Loading...
HomeMy WebLinkAboutBLD2015-00072 - 01 PERMIT APPLICATION BLD15-00072 BUILDING PERMIT APPLICATION Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD15-00072 Received Date: 3/11/2015 SITE ADDRESS: 585 RAINIER LN PORT LUDLOW, 98365 OWNER: STEPHANIE HEW PHONE: 585 RAINIER LN PORT LUDLOW WA 98365 9901 SUBDIVISION: Block: Lot: PARCEL NUMBER: 990100021 Section: 8 Township: 28 N Range: 1E CONTRACTOR: WAYNE LOUNSBURY PHONE: 360-821-2919 P.O. BOX 65191 PORT LUDLOW WA 98365 Contractor's License GENERPM866JA Expires 4/1/2016 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOt NEW DECK 320 SQ FT. TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP DEK MAIN: VALUATION 9,248.00 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: 320 BANK HEIGHT: SEWAGE DISPOSAL: SEW WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $0.00 SRE 03/11/15 Plan Check $0.00 SRE 03/11/15 APPROVEL State Building Code $0.00 SRE 03/11/15 Total: $0.00 MAR 19 2015 Jefferson County DCD \\tidemark\data\forms\FBLD_App_Bld.rpt 3/11/2015 •BUILDING PERMIT APPLICATION BL v T 072 Review iew Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD15-00072 Received Date: 3/11/2015 SITE ADDRESS: 585 RAINIER LN PORT LUDLOW, 98365 OWNER: STEPHANIE HEW PHONE: 585 RAINIER LN PORT LUDLOW WA 98365 9901 SUBDIVISION: Block: Lot: PARCEL NUMBER: 990100021 Section: 8 Township: 28 N Range: 1E CONTRACTOR: WAYNE LOUNSBURY PHONE: 360-821-2919 P.O. BOX 65191 PORT LUDLOW WA 98365 Contractor's License GENERPM866JA Expires 4/1/2016 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr NEW DECK 320 SQ FT. TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP DEK MAIN: VALUATION 9,248.00 ADD'L: HEAT TYPE: CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: 320 SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: SEW WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $0.00 SRE 03/11/15 Plan Check $0.00 SRE 03/11/15 State Building Code $0.00 SRE 03/11/15 Total: $0.00 \\tidemark\data\forms\F_BLD_AppBld.rpt 3/11/2015 . . )._6ON DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street.PortTo�anceadt yA'_i'iS;r'_ Tel:360379.4450 Fax:360.3-9-4-F- Weh:www.co.jefferson.wa.us C utnunit y.d y eion_nent E-mail:dedfa co.iek erstnt.Wa us PERMIT APPLICATION Steps in the Permit Process: -Review application checklist to ensure all information is completed prior to submitting appiicauoz -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 #5: MLA# Site Information Assessor Tax Parcel Number: Ctbt a'b(DI� Site Address and/or Directions to Property: "n5 ?ark Vre., ou 14, Access(name of street(s)) from which access will be gained: Present use of property: � ��Q,Q,y` , ct\ Description of Work(include proposed uses : /3%t.0 S .cc- llUJ1 1' .r ' 7rto - .• l ozyvv .,r.i -tl�n . 6421"`5 ("k cxe = - . Li yq as � s \tt__\ Top rul Wastewater-Sewage Disposal This property is served by Port Townsend of Port Ludlow sewer system? YES ) x NOX If not served by sewer identified above,identify type of septic system below: Type of Sewage System Serving Property: Septic Septic Permit#: JCsI t-.t—AJ_ (1-4' Community Septic Name of System: Case#: Are other residences connected to the septic system? Additions or repairs to sewage system: Is it a complete or partial system installation: Complete _ Partial Has a reserve drainfield been designated? Yes _ No Date of Last Operations& Maintenance check: Attach last report to application Describe or attach any drainfield easements, covenants or notices on title,which may impact the property: • The authorized agent/representative the primary contact for all project-related questions and correspondence. The Counts 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 mar). Applicant/Property Owner Information Property Owner: Name: S ,per �1e ,,//�� Address: Ste 0,WI t�P.,f' l efq LA 1cw Phone#: E-mail Address: `i Q Please contact Authorized Agent/Representative with project info. (select only one). Property Owner Signature:Kc5foipS—LAjr ,9_ Date:3/5 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: Address: Phone#: E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor x Contractor Consultant Name: Address: ?,e, p "K Gstet [!��'' L.tr 1644) V.56. 4 6c Phone#: E-mail Address: G (l• • ..i 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/Represe tative for this project? NO YES Engineer Architect ` Surveyo Contractor Consultant Name: Address: Phone#: E-mail Address: Professional: Is this an Authorized Agent/R-presentative for this project? NO YES Engineer Architect \ eyor 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: Print Name: Date: SON c DEPAR•ENT OF COMMUNITY DE•LOPMENT .4� �6 621 Sheridan Street.Port 1 ovv isend,A\_A 98 368 U./ Tel 360.3-9.4431 i l~ax: 36n 3'9 4451 ti .-C \V Deb:vcv«v.CO.,efferson.v.a.usFcon munatidev-elopment F-mail:dcdd co.jcrtersonava.us 16'1/INCs 9 SUPPLEMENTAL APPLICATION RESIDENTIAL OR COMMERCIAL BLDG PERMIT For Department Use Only Receipt#: Date: Related Application#s: Payment#: Site Information Owner Name: 1 e.[p c\i- '1� I1 e_u) Assessor Tax Parcel #: ` C)fccca 1 Type of Building New �( Replacement Relocated Addition /` Repair Demolition * *A separate permit is required Select One: Single Family Residence Modular Other list Proposed Building/Project Number of floors 1 # new bedrooms O existing iJ total bed n # new bathrooms C) existing c total bath e Heat Source Select all that apply: Electric X Heating Oil Wood Propane Enter the square footage(sq/ft)that applies in each field: Structure Existing Sq/Ft Proposed Sq/Ft ICC Valuation (Office Use) Residential/Commercial Main Floor / LI l'. 5 Residential/Commercial Second Floor CD 0 Additional Floors- heated/ unheated 0 Basement unfinished Basement-finished space or habitable d Detached Garage- heated/unheated 0 Cj Attached Garage- heated/unheated 5-I/ 66P C Garage 2nd fl- unfinished storage a Garage 2nd fl -finished space or habitable ,J Carport -2 walls or less Deck - uncovered 6.6. 5- s a Covered porch Other(shed, barn, pole bldg,etc.) ("' I Estimated Cost of Project (Required): $ p .00 $ 1 ! • List existing buildings on property (i.e. house, garage, accessory dwelling unit, shed, barn, mobile home, other): All Existing Buildings on Property Use I p P _,Li Ir CAS\ap.vlc P Builders Statement The signer of this statement certifies that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Print Name: Date: By signing this application form,the owner/agent attests that the information provided herein, and in any attachments, is true and correct to the best of his or her knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in making any issued permit null and void. Signature: •• . Print Name:Wot,ti,n,e. - oui S x.),01 Date: 3 J'(/6 For Department Use Only Building Permit Fees Building Base Plan Check Review Land Use Review $234.00 Septic Review $80.00 Potable Water $109.00 Technology/Scan $19.50 State Fee $4.50 Other Fees Shoreline Exemption Zoning Zoning Other New Address Road Approach Total Fees Receipt # Date: Cash/Check/CC: 0 0 � � orr coG JEFFERSON COUNTY /:4 a , DEPARTMENT OF COMMUNITY DEVELOPMENT ti rC 621 Sheridan Street • Port Townsend • Washington 98368 1 0 360/379-4450 • 360/379-4451 Fax HIN http://www.co.jefferson.wa.us/commdevelopment/ Stormwater Calculation Worksheet MLA# PROJECT/APPLICANT NAME: -i' hot pej fl e(e) 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 E: / `fit / acres An acre contains 43,560 square feet. Multiply the acreage by this figure. Size of parcel in square feet... 1 ,'-1`�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 3A 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 0 Well, utilities, etc. sq/ft Does the project convert 21/2 acres or more of native vegetation to pasture? Driveway, parking, roads, etc. sq/ft 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 l) Fill C� (cu/yd) [over] • • 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) sq/ft Sidewalks sq/ft Sidewalks sq/ft Patios ) C . l`! 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 ) , sq/ft Total Existing 4 e sq/ft G� TOTAL NEW+ TOTAL EXISTING" � .,, r .' 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: I°A) Does the site have 35% or more of existing impervious surface? Circle: Yes No FURTHER INSTRUCTIONS: If the answer is yes, the proposal is considered redevelopment and the attached Figure 2 should be used to determine the applicable Minimum Requirements. If the answer is no, the proposal is considered new development and the attached Figure 1 should be used. At this juncture, the applicant should refer to the applicable Flow Chart to determine the Minimum Requirements for stormwater management. DCD staff will help verify the classification of the project and the application requirements. For proponents of "small" projects who must comply only with Minimum Requirement #2—Construction Stormwater Pollution Prevention—an additional submittal is not required. The proponent is responsible for employing the 12 Elements to control erosion and prevent sediment and other pollutants from leaving the site during the construction phase of the project. Pick up the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet. Proponents of"medium" projects—those that must meet only Minimum Requirements #1 through #5—and for "large" projects—those that must meet all 10 Minimum Requirements—are required to submit a Stormwater Site Plan. DCD has prepared a submittal template of a Stormwater Site Plan, principally for rural residential projects. Complete the template in the Stormwater Site Plan Instructions and Submittal Template or prepare a Stormwater Site Plan using the step-by-step guidance in the Stormwater Management Manual. APPLICANT SIGNATURE By signing the 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. E �.. • ó .4 (LANDOwN_R 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 9/9/2013 So v JEFFERSON •COUNTY III I G2{ DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street I Port Townsend,WA 98368 I Web:www.co.iefferson.wa.us/communitydevelopment 4-9s, ,, c)� Tel:360.379.4450 Fax:360.379.4451 Email:dcd(�co.jefferson.wa.us Building Permits&Inspections I Development Consistency Review I Long Range Planning I Watershed Stewardship Resource Center REQUEST FOR WAVIER FROM SPECIAL REPORTS I, ` p Yl.t l e eq./ owner of parcel 91 0 ( 00 d t Property Owner's Name Parcel number located at 1-.2.-- i,l/1 L L. _ �� �E I`= n V7 -1A �. �. ._ t_-=; - �1 lam-, Property Address 1 / hereby request a waiver from the requirement for a -e€) (e_ I . �-; �yagR 1 5 205 Type of Special Report 4' -j` under JCC 18.22.370, in association with critical area review and protection standards under JCC for permit application t3C---6 f -- for the following reasons: Code Section permit case number 18.22.370 Waivers. The administrator may waive the requirement for a special report when an applicant demonstrates all of the following: (1) The proposal involved will not affect the critical area in a manner contrary to the goals, purposes and objectives of this code, because: • - u- ,•_.. , 1 of - ` • 1n EA- c •r -�,�Q. cQt'b� t,►� ©Aua'. a.,/"..` G t ecun in .I"1N& t.,tl.k W l l 1 Yb A. f . _ q t,c ts4,v (1c>wxc.Q n ut4S Atr'S 4 o b_l• NQ (2) The minimum protection standards required b this chapter are satisfied, by: �' t .... _ . 1. .. .•' '- _ A.,.-___A I% .: Ca .■, V rI • 1 , • t . Signed 1 r ) • / 2- • (6 Alljerty • ner Date ��Request is granted denied s _ ed .lj (2 i 'JAZ ator/Staff Date err 0 0 ���5ON e DEPARTMENT OF COMMUNITY DEVELOPMENT ,� 621 Sheridan Street,Port Townsend,WA 98368 ,W, ,.0 Tel:360.379.4450 I Fax:360.379.4451 Web:ww-w.co.iefferson.wa.us/communitadevelopment Email:dcd cllco.jefferson.wa.us YYSN I N 6 ° PERMIT FEES WORKSHEET Name Wayne Lounsbury Parcel# 990100021 Estimated Cost of Project $9,248.00 Permit# bid15-00072 Building Base Fees Building Base $157.00 Plan Check Review $102.05 Land Use Review $234.00 Septic Review Potable Water Technology/Scan $19.50 State Fee $4.50 Other Fees Shoreline Exemption Zoning Zoning New Address Public Works Total Fees $517.05 Office Use Only Receipt Number: 1 3 .. \CI O Cash/Check/CC: Lk Date: .b/t r f r c- sON ooG DEPARTMENT OF COMMUNITY DEVELOPMENT w '?1 621 Sheridan Street,Port Townsend, 98368 vett Tel:360.379.4450 Fax:360.3 79.4451 -C T� ik Web:x=`" eb:www.coiefferson.wa.us communitydevelopment E-mad:dcd(aco.jefferson.wa.us gAl I N G SO 1 l _' PERMIT APPLICATIO Steps in the Permit Process: � ! It ! MAR 1 1 2015.., -Review application checklist to ensure all information is completed prior to submitting apoiicatioi -Make sure septic has been applied for and water availability has been proven. EffE 1 �FERSON COUNTY -Make an appointment to meet with the Permit Technician by calling 360-379-4450.' rrr rtt+NITYDEVFLOPME"" -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: '1101 1>e'((-)1‘. pp Site Address and/or Directions to Property: n5 tkok,t 11�er Ntri kvUU�\ou l Access(name of street(s)) from which access will be gained: Present use of property: Description of Work(include proposed uses): '3%.t r) (-. cam, 6. P. 7no - ► 0e.AAt,. ���5 tukt C y Ra 4-5 w b To w �w x� � t p� �Ek � � l 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#: Community Septic Name of System: Case#: Are other residences connected to the septic system? Additions or repairs to sewage system: Is it a complete or partial system installation: Complete _ Partial Has a reserve drainfield been designated? Yes _ _ No Date of Last Operations& Maintenance check: Attach last report to application Describe or attach any drainfield easements,covenants or notices on title,which may impact the property: • The authorized agent/representative is the primary contact for all project-related quests 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(ii.e.,County email is not blocked or sent to`junk mail"). Applicant/Property Owner Information Property Owner: Name: S Q,u.N Address: Si166,04 fir A .f La t bwt> Lot , Phone#: E-mail Address: iit Q Please co tact Authorized Agent/Representative with project info. (select only one). Property Owner Signature: ` ,a,kx) Date:3/5/6 Note: For projects with multiple o ners,attach 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 X YES Engineer Architect Surveyor y Contractor Consultant Name: +rse, S _64 rA- - - Qa Address: goy (,St 4 �48,Lei�.i IA)6. S34c /�� Phone#: E-mail Address: GPM d l� �SW" S 3 reCniej 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/Represe ative for this project? NO YES Engineer Architect \ Surveyo Contractor Consultant Name: Address: Phone#: E-mail Address: Professional: Is this an Authorized Agent/R-•resentative for this project? NO YES Engineer Architect eyor Contra L ` � t� Name: L - -..�_.. Address: L./` Phone#: E-mail Address: MAR 1 1 2015 L.. Attach additional pages if necessary —1 JEE}ERSOIN COUNTY Builders Statement __ ti'„T.OF COMMUNITY DEVELOPMENT 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: r SON c DEPARTNT OF COMMUNITY DE's: _ ° :•,r"! , ■ ,�� °�j• 621 Sheridan Street,fort l ownsend,WA 98368 I ' V E W A Tel:36039.4470 Fax:360 3'9 4451 l,� ti •C Web:www.co.Jefferson.wa.us/communitydevelopment fl\ 2015 'i E mail:dcd(aco.jefferson.wa.us n , i MAR 1 1 t 17SkI NO ° SUPPLEMENTAL APPLICA ION �r�rErz;c,�cuur�n{� RESIDENTIAL OR COMMERCIAL 3LI O '`':,1A1 EIOPr�ENT For Department Use Only Receipt#: Date: Related Application#s: Payment#: Site Information Owner Name: 41 e 4 i ' • p, _ Assessor Tax Parcel#: Cf./rj00,a, Type of Building New ", Replacement Relocated Addition�"� Repair Demolition * *A separate permit is required Select One: Single Family Residence Modular Other INPri . list Proposed Building/Project Number of floors l # new bedrooms 0 existing (3 total bed O # new bathrooms existing C 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 /Li 13 6 C) Residential/Commercial Second Floor n 6 Additional Floors- heated/unheated 0 Basement- unfinished a Basement-finished space or habitable Detached Garage - heated/ unheated 0 Attached Garage - heated/:uh ated2 5- cs. C)Garage 2nd fl - unfinished storage 0 Garage 2nd fl-finished space or habitable 0 0 Carport-2 walls or less i Deck- uncovered 63 l _a O 9 2 4 °'° Covered porch Q Other(shed, barn, pole bldg,etc.) ,yam' Estimated Cost of Project (Required): $ (:,t ry2,0 .0° • • List existing buildings on property (i.e. house, garage, accessory dwelling unit, shed, barn, mobile home, other): All Existing Buildings on Property Use F( c Builders Statement The signer of this statement certifies that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Print Name: Date: By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of his or her knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in making any issued permit null and void. Signature: Wa1LAs 41-0-1-trNA)KA(5 II Print Name:D)WAne. 1 Date: 31°(115 For Department Use Only Building Permit Fees Building Base 15-1—°° Plan Check Review 011: Land Use Review $234.00 Septic Review $ Potable Water $ Technology/Scan $19.50 State Fee $4.50 Other Fees Shoreline Exemption Zoning Zoning Other New Address Road Approach Total Fees A 51 -?... . 0s- Receipt # Date: Cash/Check/CC: • 0 �.��oN c0� JEFFERSON COUNTY , H 4 -4 -+':=>. DEPARTMENT OF COMMUNITY DEVELOPMENT L` �,` MAC 1i ,; ^,. 621 Sheridan Street • Port Townsend • Washington 98368 f D 360/379-4450 • 360/379-4451 Fax ,L.,' �__ �`� INO� http://www.co.jefferson.wa.us/commdevelopment/ iY DEPT.OF COMMUiN!1Y DEVELG:MENT Stormwater Calculation Worksheet MLA## PROJECT/APPLICANT NAME: 5-�erP 'le, „10. 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. J PARCEL SIZE(I.E., SITE) Size of parcel I '7C) acres An acre contains 43,560 square feet. Multiply the acreage by this figure. Size of parcel in square feet,l�kii .`���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 l;) Well, utilities, etc. sq/ft Does the project convert 21/2 acres or more of native vegetation to pasture? Driveway, parking, roads, etc. -'f sq/ft 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 0 Fill 0 (cu/yd) [over] stormwater calc worksheet Rev 9-9-2010--REV 9/9/2010 1 • I 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) sq/ft Sidewalks sq/ft Sidewalks sq/ft Patios j Rep 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 NewO sq/ft Total Existing ''1` i�r• sq/ft TOTAL NEW+TOTAL EXISTING* 5,?,. v1k0 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: '(J % Does the site have 35% or more of existing impervious surface? Circle: Yes 'No) FURTHER INSTRUCTIONS: If the answer is yes, the proposal is considered redevelopment and the attached Figure 2 should be used to determine the applicable Minimum Requirements. If the answer is no, the proposal is considered new development and the attached Figure 1 should be used. At this juncture, the applicant should refer to the applicable Flow Chart to determine the Minimum Requirements for stormwater management. DCD staff will help verify the classification of the project and the application requirements. For proponents of "small" projects who must comply only with Minimum Requirement #2—Construction Stormwater Pollution Prevention—an additional submittal is not required. The proponent is responsible for employing the 12 Elements to control erosion and prevent sediment and other pollutants from leaving the site during the construction phase of the project. Pick up the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet. Proponents of"medium" projects—those that must meet only Minimum Requirements #1 through #5—and for "large" projects—those that must meet all 10 Minimum Requirements—are required to submit a Stormwater Site Plan. DCD has prepared a submittal template of a Stormwater Site Plan, principally for rural residential projects. Complete the template in the Stormwater Site Plan Instructions and Submittal Template or prepare a Stormwater Site Plan using the step-by-step guidance in the Stormwater Management Manual. APPLICANT SIGNATURE By signing the 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. I i • .atL1..J+_. � CS (LANDOWN R OR AUTHORIZED REPRES ATIVE SIGNATURE) (DAT ) FOR OFFICE USE ONLY, SMALL MEDIUM LARGE REDEVELOPMENT Stormwater Site Plan: Yes No stormwater calc worksheet Rev 9-9-2010—REV 9/9/2010 2 General Project Management Page 1 of 2 II?tome Inicio en Espanol Contact. Search L&I A-Z Index Help My Secure L.&I Safety Claims&Insurance Workplace Rights Trades&Licensing CioWashington State Department of Labor & Industries General Project Management Owner or tradesperson P 0 BOX 65191 LOUNSBURY,WAYNE E PORT LUDLOW,WA 98365 360-821-2919 Principals JEFFERSON County LOUNSBURY,WAYNE E,OWNER Doing business as General Project Management WA UBI No. Business type 601 748 752 Individual License Verify the contractor's active registration/license/certification(depending on trade)and any past violations. Construction Contractor Active. Meets current requirements. License specialties GENERAL License no. GENERPM866JA Effective—expiration 04/0112014—04/01/2016 Bond Lexon Ins Co $12,000.00 E o L_ A V rr Bond account no. , --- i 9817830 I / ,,--- 1C Received by L&I Effective date 1 ( MAR 1 1 2015 04/01/2014 04/01/2014 ' 1 Expiration date Until Canceled – i JEFFERSON COUNTY Insurance lM_ DEPT.OF COMMUNITY DEVELOPMENT Contractors Bonding&Insuranc $1,000,000.00 Policy no. C11SK0814 Received by L&I Effective date 03/10/2015 04/01/2014 Expiration date 04/01/2016 Savings No savings accounts during the previous 6 year period. Lawsuits against the bond or savings No lawsuits against the bond or savings accounts during the previous 6 year period. L&I Tax debts No L&I tax debts are recorded for this contractor license during the previous 6 year period,but some debts may be recorded by other agencies. License Violations No license violations during the previous 6 year period. I I https://secure.lni.wa.gov/verify/Detail.aspx?UBI=601748752&LIC=GENERPM866JA&SAW= 3/11/2015 General Project Management . Page 2 of 2 IWorkers' comp • I Do you know if the business has employees?If so,verify the business is up-to-date on workers'comp premiums. L&I Account ID Account is closed. 921,725-00 Doing business as WAYNE E LOUNSBURY Estimated workers reported N/A L.&I account representative T2/HAN CHUNG(360)902-4713-Email:CHUK235©Ini.wa.gov Workplace safety and health No inspections during the previous 6 year period. "Washington State Dept.of Labor&industries.Use of this site is subject to the laws of the state of Washington. https://secure.lni.wa.gov/verify/Detail.aspx?UBI=601748752&LIC=GENERPM866JA&SAW= 3/11/2015 Parcel Details Page 1 of 2 rte., e erson ount Home County Info Departments Search I Parcel Number: 990100021 SEARCH Parcel Number: 990100021 Printer Friendly Owner Mailing Address: STEPHANIE R HEW 585 RAINIER LN PORT LUDLOW WA98365 Site Address: 585 RAINIER LN PORT LUDLOW 98365 Section: 8 School District: Chimacum (49) Qtr Section: SE1/4 Fire Dist: Port Ludlow (3) Township: 28N Tax Status: Taxable Range: 1E Tax Code: 0231 Planning area: Port Ludlow (7) Sewer: PLSEWER - Connected(No CWF) Drainage: PLDD - YES Bank: View 1: View 2: Zoning 1: Zoning 2: Zoning 3: Sub Division: 9901 - PORT LUDLOW NO. 7 Assessor's Land Use Code: 1100 - Residential - Single Unit Property Description: PORT LUDLOW NO 7 LOT 21 SUB] TO ESMTS OF RECORD 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 viewed with Microsoft Internet Explorer 6.0 or later Windows - Mac http://www.co.jefferson.wa.us/assessors/parcel/parceldetail.asp?Parcel N0=990100021 3/11/2015 �� Cases Associated with a Parce Page 1 of 2 ill .,,-(4------„,, e ferson un ‘ , , , , , ,., ° �. ,,.. „ 5.----,---:a...„.b.,t,,.„, t,..--..--,,T.p.t., ,,,,,,,.......„4........ktwia.., . ____ .. Home County Info Departments Search Cases Associated with Parcel No: 990100021 This may not be a complete listing of information that exists for this parcel. There may be other information pertinent to the property on file. Please contact the Department of Community Development for additional information. To view the scanned documents from the case file's listed below click DCD CASE FILES and go to the year listed on your permit number to view the documents. Case Number CAM15-00116 Description Documents that are required to replace and extend an existing deck for a single family residence? Last Name LOUNSBURY Received Date 3/5/2015 2:05:58 PM LaserFiche Links CAM15-00116 (If document is unavailable please contact the applicable department to view the file.) No Images Case Number BLD02-00107 Description SINGLE FAMILY RESIDENCE W/ ATTACHED GARAGE Last Name PORT LUDLOW ASSOCIATES LLC Received Date 3/1/2002 LaserFiche Links BLD02-00107 (If document is unavailable please contact the applicable department to view the file.) No Images Case Number RAP02-00037 Description ROAD APPROACH & 911 - RAINIER LN Last Name PORT LUDLOW ASSOCIATES LLC Received Date 3/1/2002 LaserFiche Links RAP02-00037 (If document is unavailable please contact the applicable department to view the file.) No Images HOME I COUNTY INFO I DEPARTMENTS I SEARCH http://www.co.j efferson.wa.us/commdevelopment/ppquery/cm.asp?value=990100021 3/11/2015 • Begin Time: End Time: r,.5._, 0N c, °(, DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street, Port Townsend,WA 98368 J Tel:360.379.4450 I Fax: 360.379.4451 Web:www.co.Jefferson.wa.us/communitvdevelopment ij. E-mail:dcd @co.jefferson.wa.us �Sfyl N6 ' Customer Assistance Intake Form Help us provide you the information you need by filling out this form. This is a public information form,the contents of this form is available to view by the public. • The first 15 minutes of staff time is free. Office Use Only • After the first 15 minutes, a minimum of one hour will be charged at the rate of $78.00 a hour with additional time over Receipt#: one hour billed in 15 minute increments. Check/CC#: • Please complete form and submit to the address or email Date Paid: above and a staff member will contact you. • Our goal is to respond within 14 calendar days of the request. Received By: . n NAME: ' .(:e..(:e..._� '--'Ck5 U/\ DATE: 3/ //,5 3 It EMAIL ADDRESS: G Pun uC41- ) ( C Ccw -\ MAILING ADDRESS: C� �C cl,\ V o,■ TELEPHONE: (HOME) -- ---` -_._" ��� (CELL) , V� f o \- �� ` � `` C PLEASE NOTE: Information and guidance provided through Customer Assistance is advisory only and is based on information provided by the customer. This is not intended to be an exhaustive review of all potential issues.Any discussion or information provided shall not bind or prohibit the County's future implementation or enforcement of all applicable laws and regulations. No statements or assurances made by County representatives shall in any way relieve the applicant of his or her duty to submit an application consistent with all relevant requirements of County, state and federal codes, laws, regulations, land use plans,and other requirements. ice. �/' I I Your Signature: '.: ,-t �g` 1,),,'`'', ''y 4 Monday, September 29, 2014