HomeMy WebLinkAboutBLD2016-00562 - CANCELLED 0562
BUILDING PERMIT APPLICATION B Review Type:Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD16-00562 Received Date: 1/5/2017
SITE ADDRESS: 170 MC DONALD COVE RD
BRINNON, 98320
OWNER: KAREN BIANCHI PHONE: 206-605-5602
1334 S DAWSON
SEATTLE WA 98108-2359
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 502282012 Section: 28 Township: 25 N Range: 2V1
CONTRACTOR: SAM DAVIES PHONE: 360-808-3446
P.O. BOX 3170
PORT ANGELES WA 98362
Contractor's License #SEAMLB*885K2 Expires 6/14/2018
REPRESENTATIVE: NTI ENGINEERING PHONE: 800-654-5545
717 S PEABODY ST
PORT ANGELES WA 98362
PROJECT DESCRIPTION: REPLACEMENT OF STEPS/DOCK AND TWO FOUNDATION PIERS-
STAIRS TO BEACH
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN:
VALUATION 25,000.00 ADD'L: HEAT TYPE:
CODE EDITION: 2015 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: 248 SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS: Type Amount Paid By: Date: Receipt
Exist: Exist: SMP Exemption Base $595.00 SRE 12/28/16 166023
Prop: Prop: Scanning Fee $21.00 SRE 12/28/16 166023
Total: Total:
Permit $267.00 JJC 04/17/17 169637
Approved/Date Plan Check $173.55 JJC 04/17/17 169637
State Building Code $4.50 JJC 04/17/17 169637
Total: $1,061.05
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Up Front Parcel Review eLP/w-
Parcel 502282012
Printed: June 12, 2017
KAREN BIANCHI Site Address(es):
1334 S DAWSON 170 MC DONALD COVE RD BRINNON, WA 98320
SEATTLE, WA 98108-2359
Parcel Number: 502282012 S-T-R: 28-25N-2W Total Acreage 1
Legal Description S28 T25 R2W TAX 5(LS W105') W/TL TX A-7(E1/2) 1.90CH Land Use: 1100
Flood District: Fire District: 4 Planning Area:
Flood Map (FIRM)Panel No: School District 46 Zoning: R q ( 5
COMP PLAN
DESIGNATION:
COMMUNITY PLAN: UGA: UGA Trans
fPlot plan states "property line"
tAssessor's Map (Property lines on submitted plot plan must match the property lines as identified on the Assessor's 1/4 map)
]
Legal Access to Property Q..9 NO
] Parcel Tags or Scanned Documents YES .@.
] ESA's: Special Reports Nearby YES
Designated Ag YES (N
Shoreline Designation: Y NO c f9 V fii l/Ci q' �
,] Shoreline Slope Stability: M NO ( o.� (114ck . S ( Q - — \ -a7
Stream Type:sJ NO - A
FWHCA: * NO A 'e
Wetlands: Y i r, ct S 7 (I
Rare Plants:YES ti
Seismic: YES
Landslide: YES
Flood: YES GIM5
Erosion: YES i`•
Aquifer Recharge Area:YES �i
SIPZ: no At Risk High Risk Coastal
CMZ: none High Risk Mo era e isk Disconnected CMZ
Stormwater site plan submitted: YesNo
] Forest Lands: YES 66
Adjoining Forest Lands: Commercial/ Rural/ Inholding
Mineral Lands: YES
K] Agricultural Lands: YES w'
Archaeology: YES NO _�^�
54 No Shooting Zone: NO �J !1(�� 0`, ) C C`Q k1q,J (t
`� Stormwater: New Impervious Surface 0. c75t Land Disturbing Activity 3 In 22 ESA's
Stormwater Req's:On Req#2 Min Req#1 thru#5 Min Req#1 thru#10 Engineering
] Notice Provisions/Disclosure:Airport YES eMRL YES (No Forest Lands YES f NO
IX Landscaping Required: Yes 10.
_ Parking Spaces Required NO C2 Other
Building Height: (35' UBC Standard
PRE16-00006 BIANCHI NA M David Wayne Johnson
Application Received: 2/25/2016 Permit Issued/Case closed: 3/18/2016 Case Finaled:
Consolidated on-site pre-app for two projects on two adjacent parcels with common ownership: 1st project: Two
platforms and stairs on shoreline bluff(one viewpoint on each parcel); 2nd project: replacement dock and stair from
existing SFR(Parcel 502-282-012). Fees in excess of$616 accounted for in MLA16-00032
PRJ11-00229 BUSTEED F
Application Received: 11/16/2011 Permit Issued/Case closed: Case Finaled:
SEP70-00120 BUSTEED F
Application Received: 3/24/1970 Permit Issued/Case closed: 3/24/1970 Case Finaled: 4/28/1970
SOM70-00120 BUSTEED RNC
Application Received: 11/16/2011 Permit Issued/Case closed: 4/13/2016 Case Finaled:
\\tidemark\data\forms\R_Parcel_CRMLA.rpt 6/12/2017 Page 3 of 3
,sL4ON c�G DEPARTMENT OF COMMUNITY DEVELOPMENT
44, 631 Shcridan Strcct,Port'1'ownscnd,AX';A 98368
ti Icl:360 379.4450 [ax:360 379 4451
\N LI) vvww.co.jcffcison.wa u./conununitV-dcvclopmcnt
1�,-mail:dcd9i;co.jcffcrson.wa.us
'16' l N G '()
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: 5-424 z 8 2.a /
Site Address and/or Directions to Property: l 7 D lit e: D 0,,,w I ok Co✓c. k2�
tJr'1 vin0 r\ 1-u Pr
Access (name of street(s)) from which access will be gained: (11.c Dv1z Iek Co k-e(
Present use of property: S ` "� 1 i. res jai c f"ct
Description of Work(include jproposed uses): refJu�e w�exit- A{ce. Li a v'ep)ac 64.t.tn1
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#: 5 E f 70 — / ;{ G)
_ Community Septic Name of System: Case#:
Are other residences connected to the septic system? IVa
Additions or repairs to sewage system: Wo
Is it a complete or partial system installation: n- Complete _ Partial
Has a reserve drainfield been designated? Nil-,0,t;9 i vn c.I Yes _ No
Date of Last Operations& Maintenance check: '-///3/i �. Attach last report to application
Describe or attach any drainfield easements, covenants or otices on title, which may impact the property:
1'rnr7° pl)lican",n Pi: 1 0{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: Kcil/evi D GCt.vtG�
Address: ( 3 3 `t S , . 1")tit eA 1t/ ` ; IA) A- Q ;'/v rd
Phone#: Z.cto -- 6, 0s'- C E-mail Address: 9,14_,14i„ ; lore.,, (e it,I• c v +yl
— — Please contact Authorized Agent/Representative with project info. (select only one).
_-
Property Owner Signature: "• Date: /° / aqi
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: G-It.k livcuAe_
Address: - 17 5 0 Lt1"1 Pe, 6 v A,A 'c r j9-1A9 C t-es I GO k`}- 9 $ 3 Ce Z
Phone#: I( g oc) S I — 5$ S E-mail Address: q t e rti t vt t a L0 w�
Professional: Is this an Authorized Agent/Representative for this project? NO YES
—
Engineer Architect _ Surveyor _ — Contractor V' onsultan>t
Name: S re„I,e w 5 p,re License# 3 G 5 9
Address:
Phone#: E-mail Address:
Professional: Is this an Authorized Agent/Representative for this project? NO YES
EnginY .f Architect _ _ Surveyor _ Contractor _ Consultant _
Name: (t r. •y e License# /±/F3 et
Address: l `fol V. 2- 5t�, P0.rt- MrtjeIesi W {4 `z 836 3
Phone#: 3400 — a 9 € E-mail Address: 1 n e r p e.( s ea
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: i<4,t7',../.1 f 13 v Date: /2 ` C
SON DEPARTMENT OF COMMUNITY DEVELOPMENT °„
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621 tihc0c1to Sheet,Yost 7 ownscnd 1.1 1 98368
"I cl•360.3"9.4450 I I iv 360 379.4451
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L, mail dcdki;co.jcffc snn.wa.us /1/
-To
ys Ii NG�O SUPPLEMENTAL APPLICATION �Fr
SHORELINE DEVELOPMENT
A completed application form is a requirement of submittal. Include"N/A"in spaces that do not apply.
MLA# Case#
Application Type(select one):
Statement of Exemption- Variance* Substantial Development*
NISee Examples on back side ----
ofapplication Conditional Use (administrative)* Conditional Use (discretionary)*
i J
1) Does your proposal require in water work and/or works below ordinary high water mark? Yes X ] No [ ]
2) Does your pronncal require 1n,000 sq/ft or more of impervious surface and/or non-single family structures of 5,000 sq/ft or
more? Yes [ ] No [ <
* If either of the boxes for 1 or 2 above are checked yes or if the permit type above has an asterisk then a pre-application
conference is required prior to submitting for a shoreline permit.
Site Information
Assessor Tax Parcel#: 4 fy Name of Body of Water: Ott
1 4—C.
Property Owner Name(s): / ✓ /,/i'/t/cylf
Project Description
Describe the existing property use and condition:
S i(1) I.e i��i t , y-e S ire( e,7 [ Li) , +hdo 4.,t r; V C' i.2J"Lei
a 1,0 0 t S 1 A
Proposed distance from ordinary high water mark to use/development: t I o,J 0 t-t W 64 feet
Describe the proposed work that requires a shoreline permit or permit exemption:
112t(3,14_, 1,41 e.-v.t- t7 S �t-tS l� 4 lGIdi ICS 1-1-1)d `1 Gd v, c�.t iso
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.
Owner Signature: IDate: /.47A V
Print Name: vYpv. 1 . k
1, Int
These activities require a formal statement of Exemption issued by Jefferson County.
Check 'Statement of Exemption' box on the front of this form and submit with Permit Application
to apply for your Exemption Approval.
18.25.570 Statement of Exemptions
(1)The administrator is hereby authorized to grant or deny requests for statements of exemption from the shoreline
substantial development permit requirement for uses and developments within shorelines that are specifically listed
above. Such statements shall be applied for on forms provided by the administrator. The statement shall be in writing
and shall indicate the specific exemption of this program that is being applied to the development, and shall provide a
summary of the administrator's analysis of the consistency of the project with this program and the Act. As appropriate,
such statements of exemptions shall contain conditions and/or mitigating measures of approval to achieve consistency
and compliance with the provisions of this program and Act.A denial of an exemption shall be in writing and shall
identify the reason(s)for the denial.The administrator's actions on the issuance of a statement of exemption or a denial
are subject to appeal pursuant to the appeal provisions in Article X of this chapter.
18.25.560 Exemptions listed—This is a summary from JCC18.25.560, please review the code section for
detailed information regarding these exemptions.
(1) Fair Market Value.
(2) Maintenance and Repair.
(3) Residential Bulkhead.
(4) Emergency Construction.
(5)Agriculture.
(6) Drainage.
a,,..+ B dt
(7) Na; : esdences
gatitr
.
(9) Residential Docks. " 1
(10) Irrigation. I/
(11) State Property. `()
(12) Energy Facilities. U"'
(13) Site Exploration. a C
(14) Noxious Weeds.
(15)Watershed Restoration.
(16) "Watershed restoration project"
(17) "Watershed restoration plan"
(18)A public or private project, the primary purpose of which is to improve fish or wildlife habitat or fish passage.
Suj�denx: t,tl Shoreline 1Frplican<rn
Z.47:.47
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-,SL DEPARTMENT OF COMMUNITY DEVELOPMENT 4 ,i,
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',G, de, 621 Sheridan Street,Port"Townsend,\\`:1 98368 ^�.�`
144 !„3 Tel:360.379.4450 I Fax:360.379.4451 /�� �'��
• V`.eb:New>.XI)ac11ur,o.on.w.t.11Sittxnrnntirltt)d vc-lolprm U11 40. r ,
Ii-mail:dcd@co.jefferson.wa.us d� 4
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SUPPLEMENTAL APPLICATION e1
RESIDENTIAL OR COMMERCIAL BLDG PERMIT
For Department Use Only Receipt#: Date:
Related Application#s: Payment#:
Site Information
Owner Name: 10,3-E..)...:, '1.4J C \ Assessor Tax Parcel#: SO Z7-62.-e \Z.,
Type of Building
NewReplacement Relocated
Addition Repair >( — Demolition *
•A separate permit is required
Select One:
Single Family Residence Modular__. Other k list
IIX04 .N tti S S 5" LO E
Proposed Building/Project -
Number of floors 1,111,s #new bedrooms existing total bed
#new bathrooms existing total bath
Heat Source
Select all that apply: 1-1/6
(�
Electric Heating Oil Wood I 1 Propane 11
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.) Z-4E 142, S,F, 22f S.
(Estimated Cost of Project(Required): $ $
vg-E-s`xts it LC ,ice. - c c_ Z_ „_,,,;,r;» n.a;i.R 1
List existing buildings on property(.e. house,garaget 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. .`,; .uK_. ., pt 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: Date:
Building Permit Fees
Building Base
Plan Check Review
Land Use Review $270.00
Septic Review $131.00
Potable Water $176.00
Technology/Scan $23.00
State Fee $4.50
Other Fees
Shoreline Exemption
Zoning
Zoning
Other
New Address
Total Fees
Receipt# Date: Cash/Check/CC:
j i��.lcit?enraCI 3.
A .
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��5°N coy DEPARTMENT OF COMMUNITY DEVELOPMENT
� 4, 621 Shcridmi Strcct Pert Townscnd,AV:1 98368 6�ti ,
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l ul 360.3 79 4450 I l ax:360 379.4451
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STORMWATER CALCULATION WORKSHEET
MLA# 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.,SITE)
Size of parcel 0, 4'1 acres i An acre contains 43,560 square feet. Multiply the acreage by this figure.
Size of parcel in square feet 2l, 3 4-4-so/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 t3, sq/ft native vegetation to lawn or landscaped areas?
Drainfield, septic tank, etc. sq/ft Circle: Yes GID
Well, utilities,etc. sq/ft Does the project convert 2'/z 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 3- sq/ft Cut t Fill d 'T (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.
stormwater calc worksheet—REV.10/20/2014 1
STORMWATER CALULATIONS–IMPERVIOUS SURFACE
NEW EXISTING
Structures(all roof area) sq/ft Structures(all roof area) I/ U 0 0 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 i sq/ft
Other 1)OCV` (�'�`� �ZL -7 j sq/ft Other 1� LY` PIE —' i� 1 sq/ft
Total New 2• l .2.�T> o C 5 sq/ft Total Existing (/00L- I – sq/ft
TOTAL NEW+TOTAL EXISTING* I/ 00 71 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 ((LL
Divide the total existing impervious surface above by the size of the parcel and convert to a percentage: 14-, 7
Does the site have 35%or more of existing impervious surface? Circle: Yes No 71‘
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 1n
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 Storm water Management Manual.
APPLICANT SIGNATURE •: : t
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 knoledge. I also certify that this application is being made with the full knowledge and consent of all owners of the affected
property. IL)L
( 1/ 7— q,/
(LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE)
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stormwater calc worksheet—REV.10/20/2014 2
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