The URL can be used to link to this page

Home My WebLink AboutBLD2021-00094 - 01 PERMIT APPLICATION DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street, Port Townsend, WA 98368 Tel: 360.379.4450 | Fax: 360.379.4451 Web: www.co.jefferson.wa.us/communitydevelopment E-mail: dcd@co.jefferson.wa.us 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: Site Address and/or Directions to Property: Access (name of street(s)) from which access will be gained: Present use of property: Description of Work (include proposed uses): Wastewater - Sewage Disposal This property is served by Port Townsend or 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: Permit Application Page 1 of 2 4 9100 - Vacant Land Property is located in the Olympic Terrace II Subdivision on Lot 6. Construction of a single family home with attached garage Mount Constance Way 978802041 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: Address: Phone #: E-mail Address: Please contact Authorized Agent/Representative with project info. (select only one). Property Owner Signature: Date: 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 Contractor Consultant Name: License # Address: Phone #: E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: License # Address: Phone #: E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: License # Address: Phone #: E-mail Address: 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. I further agree to that all activities I intend to undertake or complete associated with this permit will be performed in compliance with all applicable federal, state and county laws and regulations and I agree to provide access and right of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application review and any required later inspections. Applicant may request notice of the County’s intent to enter upon the property for visits related to this application and subsequent permit issuance. Signature: Print Name: Date: ______________ Permit Application Page 2 of 2 276 NW Ferry Street, Poulsbo, WA 98370 cobrien@westharborhomes.com cobrien@westharborhomes.com 4 Cliff OBrien Digitally signed by Cliff OBrien DN: cn=Cliff OBrien, o, ou=Westharbor Homes, email=cobrien@westharborhomes.com, c=US Date: 2021.02.09 12:19:16 -08'00' 4 Cliff O'Brien 4 (360) 301-3179 (360) 437-2101 (206) 261-6581 Cliff OBrien Digitally signed by Cliff OBrien DN: cn=Cliff OBrien, o, ou=Westharbor Homes, email=cobrien@westharborhomes.com, c=US Date: 2021.02.09 12:18:33 -08'00' 4 Cliff OBrien PORTLAL994L8 02/09/2021 edjonson@msn.com 4 Edward Jonson Port Ludlow Associates Port Ludlow Associates Union Studio (401) 272-4724 (360) 301-3179 4 02/09/2021 70 Breaker Lane, Port Ludlow, WA 98365 70 Breaker Lane, Port Ludlow, WA 98365 70 Breaker Lane, Port Ludlow, WA 98365 140 Union Street, Providence, RI 02903 4 Up Front Parcel Review Parcel Date Completed: Owner Name: Add. Name: Mailing Address: Site Address(es): Parcel Number: S-T-R: --Total Acreage Legal Description Land Use: Flood District:Fire District:Planning Area: Flood Map (FIRM) Panel No: School District Zoning: [ ] Zoning ________________________________________________________________________________ [ ]Setbacks:Front:_______Left Side:__________Right Side: __________ Rear:_______________ Informed by JCC 18.30 or Title 17 for Master Planned Resorts: Shoreline Setback:____________Critical Area Buffer__________________________________________ Building Setback: ______________________________________________________________________ Adjoining Forest Lands: Commercial/ ____________ Rural/______________Inholding_______________ [ ] Lots/Require Declaration of Restrictive Covenant YES NO, submitted: YES NO __________________ [ ] Legal Access to Property YES NO _____________________________________________________ [ ] Parcel Tags or Scanned Documents YES NO List:_________________________________________ [ ] Sepcial Reports Nearby YES NO List:____________________________________________________ [ ] Shoreline Designation: YES NO _______________________________________________________ [ ] Critical Areas Geologically Hazardous Areas YES NO Shoreline Slope Stability:____________Landslide____________Erosion_____Seismic___________ CMZ: none High Risk Moderate Risk Disconnected CMZ__________________________ Report Submitted________________________________________________________________________ FWHCA: YES NO Stream type: __________________________ Pond or Lake < 20 acres________ Marbled murrelet/Spotted owl_____________ marine nearshore______________ Wetlands:YES NO ___________________________________________________________________ Flood:YES NO List FIRM map:_______________________________________________________ Flood Certificate: ______________________________________________________ Aquifer Recharge Area:YES NO___________________________________________________________ SIPZ: none At Risk High Risk Coastal ________________________________________[ ] Site Visit conducted YES NO _____________________________________________________ [ ]Notice Provisions/Disclosure Forest Lands:YES NO Airport YES NO MRL YES NO Agricultural Lands: YES NO No Shooting Zone:YES NO [ ] Archaeology:YES NO _____________________________________________________________ 4 No No 4 Yes No None No None None None No No Yes No 172'20' 4 No No No 15' 12'14' Case #: BLD2021-00094 No 978802006 978802006 No 4 4 NONE 4 No 5' from FWHCA No No 4 No 4 None No 4 Fish habitat and Non-fish habitat 4 No MPR-SF-4 MPR-SF-4 April 5, 2021 4 No No X 0.2 PCT Annual Chance Flood Hazard No Land Use Requirements [ ] SEPA Required:YES EXEMPT _________________________________________________ [ ] Landscaping Required: Yes No_______________________________________________________ [ ] Parking Spaces Required NO 2 Other_______________________________________________ [ ] Building Height: 35' UBC Standard __________________________________________________ [ ]Stormwater: New Impervious Surface_____________Land Disturbing Activity ________________ Min Req #1 thru #5Stormwater Req's: Min Req #2 Min Req #1 thru #9 Engineering ________________ Drainage District Review Required___________ [ ] Stormwater Pollution Prevention Plan Submitted: Yes No __________________________________ [ ] Impervious Surface coverage percentage: __________________________________________ Resource Lands & Public: 10%Rural Residential: 25%Rural Industrial: Per UDC Sec 6.7 Rural Commercial: 60%Area of Building Coverage: 60% in Rural Industrial Lands only [ ] ADMIN: Setbacks entered in Permit Plan case N/A YES ________________________________ New Parcel Tags entered in Permit Plan N/A YES ____________________________________ Special Reports Scanned N/A YES _________________________________________________ [ ] ADU Proposed YES NO Square Footage: ______________________ [ ] Total Building (s) Size:____________________________________________________________ RVC: 20,000 SF CC: 5,000 SF NC: 7,500 SF GC: 10,000 SF All others: subject to septic & water constraints/None specified [ ] Road Classification:_______________________________________________________________ Road Approach:EXISTING NOT REQ'D RAP__________________________________________ [ ] Require Final Zoning Approval/inspection YES NO __________________________________________ [ ] UGA No Protest Agreement YES NO, submitted: YES NO _____________ [ ] Recorded Date of Subdivision:_______________AFN____________________________Over 5yrs=UDC Plat Conditions:_____________________________________<5yrs=Plat Conditions on plat or Old Ordinance Reviewed By: Additional Notes: No No 4 4 4 The Olympic Terrace Division II - Phase I subdivision was approved in May, 2007. Amendment 2 of the subdivision established vesting of the plat on a 10 year horizon, ending in May of 2017. An extension may have been provided by DCD, which would maintain the platted 15' FWHCA buffer. Austin Watkins and David Wayne Johnson have been contacted to confirm whether a plat vesting extension was approved for this subdivision. Platted FWHCA buffer renewed with development agreement--all MPR zoning reviewed under the special critical areas ordinance per the development agreement and amendments. No other critical areas on site or impacting development proposal. Stormwater worksheets A1, B1, and C need alteration. Current SWPPP provided by applicant identifies BMP T5.30 for Full Dispersion for both roof runoff and other hard surfaces. Site conditions will prevent the use of this BMP, however site plan shows that BMP T5.10C for perforated stub out connections is planned. In addition, BMP T5.12 for sheet flow dispersion will be appropriate for the SFR's driveway. Additional information request sent 3/29/21. Site plan and stormwater worksheets revised and resubmitted on April 5, 2021 to reflect changes to BMPs per 2019 SWMMWW. Project approved. N/A N/A County 13% Bryan Benjamin RAP REQ'D 4 No 4 No 4 No 8,025 SF N/A 4 2 4 2,888 SF 4 4 4 4 Property subject to utility and other easements; critical area buffers platted No No Exempt4 2,294 SF 4 4 May 2007 Yes 4