HomeMy WebLinkAboutBLD2015-00127 - 01 PERMIT APPLICATION •
• BLD15-00127
BUILDING PERMIT APPLICATION Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD15-00127 Received Date: 4/15/2015
SITE ADDRESS: 1765 WEST VALLEY RD
OWNER: BOYD ANGLIN PHONE: 360-732-4932
1765 W VALLEY RD
CHIMCACUM WA 98325
SUBDIVISION: Block: Lot: LOT 1
PARCEL NUMBER: 901221009 Section: 22 Township: 29 N Range: 1V1
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 SHOP! GARAGE- NO PLUMBING - NO HEAT
SEP14-00021
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 0
VALUATION 40,460.00 ADD'L: HEAT TYPE: UH
CODE EDITION: 2012 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: 1,400 SHORELINE:
CONST TYPE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total:
Routing Date:
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $496.00 SRE 04/15/15 154330 /C
State Building Code $4.50 SRE 04/15/15 154330 APPROVED
Plan Check $234.40 SRE 04/15/15 154330
Total: $734.90 APR 2 4 2015
Jefferson County DCD
\\tidemark\data\forms\F_BLD_App_Bld.rpt 4/15/2015
. •
��SON cot,. DEPARTMENT OF COMMUNITY DEVELOPMENT
W� -4 621 Sheridan Street,Port Townsend,WA 98368
■C Tel:360.379.4450 I Fax:360.379.4451
Web:www.co.jefferson.wa.us/communitydevelopment
yy.-ii„ E-mail:dcd @co.iefferson.wa.us
%.A7`
PERMIT APPLICATION 2 nn I�
Steps in the Permit Process: I. c. � f. 1! V L.
-Review application checklist to ensure all information is completed prior to submitting a�(�licafIon. ---
-Make sure septic has been applied for and water availability has been proven. I 1 n 1
-Make an appointment to meet with the Permit Technician by calling 360-379-4450. I ' ` APR 1 5 2015
-This is not a standalone application; it must be accompanied by a project specific supplerriental application. IL/
-Fees will be collected at intake. Additional fees may apply after review and payment is required beforgperil tt issud.
C0Vi/IlNftY DUCLOINDIl
For Department Use Only Building Permit#
Related Application#s: MLA#
Site Information
Assessor Tax Parcel Number: q0 17i7ii c7,0 g
Site Address and/or Directions to Property: (1(pc IA/, V 0044...k6325._/?/P
9Ofri i lld 44-r. w 14-
Access(name of street(s)) from which access will be gained: w, 04-/.4..4,1 ►'LO
Present use of property: 5f-9-/ P6/21 L()LTV✓Li4'Li
Description of Work(include proposed uses): Std(or1 (.7,9-a-P-- F„
Wastewater-Sewage Disposal — —
This property is served by Port Townsend or Port Ludlow sewer system? YES NO XV
If not served by sewer identified above, identify type of septic system below:
Type of Sewage System Serving Property: '
_
X Septic Septic Permit#: ILA
Community Septic Name of System: Mound — Case#: -
Are other residences connected to the septic system? N D
Additions or repairs to sewage system: N 0
Is it a complete or partial system installation: Complete )( _ Partial _ _
Has a reserve drainfield been designated? Yes .' _ No _
Date of Last Operations& Maintenance check: (WS;4-t2f'4 ellc( 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 PTe primary contact for all project-related questiOand 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: ?-3 C 5 / Q D. n�./c L l ti
Address: 1'/(,$ (eve (JIQLLty TRO. cAi lvgcc.r/Yt„ LA). f��7iS
Phone#: - 1-79:s 2— E-mail Address: ob y gob Gt(Cll �� U__ GOWt-
X _ Please contact Authorized Agent/Representative with project info. (select only one).
Property Owner Signature: ' U Date: 3—/ /S
Note: For projects with multiple owners,attach a separate sheet with each owner(s)information and signatures.
Applicant: Authorized Agent/Representative(it other than owner)
Name: ,L GovnJT1Z-(/0/0^AT Lir
Address: 1647 kwt " L ,i jU two- U Sv/7Y2 "C "
Phone#: 6/7A--- 7'13 /SC E-mail Address:
Professional: Is this an Authorized Agent/Representative for this project? NO YES
Engineer Architect Surveyor Contractor Consultant
Name: License#
Address:
Phone#: E-mail Address:
Professional: Is this an Authorized Agent/Representative for this project? NO YES
Engineer Architect Surveyor Contractor Consultant
Name: License#
Address:
Phone#: E-mail Address:
Professional: Is this an Authorized Agent/Representative for this project? NO YES
Engineer Architect Surveyor Contractor Consultant
Name: License#
Address:
Phone#: 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 notice of the County's intent to enter upon the property for visits related to this application and subsequent permit issuance.
Signature: rt, C Print Name: f 'yr /0,16=, h' Date: —/p—/5
. • •
ON ( DEPARTMENT OF COMMUNITY DES Mil \\/7 rg, ir)
(/� .0� 621 Sheridan Street,Port Townsend,WA 98368 j c
4,.t, Tel:360.379.4450 I Fax:360.379.4451 1U. i l
Wit' t`1iz,,, -C Web:www.co.Jefferson.wa.us/communitydevelopment
"ti E-mail:dcd a@co.jefferson.wa.us ��i APR 701;
�'s�i r cs\o SUPPLEMENTAL APPLICATION
n5
RESIDENTIAL OR COMMERCIAL BLDG PERMIT IinITY "F19P'1F^R
For Department Use Only Receipt#: Date:
Related Application its: Payment#:
Site Information
Owner Name: %-, . ,f ir ; , Assessor Tax Parcel#:
Type of Building
New X Replacement Relocated
Addition Repair Demolition *
'A separate permit is required
Select One:
Single Family Residence Modular Other i list
Proposed Building/Project 1 'l� �,
Number of floors i #new bedrooms existing total bed
#new bathrooms existing total bath
ieatSo rc ll. "
Select all that apply:
Electric Heating Oil Wood Propane
Enter the square footage(sq/ft)that applies in each field:
1 + F j ;' Existing Sq/Ft Proposed Sq/Ft
Residential/Commercial Main Floor
Residential/Commercial Second Floor
Additional Floors-heated/unheated
Basement-unfinished
Basement-finished space or habitable
Detached Garage-heated/unheated a / 0°
Attached Garage-heated/unheated
Garage 2nd fl-unfinished storage
Garage 2nd fl-finished space or habitable
Carport walls a ll s o rless
Deck-uncovered
Covered porch
Other(shed, barn, pole bldg,etc.)
Estimated Cost of Project(Required): $ 3c zoo
Supplemental SFR 1
• •
List existin: buildin:s on •ro•ert i.e. house :ara:e accesso dwellin: unit shed barn mobile home other,:
(��y
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 County and its employees, representatives or agents for the sole purpose of application
review and any required later inspection-. Applicant may request notice of the County's intent to enter upon the
property for visits relates to this appli : ion and subsequent permit issuance.
Signature: si Print Name: /K/10`1G S
N "T7— Date: 3-77
Estimated Cost of Project $
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 L
Receipt# Date: Cash/Check/CC:
Supplemental SFR 2
•
<< L (>1),„ DEPARTMENT OF COMMUNITY DEVE 11 °TUFT
• L 621 Sheridan Street,Port Townsend,WA 98368
Tel:360.379.4450 I Fax:360 379.4451 R APR p
Web:www.co.jef ferson.wa.us/communitydevclopment i I Y'r '1 %i��5 ;
L matl:dcd @co.ie ff ( ;117.9
erson.wa.us [
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9S/1ING'S� Jr Y
n':CDSfWi'JNITY DEVELOPMENT
STORMWATER CALCULATION WORKSHEET /�
MIA# PROJECT/APPLICANT NAME: A/f dakrri e l�i,S'rlKAri/L/,/1 C --ANI yL//U
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 _____tiLnT acres An acre contains 43,560 square feet. Multiply the acreage by this figure.
Size of parcel in square feet J y5-54 g 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:
t Does the project convert 5,4 acres or more of
Construction site for structures /140 0 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 1/z acres or more of
native vegetation to pasture?
Driveway, parking,roads,etc. Scgl) sq/ft
Circle: Yes g)
Lawn, landscaping,etc. sq/ft
Other compacted surface,etc. sq/ft Indicate Total Volumes of Proposed:
Total Land Disturbance 7.20U sgfft Cut I L Fill 2-i, (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 tale worksheet-REV.10120/2014 1
STORMWATER CALULATIONS-IMPERVIOUS SURFACE
NEW EXISTING
Structures(all roof area) 3 sq/ft Structures(all roof area) /7 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 ir9 b sq/ft Driveway,parking, roads,etc 2-FO — sq/ft
Other ty sq/ft Other sq/ft
Total New Z4 a 31_ 1 1sq�/ft Total Existing U 2-41 sgfft
TOTAL NEW+ TOTAL EXISTING* 4�1 `I"1 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: I r7 %
Does the site have 35%or more of existing impervious surface? Circle: Yes n 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#S—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 Storm -t= Calculation Worksheet,I as the applicant/owner attest that the information provided herein is true and correct to the
best of my know •dg:. I also certify that this application is being made with the full knowledge and consent of all owners of the affected
property.
' -
- . -'' 9,DO -OR AUTHORIZED REPRESEN IVE SIGNATURE) (DATE)
FOR OFFICE USE ONLY
SMALL MEDIUM LARGE REDEVELOPMENT Stormwater Site Plan: Yes No
stormwater wlc worksheet—REV.10/20/2014
• •
,.,s,_g0N �o DEPARTMENT OF COMMUNITY DEVELOPMENT
U 621 Sheridan Street,Port Townsend,WA 98368
W
ti < Tel:360 379.4450 Fax 360.379.4451
Web:www.co.jefferson.wa.us/communit,,Alt eluuffient
#- ' '- E-mail:dcd@.co.jcffcrson.wa.us
`QSN) NG�O
SITE PLAN CHECKLIST
Site plan must be legible.
Only a complete site plans can be accepted at time of appointment. The permit technician is unable to complete
the site plan for you. If you have questions please call before submittal.
You must ensure that every item below is included in the site plan. Check each item below when completed in
site plan. The permit technician will review at time of submittal, incomplete site plans will be returned.
DCD YOU
t/ Title Block
/ Indicate applicants name, site address,Assessor's Tax Account it(Parcel 14).
_ V Scale
Indicate map scale. Use appropriate scale and note it on your site plan. (example-Scale 1" -40')
V
North Arrow
Show an arrow indicating the NORTH direction.9`
Property Boundaries/Easements-full site plan is needed,attach detailed plan if needed
Show property lines and all easements(utility,drainage, dike, access, railroad, etc). Indicate site
/ dimensions. Include building footprint square footage and names of adjacent roads.
V Driveway
V
/Show entire length and width of driveway in feet. Indicate grade of driveway in percent(%)slope.
_ Building Footprint
Show location and dimensions of all existing and proposed buildings or structures. If this
project includes an addition,clearly show the addition different from the existing building.
Identify each building by its use(residence,garage). Indicate any decks, porches,or retaining walls.
Impervious Surface
Indicate the amount of new impervious area. Label new and old impervious areas. Include the
/sq/ft of building, roof area, parking area, patios and any new driveway(including non-paved driveways).
_ / Setbacks
Indicate the building setbacks from all property lines with a dashed line. Include distances between
/structures, and distances from structures to critical areas, including shoreline setbacks when applicable.
✓ Power Lines from property boundary to structure
_ ti On-Site Septic System Location or Sewer Lines
Indicate method of sewage disposal. See back side for septic site plan requirements.
Well Location or Water Lines-must show 100 foot radius around well.
Indicate the drinking water supply(existing and/or proposed, public or individual). Show all
private well(s), public water mains and water supply pipes to all buildings.
Propane
Show the location of the propane tank(if any).
Propane is prohibited in locations such as basements or pits or anywhere gas can unsafely collect.
Propane tanks >125 gallons-micjimriftetiwIppinlaft.cfmn property line and buildings. Page 1
Environmental Health Requirements
Note-this building permit application may require you to bring your septic system up to current codes.
DCD YOU
v On-site septic system location or sewer lines(existing and/or proposed).
Show measurements from the foundation to septic tank,drainfield and reserve area.
Sewage transport line
Current O&M inspection.
—7/Reserve area
Is the stormwater diverted from drainfield/tank area? Show measurement from stormwater facility
_ facility to septic tank and drainfield.
Are all septic system components completely installed (tanks,transport lines, drainfield)?
Is the septic system finaled, please contact EH to see what requirements they may have.
Water
_ Well location(s)with a 100 foot radius around well.
Water Lines and water meters,from water source to all buildings.
DCD YOU
Shorelines
For shoreline properties,show the ordinary high water mark(OHWM),the shoreline buffer,
the shoreline setback, and the distances from OHWM to all structures, including structures within
300 feet from both sides of property.
Slope
Indicate slope (elevation change)of building site. Use contour lines or arrows to show direction
and percent(%) slope(s). Identify slopes greater than 15%.
Percentage%of slope= Rise(height)divided by Run (distance) multiplied by 100.
Critical Areas
Show all critical areas such as geologically hazardous areas,wetlands, rivers,streams, ponds, etc.
Stormwater
Method and location of stormwater disposal facilitates such as rain gardens, splash blocks, dry wells
based on the current Stormwater Management Manual for Western Washington.
,:...ems 'r,;„sur. ,r. >.kvt . . � - , • a - '.�. --�-•
A site plan prepared by a licensed civil engineer, architect, or landscape architect containing the following
information in addition to the general information required above.
DCD YOU
_ Existing structures and significant features on the subject property and on adjacent properties.
Property lines,adjoining street and immediately adjoining properties and their ownership.
The layout of an internal vehicular and pedestrian circulation system, including location and dimensions
of existing and proposed improvements on public right-of-way such as roads, sidewalks,and curbs.
Corner grades and exisiting contours of topography at five-foot intervals.
_ Existing and proposed grades and volume and disposition of excavated material, if applicable
Natural drainage direction and storm drainage facilities and improvements.
Locations of all existing and proposed utility connections.
Parking spaces and driveways.
Identify all uses in existing and proposed structures.
Proposed landscaping. Checklist-Site Plan Checklist Page 2
Sip Front Parcel Review • s (6-72- 3-
Parcel 901221009
Printed: April 16, 2015
BOYD ANGLIN Site Address(es):
1765 W VALLEY RD 1765 WEST VALLEY RD , WA 98325
CHIMCACUM, WA 98325
Parcel Number: 901221009 S-T-R: 22-29N-1W Total Acreage 9
Legal Description S22 T29 R1W TAX 28/PARCEL I V32/P107-9 Land Use: 8300
Flood District: Fire District: 1 Planning Area:
Flood Map(FIRM)Panel No: School District 49 Zoning: Act L: 2,6
COMP PLAN fir
DESIGNATION:
COMMUNITY PLAN: UGA: UGA Trans
[ 14 Plot plan states "property line"
[ (4 Assessor's Map (Property lin , submitted plot plan must match the property lines as identified on the Assessor's 1/4 map)
[ vir- Legal Access to Property NO
[ C.r Parcel Tags or Scanned Documents YES N
[ t ESA's: Special ' - •arts Nearby YES vo
3-[ r4 Designated Ag NO
[ V]' Shoreline Designation: YES
[ Cr- Shoreline Slope Stability: YES
Stream Type:YES NO
FWHCA: YES NO
Wetlands: ES NO 7 0
Rare Plants:YES NO
Seismic: YES NO
Landslide: YES NO
Flood: YES NO
Erosion: YES NO
Aquifer Recharge Area:YES NO
SIPZ: none At Risk High Risk Coastal
CMZ: none High Risk Moderate RiskDisconnected CMZ
Stormwater site plan submitted: YesNo
[ Ir Forest Lands: YES
Adjoining Forest Lands: Commercial Rural Inholding
[ (/( Mineral Lands: YES 1
[ vr Agricultural Lands: 4J NO
[ (h Archaeology: YES I,
[ ter No Shooting Zone: YES 'O // C�
[ (/] Stormwater: New Imperv.• urface 1-!C2 T-7 Land Disturbing Activity 27 7--E-E0 ESA's
Stormwater Req's: n Req#2 Min keg#1 thru#5 Min Req#1 thru#10 Engineering
[ yr Notice Provisions ►—c osure:Airport YES NO MRL Yes NO Forest Lands YES NO
[ j4 Landscaping Required: Yes .r•
[
vt.,. Parking Spaces Rev ' ea NO 2 Other
I Buildine Heieht:41010 UBC Standard
[ 1,.?" Impervious Surface covera percentage:
Resource Lands&Public: IOW Rural Residential:ggl Rural Ind.: Per UDC Sec 6.7
Rural Commercial: 60% Area of Building Co erage:60%in Rural Industrial Lands only
[ (/r Total Building(s) Size:
RVC:20,000 SF CC:5,000 SF NC: 7,500 SF GC: 10,00 All others:subject tozplic&water constraints/N s ecified
[VI�
Front: � Left Side: Right Side: one Rear:
Shoreline Setback:
LSHA Setback:
[ VI Road Classification:
Road Approach: EXIST REQ'D RAP
[ SEPA Required: YES EXEMPT 1
[ (,jam Flood Certificate:
[ (J/ Existing Case(s)& Condition(s):
Violations: Yes No
[ Recorded Date of Subdivision: AFN Over 5yrs=UDC
Plat Conditions: <5yrs=Plat Conditions on plat or Old Ordinance
[ Lots/Require Declaration of Restricti ovenant YEjubmitted: YES NO
[ (A- UGA No Protest Agreement YES submitted: YES NO
[ j4 Site Visit conducted YES 414
[ Vp Require Final Zoning Approval YES
[ ✓� ADMIN: Setbacks entered in Permit Plan case al) YES
New Parcel Tags entered in Permit Plan 440 YES
Special Reports Scanne s 4 YES
No parcel tags found for parcel
Cases Associated with APN 901221009 Review
Cases Name Type Status P lanner
ADR13-00059 ANGLIN F
Application Received: 12/19/2013 Permit Issued/Case closed: Case Finaled: 1/21/2014
NEW ADDRESS REQUEST OFF WEST VALLEY RD
BLD14-00060 ANGLIN I F Donna Frostholm
Application Received: 2/19/2014 Permit Issued/Case closed: 5/2/2014 Case Finaled: 9/15/2014
Manufactured home on concrete foundation. 61'2x 26'8 serial#tbd
BLD15-00127 ANGLIN P David Wayne Johnson
Application Received: 4/15/2015 Permit Issued/Case closed: Case Finaled:
NEW SHOP/GARAGE- NU PLUMBING - NO HEAT
SEP14-00021
SEP14-00021 ANGLIN I F Donna Frostholm
Application Received: 2/18/2014 Permit Issued/Case closed: 4/28/2014 Case Finaled: 9/3/2014
USR13-00043 ANGLIN CMP
Application Received: 12/16/2013 Permit Issued/Case closed: 4/28/2014 Case Finaled: 4/28/2014
first driveway n of 183Iwest valley rd.
1ltidemarkldatalforms\R_Parcel_CRMLA.rpt 4/16/2015 Page 2 oft
• • •
_ II \\/ rc-1
(4--5
ON °G DEPARTMENT OF COMMUNITY DEVELOPMENT " �I� '1I
-j. 621 Sheridan Street,Port Townsend,WA 98368
Tel:360.379.4450 i Pax:360.379.4451
\Vcb:www.co.jcfferson.wa.us/communitydevelopment I�
�La
9Sty1NG�O E-mail:dcd�:co.ieffcr on.wa.us i j �i
?TY r r�nDr rtr^;i
STORMWATER CALCULATION WORKSHEET ---
MIA# PROJECT APPLICANT NAME: .� 1 N! _`//.L` ,
/ fa�.v oar>,ey nsr�i�I'(<t/�s-�f�✓cci,u
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 9i a y acres An acre contains 43,560 square feet. Multiply the acreage by this figure.
Size of parcel in square feet 3 y5-5Z-41 g 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:
1 Does the project convert 311 acres or more of
Construction site for structures I tO 0 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. S-(40 sq/ft
Cirde: Yes (No'
Lawn, landscaping,etc. sq/ft
Other compacted surface,etc. sq/ft Indicate Total Volumes of Proposed:
Total Land Disturbance 7 u0 sq/ft Cut 26, Fill 2-4, (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.
slormwaler talc worksheet—REV.10/202014 1
• •
STORMWATER CALULATIONS-IMPERVIOUS SURFACE
NEW J EXISTING
Structures(all roof area) j 6-t 3 sq/ft Structures(all roof area) /7 ' 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 5*U sq/ft Driveway,parking, roads, etc Z�U 5 sq/ft
Other sq/ft Other sq/ft
Total New 2-4?-5 3 sq/ft Total Existing 1424/ sq/ft
//''
TOTAL NEW+TOTAL EXISTING* of 1 L 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: it 7 o/a
Does the site have 35%or more of existing impervious surface? Circle: Yes Ei No T' 1
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. OCD 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 Storm -terr Calculation Worksheet,l as the applicant/owner attest that the information provided herein is true and correct to the
best of my know.dge: I also certify that this application is being made with the full knowledge and consent of all owners of the affected
property.
_
DOW 'OR AUTHORIZED REPRESEN IVE SIGNATURE) (DATE)
r• s c ;
tip++ rh "
•stemmater talc worksheet—REV.10/20/2014 2
• •
BUILDING PERMIT APPLICATION BR eview T ype :e:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD15-00127 Received Date: 4/15/2015
SITE ADDRESS: 1765 WEST VALLEY RD
OWNER: BOYD ANGLIN PHONE: 360-732-4932
1765 W VALLEY RD
CHIMCACUM WA 98325
SUBDIVISION: Block: Lot: LOT 1
PARCEL NUMBER: 901221009 Section: 22 Township: 29 N Range: 1\A
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 SHOP / GARAGE- NO PLUMBING - NO HEAT
SEP14-00021
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 0
VALUATION 40,460.00 ADD'L: HEAT TYPE: UH
CODE EDITION: 2012 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY:
OTHER:
CONST TYPE: SHORELINE:
GARAGE: 1,400
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total:
Routing Date:
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $496.00 SRE 04/15/15 154330
State Building Code $4.50 SRE 04/15/15 154330
Plan Check $234.40 SRE 04/15/15 154330
Total: $734.90
\\tidemark\data\forms\F_BLD_App_Bld.rpt 4/15/2015
.� ,v7
• •
w,$. �'o� DEPARTMENT OF COMMUNITY DEVELOPMENT_,
, .,y
,,s ,.0
C4� 621 Sheridan Street,Port Townsend,\1".1 98368
„W, Tel:360.3-9.4450 I Fax:360.379.4451
Web:www.co.jefferson.wa.usi communitvdevelopment
E-mail:dcd(a co.jefferson.wa.us 1.---
�
`
PERMIT APPLICATION
Steps in the Permit Process: r� 11 \V +1-:: -
-Review application checklist to ensure all information is completed prior to submitting application. _____I
-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;] iss�u d.
For Department Use Only Building Permit#
Related Application#s: MLA#
Site Information
Assessor Tax Parcel Number: q I 7.7il 47 09
Site Address and/or Directions to Property: I e0 S.— (fit !vy
6 ki4.A Gvn,. w 14- 9 s
Access(name of street(s)) from which access will be gained: w, v 41.r.Fcw ✓GQ
Present use of property: 5f9--1 AGAtC-U LTV)2441—, I
Description of Work (include proposed uses): sal f2 (.709. -o ..
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: 1 `
S
•
eptic Septic Permit#: Sek l -1 - ca)-2-1
Community Septic Name of System: Nt.eUrIck Case #:
Are other residences connected to the septic system? N U
Additions or repairs to sewage system: N 0
Is it a complete or partial system installation: Complete X _ Partial
Has a reserve drainfield been designated? Yes _ No
Date of Last Operations & Maintenance check: (WS714L-L- 2i eilLf 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 t it rimary contact for all project-related question nd 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: BO D D. Alvah/0
Address: J ,r$ (NeST IALLey 1ZIW. CAimActan, IA=h. yin
Phone#: _ -34n- f-37,' _1 2-, E-mail Address: n at, Allot)ELLeIv 6) _,we,. co)�
x _ Please contact Authorized Agent/Representative with project info. (select only one).
Property Owner Signature: a9,i,ej V. 0 enn Date: 7-15'/.
Note: For projects with multiple owners,attach a separate sheet with each owner(s)information and signatures.
Applicant: Authorized Agent/Representative(if other than owner)
Name: OW u r�- Go% T✓T 'FG/1,04 AK(Jr
Address: go C.24 ?{w1,( 99 L ,vwfxn wo- gb0 37 cv/T1- `rG "
Phone #: £7i'- 7,13 /CS– E-mail Address:
Professional: Is this an Authorized Agent/Representative for this project? NO YES
Engineer Architect Surveyor Contractor Consultant
Name: License#
Address:
Phone#: E-mail Address:
Professional: Is this an Authorized Agent/Representative for this project? NO YES
Engineer Architect _ Surveyor Contractor Consultant
Name: License#
Address:
Phone#: E-mail Address:
Professional: Is this an Authorized Agent/Representative for this project? NO YES
Engineer Architect Surveyor Contractor Consultant
Name: License# I-
Address:
Phone#: 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 notice of the County's intent to enter upon the property for visits related to this application and subsequent permit issuance.
Signature: ' r9' Ge, l ( Print Name: I i'1 t). t f/-' Date: J—/p-/3
• •.
VSON C. DEPARTMENT OF COMMUNITY DE ° en 17'ENT 0 \\,7 [ I�,I1
4�' JG 621 Sheridan Street,Port Townsend,WA 98368
L �� Tel:360.3'9 4460 I Fax 360.379.4451
-<y Web:uw'a co.jeff erson.wa.us/communitydei�elopment I 1
E-mail:dcd Nco.icffcrson.wa.us
tL9s f, . �O� i J Ji'
t N SUPPLEMENTAL APPLICATION'
RESIDENTIAL OR COMMERCIAL BLDG PERMIT
For Department Use Only Receipt#: Date:
Related Application#s: Payment#:
Site Information
Owner Name: ��/ f/RE?L(„ Assessor Tax Parcel#: (76/ 0.-Z-100 9
Type of Building
New X Replacement Relocated
Addition Repair Demolition *
"A separate permit is required
Select One:
Single Family Residence Modular Other y'. it
Proposed Building/Project
Number of floors , # new bedrooms existing total bed
#new bathrooms existing total bath
Heat Source
Select all that apply:
Electric Heating Oil Wood Propane
Enter the square footage(sq/ft)that applies in each field:
Structure Existing Sq/Ft Proposed Sq/Ft
Residential/Commercial Main Floor
Residential/Commercial Second Floor
Additional Floors-heated/unheated
Basement-unfinished
Basement-finished space or habitable
Detached Garage-heated/unheated 7/6°
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): $ 3c- zoo
Supplemental SFR 1
M •
�so�r co DEPARTMENT OF COMMUNITY DE one h'E , \\17
621 Sheridan Street,Port Townsend,WA 98368 1
a Tel:360.3'9.4450 I Pax:360.3'9.4451 ! I I
.G Web:lcmco.iefferson.wa.us/communidve,lonment
G-mail:
dcd@co.jefferson.wa.us j
'‘SW i N Oho SUPPLEMENTAL APPLICATION'
RESIDENTIAL OR COMMERCIAL BLDG PERMI`P
For Department Use Only Receipt#: Date:
Related Application#s: Payment#:
Site Information
Owner Name: JLt <7t� i� .v' Assessor Tax Parcel#: 476/ LZ/GU 9
Type of Building
New X Replacement Relocated
Addition Repair Demolition
*A separate permit is required
Select One:
Single Family Residence Modular Other pt„. list
Proposed Building/Project
Number of floors #new bedrooms existing total bed
# new bathrooms existing total bath
Heat Source
Select all that apply:
Electric Heating Oil Wood Propane
Enter the square footage(sq/ft) that applies in each field:
Structure Existing Sq/Ft Proposed Sq/Ft
Residential/Commercial Main Floor
Residential/Commercial Second Floor
Additional Floors-heated/unheated
Basement-unfinished
Basement-finished space or habitable
Detached Garage-heated/unheated
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): $ 35 zoo
Supplemental SFR 1