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HomeMy WebLinkAboutBLD2015-00078 - 01 PERMIT APPLICATION S BUILDING PERMIT APPLI•ION M LA15-00014 Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD15-00078 Received Date: 3/12/2015 SITE ADDRESS: 205-A N OTTO ST PORT TOWNSEND, 98368 OWNER: GABRIEL GREENSTEM PHONE: 206-327-0149 1014 NW 178TH ST SHORELINE WA 97177 9867- PHILLIPS BAY VIEW SUBDIVISION: Block: 19 Lot: 3+ PARCEL NUMBER: 986701902 Section: 16 Township: 30 N Range: 1V1 CONTRACTOR: PHONE: PHONE: REPRESENTATIVE: MICHAEL ANDERSON PHONE: 360-531-1011 330 CLEVELAND ST PORT TOWNSEND WA 98368 PROJECT DESCRIPTION CHANGE OF USE PERMIT 1-502 PROCESSING & MANUFACTURING Existing floor plan permitted through BLD15-150, no change in floor plan on this permit. CO2 machines permitted through BLD15-175 SEP07-159 TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: 2,500 TYPE OF IMP COU MAIN: INDUSTRIAL: VALUATION 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: BANK HEIGHT: SEWAGE DISPOSAL: ALT NUMBER OF EMPLOYEES: WATER SYSTEM: 69000 BATHROOMS: Exist: Prop: 1 Total: 1 Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Change of Use or Occupar $468.00 SRE 03/11/15 154202 State Building Code $4.50 SRE 03/11/15 154202 a a AtUnOD uosiej ar Potable Water Application $68.00 SRE 03/19/15 154226 Total: $540.50 5IOZ 1 I Nnr ]3AOUddV \\firinm,rIArlafn\fnrmc\F RI n Ann Plri rnf L./g/W11g °BUILDING PERMIT APPLICAON MLA15-00014 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD15-00078 Received Date: 3/12/2015 SITE ADDRESS: 205-A N OTTO ST PORT TOWNSEND, 98368 OWNER: GABRIEL GREENSTEM PHONE: 206-327-0149 1014 NW 178TH ST SHORELINE WA 97177 9867 SUBDIVISION: Block: 19 Lot: 3+ PARCEL NUMBER: 986701902 Section: 16 Township: 30 N Range: 11/1 CONTRACTOR: PHONE: PHONE: REPRESENTATIVE: MICHAEL ANDERSON PHONE: 360-531-1011 330 CLEVELAND ST PORT TOWNSEND WA 98368 PROJECT DESCRIPTION CHANGE OF USE PERMIT 1-502 PROCESSING & MANUFACTURING TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: 2,500 TYPE OF IMP COU MAIN: INDUSTRIAL: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: NUMBER OF EMPLOYEES: WATER SYSTEM: BATHROOMS: Exist: Prop: 1 Total: 1 Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Change of Use or Occupar $468.00 SRE 03/11/15 154202 State Building Code $4.50 SRE 03/11/15 154202 Potable Water Application $0.00 SRE 03/12/15 Total: $472.50 11 tidemark ldata1forms\F_BLD_App_Bld.rpt 3/12/2015 010 111 r ����sON DEPARTMENT OF COMMUNITY DEVELOPMENT 6?I shcnc:;::greet,P.m Townsend,\\.-1 9830 J a Td:360.3 794-430 Pas.360.379.44 51 Web:v.-ww.co.iefferson.wa.us/communimievelopinent E-mail:dedkico.iefferson.wa.us 4".‘1skI N G5 PERMIT APPLICATION Steps in the Permit Process: -Review application checklist to ensure all information is completed prior to submitting application. -Make sure septic has been applied for and water availability has been proven. -Make an appointment to meet with the Permit Technician by calling 360-379-4450. -This is not a standalone application;it must be accompanied by a project specific supplemental application. -Fees will be collected at intake. Additional fees may apply after review and payment is required before permit is issued. For Department Use Only Building Permit# Related Application#s: MLA# Site Information Assessor Tax Parcel Number: y t b > Site Address and/or Directions to Property: 6,35 .IV b' Raft- (0,./0-4 ‘?1' Access(name of street(s)) from which access will be gained: V Present use of property: 11 p, Description of Work(include proptosed uses),::( ( iffy �p 6(f tR dn( (e�:a P 1} t° I�;-` 1/Ci J 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: - Septic Septic Permit#:' 07 - 0 S Community Septic Name of System: Case#: Are other residences connected to the septic system? Additions or repairs to sewage system: Is it a complete or partial system installation: Complete , _ Partial Has a reserve drainfield been designated? Yes No Date of Last Operations & Maintenance check: a- — Attach last report to application Describe or attach any drainfield easements, covenants or notices on title, which may impact the property: Z C)N \5 -eCCO(C) 1,A 15 -18 0 0 The authorized agent/representative i the primary contact for all project-related questions and correspondence. The County will mail / e-mail requests and information about the application to the authorized agent/representative and will copy(cc) the owner noted below. The authorized agent/representative is responsible for communicating the information to all parties involved with the application. It is the responsibility of the authorized agent/representative and owner to ensure their mailbox accepts County email,i.e..County email is not blocked or sent to "junk mail'). Applicant/Property Owner Information Property Owner: ,(-) i 1 p (, Name: 'VC&-V \ ' '(ke vie\ � �7 Address: lot ic■ a t V'NV Vie It- Phone#: — 3 () ' 3C)( ' 1-77et 1mailAddress: _ _ Please ontact Authorize.. Agent/Representative with project info. (select only one). ..- �'� �/ `� Property Owner Signature: �.,( �iLt-�-e- � / -f�y'>�._.../ �(afl,K-�'�' Date: �ll` Note: For projects with multiple ners,attach a separa e "heet with each owner(s)information an signatures. Applicant: Authorized Agent/Representative(If other than owner) Name: / ' 4- 'z-., L.. ; isloe 'So0•Address: 5,c, G /rJ yR •% !/44- . Qe'.eg' Phone#: 3ed .- 5J/ _,_./ON E-mail Address: Pro 'enal. Is this an Authorized Agent/Representative for this project? NO YES , J' ngineey-° Architect !Surveyor jontraZr Consultant Address: Phone#: E-mail Address: �i aiy00iC 6/e1��.1i -1 J 4- Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Archite U- Surveyor or Contractor Consultant V Name: C . eIi f try) . C Address: WA- AAA] I T i S Xii- IL . k,t l Phone#: . i f s. • ALA E-mail Address: ,.' 0. , ,I t r" w. 4.97 t - , (ui _—_ ■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 Na me: 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: Print Name: Date: ego�SO c� JEFFERSON SLATY DEPARTMENT OF COVMUNITY DEVELOPMENT / 621 Sheridan Street I Pon Tov;nsend, WA 98368 Web:v,MN�.co.jefterso;.'r a.us;communitydevelopment syr °�° Tel: 360.379.4450 Fax:360.379.4451 Email:dcd©co.jeflerson.v;z.us Building Permits&Inspections(Development Consistency Review(Long Range Planning(Watershed Stewardship Resource Center LIFE / FIRE AND CONSISTENCY REVIEW APPLICATION Please check one: n CHANGE OF USE REVIEW SITE ADDRESS: -Lb S— iU • 0 T c ca 7 (I r'9 --- ZIP 9 DIGIT PARCEL ID NUMBER ,. %,a, r' — Legal Description: Subdivision Name 0 7 47 Block Lot(s)_ Section Township North, Range WM l APPLICANT r(_.((11\t4 ( I PHONE E 2 Ion 7 - Q( flet MAILINGADDRESS ::::,'__�-�-,; 1l'ik ii.itP.M.. . 0` } *Mu ��Z 6 ' wr e -"\- �` i�vs�'�- I'm 6 ZIP ,.;:.r ✓ qV ke PROPERTY OWNER )Cl,(n 'k6._kyi c ` PHONE '• ' i77 MAILING ADDRESS ,,41nn rl W r �j` +Q ZIP -1 ■ ' E CURRENT USE(S) Rt1f vet Jj1 PROPOSED USE(S) — 161 )f cX Y'SS- G_ I � _1 x SEPTIC PERMIT NUMB R IBC OCCUPANCY h(` IBC TYPE OF CO : l UCTION Set, O 3 *t) I Classification Classification NUMBER OF BEDR•s MS NUMBER OF BATHROOMS WAT;grol PROPOSED PROPOSED ublic Water EXISTING EXISTING ❑ Private Well TOTAL TOTAL EXISTING#OF PARKING SPACES � � 2-party Well � L 0 #OF HANDICAP PARKING SPACES It. ( i¢,F t.;�'G 4 CURRENT NUMBER OF OCCUP�arTS(includes owners, PROPOSED NUMBER OF OCCUPANTS includes�n rs,7 tenants, employees,etc) tenants, employees, etc) CURRENT TOTAL SQUARE FOOTAGE(includes decks,porches,outbuildings,shed...etc) '-'4,_ .5- 4 Ca PROPOSED TOTAL SQUARE F'iOTAGE(includes decks, porches,outbuildings, shed...etc) 2,4 (.:;'-t C APPLICANT SIGNATURE augs C� ./... , '71.--..—/r DATE j 1 I CONSISTENCY RE EW $ FOR OFFICE USE ONLY BASE FEE RECEIPT# 159 1-! lb/ STATE SURCHARGE 4.50 CASH/CK# `I 0 TOTAL DATE 3 i t( / ( S • .0.5 >4 c c. JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street Port Townsend,WA 98368 j Web:www.co.jefierson.wa.uslcommunitydevelopment •ISHr,soco Tel:360.379.4450 j Fax:360.379.4451 I Email:dcdCco.jefferson.wa.us Building Permits& Inspections I Development Consistency Review Long Range Planning I Watershed Stewardship Resource Center LIFE / FIRE AND CONSISTENCY REVIEW CHECKLIST A COMPLETE APPLICATION CONSISTS OF: MASTER PERMIT APPLICATION. Must be signed by property owner of record. FLOOR PLANS. One floor plan showing existing structures and uses. One floor plan showing proposed structure and uses. THE SITE PLAN. Please include all information requested on the site plan checklist. If the size of the site plan is larger than 11" x 17" you must provide us with 7 copies at the time of application. We cannot copy documents larger than 11" x 17". LIFE/ FIRE AND CONSISTENCY REVIEW APPLICATION. The application asks for number of employees, number of bathrooms, number of parking spaces, square footage, heat source, and water source. Please sign and date. LANDSCAPE PLAN. Please include location and type of signs, vegetation, parking spaces, including handicap parking and route of travel. PRE-APPLICATION CONFERENCE. The Development Review Division will determine if your project requires a zoning permit or a pre-application conference. This may be accomplished by phoning the Planner of the Day. PERMIT FEES. Payable at time of application. ,SON DEPAR•ENT OF COMMUNITY DE•LOPMENT �z(c, °c, 621 621 Sheridan Street,Port Townsend,\Vr 98368 Te1:3603"9.4450 Fax:3603'9.4451 `' ■-C \\'eb:www.co.iefferson.wa.usicommunitydeveloprnent E-mail:dcd@ co.iefferson.wa.us 4 Ni N O SUPPLEMENTAL APPLICATION RESIDENTIAL OR COMMERCIAL BLDG PERMIT For Department Use Only Receipt#: Date: Related Application#s: Payment#: Site Information Owner Name: h ,ti lkit V he }‘j Assessor Tax Parcel#: D[ 7 I. y ` Type of Building New Replacement Relocated Addition Repair Demolition *A separate permit is required Select One: Single Family Residence Modular Other I list Proposed Building/Project Number of floors #new bedrooms?) existing V total bed Q #new bathrooms existing f 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 a O O 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): $ $ • I List existing buildings on property (i.e. house, garage, accessory dwelling unit, shed, barn, mobile home, other): All Existing Buildings on Property Use cu e � .1/41 r t1 11 Jerf ' (\ Vhf Builders Statement The signer of this statement certifies that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed project. Signature:, Print Name: Date: By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of his or her knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respeEtlo this application packet may result in making any issued permit null and void. Signature: 4i Print Name: RW«4e4 J ,"A49.6r' J Date: "/%7//5 For Department Use OiThj Building Permit Fees Building Base Plan Check Review Land Use Review $234.00 Septic Review $80.00 Potable Water $109.00 Technology/Scan $19.50 State Fee $4.50 Other Fees Shoreline Exemption Zoning Zoning Other New Address Road Approach Total Fees Receipt# Date: Cash/Check/CC: • �w�gON 006. DEPARTMENT OF COMMUNITY DEVELOPMENT W631 Sheridan Street,Port To i'nsend,\\'-\98368 K' Tel:360.379.4450 Fax:360.379.4431 Web:www.co.jefferson.wa.usicoannunit-ydevelopment unindecdopment ) E-mail:dcki.co.iefferson.wa.us I Olt I I kISN I N O t0 CiN NEW ADDRESS AI Steps in the Permit Process: B).,k - S/ ��-Review required submittal items to ensure all information is complet SS O-- an appointment to meet with the Permit Technician by calling -Fees will be collected at intake. Additional fees may apply after reviE J. New Address Correction E For Department Use Only Rec �� ~ " Related Application#s: rayiiiaili n. 1 " ✓ New Driveway must be flagged with striped and yellow flagging tape received from DCD. 0 Required Submittal Items—use column on left to check off items included with your submittal Current copy of parcel map from Jefferson County Assessor's Office, showing: a. North Arrows /irk b. Road names in the area c. Existing access easements d. Parcel driveway location, label any driveways as new or existing e. Addresses of neighboring properties f. Travel path from main named county road to the driveway,then the structure Copy of a site plan,showing: a. If there are multiple structures,the addresses of all existing structures b. For commercial permits, identify suite numbers for all existing and proposed businesses and identify the business names. Property Information Assessor Tax Parcel Number: , 1 ` 7 4 ( c1 0 Z Directions to Property: Name of street(s) from which access will be gained: p), G? : Cross Street Is this a private road? Yes I j No n Neighbor's Name &Address if known: }`�' Name/Address: , t0 t) rD • ern 0 Name/Address: Do you need to construct a driveway from road onto your property? Yes 0 No X County or State Permit#: ROAD APPROACH OR STATE HWY ACCESS PERMITS ARE REQUIRED IF YOUR DRIVEWAY IS OFF A COUNTY OR STATE ROAD IN ORDER TO PROCESS ADDRESS REQUEST. PLEASE CONTACT PUBLIC WORKS WITH QUESTIONS 360-379-9160 • • • Property Owner Name: Address: Phone #: E-mail Address: Please contact Authorized Agent/Representative with project info. Property Owner Signature: Date: Applicant/Contractor: Authorized Agent/Representative Name: Phone #: E-mail Address: License #: Expiration Date: By signing this application form, the owner/agent attests that the information provided herein, and in any attachments, is true and correct to the best of his, 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 inspections. Applicant may request notice of the County's intent to enter upon the property for visits related to this application and subsequent permit issuance. Signature: Print Name: Date: Jefferson County will notify the appropriate postmaster,fire district, and emergency services of your new address. We will provide you with a new fire plate and you will be required to install it on your property once the address is assigned. FOR OFFICE USE ONLY DIFF LEFT M.P. RIGHT DIFF Notes Tidemark Entry: Road database entry: Post Office: New Address Date plates mailed: ff Plates: OFFICE USE ONLY Permit Fees New Address Permit Fee $234.00 * *Additional fees may apply try �- QOflT ro City of Port Townsend 4 O� �,. "00 Development Services Department ='" ° 250 Madison Street,Suite 3,Port Townsend,WA 98368 - �J (360)379-5095 FAX(360)344-4619 AVAILABILITY LETTER Name: 0 AUTI T(El`ti Date: 3 ` l " Site Address: %J`DA Phone: >C) 30/ City/State/Zip j Qt2 i � C � 1� .y Parcel: Cfeb ° 7o/`90 2_ Legal Description: \ • The above-referenced property is within the City of Port Townsend's Water Service Area and p P Y Y 4 " erved by City water. tAwc,r ` ofPort .w s:� Date r- F;, T`� ND 4g ON Cp DE DEPARTMENT 41111C0 tiUNiT /1;LVELOPMEN'f .. Cr 521 wend n StTett,Port lo} WA Si Li '� 'lei:3633194150 I Fcu:360379/45 i . Wei v v7unj r r.o!_._ m �So i,ut)Ja f op-ro:- 96'ti1 NO`SO,s SUPPLEMENTAL,APPLICATION DETERMINATION OF ADEQUATE POTABLE WATER Owner Name: DAM rcreK 5 Parcel No. �8j(O 701/ 9 OZ Cla Ste Address: ZO5A `Sr; ?OP.1 'arOGvn15EA)Ot WA. y8436e D. Water SJurce 6dsting Proposed Attach Copies of: 1) Well Logs Private well (if no log report on file,a l hr stabilizat ion test may be aibaituted.) 2) Lab anaJysistested within 3 years of application. -Total tbliform,Ntrate-N,Chloride 2-Party Well Items above AND recorded Operations&Maintenance agreement and recorded Easement. Atemative Provide justifi[ation and design per.bffersen County System: Environmental Health polio/97-01 www.jeffersonmtmtyp blidteeith.org'pA/Fblicy_97-01_Ranwater_alledion.pd Valid Water Fit Generally appliesto springs,attach copy. Permit: Rtblic Water: Name of Water Provider: 8ttxnit Water Availability Notification form completed by your water purveyor. NOTE If any of the above utilities need to be installed and disturbance will occur in a public maintained or unmaintained County road and/or Rght-of-Way ea rent,then a Fight-of-Way application will be needed. Resolution#99-90 requires build ng permit mit appl icationsto provide evidenoeofanadequate potable water supply per the conditions of FON 19.27.097 and the k3tidelines for Determining Water Availability for New Buil6rgs By signing this application form,the owner/agent attests that the information provided herein,and in atyattachments is true aid correct to the best of his,her or its knowledge. My 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 applicalion will be performed in compliance with all applicable federal,state and county laws and regulations and I agree to provide aooessaid right of entry to .Jefferson(Aunty and its employees,representatives or agentsfor the sole purposed application review and any required later inspections Applicant may request not ice of the Count y's intent to enter upon the property for vials related to thisapplication and subsequent permit issuance. Bgeature: Print Name: Date: FOROFf9(EUgcu-Y 1)Water Rcjit Permit# 3)Individual Well 2)FUdic Wafer SipplyWSlD# Meets Water Dualityaandards? Yes Na Intimplia ce Yes No WRA179ibbasn SPZ-Cbaaal f Moderate!Figs Yes No &'used upon information provided by the applicant,it appearsthat the potable water sixty: Meets (brdiitionallyMeets Does not Meet Gmac' 6 12-cE --r E/4 °` `-j`l sON DEPARTMENT 9001vIVu \I DEVELOPMENT • IA 621 Sheridan Street,Po:t Towne-m:1,WA c;36 < TeL 360379A450 I Fx::360379.1451 Web:yal-wortiaffett„yart=lommitintra-levalmetil ilalei I I NO WATER AVAILABILITY NOTIFICATION PUBLIC WATER SYSTEM Jefferson County Environmental Heath Department RCM: (Water System Narne) Sjstem Cperator: Rate ID Number: Total connections f or which system is approved: Number of service oannections ef.d ing(in use): Number of service connections committed: Date and result s of most recent water bacteriological analyds: / / The water system iscspable of and will supply potable water to the following location: Assessor's Parcel 113#: 98 (4, 70 ( 9 02- Legal Desiption: SteAddrese: 2-0S 4Q2 CiTrep sr PUIZT:-1-70W – ,6s3(,6 Operator Sgnature: Date: / / RATICN DATEOFTHIS931110ECOMMITM / / • • no,�` ©N cJEFFERSON COUNTY }W DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend • Washington 98368 IS N0`s0) 360/379-4450 • 360/379-4451 Fax http://www.co.jefferson.wa.us/commdevelopment/ Stormwater Calculation Worksheet 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. PARCEL SIZE(I.E.,SITE Size of parcel 1 Z3 acres An acre contains 43,560 square feet. Multiply the acreage by this figure. Size of parcel in square feet 3 ¢7 7 sgfft 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 No Well,utilities, etc. sq/ft Does the project convert 2'A acres or more of native vegetation to pasture? Driveway, parking, roads, etc. sq/tt Circle: Yes No Lawn,landscaping, etc. sq/ft Other compacted surface,etc. sq/ft Indicate Total Volumes of Proposed: Total Land Disturbance sq/ft Cut Fill (cu/yd) [over] I stormwater colt worksheet—REV.2/20/2008 1 • • 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 EXISTING Structures(all roof area) sq/ft Structures (all roof area) /¢y S 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 r^'7/o sq/ft Total New sq/ft Total Existing /96(00 sq/ft TOTAL NEW+TOTAL EXISTING* /0-. 0.0 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 .----7,i,7 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. £6t C C / . /& ,L._' z 7 7 /5--. /5 (ILAND�YOWNNEER OR(AUTHO�RIIZED REPRESENTATIVE SIGNATURE)1 (DATE) {fit„,elFl=.l ,flS P f ,t ,! •." us �-k`x�F% 4.,." ,y,rc'n'. fl rF 2 . 'li A„� �� - ey,• t', a' r* ` r Ins 'ate hk�" :, '"��r 7 t , 15, vim`: 4 � a :f c 4M415.s.�+..— , L4tO v tr y ' t.'x...Rg? g'l', l �e:u t ; §41-1'�y aft ii ' 'i x` k^t-';t;' , stormwater chic worksheet-REV.2/2012008 2 Parcel Details P `` l of Jefferson County w � " _Weather Station Database Tools ah Maps (r, Webcarn Houle County Info Deportmerls Search Parcel Number: ;986701902 I SEARCH Parcel Number: 986701902 Printer Friendly Owner Mailing Address: GLEN COVE PROPERTIES LLC 101 KIWI LN SEQUIM WA98382-8550 Site Address: 205NO1- OST PORT TOWNSEND 98368 Section: 16 School District: Port Townsend (50) Qtr Section: SW1/4 Fire Dist: Chimacum (1) Township: 30N Tax Status: Taxable Range: 1W Tax Code: 0111 Planning area: Quimper (2) Sewer: Drainage: Bank: View 1: View 2: Zoning 1: Zoning 2: Zoning 3: Sub Division: 9867 - PHILLIPS BAY VIEW Assessor's Land Use Code: 2000 - Manufacturing Property Description: PHILLIPS BAY VIEW ADDITION BLK 19 LOTS 3,4,9 & 10 AND TAX 73 LS PTN TAX 75 Tax. A/V Sales Photos, arIc 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 Windows - Mac > «. .��.. .,..,,.n :offarenn Iva nc/n e¢c(lrCInArrelinarceldetail.asn 3/13/2015 • Simla Excavating Inc. PO Box 179 3003e5-prao� Port Hadlock WA 98339 ^PROPERTY INFORMATION 2031205 N.Otto Location;203 N OTTO ST Port Townsend Taxi() 986701902 oho Ty. GLEN COVE PROPERTIES LLC Use PORT TOWNSEND,WA 983680942 Owner GLEN COVE PROPERTIES LLC ON ID'SOM07-00159 Fa1Q ON• 1TE WASTEWATER TREATMENT SYSTEM INSPECTION REPORT ear ,.n. Inspected:02118/2815 -Inspection Type:ROUTINE • Correction Status:No corrections needed Company- Certification Level 2 (Mork Performed By Submitted 02/24/2015 by Shod Excavating Inc. Timothy Johnson Timothy Johnson This report does not assure approvals by Jefferson County Public Health for ANY future budding permits or development COMMENTS&GENERAL INSPECTION NOTES No Deficiencies Noted GENERAL SITE&SYSTEM CONDITYONS The General Site and System Conditions week sty Inspected At Components accessible for maintenance,sewn and in good mtttl8lan _.-. _.._ YES tiding r_._ ._..__._...N ............ Surfacing effluent from any component(including moues seepage): ..... NO .__._.nts appear w_..t._ Components a _. ppear b be walanigtn. no visual leaks: YES Improper encroachment(roads,hulWltgs,cC.)omit emlpawtl{a): NO ........_..... Component setting ptobbmn oMervatl: ... . NO Abnormal pending present for one or rnrone of the disposal components, '�-- NO Subsurface components adequately coveted yES Owner compliance Issues noted N/A Site maintenance e urced a g.Landscape r�nseande)if y es,describe in comments h N0 occupant __-- YES, OaupaM wmpliance problem{occupant not operating the s stem ..__ .. .. __ ............. .........._.. y ProPxN)vif dascnbe m notes. NC c_ _._n It deficiencies were identified on lest inspection were they corrected before or duffing this Inspection? (If NO.deacnbe In rotes.NA=no deficiencies on lest report): OSS Components. oenM structures and appurtenances located per as-bull Mtrecord tlrawing Of NO de+refba YES in notes) If no as-bud/exists or chanpee merle_state NO end provide record to Health Dept e___ NO Anarations made to the 055(valves adjusted,finer settings modiked pone installed,etc.)(If YES. describe m notes)' ure was . .i_. The hwusa+atrucare was vacant or used Infrequently,assessment d gte dralnFeid was not possible. NO u n.w..__ Is the SEP case in.a finaNtltcanpiafetl shwa?(it NO explain Al comments) YES ONSITE SEWAGE SYSTEM INSPECTION DETAIL TANK.Sepec Tank-2 Compartment This eprlpcnent was: =sir Inspected Component appears to be functioning as intended. YES Effluent level within operational limits al NO explain in comments): YES Alt required baffles in place(WA=No baffles required) YES Effluent Filter Cleaned(NIA=Not Present)' YES Convenient 1 Sam aceumuiton(Inches,it other speedy): e' Effluent fdleriscreen needed cleaning on entvat NO Compartment 1 Sludge accumulation(Inches,if other specify): Compartment 2 Scum accumulation(Inches.if other specify): z' Compartment 2 Sludge accumulation(Indies,if other specify): Z' } Pumping needed: NO (Approximate Gallons to oe pumped(if needed)by Certified Pumper: 0 ReportlO:422888 View inspection reports online at www.ontestine.com Page 1 of 2 I h1 .a Thus component was Cult I l000Otea Component appears to be fund:oiling as intended: YES Compartment 1 Scum accumulation()ncites,if other specify): D" Pump vault screen needed ctearnng on atnvai MA Compartment 1 Sludge accumulation(inches,it other specify): Pumping needed'ec: Pump Vaud Filter cleaned(NIA is not present): sea_. ;Approximate Gallons to be pumped(if needed)by Certified Pumper: Panel'Conlon 1 Pratte i:This component was p;tgj Irspecmc Panel functioning(inc:ud:ii alarm): YES Pump 1:on Minutes;overrule in parentheses-f present; Pump 1:off hours(override In parentheses-if present)'. ;( nts. Pump 1:gallons per dose(override in parentheses-if present) ii 40 Pump I:ETM hours;override in parentheses-if present): i 77.2722 Pump I:Cycle Count(override in parentheses-if present): : 8873 usrpr EtltHen(Pump This component was: s,:;,.,•in,nrrcte r Component appears to the functioning as Intended. YES Consols functioning. Dose setting different than engine!(If YES.detail in comments) v'C Dose seeing adjusted to meet as-built:record drawing spat Icaticns)by the O&M SPeaalist) Tested ganons per minute flaw: This component was -e;;;impacted ; z Component appears to be functioning as intender ?ttS Lateral titres hushed: Average spurt height rif performed)(feel.i;Other snccay Ponding present?EYES explain in comments. I NO This man awcafes teak,ctornotr;arra eV*onsRo sewage steam aE me Now sheet in m'way Is this regal a guaranies or opennor or axnm pe■amnxx, ReportiD:422888 View inspection reports online at www oniinemte.corn Paper 2 of 2 PPP Parcel Details Page 1 of 2 e erson oun y Weather Station �.. _ Home County Info Departments Search] Parcel Number: 986701902 SEARCH Parcel Number: 986701902 Printer Friendly Owner Mailing Address: GLEN COVE PROPERTIES LLC 101 KIWI LN SEQUIM WA98382-8550 Site Address: • 205 N OTTO ST \ PORT TOWNSEND 98368 Section: 16 School District: Port Townsend (50) Qtr Section: SW1/4 Fire Dist: Chimacum (1) Township: 30N Tax Status: Taxable Range: 1W Tax Code: 0111 Planning area: Quimper (2) V Sewer: Drainage: 1. Bank: View 1: View 2: Zoning 1: Zoning 2: Zoning 3: Sub Division: 9867 - PHILLIPS BAY VIEW Assessor's Land Use Code: 2000 - Manufacturing Property Description: PHILLIPS BAY VIEW ADDITION BLK 19 LOTS 3,4,9 & 10 AND TAX 73 LS PTN TAX 75 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[xplorer 6.0 or later OS Windows - Mac http://www.co.jefferson.wa.us/assessors/parcel/parceldetail.asp?Parcel N0=986701902 3/12/2015 • �4SON co DEPARTMENT OF COMMUNITY DEVELOPMENT � 621 Sheridan Street,Port Townsend,WA 98368 Tel:360.379.4450 Fax:360.379.4451 Web:wvw.co.iefferson.wa.us/communitvdevelopment E-mail: dcd a,co.jefferson.wa.us �SNI NC;C() PERMIT FEES WORKSHEET Name PUD Parcel # 1333037 Estimated Cost of Project Permit# Building Base Fees Building Base Plan Check Review Land Use Review Septic Review $160.00 Potable Water Technology/Scan $19.50 State Fee $4.50 Other Fees Shoreline Exemption Zoning Change of Use $468.00 Zoning New Address $20.00 Public Works Total Fees $672.00 Office Use Only Receipt Number: ny ZO 2_ Cash/Check/CC: 1052 Date: 3l y