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Home My WebLink AboutBLD2021-00178 - WITHDRAWNPermit Application Page 1 of 2 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: Bachelor Rd Enter Bachelor Rd from gardiner Beach Rd, heading east. The parcel is on the north side of the road No septic - no bathroom planned Vacant Land immediately east of 141 Bachelor Rd. The gravel driveway is on the southeast corner of the property. 002341010 Build garage w/ water hookup for basic sink. No heat, bathroom, or kitchen. Permit Application Page 2 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: 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: ______________ 4 3/24/2021 8057203900 3/24/2021 julianne.demars@gmail.com Julianne DeMars 32 6th St S, Kirkland WA, 98033 Julianne DeMars Supplemental SFR 1 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 SUPPLEMENTAL APPLICATION RESIDENTIAL OR COMMERCIAL BLDG PERMIT For Department Use Only Receipt #: Date: Related Application #s: Payment #: Site Information Owner Name: Assessor Tax Parcel #: 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 # new bedrooms existing total bed # new bathrooms existing total bath Heat Source Select all that apply: Heat Pump 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 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): $ $ Fair market value of project 0 4 0.00 4 0 0.00 1.00 $ 30,000.00 0 Julianne DeMars (tax parcel = 002341010) 0 0 0 0 0.00 0 0 0 0 0.00 0 0 0 0 0 0 0 0 0.00 0.00 0 2,341,010 0 0 0 120 520 (unheated)0 Supplemental SFR 2 List existing buildings on property (i.e. house, garage, accessory dwelling unit, shed, barn, mobile home, other): All Existing Buildings on Property Use 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 tr ue 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: Date: For Department Use Only Building Permit Fees Building Base Plan Check Review Land Use Review $291.00 Septic Review $141.00 Potable Water $141.00 Technology/Scan $24.00 State Fee $6.50 Other Fees Shoreline Exemption Zoning Zoning Other New Address Technology Fee – 5% Total Fees Receipt # Date: Cash/Check/CC: 3/24/2021 3/24/2021 Julianne Demars Digitally signed by Julianne Demars Date: 2021.03.24 15:32:55 -07'00' Julianne Demars Digitally signed by Julianne Demars Date: 2021.03.24 15:32:46 -07'00'Julianne DeMars Julianne DeMars stormwater calc worksheet QR code – REV. 5/31/2019 page 1 of 2 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 STORMWATER CALCULATION WORKSHEET PARCEL # 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 re quired 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. 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 of plant species, other than noxious weeds, 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 ¾ acres or more of Construction site for structures _________________ sq/ft native vegetation to lawn or landscaped areas? Drainfield, septic tank, etc. ____________________ sq/ft Circle: Yes No Well, utilities, etc. ___________________________ sq/ft Does the project convert 2 ½ 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: (Includes BMP T5.13 Fill Volume) Temporary construction area ______________ sq/ft Total Land Disturbance ____________________ sq/ft Cut __________ Fill __________ (cu/yd) PARCEL SIZE (I.E., SITE) Size of parcel _________ acres An acre contains 43,560 square feet. Multiply the acreage by this figure. Size of parcel in square feet _________________ sq/ft Scan the QR code to access the digital form 002341010 Julianne DeMars 5 217800 800 0 300 (water line) 100 0 0 0 1200 stormwater calc worksheet QR code – REV. 5/31/2019 page 2 of 2 ~ Applicants for “small” projects must comply only with Minimum Requirement #2—Construction Stormwater Pollution Prevention. Please submit the Small Project Certification (Worksheet “s). 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 u p the Construction Stormwater Pollution Prevention (SWPPP) Best Management Practices (BMPs) Fact Sheet. ~ Applicants for “medium” projects—those that must meet only Minimum Requirements #1 through #5 must submit Worksheet A1 and B1, a stormwater site plan and a construction stormwater pollution prevention site plan (See Reference A1A and B1A for guidance).). ~ “Large” projects—those that must meet all 9 Minimum Requirements— must submit Worksheet A1 and B1, a stormwater site plan and a construction stormwater pollution prevention site plan (See Reference A1A and B1A for guidance). Large projects also may require engineering. See Worksheet L to determine additional large project requirements. 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. ________________________________________ ________________________ (LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) STORMWATER CALCULATIONS – IMPERVIOUS SURFACE Impervious surface is a hard surface that either prevents or slows the entry of water into the soil 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. NEW EXISTING Structures (all roof area) _________________sq/ft Structures (all roof area) _________________sq/ft Sidewalks _________________sq/ft Sidewalks _________________sq/ft Patios _________________sq/ft Patios _________________sq/ft Solid Decks _________________sq/ft Solid Decks _________________sq/ft (without infiltration below) (without infiltration below) Driveway, parking, roads, etc _______________sq/ft Driveway, parking, roads, etc _______________sq/ft Other _________________sq/ft Other _________________sq/ft Total New _________________sq/ft Total Existing _________________sq/ft TOTAL NEW + TOTAL EXISTING* _________________sq/ft *This amount will be used to check total lot coverage. DEVELOPMENT v. REDEVELOPMENT Divide the total existing impervious surface above by the size of the parcel and convert to a percentage. ____________% Does the site have > 35% or more existing impervious surface? The proposal is considered new development. Answer questions in Figure 2.4.1 Flow Chart for New Development to determine project size (next page). The proposal is considered redevelopment Answer questions in Figure 2.4.2. Flow Chart for Redevelopment to determine project size (next page). yes no 0 0 260 900 0 0 0 0 3000 0 3000 3900 640 (includes 120 sqft covered patio) 1.3 3/24/2021