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HomeMy WebLinkAboutBLD2015-00051 - 01 PERMIT APPLICATION S ILDING PERMIT APPLICATOR BLD15-00051 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD15-00051 Received Date: 2/23/2015 SITE ADDRESS: 4429 COYLE RD OWNER: PEN AIR LLC NORTHERN CANAL INVESTMENTS LLC PHONE: 360-301-0257 PO BOX 130 QUILCENE WA 98376-0130 SUBDIVISION: Block: Lot: PARCEL NUMBER: 701142002 Section: 14 Township: 27 N Range: 1Vt CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: DAVID WARD PHONE: 360-301-0257 P.O. BOX 130 QUILCENE WA 98376 PROJECT DESCRIPTIOI' NEW STEEL POLE BUILDING- 50X60 (1-502) BUILDING A SEP05-00002 TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: 3,000 TYPE OF IMP NEW MAIN: INDUSTRIAL: VALUATION 20,000.00 ADD'L: HEAT TYPE: EEE CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: 1 OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: ALT NUMBER OF EMPLOYEES: WATER SYSTEM: 1 PWELL BATHROOMS: Exist: 0 Prop: 1 Total: 1 Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $267.00 SRE 02/23/15 154126 APPROVED Plan Check $173.55 SRE 02/23/15 154126 State Building Code $4.50 SRE 02/23/15 154126 AP 10 2015 Potable Water Application $68.00 SRE 02/23/15 154126 Jeffers() County LY..7 . Total: $513.05 \\tidemark\data\forms\F_BLD_App_Bld.rpt 2/24/2015 • DP,0 • BUILDING PERMIT APPLICATION B 51 Reeviewview 0pType: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD15-00051 Received Date: 2/23/2015 SITE ADDRESS: 4429 COYLE RD OWNER: PEN AIR LLC NORTHERN CANAL INVESTMENTS LLC PHONE: 360-301-0257 PO BOX 130 QUILCENE WA 98376-0130 SUBDIVISION: Block: Lot: PARCEL NUMBER: 701142002 Section: 14 Township: 27 N Range: 11./t CONTRACTOR: OWNER/BUILDER PHONE: I)/ REPRESENTATIVE: DAVID WARD PHONE: 360-301-0257 P.O. BOX 130 QUILCENE WA 9837E UU PROJECT DESCRIPTION NEW STEEL POLE BUILDING- 50X60 (1-502) BUILDING A SEP05-00002 TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: 3,000 TYPE OF IMP NEW MAIN: INDUSTRIAL: VALUATION 20,000.00 ADD'L: HEAT TYPE: EEE CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: 1 OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: ALT NUMBER OF EMPLOYEES: WATER SYSTEM: 1PWELL BATHROOMS: Exist: 0 Prop: 1 Total: 1 Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $267.00 SRE 02/23/15 154126 Plan Check $173.55 SRE 02/23/15 154126 State Building Code $4.50 SRE 02/23/15 154126 Potable Water Application $68.00 SRE 02/23/15 154126 Total: $513.05 2YS (Qvite� R\ di, +, con e_� ( tee \\tidemark\data\forms\F_BLD_App_Bld.rpt 2/24/2015 • • Northern Canal Investments LLC P.O. Box 130 Quilcene WA. 98376 Joel Peterson Jefferson County Assoc. Planner The sides and roofs of our temporary greenhouses will be covered with Polyethylene, Polyvinyl or a similar flexible synthetic material. Sincerely, - David Ward Northern Canal Investments LLC • • SON Co DEPARTMENT OF COMMUNITY DEVELOPMENT (i'I Shrridan?acct. Port rumnacud,l\.1 98368 ---�`� 1 c 360379 4450 las:361).F9.4451 1l<b c r.0 icttcr'un.w1 a -'conunwlitsdcvclupnsnr ° �� � li-nail:dcdiia�.tcttcrrtt<,v.�ca_u> tf = Sty] N GAO �1l 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: 701142002 Site Address and/or Directions to Property: 4429 Coyle rd. Access(name of street(s)) from which access will be gained: Coyle Rd. Present use of property: Commercial Forest Land Description of Work(include proposed uses): We are building 1 steel pole buildings 50'X60' (BUILDING "A") and we are building 3 soft sided temporary greenhouses. 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: 1 Septic septic Permit#: Snnj��j - 000o Z Community Septic Name of System: OtCX ,nttf J P Case#: Are other residences connected to the septic system? NO Additions or repairs to sewage system: NO 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 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 "funk mail"). Applicant/Property Owner Information Property Owner: Name: Northern Canal Investments LLC Address: P.O. Box 130 Quilcene WA 98376 Phone#: 360-301-0257 E-mail Address: davew@olypen.com Please con tAuth rized Agent/Representative with project info. (select only one). Property Owner Signature: J/UJo.—�„.( Date:XI 4.3/2015 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: David Ward Address: P.O. Box 130 Quilcene WA. 98376 Phone#: 360-301-0257 E-mail Address: davew@olypen.com 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: • 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 an that they will be assuming the responsibility of the General Contractor for the proposed project. Signature: 7 Print Name: 1)&1 ,c.( l,(%/.� Dater!d-3/2015 • • ��4c ON cOG DEPARTMENT OF COMMUNITY DEVELOPMENT Street,621 Sheridan 1 W el 360.379 4450 ! F, 36(1379.4451 74, -< Web:Ww', co icfters°i n1 us/communin'decelopment -1/1 4` _ L mail:dcd aico.leffenon.��a.us 1 `tet l C I 14/I Nolo SUPPLFMENTAL APPLICATION RESIDENTIAL OR COMMERCIAL BLDG PERMIT For Department Use Only Receipt#: ,,Dat . I Related Application#s: ic)ayment#: Site Information Owner Name: Assessor Tax(Parcel#: I—1'-I Z--(X)2 Type of Building New Replacement Relocated Addition Repair Demolition *A separate permit is required Select One: Single Family Residence Modular Other iist Proposed Building/Project Number of floors '( # new bedrooms 0 existing total bed # new bathrooms / existing b total bath ( 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 Residential goTnmercial Main Floor 3C00 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): $ c:2L)D C3 S List existing buildings on property(i.e. house, garage, accessory dwelling unit, shed, barn, mobile home, other): All Existing Buildings on Property Use that the informationprovided herein, and in anyattachments, is By signing this application form, the owner/agent attests 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: , 4 L... 1rd Date: �/07 3//5— Estimated Cost of Project $ a' y�.r "g L` '. , AS 'r^xy*, Ckt 5` , E 2�'. ,r`. ''H pw x6 i 5 Forbepartment Use Only ,�t• � t �F i .� r� ��&� x � _a�;�y;�4 t.,r��` ��., k ."� �< � �r>��.+ ,... `s Building Base Fees Building Base (0-7-' G Plan Check Review Land Use Review $234.00 Septic Review $86.00 Potable Water $109.00 Technology/Scan $19.50 State Fee $4.50 Other Fees Shoreline Exemption Zoning Zoning Other New Address Road Approach Total Fees Receipt # Date: Cash/Check/CC: 0 • 1..,s ON �(.),:,./ EPARTMENT OF COMMUNITY DEVELOPMENT i , , 4, , 6 I Shcrid ut Srrccr.1'1w I utcn-cud,\\.\08366 1 :la1 I _ I d 360.3 79.4450 '. I'av•. 3603-9.44?i I l l \\cb:www.c:r.lcffe �/ I • I r+uu a u :'c. nvnunindccelupnnnl _J�.-.- Ii-'Wali:dcd:rLcr p.j tier on Ictus -. I+ ��Sfi1NG`O�' _ STORMWATER CALCULATION WORKSHEET MLA JE _ PROJECT/APPLICANT NAME: A J-/ h e -r\ `-rte*la I 2-~v.e s1-01. „t$ 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 Q.E.,SITE) Size of parcel 100 acresAn acre contains 43,560 square feet. Multiply the acreage by this figure. Size of parcel in square feet 4,356,000 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 n 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 t e area to be cleared for: 71000 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. 5,00s sq/ft Circle: Yes No Well, utilities,etc. 1000 sq/ft Does the project convert 2'/z acres or more of 21 000native 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: 250 Total Land Disturbance 97'0 10 sq/ft Cut Fill (cu/yd) Impervious surface is a hard surface th. either prevents or retards the entry of water into the soil mantle as under natural conditions prior to development. A har. surface area which causes water to run off the surface in greater quantities or at an increased rate of flow from the flow pres-nt 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, maca am or other surfaces which similarly impede the natural infiltration of stormwater. 1 Stormwater talc worksheet-REV.10/212014 0 • • STORMWATER CALULATIONS—IMPERVIOUS SURFACE NEW EXISTING Structures(all roof area) 24,480 s /ft 0 4 Structures(all roof area) sq/f1 Sidewalks 0 sq/ft Sidewalks 0 sq/ft 0 0 Patios sq/ft Patios sq/ft Solid Decks 0 sq/ft Solid Decks 0 (without infiltration below) sq/ft (without infiltration below) Driveway, parking, roads, etc 3,000 sq/ft Driveway,parking, roads,etc 1 8,000 sq/ft Other sq/ft Other sq/ft Total New 27,480 sq/ft Total Existing 18,000 sq/ft TOTAL NEW+TOTAL EXISTING* 45,480 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: 0.4 % Does the site have 35%or more of existing impervious surface? Circle: Yes I I 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. 1/ /2015 (LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) IFOR OFFICE USE ONLY SMALL MEDIUM LARGE REDEVELOPMENT_ Stormwater Site Plan: Yes No I slormwater talc worksheet—REV.1040/2014 • • STORMWATER CALULATIONS—IMPERVIOUS SURFACE NEW EXISTING Structures (all 24,480 roof area)) sq/ft Structures(all roof area) � sq/ft Sidewalks 0 sq/ft Sidewalks sq/ft Patios 0 sq/ft Patios 0 sq/ft Solid Decks 0 sq/ft Solid Decks 0 sq/ft (without infiltration below) (without infiltration below) Driveway. parking, roads.etc 3,000 sq/ft Driveway, 18,000 parking, roads.etc sq/ft Other sq/ft Other sq/ft Total New 27,480 sq/ft Total Existing 18,000 sq/ft TOTAL NEW+ TOTAL EXISTING* 45,480 sq/ft This amount will be used to check total lot coverage. The following questions will help determine hether the proposed project is considered development or redevelopment. DEVELOPMENT v. REDEVELOPMENT Divide the total existing impervious -urface above by the size of the parcel and convert to a percentage: 0'4 Does the site have 35%or more of e istinq impervious surface? Circle: Yes No FURTHER INSTRUCTIONS: If the answer is ye ,the proposal is considered redevelopment and the attached Figure 2 should be used to determine the applicable Minimum Requ ements. If the answer is no, the proposal is considered new development and the attached Figure 1 should be used. At this 'uncture, the applicant should refer to the applicable Flow Chart to determine the Minimum Requirements for stormwater man agement. DCD staff will help verify the classification of the project and the application requirements. For proponents of "small" projects who mu t comply only with Minimum Requirement #2—Construction Stormwater Pollution Prevention—an additional submittal is not re.uired. 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 Prevent on (SWPP) Best Management Practices (BMPs) Packet. Proponents of "medium" projects—those that must meet only Minimu Requirements#1 through#5—and for"large"projects—those that must meet all 10 Minimum Requirements—are required to su.mit a Stormwater Site Plan. DCD has prepared a submittal template of a Stormwater Site Plan, principally for rural residential proj cts. Complete the template in the Stormwater Site Plan Instructions and Submittal Template or prepare a Stormwater Site Plan .ing 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 a.plication is being made with the full knowledge and consent of all owners of the affected property. 1/ /2015 (LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) FOR OFFICE USE ONLY SMALL MEDIUM LARGE REDEVELOPMENT Stormwater Site Plan: Yes No stormv,ater calc worksheet—REV.10/202014 7 • • ("1.5 ON DART tt OG 621EPSheridan StreetMENT,Pgrt TOF ownsend,WA 98368COMMUNITY DEVELOPMENT W Tel:360.379.4450 I Fax:360.379.4451 / Web:w«w.co.iefferson.wa.us/communitydevelopment 1 � E-mail:dcd@colefferson.wa.us -)'•i--- _-_) i ' i VV SkiNovo SUPPLEMENTAL APPLICATION ' FEB 2 3 2015 l+, RESIDENTIAL OR COMMERCIAL BLDG PERMIT III For Department Use Only Receipt#: Date: Related Application#s: Payment#: Site Information Owner Name: Assessor Tax Parcel It I-1'4 Z-06 Z Type of Building New h Replacement Relocated Addition Repair Demolition *A separate permit is required Select One: Single Family Residence Modular Other list Proposed Building/Project Number of floors (' # new bedrooms existing v total bed # new bathrooms / existing ['j total bath Heat Source Select all that apply: Electric x, Heating bil Wood Propane Enter the square footage(sq/ft)that applies in each field: Structure Existing Sq/Ft Proposed Sq/Ft Residential/Commercial Main Floor 3C00 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): $ c-2()> pp D 0 List existing buildings on properte. house,garage, accessory dwelling unit, shed, barn, mobile home,other): All Existing Buildings on Property Use 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: 4 / __5 Estimated Name: i 11 j 1,C�4 rc, Date: ( ./.:) 3l Estimated Cost of Project $ For Department Use Only Building Base Fees Building Base c ( 7 • 0 0 Plan Check Review 1 -3 'C-C Land Use Review $234.00 Septic Review $86.00 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: • • E 4& .S°N C DEPARTMENT OF COMMUNITY DE PMENT 621 Sheridan Street,l'ler Townsend,W. 98368 i l FEB 2 3 ���� J I -cb:w�ew at I�ttcr;up wa u-.:'crnnm units& Flu nncnr 0 I.mail:JcJ rcu uEEcrson ti �.us ON N L-_`nEPT.,OF COMMJEFFERSUNITYCOUOEVETYLOPSIENT 1St, NGCO STORMWATER CALCULATION WORKSHEET EET MIJ# PROJECT/APPLICANT NAME: 3/4 r f-tt e V J\ lGi lip,I J ✓Q,S/jJ� „'t' DETERMINING STORM WATER MANAGEMENT REQUIREMENTS:This stormwater calculation worksheet should be completed first to classify the proposal as "small," "medium," or "large." The size determines whether a Stormwater Site Plan is required in conjunction with a stand-alone stormwater management permit application, building permit apiblication,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 100 acres An acre contains 43,560 square feet. Multiply the acreage by this figure. Size of parcel in square feet 4,356,000 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 pror'osed development conversion of native vegetation: project. Include in this calculation th=area to be cleared for: 7011,00 Does the project convert 3/.acres or more of Construction site for structures ' sq/ft native vegetation to lawn or landscaped areas? Drainfield, septic tank,etc. 5,000 sq/ft Circle: Yes No Well, utilities,etc. 1000 sq/ft Does the project convert 2%acres or more of 21,000 native vegetation to pasture? Driveway, parking, roads,etc. r sq/ft Circle: Yes No Lawn, landscaping,etc. sq/ft Other compacted surface,etc. sq/ft Indicate Total Volumes of Proposed: Total Land Disturbance 97,00 sqlft Cut 250 Fill (cu/yd) Impervious surface is a hard surface that ither prevents or retards the entry of water into the soil mantle as under natural conditions prior to development. A hard s rface area which causes water to run off the surface in greater quantities or at an increased rate of flow from the flow present nder natural conditions prior to development. Common impervious surfaces include, but are not limited to roof tops,walkways, p tios,driveways, parking lots or storage areas,concrete or asphalt paving,gravel roads, packed earthen materials,and oiled,macada or other surfaces which similarly impede the natural infiltration of stormwater. stormwater caic worksheet-REV.10/20/2014 1 • . STORMWATER CALULATIONS–IMPERVIOUS SURFACE NEW EXISTING Structures(all roof area) 24,480 sq/ft Structures(all roof area) 0 sq/ft Sidewalks 0 sq/ft Sidewalks 0 sq/ft Patios 0 sq/ft Patios 0 sq/ft Solid Decks 0 sq/ft Solid Decks 0 sq/ft (without infiltration below) (without infiltration below) Driveway,parking, roads, etc 3,000 sq/ft Driveway, parking, roads,etc 18,000 sq/ft Other sq/ft Other sq/ft Total New 27,480 sq/ft Total Existing 1 8,000 sq/ft TOTAL NEW+TOTAL EXISTING* 45,480 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: 0.4 °r; Does the site have 35%or more of existing impervious surface? Circle: Yes U No I 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. 1/ /2015 (LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) FOR OFFICE USE ONLY SMALL MEDIUM LARGE REDEVELOPMENT Stormwater Site Nan: Yes No stormwater talc worksheet—REV 10202014 • • ,SON c DEPARTMENT OF COMMUNITY DE s , ' - 4c.`'' OG 621 Sheridan Street,Pact Townsend,IX%A 98368 � (�`� �___ M ' Tel:360.379.4450 Fax:360.379.4}51 I Lam_ � I -G Web:www.co.jefferson.wa.us/communitydevelopment E-mail:dcd@co.iefferson.wa.us I I FEB 2 3 2015 I' 'J �9s-/t N Cs t°� SUPPLEMENTAL APPLICATION I --� J rrERS(..:'COUNTY DETERMINATION OF ADEQUATE POTABLE WATERIEVEt9PMFNT Owner Name: '.e ii $ /r? / L (—C Parcel No. 7o(/ v.z v O Q Site Address: �jlCrta 9 C' J_ /<,.t : cmr Water Source Existing Proposed Attach Copies of: „ .� 1) Well Logs Private well (if no log report on file,a 1 hr stabilization test may be substituted.) 2) Lab analysis tested within 3 years of application. -Total Coliform, Nitrate-N,Chloride 2-Party Well Items above AND recorded Operations& Maintenance agreement and recorded Easement. Alternative Provide justification and design per Jefferson County System: _ - Environmental Health policy 97-01 www.jefferso nco u ntypubliche a Ith.org/pd f/Policy_97-01_Ra i nwater_Col lectin n.pdf Valid Water Right Permit: Generally applies to springs, attach copy. Public Water: _ Name of Water Provider: -Submit 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 Right-cf-Way easement,then a Right-of-Way application will be needed. Resolution#99-90 requires building permit applications to provide evidence of an adequate potable water supply per the conditions of RCW 19.27.097 and the Guidelines for Determining Water Availability for New Buildings. By signing this application form,the owner/age t attests that the information provided herein, and in any attachments, is true and correct to the best of his, her or its knowl dge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application pa ket 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 application 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 th County's intent to enter upon the property for visits related to this application and subsequent permit oissuuance./ /J n n Signature: -- 44/+-�1� Print Name: ...a7&,01 �X (�cJa�-fir Date: a/-1// (5" FOR OFFICE USE ONLY 1) Water Right Permit# 3)Individual Well i 2)Public Water Supply WS Ott Meets Water Quality Standards? Yes No In Compliance Yes No WRIA 17 Subbasin SIPZ -Coastal/Moderate/High Yes No Based upon information provided by the applicant,it appears that the potable water supply: Meets Conditionally Meets Does not Meet • • SON r • DEPARTMENT OF COMMUNITY DEVELOPMENT `Lz 621 Sheridan Street,Port Townsend, A 98368 WA < "fel:360.379.4450 Fax:360.379.4451 Web:uww.co.Jefferson.wa.us/comnntnirvdeveiopment -mail:dcea%,co.iefferson.wa.us WATER AVAILABILITY NOTIFICATION PUBLIC WATER SYSTEM TO: Jefferson County Environmental Health Department FROM: (Water System Name) System Operator: State ID Number: Total connections for which system is approved: Number of service connections existing(in use): Number of service connections committed: Date and results of most recent water bacteriological analysis: / / The water system is capable of and will supply potable water to the following location: Assessor's Parcel IDq: Legal Description: Site Address: Operator Signature: Date: / / EXPIRATION DATE OF THIS SERVICE COMMITMENT: / /_ • ,SON row DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street,Port Townsend,WA 98368 rw Tel:360.379.4450 I Fav:360.379.4451 Web:www.co.tefferson.wa.us/communitvdevelopment I?-mail:dcdnco.iefferson.wa.us PERMIT FEES WORKSHEET Name Building A Parcel # 701142002 Estimated Cost of Project $20,000.00 Permit# Building Base Fees Building Base $267.00 Plan Check Review $173.55 Land Use Review Septic Review $160.00 Potable Water $109.00 Technology/Scan $19.50 State Fee $4.50 Other Fees Shoreline Exemption Zoning Zoning New Address Public Works Total Fees $733.55 Office Use Only Receipt Number: 15(-11 Cash/Check/CC: Star Date: • � �t�r w� •WATER WELL REPORT • Notice of Intent No WE19897 Department of Ecology •owmare COPY STATE OF WASHINGTON IfNIQUE WELL!D.# BCK627 A1i i Copv- 'Copy Water Rights Permit No. (1)OWNER: Name: PEN AIR LCC Address:PO BOX 130,QUILCENE,WA 99376 (2).LOCATION OF WELL: County: JEFFERSON NW 1/4 of the SW 1/4, Sec. 14, Twrsp 27 N, R. 1 W W.M. (2a)STREET ADDRESS OF WELL(or nearest address 4429 COYLE RD.QUILCENE, PARCEL#701142002 (3)PROPOSED USE: W Domestic r Test weti wig n r (10)WELL LOG or r Industrial r Dewater r Other ABANDONMENT PROCEDURE DESCRIPTION (4)TYPE OF WORK: Owner's number of w Il(it more than ons): I �.• Formation: Describe by color,character,size of material and r Decommissioned N. New welt RlethDd: 3 D� &� structure,and show thickness of aquifers and the kind and nature of r K Cable r Driven the material in each stratum penetrated,with at least on entry for r Reconditrooedr Rotary ('Jetted each change of formation_ (5)DIMENSION&: Diameter of'welt 6 inches MATERIAL FROM TO Drilled 284 feet Depth of completed well 282 feet m (6)CONSTRUCTION DETAILS: BROWN HARDPAN ' 0' I 28' Casing h:stalled: 6 in.dram.from 0 ft.to 272 ft. W Welded in.diem.from ft to ft , GRAY TILL 28' 35' I-Lmet installed in.Wim.from ft.to ft. BROWN TILL 35' 44' r Threaded in.dianr.from ft to it BROWN HARDPAN 44' 55' Perforations: Were perforations made? Yes Perforator type: [ GRAY SANDY CLAY 55' 74' She in. by. in. 1- CLAY 74' 85' Perforations from: R to IL Perforations from: ft.to 1 tt BROWN SAND&GRAVEL 85' 97' screens: Screens installed BROWN SANDY CLAY W/GRAVEL j 97' 112' Manufacturer's name: Johnson Type Telescoping BROWN SAND 112' 247' Diem. 5 in.slot sae .010 from 272 ft.to 277 R GRAY SILTY SAND j 247' 253' Diem. in.slot size .008 from 277 ft.to 282 ft. Gravel: I"Yes See of gravel: In. BROWN SILTY SAND W/B 253' 265 Gravel Placed from: ft.to ft. BROWN SAND W/B i 265' 282' Surface seat: X Yes Ta what depth?: 18 S Materialused in seal: Bentonite GRAY FINE SAND WM j 282' ? Did any strata contain arum-2W water% r Yes Type of water. Depth of strata: ft. Method of seating strata: , (7)PUMP: Manufacturer's name: Type: HP: (8)WATER LEVELS Land-surface elevation above mean sea-level 560 ft Static level: 228 fL below top of well Date: 2/12/2015 Artestian pressure: PSI' Date: Artesian water is controlled by: (9)WELL TESTS orswbown is amcsrnt KW Ieve Is Ichvered pe1qW staff IVO. 7 Was a pump test made? 1- by Work started: 1/31/2015 Work completed: 2/12/2015 Yield: GPM with ft.drawdown after his WELL CONSTRUCTOR CERTIFICATION: Yield: GPM with ft.drawdown after Firs . I constructed and I or accept responsibility for construction of this Recovery data(time taken as zero when pump turned off)(mer level well,and to the compliance with all Washington well construction measured from well top to water level) standards. M'ateriats used and the infinrrmation reported above are Water Water Water r true to my best knowledge end belief. Time level Time level Time level Contractor. LOFALL WELL DRILLING, INC. Date of test Address: 180 NW Lofall Rd, Poulsbo, WA 98370 , .....2:".. i,Bailer test 22 GPM with 14 R drawdown after 3 hrs. Air test GPM va7tr stent set at ft.for hrs. Sgt „ nse# 1029 Artesian flowGPM Date: Oral Contractors Temp of water: deg. Was a chemical analysis made*Yes } Registration No: LOFALWD922BH (Inc 2/17/2015 I- i • -� 26276 Twelve Trees Lane, C • 1 S Poulsbo,WA1 981370 ritLABORATORIES (360)779-5141 / / A aSPECTRA company COLIFORM BACTERIA ANALYSIS Date Sample Collected Time Sample County qq Collected Nonni Day Year !"4 G �� Type of Water System(check only one box) ❑Group A ❑Group B j:Otiler jOfa bet-i-t.. Group A and Group B Systems-Provide from Water Facilities Inventory(WEI): ID# - System Name: . GL 441.... 1AJ. Contact Person: L64// 1 r)$4;1f:A..417 , lKc_ Day Phone:(36,0 ?,7I1 yL/L Cell Phone:( Eve.Phone:( ) FAX:( ) Email Address: 4f0 // //®Corkc a6'1":Pte . Send results (Print full namp,address and zip code) On i /g0 Anti 46411 Poo/s6o, t./4 ?S3 70 SAMPLE INFORMATION Sample collected by(name): Specific location where sample collected: Special instructions or comments: 6.1 i17FA�3cy 27 ' Type of Sample(must check only one box of#1 through#4 listed below) 1.❑Routine Distribution Sample ..2.Repeat,Sample.(after unsatisfactory routine) Chlorinated:Yes No 0 Distriution System Chlorine Residual:Total Free_ 0 Source Groundwater Rule(GWR) :� 3.Raw Water Sou Semple (Population of 1,000 or less) LD E.coG-GWR urce sample Unsatisfactory routine lab number. ❑Fecal-Surface,GWI,some springs ——— - ————- ❑Other' Unsatisfactory routine collect date: ISS I I / I Pubicsa,�wF1 Chlorinated:Yes_No Chlorine Residual:Total Free_ 4ASample Collected for Information Only Investigative Construction/Repairs X .Private Residence_ Other • LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY Analyst Remarks: _l r C y CiG 0 Unsatisfactory TotaltF.orrform Present and ..-x- Satisfactory ❑E.col/present ❑E.coliabsent r. 0 Fecal colifomlpresent 0 Fecal coliform absent Replacement Sample Required: \ ❑Sample too old(>30 hours) 0 TNTC 0. ❑Improper Container 0 Turbid culture Bacterial Density Results:Plate Count /mL E.col /100m1. Total Coliform /100m1. Fecal Coliform /100m1. Method Code: Date and Tone Received: MICR- 2730 21,1•31/5- )00' Date Analyzed: ; 1-_WJDatee Reported: /At/ - Sample Number(DON digils) Lab Use Only _o L o _ OI / )pia— ©r DOH Form#331-1 (revised 11/10) ' Lab revision 11/14 I TWISS LABORATORIES u . 26276 Twelve Trees Lane,Silk Poulsbo,WA 98370 Telephone(360)779-5141 1(360)779-5150 IOC SHORT IOC-SHORT by Various EPA Approved Methods Source/Point of Entry-Report of Analysis Date Collected: 2/12/2015 Group: Private System ID No: Private System Name: David Ward Lab-Sample#: 01001102 County: Jefferson Sample Location: Well Tag#BCK627 DOH Source No: Sample Purpose: I Date Received: 2/13/2015 Sample Composition: S Date Analyzed: 2/13/2015 Send Report To: Lofall Well Drilling Date Reported: 2/17/2015 180 NW Lofall Rd Sample T Poulsbo,WA 98370 P YPe Pre-treatment/Raw Collected By: Lofall Well Drilling Phone Number: 360-697-1194 Bill To: Lofall Well Drilling 180 NW Lofall Rd Poulsbo,WA 98370 DOH# Analyte Results Units SRL]Trigger MCL* MCL Method 112 Exceeded (Analyst Init.) 20 ) Nitrate-N 2.36 m 0.5 5 10 EPA300.Q(KW) 21 1 Chloride 1 4.17 1 20 1 250 I EPA 300.0(KW) SRL: (State Reporting Level),indicates the mm®ion reporting level required by the Washington Department of Health (DOH). Trigger Level: DOH Drinking Water response level. Systems with compounds detected at concentrations in excess of this level are required to take additional samples.Contact your regional DOH office for fiintber information. MCL: (Maximum Contaminant Level),If the contaminant amount exceeds the MCL,immediately contact your regional DOH office. NA' (Not Analyzed),in the results column indicates this compound was not included in the current analysis. ND: (Not Detected),in die results column indicates this compound was analyzed and not detected at a level greater than or equal to the SRL <(0.004 indicates the compound was not detected in die sample at or above the concentration indicated. The 0.010 mg/L.MCL for Arsenic is for Croup A NTNC systems. All other systems should check with their county Health District to determine what level is applicable. 147011 • • � SoN �o�,..,, DEPARTMENT OF COMMUNITY DEVELOPMENT ,r� G 621 SheridanStreet Port'1ownsend,1X%.198368 Tek 360.379.4450 I Rax:360 3 79.4451 W'cbwwweuafft onwau,icommunity devclopment �� EO �� ad:dcd(tilco.ic ferson.wa.us ``9S77r N�>t°� FEB 2 PERMIT APPLICATION 3 2015 JEFfCRSON COUNTY Steps in the Permit Process: j.Of COMMUNITyp -Review application checklist to ensure all information is completed prior to submitting application. 'EiOPMENT -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: 701142002 Site Address and/or Directions to Property: 4429 Coyle rd. Access(name of street(s)) from which access will be gained: Coyle Rd. Present use of property: Commercial Forest Land Description of Work(include proposed uses): We are building 1 steel pole buildings 50'X60' (BUILDING "A") and we are building 3 soft sided temporary greenhouses. 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: t 1 Septic Septic Permit#: - 00002- _ Community Septic Name of System: 0...Q4 (loch.J.e Case If: Are other residences connected to the septic system? NO Additions or repairs to sewage system: NO 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: ()3iD►5 - 51 • • 0 The authorized agent/representative is 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 Name: Northern Canal Investments LLC Address: P.O. Box 130 Quilcene WA 98376 Phone#: 360-301-0257 E-mail Address: davew@olypen.com Please contest Auth�grized Agent/R presentative with project info. (select only one). Property Owner Signature: dC1 `�r LA) Date: a3/2015 Note: For projects with multiple owners,attach a separate sheet with each owner(s)information and signatures. Applicant: Authorized Agent/Representative(if other nan owner) Name: David Ward Address: P.O. Box 130 Quilcene WA. 98376 Phone#: 360-301-0257 E-mail Address: davew@olypen.com 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: 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 an that they will be assuming the responsibility of the General Contractor for the proposed project. Signature: an Print Name: (1)44,v i 4 I,4),:t e-411 Dater 0-312015 . • Z.1 Cay) or,, ce ( -606 s t,�� (gvhaz -c Le le* ? lir) it6 — Cosmo, VoFiat