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Home My WebLink AboutBLD2018-00489 - 01 PERMIT APPLICATIONDEPARTMENT OF COMMUNITY DEYELOPMENT 621 Sheridan Street, Port Townsend, WA 98368 Tel: 360.379.M50 | Fax 360.379.4451 Web: www.co.iefferson.wa.us /communitydevelopment E-mail: dcd@co. iefferson.wa.us CERTIFICATE OF OCCUPANCY PERMIT #: APPLICANT. BLD18-00489 JEFFERSON COUNTY PUD #,1 310 4 CORNERS RD PORT TOWNSEND WA 98368-9368 PHONE SITE ADDRESS.310 FOUR CORNERS RD PORT TOWNSEND, 98368 lssue Date Final Date: 12t10t2018 1t14t2020 SUBDIVISION: PARCEL NUMBER:001 333037 Block: Lot: Section: 33 Township: 30 N Range: 1W PROJECT DESCRIPTION: NEW OFFIGE MOBILE UNIT- 36x60 DtrTIC.UUUZU THE PROJECT LISTEDABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2015 EDITION. OCCUPANCY GROUP: TYPE OF CONSTRUCTION SPRINKLER SYSTEM THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 1I14I2O2O Acting Building Official, Patty Charnas \\tidem a rk\d ata\forms\F_BLD_Occupa ncy. rpt 1t15t2020 DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street, Port Townsend, WA 98368 'I' el: 360.37 9.4450 | Fax: 360.37 9.4451 Web: www.co.icfferson.wa.us /communitydevelopment E-mail: dcd@co.icffcrs<n.wa.us TEMPORARY CERTIFICATE OF OCCUPANCY PERMIT#: SITEADDRESS: BLD18-00489 310 FOUR CORNERS RD PORT TOWNSEND, 98368 lssue Date lnspection Date PHONE: Stilt 17 APPLICANT:JEFFERSON COUNTY PUD #1 310 4 CORNERS RD PORT TO\A/NSEND WA 98368.9368 SUBDIVISION: PARCEL NUMBER: Block: 30 N Range Lot: 001 333037 Section: 33 Township:1W PROJECT DESCRIPTION: NEW OFFICE MOBILE UNIT-36X60 sEPl5-00020 THE PROJECT LISTEDABOVE COMPLIES WTH THE REQUIREMENT OF THE INTERNATIONAL BUILDING CODE 2015 EDITION. OCCUPANCY GROUP: UBC TYPE OF CONSTRUCTION: THE PROJECT RECEIVED ITS TEMPORARY SIGN OFF ON THIS DOCUMENT IS VALID FOR t,"C DAYS. THE BUILDING MUST RECEIVE A FINAL CERTTFICATE OF OCCUPANCY WITHIN THAT TIME OR THE TEMPORARY OCCUPANCY WLL BE NULL AND VOID. Acting Building Official, Patty Charnas Z^?ire 5 Sl tt/ t9 ye loc8l lnvoice JEFFERSON COUNTY DEPARTIIET{T OF COilMUNITY DEVELOPTIEiIT 621 SherirJan St eet I Port Townsend, WA 98368 36G379,1450 | email: dcd@co.iefferson.wa.us wnm.co.iefierson.wa.us/commdevelopment Date: 1012512018 lnvoicE lD: 201 8BLDI 8-00489 Date Due: 1112412018 ffi Please r6tum the abov€ portion with your payment Payment is accepted by cash, check, debit or credit card (Visa, Mastercard, Discover). To pay by credit card, go to http://www.cojefferson.wa.us/617/Credit-Card-E-Check-Payments-for-Permits, and click on the "Online Credit Card & echeck Payments" link on the left side of the page. For questions: call 360-379-4450 tr tr[v No\/ - 5 2018 BILLING ADDRESS: JEFFERSON COUNTY PUD #1 310 4 CORNERS RD PORI TOWNSENO WA 98368-9368 .J'i ;'{ o[iT Jefferson County DCD 621 Sheridan St. Port Townsend, WA 98368 REiIIT TO: Permit Consistency Review Scanning Fee EH SEP/Commercial Rev Potable Water Application Tech Fee 4n4.00 276.00 23.00 267.@ 134.00 67.24 Total Arnount Due: $1,411.2O 5 ;tl!: *t $1,411.20 Permit Consistency Review Scanning Fee EH SEP/Commercial Rev Potable Water Application Tech Fee 644.00 276.00 23.00 267.00 134.00 67.20 I ) lq1 ) Permit Number: BLDl 8-00489 Total Amount Due: ieptCd&Activi$Co ,oor/d bv& lntials 'POil WOfl&ftrgtooe FleetUfl&ErpCode: ?ivison&GLAcct, DEPARTMENT OF COMMUNITY D 621 Sheridan Street, Port Townsend, WA 98368 Tel: 360.379.4450 | Fax: 360.379.4451 Web: www.co.iefferson.wa.us /communiqvdevelopment E-mail: dcd@co.iefferson.wa.us PERMIT FEES WORKSHEET Estimated Cost of Project Manufacture office Parcel # Permit # Building Base Fees Building Base Plan Check Review Land Use Review Septic Review Potable Water Technology/Scan State Fee Other Fees Shoreline Exemption Zoning New Address Road Approach Tech Fee Total Fees Receipt Number: Cash/Check/CC: Date: lnitia ls: BLD18-00489 51.,4LL.20 PMENT 0cr "l€peenSOrv 2t ws courvTy {Eo So++.oo s276.00 $267.00 s134.oo s23.oo |at.zo Office Use Only ) JEFFERSoN couNrY a DEPARTMENT OF COMMUNITY DEVELOPI'IENT 621 Sheridan Street I Port Townsend, WA 98368 360-3794450 | email: dcd@co.jefferson.wa.us www. co.jefferson. wa. us/com mdevelopment BUILDING PERMIT PERMIT #: SITE ADDRESS: OWNER: SUBDIVISION: PARCEL NUMBER: BLD18-00489 310 FOUR CORNERS RD PORT TOWNSEND, 98368 JEFFERSON COUNTY PUD #1 310 4 CORNERS RD PORT TOWNSEND WA 98368-9368 001 333037 Received Date: 1012312018 lssue Date 1211012018 Expiration Date 1211012019 PHONE: Section: 33 Township: 30 N Range: 1\l CONTRACTOR: OWNER/BUILDER PROJECT DESCRIPTION: NEW OFFICE MOBILE UNIT- 36X60 sEPl5-00020 { TYPE OF WORK TYPE OF IMP VALUATION CODE EDITION: OCCUPANCY: OCCUPANCY: CONST TYPE: CONST TYPE: coM NEW 2015 SQUARE FOOTAGE: MAIN: ADD'L: HEAT BASE: UNHEATED: OTHER: GARAGE: DECK: COMMERCIAL INDUSTRIAL: HEAT TYPE: HEAT TYPE: # OF STORIES: SHORELINE: SETBACK: BANK HEIGHT: 2,160 SEWAGE DISPOSAL: WATER SYSTEM: ALT 05783 BATHROOMS: Exist:Prop: 2 Total: 2 NUMBER OF EMPLOYEES HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED BUILDING INSPECTION HOT.LINE 379.4455. Request must be received by 3pm the day before the inspection is needed. Final lnspections require 24 hour notice. Office Hours 9:00 am - 4:30 pm MONDAY - THURSDAY HOT LINE AVAILABLE 24 HOURS A DAY SPECIAL CONDITIONS APPLY. SEE ATTACHED Amount Paid Bv: Date: Receipt: Permit Consistency Review Scanning Fee EH SEP/CommercialRev Potable Water Application $644.00 $276.00 $23.00 $267.00 $134.00 $67.20 $92.00 $92.00 NVA NVA NVA NVA NVA NVA NVA NVA 11106t18 11t06t18 11t06t18 11t06t18 11t06t18 11t06t18 12t10t18 12t10t18 1 81 046 1 81 046 1 81 046 1 81 046 1 81 046 1 81 046 181202 181202 $1,595.20 105.5 Expiration. Every permit issued shall become invalid unless the work authorized by such permit is commenced within 180 days after its issuance, or if the work authorized by such permit is suspended or abandoned for a period of 180 days after e time the work is commenced Tech Fee Plan Check Plan Check Tota!: Jefferson County Building ston Permit N BLDl 8-00489 Applicant. JEFFERSON COUNTY PUD #1 BUILDING PERMIT INSPECTION APPROVALS Appticabte Code: 20'l5 tnternationat Buildins Codes To schedule inspections, call (360)379-4455 no later than 3:00PM the day before the inspection is needed. Requests received after 3:00 PM will not be scheduled for the next day's inspections. ELECTRICAL PERMITS are issued by the Washington State Department of Labor & lndustries. The electrical permit must be signed off by the State lnspector prior to the County's Framing lnspection lnspection ltem Date Approval Signature Notes Miscellaneous 03t14t2011 DONE NRW access Ramp per IBC l0l2 Miscellaneous Site installation for any siding , roofing, and or trim installed on site. Setbacks 02t21t2015 DONE JDC Foundation Footing 02t21t2011 DONE JDC Blocking and tie downs Straps (hold downs)03t14t2011 DONE JDC straps Rough-in Plumbing 03t14t2015 DONE NRW on to service and termination of water heater pressure relief Rough-in Plumbing of heat tape for plumbing lines Airseal and vapor barrier at marriage line Blocking & Tie Down 02t21t2011 DONE JDC Mechanical Systems 03t14t2015 DONE NRW report ofhvac system Parking 03t14t2011 DONE DWJ ADA parking space with signage. Sign Load - 20 people Exterior Lighting z,o X6 Address Posted Add'l Septic lnspect c DONE RJP hold condition, may require site inspection by this office with fees. drawing. In Septic file. final inspection will not be scheduled until the following are completed and signed off by the applicable DepartmenU o Building Permit Conditions are met . Septic Permit Finol/Complete for any building contoining plumbing e Land lJse Conditions met and signed olJ o Public Works Permit Finol (where opplicoble) FINAL INSPECTION tltqlo*L- MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR FINAL INSPECTI Jefferson County Building Permit Nu BLD18-00489 Applicant: JEFFERSON COUNTY PUD #1 BUILDING PERMIT INSPECTION APPROVALS Appticabte code: 2015 tnternationat Buitdins Codes To schedule inspections, call (360)3794455 no later than 3:00PM the day before the inspection is needed. Requests received after 3:00 PM will not be scheduled for the next day's inspections. ELECTRICAL PERMITS are issued by the Washington State Department of Labor & lndustries. The electrical permit must be signed off by the State lnspector prior to the County's Framing lnspection lnspection ltem Date Approval Signature Notes Miscellaneous I \-I access Ramp per IBC l0l2 Setbacks o Foundation Footing l t"r and tie downs. Straps (hold downs)t..t (t.straps Rough-in Plumbing 'n to service and termination of water heater pressure relief Mechanical Systems Lw l+?report of hvac system h-*_\a.ti\_.2 Fire Protection extinguishers. Parking t(ADA parking space with signage. Sign ,tG+b Exterior Lighting Address Posted Add'l Septic lnspect r&\N hold condition, may require site inspection by this office with fees. final inspection will not be scheduled until the following are completed and signed off by the applicable Department.. o Building Permit Conditions are met o Septic Permit Final/Complete lor ony building containing plumbing o Lond Use Conditions met and signed off o Public Works Permit Final (where applicable) FINAL INSPECTION FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR {1 )Jl )? ft" Y< vlln Lt^l 4tul n valve. .v , -'Prrl{- ---;q (A, f q o SePeMigalien-- U ,($-' for Building Permit # :B 8-00489 1.) This permit does not constitute an increase in water use or proposed capacity of the septic system-it is an additional space for existing staff. Approval of this permit does not provide any assurance of future approvals for onsite sewage disposal on the property or use of any existing septic systems. Actions taken to date and proposed as part of this project may limit or prevent future development of an onsite sewage system. Future proposals must meet current code at the time of application. .) 10' minimum separation required between the water line and any onsite sewage system components including sewage transport lines. The proposed sewer line will need to be installed in accordance with the septic designer Mike Deeney requirements per e-mail dated 10/9/18 which states: There is between 1.7% to 1.9% slope between the proposed building and the existing sewer line. This slope is more than adequate to provide gravity flow, however, this proposed sewer line will be shallow and will require casing in cast iron pipe or equivalent. PRIOR TO FINAL OCCUPANCY an updated record drawing must be submitted by the septic designer with specification of installation and site plan. lnspection by this office may be required. Afee will be charged. ) DWJ 5.) The project shall adhere to the Best Management Practices (BMPs) to control stormwater, erosion and sediment during construction. BMPs shall address permanent measures to stabilize soil exposed during construction, and in the design and operation of stormwater and drainage control systems. ) The site plan as submitted with the Building Permit application on October 22,2018 has been reviewed for consistency under the UDC, and has been approved by Jefferson County Department of Community Development. Any modifications, changes, and/or additions to the stamped, approved site plan dated November 15, 2018 shall be resubmitted for review and approval by Jefferson County Department of Community Development. This approval is for a Modular Office Building only. Any future permits on this site are subject to review for consistency with applicable codes and ordinances and does not preclude review and conditions which may be placed on future permits. ) Project requires at least one ADA Handicapped Parking Space with signage sited for easy access to the \\tidemark\data\forms\F_BLD_Perm it_B ld g. rpt 12t10t2018 t, ro, *c PERMTT APPLrcer|BLD18-00489 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERTI/IT #: SITE ADDRESS: OWNER: SUBDIVISION: PARCEL NUMBER BLD18-00489 310 FOUR CORNERS RD PORT TOWNSEND, 98368 JEFFERSON COUNTY PUD #1 310 4 CORNERS RD PORT TOWNSEND WA 98368-9368 001 333037 Received Date: 1012312018 PHONE: Block: Section: 33 Township: 30 N Range: 1\i1 Lot: REPRESENTATIVE PHONE PHONE: 360-385-8363SCOTT BANCROFT 310 FOUR CORNERS RD. PORT TOWNSEND WA 98368 PROJECT DESCRIPTION: NEW OFFICE MOBILE UNIT- 36X60 sEP79-00126 TYPE OF WORK TYPE OF IMP VALUATION CODE EDITION: OCCUPANCY: OCCUPANCY: CONST TYPE: CONST TYPE: 2015 SEWAGE DISPOSAL: WATER SYSTEM:05783 BATHROOMS: Exist: Prop: Total: Approved/Date APP ?ED I J ,clJlS - -..rnty DCD(- SQUARE FOOTAGE: MAIN: ADD'L: HEAT BASE: UNHEATED: OTHER: GARAGE: DECK: COMMERCIAL: INDUSTRIAL: 2,160 HEAT TYPE: HEAT TYPE: # OF STORIES: SHORELINE: SETBACK: BANK HEIGHT: Amount Paid Bv: Date: Receipt COM NEW NUMBER OF EMPLOYEES: Type L L Exist: Prop: Total: Permit Consistency Review Scanning Fee EH SEP/Commercial Rev Potable Water Application Tech Fee Total: $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 SRE SRE SRE SRE SRE SRE 10t25t18 10t25t18 10t25118 10t25t18 10t25118 10125118 $0.00 APPROVEM DEC | 0 20ts Jderson County DCL CONTRACTOR: OWNER/BUILDER L , Department of Labor and Industries Factory Assembled Structures PO Box 44430 Olympia WA 98504-4430 raro oate Uheck lee $ NOTIFICATION TO LOCAL AGEN rY\t'w.lya. gov/l n i/ FA S/ (case sensitive) The Factorv-Built unit identified below requires comDletion lvork at the as name no. Jefferson Cou PUD Office 310 Four Corners Rd Port Townsend wA 98368 Jefferson Installation site is in:City fl countv DESCRIBE ITEMS REQUIRING COMPLETION WORK AT THE SITE 1. Foundation Plan Review and lnspections Electrical connection to service 2. Air Banier Test Electrical service grounding, electrode system and 3. An Accesible route shall be provided as reguired in IBC 1104 bonding. 4. Removal of axles,draw bars, spring hangerc and related 3. Available fault current field markings poer NEC110.24. running gear from the steel transporling frame Required arc flash labeling per NEC 110.,16. 5. Plumbing connection to service 6. Water heater pressure relief valve terminates at bldg exterior. 7. Fire extinguisher installed near exterior door on site. 8. lnsulation, vapor barrier & air barriers at marriage line on site 9. Register airflow test and balancing of HVAC system to be performed by others on site. Office Electrical section Inspector Building departrnent Customer M106 1014t2018 Date Mlg Blazer lndustries, lnc 18 19307 -0'l & 02 no l )?e ot construction VB BH BUILDTNG DEPAR INSERT NAME AND ADDRESS IN SHADED TMENT AREA www.wabo.org/ ELECTRICAL DEPARTMENT www.wa.goy/In i/electrical/ INSERT NAME AND ADDRESS IN SHADED AREA 1605 East Front St., Suite C Port Angeles, WA 98362-4GZB L& I Electrical JEFFERSON COUNTY AL SCALF 621 SHERIDAN ST PORT TOWNSEND, WA 98368 tt ONLY F623-013-000 (PDF) notification to local enforcement agency 11-00 signature a 3. a New plan (Design) FB CC CH 11 CC CST WA Only WA Rev/OR Courtesy 0R RevMA Courtesy Other state reciprocity R $644.73 For Non-PostalDelivery FedEX, UpS) Department of Labor and lndustries 7273 Linderson WA SW Tumwater WA 98501 t rww,wa.gov IlniIFASI (case sensitive) -PLAN APPROVAL REOUEST FACTORY BUILT STRUCTURES & COMMERCIAL COACHES $0.00 (1 See appropriate WAC for fees Date Approved /9 I -2 8 lnitial MFG filing No fee required _ Resubmittal $0.00 AppllD-- Plans reviewed by L&l listed professional Renewal Addendum Note: $0.00 $0.00 AP No. AP No. a t Mfg. No. lnc Plans to returned to: Amounl ID omle name: 1014t2018 FAS Phone No. 749-1 900 (503) 749-3969 No. ' Code cycles IBC,IMC:712016 UPC: 712016 VtAe: N/A NEC: r)see WSEC:712016 IFC: 7120162017 Energy Area (Sq Ft): 2039 modules: 2widrh36Length: 60 Group: B Sub yr 15 Seismic Zone; D of Construction Use SEC VB Roof live load PSF 40 (PSF for CC)Floor load PSF:Wind load MPH - EXP Plot plan submitted? Front: 1 0 Yes 10 No Left Side: lf "No" 10 provide distance from farthest projection to nearest building/property line:X Rear:Right Side: 10 Central torced air Electric Fan Powered room heater 0it X X Type heat: Type of fuel:Natural Gas BaseboardHydronics Other: Olher: Heat Walls 21 Roof (flat) 0 Roof (Vault) 24 + 17.4 ,; Heating Zone:X Zone 6b Floor 30 x Energy Calculations: I Attached El on rite - np* HeatPump I Yes D Air Conditioning I Yes tr No No trtr Prescriptive N/A WSEC compliance chapter:Itr Component Systems Performance Analysis Amps: 1 Phase Electrical Service 400 3 Phase AP# AP# AP# AP# AP# AP# AP# AP# AP# AP# AP# X X X x X X X On File Total developed length60 N/A Attached L&l Review No. offixtures 5 Attached Design Professional Review Operating pressure 46 to 0ross section and elevation Foundation Plan Electrical load demand calculation Panel box schedule/Hectflcal load calc's 0hassis drawing (CC units onty) Plumbing systems: Structural calculalion or test proposals Iruss or ratter drawtng(s) lruss plan it over 3 dttterent trusses Grrder truss or ndge beam drawrng HVAC Drawtng RETURN PLANS E Regular mail E Overnight @ custome/s expense VIA: I Other FederalExpress F623-006-000 (PDF) plan approvat request 11-00 tr Carrier Acct #1104-5500-3 I5-g;;;;1?iJlriff ,.0,, n,., Factory Assembled Structures PO Box 44430 0lympia, WA 98504-4430 Eneropane E o 7'. For Postal Delivery Depa(ment of Labor and lnduskies Factory Assembled Skuctures P0 Box 44430 0lympia, WA 98504-4430 Department of Labor and lndustries Factory Assembled Skuctures 7273 Linderson Way SW Tumwater WA 98501 n'wl'.1 a. gor'fl ni/FAS/ (case sensitil e) Regular mail Applicant: Fillout Completely Fee $24.60 Fee Fee on reverse + Canier Federal Express Acct# 1104 5500-3 I H Permanent Alteration Replacement ID Other RECE/ lcr uo t8APPLICATION FOR INSI A F4sFOR FACTORY BUILT STRUCTU suBMlr oNE coPY ' N}TE: a separate form is to be used for each huirding unless mullipQ!ffings have the same plan Approval number. For Non-Postal Delivery p.g. FedX, upS)Multi-Tagged E WA OR A FEE FOR EACH INSIGNIA IS DUE WTH APPLICATION. NOT SUBJECT TO REFUND MAKE CHECKS PAYABLE TO DEPT. OF LABOR & INDUSTRIES I $273.40 P 5 B OG 2 o Manufacturer to Number of tags: 3 4 5 6 7 8 Fee Fee Fee Fee Blazer lndustries lnc. MFG. NO, I\4-106 IIIANUFACTURER PRODUCTION FACILITY ADDRESS P.O. Box 489 Aumsville, OR 97325 OITY/STATE/ZIP (503) 749-1900 (503) 749-s969 TELEPHONE NO FAX NO, 'TTif$r\sspEr HoI UUL I ffillocen Iougg,l S AMOUNT 1L\9 0\ person's printed name: mie Holm 1014t2018 Fee enclosed $298.00 749-1900 749-3969 Dept. Insignia No.Mfg Serial No. 18 19307 -01 Design Option N/A 1 0F2 TC VB tsf SMP sus vnl sEC YR 15 l'% ESL 400 r',sfl4t1 RF 40 w 120C SZONE D TD HTG SPVHP AC yes Dept. lnsignia No.Mfg Serial No. 18 19307 .02 POD OF 2 2 Dept. lnsignia No Mfg Serial No.POD OF Dept. lnsignia No.Mfg Serial No.POD OF Dept. lnsignia No Mfg Serial No OF Dept. lnsignia No.Mfg Serial No.POD OF Dept. lnsignia No Mfg Serial No POD OF Dept. lnsignia No.Mfg Serial No.POD OF Dept. lnsignia No.Mfg Serial No POD OF F623-014-000 (PDF) app for insignia - factory built 1 Via Other ight at customer expense use on t Approved Plan No. l5F8r//ffi2/ 7 oa DEPARTMENT OF COMMTINITY DEVELOPMENT 621 Sheridan Steet, Port Townsend, WA 98368 Tel: 360.379.M50 | Fax: 360.379.4451 Web: www.co.iefferson.wa.us /communitydevelopment E-mail: dcd@co.i efferson.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 # MLA #Related A ication #s: 1 Site I nformation 6ga nS er'lSite Address andf or Directions to Property: Assessor Tax Parcel Number: Access (name of street(s)) from which access will be gained Lodude proorkWtncluof Present use of property: Wastewater - Sewage Disposal This property is served by Port Townsend or Poft Ludlow sewer system? lf not served by sewer identified above, identify type of septic system below: NOYES Are other residences connected to the septic system? Additions or repairs to sewage system: ls it a complete or partial system installation: Has a reserve drainfield been designated? Date of Last Operations & Maintenance check: Describe or attach any drainfield easements, covenants or notices on title, which may impact the property: sEP7q *rDlLb fOLtn e Attach last report to application Case #: Type of Sewage System Serving Property: X Septic Septic Permit # Community Septic Name of System: Complete Partial Yes X No trcrE/r reilt , }CT Z Z 208 I)errrrit Applicrtion l)asc I ()fz Applicant/Property Owner lnformation >< Please contact Authorized Agent/Representative with project info Property Owner Signatu re: + ect on ly one). € 4Ln - Zfr q- {A E-mail Address Date: Property Owner: Name: Address Phone # Notei For projects with multiple owners, attach a separate sheet with each owner(s) information and signatures. En E-mail Address: q*,"" "eHD i<ffn*J, 0 f-9960 * 38U-7%3 J T 3- ntative (lf other than oyvner)licant: Name: Address: Phone #: Professional: ls this an Authorized Agent/Representative for this project? Architect Surveyor Consultant E-mailAddress Surveyor tC Architect 2S" * L{47-7Zq I E-mail Address cense # Contractor License # Engineer Name: Address: Phone #: Engineer Name: Address: Phone #: Contractor \4, Consultant Professional: ls this an Authorized Agent/Representative for this project? NO Engineer Name: Address: Phone #: Architect Consu lta ntSurveyor E-mail Address Contractor License # 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. that all activities I intend to undertake or complete associated with this permit will be performed in com pliance with a state and county laws and regulations and I aSree plicati to provide access and right of entry to Jefferson County and its e or agents for the sole purpose of ap on review and any required later inspections.icant may request notice of,the property for visits related to this application and subsequent ance Print Name Perrrut App)icatir:n Page 2 o1 2 Sig nature s inte ru Date:tfr NO YES Professional: ls this an Authorized Agent/Representative for this proiect?NO YES YES I further AI'I on ee The signer of this statement certifies that they are the Owners of the parcel referenced herein, that they are not licensed at they will be assuming the responsibility of the General Contractor for the proposed project. ttSignatu contractors and Print Name Date: By signing this application form, the owner/agent attests that the information provided herein, and in a ny 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 respect to this application packet may result in making any issued permit null and void. Signature Print Name ,1*ff rt.fr+nrr"€t Date:?lo Building Permit Fees Building Base (1-2 sections) AdditionalSections Land Use Review Septic Review Potable Water Scan Other Fees Shoreline Exemption Zoning Zoning Other New Address Technology Fee-5% Tota! Fees Receipt # Date:Cash/Check/CC: s644.00 5+6.00 each s276.oo s134.00 s134.oo s23.00 &I __, TENUoN COUiIYDCD s276.00 Suppiementel Mmufacrurcd llome 3 Builders Statement qlof r For Use I\\-_--l-i-,"vl o Jclbnon CoanV Rhllo UtllW Dlcfrlcl tl o 9t181201A 310 four corners rd port townsend, WA 98368 MailTo: FoH 350-301-0249 Hore PROPERTY INFORMANON pud electric facility Location:31O FOUR CORNERS RD port towhsend Tax lD: 001333037 Usei lndustrial, other JEFFERSON COUNTY DCD This report does not assure approvals by Jefferson County Public Heal{h for ANY future building permits or development. COrrlt E rfs E CEIIERAL ,t'rSPECIrOi, NOIES No Deficiencies Nofed Fold Here lnxpected:09/18n0fi - lnspectionType:ROUTINE - Correction Stafirs.'Nocoreclioas needed Company: Wo* Performed BY: Jefferson County Public Utility District #1 Randy Calkins Submifted O9/1 82.01 I by: Randy Calkins ON€ITE WASTEWATER TREATMENT SYSTEIII INSPEGTION REPORT construction inspeolion report for racord drawing stror,vs a run lime of 24 sec. I checkad with Mic*rael Deeney and this uras a typo. The run time is 'lm 24 sec. GE TERAL SrfE & SYSfE[t COt DrnOlrS dolicionciee were identifiod on lasl inspaction were they conec'ted boforo or during this inspeaion? describo in notes, NA = no dgficiencie6 on last CompohsntE, Sucturos and appurtenancss locatod per as.buil/rocord drawing (reforonce Seplic YES # in notoE). It NO, describo in hotes ahd if no as{uih cxists or changes mada, 6GtB NO and reord to Health made to th6 OSS (valves adjustad, timer settings modified, ports installed, etc.) (lf YES, in ON'S'TE SEWAG E S YS TEN"A'SPECT'OA' D ETAI L NO The General Site and System Conditions were:Fully lnspected @ secure ana in gooJ condition:YES NO NO NOComponent setUin g problems effiuent from any component (induding mound - no visual leaks:app€ar to encroachment buildings, etc.) onto prBsent one or mor€ of lhe disposal mmponents YES NO adequately mveredSubsurface Owner comSianca issues Landscape maintenance) lf yes,commenE: ocarpant cornptiance pro@ system properly).lf YES, deecribe ih notes:NO house/strucfure was vacant or used ass6ssment was not NO the SEP case in a statu6?in YES Fully lnspectsdThis component was: YESas intended:Component appears to YESEffuent level within operational limib (if NO explain in comments): YESAll required tn N/AEffuent Filter Cleaned (N/A = Not Presert): N/AEfruent fifter/screen needed deaning on anival 1Comparfnent 1 Scum actr:mulation (lnches, if othcr specify): Compartment 1 Sludge accumulation (lncfres, if othcr specify): NOPumping needBd: Pumpento IANK.' sepric Tank - I compartment lst comP ReportlD: 711470 Mew inspection report6 online at www.onlinerme.com Page 1 of 2 ocT 2 2 2018 YES This component was:Fully lnspected Effluent level within operational limits (it NO explain in comments):YES Component appears to b€ functioning as intendad:YES All rcquircd baff,es in place (N/A = No bafies required):YES Efiuent Filter Cleaned (N/A = Not Present):NO Effuent fifter/screen needed deaning on anival NO Compartner( 1 Scilm accumulation (lnctes, if other specify):0 Comparfnent 1 Sludge accumulation (lnches, if other spocify):-2 Pumping needed:NO compon6nt was: to Compon6nt app€ars to be funclioning as intended:YES Comparfn€nt 1 Scum acctmulation (lnches, if other specify):0 Pump vault screen needcd cloaning on anival NO Compartment 1 Sludge accumulation (lncfies, if other specify):-2 Pump Vault Filter cleaned (N/A = not present):NO Pumping nBBded:NO @mponent was: Component app6ars to be tunctioning as intended:YES Alarm mechanism functioning as intahded:YES ANK: Seplic Tank - 1 Compartment znd co,np Putnp Tank el: Alarm - High Water llanrtaclurcr: ilanufacturar: Oranco ThkEpqlindihls@lancisraclrrbtbsoftheorsirssew€gEsystamatrlEliEory&i laNwayisthisreNdagtannteaoloqtationqfutweWdomnce- This component was:Fully lnspccted Panel tunclioning (including alarm):YES Pump 1: on minutes (ovenide in par€nthBs€s - if present):1m 24s Pump 1: off hours (ovenide in parentheses - if pressnt):236:36 Pump 1: gallons per dose (ovcnide in parentheses - if presem): Pump 1 : ETM hours (ovenide in parenthases - ff pr€sent):45:53:05 Pump 1 : Cyde Count (ovenide in parcntheses - if prcsont):'tu2 This component was:Fully lnspected Componont appears to be functioning as intended:YES Controls functioning:YES Dose setting differentlhan original (lf YES, datail in comments)NO Dose setting adjusted to meet as-builUreoord drawing specifications (by tha O&M Specialist)NO compon€nt was: 52 - Component appears to bs functoning as intended:YES NO Average squirt height (if performed) (faet, if other speclfy):5' comments:NO Drainfield was vacuumed, flushad or hydro-jettad? (lf YES, explain in comments)NO ti el d (dispo sal ) : Pressttre RepoillD:711470 Mew inspection reporte onlin6 at www.onlinerm6.com Page 2 of 2 Fully Inspected Approxrmate Gallons to be pumped (rf needed) by certifisd Pumpec Fully lnspected oanel:Control-1Pump tsury tnspecl€d DESIGN SPACE MODULAR B Washington State Bepartrnent ci Labor & lndustries urLDSi S PNW LP Home Espafrol Contact Search L&l A-Z Index Help Myt&I Safety & Health Claims & lnsurance Workplace Rights Trades & Licensing o Page I of I tultlt, =:jwW DESIGN SPACE MODULAR BU]LDINGS PNW LP Owner or tradesperson BUILDING DESIGN SPACE MODULAR Doing business as DESIGN SPACE MODULAR BUIDLINGS WA UBI No. 602 261 2s8 25212 MARGUERITE PKWY STE 2OO MtsstoN vtEJo, cA 92692 Goveming persons BUILDING DESIGN SPACE MODULAR PAUL JOSEPH MC SHANE; PAUL JOSEPH MC SHANE; Workers'comp Do you know if the business has employees? lf so, verify the business is up-to-date on workers' comp premiums. L&l Account lD Account is current. 042$?341 Doing business as DESIGN SPACE MODULAR BUIDLINGS Estimated workers reported Quarter 2 of Year 2018 "1 I to 20 Workers" L&l account contact T3 / STEPHANIE HENDERSON (360)902-5598 - Email: HSTE235@lni.wa.gov Public Works Strikes and Debarments Verify the contractor is eligible to perform work on public works projects. Contractor Strikes No strikes have been issued against this contractor. Contractors not allowed to bid No debirmerits have been issued against this contractor. Workplace safety and health No inspections during the previous 6 year period O Washington State Dept. of Labor & lndustries. Use of this site is subject to the laws of the state of Washington. Help us improve t0t2sl2018https ://secure. lni.wa. gov/verifu /Detail. aspx?UBI:60226 125 8 &LIC:& SAW: orrlrrIITIDesignSpace t00utAR SuttDtxGs o 2rS -Lt.lZ- l Zsl q6L Go-L7;9.7 qg Quotation Tn tsl, f rf s\ D Jesyn 5 pa.ce,a., ad, co,yr o From Vision to Rodlity I On Time and On Budgot Customer: Attention: Phone #: Jefferson County PUD Don McDaniel 360-821-9071 Fx: Ship To:Port Townsend, WA Date: 8/16/2018 Terms: Upon lnvoice Ship Via: Common Carrier Salesperson: Bill Ackerman Quotation good for 30 days, subject to availability o o 1 1 BRAND NEW 36x60 MOBILE OFFICE PER SPECS ATTACHED Pricino Buildinq Charqes BRAND NEW 36x60 MOBILE OFFICE $161,278.00 Delivery:$11,250.00 Setup: includes block & level, tie downs, & skirting $21,400.00 MetalSteps 1,400.00 ADA Ramp NOT INCLUDED Utilities $30,000.00 Generator .$30p0os0 Totals $255,328,00 22{.'3s? ac) r\) ^)Naa m O Up Front Parcel Revieuf Parcel 001333037 Printed: November 15, 2018 Site Address(es): 310 FOUR CORNERS RD PORT TOWNSEND, WA 98368 JEFFERSON COUNTY PUD #1 310 4 CORNERS RD PORT TOWNSEND, WA 98368-9368 Parcel Number: 001333037 S-T-R: 33-30N-1W Legal Description S33 T30 RIW NESW(LS N/HWY&E255'S/FIWY) LS PTN TX2,3,18,26 Flood District: Fire District: Flood Map (FIRM) PanelNo School District 50 Total Acreage 21 Land Use: 9700 Planning Area: Zoning: CcZoning ront: Left Side:_Right Side u Setbacks: Informed by JCC 18.30 or Title 17 for Master Planned Resorts: Shoreline Setback: Critical Area Buffer Rear: Building Setback: lr-f U-fluf l, vf I t{ItY Rural/Inho ldino 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 DisconnectedCMZ Report Submitted FWHCA: YES NO Stream type: Marbled murrelet/Spotted owl_ Pond or Lake < 20 acres marine nearshore Wetlands: YES NO Flood: YES No List FIRM map: Flood Certificate: Aquifer Recharge Area:vEs No SIPZ: none At Risk High Risk Coastal Site Visit conducted YES NO I vT Notice Provisions/Disclosure Forest Lands: YES Agricultural Lands: vrs uo No Shooting Zone; No Airporl vrs No MRZ ves No YES NO tq Archaeology: YES No t t Adjoining Forest Lands: Commercial/ 4 Disturbing Activiry Req #1 thru #5 Min Req +t tn*7J Engineering Drainage District Review Required Stormwater Pollution Prevention Plan Submitted: Yes No4-f Impervious Surface coverage percentage : I { Stormwater! New Impervious Stormwater Req's: Min Req #2 Resource Lands & Public: l0% Rural Commercial: 600/o I rf ADMIN: Setbacks entered in Permit Plan New Parcel Tags entered in Permit Plan 2- lbo Land ^d Special Reports Scanned Land Use Requirements Rural Residential: 25Yo Rural Industrial: Per UDC Sec 6.7 Area of Building Coverage: 60% in Rural Industrial Lands only case(-I@ YES C[rA) YES YES l l l l l l Landscaping Required: Yes No SEPA Required: YES EXEMPT Parking Spaces Required No 2 Other Building Height: 35' UBC Standard 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 NOTREQ'D RAP Require Final Zoning Approval/inspection YES NO UGANoProtestAgreement YES NO, submitted: YES NO Over 5yrs:UDC Plat Conditions on plat or Old Ordinance Planner l Recorded Date of Subdivision: Plat Conditions: CasesAssociated with APN 001333037 Review Cases Name Tvpe Status CAROO-00424 PUGETSOUND ENERGY F Application Received: 9118/2000 Permit lssued/Case closed: 912712000 Case Finaled: 912712000 addition to storage buildih!- BLDO6-00695 PUGET SOUND ENERGY/ ELEC F Applicatlon Received: 1211112006 Permit lssued/Case closed: 11512007 Case Finaled: 211512007 FI RE ALARM SYSTETVITtrOMHREQ'D BLD13.OOO69 JEFFERSON COUNTY PUD #1 F Application Received: 212712013 Permit lssued/Case closed: 212712013 Case Finaled: 21312014 Move water heater andlipes- \\tidemark\data\forms\R_Parcel_CRMLA.rpt 1111512018 Title Notes Parcel tags found for parcel 001333037 1.) WSRC Goaching - 2013-02-25locate utilities Other Updated 05t02t2013 Page2 of 4 BLD14-00381 Application Received: l0l 1612014 JEFFERSON COUNTY PUD lssued/Case closed: 10116/2014 F Finaled: l1l19l20l4Cn.it u'Q=" lnstall New Heat P ump PRJ15.OOO22 JEFFERSON COUNTY PUD #1 P Application Received: 611912015 Permit lssued/Case closed: Case Finaled: I NSTALL COM M ERC IATIWODT]TAR BU I LD I NG sEP15-00020 BLD18.OO489 JEFFERSON COUNTY PUD #1 P Application Received: 1012312018 Permit lssued/Case closed: Case Finaled: N EW OFFICE MOBI LTT]M]-6X60 sEPl 5-00020 BLD88.OO115 JEFFERSON COUNTY PUD #1 F Application Received: 1011211988 Permit lssued/Case closed: Case Finaled: David Wayne Johnson t/19/1989 N EW M O B I L E H O M E --LT'N[IV[[]MCATI O N S B U I L D I N G BLDOO.OO6O6 PUGETSOUND ENERGY F Application Received: 911812000 Permit lssued/Case closed: 1011712000 Case Finaled: 1211812000 ADDITI ON TO STORAGEI'IITIING BLD93.OO5O2 EVERGREEN REFRIGERATION, F Application Received: 711911993 Permit lssued/Case closed: 7ll9l1993 Case Finaled: 712011994 remove and replace 2 rbb.ffoa-pZtkage heat pumps BLD93.OO752 PUGET POWER F Application Received: 1011911993 Permit lssued/Case closed: 11l5l1993 Case Finaled: 4ll9l1994 u nderg rou nd tan k insta'llStion BLD93.OO753 PUGET POWER F Application Received: l0ll9/1993 Permit lssued/Case closed: l1l5ll993 Case Finaled: 4ll9ll994 TANK REMOVAL SEP79.OO126 PUGET POWER DC Application Received: 411211979 Permit lssued/Case closed: 411311979 Case Finaled M 712611979 commercial septic CAM17-00624 JEFFERSON COUNTY PUD #1 P Kevin Hitchcock Application Received: lll17l20l7 Permit lssued/Case closed: Case Finaled: PURPOSED PROJECT'TSSSOUADDITION AND 22OO SF. PARTICAL REMODELAOF AN EXISTING 8O8O SF. TYPE 58, B OCCUPANCY, BUILDING. SEE EMAILAND SITE MAP CAM18-00621 BANCROFT NA M Michelle Farfan Application Received: 9l17l20l8 Permit lssued/Case closed: 9l17l20l8 Case Finaled: QUESTIONS REGARDIIIGPUUADDITION ON PARCELAND II{STAITATTON OF TRIPLE-WIDE. COM15.OOO13 JEFFERSON COUNTY PUD #1 CLS Application Received: ll21l20l5 Permit lssued/Case closed: Case Finaled: 4l2ll20l5 ERTS 651941 Alleged subsEfion Tire not cleaned up properly LSC15-00051 Jefferson CountY ACT Application Received: l2l8l20l5 Permit lssued/Case closed: 41912015 Case Finaled: MLA15-00038 BLD15-00057 MLA15-00038 JEFFERSON COUNTY PUD #1 I F David Wayne Johnson Application Received: 2126/2015 Permit lssued/Case closed: 91312015 Case Finaled: l2l8l20l5 I NSTALL COM M ERC IAITTOD-I]IAR B U I LD I N G sEP15-00020 zoNl5-00023 MLAl5-00039 JEFFERSON COUNTY PUD #1 lll A David wayne Johnson Application Received: 611812015 Permit lssued/Case closed: 91212015 Case Finaled: CONDITIONAL USE PERMlT=fnstallation of a 1,440 square foolfrbdilar o-ffice building with additional parking for a legal non-conforming Public Utility District in a residentialzone. Major Utilities in a Rural Residential Zone requires a Type lll Conditional Use permitwith public notice and a Public Hearing with a decision by the Jefferson County Hearings Examiner. This proposal is exempt from SEPA. MLAl8-00082 BLD18-00405 MLA18-00082 JEFFERSON COUNTY PUD #1 I A David Wayne Johnson Application Received: 915/2018 Permit lssued/Case closed: 1012312018 Case Finaled: INSTALL NEW 6X8 NO|VTIEI]IIIINATED SIGN PRJl8.OOO4O MLA18-OOO82 JEFFERSON COUNTY PUD #1 P Application Received: 9/512018 Permit lssued/Case closed: Case Finaled: lnstall new 6x8 non illuhihE1EtlSillr \\tidemark\data\forms\R_Parcel_CRMlA.rpt 1111512018 Page 3 of 4 zoNlg-ooo2g MLA1 g-00082 a JEFFERSON COUNTY PUD #1 a A David wayne Johnson Application Received: 9/5l2}l8 Perm'lEIssued/Case closed: 9ll4l20l8 CasfFinaled: lnstall new 6x8 non illuffiiffid-Si!frpREls-OOOog JEFFERSON COUNTY PUD #1 NA F David Wayne Johnson Application Received: 312012015 Permit lssued/Case closed: Case Finaled: INSTALL 1440 SQ. FT'TWODUTAR OFFICE BUILDING ADJACENT TO EXISTING BUILDING. pRE{g-ooo2l JEFFERSON COUNTY PUD #1 P Kevin Hitchcock Application Received: 612812018 Permit lssued/Case closed: Case Finaled: 4,500 square foot B oc6lpanc Fe 5b construction expansion of the existing Jefferson County PUD #1 operations and administration facility. There will also be improvements to the site including new visitor parking, new crew entry, and native drought resistant landscaping. sEpls-ooo2o JEFFERSON COUNTY PUD #1 F David wayne Johnson Application Received: 212412015 Permit lssued/Case closed: 312612015 Case Finaled: 1112412015 SEP79-126 NO LONGERMUUAND FILED HERE SOM79.OO126 PUGETSOUND ENERGY/ELEC RCR Application Received: 712611979 Permit lssued/Case closed: 912012018 Case Finaled: serves Jefferson Coun[FDflTftices and shop \\tidemark\d ata\forms\R_Pa rcel_CRM LA. rpt 11t15t2018 Paee 4 of 4 o DAI) BUILDING PERMIT APPLIC Il'o*BLD18-00489 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: SITE ADDRESS OWNER SUBDIVISION: PARCEL NUMBER: BLD18-00489 310 FOUR CORNERS RD PORT TOWNSEND, 98368 JEFFERSON COUNTY PUD #1 310 4 CORNERS RD PORT TOWNSEND WA 98368-9368 001 333037 Block: Section: 33 Township: 30 N Received Date: 1012312018 PHONE Lot: Range: 1\ CONTRACTOR REPRESENTATIVE: OWNER/BUILDER SCOTT BANCROFT 310 FOUR CORNERS RD. PORT TOWNSEND WA 98368 PHONE: PROJECT DESCRIPTION: NEW OFFICE MOBILE UNIT- 36X60 sEP79-00126 TYPE OF WORK TYPE OF IMP VALUATION CODE EDITION: OCCUPANCY: OCCUPANCY: CONST TYPE: CONST TYPE: SEWAGE DISPOSAL WATER SYSTEM: Exist: Prop: Total: coM NEW 2015 05783 BATHROOMS: Exist: Prop: / SQUARE FOOTAGE: MAIN: ADD'L: HEAT BASE: UNHEATED: OTHER: GARAGE: DECK: NUMBER OF EMPLOYEES: Type COMMERCIAL INDUSTRIAL: 60 HEAT TYPE: HEAT TYPE: # OF STORIES SHORELINE: SETBACK: BANK HEIGHT: Amount Paid By: Date: Receipt I2 Approved/Date Permit Consistency Review Scanning Fee EH SEP/Commercial Rev Potable Water Application Tech Fee Total: $0.00 $0.00 $0.00 $0.00 $0 00 $0.00 SRE SRE SRE SRE SRE SRE 10t25t18 10t25t18 10t25118 10125t18 10t25t18 10t25t18 $0.00 ffi PHONE: 360-385-8363