HomeMy WebLinkAboutBLD2015-00221 - 01 PERMIT APPLICATION BUILDING PERMIT APPLICATION BLD15-00221
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD15-00221 Received Date: 6/30/2015
SITE ADDRESS: ANCHOR LN.
OWNER: PORT LUDLOW ASSOCIATES LLC PHONE: 360-301-3179
70 BREAKER LN
PORT LUDLOW WA 98365-9766
9689- LUDLOW COVE DIVISION 2
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 968900020 Section: 17 Township: 28 N Range: 1 E
CONTRACTOR: PORT LUDLOW ASSOCIATES LLC PHONE: 360-437-2101
70 BREAKER LN
PORT LUDLOW WA 98365
Contractor's License PORTLAL994L8 Expires 5/2/2016
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION NSFR WITH ATTACHED GARAGE-
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 1,495
VALUATION 246,675.00 ADD'L: HEAT TYPE: EEE
CODE EDITION: 2012 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: SHORELINE:
RA
CONST TYPE: GAGE:CK: 190 SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: SEW
WATER SYSTEM: 68700
BEDROOMS: BATHROOMS:
Exist: 0 Exist:
Prop: 2 Prop: 2
Total: 2 Total: 2
Routing Date:
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $0.00 SRE 06/30/15 APPROVEDPlan Check $0.00 SRE 06/30/15
State Building Code $0.00 SRE 06/30/15 AUG 14 2015
Potable Water Application $0.00 SRE 06/30/15
Total: $0.00 Jefferson County DCD
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"GILDD BUBLD15-00221
ING PERMIT APPLICAN Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD15-00221 Received Date: 6/30/2015
SITE ADDRESS: ANCHOR LN.
OWNER: PORT LUDLOW ASSOCIATES LLC PHONE: 360-301-3179
70 BREAKER LN
PORT LUDLOW WA 98365-9766
9689- LUDLOW COVE DIVISION 2
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 968900020 Section: 17 Township: 28 N Range: 1E
CONTRACTOR: PORT LUDLOW ASSOCIATES LLC PHONE: 360-437-2101
70 BREAKER LN
PORT LUDLOW WA 98365
Contractor's License PORTLAL994L8 Expires 5/2/2016
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION NSFR WITH ATTACHED GARAGE-
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 1,495
VALUATION 246,675.00 ADD'L: HEAT TYPE: EEE
CODE EDITION: 2012 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: SHORELINE:
CONST TYPE: �ECRKAGE' 190 SE0 TBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: SEW
WATER SYSTEM: 68700
BEDROOMS: BATHROOMS:
Exist: 0 Exist:
Prop: 2 Prop: 2
Total: 2 Total: 2
Routing Date:
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $0.00 SRE 06/30/15
Plan Check $0.00 SRE 06/30/15
State Building Code $0.00 SRE 06/30/15
Potable Water Application $0.00 SRE 06/30/15
Total: $0.00
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• •
was°N �o DEPARTMENT OF COMMUNITY DEVELOPMENT
4 U 621 Sheridan Street,Port Townsend,WA 98368
--1 Tel:360.379.4450 1 Fax:360.379.4451 I� C a
Web:www.co.'efferson.wa.us communi -v- ..�,•
E-mail:dcd�a)co.jefferson.wa.us
N°� �l��i JUN 3 0 2015
PERMIT APPLICATION' LiEFFERsoN couNTY
I FPTTOF COMMUNITY DEVELOPMENT
Steps in the Permit Process:
-Review application checklist to ensure all information is completed prior to submitting application.
-Make sure septic has been applied for and water availability has been proven.
-Make an appointment to meet with the Permit Technician by calling 360-379-4450.
-This is not a standalone application;it must be accompanied by a project 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#
Related Application#s: MLA#
Site Information
Assessor Tax Parcel Number: 968900020
Site Address and/or Directions to Property: Property is located in the Ludlow Cove Subdivision on Lot 20
Access (name of street(s)) from which access will be gained: Paradise Bay Road,Anchor Lane
Present use of property: 9100-Vacant Land
Description of Work (include proposed uses):
Construction of a single family home with detached garage
Wastewater-Sewage Disposal
This property is served by Port Townsend or Port Ludlow sewer system? YES ✓ NO
— —
If not served by sewer identified above, identify type of septic system below:
Type of Sewage System Serving Property:
Septic Septic Permit#:
Community Septic Name of System: Case#:
Are other residences connected to the septic system?
Additions or repairs to sewage system:
Is it a complete or partial system installation: Complete Partial _
Has a reserve drainfield been designated? Yes No
— —
Date of Last Operations& Maintenance check: Attach last report to application
Describe or attach any drainfield easements, covenants or notices on title,which may impact the property:
I I
The authorized agent/representative is the primary contact for all project-related questions and correspondence. The County will mail
/e-mail requests and information about the application to the authorized agent/representative and will copy(cc)the owner noted
below. The authorized agent/representative is responsible for communicating the information to all parties involved with the
application. It is the responsibility of the authorized agent/representative and owner to ensure their mailbox accepts County email(i.e.,
County email is not blocked or sent to"junk mail").
Applicant/Property Owner Information
Property Owner:
Name: Port Ludlow Associates
Address: 70 Breaker Lane,Port Ludlow,WA 98365
Phone#: (360)437-2101 E-mail Address:
J Please contact Authorized Agent/Representative with project info. (select only one).
Property Owner Signature: Date:
Note: For projects with multiple owners,attach a sep ate sheet with each owner(s)information and signatures.
Applicant: Authorized Agent/Representative Of other than owner)
Name: Cliff OBrien
Address: 70 Breaker Lane, Port Ludlow,WA 98365
Phone#: (360) 301-3179 E-mail Address: cobrien@westharborhomes.com
Professional: Is this an Authorized Agent/Representative for this project? NO YES
Engineer Architect Surveyor Contractor 1 Consultant
Name: Port Ludlow Associates License# PORTLAL994L8
Address: 70 Breaker Lane, Port Ludlow,WA 98365
Phone#: (360) 301-3179 E-mail Address: cobrien@westharborhomes.com
Professional: Is this an Authorized Agent/Representative for this project? NO YES 1
Engineer ✓ Architect Surveyor Contractor Consultant
Name: Michael Anderson License#
Address: 330 Cleveland Street,Port Townsend,WA 98368
Phone#: (360)531-1011 E-mail Address: santiago2@cablespeed.com
Professional: Is this an Authorized Agent/Representative for this project? NO YES 7
Engineer Architect 1 Surveyor Contractor Consultant
Name: Union Studio License#
Address: 140 Union Street, Providence, RI 02903
Phone#: (401)272-4724 E-mail Address:
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.
I further agree to that all activities I intend to undertake or complete associated with this permit 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, representatives or agents for the sole purpose of application review and any required later inspections. Applicant may
request noticeof the County's intent_ to enter upon the property for visits related to this application and subsequent permit issuance.
Signature: �� '"7 v Print Name: Larry Smith Date: 06/30/2015
fermi[:1pp 6ca tion Parc 2 of 2
SON c-, DEPARTMENT OF COMMUNITY DEVELOP l
kf T621l:Sheridan360.379.4450 Street,Port Townsend,WA 98368 S C L V
T-14
eFax:360.379.4451 ---
^C Web:www.co.iefferson.wa.us/communitvdevelopment
E-mail:dcd@co.jefferson.wa.us I JUN 3 0 2015
43wi NCt�� SUPPLEMENTAL APPLICATION LJJEFFERSON
COUNTY
RESIDENTIAL OR COMMERCIAL BLDG_PERIMI MUNITYDEVELOPMENT
For Department Use Only Receipt#: Date:
Related Application#s: Payment#:
Site Information
Owner Name: Port Ludlow Associates Assessor Tax Parcel#: 968900020
Type of Building
New x Replacement Relocated
Addition Repair Demolition
*A separate permit is required
Select One:
Single Family Residence x Modular Other list
Proposed Building/Project
Number of floors 1 # new bedrooms 2 existing 0 total bed 2
# new bathrooms 2 existing 0 total bath 2
Heat Source
Select all that apply:
Electric x Heating Oil Wood Propane
Enter the square footage(sq/ft)that applies in each field:
Structure Existing Sq/Ft Proposed Sq/Ft ICC Valuation (Office Use)
Residential/Commercial Main Floor 0 1495
Residential/Commercial Second Floor 0 0
Additional Floors- heated/unheated 0 0
Basement- unfinished 0 0
Basement-finished space or habitable 0 0
Detached Garage- heated/unheated 0 260
Attached Garage- heated/ unheated 0 0
Garage 2nd fl - unfinished storage 0 0
Garage 2nd fl -finished space or habitable 0 0
Carport-2 walls or less 0 0
Deck- uncovered 0 16
Covered porch 0 174
Other (shed, barn, pole bldg,etc.) 0 0
Estimated Cost of Project (Required): $246,675 $
• •
List existing buildings on property (i.e. house,garage, accessory dwelling unit,shed, barn, mobile home,other):
All Existing Buildings on Property Use
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.
Signature: Print Name: Date:
By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and
correct to the best of his or her knowledge. Any material falsehood or any omission of a material fact made by the owner/agent
with respect to this application packet ay result in making any issued permit null and void.
Signature: �� �-✓ Print Name: Larry Smith Date: 06/30/15
For Department Use Only
Building Permit Fees
Building Base
Plan Check Review
Land Use Review $234.00
Septic Review $80.00
Potable Water $109.00
Technology/Scan $19.50
State Fee $4.50
Other Fees
Shoreline Exemption
Zoning
Zoning
Other
New Address
Road Approach
Total Fees
Receipt# Date: Cash/Check/CC:
MICHAEL I.ANDERSON
Civil Engineer a Land Surveyor
330 Cleveland Street
Port Townsend,WA 98368
MEMO
DATE: December 7,2015
TO: Jefferson County Community Development Department
Attention: Building Department
FROM: Michael J.Anderson
PE&PLS J•
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e
414
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/ �,! � `�
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EXP. DATE: 05 / 05 / 16
SUBJECT: Ludlow Cove Phase II
Project Architectural Plans by Union Studio
This is to certify that the following changes to the footing detail apply to all the approved
building permit plans for the subject development:
1. The formed key has been deleted from the plans and is not required.
2. The two(2)number 4 bars are sufficient for the footing typically shown as 1'8"wide
by 10"deep and consistent with the 2012 IRC.
Please attach this information into all the applicable
aapplicable fines.. Thanks for your consideration.
e: Port Ludlow Associates, Owner
p lor 0
LUDLOW COVE 2
BUILDING PERMITS
DECEMBER 7, 2015
LOT NUMBER APN PERMIT NUMBER
1 968 900 001 BLD14-00123
2 968 900 002 BLD14-00276
5 968 900 005 BLD15-00366
10 968 900 010 BLD15-00353
14 968 900 014 BLD15-00339
15 968 900 015 BLD14-00468
16 968 900 016 BLD15-00101
17 968 900 017 BLD15-00346
19 968 900 019 BLD15-00274
20 968 900 020 BLD15-00221
23 968 900 023 BLD15-00222
25 968 900 025 BLD15-00249
32 968 900 032 BLD15-00336
38 968 900 038 BLD14-00277
42 968 900 042 BLDI.5-00345
2012 Washington State Enereode: UA Alternative Worksheet, Type Occupancies
Zero_Energy Plans Version
Lot 20 Kingston (G6) Garage Left Waterfront D ! O ! Q v 1
Ludlow Cove Phase 2
Port Ludlow Associates LLC I I'�I,, . JUN 30 2015 {J
70 Breaker Lane u Ll!
Port Ludlow, WA 98365 Ll
JEFFERSON COUNTY 1
360-437-8242 I DEPT.OF COMMUNITY DEVELOPMENT
Contact: Cliff Obrien
Conditioned Floor Area 1,495
Conditioned Building Volume 13455
Weather Station Pon Townsend •i
Component Performance, R-3 occupancies Code Target Values
Area UA Area UA
Doors U = 0.300 113 34 113 26
Overhead Glazing U = 0.500 0 0 0 0
Vertical Glazing U = 0.300 224 67 253 76
FlatNaulted Ceilings U = 0.026 1,495 39 1,495 40
Wall (above grade) U = 0.056 1.514 85 1,485 85
Floors U = 0.029 1,495 43 1,495 37
Slab on Grade F = 0.540 0 0 0 0
Below Grade Wall U = 0.042 0 0 0 0
Below Grade Slab F = 0.570 0 0 0 0
Target UA Total 268 Proposed UA Total 264
Target Credits from Table 406.2 0.5 Proposed Credits from 1.5
Table 406.2
Qualifies
If the Proposed UA<_the Target UA, and the Proposed Credits From Table 406.2 are>_those required in Section R406.2 than
the home meets the 2012 WSEC.
Exterior Doors
Plan Component Door Width Height
ID Description Ref. U Qt. Feet inch Feet Inch Area UA
Therma Tru Classic Craft • Custom 0.23 1 6 ° 6 8 40 9
Therma Tru Smooth Star • Custom 0.14 1 3 ° 6 8 20 3
PlyGem Pro Series 960 HPSC Patio Door • Custom 0.27 1 7 6 7 ° 53 14
• ' Custom 0.00 0 0
• Custom 0.00 0 0
• 0 0.00 0 0
• 0 0.00 0 0
Copyright 2013,WSUEEP10-009(Version 11)Copied by permission from Washington State University Extension Energy Program. (see
copyright restrictions) 6/29/2015 1 of 6
2012 Washington State Ener ode: UA Alternative Worksheet, Type `Occupancies
Sum of Area and UA 113 26
Overhead Glazing:
Plan Component Glazing Width Height
ID Description Ref. U Qt. Feet Inch Feet Inch Area UA
v 0 0.00 0 0
• 0 0.00 0 0
• 0 0.00 0 0
• 0 0.00 0 0
• 0 0.00 0 0
Sum of Area and UA 0 0
Copyright 2013,WSUEEP10-009(Version 11)Copied by permission from Washington State University Extension Energy Program. (see
copyright restrictions) 6/29/2015 2 of 6
2012 Washington State Ener ode: UA Alternative Worksheet, Type fjOccupancies
Vertical Glazing
Plan Component Glazing Width Height
ID _ Description Ref. U Qt. Feet Inch Feet Inch Area UA
PlyGem 400 Series Single Hung HPSC • 0 0.30 12 2 8 5 ° 160 48
PlyGem 400 Series Single Hung HPSC V 0 0.30 5 2 8 4 2 56 17
PlyGem 400 Series Fixed HPSC • I 0 0.29 3 2 4 2 4 16 5
PlyGem 400 Series Fixed HPSC • 0 0.29 2 1 4 2 4 6 2
PlyGem 400 Series Fixed HPSC • 0 0.29 1 4 8 2 4 11 3
PlyGem 400 Series Fixed HPSC • 0 0.29 1 2 ° 2 D
4 1
• 0 0.00 0 0
• 0 0.00 0 0
V 0 0.00 0 0
• 0 0.00 0 0
• 0 0.00 0 0
I• 0 0.00 0 0
• 0 0.00 0 0
• 0 0.00 0 0
• 0 0.00 0 0
V 0 0.000 0
• 0 0.00 0 0
• 0 0.00 0 0
• 0 0.00 0 0
• 0 0.00 0 0
• 0 0.00 0 0
• 0 0.00 0 0
,I • 0 0.00 0 0
' • 0 0.00 0 0
'• 0 0.00 0 0
• 0 0.00 0 0
• 0 0.00 0 0
• 0 0.00 0 0
• 0 0.00 0 0
• 0 0.00 0 0
I• 0 0.00 0 0
• 0 0.00 0 0
• 0 0.00 0 0
• 0 0.00 0 0
• 0 0.00 0 0
• 0 0.00 0 0
• 0 0.00 0 0
• 0 0.00 0 0
• 0 0.00 0 0
• 0 0.00 0 0
V
0 0.00 0 0
Copyright 2013,WSUEEP10-009(Version 11)Copied by permission from Washington State University Extension Energy Program. (see
copyright restrictions) 6/29/2015 3 of 6
2012 Washington State Ener ode: UA Alternative Worksheet, Type Occupancies
• 0 0.00 0 0
• ' 0 0.00 0 0
• 0 0.00 0 0
• 0 0.00 0 0
• 0 0.00 0 0
• 0 0.00 0 0
• 1 0 0.00 0 0
• 0 0.00 0 0
• I 0 0.00 0 0
• 0 0.00 0 0
• 0 0.00 0 0
vl 0 0.00 0 0
• 0 0.00 0 0
• 0 0.00 0 0
Sum of Area and UA 253 76
Glazing Area Weighted U 0.299
FlatNaulted Ceilings
Plan Component Attic
ID Description Ref. U Area UA
R49 blown Attic STD baffled • 10-7 0.027 1,495 40
• Custom 0.000 0
• ! Custom 0.000 0
• Custom 0.000 0
Sum of Area and UA 1,495 40
Walls (Above Grade)
Plan Component Wall
ID Description __ Ref. U Net Area UA
R21 cavity+RO foam STD 2X6W Lap • 10-5 0.057 1,485 85
Custom 0.000 0 0
• l Custom 0.000 0 0
• Custom 0.000 0 0
Sum of Area and UA 1,485 85
Floor(over crawl or exterior)
Plan Component Floor
ID Description Ref. U Area UA
R38 vented Joist 16oc • 10-3 0.025 1,495 37
• 0 0.000 0
• l 0 0.000 0
Copyright 2013,WSUEEP10-009(Version 11)Copied by permission from Washington State University Extension Energy Program. (see
copyright restrictions) 6/29/2015 4 of 6
2012 Washington State Enerode: UA Alternative Worksheet, Type.Occupancies
V I 0 0.000 0
Sum of Area and UA 1,495 37
Slab on Grade(less than 2 feet below grade)
Plan Component Slab Slab
ID Description Ref. F Length UA
V I Custom 0.000 0
V 0 0.000 0
V 0 0.000 0
VI 0 0.000 0
Sum of Area and UA 0 0
Below Grade Walls and Slabs
Plan Component Wall Wall Wall Slab Slab Slab
ID Description Ref. U Area UA F Length UA
0 0.000 0.0 0.000 0
0 0.000 0.0 0.000 0
0 0.000 0.0 0.000 0
0 0.000 0.0 0.000 0
Sum of Area, Length and UA 0 0.0 0 0
Copyright 2013, WSUEEP10-009(Version 11)Copied by permission from Washington State University Extension Energy Program. (see
copyright restrictions) 6/29/2015 5 of 6
2012 Washington State Ener ode: UA Alternative Worksheet, Type•Occupancies
Table R406.2 Summary
Opt. Description
Credit(s)
1a Efficient Building Envelope la 0.5 ❑
1b Efficient Building Envelope 1b 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 V 1.0 ❑ 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 2 0.5
5b Efficient Water Heating 1.5 ❑
6 Renewable Electric Energy 0.5 3448 kWh ❑
Total Credits 1.5
*Please refer to Table R406.2 for complete option descriptions
Copyright 2013,WSUEEP10-009(Version 11)Copied by permission from Washington State University Extension Energy Program. (see
copyright restrictions) 6/29/2015 6 of 6
• •
Simple Heating System Size: Washington State
This heating system sizing calculator is based on the Prescriptive Requirements of the 2012 Washington State Energy Code(WSEC)and ACCA
Manuals J and S.This calculator will calculate heating loads only.ACCA procedures for sizing cooling systems should be used to determine cooling
loads.
The glazing(window)and door portion of this calculator assumes the installed glazing and door products have an area weighted average U-factor of
0.30. The incorporated insulation requirements are the minimum prescriptive amounts specified by the 2012 WSEC.
Please fill out all of the green drop-downs and boxes that are applicable to your project.As you make selections in the drop-downs for each section,
some values will be calculated for you.If you do not see the selection you need in the drop-down options,please call the WSU Energy Extension
Program at(360)956-2042 for assistance.
Project Information Contact Information
Lot 20-Kingston(G6)Garage Left Waterfront Port Ludlow Associates LLC '.x
Ludlow Cove Phase 2 ';� Cliff Obrien °: `
360-437-8242
Heating System Type: 0 All Other Systems ®Heat Pump
To see detailed instructions for each section,place your cursor on the word"instructions".
Design Temperature
Instructions — Design Temperature Difference(ST) 45
Port Townsend
A=Indoor(70 degrees)-OutdoorDesgn Temp
Area of Building
Conditioned Floor Area
err
Instructions Conditioned Floor Area(sq ft) 1,495
Average Ceiling Height Conditioned Volume
Instructions Average Ceiling Height(ft) 9.0 13,455
Glazing and Doors U-Factor X Area = UA
Instructions
0.30 337 101.10
Skylights U-Factor X Area = UA
natructions 0.50 0 ---
Insulation
Attic X Area = UA
Instructions
R-49 D.026 1,495 38.87
Single Rafter or Joist Vaulted Collin 93 U-Factor X Area UA
Instrucrx: s R-38 Vented ♦ 0.027 0
Above Grade Walls(see Figure 1) U-Factor X Area UA
Instructions R21Irtermedlate 0.056 1,485 83.16
Floors U-Factor X Area UA
Instructions
R-38 0.025 1,495 37.38
Below Grade Walls(see Figure 1) U-Factor X Area UA
InstructionsNo may Grade Walls In this project. 0 ---
Slab Below Grade(see noun.l) F-Factor X Len.th UA
Instructions ..--�
No Slab Below Grade in this project. ♦ ---
Slab on Grade(seeF-rouret) F-Factor X Length UA
Instructions No Slab on Grade In this project. ♦ --- 0
Location of Ducts
Instructions Duct Leakage Coefficient
0 No Ducts ♦
1,00
Sum of UA 260.51
Envelope Heat Load 11,723 Btu/Hour
Figure 1. Sum ofUAX AT
Air Leakage Heat Load 6,539 Btu/Hour
volume 0.6 XATX.O18
Above Grade Building Design Heat Load 18,262 Btu/Hour
Air Leakage+Envelope Heat Loss
Building and Duct Heat Load 18,262 Btu/Hour
Ducts in unconditioned space.'Sum or Building Heat Loss X 1.10
Ducts in conditioned space.Sum of Building Heat Loss X 1
Maximum Heat Equipment Output 22,827 Btu/Hour
Building and Duct Heat Loss X 1 40 for Forced Air Furnace
Building and Duct Heat Loss X 1.25 for Heat Pump
(07/01/13)
I
• •
r<?...$0N w DEPARTMENT OF COMMUNITY DEi PA _.I::�t
�,� 621 Sheridan Street,Port Townsend,W.1 98368 ,
Tel 360 379.4450 I Fax 360379 4451 JUN 3 0 2015
Wch:www.co.jeffcrson.wa.us/communitydevelopment w j
�. �� F.-mail:dcd a co.jeffcrson.wa.us
�SHI N CSC) OF COMMUNITY DEVJEFFERSON ELOPMENT
t __DEPT.
PERMIT FEES WORKSHEET
Name PLA Parcel# 968900020
Estimated Cost of Project $246,675.00 Permit#
Building Base Fees
Building Base $2,056.00
Plan Check Review $1,336.40
Land Use Review $234.00
Septic Review
Potable Water $170.00
Technology/Scan $19.50
State Fee $4.50
Other Fees
Shoreline Exemption $546.00
Zoning I
Zoning
New Address $234.00
Public Works
otal Fees $4,600.40
Use Only
` Number:
,ck/CC:
•
ON oG� DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street,Port Townsend,WA 98368
`U — Tel:360.379.4450 I Fax:360.379.4451
Web:www.co.iefferson.wa.us/communitydevelopment
E-mail:dcd@co.jefferson.wa.us
Ij� f1J N3 � c C c R V c
PERMIT APPLICATION
? Ijn JUN 3 0 2015
Steps in the Permit Process: L i
-Review application checklist to ensure all information is completed prior to submitting a(iplica
JEFFERSON EY
-Make sure septic has been applied for and water availabilityhas been proven. �___ DEPT OF COMMUNITY DEVELOPMENT
-Make an appointment to meet with the Permit Technician by calling 360-379-4450.
-This is not a standalone application;it must be accompanied by a project 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#
Related Application#s: MLA#
Site Information
Assessor Tax Parcel Number: 968900020
Site Address and/or Directions to Property: Property is located in the Ludlow Cove Subdivision on Lot 20
Access (name of street(s)) from which access will be gained: Paradise Bay Road,Anchor Lane
Present use of property: 9100 -Vacant Land
Description of Work (include proposed uses):
Construction of a single family home with detached garage
Wastewater-Sewage Disposal
This property is served by Port Townsend or Port Ludlow sewer system? YES ✓ NO
If not served by sewer identified above, identify type of septic system below:
Type of Sewage System Serving Property:
Septic Septic Permit#:
Community Septic Name of System: Case#:
Are other residences connected to the septic system?
Additions or repairs to sewage system:
Is it a complete or partial system installation: Complete _ Partial _ —
Has a reserve drainfield been designated? Yes _ —
No
Date of Last Operations& Maintenance check: Attach last report to application
Describe or attach any drainfield easements, covenants or notices on title, which may impact the property:
• •
The authorized agent/representative is the primary contact for all project-related questions and correspondence. The County will mail
/e-mail requests and information about the application to the authorized agent/representative and will copy(cc)the owner noted
below. The authorized agent/representative is responsible for communicating the information to all parties involved with the
application. It is the responsibility of the authorized agent/representative and owner to ensure their mailbox accepts County email(i.e.,
County email is not blocked or sent to"junk mail").
Applicant/Property Owner Information
Property Owner:
Name: Port Ludlow Associates
Address: 70 Breaker Lane, Port Ludlow,WA 98365
Phone#: (360)437-2101 E-mail Address:
✓— _ 2 Please contact Authorized Agent/Representative with project info. (select only one)/ //Property Owner Signature: H7\ Date: 5
Note: For projects with multiple owners,attac a separate sheet with each owner(s)information and signatures.
Applicant: Authorized Agent/Representative(if other than owner)
Name: Cliff OBrien
Address: 70 Breaker Lane, Port Ludlow,WA 98365
Phone#: (360) 301-3179 E-mail Address: cobrien@westharborhomes.com
Professional: Is this an Authorized Agent/Representative for this project? NO YES ✓
Engineer Architect Surveyor Contractor ✓ Consultant
Name: Port Ludlow Associates License# PORTLAL994L8
Address: 70 Breaker Lane,Port Ludlow,WA 98365
Phone It: (360) 301-3179 E-mail Address: cobrien@westharborhomes.com
Professional: Is this an Authorized Agent/Representative for this project? NO YES ✓
Engineer 7 Architect Surveyor Contractor Consultant
Name: Michael Anderson License#
Address: 330 Cleveland Street,Port Townsend,WA 98368
Phone#: (360)531-1011 E-mail Address: santiago2@cablespeed.com
Professional: Is this an Authorized Agent/Representative for this project? NO YES
Engineer Architect 1 Surveyor Contractor Consultant
Name: Union Studio License#
Add ress: 140 Union Street,Providence, RI 02903
Phone#: (401) 272-4724 E-mail Address:
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.
I further agree to that all activities I intend to undertake or complete associated with this permit 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, representatives or agents for the sole purpose of application review and any required later inspections. Applicant may
request noticeof the County's intent to enter upon the property for visits related to this application and subsequent permit issuance.
Signature:c j '7/ ""► ' Print Name: Larry Smith Date: 06/30/2015
Pcrmrz\pphcation P;g*c 2 of 2
s •
��sySON coy DEPART621 Sheridan rMENT OF COMMUNITY DEVELOP 7•eet,Port Townsend,WA 98368 L_
CEIWIE
W Tel:360.379.4450 I Fax:360.379.4451 D I 1
-< Web:www.co.jefferson.wa.us/communitydevelopment { I
E-mail:dcd@uico.jefferson.wa.us 1 n i ! JUN 3 0 2015 I
I S�
�ISHI NG. .O SUPPLEMENTAL APPLICATIONi
JEFFERSON COUNTY
RESIDENTIAL OR COMMERCIAL BLDG 1 RABT COMMUNITY DEVELOPMENT
For Department Use Only Receipt#: Date:
Related Application#5: Payment#:
Site Information
Owner Name: Port Ludlow Associates Assessor Tax Parcel#: 968900020
Type of Building
New x Replacement Relocated
Addition Repair Demolition *
*A separate permit is required
Select One:
Single Family Residence x Modular Other list
Proposed Building/Project
Number of floors 1 # new bedrooms 2 existing 0 total bed 2
# new bathrooms 2 existing 0 total bath 2
Heat Source
Select all that apply:
Electric x Heating Oil Wood Propane
Enter the square footage(sq/ft)that applies in each field:
Structure Existing Sq/Ft Proposed Sq/Ft ICC Valuation (Office Use)
Residential/Commercial Main Floor 0 1495 I 1pilJ 1411 - }C---
Residential/Commercial Second Floor 0 0
Additional Floors- heated/unheated 0 0
Basement- unfinished 0 0
Basement-finished space or habitable 0 0
Detached Garage- heated/ unheated 0 260 1 2.-t0S • Uv
Attached Garage- heated/unheated 0 0
Garage 2nd fl- unfinished storage 0 0
Garage 2nd fl-finished space or habitable 0 0
Carport- 2 walls or less 0 0
Deck- uncovered 0 16 3!- -
Covered porch 0 174 34 5 2_ I So
Other(shed, barn, pole bldg,etc.) 0 0
Estimated Cost of Project (Required): $246,675 $ I $ '1j 11-1- 7'U°
i •
List existing buildings on property(i.e. house, garage,accessory dwelling unit, shed, barn, mobile home, other):
All Existing Buildings on Property Use
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.
Signature: Print Name: Date:
By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and
correct to the best of his 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.
Signature: v� �/ ) Print Name: Larry Smith Date: 06/30/15
For Department Use/rOnly
Building Permit Fees
Building Base Ds(Q ' O0
Plan Check Review �
317 .L# 0
Land Use Review $234.00
Septic Review $80.00
Potable Water $109.00
Technology/Scan $19.50
State Fee $4.50
Other Fees
Shoreline Exemption 51-41,'°
Zoning
Zoning
Other
New Address 234 c7 °
Road Approach
Total Fees
Receipt# Date: Cash/Check/CC:
,
Parcel Details4111/ • Page 1 of 2
9' Jefferson County
,r,R = s S
,yo-
II �� H e �County Info ��Departments arch
, I
Parcel Number: 968900020 SEARCH
Parcel Number: 968900020 Printer Friendly
Owner Mailing Address:
PORT LUDLOW ASSOCIATES LLC
70 BREAKER LN
PORT LUDLOW WA98365-9766
Site Address:
Section: 17 School District: Chimacum (49)
Qtr Section: NE1/4 Fire Dist: Port Ludlow (3)
Township: 28N Tax Status: Taxable
Range: 1E Tax Code: 0231
Planning area: Port Ludlow (7)
Sewer: Drainage: PLDD - YES
Bank: View 1:
View 2: Zoning 1:
Zoning 2: Zoning 3:
Sub Division: 9689 - LUDLOW COVE DIVISION 2
Assessor's Land Use Code: 9100 - Vacant Land
Property Description:
LUDLOW COVE DIVISION 2 LOT 20
Sales, Photos, and
Tax, A/V.
No Permit Data Bldg Data Map Parcel No records
Available returned. j
� e Cpjt HOME I COUNTY INFO I DEPARTMENTS I SEARCH
Best viewed with Microsoft Internet Explorer 6.0 or later
Windows- Mac
http://www.co.jefferson.wa.us/assessors/parcel/parceldetail.asp?value=968900020 6/30/2015
• •
Jefferson County Permit Center
621 Sheridan Avenue
Port Townsend, WA 98368
SEWER AVAILABILITY NOTIFICATION
RE: Lot 20, Ludlow Cove 2
TPN 968900020
To Whom It May Concern:
Olympic Water and Sewer, c. will i rovide urrentl i rovides domestic sewer service to one
single family residence at the .ove refe ed lot.
b/ /i5
LarryTS) . 11 Date
President
Olympic Water and Sewer, Inc.
70 Breaker Lane
Port Ludlow, WA 98365
• •
JEFFERSON COUNTY PERMIT CENTER
621 SHERIDAN ST.
PORT TOWNSEND WA 98368
(360) 379-4450
WATER AVAILABILITY NOTIFICATION
PUBLIC WATER SYSTEM
TO: Jefferson County Environmental Health Department
FROM: Water System Name OLYMPIC WATER& SEWER, INC.
System Operator OLYMPIC WATER & SEWER, INC.
State ID Number 68700L
Total Connections for which system is approved 2,169
Number of service connections existing 1,543
Number of service connections committed 1,543
Date and results of most recent water bacteriological analysis
June 2015 = SATISFACTORY
OLYMPIC WATER AND SEWER, INC; water syst will provid / currently provides potable
water service at the following location:
Assessors Parcel ID 968900020
Legal Description Lot 20, Ludlow Cove 2
Site Address
Operator Signature V �l "'
1,7
Date June 30, 2015
II
�sOv �� DEPARTMENTOFC MMUNITY DEVELOPMENT
� l Sheridan Street,Port Townsend, 98368
Te1:360.379.450Fax:360.379. 451 �E
C E Q V
E� I
-< Web:www.co.jefferson.wa.us/communitydevelopment JN� E-mail:dcd@co.jefferson.wa.us 302015
s11i NO 0 1
SUPPLEMENTAL APPLICATION U'dDETERMINATION OF ADEQUATE POTABLE ,7'.._,A, FFERSONC0UNnLOPM
"EPI.OF COMMUNITY DEVFrNT j
Owner Name: Port Ludlow Associates Parcel No. 968900020 Q
as
Site Address: Lot 20, Ludlow Cove ro
It
Water Source Existing Proposed Attach Copies of:
1) Well Logs
Private well (if no log report on file,a 1 hr stabilization test may be substituted.)
2) Lab analysis tested within 3 years of application.
-Total Coliform, Nitrate-N,Chloride
2-Party Well Items above AND recorded Operations& Maintenance
agreement and recorded Easement.
Alternative Provide justification and design per Jefferson County
System: Environmental Health policy 97-01
www.jeffe rsonco u ntyp u blichealt h.org/pdf/Pa licy_97-01_Ra i n water_Collection.pdf
Valid Water Right Generally applies to springs,attach copy.
Permit:
Public Water: Name of Water Provider: Olympic Water&Sewer Inc
-Submit Water Availability Notification form completed by
your water purveyor.
NOTE: If 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#99-90 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 Availability for New Buildings.
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 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, representatives or agents for the sole purpose of application review and any required later
inspections. Applicant may request notice of the County's intent to enter upon the property for visits related to this application
and subsequent permit issuance.
Signature: /�Print Name: Cliff OBrien Date: `-P 3c7 '<----
FOR OFFICE USE ONLY
1) Water Right Permit 4* 3)Individual Well
2)Public Water Supply WS ID# Meets Water Quality Standards? Yes No
In Compliance Yes No WRIA 17 Subbasin
SIPZ -Coastal/Moderate/High Yes No
Based upon information provided by the applicant,it appears that the potable water supply:
Meets Conditionally Meets Does not Meet
II •
.
4.4oN coU DEPARTMENT OF COMMUNITY DEVELOP�1{ ,-
621 Sheridan Street Port Townsend WA 98368
-I, 621
Tel:360.379.4450 Fax:360.379.4451 '!�� ) JUN 0 ;01 i
�v�5I )
Web:uulv.co.Jefferson.wa.us/communitydevelopment
H i'' '
E-mail:dcdCa.co.jefferson.wa.us i JEFFERSO coy Y
l`s/I1 N C)r D1-Pi OF COMML'nITY DBIEIOPPj
ENT
STORMWATER CALCULATION WORKSHEET
MLA# 07-00593 PROJECT/APPLICANT NAME: Lot 20 Ludlow Cove/Port Ludlow Associates
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 '15 acres An acre contains 43,560 square feet. Multiply the acreage by this figure.
Size of parcel in square feet 6706 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:
1786 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. 0 sq/ft Circle: Yes No
Well, utilities,etc. 0 sq/ft Does the project convert 2'/acres or more of
native vegetation to pasture?
Driveway, parking, roads, etc. 500 sq/ft
Circle: Yes No
Lawn, landscaping, etc. 4420 sq/ft
Other compacted surface, etc. O sq/ft Indicate Total Volumes of Proposed:
Total Land Disturbance 6706 sq/ft Cut 0 Fill 0 (cu/yd)
Impervious surface is a hard surface that either prevents or retards the entry of water into the soil mantle as under natural
conditions prior to development. A hard surface area which causes water to run off the surface in greater quantities or at an
increased rate of flow from the flow present under natural conditions prior to development. Common impervious surfaces include,
but are not limited to roof tops, walkways, patios, driveways, parking lots or storage areas, concrete or asphalt paving,gravel roads,
packed earthen materials, and oiled, macadam or other surfaces which similarly impede the natural infiltration of stormwater.
stormwater calc worksheet—REV.10/20/2014 1
• •
STORMWATER CALULATIONS—IMPERVIOUS SURFACE
NEW EXISTING
Structures (all roof area) 1786 sq/ft Structures (all roof area) sq/ft
Sidewalks sq/ft Sidewalks 0 sq/ft
Patios 0 sq/ft Patios 0 sq/ft
Solid Decks 174 sq/ft Solid Decks 0 sq/ft
(without infiltration below) (without infiltration below)
Driveway, parking, roads, etc 0 sq/ft Driveway, parking, roads, etc sq/ft
Other 0 sq/ft Other 0 sq/ft
Total New 1960 sq/ft Total Existing 0 sq/ft
TOTAL NEW+TOTAL EXISTING* 1960 sq/ft *This amount will be used to check total lot coverage.
The following questions will help determine whether the proposed project is considered development or redevelopment.
DEVELOPMENT v. REDEVELOPMENT
Divide the total existing impervious surface above by the size of the parcel and convert to a percentage: 29
Does the site have 35% or more of existing impervious surface? Circle: Yes I• I No
FURTHER INSTRUCTIONS: If the answer is yes, the proposal is considered redevelopment and the attached Figure 2 should be used
to determine the applicable Minimum Requirements. If the answer is no, the proposal is considered new development and the
attached Figure 1 should be used. At this juncture, the applicant should refer to the applicable Flow Chart to determine the
Minimum Requirements for stormwater management. DCD staff will help verify the classification of the project and the application
requirements.
For proponents of "small" projects who must comply only with Minimum Requirement #2—Construction Stormwater Pollution
Prevention—an additional submittal is not required. The proponent is responsible for employing the 12 Elements to control erosion
and prevent sediment and other pollutants from leaving the site during the construction phase of the project. Pick up the
Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet. Proponents of "medium"
projects—those that must meet only Minimum Requirements#1 through #5—and for "large" projects—those that must meet all 10
Minimum Requirements—are required to submit a Stormwater Site Plan. DCD has prepared a submittal template of a Stormwater
Site Plan, principally for rural residential projects. Complete the template in the Stormwater Site Plan Instructions and Submittal
Template or prepare a Stormwater Site Plan using the step-by-step guidance in the Storm water Management Manual.
APPLICANT SIGNATURE
By signing the Stormwater Calculation Worksheet,I as the applicant/owner attest that the information provided herein is true and correct to the
best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all owners of the affected
property.
6/30/15
(LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE)
FOR OFFICE USEONLY-
SMALL MEDIUM LARGE REDEVELOPMENT Stormwater Site Plan: Yes No
stormwater calc worksheet—REV.10/20/2014 2
•
441-
Gray &r sborne, Inc.
CONSULTING ENGINEERS
E
July 21, 2015 C ll v
JUL 2 4 2015 lb
Mr. David Wayne Johnson J 1
JEFFERSON COUNTY
Planner Dm OF COMMUNITY DEVELOPMENT
Jefferson County Department of Community Development
621 Sheridan Street
Port Townsend, Washington 98368
SUBJECT: SITE PLAN REVIEW, BUILDING PERMIT
APPLICATION BLD15-00221, LOT 20, LUDLOW COVE II
SUBDIVISION
PORT LUDLOW DRAINAGE DISTRICT, JEFFERSON COUNTY,
WASHINGTON
G&O #14559.00
Dear Mr. Johnson:
Thank you for the opportunity to review the Master Permit Application and Stormwater
Calculation Worksheet for the proposed single-family residential structure on Lot 20
(Permit BLD15-00221) in the Ludlow Cove II Subdivision. We have the following
comments regarding the information provided:
1. Stormwater Calculation Worksheet
a. The table titled"Land Disturbing Activity, Conversion of Native
Vegetation and Volume of Cut/Fill"requires correction.
b. The "Construction site for structures"totals 1,929 square feet
(House— 1,495 square feet, Garage—26 square feet, Covered
Porch— 174 square feet).
c. The amount of lawn/landscaping is 4,261 square feet.
d. The table titled"Stormwater Calculations—Impervious Surface"
requires corrections as shown on the attached Stormwater
Calculation Worksheet. The total new plus total existing
impervious surface is 2,145 square feet.
701 Dexter Avenue N. Suite 200 Seattle, Washington 98109 (206) 284-0860 Fax (206)283-3206
! Printea on recpcletl paper
• •
Mr. David Wayne Johnson
July 21, 2015
Page 2
e. The table titled "Development v. Redevelopment"requires
correction. There is no existing impervious surface; therefore, the
percentage of the parcel covered by impervious surface is 0. The
site does not have more than 35 percent existing impervious
surface.
f. The project is New Development, not Redevelopment, since the
existing amount of impervious surface is 0. The Figure 1 flow
chart must be followed to determine the minimum requirements
that should be applied to the project. According to Figure 1 (see
attached)this project should be required to comply with Minimum
Requirements#1 through#5 since the project will result in the
installation of more than 2,000 square feet of new impervious hard
surfaces.
2. Site Plan
a. Minimum Requirement#2 requires Construction Stormwater
Pollution Prevention(S WPP)measures. The site plan should
indicate the nature and location of erosion control measures that
will be employed to prevent discharge of sediment to the
downstream storm collection system and Ludlow Bay.
b. Minimum Requirement#5 requires On-Site Stormwater
Management BMPs meeting the Low Impact Development BMPs
included in List 1 (Ecology 2012 Manual, Volume I,page 2-30).
The site plan must indicate how these requirements will be met.
List#1 includes the use of full dispersion(BMP T5.30), full
infiltration (BMP T5.10A), rain gardens, downspout dispersion
systems, or perforated stub-out connections for management of
roof runoff. The site plan indicates that stormwater collected in the
footing drains and presumably the roof drains will discharge to dry
wells for infiltration. For dry wells to function properly,they
require the appropriate soils and a minimum of 1 foot of separation
between the bottom of the dry well (minimum depth of the dry
well is 4 feet) and the seasonal high groundwater level or
impermeable soil layer. These conditions are most likely not
available adjacent to Ludlow Bay; therefore,the proponent should
propose, and provide a design for, an alternative approved method
for on-site stormwater management.
Printed on recycled paper
...-
•
• •
1
��ft-`�N Coy DEPARTMENT OF COMMUNITY DEVELOPMENT - `'
G21 Sheridan Street,Port.Townsend,W A 98368 ti) {
' Tea 36,t�'"94W Fax 363379.4451 j
ttie1J w�iuc �c£t w u i 7
1 -sal:dCdf co f' o va.us I
�f I4�R piJ lV�}��.1 . ' . YV;_ i'. ...,,.,....J
1
STORMWATER CALCULATION WORKSHEET
MLA 1f 07-00593 PROJECT/APPLICANT NAME: Lot 20 Ludlow Cove/Port Ludlow Associates
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 '15 acres An acre contains 43,560 square feet. Multiply the acreage by this figure.
Size of parcel in square feet 6706 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
f Calculate the total area to be cleared,graded,filled, Answer the following two questions related to
'Ic excavated,and/or compacted for proposed development conversion of native vegetation:
cL'�� project. Include in this calculation the area to be cleared for:
tIA`tv"r { Does the project convert'A acres or more of
(fes' a (' Construction site for structure I 1 sq/ft native vegetation to lawn or landscaped areas?
P ! Grainfield,septic tank,etc. sq/ft Circle: Yes .
1II 2 Well,utilities,etc. 0 sgHt Does the project convert 2'/2 acres or more of
native vegetation to pasture?
Driveway, parking, roads, etc. 500 sq/ft
Circle: Yes
Lawn,landscaping,etc. ' sq/ft GIO
Other compacted surface,etc sq/ft Indicate Total Volumes of Proposed:
Total Land Disturbance 6706 sq/ft Cut 0 Fill 0 (cuiyd)
Impervious surface is a hard surface that either prevents or retards the entry of water into the soil mantle as under natural
conditions prior to development. A hard surface area which causes water to run off the surface in greater quantities or at an
increased rate of flow from the flow present under natural conditions prior to development. Common impervious surfaces include,
but are not limited to roof tops,walkways, patios,driveways,parking lots or storage areas, concrete or asphalt paving,gravel roads,
packed earthen materials,and oiled,macadam or other surfaces which similarly impede the natural infiltration of stormwater.
stun,water oak worksheet-REV.W/2012014 1
gewat.
�et idbr �i --, �0 7--(i�
r STORMWATER CALULATIONS—IMPERVIOUS SURFACE
NEW 1y�{/ EXISTING
Structures(all roof area) �" " //01 sglft Structures(all roof area) 0 sq/ft
Sidewalks 0 sq/ft Sidewalks 0 sq/ft
Patios fk I(a sq/ft Patios 0 sq/ft
Solid Decks 0 sq/ft Solid Decks 0 sq/ft
(without infiltration below) (without infiltration below)
o^y�
Driveway, parking, roads,et ' v�yf V 0 sq/ft Driveway,parking, roads, etc 0 sq/ft
Other 0� p sq/ft Other 0 sq/ft
Total New ,/ °21 J� ' sgfft Total Existing 0 sq/ft
TOTAL NEW+TOTAL EXISTING'— "/ i/ �tt-sq/ft 'This amount will be used to check total lot coverage.
The following questions will help determine whether the proposed project is considered development or redevelopment.
DEVELOPMENT v. REDEVELOPMENT
Divide the to . e !sting it pervious surface
above by the size of the parcel and convert to a percentage:X° %
Does the site have 35%or more • 7 pervious surface? Circle: Yes X No fC//
FURTHER INSTRUCTIONS: If the answer is yes,the proposal is considered redevelopment and the attached Figure 2 should be used
to determine the applicable Minimum Requirements. If the answer is no, the proposal is considered new development and the
attached Figure 1 should be used. At this juncture, the applicant should refer to the applicable Flow Chart to determine the
Minimum Requirements for stormwater management. DCD staff will help verify the classification of the project and the application
requirements.
For proponents of "small" projects who must comply only with Minimum Requirement #2—Construction Stormwater Pollution
Prevention—an additional submittal is not required. The proponent is responsible for employing the 12 Elements to control erosion
and prevent sediment and other pollutants from leaving the site during the construction phase of the project. Pick up the
Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet. Proponents of "medium"
projects—those that must meet only Minimum Requirements#1 through#5—and for"large" projects—those that must meet all 10 I
Minimum Requirements—are required to submit a Stormwater Site Plan. DCD has prepared a submittal template of a Stormwater
Site Plan, principally for rural residential projects. Complete the template in the Stormwater Site Plan Instructions and Submittal
Template or prepare a Stormwater Site Plan using the step-by-step guidance in the Stormwater Management Manual.
APPLICANT SIGNATURE
By signing the Stormwater Calculation Worksheet,I as the applicant/owner attest that the information provided herein is true and correct to the
best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all owners of the affected
property.
�,,�'.—_ .-_ — _'" 6/30/15
(LANDOWNER OR AUYnORIZED RPRESENTATIVE SIGNATURE) (DATE)
Fog Orcin USE ONLY
7,;;.,;i.}.
SMALL MEDIUM _ LARGE__ REDEVELOPMENT Storrnwater Site Plan. Yes No „
siormwaim caiE worksheet—REV 10/20/2014
FIGURE 1 : NEW DEVELOPMENT
Start Here
i -
Does the site have Yes See Redevelopment
35% or more of Minimum
existing impervious Requirements and
coverage? Flow Chart
(Figure 2)
I o Does the project convert%
acres or more of native
----- vegetation to lawn or
Does the project add No landscaped areas, or
5,000 square feet or convert 2.5 acres or more
o
more of new of native vegetation to
impervious surfaces? pasture?
Yes Yes No
Does the project have
• 2,000 square feet or
"LARGE" PROJECT more of new,replaced,
All Minimum Requirements or new plus replaced
apply to the new impervious impervious surfaces?
surfaces and converted
pervious surfaces. 0 No
•
"MEDIUM" PROJECT Does the project have
Minimum Requirements#1 land-disturbing
through#5 apply to the new Yes activities of 7,000
and replaced impervious . square feet or more?
surfaces and the land
disturbed. No
"SMALL" PROJECT
See Minimum
Requirement#2,
Construction Stormwater
Pollution Prevention
Based on Fig.2.2 from 2001 Ecology Stormwater Management Manual for Western Washington