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Home My WebLink AboutBLD2015-00095 - 01 PERMIT APPLICATION 11, BUILDING PERMIT APPLICASON Review Type: Jefferson County Department of Community Development BLD15-00095 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD15-00095 Received Date: 3/26/2015 SITE ADDRESS: 170 SUNSET BLVD PORT TOWNSEND, 98368 OWNER: KRISTINE EASTERDAY PHONE: 206-459-2233 JAMES M HECKINGER 1614 32ND AVE SEATTLE WA 98122-3318 9381 SUBDIVISION: Block: 3 Lot: 5 PARCEL NUMBER: 938100305 Section: 12 Township: 30 N Range: 21/1 CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTION NEW DECK PLUS 9 NEW WINDOWS TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP ADD MAIN: VALUATION 40,000.00 ADD'L: HEAT TYPE: CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: SETBACK: DECK: 450 BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $496.00 SRE 03/26/15 154238 State Building Code $4.50 SRE 03/26/15 154238 APPROVED Plan Check $322.40 SRE 03/26/15 154238 Total: $822.90 APR 0 7 2015 Jefferson County DCD \\tidemark\data\forms\F_BLD_App_Bld.rpt 3/26/2015 1 • • 4gON cow DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street,Port Townsend,WA 98368 -1� Tel:360.379.4450 I Fax:360.3794451 Web:www.co.iefferson.wa.us/communi develo mens , :�' V root. E-mail:dcd@co.jefferson.wa.us I� �� NO.-CC) I II 1811102 g 42(CIW5 ) PERMIT APPLICATION I .� JEFPERkikaiNifilTY Steps in the Permit Process: 0r `u 1„^,it;:.e!JVA.1 da NT -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: 91 g '00305 Site AddPI and/or Directions to Property: `7 0 Sl i,Vle,.e+ -81 yd. co!o t lJ) —PovLo cnol'152 hGl , 1�1�Qc UC I Access(name of street(s)) from which access will be gained: 6(,u45.r- `42)I ud Present use of property: (11L.12. •FakA,iI • e4ic41 Description of Work(include proposed uses): / 2t.¢ 67175{-rud--i'o- o4 cI2c.IL 4-FA, rear cr - +k,e.. ' F R � PISS a 5 vv a 1I GOv•e„✓i is ever -I424-ik -Pron+ aGLe45 1'0.144.0. PIcl,s Jq WInde(,os / Ne lac t�t�.r - Wastewater-Sewage Disposal This property is served by Port Townsend of 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: k daXZ d ✓ Septic Septic Permit#: .5 EP "]¢- 1 (p 1 Community Septic Name of System: Case#: Are other residences connected to the septic system? rip Additions or repairs to sewage system: Is it a complete or partial system installation: Complete _ — Partial _ Has a reserve drainfield been designated? Yes V _ No _ Date of Last Operations&Maintenance check: 5//4/2o 14- Attach last report to application Describe or attach any drainfield easements,covenants or notices on title, which may impact the property: . • • mail / e-mail requests and information about the application to the authonzed agent/representatives- cc the owne� noted below. The authorized agent/representative is responsible for communicating the tYfrrmr rr k the application. It is the responsibility of the authorized agent/representative and owner td¢t� �ix%„�e, � N_ _ r�lty email((i.e., County email is not blocked or sent to"junk mar). Applicant/Property Owner Information v "� a� � � Property Owner: (( �I)l i iii ' F.. 2 , ri ,� „ Name: J0.WtfS lice k.lv� -er + Vv-s Easkerdfi�y L 1, Address: 1 (1)14- 32nd Ave , 57t a..+4 Ie. , W l� 9 e, 1 2 Z. ' ) �� 04417-7 T Phone#: SOU - 4 4 - 22.33 E-mail Address: Vn ke.a WO-1°' ° ' Pr , Gown. — _ Please ntact Authorized Agent/Representative with project info. (select only one). Property Owner Signature: �J'a.6 Date: _ - Z 41— ( i Note: For projects with multiple ownegs a ach a separate sheet with each owner(s)information and signatures. Applicant: Authorized Agent/Representative(If other than owner) Name: Address: Phone#: E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: ` ..e_ CO1n1et- ra --,krcL 9-ec-F Address: 40.5 Rdc>f `Pos-�owvl 'ev,d , WA- c183/08 Phone#: 62 p— 3 gs _ 2 4 P E-mail Address: c0.'-E C.a..ie.Gpvvler--c'ord .c-ow,, Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: Address: Phone It E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: Address: Phone if: E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: Address: Phone#: E-mail Address: Attach additional pages if necessary 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. t Signature: .(If Print Name: J. /k Ale u- Date: 3-Z y-(s- (j (j(j 0 INVOICE ate: 5/28/2015 fivoice ID DCD15BLD15-00095 C--c- Cb JEFFERSON COUNTY 2, DEPARTMENT OF COMMUNITY DEVELOPMENT ' 621 Sheridan Street i Port Townsend, WA 98368 360-379-4450 I email: dcd@co.jefferson.wa.us /L�S,HIG�c_) www.co.jefferson.wa.us/commdevelopment NI Date Due: BILLING ADDRESS: 6/27/2015 KRISTINE EASTERDAY JAMES M HECKINGER 1614 32ND AVE SEATTLE WA 98122-3318 Plan Check 78.00 Total Amount Due: $78.00 REMIT TO: Jefferson County DCD 621 Sheridan St. Port Townsend. WA 98368 Please return the above portion with your payment Permit Number: BLD15-00095 Plan Check 78.00 Total Amount Due: $78.00 .- --- 610C9F Payment is accepted by cash, check, debit or credit card (Visa, Mastercard, Discover, American Express) To pay by credit card, go to www.co.jefferson.wa.us/commdevelopment, and click on the "Online Credit Card & echeck Payments" link on the left side of the page. (questions: call 360-379-4450) • i goN DEPARTMENT OF COMMUNITY DEVELOPME OG 621 Sheridan Street,Port Townsend,WA 98368 mco i Tel:360.379.4450 I Fax:360.379.4451 tiWeb:www.co.iefferson.wa.us/communitpdevelopment E-mail:dcd(aco.j_efferson.wa.us Ibrie-TINMer,22342 15 �9S tINC3' SUPPLEMENTAL APPLICATIO • �co RESIDENTIAL OR COMMERCIAL BLDG PE e, . ,rin u`` .1,_,_ For Department Use Only Receipt#: Date: Related Application#s: Payment it Site Information II'' Owner Name: - eciL4 . f 4 f� , +tri Assessor Tax Parcel If: 38 LOD ' 'O Type of Building New Replacement Relocated Addition Repair Demolition *A separate permit is required Select One: � Single Family Residence ✓ Modular ✓Other"De c—)L, 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 ICC Valuation (Office Use) 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 4 'O SF 1 bit:0S 1 ;6°5 Covered porch Other(shed, barn, pole bldg,etc.) Estimated Cost of Project (Required): $ 4o I o oo • $ • ill List existing buildings on property (i.e. ouse, garage, accessory dwelling unit, shed barn, mobile home, other): All Existing Buildings on Property Use F Builders Statement The signer of this statement certifies that they are the Owners of the parcel referenced herein,that they are not licensed contractor and that they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Print NameAA . . l 4. /41:-/-c-K i r.JZ Len_ Date: 3--z K- ' 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: \ Print Name: f-) . /U. /46Se_x i wG vvc_. Date: 1 -Z 54-/S- For Department Use Only Building Permit Fees Building Base Li.Cj (4.. on Plan Check Review �{0 Land Use Review $234.00 Septic Review $80.00 Potable Water $ . Technology/Scan $19.50 State Fee $4.50 Other Fees Shoreline Exemption 532_.°° Zoning Zoning Other New Address Road Approach Total Fees 1 ) (4,6S ' 14b Receipt # Date: Cash/Check/CC: 15`F23f� 3/Qt-P✓(5 5 2-8 co • • ON 'OGS JEFFERSON COUNTY �. r 7 ra DEPARTMENT OF COMMUNITY DEVELOPMENT yl j Ma 71 N ' i $ 621 Sheridan Street • Port Townsend • Washington 98368 "' 1BEF tilii03111114/ 11 cO 360/379-4450 . 360/379-4451 Fax R! ?TtOFtu p;; :; Ii., ; , RING http://www.co.jefferson.wa.us/commdevelopment/ Stormwater Calculation Worksheet MLA# PROJECT/APPLICANT NAME: J • 14 c-k41►(. k• Fa4 er ci 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 C. 141 acres An acre contains 43,560 square feet. Multiply the acreage by this figure. Size of parcel in square feet I, I 0 b 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 sA acres or more of Construction site for structures 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 Y2 acres or more of native vegetation to pasture? Driveway, parking,roads, etc. sq/ft Circle: Yes Lawn, landscaping, etc. sq/ft Other compacted surface, etc. sq/ft Indicate Total Volumes of Proposed: Total Land Disturbance ci0 sq/ft Cut Fill 0 (cu/yd) [over] store-water talc worksheet Rev 9-9-2010—REV 9/9/2010 • 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 CALULATIONS - IMPERVIOUS SURFACE NEW Sepr EXISTING Pp a e Structures(all roof area) af ! r Jar sq/ft Structures(all roof area) I l sq/ft Sidewalks sq/ft Sidewalks sq/ft Patios sq/ft Patios sq/fl Solid Decks sq/ft Solid Decks sq/ft (without infiltration below) (without infiltration below) Driveway, parking, roads, etc sq/ft Driveway, parking, roads,etc sq/ft Other sq/ft Other sq/ft Total New 2.5 sq/ft Total Existing I DIS sq/ft TOTAL NEW+TOTAL EXISTING* 10 40 sq/ft 'This amount will be used BY STAFF 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: (0 % Does the site have 35%or more of existing impervious surface? Circle: Yes 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 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. J. oM. f(�rc�crw� L� Z - (LANDO ER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) FOR OFFICE USE ONLY SMALL MEDIUM LARGE REDEVELOPMENT Stormwater Site Plan: Yes No stormwater calc worksheet Rev 9-9.2010—REV 9/9/2010 • • �� 3/24/2015 EnvIA Chock LLC l� P v✓//p E 1612 Hastings Ave. West 360-3 Port Townsend, WA 98368 MAR 2 3 2015 PROPERTYINFORMATI� 421) House Z Location:170 SUNSET BL COUNTY t\ - \\11k\:\ JEFFERSOfJ l 1r` Port Townsend I WPT.OF COMMUNITY DEVELOPMENT _ G0�1V5Y PM NS Tax ID:938100305 Mels ro' 1614 32nd AvJames er �` . tR�ON\S!DE lE10 E 161413,WA ? (.`COh^1.... Use:Residential,Single Family System Design Flow:240 98122 GENERAL SYSTEM TYPE:Gravity Owner.James Heckinger ON ID:SOM74-00016 Fold • • • .. .��. . . . _ • • . . • ' FON Here Here Inspected:05/20/2014 - Inspection Type:ROUTINE - Correction Status:All corrections made Company: Work Performed By: Submitted 05/20/2014 by: Enviro Check,LLC Dale Wurtsmith Dale Wurtsmith This report does not assure approvals by Jefferson County Public Health for ANY future building permits or development. COMMENTS&GENERAL INSPECTION NOTES Deficencies Were Noted:Corrections were made to resolve the deficiencies. 1-What I observed was consistent with plan. GENERAL SITE&SYSTEM CONDITIONS The General Site and System Conditions were: Fully Inspected All Components accessible for maintenance,secure and in good condition: YES Surfacing effluent from any component(including mound seepage): NO Components appear to be watertight-no visual leaks: _ - YES Improper encroachment(roads,buildings,etc.)onto component(s): NO Component settling problems observed: NO Abnormal ponding present for one or more of the disposal components: N/A Subsurface components adequately covered YES Owner compliance issues noted NO Site maintenance required(e.g.Landscape maintenance)If yes,describe in comments: NO Occupant compliance problem(occupant not operating the system properly). If YES,describe in notes: NO If deficiencies were identified on last inspection were they corrected before or during this inspection? N/A (If NO,describe in notes,NA=no deficiencies on last report): OSS Components,structures and appurtenances located per as-built/record drawing(If NO,describe YES in notes). If no as-built exists or changes made,state NO and provide record to Health Dept: Alterations made to the OSS(valves adjusted,timer settings modified,ports installed,etc.)(If YES, NO describe in notes): _ The house/structure was vacant or used infrequently,assessment of the drainfield was not possible. YES-Corrected Is the SEP case in a finaled/completed status?(if NO explain in comments) YES ONSITE SEWAGE SYSTEM INSPECTION DETAIL TANK:Septic Tank-1 Compartment fiberglass This component was. Fully Inspected • Component appears to be functioning as intended: YES Effluent level within operational limits(if NO explain in comments): YES All required baffles in place(N/A=No baffles required): YES Effluent Filter Cleaned(N/A=Not Present): N/A Compartment 1 Scum accumulation(Inches,if other specify): 4 Effluent filter/screen needed cleaning on arrival N/A Compartment 1 Sludge accumulation(Inches,if other specify): 5 Pumping needed: NO Approximate Gallons to be pumped(if needed)by Certified Pumper: ReportiD:376322 View inspection reports online at www.onlinerme.com Page 1 of 2 i • This component was: Fully Irspected Component appears to be functioning as intended: YES • Ponding present?If YES explain in comments: N/A This report Indicates certain Characteristics oftte onsite sewage system at the time or vise In no way is this report a guarantee of operation or film performance. ReportiD:376322 View inspection reports online at www.onlinerme.com Page 2 of 2 IC v N - So - 0601(0 L n 5ped`on LDue dccie 512_0/ 1 7-- • To- Jefferson County Environmental Health From- E'nviro Check, LLC Date- 09'1410 �� E c Q M C SOM 74-00016 APN 933100305 �I MAR 2 3 2015 L i Address- 170 Sunset Blvd., PT V JEFFERSON COUNTY Owner- Wes Dickson i__. FIT.OFCOMMUNITY DEVELOPMENT Subject- , ; i i i, MAR 2 4 ;n15 , Submitting for Final on permit. _j CF COMMUINM DEVELOPMENT 4G) ii 't010 Jetfersor., Count%.• =nvironrnerrtai Hr alis r 0%% 1Le,�.x:4 t,� arrl /{Wc ; is tar, AP✓%)(.N — c':',GTti EN VIRO /O HECK, L.L.C. 1612 Hastings Ave. W. Port Townsend, WA 98368 ---_ _ _.� ENViRON/t HECK, L.4 C. 1612 Hastings Ave. W. PH 36',J-379V0- g3 8 p �_ l*7r DAA f � • • �4SON cow DEPARTMENT OF COMMUNI D.-,VE O V E 44, ,t, 621 Sheridan Street,Port Townsend,A\A 98368 L.li n ti "fel.360.379A450 Fav 360.379.4451 ,ii, i q Web.ww co.iefferson wa.u9/communin,development�' 11 , MAA 2 3 2 5 �� f 17-mall:dcd@co.jefferson.wa.us � � �rJTY _ 1S4 j N G So Cu 'IviUNITY DEVELOPMENT JGOMMUON COUNTYOPMEN i- 'Ter COMMUNITY DEVELOPMENT PERMIT FEES WORKSHEET Name James & Kris Easterdati Parcel# 938100305 Estimated Cost of Project $40,000.00 Permit# Building Base Fees Building Base $496.00 Plan Check Review $322.40 Land Use Review $234.00 Septic Review $80.00 Potable Water Technology/Scan $19.50 State Fee $4.50 Other Fees Shoreline Exemption $532.00 Zoning Zoning New Address Public Works Total Fees $1,688.40 Office Use Only Receipt Number: Cash/Check/CC: Date: Parcel Details Page 1 of 2 11111 Jefferson County Home County info Departments Search Parcel Number: 938100305 SEARCH Parcel Number: 938100305 Printer Friendly Owner Mailing Address: KRISTINE EASTERDAY JAMES M HECKINGER 1614 32ND AVE SEATTLE WA98122-3318 Site Address: 170 SUNSET BLVD PORT TOWNSEND 98368 Section: 12 School District: Port Townsend (50) Qtr Section: SW1/4 Fre Dist: Chimacum (1) Township: 30N Tax Status: Taxable Range: 2W Tax Code: 0111 Planning area: Quimper (2) Sewer: Drainage: Bank: View 1: View 2: Zoning 1: RR-5 - Rural Residential Zoning 2: Zoning 3: Sub Division: 9381 - CAPE GEORGE COLONY DIV. 2 Assessor's Land Use Code: 1100 - Residential - Single Unit Property Description: CAPE GEORGE COLONY DIV 2 BLK 3 LOT 5 Tax, A/V, Sales, Photos,and Permit Data Bldg Data Map 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 110 Windows - Mac http://www.co.jefferson.wa.us/assessors/parcel/parceldetail.asp?Parcel N0=938100305 3/26/2015 D�� BLD15-00095 •BUILDING PERMIT APPLICATION Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD15-00095 Received Date: 3/26/2015 SITE ADDRESS: 170 SUNSET BLVD PORT TOWNSEND, 98368 OWNER: KRISTINE EASTERDAY PHONE: 206-459-2233 JAMES M HECKINGER 1614 32ND AVE SEATTLE WA 98122-3318 9381 SUBDIVISION: Block: 3 Lot: 5 PARCEL NUMBER: 938100305 Section: 12 Township: 30 N Range: 2VA CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTION NEW DECK PLUS 9 NEW WINDOWS TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP ADD MAIN: VALUATION 40,000.00 ADD'L: HEAT TYPE: CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: OCCUPANCY: UNHEATED: #OF STORIES: OTHER: CONST TYPE: SHORELINE: GARAGE: CONST TYPE: SETBACK: DECK: 450 BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $496.00 SRE 03/26/15 154238 State Building Code $4.50 SRE 03/26/15 154238 Plan Check $322.40 SRE 03/26/15 154238 Total: $822.90 \\tidemark\data\forms\F_BLD_App_Bld.rpt 3/26/2015 • • ¢SON cow DEPARTMENT OF COMMUNITY DEVELOPMENT 4, ,i, 621 Sheridan Street,Port Townsend,WA 98368 W `a Tel:3603 9.-450 I Fax:360.379.4451 firi ! -- �n �� ' Web:�c1�w.co.ietterson.wa.usi communit}'der elopment ' i,� V .i 1 4. . . E-maildcd taco jefferson.wa.us vSXiN��° I j- iii ! klL`3 2 3 '+;nir 1 PERMIT APPLICATION 43 ' '/ ilrfctt�L Iv O� �r Steps in the Permit Process: r. r• G+i •',j.' i' 'iF,:45,ai,NT -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: ci 3 8 I 00 30 5 Site Address and/or Directions to Property: I 1 0 Su.vtS2,+ ')Ltd.i e&1.e._ .e.or3e Co I oh y) 1054- 7004s2h<,l , W Ac Access(name of street(s)) from which access will be gained: '�n cu - `BI Ud Present use of property: r hcJL.e_ rill .i IR I y e'I ar.n ct Description of Work(include proposed uses): 60Y1•51-r1444 ern 0-F c I e c.IL of-c `I-L. r e cur c,+ ‘--1-41..e.. 5 F R , p l tx a g vvlcJ I p U•e(t VI ever +L.e- se-A-1424414 "P^o,1f acze45 ha-Wird Pi L4,5 j 9 Wivvder c / r.e,ro(ac Wastewater-Sewage Disposal This property is served by Port Townsend of Port Ludlow sewer system? YES _ _ NO s., If not served by sewer identified above, identify type of septic system below: Type of Sewage System Serving Property: krd d ✓ Septic Septic Permit#: SEP '7 4 l (0 1 Community Septic Name of System: Case#: Are other residences connected to the septic system? y,D 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: (i//4/2014- Attach last report to application Describe or attach any drainfield easements,covenants or notices on title, which may impact the property: • • mail / e-mail requests and intormatton about the application to the authorized agent/representative_and- • e: cc the owner • noted below. The authorized a ent/re resentative is responsible for communicating the .•. 214.10.• a r6•. the application. It is the responsibility of the authorized agent/representative and owner to,en 2r,_ _t .•,'•.x' /c: +�r a ntc email(i.e.,County email is not blocked or sent to"junk mail'). 1 , - - Applicant/Property Owner Information , V Property Owner: (( / I � 'll Name: slimes acc-kllt -et'' + Vtrzs Easrk-erday iU J , Address: l (0I 4- 332nd Ave J'ta.'TI'� W 1a q g 12 Z J. ,;,.1., ��{.��A-:� ','`. a,��. C zq iI Phone#: — SOC' - 4 5 q - 22 3 3 1E-mail Address: l yt ke. W G C', Wu �L'4 OM. Please crct Authorized Agent/Representative with project info. (select only one). — — Property Owner Signature: ).}'i L 7---\ Date: _' - Z Y- i i Note: For projects with multiple owners,atyach a separate sheet with each owner(s)information and signatures. Applicant: Authorized Agent/Representative(If other than owner) Name: Address: Phone#: E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: e +� __2Nkerr -ct V-c-�.�-i-eC.-(- Address: 40. Rey • 'Po r+-17)(,)vi- vid i 4J `163 toe Phone#: 362 0- 3 g5- 2 40 3 E-mail Address: caci-e, Lr cape r_omer_cord.Gown, Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: Address: Phone#: E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: Address: Phone#: E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: Address: Phone#: E-mail Address: Attach additional pages if necessary 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: a,r( Print Name: ) i L . / Ifc/c r -c,,L Date: -2 -(. • • 4c-c<) ¢ SO `r co DEP624 621 ARTMENT OF an Street,Port COMMUNITY DEVELOPMEN\X A 98368 T Tel 360.3724450 Fax 360 3-9.4451 C Web: «c.co.iefterson.wa.usicommunitydei elopment E-ma l:dcd�aco.iefferson.wa.us _ ��SNtNOO SUPPLEMENTAL APPLICATION L, RESIDENTIAL OR COMMERCIAL BLDG PE , ',nFp'ENT For Department Use Only Receipt#: Date: Related Application#s: Payment#: Site Information Owner Name: J a,yyho6 .j f per, ms).er d >V ,51-,�- if Assessor Tax Parcel#: q 3 8 loo •O 15 Type of Building J New Replacement Relocated Addition Repair Demolition *A separate permit is required Select One: Single Family Residence ✓ Modular 176-ther-De c-42_, 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 ICC Valuation (Office Use) 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 40 1 'la CanS ) 3605 Covered porch Other(shed, barn, pole bldg,etc.) Estimated Cost of Project (Required): $ 401 000 • $ • • List existing buildings on property(i.e. house, garage, accessory dwelling unit, shed, barn, mobile home,other): . All Existing Buildings on Property Use F i=2. Builders Statement The signer of this statement certifies that they are the Owners of the parcel referenced herein,that they are not licensed contractor and that they will be assuming the responsibility of the General Contractor for the proposed project. Signature: , , Print Name'J. /k. /-4c= clX i wG e.'rt_. Date: 3-2K-(... 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: Print Name: 01- /-6:c-rte / "--)(: L• Date: "Z Y-i For Department Use Only Building Permit Fees Building Base 1.4q Lo. 60 Plan Check Review 40 Land Use Review $234.00 Septic Review $80.00 Potable Water $ Technology/Scan $19.50 State Fee $4.50 Other Fees Shoreline Exemption 5 3 2.O O Zoning Zoning Other New Address Road Approach Total Fees ' ) (4/6S . Lv Receipt # Date: Cash/Check/CC: 15(-t23epl 3/at--P f I5 52-8 Co • • 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 CALULATIONS–IMPERVIOUS SURFACE NEW Sopr EXISTING rtk P Structures(all roof area) avi(-f vi(—fro sq/ft Structures (all roof area) ( 01 rJ 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 sq/ft Other sq/ft Other sq/ft Total New 2.5 sq/ft Total Existing 1 C) I5 sq/ft TOTAL NEW+TOTAL EXISTING" ) D 40 sq/ft "This amount will be used BY STAFF 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: (.0 % Does the site have 35%or more of existing impervious surface? Circle: Yes CD 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 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. • (LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) FOR OFFICE USE ONLY SMALL MEDIUM LARGE REDEVELOPMENT Stormwater Site Plan: Yes No slormwalercalcwnrkshuel R RV 9-9.M10_RPV 004/9111n .. • • �wgsON COG JEFFERSON COUNTY �' ai �-. DEPARTMENT OF COMMUNITY DEVELOPMENT 7 15 �'� 1 , ... ,p,-,•%•"6,`,7 `'. . 621 Sheridan Street • Port Townsend • Washington 98368 11 ti z1:,wi1;hTY1 qs,, G,O 360/379-4450 • 360/379-4451 Fax ,71' C'tA9r iltillYTIBI?1,W http://www.co.jefferson.wa.us/commdevelopment/ Stormwater Calculation Worksheet / 7� MLA# _ PROJECT/APPLICANT NAME J J . PitC- -4 kV." + V. a44-er Q dui DETERMINING STORMWATER MANAGEMENT REQUIREMENTS: This stormwater calculationtiworksheet should be completed first to classify the proposal as"small,""medium,"or"large." The size determines whether a Stormwater Site Plan is required in conjunction with a stand-alone stormwater management permit application, building permit application, or other land use approval application that involves stormwater review. The basic information will also be helpful for completing a Stormwater Site Plan, if required. PARCEL SIZE(I.E., SITE] Size of parcel 0. 3 9 acres An acre contains 43,560 square feet. Multiply the acreage by this figure. Size of parcel in square feet 11 t 1 0 D 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%acres or more of Construction site for structures sq/ft native vegetation to lawn or landscaped areas? Drainfield, septic tank,etc. sq/ft Circle: Yes ED Well, utilities, etc. sq/fl Does the project convert 2''A acres or more of native vegetation to pasture? Driveway, parking, roads,etc. sq/ft Circle: Yes 0 Lawn, landscaping, etc. sq/ft Other compacted surface, etc. sq/ft Indicate Total Volumes of Proposed: Total Land Disturbance ci0 sq/ft Cut 0 Fill D (cu/yd) [over]