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Home My WebLink AboutBLD2015-00141 - 01 PERMIT APPLICATION iltUILDING PERMIT APPLICASJN BRD15-001 1 Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD15-00141 Received Date: 4/24/2015 SITE ADDRESS: 11633 COYLE RD QUILCENE, 98376 OWNER: MONTY L GRABNER PHONE: 360-316-9728 STAN KERN 11633 COYLE RD QUILCENE WA 98376-8632 SUBDIVISION: Block: Lot: PARCEL NUMBER: 601222006 Section: 22 Township: 26 N Range: 1111 CONTRACTOR: TOWN &COUNTRY POST & FRAME PHONE: 425-743-1555 16521 HWY 99 SUITE C LYNNWOOD WA 98037-3161 Contractor's License TOWNCPF099LT Expires 6/30/2015 REPRESENTATIVE: TOWN & COUNTRY POST FRAME PHONE: (425) 743-1555 BRYAN BORCHERS (425) 742-4378 16521 HWY 99 STE C PROJECT DESCRIPTIOP NEW DETACHED POST & FRAME SHOP NO PLUMBING NO HEAT ****NO SEPTIC'"**** TYPE OF WORK GAR SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 20,900.00 ADD'L: HEAT TYPE: UH CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: SHORELINE: GARAGE: 720 CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $366.00 SRE 04/24/15 155953 APPROVED Plan Check $237.90 SRE 04/24/15 155953 APR 2 9 2015 State Building Code $4.50 SRE 04/24/15 155953 Total: $608.40 Jefferson County DCD 11 tidemark\data\forms\F_BLD_App_Bld.rpt 4/24/2015 • • April 24, 2015 TO: MONTY L GRABNER STAN KERN 11633 COYLE RD QUILCENE WA 98376-8632 FROM: Permit Coordination Division RE: SITE ADDRESS: 11633 COYLE RD CASE#: BLD15-00141 During the review of your permit application for a non-residence building without plumbing, the regulations and requirements for an on-site sewage system were not considered. Please be strongly cautioned that building on your property without primary and reserve drainfield areas may impact the ability to EVER place a residence on the property in the future. The non-residence building may be placed on the location that was best suited for the primary or reserve drainfield areas and you may never be able to build a residence on the property because of it, or you may be required to install an engineered septic system when a conventional system could have been installed in the building location. Enclosed is some on-site sewage disposal information as well as the website address of state licensed designers for your reference. It would be advised to have a site evaluation before any land is disturbed (building taking place) on your property. If you have any questions, please phone the Permit Center, (360) 379-4450. 1ltidemark\data\forms\F BLD nonOSS_Letter.rpt 4/24/2015 • • , JEFFERSON COUNTY DEVELOPMENT `,, COMMUNITY i W y 621 Shannon an Stmt E Fort Townsend,WA"ice.a,1 Web+: .ce.ietferson vra.usicornr,°,aty eveiooment Tel .3755 44501 Fax 360.379 4451 1 :tied.i.r - at,waus 7strl s.9 ROOM Permits&Inspections 1 Development nt Oonsratency Rewew 1 wrong Range Plefireng I *aterseea`Stewardahrp Resource Center DATE: Irk -/5- TO: Applicant FROM: Permit Coordination Division RE: Permit Application Number During the review of your permit application for a non-residence building without plumbing, the regulations and requirements for an on-site sewage system were not considered. Please be strongly cautioned that building on your property without primary and reserve drainfield areas may impact the ability to EVER place a residence on the property in the future. The non-residence building may be placed on the location that was best suited for the primary or reserve drainfield areas and you may never be able to build a residence on the property because of it, or you may be required to install an engineered septic system when a conventional system could have been installed in the building location. Enclosed is some on-site sewage disposal information as well as the website address of state licensed designers for your reference. It would be advised to have a site evaluation before any land is disturbed (building taking place) on your property. If you have any questions, please phone the Permit Center, (360) 379-4450. zP ju,a.J2 4 cei.,, ei To Page 5 of 6 2015-04-01 23 46 12(GMT) 14134030046 From: Beth Juran (---) vsON e DEPARTMENT OF COMMUNITY DEVELOPMENT f4 / > ...k 621 Sheridan Street Port Townsend,WA 98368 14 I lck 360.379A450 1 Far 360 1794451 A"< Web:www.cfmclicts00 rmusicommun0ydevelopment aixi@ceidkoonAva.u,s kir) PERMIT APPLICATION Steps in the Permit Process: -Review application cheddist 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. [Iglu c_t. 2ió Assessor Tax Parcel Number: dry2/ (:)€* Site Address and/or Directions to Property: Access(name of street(s)) from which access will be gained: ( y 6-- Present use of property: ,— A.1 ■6_,•,16 Ar r e Description of VVork(include proposed uses): 02o.x..3 00.&7:4441 ?,c-/ste07.6.- .41-04"7"...S-72,41Z) SAAEZd 1;2.7, 77,7 c - This property is served by Port TownSend of Port Ludlow sewer system? YES NO If not served by sewer identified above,identify t pe of se• ic stem below: Type of Sewage System Serving Property: Septic Septic Permit#: Community Septic Name of System: Case If • Are other residences connected to the septic system? No Additions or repairs to sewage system: Is it a complete or partial system installation: Complete Partial Has a reserve drainfield been designated? 2 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: 4pip. • Aviolai 6 20/5 nr -. SONC,r) 0-140' fir10,04,71.41 To 4 Page 6 of 6 • 2015-04-01 23 46 12(GMT) Aimik 14134030046 From: Beth Juran IIP The authorized agcntfrcprcscnttiv e is the primary contact for all project-telated questions and correspdonwlencce.0 1-(!i aunty will mail/e-mail requests and information about the application to the authonzed.agent/representati an noted below. The authorized agent/representative is responstk for communicating 2ircia g th- information to all parnpC.Is Involved with the ap.licatiOn. It is the responslil*ru of the dm-owner to ensure their mailbox accepts County "d sent ot112."zrimagariePres . . elP?11.-- -e-,-.C911--- -..S.T0,..!-,s,77?j ,!5E 91!,so r--z.,77-:,:7,77WAkrpg'44171T-M.,,;CPAS"F:',,i ';.4,-,ii..71,704SigW,074177F7.4C;0710 )( Property Owner: _., i i Name: 74to,v/y 4. 6-644-•.e/t/ C--} Address: c 42■,et, igeii C/7' eQaiZeivcg-i; it4 - 9827-6 Phone th M4 )-,g,./ ,- ), ..,.1...,0 E-mail Address: 463 4-7 7.40/-,4 Plea - •• - , . eri Representative with project info.(select only one). _.„.„. - i< Property Ow.:-r Signature: -- --.. Date: Note: For projects with multiple ownexs,attach a separate sheet with each owner(s)information and signatures .s'"' ''''—'''.w.:,•r,i.."`...."-rill/F.r.cdr;..;.■W.,L-' 7.77774, , ,I,,.. ,,,.-„,.,,,_:-.7--_---,„,i., '...-:'',..1:„.,',47,:;;;;7.;,,'-7.77.2,Fiii;:,14,,,,V't,i‘zic^:Zw.t.4.14pq-6.1i, 1".- +ripe:.: - ‘-'2• 4..,:4, ' '-'. Name: "%Wry,"4ez.v...77-ey c ....rg - ,g7L---V - 74042-Z-77- Address: /45"s../ /1.4 4 9 -P 7 531e, C.,- i .„, yx,k,-,AJooesit, M-49 9:9 el 3 7 Phone#: Vg_c-703-15-5-5" E-mail Address: cer•-•- Engineer Architect Surveyor Contractor Consultant Name: Address: Phone#: C-malf Address: - ' - -,4.''''.' '^''',.'"' '',' ';'77.7-751"r'it:T.1:•%?'''VTC4.7■IP:3:47.75i'F.,0 kat: px,r;,7?-6,0c, 7,75, Engineer Architect Surveyor Contractor Consultant Name: Address: Phone#: E-mail Address: Engineer Architect Surveyor Contractor Consultant Name: Address: Phone#:; E-mail Address: Aiir;La:tisiti , III.I.,7,4gili-iltit-,640:3,'.5:fifflu.19, k.t.':',55-1,iti.,,,,N,..:..n.01,,,14,.,c„-,4,ick,■:t:-.,."7,;:_..j_,.;f:Pli V.ILIT4ii; Te.13. Engineer Architect Surveyor Contractor Consultant Name. ' Address: i Phone#: E-mail Address; 1 1 Attach additional pages if necessary _ . . , The signer of this statement certifies that they are the Owners of the parcel refe -. .., . henein,that they are not licensed contractors and that they will be assuming the responsibility of the General Con• iA .-__.1- • ,• ed project. .- Signature: Print Name: ":' ' neW 1/ ... __- _._.., ---_____. , I 1 i Permit ApplicatinPage2of2 PR 1 6 z ,'' t; nveo,,, E • • SON r\ DEPARTMENT OF COMMUNITY DEVELOPMENT G i tt4 O 621 Sheridan Street,Port Townsend,WA 98368 ' Tel:360.379.4450 I Fax:360.3794451 ti -C Web:www.co.jcfferson.wa.us/communitydcvclopment pry Gmail: dcd@co.jefferson.wa.us 4`5'II No- SUPPLEMENTAL APPLICATION RESIDENTIAL OR COMMERCIAL BLDG PERMIT WE ® • tike Only „ Receipt# Date: _ � P .� ''.'" -y;+��$s.« zta� , ,.,h ,,.k. ti .� �„ 2a e e a s '�'d. `^., a v C'S e-r - Payment#: Owner Name:277t;-"42,,v-7'""‘ Tf- � %'vfG'/Gf Assessor Tax Parcel#: ( �� Z?= G4.?Lz..+.. YS..xL ✓. ,+ Yq �r:, ' ? "Y 6'� � K 'Opt y ` `J �al*E* $ . NM Qt'p New /,C Replacement Relocated Addition Repair Demolition "A separate permit is required Select One: Single Family Residence Modular Other � --d/ list ,kP av em 4 r . { x c �3 ' n w 1i ,1'ki 6 = S y ,• ,... "s^ ,.� `rKn. :. Number of floors ( #new bedrooms existing total bed #new bathrooms existing total bath xx.�,� s y'v s J•,y'-k 7 attTyU�.N � 'Y w, ti y a n v-� +#x v. yz >`�,"may 5 � ,� ' � y� , .,4�' r9��. , Select all that apply: Electric Heating Oil Wood Propane Enter the square footage(sq/ft)that applies in each field: Z -- `,h�5' .� i5*�°` x 'X. F two �s t a�,m ' % `t•'t..4.141167.4- ✓ f " ✓ � t '�' S w Xc{ . .e @g • \'`�` { ,, Residential/Commercial Main Floor • Residential/Commercial Second Floor Additional Floors- heated/unheated Basement-unfinished Basement-finished space or habitable 7Za Detached G,asege-heateiunheated73 szie f Attached Garage-heated/unheated Garage 2nd fl-unfinished storage Garage 2nd fl-finished space or habitable — n Carport-2 walls or less j Deck-uncovered L.) Covered porch 2 Other(shed, barn, pole bldg,etc.) U Estimated Cost of Project(Required): $ Spa an Supplemental SFR 1 C COMMUNITY DEVELOPMENT S • List existing buildings on property(i e house,$ara,je1 accessory dwelling unit,shed, barn, mobile home,other): g w.lt► B i gs rt rop?rty h l se '.... -----�.h�/>wLC•I c;,g.e, �fylED 6•&?Ut v%7'd1 Sf-17 i 7iA-[ 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 compliance with all applicable federal, state and county laws and regulations and I agree to provide access and right of entry to Jefferson Cou• .nd its employees, representatives or agents for the sole purpose of application review and any required - :r inspections. Applicant may request notice of the County's intent to enter upon the property for visits relat:: to this application and subsequent permit issuance. Signature: der-- %_ ' g - � Print Name: /�yr- /�'ir�G&-7--/ Date: 'V--,77/-/..S- Estimated Cost of Project $ 025 9L" _'. 1'1Gt zaeYzlK' . _ _ Building Base Fees Building Base Plan Check Review Land Use Review $228.00 Septic Review $79.00 Potable Water $107.00 Technology/Scan $19.00 State Fee $4.50 Other Fees Shoreline Exemption • Zoning Zoning IS f1 \\_� Other I } New Address i �i 4 Road Approach -- Total Fees Receipt# Date: Cash/Check/CC: Supplemental SFR 2 Parcel Details Page 1 of 2 • Jefferson County wealfier station r$'' a"" s 717-77 Home County Info Departments Search Parcel Number: 1601222006 [ SEARCH Parcel Number: 601222006 Printer Friendly Owner Mailing Address: MONTY L GRABNER STAN KERN 11633 COYLE RD QUILCENE WA98376-8632 Site Address: 11633 COYLE RD QUILCENE 98376 Section: 22 School District: Quilcene (48) Qtr Section: NW 1/4 Fire Dist: Quilcene (2) Township: 26N Tax Status: Taxable Range: 1W Tax Code: 0323 Planning area: South Toandos Peninsula,Coyle Area (9) Sewer: Drainage: Bank: View 1: View 2: Zoning 1: RR-5 - Rural Residential Zoning 2: Zoning 3: Sub Division: Assessor's Land Use Code: 9800 - Garages, Outbuildings, Other Imps Property Description: S22 T26 R1W SE NW (N1/2 S1/2 N1/2) LESS W OF RD. SUB) TO DECL COVT AFN#441017 Tax,AN, Sales, Photos,and Permit Data Bldg Data Map Parcel Plats&Survev Septic Monitoring Info `4,,. Jefferson County 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=601222006 4/24/2015 • �4��SaN Rio DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street,Port'Townsend,WA 98368 ,,,1 Tel.360.379.4450 I Fax 360.379.4451 Web:www,co.icffcrson.wa.us/communitydevelopment E-mail:dcd@a co.jeffcrson.wa.us 4,./"Ns STORMWATER CALCULATION WORKSHEET MLA P PROJECT/APPLICANT NAME: � .e u9ir•Zi/�J 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.,SITE1 Size of parcel 7S" acres An acre contains 43,560 square feet. Multiply the acreage by this figure. Size of parcel in square feel IA" Z!(,, sq/ft Land-disturbing activity is any activity that results in movement of earth,or a change in the existing sQ4.soveir(hatb_yoetative and non-vegetative)and/or the existing soil topography. Land disturbing activities include,but are not Ii mile1d-E2 Id i_ g r ing7 fViyg excavation,and compaction associated with stabilization of structures and road construction. �1�'�E Native vegetation is vegetation comprised on plant species,other than noxious weeds,that are indigenous to the coastal region of 1 the Pacific Northwest and which reasonably could have been expected to naturally occur on the site. Examples in I01:te e9ies, h l; ld as Douglas fir, western hemlock, western red cedar, alder, big-leaf maple, and vine maple; shrubs such as willow, eer6�r ,,, salmonberry,and salal;herbaceous plants such as sword fern,foam flower,and fireweed. J 1JTy LAND DISTURBING ACTIVITY CONVERSION OF NATIVE VEGETATION AND VOLUME OF CUTIF %'iUNITYD VrLOPMENT 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 Geared for: Does the project convert%acres or more of Construction site for structures "7 sq/ft native vegetation to lawn or landscaped areas? Drainfield,septic tank,etc. sq/ft Circle: Yes Well, utilities,etc. sq/ft Does the project convert 2%acres or more of native vegetation to pasture? Driveway,parking, roads,etc. sq/ft Cirde: Yes Iso Lawn, landscaping,etc. sq/ft Other compacted surface,etc. sq/ft Indicate Total Volumes of Proposed: Total Land Disturbance '7 ZL) sq/ft Cut 2,4 Fill ZS (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. stamwater cabs worksheet—REV.1020/2014 1 • • STORMWATER CALULATIONS—IMPERVIOUS SURFACE NEW EXISTING Structures(all roof area) $`) -] sq/ft Structures(all roof area) sq/ft Sidewalks sq/ft Sidewalks sq/ft Patios sq/ft Patios sq/ft Solid Decks sq/ft Solid Decks sq/ft (without infiltration below) (without infiltration below) Driveway,parking,roads, etc sq/ft Driveway,parking, roads, etc 2/ 50 sq/ft Other sq/ft Other sq/ft Total New sgfft Total Existing 2170 sq/ft TOTAL NEW+TOTAL EXISTING* �,(/7 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: Does the site have 35%or more of existing impervious surface? Circle: Yes No FURTHER INSTRUCTIONS:If the answer is yes,the proposal is considered redevelopment and the attached Figure 2 should be used to determine the applicable Minimum Requirements. If the answer is no, the proposal is considered new development and the attached Figure 1 should be used. At this juncture, the applicant should refer to the applicable Flow Chart to determine the Minimum Requirements for stormwater management. DCD staff will help verify the classification of the project and the application requirements. For proponents of "small" projects who must comply only with Minimum Requirement #2—Construction Stormwater Pollution Prevention—an additional submittal is not required. The proponent is responsible for employing the 12 Elements to control erosion and prevent sediment and other pollutants from leaving the site during the construction phase of the project. Pick up the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet. Proponents of "medium" projects—those that must meet only Minimum Requirements#1 through#5—and for"large"projects—those that must meet all 10 Minimum Requirements—are required to submit a Stormwater Site Plan. DCD has prepared a submittal template of a Stormwater Site Plan, principally for rural residential projects. Complete the template in the Stormwater Site Plan Instructions and Submittal Template or prepare a Stormwater Site Plan using the step-by-step guidance in the Stormwater Management Manual. APPLICANT SIGNATURE By signing the Stormw. rFalculation Worksheet,I as the applicant/owner attest that the information provided herein is true and correct to the best of my knowl•,:e,Ialso certify that this application is being made with the full knowledge and consent of all owners of the affected property. 71-1--/ ANDOWNER OR AUTHORIZ ATIVE SIGNATURE) (DATE) 'FOR OFFICE USE ONLY SMALL MEDIUM ` .* "'QRGE ,r':* REDEVELOPMENT' Stormwater Site Plan: Yes NO stormwater talc worksheet—REV.10120/2014 2 (20 BLD15-00141 �UILDI G PERMIT APPLICAPON Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD15-00141 Received Date: 4/24/2015 SITE ADDRESS: 11633 COYLE RD QUILCENE, 98376 OWNER: MONTY L GRABNER PHONE: 360-316-9728 STAN KERN 11633 COYLE RD QUILCENE WA 98376-8632 SUBDIVISION: Block: Lot: PARCEL NUMBER: 601222006 Section: 22 Township: 26 N Range: 1V■ CONTRACTOR: TOWN &COUNTRY POST & FRAME PHONE: 425-743-1555 16521 HWY 99 SUITE C LYNNWOOD WA 98037-3161 Contractor's License TOWNCPF099LT Expires 6/30/2015 REPRESENTATIVE: TOWN & COUNTRY POST FRAME PHONE: (425) 743-1555 BRYAN BORCHERS (425) 742-4378 16521 HWY 99 STE C PROJECT DESCRIPTION NEW DETACHED POST & FRAME SHOP NO PLUMBING NO HEAT ****NO SEPTIC***** TYPE OF WORK GAR SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 20,900.00 ADD'L: HEAT TYPE: UH CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: SHORELINE: CONST TYPE: DECRKAGE. 720 SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $366.00 SRE 04/24/15 155953 Plan Check $237.90 SRE 04/24/15 155953 State Building Code $4.50 SRE 04/24/15 155953 Total: $608.40 1\tidemark\data\forms\F_BLD_App_Bld.rpt 4/24/2015 To Page 5 of 6 • 2015-04-01 23:46:12 (GMT) 14134030046 From et Juran i 04 DEPARTMENT OF COMMUNITY DEVELOPME i. 1 e,7 2 .621 Sbnidan Street,Pon Townsend,WA 98368 ^, .. Tel:360.379.4450 +-C I I'ax.350 379.4451 SI r.Y Web.wu•w.cn.ICffcrsoa\" . of u t i It.-;,,yt r .�� r !. `'3 0 04 L-mail:� a.ckjctlC�.sy�an.us . ySffl Nc3 ° O 22 213 PERMIT APPLICATIO N. Steps in the Permit Process: Li �'ui0 -Review application checklist to ensure all information is completed prior to submitting appy ti t0M 0� ,'DEVE`� ^E -Make sure septic has been applied for and water availability has been proven. -Make an appointment to meet with the Permit Technician by calling 360-379-4450. -This is not a standalone application;it must be accompanied by a project specific supplemental application. -Fees will be collected at intake. Additional fees may apply after review and payment is required before permit is issued. i.°txC'i 4 i' n S •:6-1: .v a ' PS.-.-..st•'n. ... - i. r Sr`4 :g 8:'- .t .S ' .i .y 30. �.� tL.0 1 '�� .� t a 7 �''�>. X�i;7 F+v 6. `v .s �—. =4 �. .� trp• .7„P e;> .''.r :•r�� ,J.�.�. .. a `r�.R'� Yi:; `F `. i" i�-Wixkd 4 a LSA:AMT:Rs M,, MFn + ? �MSt-MIX v_ _v3sF0 .� Y� Assessor Tax Parcel Number: / / :_. Z Z-O6(. Site Address and/or Directions to Property: 4:4 3'5 lAyt.$�.6 Access(name of street(s)) from which access will be gained: 9yt Present use of property: 4g Au z S/.")F M. Description of Work(include proposed uses): 4,2el X (apG�gr p F�147)t -g-/er-C-72"-bib sou Li 4ila4A �W i L 7 i s 3,�s4 W Wry-WW. ITX4:4' .. •, . This property is served by Port Townsend of Port Ludlow sewer system? YES _ _ NO _pc _ If not served by sewer identified above,identify type of septic system below: Type of Sewage System Serving Property: T _'Septic Septic Permit It Community Septic Name of System: Case it: Are other residences connected to the septic system? ND • Additions or repairs to sewage system: Is it a complete or partial system Installation: Complete Partial _ Has a reserve drainfield been designated? 7 Yes _— No _ Date of Last Operations&Maintenance check: f ixNi4-o,..ht Attach last report to application . Describe or attach any drainfield easements,covenants or notices on title,which may impact the property: J D ,fir Pinar Apptin(wn Pug 1oF3 To Page 6 of 6 • 2015-04-01 23:46:12(GMT) 14134030046 From Beth Juran 1 I Tltc authorized agent/representative is the primary contact for all project-related questions and correspondence. The County will mail/e-mail m uests and information about the application to the authorized agent/representative and will copy(cc)the owner i noted below. The authorized agent/representative is responsible for communicating the information to all pages involved with the applic ton. It is the responsibility of the authorized agent/representative and owner to ensure their mailbox accepts County email fie Coun email is not blocked or sent to" k mail r�ryY �' � � `n h:'Gn 3. .'75 C. C"p� e= • "P,�a°{ i a ,11f.,, ' ,e.1.2,"'i(WA '`t3.�:.:`:3F-1s3iy,Y .'#Sr `.4a 74:4 Property Owner: /f Address: a ,/,,IZ//7LL) /8E/tC/f .L).C.o'v� l�4,,,C.E•w�/ JJcc • 983-7-- -, i ` -Phone/4: _ �- � -- �� E-mail Address: G2s 1 '(4 �r/1rq.,rL cr' e( _ Plea orRepresentative with project info.(select only one). x Property Olt_ rSign 2- �` Date: 7i/ /_S Note: for projects with multiple owners,attach a separate sheet with each owner(s)information and signatures. // t a i f t• �al'r . 1:6i -.d l 'WPM�� R� g,`> li. P7i 4",*7^-;.t^.^ _` �. ��=r�t. i� �E fX?:s..�..:• :.- r'm �^�k�_��'C.s:._ ..s;^.,v ra� E Name: 1-7, . i MFM: o ` - ` 71.0.42 --7- Address: `d,S-Z/j/49, ,/ S,1e c. L...r:✓z✓oaz,j l t://s9 9073 7 Phone It 7Z5=703-/55-5 E-mail Address: )2.4w : /..ire ., , «., (�4ta r.T??u� : AxtiTi ° ta ig ZO si l itrg�ro i€ fr Y �4"° figf' e '01 1 Engineer Architect Surveyor Contractor Consultant Name: Address: Phone tt: E-mail Address: �i • r�� 1y.. Yv }} �{ t tH]s y�pt 3.r�*.'t'yF'1i.1 t '� "T7 _... -.-,ra.. 'Y 0!r#;M:N �?�Tt iiA`, a .4 1 _ !i ti'n SLi-;s a '7°_ :.r4av"''^ 1t.�w t.,, iv rk'72 a Iligi Engineer Architect Surveyor Contractor Consultant Name: Address: Phone#: E-mail Address: Engineer _ Architect Surveyor Contractor Consultant Name: Address: Phone#; E-mail Address: of :4:1W 3r+ �� ,lit +�^'.. i N" c z i3. - l n. 'vr -' y ''k.�tC3 � t�� 'Y'k5.�'�, eP l"-Ss�s,'i'�,�r` '��.� ?� �iL+� °.=�k4j�r;+��'�ug .� �:�.,w �'? ' 6 a Engineer Architect Surveyor Contractor Consultant Name: • Address: j Phone#: E-mail Address: -Attach additional pages if necessary i p i iaJl r_ggiraii,�i[' 41 :7R 'a""araW77 :-v:�^fa` ,tfdr i W' `7045 x .-,:43.b, ..y t1 '".-iX•"q„?Z t5SSS' 3 =mow � sx-.n:.:..u t '`....�..�-s:. E --t� _ The signer of this statement certifies that they are the Owners of the parcel referenced herein,that they are not licensed l contractors and that they will be assuming the responsibility of the General ContriactoK{{?r3h capos_ed project. 1 Signature: Print Name: i 1 ,�` Date r.mit Applicmwu l'age,2or2 ' i • e • ;l-soN co Port"T DEPARTMENT OF COMMUNITY DEVEL•I IN : f' . 1 M E p & 621 Sheridan Street,Voownsend,WA 98368 ,a Td'360.379.4-450 , Fax:360.379 4451 I^ , -CI Web:www.co.jefferson.wa.us/communitydevelopment 1 mail:dcd¢co.ieffcrson.wa.u� APR 2 2 (r15 IJ lL ,� RI �� SI�1 ono SUPPLEMENTAL APPLICATION ,.,n RESIDENTIAL OR COMMERCIAL BLDG PERMIT ''' r i' :-1--��1�� For Department Use Only Receipt#: Date: Related Application Us: Payment#: Site Information Owner Name: / .. �7fJVV?y '.7%v� ✓t f-. Assessor Tax Parcel#: („'of Lo z 00 Type of Building New y� Replacement Relocated _ Addition Repair Demolition * 'A separate permit is required Select One: Single Family Residence -_ Modular Other / list , = 4" ," ": q ` ` afo,)sProposed Building/Project } Number of floors % #new bedrooms existing total bed #new bathrooms existing total bath iieat Source _ Y6� t`§� +< ',zit. 3. '4 a3' i" . e� {,�xh +'t' r i w?r. 'ytt` -,e, -.- �a. -. ... '+...,- _ "" �k'�ir 1.. �'.��. w.tY��nw.Y..ea{`","�e 1`3:k 1_�k�� ..w+sl'r y5! Select all that apply: Electric Heating Oil Wood Propane Enter the square footage(sq/ft)that a°:lies in each field: x...-v...}�:.«,.,.....,.say_:.;.:..!a..1,.,1�;' �",3$. ." « ," F. e KG� ��x° fv.Fia..,waC::� �1��4�aA.�� ;' Residential/Commercial Main Floor Residential/Commercial Second Floor Additional Floors-heated/unheated Basement-unfinished Basement-finished space or habitable 7"2_in Detached Game-heatefl funheate -3 $,7(.g/° Attached Garage-heated/unheated Garage 2nd fl-unfinished storage Garage 2nd fl-finished space or habitable Carport-2 walls or less Deck-uncovered Covered porch Other(shed,barn, pole bldg,etc.) Estimated Cost of Project(Required): $ .>200 9ora i Supplemental SFR I • • List existing buildings on property(i.e. house,garage, accessory dwelling unit,shed, barn, mobile home,other): All Existing Buildings on Property Use L'J7-k,5'fiE b, Cy&A,e7?_dr62-Sffri2 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 compliance with all applicable federal, state and county laws and regulations and I agree to provide access and right of entry to Jefferson Caul .rd its employees, representatives or agents for the sole purpose of application review and any required - =r inspections. Applicant may request notice of the County's intent to enter upon the property for visits relat:• to this application and subsequent permit issuance. Signature: _�`". Print Name: - /T,ir=/7C 7'7 Date: '/o?j1/..s-Estimated Cost of Project $ For Department Use Only ate :E3 q $lta ,gtr s '�•«t&.EU *�,�s-= Building Base Fees Building Base Plan Check Review Land Use Review $228.00 Septic Review $79.00 Potable Water $107.00 Technology/Scan $19.00 State Fee $4.50 Other Fees Shoreline Exemption Zoning Zoning Other New Address Road Approach Total Fees Receipt Date: Cash/Check/CC: Supplemental SFR 2 • w4SON Co� DEPARTMENT OF COMMUNITY DEVE • ' -�'Il% n"/ k 621 Sheridan S Street,Port Townsend WA 98368 Tel:360 379.4450 I Fax:360.379.4451 Web:www.co.jcfferson.wa.us/communitydevelopment D ' 2 2 776 E-mail:dcd @co.jefferson.wa.us 1\‘:31. S 1 ING J J1 STORMWATER CALCULATION WORKSHEET , }cpt,g03 sly"EVElOoMEIdT MLA# PROJECT/APPLICANT NAME: 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. • (i PARCEL SIZE(I.E..SITE Size of parcel 76 acres An acre contains 43,560 square feet. Multiply the acreage by this figure. Size of parcel in square feet 709, 'Z/, sq/ft Land-disturbing activity is any activity that results in movement of earth,or a change in the existing soil cover(both vegetative and non-vegetative)and/or the existing soil topography. Land disturbing activities include,but are not limited to clearing,grading,filling, excavation,and compaction associated with stabilization of structures and road construction. Native vegetation is vegetation comprised on plant species,other than noxious weeds,that are indigenous to the coastal region of the Pacific Northwest and which reasonably could have been expected to naturally occur on the site. Examples include species such as Douglas fir, western hemlock, western red cedar, alder, big-leaf maple, and vine maple; shrubs such as willow, elderberry, salmonberry,and salal;herbaceous plants such as sword fern,foam flower,and fireweed. LAND DISTURBING ACTIVITY.CONVERSION OF NATIVE VEGETATION.AND VOLUME OF CUT/FILL Calculate the total area to be cleared,graded,filled, Answer the following two questions related to excavated, and/or compacted for proposed development conversion of native vegetation: project. Include in this calculation the area to be cleared for: Does the project convert'A acres or more of Construction site for structures '?2-O sq/ft native vegetation to lawn or landscaped areas? Drainfield,septic tank,etc. sq/ft Circle: Yes Well,utilities,etc. sq/ft Does the project convert 2'/acres or more of native vegetation to pasture? Driveway,parking, roads,etc. sq/ft Circle: Yes to Lawn, landscaping,etc. sq/ft Other compacted surface,etc. sq/ft Indicate Total Volumes of Proposed: Total Land Disturbance '7 Z V sq/ft Cut 2.5" Fill ZS (culyd) 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. stonmater calc vsrksheet-REV.10/202014 1 • • N coG DEPARTMENT OF COMMUNITY DEVELOPMENT - 621 Sheridan Street,Port Townsend,WA 98368 44 -4 Tel:360379.4450 I Pax:360.379.4451 Web:wuw.co.jcffcrson.wa.us/communirydcvclopmcnt • '` B-mail:dcdEllco.icffcrson.waus STORMWATER CALCULATION WORKSHEET MLA II PROJECT/APPLICANT NAME: (7/C1//v , r<�d7 S7!//), DETERMINING STORM WATER 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) a Size of parcel 7� acres An acre contains 43,560 square feet. Multiply the acreage by this figure. Size of parcel in square feet 7C'fj� 7iL, sq/ft Land-disturbing activity is any activity that results in movement of earth,or a change in the existing soil cover(both vegetative and non-vegetative)and/or the existing soil topography. Land disturbing activities include,but are not limited to clearing,grading,filling, excavation,and compaction associated with stabilization of structures and road construction. Native vegetation is vegetation comprised on plant species,other than noxious weeds,that are indigenous to the coastal region of the Pacific Northwest and which reasonably could have been expected to naturally occur on the site. Examples include species such as Douglas fir, western hemlock, western red cedar, alder, big-leaf maple, and vine maple; shrubs such as willow, elderberry, salmonberry,and salal; herbaceous plants such as sword fern,foam flower,and fireweed. LAND DISTURBING ACTIVITY,CONVERSION OF NATIVE VEGETATION,AND VOLUME OF CUT/FILL Calculate the total area to be cleared,graded,filled, Answer the following two questions related to excavated, and/or compacted for proposed development conversion of native vegetation: project. Include in this calculation the area to be cleared for: Does the project convert'A acres or more of Construction site for structures "7 2-6 sq/ft native vegetation to lawn or landscaped areas? Drainfield,septic tank,etc. sq/ft Circle: Yes Well, utilities,etc. sq/ft Does the project convert 2'A acres or more of native vegetation to pasture? Driveway, parking, roads,etc. sq/ft Circle: Yes Lry . Lawn, landscaping,etc. sq/ft Other compacted surface,etc. sq/ft Indicate Total Volumes of Proposed: Total Land Disturbance 7 Z U sq/ft Cut 2,,-5-• Fill ZS (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. stern mater calc worksheet-REV.10/202014 1 • • .w- STORMWATER CALULATIONS—IMPERVIOUS SURFACE NEW EXISTING Structures(all roof area) 89 7 sq/ft Structures(all roof area) `�' ' sq/ft Sidewalks sq/ft Sidewalks sq/ft Patios sq/ft Patios sq/ft Solid Decks _sq/ft Solid Decks sq/ft (without infiltration below) (without infiltration below) Driveway,parking, roads, etc sq/ft Driveway, parking, roads,etc Z/ 5 sq/ft Other _sq/ft Other sq/ft Total New sq/ft Total Existing 2.00 sq/ft TOTAL NEW 4-TOTAL EXISTING* 3 (p'7 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: Does the site have 35%or more of existing impervious surface? Circle: Yes No FURTHER INSTRUCTIONS: If the answer is yes,the proposal is considered redevelopment and the attached Figure 2 should be used to determine the applicable Minimum Requirements. If the answer is no, the proposal is considered new development and the attached Figure 1 should be used. At this juncture, the applicant should refer to the applicable Flow Chart to determine the Minimum Requirements for stormwater management. DCD staff will help verify the classification of the project and the application requirements. For proponents of "small" projects who must comply only with Minimum Requirement #2—Construction Stormwater Pollution Prevention—an additional submittal is not required. The proponent is responsible for employing the 12 Elements to control erosion and prevent sediment and other pollutants from leaving the site during the construction phase of the project. Pick up the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet. Proponents of "medium" projects—those that must meet only Minimum Requirements#1 through#5—and for"large" projects—those that must meet all 10 Minimum Requirements—are required to submit a Stormwater Site Plan. DCD has prepared a submittal template of a Stormwater Site Plan, principally for rural residential projects. Complete the template in the Stormwater Site Plan Instructions and Submittal Template or prepare a Stormwater Site Plan using the step-by-step guidance in the Stormwater Management Manual. APPLICANT SIGNATURE By signing the Stormw31r 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. /. � r NOOWN ER OR AUTHORI� ATIVE SIGNATURE) (DATE) / � r'',re c < a r ±s �" t7yJJ' i° _�i �. _ rTj' ,� 'ig, i fat �Ns a .i�1 sf ;_.. stormwater calc worksheet—REV.10/20/2014 2 u' 1"„'a" Page 1 of 2 • • Jefferson County : .t ' # Weather Station ` �' Database Tools- cal Maps Webcam Home County Info Depo /� Parcel Number 1.601222006 I SEARCH Friendly 2 2 x!!15 Parcel Number: 601222006 Printer Owner MONTY MaGRABNERress: nCCIYI\—pF„npo^s,nN1f STAN KERN 11633 COYLE RD QUILCENE WA98376-8632 Site Address: 11633 COYLE RD QUILCENE 98376 Section: 22 School District: Quilcene (48) Qtr Section: NW1/4 Fire Dist: Quilcene (2) Township: 26N Tax Status: Taxable Range: 1W Tax Code: 0323 Planning area: South Toandos Peninsula,Coyle Area (9) Sewer: Drainage: Bank: View 1: View 2: Zoning 1: RR-5 - Rural Residential Zoning 2: Zoning 3: Sub Division: Assessor's Land Use Code: 9800 - Garages, Outbuildings, Other Imps Property Description: 522 T26 R1W SE NW (N1/2 S1/2 N1/2) LESS W OF RD. SUB) TO DECL COVT AFN#441017 Tax, A/V. Sales. Photos, and Permit Data Bldg Data Map Parcel Plats &Survey Septic Monitoring Info r'".� i, Jefferson County HOME I COUNTY INFO I DEPARTMENTS I SEARCH Best viewed with Microsoft Internet Explorer 6.0 or later aWindows - Mac Parcel Details • • Page 1 of 2 Jefferson County -'' - : ,._ ._ alki Maps ebz n Home County Info Departments Search Parcel Number: 601222006 SEARCH Parcel Number: 601222006 Printer Friendly Owner Mailing Address: MONTY L GRABNER STAN KERN 11633 COYLE RD QUILCENE WA98376-8632 Site Address: 11633 COYLE RD QUILCENE 98376 Section: 22 School District: Quilcene (48) Qtr Section: NW1/4 Fire Dist: Quilcene (2) Township: 26N Tax Status: Taxable Range: 1W Tax Code: 0323 Planning area: South Toandos Peninsula,Coyle Area (9) Sewer: Drainage: Bank: View 1: View 2: Zoning 1: RR-5 - Rural Residential Zoning 2: Zoning 3: Sub Division: Assessor's Land Use Code: 9800 - Garages, Outbuildings, Other Imps Property Description: S22 T26 R1W SE NW (N1/2 S1/2 N1/2) LESS W OF RD. SUBJ TO DECL COVT AFN#441017 Tax, A/V, Sales, Photos, and Permit Data Bldg Data Mao Parcel Plats &Surveys Septic Monitoring Info °^; , Jefferson County -`, HOME i COUNTY INFO I DEPARTMENTS I SEARCH Best viewed with Microsoft Internet Explorer 6.0 or later 40 Windows - Mac http://www.co.jefferson.wa.us/assessors/parcel/parceldetail.asp?value°601222006 4/24/2015 Cases Associated with a Parcel Page 1 of 1• Jefferson County '444411141r _weait erSiahiax , ." uataoa3d,7tt6r5- ` ::M3 s..:_:+ . * ::Webc?n Home County Info Departments Search Cases Associated with Parcel No: 601222006 This may not be a complete listing of information that exists for this parcel. There may be other information pertinent to the property on file. Please contact the Department of Community Development for additional information. Case Number RAP03-00191 Description ROAD APPROACH - COYLE ROAD Last Name KERN Received Date 8/8/2003 LaserFiche Links RAP03-00191 (If document is unavailable please contact the applicable department to view the file.) Case Number FPA2603134 Description Forest Practice Application. Last Name MOSTELLER Received Date 2/4/2000 LaserFiche Links FPA2603134 (If document is unavailable please contact the applicable department to view the file.) Case Number FPA2602346 Description Forest Practice Application. Last Name HOSTELLER Received Date 3/26/1999 LaserFiche Links FPA2602346 (If document is unavailable please contact the applicable department to view the file.) f.ier Jefferson County ,, - ; HOME 1 COUNTY INFO I DEPARTMENTS 1 SEARCH Best viewed with Microsoft Internet Explorer 6.0 or later Windows - Mac http://www.co.jefferson.wa.us/commdevelopment/ppquery/cm.asp?value=601222006 4/24/2015