The URL can be used to link to this page

Home My WebLink AboutBLD2015-00023 - 01 PERMIT APPLICATION BLD15-00023 BUILDING PERMIT APPLICATION Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: = D15-00023 Received Date: 1/23/2015 SITE ADDRESS: 1057 TEAL LAKE RD PORT LUDLOW, 98325 OWNER: ""la a .1•'$. C/O GENERAL DYNAMICS PHONE: 404-583-9606 8880 NIMBUS AVENUE SUITE B BEAVERTON OR 97008 SUBDIVISION: Block: Lot: TX 1+ PARCEL NUMBER: 821222001 Section: 22 Township: 28 N Range: 1E CONTRACTOR: TBD PHONE: 253-584-6606 REPRESENTATIVE: GENERAL DYNAMICS PHONE: 770-225-1563 AUTHORIZED AGENT FOR SPRINT 1750 FOUNDERS PARKWAY# 120 PROJECT DESCRIPTION remove existing (6) cdma antennas, and replace with (3) Network Vision antennas and (3) remote radio units. TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: TYPE OF IMP NEW MAIN: INDUSTRIAL: VALUATION 25,000.00 ADD'L: HEAT TYPE: CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: NUMBER OF EMPLOYEES: WATER SYSTEM: BATHROOMS: Exist: Prop: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $322.00 SRE 01/23/15 154043 APPROVED Plan Check $209.30 SRE 01/23/15 154043 State Building Code $4.50 SRE 01/23/15 154043 FEB 10 2015 Total: $535.80 Jefferson County DCD II 1\tidemark\data\forms\F_BLD_App_Bld.rpt 1/23/2015 474e #1- lUyvodS Qa-1tia✓� ?� 71,1 A AMERICAN TOWER 1/14/2014 SPRINT NEXTEL Notice to Proceed Letter ATC Site Name:PORT LUDLOW,WA ATC Site#:83038 Customer Site Name:Teal Lake Customer Site#:SE33XC183 Collocation Project Number 539590 Dear Customer, American Tower is pleased to inform you that all construction prerequisites have been met and you are approved to begin construction.Per the schedule provided to ATC,you are scheduled to start construction on 2/12/2014. In order to ensure that all contingencies are met,this NTP package must be sent to the contractor that will be performing the work. The contractor approved for this install is SatTel Broadband,Inc.The contractor must contact the ATC NOC when entering and leaving the site at 877-518-6937(877-51-TOWER). If the Contractor changes before work commences,please notify ATC. Please note that installation must be performed in accordance with the specifications outlined in your most current Structural Analysis. Please contact the ATC NOC,to coordinate a Pre-Con Walk at 877-518-6937(877-51-TOWER). A Pre-Con must occur prior to construction starting on site. ATC NOC will also assist with site access or if you have any questions or require additional information. If the ATC NOC is not notified of daily site work or a Pre-Con Walk,the contractor's ATC Approved status could be suspended or permanently revoked. Please contact me if you have any questions or concerns.Thank you for choosing American Tower Corporation. Sincerely, Bobby Lee Project Specialist Cc: Rebecca Nichols Account Project Manager Aaron Bloom Territory Manager—Business Development 5CJL fie �� $ON e0 DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street,Port Townsend,WA 98368 w Tel:360.379.4450 I Fax:360.379.4451 Web:www.co.jefferson.wa.us/conununitydevelolanent E-mail:cicd@c '-fferson.wa.us ! SNlNG'' fI II PERMIT APPLICATION JAN 2 3 2015 �' Steps in the Permit Process: V -Review application checklist to ensure all information is completed prior to submitting application. ----i „TY -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: 821222001 Site Address and/or Directions to Property:1055 Teal Lake Road, Port Ludlow,WA 98365 Access(name of street(s)) from which access will be gained: Watson Road Present use of property: Telecommunications facility Description of Work(include proposed uses): Remove existing six (6) CDMA antennas. and replace with three (3) Network Vision antennas and three (3) remote radio units. 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#: N/A _ _ Community Septic Name of System: N/A Case#: /� Are other residences connected to the septic system? N/A �I \ Additions or repairs to sewage system: N/A ` t\1 Is it a complete or partial system installation: Complete _ Partial C`v Has a reserve drainfield been designated? Yes No — — i Date of Last Operations& Maintenance check: N/A Attach last report to application Describe or attach any drainfield easements, covenants or notices on title,which may impact the property: N/A (4-- Permit Application Page 1 of 2 • • 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: Name: General Dynamics, on behalf of Sprint Wireless Address: 8880 Nimbus Avenue, Suite B, Beaverton, OR 97008 Phone#: 404-583-9609 E-mail Address: chris.edwards @gdit.com _ Please conta Aut rized Agent/Rei ese tative with project info. (select only one). erSignature: - JD, �� ' Date: 1/21/15 Ci ii. ljaduS )) SIT�z 64-c?fir t in/)lrtrl/6"C Note: For projects with multiple owners,attach a separate sheet with each owners information aria signatures. Applicant: Authorized Agent/Representative(Ifotherthan owner) Name: Steve Watkins (General Dynamics, authorized Agent for Sprint Wireless) Address: 1750 Founders Parkway, #120, Alpharetta, GA 30009-7600 Phone#: 404-502-4264 E-mail Address: stephen.watkins @GDIT.com Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer ✓ Architect 1 Surveyor Contractor Consultant Name: KDC Architects/Engineers (ATTN: Aron De Los Angeles) Address: 4720 200th St. SW, #200, Lynnwood, WA 98036 Phone#: 425-670-8651 /425-712-3084 E-mail Address: aron.delosangeles @KDCarchitects.cor Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: American Tower Corporation, ATTN: Josh Smith Address: 10 Presidential Way, Woburn, MA 01801 Phone#: 781-926-4613 E-mail Address: joshua.smith @americantower.com Professional: Is this an Authorized Agent/Representative for this project? NO Engineer Architect Surveyor Contractor 1 Consultant Name: Jason Key Address: Sabre Industries / MUTI, 26609 79th Ave. S, Kent, WA 98032 Phone#: 253-246-7132 E-mail Address: jkey @mutionline.com Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: Address: Phone#: E-mail Address: Attach additional pages if necessary Builders Statement The signer of this statement certifies that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that the wil b/, suming the responsibility of the General Contractor for the proposed project. Signature i j7/� Print Name: $tegvEIU Catkins Date:1/21/15 abstietAt Perrait Appficatinn Page 2 of 2 � ON °G� DEPARTMENT OF COMMUNITY DEVELOPMENT P 621 Sheridan Street,Port Townsend,WA 98368 ( . --, ti ^C Tel:360.379.4450 Fax:360.379.4451 Web:www.co.Jeff exson.wa.us/communitydevelopment j u fl i J 2 3 2015 E mail: ff dcd @co.jcetson.wa.us 1 (I N G�O ,i LLJJ SUPPLEMENTAL APPLICATION a d� SINGLE FAMILY RESIDENCE PERMIT OR DUPLEX in-E-i�FloPaaFnlr For Department Use Only Receipt#: Date: Related Application Us: Payment#: Site Information Owner Name: Assessor Tax Parcel #: ........._. Type of Single Family Residence or Duplex New Replacement Relocated Addition Repair Demolition *A separate permit is required Select One: Modular Duplex Single Family Residence Proposed Building/Project Number of floors #new bedrooms existing total bed #new bathrooms existing total bath Heat Source Select all that apply: Electric Heating Oil Wood Propane Enter the square footage(sq/ft)that applies in each field: Structure Existing Sq/Ft Proposed Sq/Ft Main Floor Second Floor Additional Floors-heated/unheated Basement-unfinished Basement-finished space or habitable Detached Garage-heated/unheated Attached Garage-heated/unheated Garage 2nd fl-unfinshed storage Garage 2nd fl-finshed space or habitable Carport-2 walls or less Deck-uncovered Covered porch Other(shed, barn, pole bldg,etc.) Estimated Cost of Project(Required): $ Supplemental SFR l • • List existing buildings on property(i.e. house,garage,accessory dwelling unit,shed, barn, mobile home,other): All Existing Buildings on Property Use Public Health Information Water Source Existing Proposed Attach Copies of: Private well 1) Well Logs(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 http://www.jeffersoncountypublichealth.org/pdf/Policy_97- 01_R a i nwat a r_Co l le ct io 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-of-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.http://www.co.jefferson.wo.us/commissioners By signing this application form, the ev�i nedagent 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 •..lic- ..n and subsequent permit issuance.4)41-11(744-1- Signature: �%+ /' / Print Name:✓ v1 Date: / 07/6"— FOR OFFICE USE ONLY 1) Water Right Permit# 3)Individual Well 2)Public Water Supply WS ID# 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 Supplemental SFR 2 1 • • ��gaN c'o6 DEPARTMENT OF COMMUNITY DEVE •)l Irr [I V [ 621 Sheridan Street,Port Townsend,WA 98368 I >— Tel:360.379.4450 I Fax:360.379.4451 Web:www.co.jefferson.wa.us/communitydevelopment I JAN 2 3 2015 F.-mail:dcd@co.jefferson.wa.us ( ,I / JAI I LRSOiV COUNTY STORMWATER CALCULATION WORKSHEET 'COMMUNITY MLA tI 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.,SITEI Size of parcel 73 acres An acre contains 43,560 square feet. Multiply the acreage by this figure. Size of parcel in square feet 3,179,880 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 0 sq/ft native vegetation to lawn or landscaped areas? Drainfeld, septic tank,etc. 0 sq/ft Circle: Yes No Well, utilities,etc. 0 sq/ft Does the project convert 2%acres or more of native vegetation to pasture? Driveway,parking, roads, etc. 0 sq/ft Circle: Yes No Lawn, landscaping,etc. 0 sq/ft Other compacted surface,etc. 0 sq/ft Indicate Total Volumes of Proposed: Total Land Disturbance 0 sq/ft Cut N/A Fill N/A (cu/yd) Impervious surface is a hard surface that either prevents or retards the entry of water into the soil mantle as under natural conditions prior to development. A hard surface area which causes water to run off the surface in greater quantities or at an increased rate of flow from the flow present under natural conditions prior to development. Common impervious surfaces include, but are not limited to roof tops,walkways, patios,driveways, parking lots or storage areas,concrete or asphalt paving,gravel roads, packed earthen materials,and oiled,macadam or other surfaces which similarly impede the natural infiltration of stormwater. stor m+aler talc worksheet—REV.10/20/2014 1 • • STORMWATER CALULATIONS–IMPERVIOUS SURFACE NEW EXISTING Structures(all roof area) 0 sq/ft Structures(all roof area) 500 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 500 sq/ft (without infiltration below) (without infiltration below) Driveway, parking, roads,etc 0 sq/ft Driveway, parking, roads,etc 500 sq/ft Other 0 sq/ft Other 1,000 sq/ft Total New 0 sq/ft Total Existing 2,500 sq/ft TOTAL NEW+TOTAL EXISTING` 2,500 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: 0.08 Does the site have 35%or more of existing impervious surface? Circle: Yes 111 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 1/21/15 (LA nil_ER OR AUTHORIZED REPRESENTATIVE SIGNATURE) S LPL rem( (DATE) FOR OFFICE USE ONLY -_....- ....... w . .,, ,,..,.,�..,. . `1L MEDIUM'. .,; RGE ll. -EVELOPMENT Stormwater Site Plan: Yes No stornrwater calk worksheet—REV.10/20/2014 2 Parcel Print • Page 1 of 1 Parcel Number 821222001 08/15/2014 Owner Mailing Address: POPE RESOURCES I �/J I C/O OLYMPIC RESOURCE MGMT ATTN: LAND RECORDS 19950 7TH AVE NE #200 ! JAN 2 3 2015 POULSBO WA 98370 U Site Address: ,dn 1057 TEAL LAKE RD d N flP FP;' CHIMACUM 98370 Section: 22 School District: Chimacum (49) Qtr Section: NW1/4 Fire Dist: None Township: 28N Tax Status: Taxable Range: 1E Tax Code: 0203 Planning area: 98370 Sub Division: Land Use Code: 8800 98370 Property Description: S22 T28 R1E E1/2 NW(LESS TAX 1) N1/2 SW (LESS PTN TAX 2) htt p://www. arcel rint.as ?PARCEL NO°821222001 1/20/2015 P J P P P P _ Parcel Print • • Pale 1 of 1 Parcel Number:821222001 08/15/2014 Owner Mailing Address: POPE RESOURCES /a \ C/O OLYMPIC RESOURCE MGMT ATTN: LAND RECORDS —tl 19950 7TH AVE NE #200 ` POULSBO WA 98370 it Site Address: 1057 TEAL LAKE RD CHIMACUM 98370 Section: 22 School District: Chimacum(49) Qtr Section: NW 1/4 Fire Dist: None Township: 28N Tax Status: Taxable Range: lE Tax Code: 0203 Planning area: 98370 Sub Division: Land Use Code: 8800 98370 Property Description: S22 T28 R1E E1/2 NW(LESS TAX 1) N1/2 SW (LESS PTN TAX 2) t_.._.//......... .... :—c r.......,... .,,„913 o I?CPT 1\11-1—R')1TY,nni 1/7n»01 ; Ill ID �gsoN co DEPARTMENT OF COMMUNITY DEVELOPMENT �k �4, 621 Sheridan Street,Port Townsend,WA 98368 ti Tel:360.379.4450 Fax:360.379.4451 Web:www.co.jeffcrson.wa.usfcommunity-development �G E-mail:dcd(t@.co.jefferson.wa.us -9549.f N C), 0 PERMIT FEES WORKSHEET Estimated Cost of Project $25,000.00 Parcel# Permit# Building Base Fees Building Base $322.00 Plan Check Review $209.30 Land Use Review $234.00 Septic Review Potable Water Technology/Scan $19.50 State Fee $4.50 Other Fees Shoreline Exemption Zoning New Address Road Approach Total Fees $789.30 Office Use Only Receipt Number: , 0 L4 1 E0 -PE I V E Cash/Check/CC: Li I L}- Date: l�Z 'j/1 )Initials: LO I 1 ID FERSON COUN 2E7 OF COMMUNITY DEVELOPMENT