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BLD2014-00063
•UILDING PERMIT APPLICAN BLD14-00063 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00063 Received Date: 2/21/2014 SITE ADDRESS: 71 CHICKADEE LN QUILCENE, 98376 OWNER: CARL F SMITH PHONE: 360-765-3692 PO BOX 868 QUILCENE WA 98376-0868 QUILCENE BAY VISTA SUBDIVISION: Block: Lot: 7 PARCEL NUMBER: 701205007 Section: 20 Township: 27 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr Addition: first floor rec room to existing SFR attached garage, expanding footprint; expanding great room on second floor. TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP ADD MAIN: 480 VALUATION 116,404.00 ADD'L: 480 HEAT TYPE: EEE 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: 2 Exist: 2 Prop: Prop: Total: 2 Total: 2 Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Total: APPROVED Jefferson County DCD %lfirlomorlArlofoNfnrmc\G RI 11 Ann PIA rni 1/11/11)1A e ,#toir 1.soN ( DEPARTMENT OF COMMUNITY DEVELOPMENT =a. 2,: 621 Sheridan Street,Port Townsend,WA 98368 "< Tel:360.379.4450 I Fax:360.379.4451 Web:www.co.jefferson.wa.us/communitydevelopment g O E-mail:dcd @co.jefferson.wa.us sIii!N O CERTIFICATE OF OCCUPANCY PERMIT#: BLD14-00063 APPLICANT: CARL F SMITH PHONE: 360-765-3692 PO BOX 868 QUILCENE WA 98376-0868 SITE ADDRESS: 71 CHICKADEE LN Issue Date: 03/11/2014 QUILCENE, 98376 Final Date: 3/9/2015 SUBDIVISION: Block: Lot: 7 PARCEL NUMBER: 701205007 Section: 20 Township: 27 N Range: 1W PROJECT DESCRIPTION:Addition: first floor rec room to existing SFR attached garage, expanding footprint; expanding great room on second floor. THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2012 EDITION. OCCUPANCY GROUP: R-3 TYPE OF CONSTRUCTION: 5N SPRINKLER SYSTEM yes o THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 3/9/2015 \\tidemark\data\forms\F_BLD_Occupancy.rpt 3/18/2015 - ''';'%•‘C.1-,,‘,.•:-11:'..i'-.- .... ,,....141.1"4"*,.‘•14t,'..-, N„„ ••,,,, 8 0 _St \ \ 111r \j.-..,., .. . pi•g = CL■IIII P''' 11 r ' il, RS_9/143 F '" P– n \ 8 ° .p z \ IN. .9 ,. ..0 .p. V7 \ \ s 8.324 h, 13 ' 4 I - 0 0 (-) 0 c. o I / I( ' z \ \ LO 9 \ 01 Iv o ■ • \ 0 \ l't \ — -- --"r‘ --' / * \ (.7\ ----- /„.c.-4 .....‘••,, \-14\li i ds• '15" \ \ 1 I A> N CO 4k (I) rn Oz,1Z o m N o o r"-- m \ --- -- 4Pi C/ 0 N CieN. --..,, --r- 0 N N ,z . -J— r— 1,> fron 0 c) > N N cbcv rrl . 4,4,.. .4 II=1 Z o 11 / 0 N N cr■ c cv :. z ri > -d "I't N N N C. 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C 0 • ' •. 7-3 c;1 : (A - rn 0 : N) • —I Fri 0 -1:3 CA 1.- ti u) C • • • -‹ 0 • • o • ' • • . < < z 0 - . - • - • 7o 1-- w • ).- cj 'C ' N) N) -- _ -0 (0 2 _, iv —1 ,, -1 '„, — 1 CA -IN. o cA i 2 Co Ci z Co A cn u) cn u) r-l- --I-1 (-I-- -h Standard Conditions for Residentillevelopment in Jefferson County I 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 i alties. Portions of Jefferson County, it ding 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 arp 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 sldpes, wetlands, and forested areas near surface waters Remove minimal vegetation for site development, elspecially large trees Allow trees that have fallen into surface waters to remain there Infiltrate stormwater from buildings and driveways gnsite through drywells rather than discharging directly into surface waters or roadside ditches The Federal Bald and Golden Eagle Protection Act require 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 action, "take" includes a disturbance of bald eagles or their habitat. Under federal law a permit may still be requited 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 la1Nsuit 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 th@ National Marine Fisheries Service in Seattle, or the U.S. Fish and Wildlife Service. ‘,..12;tiujouAft I ' ii 2013-09-06_SFR_StdConditions 9/6/2013 2 Design Criteria for Splashblocks A typical downspout splashblock is shown in Figure 3.1.7. In general, if the ground is sloped away from the foundation and there is adequate vegetation and area for effective dispersion, splashblocks will adequately disperse storm runoff. If the ground is fairly level, if the structure includes a basement, or if foundation drains are proposed, splashblocks with downspout extensions may be a better choice because the discharge point is moved_away from the foundation. Downspout extensions can include piping to a splashblock/discharge point a considerable distance from the downspout, as long as the runoff can travel through a well-vegetated area as described below. The following apply to the use of splashblocks: 1. Maintain a vegetated flowpath of at least 50 feet between the discharge point and any property line, structure, slope steeper than 15%, stream, wetland, lake, or other impervious surface_ Sensitive area buffers may count toward flowpath lengths. 2. A maximum of 700 square feet of roof area may drain to each splashblock. 3. For purposes of maintaining adequate separation of flows discharged from adjacent dispersion devices,the vegetated flowpath segment for the splashblock must not overlap with other flowpath segments, except those associated with sheet flow from a non-native pervious surface. 4. Place a splashblock or a pad of crushed rock(2 feet wide by 3 feet long by 6 inches deep) at each downspout discharge point. 5. No erosion or flooding of downstream properties may result. 6. Have a geotechnical engineer or a licensed geologist,hydrogeologist, or engineering geologist evaluate runoff discharged towards landslide hazard areas. Do not place Splashblocks on or above slopes greater than 15% or above erosion hazard areas without evaluation by a professional engineer with geotechnical expertise or a licensed geologist,hydrogeologist, or engineering geologist, and approval by the Local Plan Approval Authority. 7. For sites with septic systems, the discharge point must be downslope of the primary and reserve drainfield areas. This requirement may be waived if site topography clearly prohibits flows from intersecting the drainfield or where site conditions (soil peinneability, distance between systems,etc) indicate that this is unnecessary. Volume III—Hydrologic Analysis and Flow Control BMPs-August 2012 3-15 I Ili_ Roof downspout serves up to ;iiiii 700 sf. Of roof Ii!!!: :::: 50' min. I Vegetated I, flow path rT Splash ri block • ---- Downspout extension NTS Splash block Figure 3.1.7-Typical Downspout Sp}ashblock Dispersion V • tme III—Hydrologic Analysis and Flow Co trol BMPs—August 2012 3-16 -I \ \ / _H \\\\ , ,,\ --1 - - ...-- \\ --/- 7., z / \\\\\\ / / -....1 ( 01 -I ,---- \ L..1 GI C - t \\ \ _±, \ \ \ 0 \ \ \ 0 \r---1-- \ ) ---1 ._ -5- ■ - >_5.1 I 7,- / V (-D. , \ -1 . CO I o /-/ Fri / I / / , 0 // \ , / // . . / '1 // // . . ' ....1 Li/ ' . Ai ,--- ..\ , ; 1 06 r----------- - -- --- -r--F---- - -'---------- ---------� - -' --�'' -!- - -- --- �-- � � | ' | � | | | || | C / ' m m LN \ (a mx | � / � | | | | � ~" SON C /. 4 f, O°2 JEFFERSON COUNTY r { DEPARTMENT OF COMMUNITY DEVELOPMENT / s Date: cKh–Time Received: oZ a amp Mon. Tue. 61V-4 Thur. Fri. Date: BLD: 1 -/ " 6 3 Contact Name: Owner: Contact Number: 360 77z<9g/S' Address: '7/ al.;c.- L 206 Notes: Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Under ground Furance Footing....X.,_ 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 pSG.• 4 C °? JEFFERSON COUNTY Q =- .�C DEPARTMENT OF COMMUNITY DEVELOPMENT Date: /ZZ Time Received: ' an Mon. Tue. �-.I Thur. Fri. Date: BLD: /g- G3 Contact Name: Owner: Contact Number: 360 77Z `(ctcr.r Address: 7 ( C-it 14-4.J.0 206 Notes: Foundation Plurrmhing 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 • . a a, / d ��1• air Mir r.°. 1g�+ r ,,,r \' .1 �,� r. -�` 41:-,f'ir':,:::,,' !may``,r. _ L .er- ki 9 1, r r _.,,,l• + r f": y� yy % g, , ill '....__.-m..�..�. , - .% ' 1 , �._ a ate J�y , ,,,,,..,. ,„ ... , . ....,- , ' " .''. 4110,... '. I . ..,..;...„...„ .,..,...., ..,.. , . .. �s `max G"44%; 3. ‘, : , ,, .. ,, ... ...,.. , . , - ,-, . ..,.... ..;:.,. . .. . . . , . ,.. 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N0-h cn ) CID I Nr-) --' -N- ......., 0) (1) (,) -h -1 r1 oi z U) r-i- -1-1 r-F- r-i- Prescriptive Energy Code Comce for All Climate Zones in Washingto• Project Information Contact Information a tea.... k This project will use the requirements of the Prescriptive Path below and incorporate the the minimum values listed. In addition, based on the size of the structure,the appropriate number of additional credits are checked as chosen by the permit applicant. Authorized Representative Ca V'/ $ G r 4 Date 2.,// '/ ei II- y' All°Climate'Zit ne ,,,_ R-Valuea U-Factora Fenestration U-Factorb n/a 0.30 Skylight U-Factor n/a 0.50 E i- Glazed Fenestration SHGCb�e n/a n/a Dri-- . " ��' i !�1 Ceiling 491 0.026 / u Wood Frame Wall9.k.' 21 int 0.056 FEB�\, 1 1 9 ,,,t14 Mass Wall R-Value' 21/21h 0.056 a Floor 309 0.029 .,_. Below Grade Walfk 10/15/21 int+TB 0.042 NTT.OF(� ig .lu � 7^�^9T _ _ Slabs R-Value& Depth 10,2 ft n/a *Table R402.1.1 and Table R402.1.3 Footnotes included on Page 2. Each dwelling unit in one and two-family dwellings and townhouses,as defined in Section 101.2 of the International Residential Code shall comply with sufficient options from Table R406.2 so as to achieve the following minimum number of credits: 01.Small Dwelling Unit: 0.5 points Dwelling units less than 1500 square feet in conditioned floor area with less than 300 square feet of fenestration area. Additions to existing building that are less than 750 square feet of heated floor area. 02. Medium Dwelling Unit: 1.5 points All dwelling units that are not included in#1 or#3, including additions over 750 square feet. 03. Large Dwelling Unit: 2.5 points Dwelling units exceeding 5000 square feet of conditioned floor area. Table R406.2 Summary Option Description Credit(s) la Efficient Building Envelope la 0.5 ❑ 1 b Efficient Building Envelope lb 1.0 5 1.0 1c Efficient Building Envelope lc 2.0 ❑ 2a Air Leakage Control and Efficient Ventilation 2a 0.5 ❑ 2b Air Leakage Control and Efficient Ventilation 2b 1.0 ❑ 2c Air Leakage Control and Efficient Ventilation 2c 1.5 ❑ 3a High Efficiency HVAC 3a 0.5 ❑ 3b High Efficiency HVAC 3b 1.0 0 1.0 3c High Efficiency HVAC 3c 2.0 ❑ 3d High Efficiency HVAC 3d 1.0 ❑ 4 High Efficiency HVAC Distribution System 1.0 ❑ 5a Efficient Water Heating 0.5 ❑ 5b Efficient Water Heating 1.5 ❑ 6 Renewable Electric Energy 0.5 I*1200 kwh 0.0 Total Credits 2.00 *Please refer to Table R406.2 for complete option descriptions http://www.energy.wsu.edu/Documents/2012%20Res%20Energy.pdf e b 0 0 \ • z= alir Pm N ii N n \ \ o RS_9/148 cn P o \ \ s ,gym�v \ •m? . ?m OV \ Ai ,2.6., No 7,1_ \ k)9.79732'e. 0 \ 0 `• U) m \ �"" \ rnX \ \P \ - I m o JP' �� / � ° \ N N 0957' // \ O 9' /J) r \ 0 242.19' E /// r °w \ � / \ \ / d VtilIV ItO r \ \ A> °X v+ l e \ Q \ s�ors \ m o -0 C \ \ I-- / 0O r- fTl N \ o 0 Q \ �_ vGi z In _ -o N N \ �ow• o Z G7 C7 I- \ s N ��c� D Z 'Q( N 9. \ w o D -90 \ \ o N o ----- - T v rn o „ \ . .--Z D \ -n 0 \ — �' Z c — 17 ? lluu \ © ` c.0 - _ - 2 �� in-_ion= m � ODD xx0 wo Nc ° -0 _° o ° t' .� � ) C Fri cn I- 0 � Z77 z -+ m I- -11 b .;.,. sir m —I 0 c) -I p < J c� = r O �' , D 00 D -H 0J O D —I C CD D 1-- °' z c� cn o y 0 f D m7 M C o N ('� _ _ D � OC < OO o 0 ZO CA D -� m N ) -OK ) 0ZE- O Z z � p GAT 2Dm ° � o p o -� ``� '�' ITl -p _ C D D -< m r - I cx o 01 «7 � � � n (TI G7 • 0Z � z O J 70 z in tx.i b CO , c : � o z oW Cn cnC : : : D O : � : • Om z � 0 • 00� � -P � p OOJp�p N) O °_ cn OZ ■ <77)7 . 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'B 40,0' I ■.: • •• A. . • • 0 . _ ... • • • . • • . • . ,SON c064. • /*, JEFFERS•COUNTY H --- W � ' \� r DEPARTMENT OF COMMUNITY DEVELOPMENT h '4 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax (o www.co.jefferson.wa.us/commdevelopment '9.1i1-NO Master Permit Application MLA: Project Description(include separate sheets as necessary): Tax Parcel Number: 70/ ZD 5 v o 7 Property Size: 2Z ,b,/33 (acres/square feet) Site Address and/or Directions to Property: (0• /9 AL) 7/ G1.74/ ,<A-P G.4 4'O/L eti/E / WA-/ . 837., Property Owner(s)of Record: C 4 L- s 44/TN- Telephone: Fax: email: Mailing Address:_ Applicant/Agent(if different from owner): At/1/G/-/1..-dG- f�/�// , ' 2A/ • p ‘ b 9 �3/ /O/� Fax: A//� email: � /er O .0 Telephone: � Mailing Address: }l7 GL E.V L,4n/L, 7 P T 9.838 eablt'Sp&' d`ea/n What kind of Permit?(Check each box that applies ❑Lot or Road Segregation ❑Building ❑Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor, Major or - - came - -i,•-4.. t�(. s [� ❑ Single Family ❑ Garage Attached/Detached ❑Conditional Use[C(a),C(, , : • --° _pi _ _: Il �_ L`y ❑ Manufactured Home .❑ Modular • - ❑ Discretionary"D"or Unna : • - Chast ificalion I ❑ Commercial* ❑Special Use(Essential Pu• it ,4cilities)** • Change of Use ❑Boundary Line Adjustmen i�:-1, -c u , 2014 ❑ Address ❑Road Approach_ ❑Short Plat , ❑ Home Business ❑Cottage Industry ❑Binding Site Plan** Li `L ❑ Propane ❑Long Plat** �---- I NW ❑ Sign ❑Planned Rural Residential evelopmeflt(FRT ° i s** ❑Allowed"Yes" Use Consistency Analysis ❑Plat Vacation/Alteration** r�,T rF - "V ❑ 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: A/ A O NI�Tact OF AGENT I hereby designate /�/ to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE l Date: I 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 ri.' - -ntry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any required er inspecti•ns. '.-ffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the ap licatio a e e . ,'= otice. Signature: Date: ` l 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 -re in oompli. ce h the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transfer.•e esp• •ili • • ering to and complying with the ESA. The Applicant has read this disclaim ancj�i ns and dates it below. signature: . /.Iw /LV Date: /l9(/ G(/ G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc BUILDER STATEME I The signer of this statement does . certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assu .the re • ray .f the General Contractor for the proposed pro'ect. Signature: OW" Date: /fi--7 _., 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: New Wood Existing: 2 9� I� ❑ Sewer Addition ❑ Steel Proposed: I Bank a Community System C Alteration/Remodel ❑ Concrete Total: I'7_ Height: X.-Individual System 0 Repair C Masonry 1 — P Permit# Li Demolition ❑ Other: Bedrooms: Water Supply: Existing: _ Setback: ❑ Private well 0 Two Party Type of Heat: Proposed: 12 o Public v p lA ,L Total: - 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 I Proposed 130 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 i l-.ms below that apply: 1 Underground Tank 1 Above ground Tank Size of Prop.1 e Tank: .1 H eat Stove 1 Cook Stove 1 Woodstove 1 Fireplace Insert 1 Hot Wail-r Tank 1 Pellet Stove 1 Other . Is this, fiance being installed in a Manufactured/Mobile Home? Ye. / No •When applying for a permit to install a propane tank you must also sub I, it a site plan showing all of the buildings,all property lines,tank location and size,distances from the propane tank to all pro"erty lines,buildings and septic system components, including the reserve area. Square Footage Current Proposed For Office Use Onl _ Amount I 1 Revision Main Floor Heated EH Bld Apll Review:it 2931. 2`°Floor Heated , `r 1J 2.130- )Consistency Review: ^? tr.Other .Heated `7 V Base fee: G Mezzanine Additional 1 ection: - i Heated Basement Plan Checl' fee: 1-`10• Unheated Basement State Sure'arge fee: Other Unheated Pot Water eview fee: Garage/Carport '•UBTOTAL Decks )0 A 9,11/Rd Ap'roach fee: _Other TOTAL: $ 2 �/', � Ad • .ilpReceiptN1mber. ‘ftVzim ats,L Mill. Cash/Cheek Number: 0s ESTIMATED COST(REQUIRED) Date: ,l 4( w •Fair market value of all labor and materials foundation to finish c)t") c,‘) Initials: G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Applica. n 5-29-08.doc r 0 • Cr CO I-I 0) = 0) 0 Cr LL O Z U- H O N I-I O CU CI a) — Cr) -7 LU 0 -0 - CU J O 0 L CO -0 X Cr 'O a--, Co Z c U O = H LJJ o O Co -1-, -o H 0) 0) I -- O L L L Co r' Q so C) C) U LU Z 0 CC 0 J O.. 0-- ` U I- I- O O CD CD U) "0 O 0 U O CC -0 CO W C O X CO 3 F- Cl) co O O 0 U) - J U CD I -0 CC w- Z CO C d F--i 1- -- CU ¢ - X Cr) } Cr) � o) co I- O Co 9 co (o) CC r- I-I L Cr) C w CU } J LU LU IZ O LU CO CC Q o CU } 3 LL CC o = X '- r- CC CC X o I- CO a O CO = J CC CC H co N- Co cc I- X CD _i CU L Q LU CO CO LU CE Z U F- Z U LU "O LU X LU LL X LU CC C.) C.) I- _ F- a) -J O U J = 0) 0- J CO J 0 H I- I- U) CO = CC I-I C1) = O I-I 7 a CD CC O = CD C3 J X +' U C.) Cl 0 Co CO - i-J O N- U) Co 5 O N O Imo- . O O . O N I--- •- H . O X CU N- co 1-- . O U) r- O '- N O O "O L CU O F- U CD CO 0 0) # C O I- a) -. L 3 L I--I Y C — a) co -1-, n) X C1) a) = a) -- ) co L C1) C) co u) -o > co C) L L co_ — O co Cl L C) co X -4-+ C. 10 X 10 CO ■ 10 • -- co a) I- I- X q- I- co co q- )E )E I- Q Op Front Parcel Review 0 Parcel 701205007 Printed: February 28, 2014 )q - G3 CARL F SMITH Site Address: PO BOX 868 71 CHICKADEE LN QUILCENE WA 983760868 QUILCENE, WA 983760868 QUILCENE WA, 98376 Parcel Number: 701205007 S-T-R: 20-27N-01W Total Acreage 5 Legal Description QUILCENE BAY VISTA LOT 7 SURVEY V9/P143 Land Use: 1100 Flood District: Fire District: 2 Planning Area: 10 Flood Map(FIRM)Panel No: School District 48 Zoning: COMP PLAN DESIGNATION: COMMUNITY PLAN: UGA: UGA Trans [ ] 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) [ ] Legal Access to Property Yom' NO [ ] Parcel Tags or Scanned Documents YES NO [ ] ESA's: Special Reports Nearby YES NO [ ] Designated Ag YES NOO/ [ ] Shoreline Designation: YES N9- [ ] Shoreline Slope Stability:.F%S.. NO I-ii^ r ri ci J A al_ Stream Type:YES N� ' is FWHCA: YES NAY 'An 1/ be 14'J sia ivut Wetlands: YES 1Q-' Rare Plants:YES NO 6(°Itd1424 Landslide: YES N4O Y ttic A ^ � C Landslide: F�- NO cal- � _ . � .,.�!+� : ./ • 3 Flood: YES N -' L - in 7-1 I./ e bil gl¢ Erosion: YES NQ, ce C c.n.-"A_eQ ( ' ) Aquifer Recharge Areac F. NO).6-tA.6-_.._. SIPZ: nine' At Risk High Risk Coastal CMZ: now High Risk Moderate RiskDisconnected CMZ Stormwater site p an submitted: YesNo [ ] Forest Lands: di, N9'' Adjoining Forst Lands: Commercial/ (f 7 Rural/ Inholding [ ] Mineral Lands: YES ye"- [ ] Agricultural Lands: YES 1 [ ] Archaeology: YES Nqt [ ] No Shooting Zone: S NOS [ ] Stormwater: New Impervious Surface Land Disturbing Activity ESA's Stormwater Req's:Min Req#2 Min Req#1 thru#5 Min Req#1 thru#10 Engineering [ ] Notice Provisions/Disclosure:Airport YES N.9./ MRL YES NO/ Forest Lands YE,� NO [ ] Landscaping Required: Yes N9-'` / [ ] Parking Spaces Re ired NO 0 Other 1 1 Building Height: 5' UBC Standard [ ] Impervious Surface coverag rcentage: Resource Lands&Public: 10% Rural Residential: 25% Rural Industri . Per UDC Sec 6.7 Rural Commercial: 60% Area of Building Coverage:60%in Rural Industrial Lands only [ ] Total Building(s) Size: RVC:20,000 SF CC:5,000 SF NC:7,500 SF GC: 10,000 SF All others:subject to septic&water constraints/None specified [ ] Setbacks: Front: Left Side: Right Side: Rear: Shoreline Setback: LSHA Setback: [ ] Road Classification: Road Approach: EXISTING NOT REQ'D RAP [ ] SEPA Required: YES EXEMPT [ ] Flood Certificate: [ ] Existing Case(s)&Condition(s): Violations: Yes No [ ] Recorded Date of Subdivision: AFN Over 5yrs=UDC Plat Conditions: <5yrs=Plat Conditions on plat or Old Ordinance [ ] Lots/Require Declaration of Restrictive Covenant YES N submitted: YES NO [ ] UGA No Protest Agreement YES NO, submitted: YE'S NO [ ] Site Visit conducted YES NO [ ] Require Final Zoning Approval YES NO [ ] 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 Title Notes Updated Parcel tags found for parcel 701205007 1.) STEEP SLOPES mapped as LHA2 but well vegetated...15 ft setback req 04/05/1995 Cases Associated with APN 701205007 Cases Name Review Type Status Planner BLD12-00103 SMITH F Application Received: 3/28/2012 Permit Issued/Case closed: 3/28/2012 Case Finaled: 5/3/2012 A/G 120 GAL PROP LANK, LINE & FIREPLACE INSERT BLD12-00103 SMITH F Application Received: 3/28/2012 Permit Issued/Case closed: 3/28/2012 Case Finaled: 5/3/2012 A/G 120 GAL PROP TANK, LINE & FIREPLACE INSERT BLD12-00240 SMITH F Application Received: 8/6/2012 Permit Issued/Case closed: 8/6/2012 Case Finaled: 11/28/2012 ROOF OVER EXISTING DECK BLD12-00240 SMITH F Application Received: 8/6/2012 Permit Issued/Case closed: 8/6/2012 Case Finaled: 11/28/2012 ROOF OVER EXISTING DECK BLD13-00033 SMITH F Application Received: 1/28/2013 Permit Issued/Case closed: 1/28/2013 Case Finaled: 1/31/2013 INTERIOR KITCHEN REMODEL BLD13-00033 SMITH F Application Received: 1/28/2013 Permit Issued/Case closed: 1/28/2013 Case Finaled: 1/31/2013 INTERIOR KITCHEN REMODEL BLD14-00063 SMITH P Application Received: 2/21/2014 Permit Issued/Case closed: Case Finaled: Addition: first floor rec room o existing SFR attached garage, expanding footprint; expanding great room on second floor. BLD14-00063 SMITH P Application Received: 2/21/2014 Permit Issued/Case closed: Case Finaled: Addition: first floor rec room o existing SFR attached garage, expanding footprint; expanding great room on second floor. \\tidemark\data\forms\R_Parcel_CRMLA.rpt 2/28/2014 Page 2 of 3 MLA06-00177 • • BLD06-00183 • MLA06-00177 SMITH I F M LINDBLAD Application Received: 4/14/2006 Permit Issued/Case closed: 5/9/2006 Case Finaled: 2/1/2008 NEW SFR W/ATTACHED GARAGE AND DECK(S) BLD06-00183 MLA06-00177 SMITH I F M LINDBLAD Application Received: 4/14/2006 Permit Issued/Case closed: 5/9/2006 Case Finaled: 2/1/2008 NEW SFR W/ATTACHED GARAGE AND DECK(S) M LA13-00098 ADR13-00039 MLA13-00098 SMITH I P Application Received: 7/9/2013 Permit Issued/Case closed: Case Finaled: NEW ROAD NAME OFF CHICKADEE LANE ADR13-00039 MLA13-00098 SMITH I P Application Received: 7/9/2013 Permit Issued/Case closed: Case Finaled: NEW ROAD NAME OF-I- CHICKADEE LANE CAR95-00037 KENASTON F PRM Application Received: 3/14/1995 Permit Issued/Case closed: 5/18/1995 Case Finaled: 6/1/1995 CAR95-00037 KENASTON F PRM Application Received: 3/14/1995 Permit Issued/Case closed: 5/18/1995 Case Finaled: 6/1/1995 SEP95-00052 KENASTON F Application Received: 3/14/1995 Permit Issued/Case closed: 5/21/1995 Case Finaled: 4/27/1998 SEP95-00052 KENASTON F Application Received: 3/14/1995 Permit Issued/Case closed: 5/21/1995 Case Finaled: 4/27/1998 SOM95-00052 SMITH RCR Application Received: 4/27/1998 Permit Issued/Case closed: 2/8/2013 Case Finaled: SOM95-00052 SMITH RCR Application Received: 4/27/1998 Permit Issued/Case closed: 2/8/2013 Case Finaled: \\tidemark\data\forms\R_Parcel_CRMLA.rpt 2/28/2014 Page 3 of 3 DEVEL( VIENT REVIEW TIME SH M T Date Time Comments /W l� .�/r �'v �� � � rte. 3-5-► \\tidemark\data\forms\R_MLT_Case_CRMLA.rpt September 18,2012 / Map ��� ��� Pauclofl ^ ^ ���y ��� ~ ArcIMS HTML Viewer Ma " --Th _ ?mamas 44:, ,\32,-,T) ' � ` � ) � / . ::-.. �P -1 70120500f: ,\ Lngwnd����a� s''yss Jcm=d ° le' - ' . / / rparcemw Contours '' ,,,‘-^i'y — -/--(------------> I :1.11 i,/,„:,-;;,-......:,, , m fool Como, �/ XI Fool^°�"", ' ,..._ . -.---217--- ''7 ( \7 ;'-'77- - --r- ( i — \ ' Th ~~_~' ^��z�� ~ ^ --~/' � � .�____ � / / h.,'.e....!......^ e»»~ i4:i) 7- c------: -\ /- /' ,v�'~v'z'' -`~ '~ �� I/7"./-- —~ � ______^,2il } FOR INFORMATIONAL PURPOSES ONLY- JefemonCountyd000ncdatteuttotheaoouxooyofthadatacontoinedhominondmakea no warranty with respect to its correctness or validity. Data contained in this map is limited by the method and accuracy of its collection. Fri Feb 28 15:54:16 2014 ' ` http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientVersion=4.... 2/28/2014 Map Output • • Page 1 of 1 ArcIMS HTML Viewer Map 1 -._701195014_ 701203008 , — --F__701,95073 �- — i N`ZC?[S I 8 , ` 1 i -! I I xL.f J' 70119501, 701195012 de c , I701205005 `�1.t, �\ Legend ,' '', n / 't' .,. Selected Features J C_Roads 701195008 +t �•- / "± f,',� \r,- Parcels-H 701195001 '„, 701205006 DNR FP Stream 701195007 �, Classification —.-.y_ -. / � s 1' 70,2030014 + �” / ` I AJ F F Ot tlsenyl 701193006 { rte' I 11 ! /_/ /or N Non inn Manna, I, .•70'205008 ! `;7 ve NP-Nan-1 on Habitat Porenn.3 T 701195002' j 701205607 Ns Nan-foil tlatr4a Seasana. 701195005' f 701193001E S-tnventoried Snorenne ��. �, i ./* DNR Streams 701195004 tt 1 701203068 _/ tynei .! Type 5 --7--.701193008 1Yae+ 701193001 i' .1 Typo 3 __...-y- Tyee2 701195003 r...-' _ F"~ J Type 701203001 tev, Other DNR Water Bodies 701203001 F 701/95010 rt i S J NeDes g naI,en 701203002 i /01194012 i ',/ LFA-Fish ,I u:au:de!v.,/Jafasut Carty+Leora Senecas Gt5 42f1 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. Fri Feb 28 15:54:53 2014 http://gisserver/servlet/co:m.esri.esrimap.Esrimap?ServiceName=ovmap&ClientV ersion=4.... 2/28/2014 Map Output Page 1 of 1 ArcIMS HTML Viewer Map i y Legend Selected Features 10'"=95006 JC Roads /0.205008 Parcels-H +0'2t'600F Landslide Hazard Sloes IIkjn !C' 205008 Moderate Sivnt r.,...:'i 0 ,1211 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. Fri Feb 28 15:56:23 2014 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientV ersion=4.... 2/28/2014 Map Output • • Page 1 of 1 ArcIMS HTML Viewer Map 4 r"e_ei�. 2 \ uJ. t !7. 4 .',./'s",.,....._41 12, MI& i ' h_,",..,...4....., \ 13-. v Legend 701203o,' Selected Features ' i r...._,.D_o \ �14 iC_Roads \\.7 f j Parcels-H ti Shoreline Slope Stability --- O Staete i ., O tntertnebble r1 +:)"2,:'-,.:.:,!.. 1, , I D Unstable I • Unstable Rocent Landsidte ,,le 1111. ..'.L UnriaeM Old LantlslvJo 1111 Illostrtss1 701203001 A ,...',.2.!■.:..Le Msr,x.-de t 7i-e'cso I cos,•:: c J Sa.,:.^..:stS L' 1'211 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. Fri Feb 28 15:57:41 2014 1 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientV ersion=4.... 2/28/2014 Map Output • Page 1 of 1 ArcIMS HTML Viewer Map 701195014_ 70?106007 701195013 uti. ,701202001 �'_^ '�- t. I I} 701196'_ ' 701195012 701265(06 701196 1108 I.. s� VIIIIIIk"427);. ----- 701195001 701205006 *� 701196007 / 1 / l 0 ge nd / 707203001 _�- Selected Features _____. t I � � . JC 701195006 I., I r ",+ r � 1 i 1 Parcels Fi 1 701205008 f 70120800? S I PZ 701196002 /! 701195001 I { " ; At R ak SiP2 r 1 �}J,( tU t,Risk SIPM 7011951104 i/ 1+ 701205008 4 ., n Coastal SIRE I 1 I t ;, j } m + — 701t9600s 701195004.--- � 701195001 701196002 707195003 -.-- - _-' 701203001 701203001 li 701195010 ___ ®___I 701203002 .4 701194012 , I Maas sa•dod W Atocrsm Casty Centel Sc ;..-,..,4S \ -.'01■11•11111111.■4'[it 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. Fri Feb 28 16:01:21 2014 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientV ersion=4.... 2/28/2014 Map Output • Page 1 of 1 ArcIMS HTML Viewer Ma a IrM14 . Legend Selected Features .' JC_Roads Parcels-H County Zoning M PR SF Tracts Ru ra,RmWent ui 1:5 Rural Resdont al 1:10 Rura Rosuentw 1:20 MPR-Susie Famity MPR Nuhriamary S•50: MPR Resort Commas rr .( Parks anti Recreation !O 95+':'r . MPR Open Space .�1• (} ',>(j , RurniFe,eI !_ .,�•!':s- El Commercial Forest • in hokt mg Faros! !leery Inaustruq +G":6002 Airport LPF MPR ViiRg Center III AP 1:20 .r�'i __ ■ Rural VI tago Cantor ■ Resource Daum Ind. t •;_�,�,�� Light Mdustrul MPR Recreation Warns Morn CPF ulA LVC Croarroads•GC WEED Crosvaads•CC _' Crossroads•NC ■ AL 1:20 r,;...,..;... UGA•Urban Commercial G'J_ 2 UGA Urban Light industrial •n-.,,x cksl .'4r:<ri r::.c..ct z+°:G:� "'g 3 UGA-MDR UGA-IIDR UGA-Public UGA•LDR U GA-Viseor Oriented Commercial MPR-DRN Braman C f 40'M R LO Comrercal Forest M moral Resource Overlay FOR INFORMATIONAL PURPOSES ONLY- efferson County does not attest to the accuracy of the data contained herein and makes no warranty with respect to its correctness or validity. Data contained in this map is limited by the method and accuracy of its collection. Fri Feb 28 16:01:50 2014 http://gisserver/servlet/com.esri.esrimap.Esrimap?ServiceName=ovmap&ClientV ersion=4.... 2/28/2014 Map Output • • \-, Page 1 of 1 ArcIMS HTML Viewer Ma• ,s,/ INEZ t tari r 1ti w MM. �lil giiiiNif _ Legend Selected Features / 1 F JC_Roads y-` l' j Parcels-H it 2011 Aerial Photos ,iI . I „amp, I r -. i 70'2v6C0 1 70,20300t' SIM 1 , 2 1 �i i ,, FOR INFORMATIONAL PURPOSES ONLY- efferson County does not attest to the accuracy of the data contained herein and makes no warranty with respect to its orrectness or validity. Data contained in this map is limited by the method and accuracy of its collection. Fri Feb 28 16:02:18 014 http://gisserver/servlet/com.e sri.esrimap.Esrimap?ServiceName=ovmap&ClientV ersion=4.... 2/28/2014 • • BLD14-00063 BUILDING PERMIT APPLICATION Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00063 Received Date: 2/21/2014 SITE ADDRESS: 71 CHICKADEE LN QUILCENE, 98376 OWNER: CARL F SMITH PHONE: 360-765-3692 PO BOX 868 QUILCENE WA 98376-0868 QUILCENE BAY VISTA SUBDIVISION: Block: Lot: 7 PARCEL NUMBER: 701205007 Section: 20 Township: 27 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr Addition: first floor rec room to existing SFR attached garage, expanding footprint; expanding great room on second floor. TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP ADD MAIN: 480 VALUATION 116,404.00 ADD'L: 480 HEAT TYPE: EEE 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: 2 Exist: 2 Prop: Prop: Total: 2 Total: 2 Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Total: 1\tirlamar4\rigto\fnrrne% RI r Ann R1r1 rnt ?(11r?(194 iigON cat, JEFFERSO( OUNTY • iv-Hs • • ' %k• YA DEPARTMENT OF COMMUNITY DEVELOPMENT _ "' . -- -\ " 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax *° C.: www.co.jefferson.wa.us/commdevelopment HINd Master Permit Application MLA: Project DD}e�scription(include separate sheets as necessary): ___ , Tax Parcel Number: 7e,/ ZO 5 6707 Property Size: ZZ ,61/3.3 / (acres/square feet) Site Address and/or Directions to Property: (5. /9 AG_.) 7/ e / K. 7 E e- G,4-n/ 42 v ii.c-osi , kt/A-, . 8371. � Property Owner(s)of Record: G•!-I/ZL- /Vt/Tff Telephone: Fax: email: Mailing Address: Applicant/Agent(if different from owner): if/J/G��- --�. ,4A/,2 ',/ Telephone: b2 73/ /O// Fax: JV/A email: ,t1,774/€794 2�7a Mailing Address: _3© GGEVEGA-A/ ' `57: pr 9338 eab/e•sivrz 5?d•G '#,1 What kind of Permit?(Check each box that applies ❑Lot or Road Segregation ❑Building ❑Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor, Major or - ..r=. - ,. em s {{�� ❑ Single Family ❑Garage Attached/Detached ❑Conditional Use[C(a),C( , : :: L� ❑ Manufactured Home .❑ Modular - ❑Discretionary"D"or Ur Ana :d , se-Clas ificcation C Commercial* ❑Special Use(Essential Pu• it acilities)** ❑ Change of Use ❑ Boundary Line Adjustmen ,p; 9 Q'4 ❑ Address ❑ Road Approach ❑Short Plat** I I ` r ❑ Home Business ❑Cottage Industry ❑Binding Site Plan** ❑ Propane ❑Long Plat** `j L �— N TY o Sig . ❑Planned Rural Residential;I evelopment(PR ft ** 1 . ❑Allowed"Yes"Use Consistency Analysis El Plat Vacation/Alteration** r; T J ,;, ❑ 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 0 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: ,�A �,l DESIGN TION OF AGENT I hereby designate ,4//c #'T.4 /,� .0�o 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 ri•• • .-ntry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any required ater inspecti•ns. :,-ffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the ap•licatio ail e r.• ': otice. j/ l/� Signature: Date: �/L 7 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 re in compli ce 'h the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transfer e esp ' iii ering to and complying with the ESA. The Applicant has read this disclaim r an Si ns and dates it below. Signature: '' kI Date: `z1 -.N,. __•-r__.__\.,uuc ■D\rc++444\nun Gnn N rc\r,....o.,.TIP Tl F...,,,c\Ma et-A.nA.,.,:r A.,.a;rot:n„5_90_fIR rinr —HIP • BUILDER STATEMENT The signer of this statement does y certify that they are the Owners of the parce:referenced herein,that they are not licensed contractors and that ><-they will be assn 'ng the resP y ff the General Contractor for the proposed project. Signature: G� ,!; i d Date: 2/7 Yj GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: P.IONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: 1 Shoreline: Type of Sewage Disposal: • New .g-Wood Existing: I C Sewer Proposed: Bank o Community System Addition C� Steel P Y Y E Alteration/Remodel 0 Concrete Total: '2_ Height: KIndividual System O Repair 0 Masonry — P Permit# O Demolition 0 Other: Bedrooms: Water Supply: Existing: . Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: '2- 0 Public ( e2� ,,-N G- , Total: --- Name of System: If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees, etc) Current Proposed IBC Occupancy:; IBC Type of construction: Will you have Food Service? Yes / No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: i Underground Tank i Above ground Tank Size of Propane Tank: Heat Stove i Cook Stove i Woodstove i Fireplace Insert i Hot Water Tank i Pellet Stove i Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / No 'When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. Square Footage Current Proposed For Office Use Only. Amount Revision Main Floor Heated EH Bld App Review: 2n°Floor Heated z9 30 )Consistency Review: Other Heated Base fee: GO- Mezzanine Additional Section: j 9 Heated Basement Plan Check fee: C./O • 1• Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: - Garage/Carport SUBTOTAL Decks 7 ) 1 0 911/Rd Approach fee: -Other TOTAL:' $ 2, 2.0 �5 . , -.) i t^r1 (,!�'!Gc L t Receipt Number: 6_._ CashlCheck Number: II(s--'"S ESTIMATED COST(REQUIRED) Date: -�/ c� l�/ .Fair market value of all labor and materials foundation to finish I ___ L. c Initials: I e • AV.- ° 6. JEFFERSON COUNTY z? j - DEPARTMENT OF COMMUNITY DEVELOPMENT �� L 4_, ,p<c `,. 621 Sheridan Street • Port Townsend • Washington 98368 $k9 1N0�0 360/379-4450 • 360/379-4451 Fax , I http://www.co.jefferson.wa.us/commdevelopment/ ■ JL FE1.Ui itljN{Y DrPT.OF COMMUNITY DEVELOPMENT Stormwater Calculation Worksheet MLA# PROJECT/APPLICANT NAME: _ C�G�Il(/ L 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 0.19 acres An acre contains 43,560 square feet. Multiply the acreage by this figure. Size of parcel in square feet ZZ4, /33 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: �r Does the project convert 3/4 acres or more of Construction site for structures ®� sq/ft native vegetation to lawn or landscaped areas? Drainfield, septic tank,etc. Xi��!7 sq/ft Circle: Yes (1710 Well, utilities,etc. 'X/577/U4 sq/ft Does the project convert 21/2 acres or more of native vegetation to pasture? Driveway, parking,roads, etc. sq/ft Circle: Yes C No) Lawn, landscaping, etc. sq/ft Other compacted surface, etc. sq/ft Indicate Total Volumes of Proposed: Total Land Disturbance lea sq/ft Cut Fill (cu/yd) [over] stormwater calc worksheet Rev 9-9-2010—REV.9/9/2010 1 i • , • Impervious surface is a hard surface that either prevents or retards the entry of water into the soil mantle as under natural conditions prior to development. A hard surface area which causes water to run off a surface in greater quantities or at an increased rate of flow from the flow present under natural conditions prior to development. Co mon impervious surfaces include, but are not limited to roof tops, walkways, patios, driveways, parking lots or storage areas, concre 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 E KISTING i Structures(all roof area) 44,5 sq/ft S tructures(all roof area) /0. 2- sq/ft Sidewalks sq/ft StLIewalks sq/ft Patios sq/ft Patios sq/ft Solid Decks . f/3 sq/ft Solid Decks 4 sq/ft (without infiltration below) (w ithout infiltration below) Driveway, parking, roads, etc sq/ft Driveway, parking, roads,etc Z1/5 sq/ft Other sq/ft Other sq/ft Total New • 99 sq/ft Total Existing 36 0 3 sq/ft TOTAL NEW+TOTAL EXISTING* ai442 7Z sq/ft *This amount will be used BY STAFF to check total lot coverag The following questions will help determine whether the proposed project isl considered development or redevelopment. DEVELOPMENT v. REDENAELOPMENT Divide the total existing impervious surface above by the size of t!1e parcel and convert to a percentage:Z•O1—% Does the site have 35%or more of existing impervious surface? Circle: Yes No FURTHER INSTRUCTIONS: If the answer is yes, the proposal is consid red 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 c assification of the project and the application requirements. For proponents of "small" projects who must comply only with Minirl um 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 ha;, prepared a submittal template of a Stormwater Site Plan, principally for rural residential projects. Complete the template in the Storr+rwater Site Plan Instructions and Submittal Template or prepare a Stormwater Site Plan using the step-by-step guidance in the StorrnwaterManagement Manual. APPLICANT SIGNATURE By signing the Stormwater Calculation Worksheet, I as the applicant/owper attest that the information provided herein is true and correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all owners of the affected : .a=rty. ■ �� I .K, o' Z- / (LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) /�� ) II (DATE) �r l -, ',1 § `' §IW41 --. M f)Itl i( tAti Ee Rr..: f E0,4vaI op 34. 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I ' <42> 0 .411. . . • . . • • 1 Jefferson County DCD Building Division Correction Notice PERMIT NUMBER 14 - 006 4,A OWNER 604/114 JOB LOCATION 7/ L!jiCR{pDg,a-- LA) Inspection of this stru has found the following violations: kiO D D rJ NS Er cJs gT6rr / X114 M.z D& s ,IA✓d geE0 'Irr6iirEia,)6D You are hereby notified that no more work shall be done upon these premises until the above violations are corrected, unless noted otherwise. When corrections have been made, call for inspection. Date V/67/1 Inspector _ BUILDING DIVISION(360)379-4450 I •ECTION HOTLINE(360)379-4455 THIS NOTICE MUST BE KEPT WITH APPROVED PLANS ON SITE S Jefferson County Building Division Permit Number: BLD14-00063 Applicant: SMITH 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 days 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 Ali/kVA Erosion Control Foundation Footing A1 1 Footing Drains Foundation Stem Wall Underground Plumbing 141%-f 14, t4 Under Floor Framing Straps(hold downs) q i9 Ext.Shear Wall Nailing (1)y Rough-in Plumbing Q/fib/i ,p eV, Framing 9/Zq/t qq S t°vRRee-riO Blocking 4/lbit ge Airseal 7111/ Insulation:Walls l4 Insulation: Floors Olt ,ç, ;1,11s Insulation:Ceiling ?}l6/I Int.Shear Wall Nailing / 'L7 l �/ Wallboard Nailing Gas Line: Interior Gas Line:Exterior Propane Tank Heat/Chimney Clearance -b_415- Smoke&CO2 24.1s11/3- Drywell/Alt Drainage Address Posted System Finaled ` j • A final inspection will not be scheduled until all of the following are completed and signed off by the applicable Department: • Building Permit Conditions are met • Septic Permit Final/Complete for any building containing plumbing • Land Use Conditions met and signed off • Public Works Permit Final(where applicable) FINAL INSPECTION a T I 15 FINAL INSPECTION UST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR • • CONDITIONS for Building Permit# :BLD14-00063 1.) No plumbing has been reviewed or approved for this project by Jefferson County Public Health. Additional requirements may apply if plumbing is proposed. 2.) 10' minimum separation required between the water line and any onsite sewage system components including sewage transport lines. 3.) SEPTIC SYSTEM COMPONENT SETBACKS TO STORMWATER MANAGEMENT FACILITIES- Any interceptor/curtain drain or foundation drain, or any other source of water that is downgradient or below MUST be setback a minimum of 30'from any septic system dispersal area (drainfield) and 5' from any septic tanks. Splash blocks must be directed away from ALL septic components. Subsurface stormwater infiltration systems must be located a minimum of 10 ft. downgradient of the drainfield. 4.) 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. 5.) The site plan, as submitted with the building application on February 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 March 5, 2014 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 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.) dlf \\tidemark\data\forms\F_BLD_Permit_Bldg.rpt 3/11/2014 • BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD14-00063 Received Date: 2/21/2014 SITE ADDRESS: 71 CHICKADEE LN Issue Date 3/11/2014 QUILCENE, 98376 Expiration Date 3/11/2015 OWNER: CARL F SMITH PHONE: 360-765-3692 PO BOX 868 QUILCENE WA 98376-0868 QUILCENE BAY VISTA SUBDIVISION: Block: Lot: 7 PARCEL NUMBER: 701205007 Section: 20 Township: 27 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: PROJECT DESCRIPTION: Addition: first floor rec room to existing SFR attached garage, expanding footprint; expanding great room on second floor. TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP ADD MAIN: 480 VALUATION 116,404.00 ADD'L: 480 HEAT TYPE EEE 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 Type Amount Paid By: Date: Receipt: BEDROOMS: BATHROOMS: Permit $1,139.00 ZAL 02/19/14 145784 Exist: 2 Exist: 2 Plan Check $740.35 ZAL 02/19/14 145784 Prop: Prop: State Building Code $4.50 ZAL 02/19/14 145784 Total: 2 Total: 2 Total: $1,883.85 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