HomeMy WebLinkAboutBLD2018-00185 - 01 PERMIT APPLICATION?r,.rNG PERMTT APP.,"ot*BLD18-00185
Review Type:
3
3
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #:
SITE ADDRESS
OWNER:
SUBDIVISION:
PARCEL NUMBER:
BLD18-00185
272 Lexington Pl.
QUILCENE, 98376
SCOTLAND STROHM
PO BOX 441
QUILCENE WA 98376
702021028
Received Date: 411812018
PHONE: 760-315-6868
Block:
Section: 2 Township: 27 N Range: 2\
Lot:
CONTRACTOR:NIEMAN CONSTRUCTION CO
P. O. BOX 846
QUILCENE WA 98376-0846
PHONE: G60) 434-0717
Contractor's License NIEMACC0lSMZ Expires 811512018
PHONEREPRESENTATIVE:
PROJECT DESCRIPTION: NEW SINGLE FAMILY RESIDENCE, WITH ROOF TOP SOLAR PANELS
AND EXISTING 250 GAL. PROPANE TANK
sEP16-00080
TYPE OF WORK
TYPE OF IMP
VALUATION
CODE EDITION:
OCCUPANCY:
OCCUPANCY:
CONST TYPE:
CONST TYPE:
SQUARE FOOTAGE:
1,495
PRO
400
SEWAGE DISPOSAL
WATER SYSTEM:
RES
NEW
380,000.00
2015
l PWELL
BATHROOMS:
Exist:Prop: 2
Total: 2
MAIN:
ADD'L:
HEAT BASE:
UNHEATED:
OTHER:
GARAGE:
DECK:
Type
HEAT TYPE:
HEAT TYPE:
# OF STORIES
SHORELINE:
SETBACK:
BANK HEIGHT
Amount Paid By: Date: ReceiptBEDROOMS:
Exist:
Prop:
Total:
Approved/Date
APPIiTOVED
JUL t 5 20t8
Jefferson County DCD
Permit
Plan Check
Consistency Review
State Building Code
Scanning Fee
EH SEP/RES Rev
Potable Water Application
Total
3
3
$2,749.00
$1,786.85
$276.00
$4.50
$23.00
$134.00
$134.00
04118118
04118118
04118118
04118118
04118118
04118118
04118118
177952
177952
177952
177952
177952
177952
177952
SRE
SRE
SRE
SRE
SRE
SRE
SRE
$5,107.35
\\lidamarlz\rlala\fnrme\tr Rl l't Ann Qlri rnl al))lrn.1e
Prescriptive Energy Code co,nf,""for All Climate Zones in Washington
lnformation Contact
This prolect will use the rcquircments of the Prescriptive Path below and lncorporate the
the minimum values llsted. ln based on the slze of the appropriate
number of additional credits by
Authorized Representative
R402.1.3 Footnotes on
Table R406.2 Summary
TotalCredits
*Please refer to Table R406.2 for complete option descriptions
Date t/zqld
APR t82rl$
COUNIY Dco
(ET
trtr
trtrE,E
trtr
trgh'tr
trtr.1200 kwh 0.0
'0.30Fenestration U-Factorb
nla 0.50Skylight U-Factor
nlanlaGlazed Fenestration SHGCb'"
0.026Ceilingk49
21 int 0.056Wood Frame Walle'''n
0.05621/2fMass Wall R-Valuei
0.029Floor30s
10115121int + TB 0.042Below Grade Wall"''
nla10,2ft
dwelling unit !@!gg$A!-E!!!!!g sha!! comply with sufficient options
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 greater.than 500 square feet of heated floor area but less than 1500
square feet.
Medium Dwelling Unit: 3.5 credits
All dwelling units that are not inbluded in #1 or #3. Exception: Dwelling units serving R-2 occupancies shall
require 2.5 credits.
fl3. Large Dwelling Unit 4.5 credits
Dwelling units exceeding 5000 square feet of conditioned floor area
Table R406.2 so as to achieve
77oc'iDwelling Unit: 1.5 ctodits
minimum number of credits:
Additions lesa than 500 feet .5 credlts
0.5,.'1?Efficient Building Envelope 1a
1.01bEfficient Building Envelope 1b
2.01cEfficient Building Envelope 1c
0.5'1d Efficient Building Envelope 1d
0.52aAir Leakage Control and Efficient Ventilaton 2a
1.02bAir Leakage Control and Efficient Ventilation 2b
1.52cAir Leakage Control and Efficient Ventilation 2c
1.03aHigh Efficiency HVAC 3a
Hish Efficiency HVAC 3b3b
1.53cHigh Efficiency HVAC 3c
1.03dHigh Efficiency HVAC 3d
High Efficiency HVAC Distribution System 1.04
0.55aEfficient Water Heating 5a
5b Efficient Water Heating 5b 1.0
1.55cEfficient Water Heating 5c
0.55dEfficient Water Heating 5d
Renevlprble Electric Energy 0.56
3.5 t-\rnr3
0.00
1fiL1m fl)
R-Value"U-Factor'
nla
Slabd R-Value & Depth
1.0
For sl: l foot .= 304.8 mm, ci .= continuous insulatior, inl .= intermediate framing.
' R-values are minimums. U-factors and SHGC are maximums. When insulation is installed in a
less than the labelor design thickness of the insulation, the compressed R-value of the insulati
cavity which is
ion from
ix Table A101.4 shall not be less than the R-value specified in the table
The fenestration U-factor column excludes skylights. The sHGC column applies to all glazed fenestration.
"10/LS/lL.+TB" means R-10 continuous insulation on the exterior of the wall, or R-L5 on the continuous
ns u lation on the interior of the wa il,or R.2 1 cavity ns u lation pl us a thermal brea k betwe th slab nd heeneat
base m ent wal at the nte nor of the basem e nt wa il Lo/Ls/2 L,+TB shal be itted to be met with R-perm L 3
cavity tnsu latio n on the of the ba sement wa plu S R-5 co nti nu ous tnsu lation on the nteri o exterioror
th e wa t.t0l 13 means R-10 continu ous nsu lati o n on the nte nor or exterior of the h R 13omeor cavity
insu latio n at the inte nor of t he basem ent wa II ,'TB means the rma brea k betwee n floo r slab a nd basement
wal
d R-10 continuous insulation is required under heated slab on grade floors. See R402.2.9.1.
There are no SHGC requirements in the Marine Zone
Reserved.
s Reserved,
h Reserved.
i The second R-value applies when more than half the insulation is on the interior of the mass wall.
Reserved.
For single rafter- or joist-vaulted ceilings, the insulation may be reduced to R_3g.
Reserved.
'lnt' lintermediate framing) denotes standard framing 15 inches on center with headers insulated with aminimum of R-10 insulation.
" Nonfenestration U-factors shall be obtained from measurement, calculation or an approved source or asspecified in Section R402.1.3.
interior
o
Table 406.2
Ene Gredits 2015 C
o I
i
t
t.
It
APne
i\l
I /
-".n'&sP.S[Q erfo#etoa *WDESCRIPTIONtrb\1.5 -.v c )uArrfOCO
compliancc based on Scction R402.4.1.2: Rcducc the tcgted air lcakagc to L5 air
changcs po hour maxlmurn
rnd
All wholc house ventilation rcquircmcnts as dctcrmincd by secfion M1507.3 of thc
lnternadonal Residenttal code shall bc mct with a heat rccovcry vcntilation systrcm
with minimum ssnsiblc hoat rccovery cfficicncy of 0.E5,
To qualifi to claim this cr€diq thc building pomit drawings shall spccifl thc opti-9n
Ucing sctcctcd and shatl spccifl thc maximum tcstcd building air lcakage and shall
show thc heat
1.0
Gae, propanc or oil-fired fumacc with mininnrm AFUE of 94o/o, or
Gas, p'ropane or oiled'fircd boilcr with minimum AFI.JE of 92o/o
To qualifl to claim this crcdit, thc building permit drawings shall spccify thc option
bcing sclcctcd and shall spcciff the hcating cquipmcnt typc and thc minimum
AC
1.03b"
Air-sourcc heat pump with minimum HSPF of 9.0
To qualifl to ctaim this credit, fic building permit drawings shall specif the option
bcing sclected and shall sPcciry the hcating equipment type and the minimum
1.53co
Closcd-loop ground source hcrt pump; with a minimum COP of 3.3
or
Opor loop watcr sourcc hcat pump with a maximum pumping hydraulic hcad of 150
feet and minimum COP of3.6
To quali$ to claim this credit, thc building pcrmit drawings shall speclry thc option
being selectcd and shall specifl the hcating cquipmcnt typc and thc minimum
3c:
1,0
Ductlcss Split Sysrcm Hcat Pumps, Zonal Controll In homcs whcrc thc primary spacc
heating sysiem is zonal clcctric heating a ductlcss hcat pump syEtem shall bc installcd
and providc heating to thc largest zone of the housing unit.
To qualifl to claim this credit, thc building pcrmit drawingc shall spcci$ thc option
bcing gelectcd and shall spcciff the hcating cquipmcnt tyPe and thc minimum
HV,3do
1.0UHIGH EFFICIENCY HVAC DISTRIBUTION SYSTEM:
Alt hcating and cooling system components installed insidc ttrc onditioncd specc.
This includcs all equipmott and distibution systcm componcnts such as forccd air
ducts, hydronic piping, hydronic floor hcating loop, conYcctors and radiaton. All
combustion oquipmcnt shall bc dircct vent or scsled combustion.
For forccd air ducts: A maximum of 10 lincar fcct ofrctum ducts and 5 lincar fect of
*rpply ducts may be locatcd outsidc thc conditioncd spacc. All mctallic ducts located
ouliide th. conditioned spacc must have bottr tlaffivcrsc and longitudinal joinb sealed
with mastic. Ifflcx ducts arc uscd thcy cannot contain spliccs. Flcx duct conncctions
must bc madc with nylon $raps and installcd using a plastic strapping tcnsioning tool.
Ducts locatcd outsidc thc conditioned spacc must bc insulatcd to a minimum of R-8,
Locating system componcnts in conditioncd crawl spaccs is not pcrmittcd undcr this
option.
Elcctric rcsistancc hcat and duc.tlcss hcat pumps arc not pcrmittcd undcr this option.
Direct combustion hcating cquipmcnt with AFUE lcss than E0% is tlot pcrmittcd
under this option.
To qualiff to claim this crcdit, ftc building pcrmit drawingr shall upeciS the option
bcing sclcctcd and shall spccift thc hcating equipmcnt typc and shall chow thc
locstion ofthe hcating and coolinL
(J
3ao
eouioment efficiencv.
oo
Table 406.2
Ene Credits 2015 Code
OPTTON DESCRlPNON cRErxT(s)E.dmrbd Colt
la
Prcscriptivc connpliancc ffi!$ on Tablc R402.1.1 with thc fullowing rnodifications:Vcrtical fcncstration U {O.lg \FloorR.3E 'J
Slab on gradc R-10 paimeter and undcr cntirc slab
Bclow gradc slab R-10 pcrimeter and undcr cntir,c stab
or
a:
R402.1.4: Reduce Total UAbased on
5
Prcscriptive compliancc is bascd on Tablc R402.1 .l with thc following modifications:Vcdicsl fenestration U = 0.25
Well R-21 plus R-4
Floor R-3E
Bascmcnt wall R-21 int plus R-5 ci
Slab on gradc R-10 perimetcr and undcr entirc slab
Bclow gradc slab R-10 pcrimcter and undcr entire stab
1.4:bascd on Total UA
c
Preocriptive compliancc is based on Table R402. t.l with thc following rrodifications:
Vcrtical fcncstationU = 0.22
Cciling and single-raftcr orjbirt-vaultcd R-49 advanccd
Wood fame wall R-21 int plus R.l2 ci
Floor R-3E
Baserncnt wall R-21 int plus R-I2 ci
Slab on gradc R-10 pcrimctcr and undcr cntirc slab
Bclow gradc slab R-I0 pcrimctcr and undcr entire slab
or
thc 30%.Rlm2.1
on Table R402. I .l with ttrc following modifications:Prcrcriptive
U
on&402.4.1.2: Roduce thc testcd air lcakagc b 3.0 air changcs pcr
rnd
All wholc house wntilation requircmcnE as dctcrrnincd by scction M1507.3 of theIntenadonal Resldenttol 6dc shall be met with a high cfficiency ran lmaxinmm o.rswatEy'cfln), not interlocked with tlre flrnace fan. ven[tation systims uiing a furnaccincluding an ECM nrctor are atlowed, provided that ttrcy are contmuea to-opcrarc ailow s@ in ventilation only modc,
AND
To claimtoqualifr this thccrcdit,pcrmitbuilding shsil thedrawingsspccig option
andsclectcdbcing shall thc maxtmum tGstedspociff alr shallandbuildingleakago
show
Compliancc bascd
hour mrximum
rnd
All whole housr ventilation rcquirsmcnts 8s dctarnincd by section Ml5Oz'3 of thcIntematlonal Residential code sh8u bG mct Mth a hcat rccovcry ventilation systcmwith minimum scnsiblc hcat rccovcry cfficiency of 0.70.
bascd on Section R402.4. 1.2: Rcducc thc tested air lcakage to 2.0 air
hour maximum
Compliancc
changar pcr
To to claim thisqualifl credit thc shallbuildingdrawingspermit &espcciry option
ands€lectedbcing $all thc maximum testedspeciry atr andbuilding shalllcakage
hcatthe ventilation
AIR
1.0
2.0
ld'0.5
2a 0.5
2b I.0
Table 406.2
En Credits
O
2015 Code
o
APR t0Z0g
"UllllqlllcrtcREDTT(8)OPTION DEECruPNON
0.5 sLE5aEFFICIENT WATER HEATING 5A:
All showerhcad and kitchcn sink fauccr inctallcd in thc housc shall bc rated at 1.75
GPM or lcss. All other lavabry fauccts drall be rated at 1.0 GPM or less.c
To qualifr to claim this credit, trc building pcrmit drawings shall spccifr thc option
bcing sclected and strdl.spccifl the maximum flow rates for all showerhcads, kitchen
sink faucets, and other lavatory fiucets.
1.05bEFFICIENT WATER HEATING 5b:
Watcr hcating sptcm ahall includc onc of thc following:
Gag propanc or oil watcr hcater with a minimum EF of 0.74
or
Watcr hcatcr hcatcd by ground source hcat pump mcding the requirtmonts of Option
3c.
or
For R-2 occupancy, a ccntml heat pump water heator with an EF grcatcr than 2.0 that
would supply DHW to all thc units through a ccntral watct loop insulatd with R-8
minimum pipc insulation.
To quali$ to claim thir credit, thc building permit dnwingr shall spcc'ifl thc option
bcing rclectcd and ehall speciS thc watcr hcatcr cquipmcnt tlpc and the minimum
cquipmart cffcicncy,
1.55cEPFICIEI.IT WATER HEATING 5c:
Water hcating systcm shall includc onc of thc bllowing:
Gas, propane or oil water hcatcr with a minimum EF of 0,91
or
Solar watcr heating supplcmcnting a minimum etandard watcr hcatcr. Solar watcr
hcating will pnovidc a ratcd minimum savingr of 85 drcnns or 2000 kWh bascd on thc
Solar Rating and Ccrtification Corporation (SRCC) Annual Pcrformancc of OC-300
Certified Solar Watcr Heating Systems
or
Elecfic hcat pump watcr heater with a minimum EF of 2.0 and mecting the standards
of NEEA's Northern Climatc Spccifications for Hcat Pump Water Heatcrs
To qualiff to claim thir crcdit, thc building permit drawings shall specifl thc option
bclng rclectcd and ehall speciS thc water hoater cquipmcnt tyP€ and thc minimum
cquipmcnt cfEcicncy and, for solar watc,r hcating systcru, thc calculation ofthe
minimum cncrpy gavin$,
0.55dEFFICIE}.IT WATER HEATING 5d:
A dnin watcr heat rccovcry unit(s) shall be installcd, which capturrs wastc watcr hcat
frrom all thc showcrs, and has a minimum cflicicncy of 40% if installcd for cqual flow
or a minimum effrcicncy of52% ifinstalled for unequal flow. Such units shall bc
ratcd in accordancc CSA 855, I and bc ro labclcd.
To qualifr to claim this credit, thc building pcrmit drawings shall includc a plumbing
diagram that specified the drain watcr heat rccovery units 8nd thc plumbing laput
needed to install it and labels or othcr documentation sbdl be providcd that
d€monstrates that $e unit complics with thc standard,
t'i
*td'
I
'... :..oO
Table 406.2
Ene Credits 2015 Code
OPTION DESCruPNON cREDlr(S)Er$mrtrd Colt
6
For cach 1200 kwh ofclcctrical gcncration pcr cach housing rmit providcd urnually
by on-site wind or solar equipmcnt a 0.S cr*it shall Ue allowed, ui o I "r.ait ,
Gcneration shall be calculatcd as follows:
For solar clccfic systcmi, ttrc dcsig shall b€ demonshat€d tro meet this roquircment
using thc National Rcnewablc Enqgy Laboratory calollator pVWAfis.
Documentation noting solar acccss shall be includcd on thc plans.
Forwind generation projects designs shall documcnt annual powo gcncration based
on the following factors:
The wind turbinc power curve; avcragc annuat wind speed at 0re sitc; frcquancy
distribution ofthc wind spced at thc sitc and height ofthe tower.
To qualifr to claim this crcdit, the building permit drawings shall spcciff thc option
bcing selectcd and drall show the photovoltaic or wind turtinc quipmcnt typc,
pmvide documantation ofsolar and wind access, and include a calculation olthe
minimum annual cnergy power production.
RENEWABLE ELECTRIC ENERGY:0.5
o $tota-cotBs o
'!Wreb:
E -mail: dcd@co.ieffersorLwa.u s
Steps in the Permit Process:
-Review application checklist to ensure
-Make sure septic has been applied for
-Make an appointment to meet with the Permit Technician by calling 360-379-4/50.
-This is not a standalone application; it must be accompanied by a proiect specific supplemental application.
-Fees will be collected at intake. Additional fees may apply after review and payment is required before permit is issued.
For Department Use Only Building Permit #
MLA#Related #s:
oco
Site lnformation
I
Assessor Tax Parcel Number:
Access of street(s))from which access will be gained:
of Work (include proposed uses):
Present use of property:
{,v\)
Wastewater -
This property is served by Port Townsend or Port Ludlow sewer system?YES NO
lf not served sewer identified above,below:of
Case #:(
0
o
Are other residences connected to the septic system?
Additions or repairs to sewage system:
ls it a complete or partial system installation:
Has a reserve drainfield been designated?
Date of Last Operations & Maintenance check:
o
Complete
Yes \(
t-Describe or attach any drainfield easements, covenants or on title, which the property:
of Sewage System Serving Propefi:
Partial
No
Attach Urt r"port to application
Septic Septic Permit #:
Community Septic Name of System:
DEPARTMENT OF COMMLTNITY DEVELOPMENT
621 Sheridan Street, Port Townsend" V'A 98368
Tel: 360.379.4450 | Fax: 360.379.4451
PERMIT APn t8208
Site Address and/or Directions to Property:
o o
all correspondence. The County will mail
the owner noted
below. The authorized is responsible for communicating the
It is the ity of the authorized agent/representative and owner to (i.e.,
email is not or to
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 or her 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 making any issued permit null and void.
Ourner lnformation
Owner /d
E -ma ilAddress:
Property Owner:
with project info. (select only one)
Date:
Please
re:
Name:
Address:
Phone #:
Note: For attach a sheet with each information andwith
Name:
Address:
Phone #:E-mailAddress:
Professional:ls this an Authorized for this NO YES
Contractor
License #
ConsultantEngineer
Name:
Address:
Phone #:E-mailAddress
Surveyor
'a o
Professional:ls this an Authorized NO YES
Contractor
License #
ConsultantArchitectSurveyor
q ss / ttQ
Engineer
Name:
Address:
Phone #:)-&D- ? Bt'{ -(,E-mailAddress:b
Professional:ls this an Authorized for this YESNO
Engineer
Name:
Address:
Phone #:
Consultant
E-mailAddress:
Architect Surveyor Contractor
License #
Name , fcoT {rn*rm Date: 7 -2a^ I
tI
Applicant: Authorized Agent/Representative (ff drer than owner)
I
Agent/Representative for this project?
-o
,t2of2\DDh(
o o
DIIPARTMENT OF COMMUNITY I)
621 Sherid,"rn Strect, I)ofi'fi:rvnsencl, W;\ 98368
Tcl; 56()..)79.4.150 I lra-r: 36{).1179.4451.
\X,eb: _u,r1'.s,;;o-js:.rL.xsrxr.uals,i,e.orun:uup:rigvs:lgBa:-er:t
I-i - m a j i: eieql(ijs o. Lqf tcrs{ >n.w.i._,"r.
APR t s 20tE
PP
RhSINI{NTIAI,OR COMMHRCIAY, BI,[}G DCD
For Department Use Only Receipt #Date
Related ication #s ent #:
Enter the square footage (sq/ft) that a pplies in each field
Site Information
Owner Name Assessor Tax Parcel #
of Build
Relocated
Demolition _ *
tA separate permit is required
Modular Other I ist
New
Addition
Replacement
Repair
Select One:
Single Family Residence X
osed BuildinglProP ect
# new bedrooms r?
# new bathrooms L
existing
existing
Number of floors
L*
total bed
total bath
Heat Source
Heating Oil Wood Pro pa ne >
Select all that apply
Electric
Structure Existing Sq/Ft Proposed |q/Pt ICC Valuatioh (office Use)
Residential / Commercial Main Floor -Lfils ?l}?trq-
hesidential / Commercial Second Floor
Additional Floors - heated / unheated
Basement - unfinished
Basement - finished space or habitable
etached Garage - heated / unheated
Attached Garage - heated / unheated
Gara e 2nd fl - finished s ce or habitable
rt - 2 walls or less
Deck - uncovered furr qt TqqL
Covered porch
Other (shed, barn, pole bldg,etc.)
Estimated Cost of Project {Required): 5 3fi0,tt0,*t s \brUbv"u'
3t{5 tm,'ur/owl la"
.Garage 2nd fl - unfinished storage
o
List existi buildin on
est of his or her
app ti c
Building Permit Fees
Building Base
Plan Check Review
Land Use Review
Septic Review
Potable Water
Technology/Scan
State Fee
Other Fees
Shoreline Exemption
Zoning
Zoning
Other
New Address
Total Fees
APR I E zOIE
JEFFERgON COUNTY DCD
othe
Date
s2ss.oo
s12e.oo
$t72.oo
s21.oo
$4.s0
house accesso dwell uni shed ba rn mobile
result in making any issued permit null and void
Print Name
Builders Statement
The signer of this statement certifies that they are the Owners of the parcel referenced herein, that they are not licensed
contractors and that they will be assuming the responsibility of the General Contractor for the proposed project.
Signatu printName Darc, 3 //L//e
By signing this application form, the ow gent attests that the information provided herein, and in any attachments, is true and
Any material falsehood or any omission of a material fact made by the owner/agentcorrect to the b
with respect to
Signature
Use tAll Existing Buildings on Property
f,t r,t PS .fPpu A*s ?,nrs /l e+s,$lb vsr-*Ao'tzrmo?ilorrurrt r,f-MThtAl n:(t
For De t Use On
Receipt #Date:Cash/Check/CC:
,{oo r -(rR o&+,t'z'
,
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DEPARTMENT OF COMMUNITY D
621 Shcridan Street, Port'I'ownsend, WA 98368
'l' el: 360.37 9.4450 | Fax: 360.379.44.51
Web: www.co.iefferson.wa.us /communiwdevelooment
E--^il' dsd@p.isffwo,gra.gs ,t
I II
.\.,+ [qrdOwner Name:
Site Address:
Stroh "n 1cy-c:u-ozAParcel No.
91a Lenr"a+ o^ ? I . Q.,, t<'r rA/aJ
G'
o-@
!o-3t
{+Existing Proposed Attach Copies of:Water Source
Private well
2-Party Well
1) WellLogs
(if no log report on file, a t hr stabilization test may be substituted.)
2) Lab analysis tested within 3 years of application.
-Total Coliform, Nitrate-N, Chloride
Items above AND recorded Operations & Maintenance
agreement and recorded Easement.
Alternative
System:
Provide justification and design per Jefferson County
Environmental Health policy 97-01
www.jeffersoncou ntypublichealth.org/pdf/Policy_97-01_Rainwater_Collection.pdf
Valid Water Right
Permit:
Lab Analysis as required under private well above.
Generally applies to springs, attach copy.
Public Water:Name of Water Provider:
-Submit Water Availability Notification form completed by
your water purveyor.
NOTE: lf any of the above utilities need to be installed and disturbance will occur in a public maintained or
unmaintained County road and/or Right-of-Way easement, then a Right-of-Way application will be needed
Resolution f99-90 requires building permit applications to provide evidence of an adequate potable water supply per the conditions
of RCW 19.27.097 and the Guidelines for Determining Water Availobility for New Buildings.
By signing this application form, the owner/agent attests that the information provided hereln, 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 making any issued permit null and void.
I further agree to that all activities I intend to undertake or complete associated with this application will be performed in
compliance with all applicable federal, state and county laws and regulations and I agree to provide access and right of entry to
Jefferson County and its employees,
inspections. Applicant may request
representati ves e sole purpose of application review and any required later
of enter upon the property for visits related to this application
and subsequent tss n
Signature rint Name:Ro )tL oate :/er/r
FOR OFFICE USE ONIY
1) Water Right Permit #
2) Public Water Supply WS lD*
ln Compliance
3) lndividual Well
Meets Water Quality Standards?Yes No
Yes _ No _ WRIA 17 Subbasin
SIPZ -Coastal / Moderate / High
Based upon information provided by the applicant, it appears that the potable water supply:
Meets _ Conditionally Meets Does not Meet
Yes No
x
Supplcmental l)otablc Watcr I
o O
DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Strect, Pon -l'ownscnd, Wr\ 98368
-f el: 360.37 9.4450 | Fax: 360.37 9.4451
Web: wrvw.co.iefterson.wa. us / commurutydevelopment
E-mail: dcd6)co.iefferson.wa.us
WATER AVAII.ABILITY NOTIFICATION
PUBLIC WATER SYSTEM
TO: Jefferson County Environmental Health Department
FROM:(Water System Name)
System Operator:
State !D Number:
Total connections for which system is approved:
Number of service connections existing (in use):
Number of service connections committed:
Date and results of most recent water bacteriologica! analysis:
water system is capable
of and will supply potable water to the following location:
Assessor's Parcel lD#:
Lega! Description:
The
Site Address:
Operator Signature:
Datez I I
EXPIRATION DATE OF THIS SERVICE COMMITMENT: _J J _
Supplcmental l)otablc Water 2
o
WATER WELL REPORT
oilginal & lt copy - Ecology, 2nd"opy - o*ne., 3'd copy - drilter
Construction/Decommissio n ("x" i n circle)
Construction
Decommissio n O RIG I N.4 L IN STA LLATI O N
Notice of lntent Number
CURRENT
Notice of lntent No.wE27008
Unique Ecology Well ID Tag No. BIT832
Water fught PemritNo. N/A
Property Owner Name Scotland Strohm
Well Street Address 272 LexingtonPl
City Quilcene County Jefferson
LocationSW I l4-1l4NE ll4 Sec 2 Twn27N R 2W .wnr E Check
(s, t, r Still REQUIRED) #rg on"
Lat Mir/Sec
Long Min/Sec
Tax Parcel No. (Required)702021028
CONSTRUCTION OR DECOMMISSION PROCEDURE
Fomratiou: Describe by color, chracter, size of material md structure, md the kind md
nature ofore matedal in each sbatum penetrated, rvith at least one entry for each chugc
of infomatiou. (USE ADDITIONAL SHEETS tF NECESSARY.)
MATERIAL I FROM I ro
Boulders & top soil 0 28
Soft shale 28 260
Soft shale with hard layers, some H20 in layers 260 315
Basalt 315 325
n\]fiil/ffiTmTlTr rrm,h.lIIIflrll tllfl.tll \Y lE'
T(t-s Y'-q v {lplI\\t
I I 6r, t['
Ala
Start Date 5l5lt7 Cornpleted Date 6lt4l17
City, State, Zip POULSBO wA 98370
Contractor's
Registration po GRESHPD8TIB8
o
.:rE-
ECOLO6Y
Lat/Long Lat Deg
Long Deg
WELt CONSTRUCTION CERTIFICAfION: I constructed and/or accept responsibility for construction of this well, and its compliance with all Washington well
constructio; standards. Materials used and the infomration reported above are true to my best knowledge and belief.
[lDriller! Snglneer E Trainee Name (nint )JACK WILSON Drilling Conrpany GRESHAM PUMP AND DzuLLING INC
Driller/Engineer/Trarnee Sigaature Address P O BOX t600
Driller or trainee License No.2\62
IF TRAINEE: Driller's License No:
Driller's Signature:
@ Domesric E Industrial Etluicipal
Test Well
PBOPOSED USE:
DeWater
TYPE OF WORK: Owner's nmber of well (if more thm one)
trfl New well I Reconditioned Method
Jetted
flBored E D.ir"nDug
inches, dlilled ft.DIMEN5IONS: Dimeter of well
Ew"ta"a 6 " Dimr.frour +2 fr..,o !!=-- t
E lit", inrtal"a f3- " Dim from 5 ft. ,o 315 I
ft.ft. toTlreaded " Dian. From
CONSTRUCTION DETAILS
Casing
lnstalled:
ft.to 3SIZE ofperfs 1/8 iu. bY
Perforations:Yes No
Type ofpetfoEtor used Vertical
in. md no. of perfs 100 from 255
-
from
-ft.
to
-
ft.
Model No.
ft. to
I Y.,
ft. to
Aom ft.
ft.
!K-er" Location
No Size ofgravel/smd
Tvpe
Gravel/Filter ppcked:
Matedals placed from
Dim. Slot size
p16.
-
slot si"e
sceens: Iyes ElNo
Manufactuer's Nane
SurfaceSeal: I v"s I No Towhatdepth? l8 ft
Material used in ssal Bentonite chips
Did any strata contain uusable water? E y"t E Uo
Method ofsealing suata off
Type ofwater?Depdr ofstrata
PUMP: Mmufacturel, y*" Goulds
05GS05 Su H.P,Type:
WATER LEVELS: Lmd-surface clevation above mem sea Ievel
Staticlevel 255 ft.belowtopofwell Date
Artesian pressue-lbs. per squue inch Datc
Artesim water is controlled by
6t14il7
(cap, valve, etc.)
ft.
WELL TESTS: Drawdown is mrout water level is lowered below static level
Was a pump test made? E Yes I No If yes, by whom?
Yield: _ gal./min. with _ft. &awdorvn after
-[rs
Yield: _ gal.hin. with _ f,. drawdown after _ b*.
Yield: _ gal./min. with _ ft drawdorvn after
-
hrs.
Recovery dota (time taken as zetowhen pumP turned on (water level measured fromwell
top towatet level)
Time Water Level Tirne Water Level Time Water Level
Bailer Test D gal./miu. with 55 ft' dnwdown after 2 hrs
Artcsian florv
-
g.p.n. Date
-
Temperature of water- Was a chmical malysis made? f] Yes E No
Date oftest
hrs.Airtest with stem set at _ft. for
PersonsvithhearinglosscancallTllforllashingtonRelaySenice. PersonswithaspeechdisabilitycancallSTT-833-6341
nate 8/30/17
ECY 050-1 -20 (Ret 06/08) Ifyou need this clocument in an ahenate formal, please call the Waler Resources Progratn ql i60-40 7-6600.
I l\
I ltI ttr-.DLr ADDrornto
J=FFEhIS(.)N l1nr rr.rrl/ rr
ft.
Or*rarRA Laboratories - Kitsap LLt
26276TwelveTrees Larre, Suite C Poulsbo, WA 98370 Telephone (360)779-5141 FAX (360) 779-5150
IOC - SHORT
IOC - SHORT by Various EPA Approved Methods
Source / Point of Entry - Report of Analysis
Date Collected:
System ID No:
Lab - Sample #:
Sample Location:
Sample Purpose:
Sample Composition:
Send Report To:
8t23t2017
Private
0r0r3002
272 Lexington Pt
o
S
Scot Strohm
P.O. Box 441
Quilcene, WA 98376
Date
08t24117
08t24t17
*Confirmation: Include the original lab nurnber, sample number, and collection date of the original sample in the special instruction section.
SRL (State Reporting Level): The minimum reporting level required by the Washington State Department of Health (DOH).
Trigger Level: DOH drinking water response level. Regulated systems with compounds detected at concentrations in excess of this level nray be required to take
additional samples or monitor more frequently. Please contact your DOH drinking water regional office for further information.
MCL (Maximum Contaminant Level): If the contaminant amount exceeds the MCL, please contact your regional DOH office to determine follow-up actions if you are
a regulated system. Secondary MCL limits are established for aesthetic purposes and are not health based. Secondary
parameters are iron, manganese, silver, chloride, sulfate, zinc, conductivity, color and TDS.
NA (Not Analyzed): In the results column, indicates this compound was not included in the cunent analysis.
ND (Not Detected): In the results column, indicates this compound was analyzed and not detected at a level greater than or equal to the SRL.
< (0.00x): The compound was not detected in the sample at or above the concentration indicated (usually the lab method reporting limit).
mg/L: milligrams per liter or parts per million
NTU: nephelometric turbidity units (a measure of water clarity).
unthos/cm: Micro ohms per centimeter (a measure of the ability of the water to conduct electricity). One micro ohm per centimeter is equivalent to one micro siemen per
centimeter (uS/cnD.
--: iio existing trigger ur MCL value.
t
Group:
System Name:
County:
DOH Source No:
Date Received:
Date Reported:
Sample Type:
Collected By:
Phone Number:
Bitl To:
4P;l
\
dJ
/frq'qp$OrV
oco
II
Scot Strohm
Private
Private
Jefferson
8t23/2017
8t28/2017 t8g:8
couNrv
760-3 I 5-6868
Scot Strohm
P.O. Box 44 I
Quilcene, WA 98376
DOH#Analyte Flag Units SRLResults Trigger MCL MCt
Exceeded
Method
(Analyst lnit.)
20 Nitrate-N <0. I 0.5 5 t0
2t Chloride 52.5 20 250
EPA 300.0
EPA 300.0
l7ll30
o
:-:,'r':-; .iiON COUNTV DCD
:5*i,35*-l*P":#3:,i;5^'HlB
(360) 779-5t4t
COLIFORM BAGTERIA ANALYSIS
Jellereon
CountyTime Sample Collected
trAIM
_:
-
lPlvl
t
YearVontir Day
Type of Water System (check only one box)
E Group A ! GrouP B E other
Group A and Group B Systems - Provide from Water Facilities lnventory (WFl):
lD#
System Name
t] t'In1Contact Person.
Cell Phone: ( )Day Phone: ( )
Fax: ( )Eve. Phone
Email Address:
ll ?
ii
to: (Printand rnvorces
xL 4
full name, address and zip code)Send resullq
,":\.ht
Pt
n
Wett Hru4
re sample collected:
,(
til
Soecial instructions orL?Z L<
rinments:c0r
LT
Specific I
Sample
Type ol Sample (must check only one box of #1 through #5 listed below)
1. n Rouline Distribution Sample
Chlorinated: Yes_ No-
Chlorine Residual: Total
-
Free
-
Unsatisfactory routine collect date
2. Repeal Sample (A/P)
(from distribution system after unsat. routine)
Unsatisfactory routine lab number:
Chlorinated: Yes _No
-Chlorine Residual: Total- Free
-
3. Ground Water Rule Source SamPle
I Triggered (A/P)
! Assessment (tuP)
S
4. E Sur{ace or GWI Raw Source Water Sample (Enumeration)
A E.coli E Fecal Filtered Yes- No-
s
@ormationonty
Construction / Repairs
-
Private Residence
-
other
-
lnvestigative
LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY
Fsutist.rtoryE Unsatislactory Total Coliform Present and
A E. coti present tr E. coli absent
Replacement Sample Requesled/Flagged:
E Sample too old (>30 hours) ! TNTC tr
Bacterial Density Results: Total Coliform
-
/100m1' E'coli
-
l100ml
Fecal Coliform
-
/100m1. HPC-/1 ml
Reference Number
92238
Lab
t"
/boo
l
)
I
lnl
Recerpt Ternp C' (Raw Wate0biDate/Time 0ut lncubator
Remarks:D0H Lab-Samp le#I01o-j
Form 6)
Blue - Laboratory. White- DOH OlymPia Green - WateI Supplier Gold - DOH Begional
LP,: I S 2018
Date Sample Collected
P n-t
oattfff
I {CI?o
oo
DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street, Port Townsend, WA 98368
Tel: 360.379.4450 | Fax: 360.379.4457
Web: www.co.ie fferson.wa.us /communitvdevelooment
E-mail: dcd@)co.iefferson.wa.us
Name
Estimated Cost of Project
APR I I 2018
PERMIT FEES WORKSHEET
JEFFERSON COUNTY DCD
Scottland Strohm Parcel # 702-02L-O28
S345,8oo.oo Permit # NSFR
s5,107.35
Building Base Fees
Building Base
Plan Check Review
Land Use Review
Septic Review
Potable Water
Technology/Scan
State Fee
Other Fees
Shoreline Exemption
Zoning
Zoning
New Address
Public Works
Total Fees
52,749.00
s1,786.85
Szta,oo
s134.00
S134.oo
s23.00
s4.so
Receipt Number:
Cash/Check/CC:
Date:
lnitia ls:
r1 L
Office Use Only
(or?entMENT oF coMMrN
t>21 Sheridan Stt:eci, Port ili:wrrsend, !tA 98368
Tel: .160.3i9.-{450 | Fas: 360.379^4451
\\'u1'l: r',rv.;,'.co.ieIltr:son.rva.lrs i' comrnunirvdcvclt:nmctrt
li-rnail : d cd (g)cc,. j c f [e r:son.ua.irs
MECHANICAL PERMIT APPLI
Steps in the Permit Process:
-Review required submittal items to ensure all information is completed prior to submitting application
-Mechanical Permits can be mailed into our office-and do not require an appointment.
-Fees are due at time of submittal Mechanical ermits are nera issued within 5 business da
APR ,*"^"__* ,", *u
cATroN ouVy
{\ro
I
ls this application for use in a Mobile / Manufactured Home?
* lf Yes: A permit from Washington State Department of Labor and lndustries, E! Jefferson County, is
required for appliances installed within a mobile/manufactured home. L&l - 360-417-2702* lf No: Com lete this form and make an appointment to submit to Jefferson Cou Perm it Tech 360-379-4450
nt
Complete first page and signature block only of Mechanical Permit Application
A complete solar panel supplemental application.
Assessor t^*p"rr"lllu^A"r; 70 2 O 2 l rO 2. 7
a&'e^
access will be gained:
a t
I
Site Address a or Directions to Pro
Access (name of street(s) frorq whi
- /.or
D"r.r,pti"" otw;rl{. r-E;
E-mailAddress:
oe
L I
Name:
Address:
Phone #:
icantAppl I
Name:
Phone #:
License #:
E-mailAddress:
Expiration Date:
Mechanical Application 1
Required Submittal ltems - for propane tank only
General Site plan - showing propane tank, lines, and distance from tank to all existing structures.
Receipt #:Date:
#:
For Department Use Only
Related fs:
Site lnformation
Property Owner
i
w
f-u
6r
-tr
m
;p
3I
Electric Heating Oil Propane*Woodtl tr
t
Quantity Fixture Type
Fan Bath Fan andlor Exhaust Fan
Clothes Dryer Clothes Dryer with Exhaust Vent
Cook Stove Cook Stove, Range Hood Exhaust
Fireplace - Gas Fireplace-Gas or Gas Log lnsert
Fireplace - Wood Fireplace-wood, Wood Stove, or
Pellet Stove
Electric Furnace Electric Furnace or HP +l- Ducting
Propane (LP) Gas Furnace Propane Furnace +/- Ducting
Water Heater - Gas Gas WH Vent and Combustion Air
Gas Pipe System Gas Pipe System LPG/Oil
Propane Tank LP Fuel Tank (# gallons )
Heat Pump
Generator
Air Conditioner
*Propane is prohibited in
hazardous locations such as
basements or pits or
a nywhere " heavier-tha n-a ir"
gas can unsafely collect.
ne tanks over 125
required to accompa
application, and a separate
Fire Code approval is also
required.
plan ma
thesu
t
nrs
ion s
setba ane tank
over 500 gallo
a mtntmum
Installation manual must be on site at time of inspection or a
re-inspection fee wil! be charged.
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 making any issued permit null and void.
I further agree to that all activities I intend to undertake or complete associated with this permit will be performed in
, state and county laws and regulations and I agree to provide access and right
representatives or agents for the sole purpose of appl
of the County's intent to enter uponntrequest notice the property
SU permit issuance
Property
Sign ature:Print Name Date: {-lf -/7
ication review
*Additional fees may apply
MechanicalApplication 2
Heat Source -
Description
and its
OFFICE USE ONLY
Building Permit Fees
Mechanical Pefmit fee (tank swap, woodstove, furnace, roof -sotar panet, etc )$ra+.oo
Propane - Lines, tank, and appliance (add'l 592,00)
Project Scanning Fee $23.00
Total Fees*
o"DRN .to*BLD18-00185
Review Type:
,UILDING PERMIT APPLI
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
3
3
PERIVIT #:
SITE ADDRESS:
OWNER:
SUBDIVISION:
PARCEL NUMBER:
BLD18-00185
272 Lexington Pl.
QUILCENE,98376
SCOTLAND STROHM
PO BOX 441
QUILCENE WA98376
702021028
Received Date: 411812018
PHONE: 760-315-68684
Block
27N Range: 2\
Lot
Section: 2 Township
CONTRACTOR:
REPRESENTATIVE: Owrttf
NIEMAN CONSTRUCTION CO
P. O. BOX 846
QUILCENE WA 98376-0846
Contractor'sLicense NIEMACC0lSMZ Expires
PHONE: Q60) 434-0717
811512018
PHONE:
PROJECT DESCRIPTION: NEW SINGLE FAMILY RESIDENCE, wlTH ROOF TOP SOLAR PANELS
AND EXISTING 250 GAL. PROPANE TANK
sEPl6-00080
TYPE OF WORK
TYPE OF IMP
VALUATION
CODE EDITION:
OCCUPANCY:
OCCUPANCY:
CONST TYPE:
CONST TYPE:
SEWAGE DISPOSAL
WATER SYSTEM:
BEDROOMS:
Exist:
Prop: 3
Total: 3
RES
NEW
380,000.00
2015
l PWELL
BATHROOMS:
Exist:
Prop: 2
Total: 2
SQUARE FOOTAGE:
MAIN:
ADD'L:
HEAT BASE:
UNHEATED:
OTHER:
GARAGE:
DECK:
Type
1,495
400
HEAT TYPE:
HEAT TYPE:
# OF STORIES
PRO
SHORELINE:
SETBACK:
BANK HEIGHT:
Amount Paid By: Date: Receipt
Approved/Date
Permit
Plan Check
Consistency Review
State Building Code
Scanning Fee
EH SEP/RES Rev
Potable Water Application
Total
$2,749.00
$1,786.85
$276.00
$4.50
$23.00
$134.00
$134.00
04118118
o4118118
04118118
04t18t18
04118118
04118118
o4118118
177952
177952
177952
177952
177952
177952
177952
SRE
SRE
SRE
SRE
SRE
SRE
SRE
1 ?r-ill
V
- VnA^r1
A ,dstor
firt\ne
$5,107.35
SoLY&- o?
po,hil \ r
?
\\fidomark\dafa\fnrmc\F Fll 11 Ann Etld rnf alTrt)n.1A
w
oa
DEPARTMENT OF COMMUNITY
621 Sheddan Street, Port Townsend, !7i, 98368
T eL: 360.37 9.4450 | Fax: 360.37 9.4451
Web: www.co.iefferson.wa.us / communitydeveloPment
E-mail: dcd@co.i efferson.wa.us
STORM\TATER CALCUI.ATION WO
DETERMINING STORMWATER MANAGEMENT REQUIREMENTS: This stormwater calculation worksheet should be completed first to
classify the proposal as "small," "medium," ot "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.
Lond-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.
lmpervious surfdce is a hard surface that either prevents or retards the entry of water into the soil mantle as under natural
conditions prior to development. A hard surface area which causes water to run off the surface in greater quantities or at an
increased rate of flow from the flow present under natural conditions prior to development. Common impervious surfaces include,
but are not limited to roof tops, walkways, patios, driveways, parking lots or storage areas, concrete or asphalt paving, gravel roads,
packed earthen materials, and oiled, macadam or other surfaces which similarly impede the natural infiltration of stormwater.
pnorrcr/eppLtcnNT NAME:vn#
PARCEL SIZE (I.E.. SITE)
An acre contains 43,560 square feet. Multiply the acreage by this figure.
(f,oplo
aGres
sq/ft
Z ,6
Size of parcel in square feet
Size of parcel
)#, ,/r(cu/yd@af
native vegetation to pasture ?
Cut Fiil
sq/ft
sq/ft
sq/ft
lndicate Total Volumes of Proposed:
Well, utilities, etc.
Drainfield, septic tank, etc.
Lawn, landscaping, etc.Sota
/9a'o
Does the project convert 2 lz acres or more of
Answer the following two questions related to
conversion of native vegetation:
Does the project convert To acres or more of
native vegetation to lawn or landscaped areas?
Circle: Yes
Circle: Yes
eL<Hr
-
1no
Driveway, parking, roads, etc. 4e'o
"r,o
Calculate the total area to be cleared, graded, filled,
excavated, and/or compacted for proposed development
project. lnclude in this calculation the area to be cleared for:
construction site for structures [g?t
Other compacted surface, etc.
Total Land Disturbance
sq/ft
sq/ft
sq/ft
stormwater calc workshe€t - REV. 1A!U2O15
t6 206
LAND DISTURBING ACTIVITY. CONVERSION OF NATIVE VEGETATION. AND VOLUME OF CUT/FILL
@
ta-w
--l
oa
STORMWATER CALULATIONS - IMPERVIOUS SURFACE
TorAL NEW + TorAL ExrsnNG. i 0ict< ''
"q/ft
Total New
"This amount will be used to check total lot coverage.
4&oa sqft
4SAO so/ft-_--r-'
Total Existin g 1fffi sqtt
_sq/ft
-sq/ft
_sq/ft
Driveway, parking, roads, etc
Other
Driveway, parking, roads, etc
Other
NEW
Structures (all roof area)
Sidewalks
Patios
Solid Decks
(without infi ltration below)
EXISTING
Structures (all roof area)
Sidewalks
Patios
Solid Decks
(without infi ltration below)
----' sqlft
/ sqtft
DEVELOPMENT v. REDEVELOPMENT
Divide the total existinq impervious surface above by the size of the parcel and convert to a
Does the site have 35% or more of existinq impervious surface?
,O I
Circle:Yes
Th-^ 4^ll-^,,,i,^- -!,..^-+i^F-,,.;ll !-.--1,- -J^+^-*i*--..,L^{L^.,.L- .-.--.-----t .-.--:---r:- -,.--:,!-.,- -l -!-..-t- -iiic ii.jiiiJwiii6 qijcsiiijii5 wiii iici[j uetetiiairie wliEtilei riltr Ptopu5eu pioJcca. is LUlrsluereu oeveropment oI reoevetoPment.
FURTHER INSTRUCTIONS: lf the answer is yes, the proposal is considered redevelopment and the attached Figure 2 should be used
to determine the applicable Minimum Requirements. lf 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 lnstructions and Submittal
Template or prepare a Stormwater Site Plan using the step-by-step guidance in lhe Stormwater Manogement Manual.
APPLICANT SIGNATURE
By signing the Stormwater
best of my knowledge. I
I as the applicant/owner attest that the information provided herein is true and correct to the
this application is being made with the full knowledge and consent of all owners of the affected
prope
(OR REPRESENT,ATIVE srenarunr)
stormwater calc worksheet - REV. 1213A12015 2
f6?{ ,qfi,fu "r,o
fu sqft
Ze 7{ sqn
Olp Front Parcel Review I
Parcel 702021028
Printed: May 18, 2018
gLDrl-oo\.6s
uMk
SCOTLAND STROHM
PO BOX 441
QUILCENE, WA 98376
Site Address(es):
272 Lexington Pl. QUILCENE, WA 98376
Parcel Number: 702021028 S-T-R: 2-27N-2W
Legal Description 52T27 R2WTAX 35(TR 2-4 SURVEYVl3lP223)
Flood District: Fire District: 2
Flood Panel No:School District 48
Total Acreage 22
Land Use: 9800
PlanningArea:
Zoning:I I
COMP PLAN
DESIGNATION:
COMMUNITY PLAN:UGA:UGATrans
Plot plan states "property line"
ASSeSSOftS Map (Property lines on submitted plot plan must match the property lines as identified on the Assessor's l/4 map)H
RSl
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LegalAccess to Property YES
Parcel Tags or Scanned Documents
ESA's: Special YES
NO
YES
@
@
Designated Ag
CD
Wetlands: YES
Rare Plants:YES
Seismic: YES
4r''
@
6o
CD
NO
NO
NO
Landslide:Cl
Flood:
Erosion:
YES
€P
Coastal
DisconnectedCMZ
r!
Adjoining Forest Lands:CommerciaV
'Ht\
r>{
Mineral Lands:
Agricultural Lands:
Archaeology: YES
YES
YES
@ I
t>a- Stormwater: New Impervious
Stormwater Req's: Min Req #2
'?-r 6t1S Land DisturbingActivity -7l G 1t ESA's-
No ShootingZone: YES @
Notice
Landscaping Required: Yes
Parking Spaces Required No
Min Req #l thru #10 Engineering
tNt>ft{O other
Buildins Heisht: 35' UBC Standard
orest Lands_yEs__@_
RuraV___________I nho lding_
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Total Building (s) Size:
RVC: 20,000 SF CC: 5,000
Rural Indrll: Per UDC Sec 6.7
in Rural Industrial Lands only
Side: 5
& water constraints/None specifiedSF NC:7
Setbacks: Front:I Left Side: (
Shoreline Setback:
LSHA Setback:
N Road Classification:
RoadApproach: ExtsrING REQ'D RAP
SEPA Required: YES
Flood Certificate:
Existing Case(s) &
Violations: Yes
s)
Recorded Date of Subdivision:
Plat Conditions:
AFN
Lots/Require Declaration of Restricti 4""**t YESEI
UGANo ProtestAgreement YES submitted: YES
Site Visit conducted YES
Require Final Zoning Approval 8P
GC: 10,000 SF All others: subject to septic
ct
Over 5yrs:UDC
Conditions on plat or Old Ordinance
submitted: YES
NO
NO
ADMN: Setbacks entered in Permit Plan case N/A @
New Parcel Tags entered in Permit Plan YES
Special Reports Scanned@, YES
No parcel tags found for parcel
Cases Associated with APN 702021028 Review
Gases Name Tvpe Status
BLD16.OO487 STROHM F
Application Received: 1l/312016 Permit lssued/Case closed: 111312016 Case Finaled: lll7l20l7
@
NEW MECHANICAL - INSTAIISOO GAL. PROPANE TANK
BLD17.OOO37 STROHM
Application Received: 1/3012017 Permit lssued/Case closed: ll30l20l7 Case Finaled: 212312017
NEW MECHANICAL - INSTffiTWOOD STOVE
BLD18.OO185 STROHM
Application Received: 4l18l20l8 Permit lssued/Case closed:
IP
Case Finaled:
Planner
Kevin Hitchcock
F
NEW SINGLE FAMILYTESIE'ENCE, WITH ROOF TOP SOLAR PANELSAND EXISTING 250 GAL. PROPANE
TANK
sEP16-00080
CAM17-00050 STROHM NA P Emma Bolin
Application Received: 1130/2017 Permit lssued/Case closed: Case Finaled:
Q u esti o ns rega rd i n g wa-ler we-[@id I i nes
MLAl7-00016
ADR16-00068 MLA17-00016 STROHM F Anna Bausher
Application Received: 912012016 Permit lssued/Case closed: Case Finaled: 6123/2017
N EW ADDRESS / ROATN-AIVflI\tr-6
ROAD NAMEASSIGNED LEXINGTON PLACE, QUILCENE, WA
NEW ADDRESS ASSIGNED OF 272 LEXINGTON PL.
SEP16.OOO8O STROHM A
Application Received: 5123/2016 Permit lssued/Case closed: 7113/2016 Case Finaled:
usRl7-00016
Application Received: 3l15/2017
STROHM
Permit lssued/Case closed
A
Case Finaled:
\\tidem a rk\data\form s\R_Parcel_CRM LA. rpt 5t18t2018 Page 2 of2
a
Impervious Surface
Resource Lands & Public:
Rural Commercial: 600/o
Rural Residential: 25Yo
> Ir\fc
o a
Kevin Hitchcock
From:
Sent:
To:
Subject:
scot strohm <scot@ranchosuenos.com>
Tuesday, May 22,20187:46 PM
Kevin Hitchcock
Re: BLD18-00185
Hi Kevin,
I agree, the NW gutter should be redirected to the NE corner of the house. Please make the change as you
suggested .Thank you
Scot Strohm
760-3 1 5-6868
On 5l2tl2o18 2:30 PM, Kevin Hitchcock wrote:
Hi,
l'm reviewing the building permit application for 272 Lexington Street in Quilcene. I have a question
about the stormwater flow. There is a roof gutter downspout on the northwest corner of the home that
appears to be draining towards and through the house. All downspouts need to have a vegetated
flowpath and be directed away from the structure. lf the site topography is causing water flow to be
directed towards the house I would recommend not placing a downspout on that corner and instead
routing all of the gutters to drain to the eastern side only. Site plan attached.
Let me know how you want to proceed. You can resubmit a revised site plan or I can make a change to it
with your approval.
Thanks,
Kevin
Kevin Hitchcock
Assistant Planner
Jefferson County Department of Community Development
521 Sheridan St., Port Townsend, WA 93868
(360) 379-4462 I khitchcock@co.iefferson.wa.us
All e-mail sent to this address has been received by the Jefferson County e-mail system and is therefore subject to the Public
Records Act, a state law found at RCW 42.56. Under the Public Records law the County must release this e-mail and its contents to
any person who asks to obtain a copy (or for inspection) ofthis e-mail unless it is also exempt from production to the requester
according to state law, including RCW 42.56 and other state laws.
1
oo
Standard Conditions for Residentia! 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. ln no case, shall any such junk motor vehicles be stored in a critical
atea.
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.
lf 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
2013-03-07 SFR StdConditions 317/2OL3 1
oo
as causing harm, harassing, or damaging habitat for the listed species). ln addition, the National Marine
Fisheries Service can levy penalties. Portions of Jefferson County, including marine waters, are included
as "critical habitat" for a listed species. Development of property along any marine shoreline, freshwater
shoreline,
or floodplains could harm habitat if protective measures are not taken. To minimize the potential to
damage habitat, all property owners developing adjacent to marine shoreline, freshwater shoreline, or
floodplains are advised to do the following:
All development activities should avoid unstable slopes, wetlands, and forested areas near surface
waters
Remove minimal vegetation for site development, especially large trees
Allow trees that have fallen into surface waters to remain there
lnfiltrate 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.
22013-09-06_5 FR_StdCond itions s/6/2013