S.4-n.. ,4zR
64- d4W_ (2.0d 4, t4orM a
F622-076-000 roofing affidavit 07-2011
ory Built Structur•Note: All PBS permits requilinsignia.
Commercial Coach (CC/VEN) j Vendor Medical Unit (CONFN)
Recreationa! vehicle (RV) , Reoreationai Park Trailer (RPT)
Nate: This permit expires one year after date of purchase. (Non-refundable)
rj Work is completed at thr time An inspectt:t.t,t ;i; Work is NOT completed tits Lyle I ',Mil
requested. ready.
.„;
Make check payabie to. Dept of Let oran1 i. is' -rir Signa/pfor.iicant • uL, . zed tepresentative
tri
TOTAL FEE DUE $ /coo
Provide written directions to location of the home being altered
1--eueyv tAva.,, - 4-1,S0±L5 .A , ILIA
edz.e 116,_eA 4 .12,767-0 a0.1-17
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illy-tcJa4_
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7C(/)/1 t, 3L - /S-4.j) ae
ny9/2/1e 42‘),-11e5,, / "1-e-4122.,3
Notes:
Local jurisdictions may have other fees that apply
Alteration checklists are available or trio ini.,4va,olov or at your local office
Permits expire after one year
The department charges a handling fee of $2010 for approved refund requests
=622 :236 no 37-2,7,12
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�,�ox co JEFFERS COUNTY
�� r,,, ,, _,,,) �
` ADEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street• Port Townsend •Washington 98368
44�SAN � 360/379-4450 • 360/379-4451 Fax
www.co.jefferson.wa.us/commdevelopment
G
(Master Permit Application MLA:
Project Description(include separate sheets as necessary): , ,/•
�)44.a9- /eeS 7 Cf•er��
•
Tax Parcel Number 9C / /0�/0/ / Property Size: V.2 ier square feet)
Site Address and/or Dire ions to Property:
Property Owner(s)of Record: c �dA! �- . -
O�f yv7—CY0O Fax: email: i jj r /0 [ .' /4 .c `�
Telephone: gg �l
Mailing Address: �J�• ►Z ,OZ'/ C' ✓t�at ?tA \ 1%49. !?32
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies ❑ Lot or Road Segregation
wilding ❑Critical Areas Stewardship PI: an n
❑ Demolition Permit ❑Variance(Minor, Major or Re 5•Y.• �e�V/ 1
: -Ingle Family Attached/Detached ❑Conditional Use[C(a),C(d), •r ]
1► anufactured Home .❑ Modular ❑ Discretionary"D"or Unname' 1 lassification
❑ Commercial* ❑Special Use(Essential Publi• ••I es)'OCT 1 4 2013
❑ Change of Use , ❑ Boundary Line Adjustment
❑ Address ❑Road Approach ❑Short Plat** A,
❑ Home Business ❑Cottage Industry ❑Binding Site Plan**
JEFFERSON COUNTY
❑ Propane ❑ Long Plat**
❑Sign -- 0 Planned Rural Residential D __•• =-
❑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
❑ 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 pro ••e access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any r-• Id later in •-••••• - --` and right of entry will be assumed unless the applicant informs the County in writing at the
time of the ap•�---!ant •hew"I• •��ice. t f�
Signature: 1/" "' 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 wi I 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 ar,complian - with t ;ers• o my development code.The Applicant acknowledges that he,she or it holds individual
and non-tran• - - 1-- •o it3itlty r adh: i• a •m•ying with the ESA. The Applicant has read this disclai r /�an,signs and dates it below.
�i:..•
Signature: Date: /C y✓ 3
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
BUILDER STATEMENT 4116
The signer of this s - = ent does ereby cert.-, that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be ass • he r=::• si,ility I ;/ en•r- Co `ractor for the proposed project.
Signature: • ' _�V i > Date: / .7//g
GENERAL CONTRACTOR OR MANUFACTURED OMEE INSTALLER: PHONE: FAX:
1,` Mp�.u.)I- ,tee... 1\,(- 1,.. .,,,,, 2 (.°71( ( ) ( )
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: ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: Height: 'ifJndividual System
❑ Repair ❑ Mason ry SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback:
Type of Heat: Proposed: Private well jTwo Party
Total: ❑ Public
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:
1 Underground Tank 1 Above ground Tank Size of Propane Tank:
1 Heat Stove I Cook Stove i Woodstove 1 Fireplace Insert 1 Hot Water Tank 1 Pellet Stove 1 Other
Is this appliance being ins` alled 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
fines,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 F r Office U ; y,.;
Main Floor Heated ot`` .�Rgrt
EH.Bld App Review: c.J
2"d Floor Heated Consistency Review: t 0
Other Heated Base fee: �!
� c4'
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee: q/ CT
Other Unheated `�v
Pot Water Review fee:
Garage/Carport vG'
SUBTOTAL
Decks 911/Rd Approach fee: ---r
Other
TOTAL: $ 6 y-(t
Receipt Number:
Cash/Check Number: l f 2 Z'�'
ESTIMATED COST(REQUIRED) Date: 1 b
•Fair market value of all labor and materials foundation to finish (0/ ( Li//5
Initials: l/f -
G:\PemvtCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
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•
ADDRESS ' II ST
JEFFERSO • NTY PERMIT CENTER
621 Sherida 'ort Townsend, WA 98368 (360) 379-4450
A LICANT: Please fill out items 1 through 9
1. New Address ❑ Correction ❑ Change I JReview DUPLICATE 911 A &DRESS PLATE
/� Q I ❑ Destroyed ❑ Faded
2. Applicant Name: e4 - :v j rl Other
f
3. Mailing Address: 1e,, /bOk /eV
ECH NOTES
Town/ State/Zip Ct);4 CL f�C�i9 �i 2$ • ► ' ESS ENTERED IN
4. Telephone: Work O.-6Y3 l Y !-come: 36O- ?- ', '
5. Location: Attach a Detailed Drawing or Map.
Additional Fees May Be Required if More Than One
Site Visit Is Necessary
*******PLEASE FLAG YOUR DRIVEWAY.*******
Date Flagged:/WO//O//3 Flagging Color ty 610
Nine Digit Tax Parcel Number 9o1 /0 y p/ DIFF LEFT M.P. RIGHT DIFF
6. Road N.-- '174/4 /111/ 4r-V" - — —
Is this PRIVAT or COUNTY road? CIRCL r ONE
Nearest Cross Road: t /^fjey-,^y
7. Neighbors'Address if Known:
Name/Address:
Name/Address:
8. Do You Need To Construct a 'a riveway? YES or
9. County or State Access A..roval#
ROAD APPROACH OR ST TE HWY ACCESS PERMITS
ARE REQUIRED IF YOU' DRIVEWAY IS OFF A COUNTY
OR STATE ROAD IN 0 DER TO PROCESS ADDRESS FIELD NOTES
REQUEST.
U-YSHAD- AREAS OFFICE USE ONLY £" ��`"" �(
New Address:
r
it
Postal Distri a �`L � u
ul ,
Real Mile,•ost: Road #: 11-1 (44-e--A5
Left or Right Fire District Building Permit# Plate Sent / /
Odd Even Date Paid Check Receipt# Date in Computer / /
0 •
JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT
ADDRESS REQUEST INSTRUCTIONS
• Complete the address request form in as much detail as possible. The most important
information to include is the complete name of the road where your property is located &
the nine digit parcel identification number. The fee is $ 22.8.°I)
• You must also attach a vicinity map or drawing.
• Use the survey ribbons provided to flag both sides of your driveway. If your driveway is
not in yet, mark the location where the driveway will be.
• The address technician from the Permit Center will assign your address within 5 working
days. The technician will visit the site and determine the address according to the
nearest milepost distance from the start of the road.
• The red address plate will be sent to your current mailing address, as indicated by you on
the address request form, within one week to ten days. The plate is to be posted at the
end of your driveway and is to be clearly visible from both directions.
• The Permit Center will notify the appropriate postmaster, fire district and emergency
services of your new address.
• You must apply for a Road Approach Permit if your driveway will
connect with a County Road. Please contact Public Works @ 360-385-
9160.
• You must apply for an Access Connection Permit if your driveway will
connect with a State Highway. Please contact WSDOT @
http://www.wsdot.wa.qov/Northwest/developmentservices.
(PLEASE NOTE): A copy of your approved Access Connection Permit is required
to be submitted along with the Address Request.
CONSISTENCY REVIE Project Planner:
Master#M LA13-00140 Review Type Project Description
BLD13-00325 ADU to existing primary residence
SEP13-00119
Primary: RICHARD L GIFFORD Site Address:
PO BOX 1001 605 GIFFORD HILL DR
CHIMACUM WA 983251001 CHIMACUM WA, 98325
Project Location:
Parcel Number: 901104019 S-T-R: 10-29N-01W Total Acreage 4
Legal Description S10 T29 R1W TAX 77(PARCEL 3 SURVEY V27/PG93)BND Land Use: 1100
THRU BLA#100697
Flood District: Fire District: 1 Planning Area: 4
Flood Map(FIRM)Panel No: chool D 49 Zoning:
COMP PLAN
DESIGNATION:
COMMUNITY PLAN: UGA: UGA Trans
[ frr Plot plan states "property line"
[ kr Assessor's Map(Property lines on submitted plot plan must match the property lines as identified on the Assessor's 1/4 map)
[ xi Legal Access to Property t4 NO
[ ] Parcel Tags or Scanned Documents�� NO o
[✓j ESA's: Special Reports Nearby YES NO
[v Designated Ag YES NO
[ (,)i Shoreline Designation: YES 4.01
[ 0/Shoreline Slope Stability: YES
Stream Type:YES NO
FWHCA: YES NO
Wetlands: YES NO • NN -W
Rare Plants:YES NO _
Seismic: YES NO � - 5 �� 09- - t�,� �
Landsli s��NO < c, v- C -C LAI
Flood: S NO
Erosion: YES NO
Aquifer Recharge Area:YES NO
SIPZ: none At Risk High Risk Coastal
CMZ: none High Risk Moderate RiskDisconnected CMZ
Stormwater site plan sub itted: YesNo
[ Forest Lands: YES NO�
Adjoining Forest Lands: Commercial/ Rural/ Inholding
[ C Mineral Lands: YES
[ frr Agricultural Lands: YES O
[ Archaeology: YES �o
[ c No Shooting Zone: S NO
[ V' Stormwater: New I • Surface t// ` 5 Land Disturbing Activity C r, ESA's
Stormwater Re ' :Min Re # Min FIN#1 thru#5 Min Req#1 thru#10( Engineering
DIA, ,LLA
[ kr Impervious Surface coverage centage:
Resource Lands&Public: lamp Rural Residential: 5°/ Rural In r UDC Sec 6.7
Rural Commercial: 60% Isr tvg(a4f Building Coverage:60%in Rural In is ands only
[ VI Total Building (s) Size:
RVC:20,000 SF CC: 5,000 SF NC:7,500 F GC: 10,000 SF All others:subject to septic&water constraints/None specified
[ t( Setbacks: Front: Left Side: Right Side: Rear: 41-c f
Shoreline Setback:
LSHA Setback:
[ I/.1 Road Classification:
Road Approach:Cx1STII NOT REQ'D RAP
[ti SEPA Required: YES EXEMPT
[ Flood Certificate:
[ vr Existing Case(s) &Condition(s):
Violations: Yes No
[ Pr Recorded Date of Subdivision: AFN Over 5yrs=UDC
Plat Conditions: <5yrs=Plat Conditions on plat or Old Ordinance
[ /4— ots/Require Declaration of Restrictive Covenant YES Q ubmitted: YES NO
UGA No Protest Agreemen YES submitte : YES NO
[ j/ Site Visit conducted NO Lo (3. 0 ` t g
[ L}- Require Final Zoning A r proval YES NO
[ t'1' ADMIN: Setbacks entered in Permit Plan case 40 YES
New Parcel Tags entered in Permit Plan oggp YES
Special Reports ScanneCN/A YES
Title Notes Updated
Parcel tags found for parcel 901104019
1.) WSRC Coaching - 2013-07-25, CZ 09/04/2013
Other
Parcel tags found for parcel 901104019
2.) WSRC Coaching -LID 2013-07-25, CZ 09/04/2013
Cases Associated with APN 901104019
Cases Name Review Type Status Planner
BLD13-00325 GIFFORD P
Application Received: 10/14/2013 Permit Issued/Case closed: Case Finaled:
ADU to existing primary residence
BLD13-00325 GIFFORD P
Application Received: 10/14/2013 Permit Issued/Case closed: Case Finaled:
ADU to existing primary residence
M LA04-00200
SUB04-00010 MLA04-00200 GIFFORD I F M LINDBLAD
Application Received: 4/12/2004 Permit Issued/Case closed: 6/28/2004 Case Finaled: 7/15/2004
Boundary Line Adjustment-
SUB04-00010 MLA04-00200 GIFFORD I F M LINDBLAD
Application Received: 4/12/2004 Permit Issued/Case closed: 6/28/2004 Case Finaled: 7/15/2004
Boundary Line Adjustment-
MLA04-00257
BLD04-00299 MLA04-00257 GIFFORD I F M LINDBLAD
Application Received: 5/7/2004 Permit Issued/Case closed: 7/20/2004 Case Finaled: 10/4/2006
NEW SFR W/ATTACHED GARAGE
ABOVE GROUND 120 GALLON PROPANE TANK
BLD04-00299 MLA04-00257 GIFFORD I F M LINDBLAD
Application Received: 5/7/2004 Permit Issued/Case closed: 7/20/2004 Case Finaled: 10/4/2006
NEW SFR W/ATTACHE=D GARAGE
ABOVE GROUND 120 GALLON PROPANE TANK
M LA06-00678
\\tidemark\data\forms\R_Parcel_CRMLA.rpt 10/23/2013 Page 2 of 3
• •
4 o b Jefferson County D C D Invoice No. 13-179
`; 4 621 Sheridan Street
Port Townsend, WA 98368
(360) 379-4450 fax(360)379-4451
INVOICE
Customer
Name Richard Gifford Date 10/23/2013
Address PO Box 1001 MLA#
City Chimacum WA 98325 MLA#
Phone / Case# SEP13-00119
Qty Description Unit Price TOTAL
1.25 Critical Area Review-DWJ $76.00 $95.00
Parcel 901104019
Please Mail to:
621 Sheridan St, Port Townsend, WA 98368
Please Make Payable to:
Jefferson County
US DOLLARS
SubTotal $95.00
Payment Details
0 Cash
0 Check
0 Outstanding TOTAL $95.00
Name US DOLLARS
Check# Office Use Only
Receipt#
Department of Community Development
•
•
ACCESSORY DWELLING UNITS
Monday, July 03, 2006
One accessory dwelling unit is permitted per legal lot of record as an accessory
to an existing single-family dwelling provided that the following requirements are
met: lrrd ec XbZ ,��G Cm
a. Maximum size.An accessory dwelling unit shall have a maximum size
of 1,250 square feet of gross floor area.
b. Owner occupied. To obtain an accessory dwelling unit (ADU)
designation, the owner of the subject property shall reside on the
premises, either in the main or accessory dwelling.
The accessory dwelling is based on the actual square footage of the building that
is to be considered habitable space.
If there is an attached building accessory to the ADU such as garage, storage,
carport, workshop etc... The square footage shall not be additional to the ADU.
An office that is within an accessory dwelling unit shall be considered as part of
the ADU.
Sunrooms shall be calculated as part of the habitable space when there is a door
or opening from the living space to the sunroom area. If there is a sunroom with
the access solely from the outside it should not be calculated in the square
footage of the ADU.
In all cases, insulated and /or heated areas do not constitute living space; it is
based on the use determined by the International Building Code, Chapter 3.
Fred Slota
Building Official
Cc: Stacie Hoskins
G:\PermitCenter\BO-Fred Slota\Policies\ACCESSORY DWELLING UNITS.doc
. . •
�¢,sonr � ). JEFFERSON COUNTY C� d d
1 7 D
ti �� �� DEPARTMENT OF COMMUNITY DEVELOPMENT OCT 1 4 2013
` 621 Sheridan Street • Port Townsend • Washington 98368
1,9 N (0o 360/379-4450 . 360/379-4451 Fax JEFFERSON COUNTY
http://www.co.jefferson.wa.us/commdevelopment/ DEPT.OF COMMUNITY DEVELOPMENT
Stormwater Calculation Worksheet
MLA# PROJECT/APPLICANT NAME: gQ(s Jr1
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 7, Z/ acres �/ An acre contains 43,560 square feet. Multiply the acreage by this figure.
Size of parcel in square feet /I7 g G/ 7 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 sq/ft native vegetation to lawn or landscaped areas?
Drainfield,septic tank,etc. all 00 sq/ft Circle: Yes No
Well,utilities,etc. /CO sq/ft Does the project convert 2 1/2 acres or more of
native vegetation to pasture?
Driveway, parking,roads, etc. i-5- sq/ft
Circle: Yes
0
Lawn, landscaping, etc. /sue sq/ft
Other compacted surface,etc. sq/ft Indicate Total Volumes of Proposed:
Total Land Disturbance 71 7.S.-- sq/ft Cut 202.) Fill (cu/yd)
[over]
stormwater calc 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 flew 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
4 `'NEW EXISTING
Structures(all roof area) ';-5e, sq/ft Structures(all roof area) / a sq/ft
Sidewalks /CO sq/ft Sidewalks 1 CZ) /ft
Patios sq/ft Patios 9'OZ) sq/ft
Solid Decks sq/ft Solid Decks 30Z, sq/ft
(without infiltration below) (without infiltration below)
Driveway, parking, roads, etc sq/ft Driveway, parking, roads,etc sq/ft
Other sq/ft Other sq/ft
Total New sq/ft Total Existing Z 600 sq/ft
TOTAL NEW+TOTAL EXISTING* V050 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: ,E O/
Does the site have 35%or more of existing impervious surface? Circle: Yes No
FURTHER INSTRUCTIONS: If the answer is yes, the proposal is considered redevelopment and the attached Figure 2 should be
used to determine the applicable Minimum Requirements. If the answer is no, the proposal is considered new development and the
attached Figure 1 should be used. At this juncture, the applicant should refer to the applicable Flow Chart to determine the Minimum
Requirements for stormwater management. DCD staff will help verify the classification of the project and the application requirements.
For proponents of "small" projects who must comply only with Minimum Requirement #2—Construction Stormwater Pollution
Prevention—an additional submittal is not required. The proponent is responsible for employing the 12 Elements to control erosion and
prevent sediment and other pollutants from leaving the site during the construction phase of the project. Pick up the Construction
Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet. Proponents of"medium" projects—those
that must meet only Minimum Requirements #1 through #5—and for "large" projects—those that must meet all 10 Minimum
Requirements—are required to submit a Stormwater Site Plan. DCD has prepared a submittal template of a Stormwater Site Plan,
principally for rural residential projects. Complete the template in the Stormwater Site Plan Instructions and Submittal Template or
prepare a Stormwater Site Plan using the step-by-step guidance in the Stormwater Management Manual.
APPLICANT SIGNATURE
By signing the Stormwater Calculation Worksheet, I as the applicant/owner attest that the information provided herein is true and
correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all
owners of affected property.
��T j
t i '/3
(LANDOWNER OR AUTHORIZED REPRESE VE SIGNATURE) (DATE)
! V:07110
ti_:� �, �� r ' gi ys.:: � � 'y�y Y?��,,MyJy�x , �ar�s��2 . v � a �., �^ ? .�
u > �„� �: 3 n rj` g �. � - fi £a ,.rF' .� a ��.sr as
x ,LL '';< „®� cR 4 t ,, � < f Ra. e 4 *`.. S xr 0.... r .mod xfl Y i'41 :
stormwater calc worksheet Rev 9-9-2010—REV 9/9/2010 2
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BLD06-00717 MLA06-00678 qp GIFFORD I F M LINDBLAD
Application Received: 12/22/2006 Perm! closed: 2/14/2007 Case coaled: 8/12/2008
NSFR W/GARAGE AI I BY f3KbEZEWAY&A/G 325 GAL PROP TANK
BLD06-00717 MLA06-00678 GIFFORD I F M LINDBLAD
Application Received: 12/22/2006 Permit Issued/Case closed: 2/14/2007 Case Finaled: 8/12/2008
NSFR W/GARAGE ATTBYBREEZEWAY&A/G 325 GAL PROP TANK
SOM04-00110 GIFFORD F
Application Received: 5/30/2006 Permit Issued/Case closed: Case Finaled:
SOM04-00110 GIFFORD F
Application Received: 5/30/2006 Permit Issued/Case closed: Case Finaled:
SEP13-00119 GIFFORD P
Application Received: 10/14/2013 Permit Issued/Case closed: Case Finaled:
SEP13-00119 GIFFORD p
Application Received: 10/14/2013 Permit Issued/Case closed: Case Finaled:
SEP04-00110 GIFFORD F
Application Received: 5/7/2004 Permit Issued/Case closed: 6/28/2004 Case Finaled: 5/30/2006
SEP95-17 DF only now filed here
SEP04-00110 GIFFORD F
Application Received: 5/7/2004 Permit Issued/Case closed: 6/28/2004 Case Finaled: 5/30/2006
SEP95-17 DF only now tiled here
SEP95-00017 GIFFORD F
Application Received: 1/25/1995 Permit Issued/Case closed: 1/4/2001 Case Finaled: 5/30/2006
Now filed with SEP04-110
SEP95-00017 GIFFORD F
Application Received: 1/25/1995 Permit Issued/Case closed: 1/4/2001 Case Finaled: 5/30/2006
Now filed with SEP04-110
\\tidemark\data\forms\R Parcel_CRMLA.rpt 10/23/2013 Page 3 of 3
;- 1 /
4 i -
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.i, ,J SEP13-00119
// (,.) SEWAGE DISPOSAL PERMIT FILE SHEET Review Type:
/ OP' (),(C7 t,(,u Jefferson County Publlg Health
615 Sheridan Street, Port Townsend WA 98368 (360) 385-9444
r
PERMIT#: SEP13-00119 Date Received: 10/14/2013
SITE ADDRESS: 605 GIFFORD HILL DR Revised Date:
CHIMACUM, WA 98325
APPLICANT: RICHARD L GIFFORD PHONE:
PO BOX 1001
CHIMACUM WA 983251001
SUBDIVISION: BLOCK: LOT:
PARCEL: 901104019 Segtion: 10 Township: 29N Range: 01 W
Legal Description: S10 T29 R1 W TAX 77(PARCEL 3 SURVEY V27/PG93)BND T
INTERESTED
PARTY:
DESIGNER: SUZANNE L MARTIN PHONE: 360-554-0224
SEPTICS BY SUZANNE
PO BOX 125
CHIMACUM WA 98325
SYSTEM DESCRIPTION: 110-CONVENTIONAL TRENCH
TYPE OF WORK: NEW TYPE OF USE: RESC
ADDITIONAL WORK: NONE
Type Amount Paid By Date Receipt
New Conventional System $555.00 SMT 10/14/2013 11622$34
Tota I: $555.00
Parcel Tags; Description Notes Updated
1.) WSRC Coaching -Other 2013-07-25, CZ September 04, 2
2.) WSRC Coaching - LID 2013-07-25, CZ September 04, 2
Associated Cases Status Issued Finaled Description
BLD04-00299 F 7/20/2004 10/4/2006 NEW SFR W/ATTACHED GARAGE
ABOVE GROUND 120 GALLON PROPANE TANK
SEP04-00110 F 6/28/2004 5/30/2006 SEP95-17 DF only now filed here
SEP13-00119 P
SEP95-00017 F 1/4/2001 5/30/2006 Now filed with SEPQ4-110
SOM04-00110 F
SUB04-00010 F 6/28/2004 7/15/2004 Boundary Line Adjustment.
\\tidemark\data\forms\F_SEP_ApplicationNW.rpt 10/14/2013
• ■
4g0N co JEFFERSON COUNTY ,
wY Y s 'ci
-' DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street I Port Townsend,WA 98368 I Web:www.co.iefferson.wa.us/communitydevelooment
�S e`` o, Tel:360.379.44501 Fax:360.379.4451 Email:dcdnu.co.jefferson.wa,us
NI NG
Building Permits&Inspections I Development Consistency Review I Long Range Planning( Watershed Stewardship Resource Center
December 6, 2013
RICHARD L GIFFORD
PO BOX 1001
CHIMACUM WA 983251001
RE: SITE ADDRESS: 305 GIFFORD HILL DR
CASE#: MLA13-00140
Dear RICHARD L GIFFORD:
The Department of Community Development is in the process of reviewing your application. The
following information is needed to continue review of your project.
Your building floor plan indicates total square footage of habitable space exceeds the 1250 square
foot limit for an ADU. Please revise your plans and submit for further processing.
Please submit the above information to the Department of Community Development by March 6,
2014. Pursuant to Jefferson County Code, JCC 18.40.110(3)and (6), if the applicant does not
submit the additional information or does not request additional time to submit the required
information within the ninety(90)calendar day period, the application will be considered abandoned
and therefore withdrawn and the applicant shall forfeit the application fee. The Department of
Community Development shall not be responsible for notifying the applicant of an impending
expiration.
Sincerely,
p. cj, ,'Saw Ste, c_ty,96
Department of Community Development Staff
c: File
\\tidemark\data\forms\F_MLT_Addlnfo_Requst.rpt 12/6/2013
--� • !
Jefferson County Department of Community Development
621 Sheridan St., Port Townsend W A 98368, (360)379-4450 `)( ` -
SEPTIC PERMIT APPLICATION
Richard Gifford IX
PROPERTY OWNER Al ►
MAILING ADDRESS PO Box 1001 P., �►►►
Chimacum, WA 98325 ►'
y siz o, •.�,►ffi
PHONE ( 360 ) 732-4092 ';} r>•Dimarr�a• ►►'►►,
SYSTEM DESIGNER Suzanne Martin Designer Phone# (360)554-0224
LEGAL DESCRIPTION: Section 10 Township 29N Range 1 W PARCEL# 901 104 019
Subdivision Name Tax 77 (Parcel 3 survey v27/p93) Division Block Lot(s)
Site address/Directions to site East portion of 305 Gifford Hill Drive
SOURCE OF SEWAGE/USE TYPE OF WORK WATER SOURCE
Residential ✓ _ New ✓ Tank/s only Private ✓
Residential ADU Modification_ _ Public
Commercial• Expansion_
Community Upgrade, +/-184488sf
Repair SITE SIZE
SYSTEM TYPE , Repair-(tank) (drainfield) Previous Evaluation
Conventional Designate RPGPrve Area Yes# SEP04-00110
Alternative Redesign No
SYSTEM DETAILS
Number of Gallons/day 480 Soil type 4 (attach soil eval.) Application Rate 0.60 gal./sq.ft./day
Drainfield Length 2671f ft. Trench Width 3' ft. Trench/Bed Depth 12" in.
Septic Tank size 1000 min _gal. Pump Chamber size.n/a gal. 4; ,,
TYPE OF Conventional trench system
By signing the application form, the applicant/owner attests that the information provided herein is true and correct to the best of
their knowledge. Any material falsehood or any omission of a material fact made by the applicant/owner 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 requires prior notice. Inspections shall occur
during regular business hours. Initial here if you require notification before entry
Appeal —A person aggrieved of a decision of the Health Officer may appeal. Appeals shall be submitted to the Health Division in
writing within fifteen days after receiving written notice of the decision.
DISCLAIMER-This application is for an on-site sewage system that meets the state and county
standards in effect on the date of application. This application for an onsite sewage system DOES
NOT assure you of any other County approvals. For example, it DOES NOT GUARANTEE that
you will later obt in permission to build a perm vent residence or other structure on this parcel. Any
future appli ti will..pe(�separ "I ,jud/.d byte rules and laws in effect at that time.
.:///
Property • er Signature Date
FOR OFFICE USE ONLY
PARTIAL ASBUILT FINAL
APPROVED
INSP/PUMP TEST PUD
ALL HOLD REQ.MET
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Date • 4 Fee..S Rec# _7 Check# d 1 Case#SEP
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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. Tue Oct 15 09:32:14 2013
1
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Screen: 01 REAL PROPERTY MASTER 410 Mode: INQUIRY
Auto Roll : OFF
Parcel # 000901104019 Geo Cd 290110404210
S10 T29 R1W Nbhd Cd 4230
TAX 77(PARCEL 3 SURVEY V27/PG93)
BND THRU BLA#100697
Loc ID
OaxpaYer Cd GIFF 7800 GIFFORD, RICHARD L T/P Chg Dt 3/28/2012
* Title Owner T/P Chg Usr JA
Tax Code 0211 Status TX TAXABLE Land Use 1100 RES-SINGLE
Affidavit 68284 Vol/Page / C/U Code
COMPLETE ADDRESS WINDOW
Taxpayer
GIFF7800 RICHARD L GIFFORD
PO BOX 1001
CHIMACUM WA 98325-1001
Search Key
CMD 6: End Window CMD 7: End of Job
•
•
CASES, DING, CONDITIONS, PERMISSIISS FOR
Parcel 901104019
Printed: October 24, 2013
Cases Name Review Type Status Planner
PRJ13-00243 GIFFORD P
Application Received: 10/24/2013 Permit Issued/Case closed: Case Finaled:
ADU to existing primary residence
No findings, conditions, or permissions found.
SUB04-00010 MLA04-00200 GIFFORD 1 F M LINDBLAD
Application Received: 4/12/2004 Permit Issued/Case closed: 6/28/2004 Case Finaled: 7/15/2004
Boundary Line Adjustment
1.) The application was reviewed by the Jefferson County Department of Community Development staff on April 15, 2004
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: Level I Landslide Hazard Areas, Special Aquifer
Recharge Protection Areas and Susceptible Aquifer Recharge Areas.
2.) Aquifer Recharge Areas in Jefferson County are characterized by porous geological formations that allow percolation
of the surface water into the soils and the underlying zone of saturation. Aquifers are geologic formations that contain
sufficient saturated permeable material to yield significant quantities of water to wells and springs. Aquifers serve as
the source of drinking water within most of the rural portions of Jefferson County.
3.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid infiltration of
recharge waters to groundwater aquifers.
4.) Critical Aquifer Recharge Areas are defined as Seawater Intrusion Areas, and Special Aquifer Recharge Protection
Areas and the following land uses located within Susceptible Aquifer Recharge Areas(1)All Industrial Land Uses(2)
All Commercial Uses(3)All Rural Residential Land Uses requiring a Discretionary Use or Conditional Use Permit(4)
All Rural Residential Land Uses with nonconforming uses that would otherwise require a Discretionary Use or
Conditional Use Permit(5) Unsewered Planned Rural Residential Developments (6) Unsewered residential
development with gross densities greater than one unit per acre. All of the above listed uses shall be subject to the
applicable requirements and standards of the Jefferson County Unified Development Code.
5.) Geologically Hazardous Areas in Jefferson County are characterized by slope, soil type, geologic material, and
groundwater that may combine to create problems with slope stability, erosion, and water quality during and after
construction or during natural events such as earthquakes or severe rainstorms.
6.) 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.
7.) Buffers are areas that shall be maintained in their natural condition, however, minor pruning or alteration of vegetation
may be permitted as long as the function and character of the buffer are not diminished.
8.) 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(AmalanchierAlnifolia), 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).
9.) Landslide Hazard Areas and their associated buffers shall remain naturally vegetated. Should buffer disturbance
occur during construction, the Unified Development Code(UDC)Administrator shall require replanting with native
vegetation. No alterations shall be made to the Landslide Hazard Area or its associated buffer without prior
authorization by the UDC Administrator.
\\tidemark\data\forms\R_MLT_Parcel_Cond.rpt 10/24/2013 Page 1 of 6
Cases Name Re ew T e Status Planner
10.) Prior to and during approved const n activities, the perimeter of the Iandslid and area buffer shall be marked
with a temporary sign. The sign shall be placed in such a manner that it can be directly observed from the
construction area. The sign shall contain the following statement: "Landslide Hazard Area and Buffer-Do not
Remove or Alter Existing Vegetation."
11.) All construction activities shall not encroach upon the buffer. This includes the storage or preparation of materials.
12.) The applicant shall permanently separate the boundary of the Landslide Hazard Area Buffer from the remainder of the
subject property through installing logs, trees, a hedge row, or any other prominent physical marking approved by the
UDC Administrator.
13.) Jefferson County determined that this proposal is categorically exempt from review under the State Environmental
Policy Act(SEPA) pursuant to WAC 197-11-800(2)(j).
14.) This approval is for a BOUNDARY LINE ADJUSTMENT 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.) This parcel has been designated as Rural Residential 1:5 under the Jefferson County Comprehensive Plan Land Use
Map effective August 28, 1998.
16.) The proposal complies with UDC Section 7.2.1.a(1) in that the proposal is to create more suitable building lots.
17.) Consistent with UDC Section 7.2.1.b(1),the proposal will not create an additional lot, tract, or parcel.
18.) Consistent with UDC Section 7.2.1.b(2) , the proposal is not within a binding site plan.
19.) Consistent with UDC Section 7.2.1.b(3), the proposal will not relocate an entire lot, tract, or parcel.
20.) Consistent with UDC Section 7.2.1.b(4), the proposal is not inconsistent with the conditions of approval of any
restrictions or covenants.
21.) The following notice shall be placed on the final survey mylar:
JEFFERSON COUNTY NOTICE TO PUBLIC
Current Jefferson County Geographic Information System (GIS)maps identify the presence of an Environmentally
Sensitive Area(ESA)such as stream,wetland,flood, landslide hazard area, erosion, aquifer recharge area, SIPZ,fish
and wildlife habitat, shoreline,etc., lying within and/or adjacent to the revised parcels encompassed by this Boundary
Line Adjustment. Prior to any land disturbing activity or construction activity, applicant/owner shall contact the
Jefferson County Department of Community Development regarding compliance for such ESA's. Approval of this
Boundary Line Adjustment does not guarantee issuance of a building permit within said parcel(s). Such determination
is dependent on approvals of water, septic, bulk and dimensional setbacks, and ESA requirements.
22.) Consistent with UDC Section 7.2.3.c, the applicant/surveyor is responsible for recording the Statement of Intent with
the Jefferson County Auditor and referencing said statement of Intent AFN on the face of the survey. (An Excise Tax
Affidavit will need to be completed for the Statement of Intent. An Excise Tax Affidavit is also required for every
document that will be recorded such as Quit Claim Deeds or Statutory Warranty Deeds.) The survey mylar and
recording fee of$85(plus$1 for additional names and $5 for each additional sheet payable to the Jefferson County
Auditor shall be submitted to the Department of Community Development for department signatures and recording of
said mylar.
BLD04-00299 MLA04-00257 GIFFORD 1 F M LINDBLAD
Application Received: 5/7/2004 Permit Issued/Case closed: 7/20/2004 Case Finaled: 10/4/2006
NEW SFR W/ATTACHED(.AKAGE
ABOVE GROUND 120 GALLON PROPANE TANK
1.) The application was reviewed by the Jefferson County Department of Community Development staff on May 11, 2004
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: Level I Landslide Area, Susceptible Aquifer
Recharge Areas and Special Aquifer Recharge Protection Areas.
2.) Aquifer Recharge Areas in Jefferson County are characterized by porous geological formations that allow percolation
of the surface water into the soils and the underlying zone of saturation. Aquifers are geologic formations that contain
sufficient saturated permeable material to yield significant quantities of water to wells and springs. Aquifers serve as
the source of drinking water within most of the rural portions of Jefferson County.
3.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid infiltration of
recharge waters to groundwater aquifers.
4.) Critical Aquifer Recharge Areas are defined as Seawater Intrusion Areas, and Special Aquifer Recharge Protection
Areas and the following land uses located within Susceptible Aquifer Recharge Areas(1)All Industrial Land Uses(2)
All Commercial Uses(3)All Rural Residential Land Uses requiring a Discretionary Use or Conditional Use Permit(4)
All Rural Residential Land Uses with nonconforming uses that would otherwise require a Discretionary Use or
Conditional Use Permit(5) Unsewered Planned Rural Residential Developments(6) Unsewered residential
development with gross densities greater than one unit per acre. All of the above listed uses shall be subject to the
applicable requirements and standards of the Jefferson County Unified Development Code.
5.) Geologically Hazardous Areas in Jefferson County are characterized by slope, soil type, geologic material, and
groundwater that may combine to create problems with slope stability, erosion, and water quality during and after
construction or during natural events such as earthquakes or severe rainstorms.
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6.) Buffers are areas that shall be maimed in their natural condition, however, mi runing or alteration of vegetation
may be permitted as long as the function and character of the buffer are not diminis ed.
7.) 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(AmalanchierAlnifolia), 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).
8.) A vegetative buffer of 30-feet shall be permanently maintained from the top or edge of the Landslide Hazard Area. All
buffers shall be measured perpendicularly from the top of the Landslide Hazard Area.
9.) Landslide Hazard Areas and their associated buffers shall remain naturally vegetated. Should buffer disturbance
occur during construction,the Unified Development Code(UDC)Administrator shall require replanting with native
vegetation. No alterations shall be made to the Landslide Hazard Area or its associated buffer without prior
authorization by the UDC Administrator.
10.) Prior to and during approved construction activities, the perimeter of the landslide hazard area buffer shall be marked
with a temporary sign. The sign shall be placed in such a manner that it can be directly observed from the
construction area. The sign shall contain the following statement: "Landslide Hazard Area and Buffer-Do not
Remove or Alter Existing Vegetation."
11.) All construction activities shall not encroach upon the buffer. This includes the storage or preparation of materials.
12.) The applicant shall permanently separate the boundary of the Landslide Hazard Area Buffer from the remainder of the
subject property through installing logs,trees, a hedge row, or any other prominent physical marking approved by the
UDC Administrator.
13.) Critical Aquifer Recharge Areas may require special protection measures to mitigate water quality degradation. The
submitted proposal does not require additional aquifer protection measures. However, during construction the project
shall follow the Best Management Practices(BMPs)and facility design standards as identified and defined in the
Stormwater Management Manual for the Puget Sound Basin.
14.) The applicant is proposing to create or add 1678 square feet of impervious surface and 1757 square feet of land
disturbing activities. Sections 6.6 and 6.7 of the Jefferson County Unified Development Code requires that your
proposal shall adhere to Best Management Practices(BMPs).
15.) Jefferson County determined that this proposal is categorically exempt from review under the State Environmental
Policy Act(SEPA) pursuant to WAC 197-11-800(1)(b)(i).
16.) The site plan as submitted with the building permit application on May 7, 2004 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 July 15,2004 shall be resubmitted
for review and approval by Jefferson County Department of Community Development.
17.) This approval is for a single family residence with attached garage 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.
18.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary
hazard.
19.) Not more than two(2)unlicensed or inoperable vehicles shall be stored on any lot less than one-half acre 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 Unified Development Code(UDC)Section 6.
Outdoor storage of thirteen (13)or more unlicensed or inoperable 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 of the
UDC, and such storage shall meet the requirements of UDC Section 4.10. In no case, shall any such unlicensed or
inoperable vehiclesbe stored in an Environmentally Sensitive Area (ESA).
20.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which
includes roof tops, driveways, concrete, etc.
21.) The building height is not to exceed 35 feet.
22.) Minimum setback from Old Anderson Lake Rd right-f-way is 20 ft. Minimum side and rear setbacks shall be 5 ft
unless an environmentally sensitive area(ESA)exists, then the stricter setback shall apply.
23.) This parcel has been designated as Rural Residential 1:5 under the Jefferson County Comprehensive Plan Land Use
Map effective August 28, 1998.
24.) A septic permit(SEP04-00110)was approved on June 28, 2004 for a tank only permit.
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25.) Old Anderson Lake Rd is a local ac road(C522009). The road approach is ing and an address of 151 Old
Anderson Lake Rd has been assigned to the parcel.
26.) A boundary line adjustment permit(SUB04-00010)was finaled on July 15, 2004. The final mylar was recorded under
AFN 486957.
27.) A minimum of two(2)on-site parking spaces are required for the single family residence.
28.) The project shall comply with Construction Stormwater Pollution Prevention (SWPP) Elements#1 through#12 of the
Department of Ecology's Stormwater Management Manual for Western Washington 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.
29.) Potable water is provided to this parcel by an onsite well.
30.) A Well Operation and Maintenance Agreement was recorded under AFN 484204,filed of record May 7, 2004 with
Jefferson County Auditor's office.
31.) A Declaration of Well Easement was recorded under AFN 485098,filed of record May 28, 2004 with Jefferson County
Auditor's office.
BLD06-00717 MLA06-00678 GIFFORD I F M LINDBLAD
Application Received: 12/22/2006 Permit Issued/Case closed: 2/14/2007 Case Finaled: 8/12/2008
NSFR W/GARAGE AFT BY BREEZEWAY&A/G 325 GAL PROP IANK
1.) The application was reviewed by the Jefferson County Department of Community Development staff on December 27,
2006 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:Special Aquifer Recharge
Protection Area and Susceptible Aquifer Recharge Area.
2.) Aquifer Recharge Areas in Jefferson County are characterized by porous geological formations that allow percolation
of the surface water into the soils and the underlying zone of saturation. Aquifers are geologic formations that contain
sufficient saturated permeable material to yield significant quantities of water to wells and springs. Aquifers serve as
the source of drinking water within most of the rural portions of Jefferson County.
3.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid infiltration of
recharge waters to groundwater aquifers.
4.) Critical Aquifer Recharge Areas are defined as Seawater Intrusion Areas, and Special Aquifer Recharge Protection
Areas and the following land uses located within Susceptible Aquifer Recharge Areas(1)All Industrial Land Uses(2)
All Commercial Uses (3)All Rural Residential Land Uses requiring a Discretionary Use or Conditional Use Permit(4)
All Rural Residential Land Uses with nonconforming uses that would otherwise require a Discretionary Use or
Conditional Use Permit(5) Unsewered Planned Rural Residential Developments (6) Unsewered residential
development with gross densities greater than one unit per acre. All of the above listed uses shall be subject to the
applicable requirements and standards of the Jefferson County Unified Development Code.
5.) Geologically Hazardous Areas in Jefferson County are characterized by slope, soil type,geologic material, and
groundwater that may combine to create problems with slope stability, erosion, and water quality during and after
construction or during natural events such as earthquakes or severe rainstorms.
6.) Development Review staff conducted a site visit of the subject parcel and determined the slope to be generally slightly
sloping with a steeper slope located on the adjacent parcel to the east.
7.) Critical Aquifer Recharge Areas may require special protection measures to mitigate water quality degradation. The
submitted proposal does not require additional aquifer protection measures. However, during construction the project
shall follow the Best Management Practices (BMPs)and facility design standards as identified and defined in the
Stormwater Management Manual for the Puget Sound Basin.
8.) The applicant is proposing to create or add 1867 square feet of impervious surface and 1987 square feet of land
disturbing activities. JCC 18.30.060 and 18.30.070 require your proposal comply with Minimum Requirement#2
(Construction Stormwater Pollution Prevention)of the Department of Ecology Stormwater Management Manual for
Western Washington 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.) The project shall comply with Construction Stormwater Pollution Prevention (SWPP) Elements#1 through#12 of the
Department of Ecology's Stormwater Management Manual for Western Washington 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.
10.) Jefferson County determined that this proposal is categorically exempt from review under the State Environmental
Policy Act(SEPA)pursuant to WAC 197-11-800(1)(b)(i).
11.) The site plan as submitted with the building permit application on December 22, 2006 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 February 13, 2007 shall be
resubmitted for review and approval by Jefferson County Department of Community Development.
12.) This approval is for a single family residence with garage attached by breezeway 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.
13.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary
hazard.
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14.) Not more than 2 unlicensed vehicle all be stored on any lot unless totally scre 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 autormobile 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 requriements 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.
15.) Minimum setback from Gifford Hill Dr right-of-way shall be 5 ft. Minimum side and rear setbacks are 5 ft. Minimum
setback from the southern property boundary adjacent to the commercial forest land use designation is 250 ft.
16.) 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.
17.) 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.
18.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which
includes roof tops, driveways, concrete, etc.
19.) The building height is not to exceed 35 feet.
20.) This parcel has been designated as Rural Residential 1:5 under the Jefferson County Comprehensive Plan Land Use
Map effective August 28, 1998.
21.) A septic permit(SEP06-00473)was approved on January 16, 2007 for a system of 360 gallons per day.
22.) Gifford Hill Dr(P625) is a private access road (P625). The road approach is existing and an address of 304 Gifford
Hill Dr has been assigned to the parcel.
23.) A boundary line adjustmnet was finaled on July 15, 2004. Final survey regardinig same was recorded under AFN
486957.
24.) A minimum of two(2)on-site parking spaces are required for the single family residence.
BLD13-00325 MLA13-00140 GIFFORD P
Application Received: 10/14/2013 Permit Issued/Case closed: Case Finaled:
ADU to existing primary resi e
No findings,conditions, or permissions found.
SEP13-00119 MLA13-00140 GIFFORD P
Application Received: 10/14/2013 Permit Issued/Case closed: Case Finaled:
No findings, conditions, or permissions found.
SOM04-00110 GIFFORD F
Application Received: 5/30/2006 Permit Issued/Case closed: Case Finaled:
No findings, conditions, or permissions found.
PRJ13-00244 GIFFORD P
Application Received: 10/24/2013 Permit Issued/Case closed: Case Finaled:
No findings, conditions, or permissions found.
SEP04-00110 GIFFORD F
Application Received: 5/7/2004 Permit Issued/Case closed: 6/28/2004 Case Finaled: 5/30/2006
SEP95-17 DF only now filed here
1.) Approval/issuance of a sewage disposal permit does not guarantee the approval of other development or a building
permit on this site. Compliance with other Jefferson County and Washington State Codes is required.
2.) As per Jefferson County Code 8.15 all onsite sewage systems require monitoring. Monitoring shall be provided by an
approved entity. THIS SYSTEM IS REQUIRED TO BE INSPECTED EVERY 6 YEARS..
3.) An asbuilt drawing and certification of completion by the Installer is required prior to final approval.
4.) 10'separation required between a Water line and all portions of the onsite sewage system; effluent transport line,
tanks, treatment and disposal components.
5.) Divert all sources of drainage, including roof drains away from septic tank and drainfield area.
6.) Any portion of transport line under a driven way is to be sleeved/cased or equivalent.
7.) Distribution boxes shall be fitted with a riser to grade, constructed of durable materials and a secured lid, adequately
sized to allow visible inspection of the liquid level in the box.
8.) Approval of this sewage disposal permit does not preclude the permit holder from complying with the Unified
Development Code for other/future development on the site.
9.) This system as designed and approved is sized for only one single family residence. It is not sized for an Accessory
Dwelling Unit(ADU).The minimum daily design flow per residence is 240 GPD.
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10.) The project shall adhere to the Besenagement Practices(BMPs)to control st ater, 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.
11.) Health Department is to be contacted for a final inspection of the septic tank prior to covering.
SEP95-00017 GIFFORD F
Application Received: 1/25/1995 Permit Issued/Case closed: 1/4/2001 Case Finaled: 5/30/2006
Now filed with SEP04-110
1.) Contact designer prior to installation for staking of drainfield area.
2.) MAXIMUM TRENCH DEPTH 18 INCHES
3.) Maintain a minimum setback of 5 feet from property lines and 100 feet from individual well(s)with the drainfield areas.
4.) Maintain a minimum setback of 50 feet from individual well(s)with the septic tank,or 100 feet if the well is a
community well.
5.) Drainlines are to be installed along the natural contours.
6.) Divert all sources of drainage away from septic tank and the drainfield areas.
7.) All components of the septic system are to be completely protected from vehicular traffic or mechanical disturbance.
Protective barriers may be required around drainfield areas.
8.) Approval/issuance of a sewage disposal permit does not guarantee the approval of a building permit on this site.
9.) When/if designated reserve area is utilized an alternative system may be required.
\\tidemark\data\forms\R_MLT_Parcel_Cond.rpt 10/24/2013 Page 6 of 6
I.
FS°O's c% JEFFERSON COUNTY
` 't DEPARTMENT OF COMMUNITY DEVELOPMENT
Date: q z?Time Received: 7 t y am pm Mon Tue. Wed. Thur. Fri.
Date: r-29
BLD: 1�j-- 32—C Contact Name:
Owner: Contact Number: 360 (p 67 z,ott
Address: Se?v ca-t A 4J/ 206
Notes: SKI lert'1
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
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DEVELOPMENT REVIEW TIME SHEET
RICHARD L GIFFORD MLA13-00140
Date Time Comments
\\tidemark\data\forms\R_MLT_Case_CRMLA.rpt October 24,2013
Jefferson County Building Pision Permit Nuer:
Applicant:
BUILDING PERMIT INSPECTION APPROVALS Applicable Code: 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
11 194
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gt. CA/' t; aw,u 7/2/W
K1 11L) a'- Lf
FINAL INSPECTION r 6-
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
•
CONDITIONS for Building Permit# :BLD13-00325
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 project shall comply with Construction Stormwater Pollution Prevention (SWPP)
Elements#1 through#12 of the Department of Ecology's Stormwater Management
Manual for Western Washington 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.
3.) The site plan as submitted with the Building Permit application on October 14, 2013 has
been reviewed for consistency under the UDC, and has been approved by Jefferson
County Department of Community Development. Any modifications, changes, and/or
additions to the stamped, approved site plan dated shall be resubmitted
for review and approval by Jefferson County Department of Community Development.
4.) The existing well for this development lies within the WRIA 17. Per Washington State
Department of Ecology consultation on 11/20/13e) , documentation has been
provided to support a determination that the well is exempted and not subject to the
in-stream flow rule for domestic use, metering, and exempt well irrigation.
5.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
6.) 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.
7.) A minimum of two (2)on-site parking spaces shall be provided for the single family
residence.
8.) The building height is not to exceed 35 feet.
9.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
10.) Building setbacks are no less than 20 feet from Gifford Hill Drive. Side and rear setbacks
are no less than 5 feet.
\\tirIemark\riafa\fnrmc\F RI 11 Permit Rhin rot 1/99/9M4
BUILDING PERMIT •
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT#: BLD13-00325 Received Date: 10/14/2013
SITE ADDRESS: 'J/SCe&GIFFORD HILL DR Issue Date 1/29/2014
/7/ CHIMACUM, 98325 Expiration Date 1/29/2015
OWNER: RICHARD L GIFFORD PHONE:
PO BOX 1001
CHIMACUM WA 983251001
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901104019 Section: 10 Township: 29 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
PROJECT DESCRIPTION: ADU to existing primary residence (detached)
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ADU
VALUATION MAIN:
CODE EDITION: 2012 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: OSS
WATER SYSTEM: 1PWELL Type Amount Paid By: Date: Receipt:
BEDROOMS: BATHROOMS: State Building Code $4.50 MEB 10/14/13 145456
Exist: Exist: Manufactured Homes $228.00 MEB 10/14/13 145456
Prop: 3 Prop: 2 Potable Water Application $66.00 MEB 10/14/13 145456
Total: 3 Total: 2 Total: $298.50
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