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BLD2016-00427 - 01 PERMIT APPLICATION
UILDING PERMIT APPLIC/�!'JN Re iew D -00427 pe: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD16-00427 Received Date: 9/28/2016 SITE ADDRESS: 326 PINECREST DR PORT TOWNSEND, 98368 OWNER: DANA NIEMINEN PHONE: 360-379-1154 GARY LAWN 21 SHORECREST CT. PORT TOWNSEND WA 98368 9650 - KALA POINT 3-8 SUBDIVISION: Block: Lot: PARCEL NUMBER: 965000218 Section: 27 Township: 30 N Range: 11A CONTRACTOR: LEXAR HOMES PHONE: (360) 379-1799 92 KALA SQUARE PLACE PORT TOWNSEND WA 98368 Contractor's License LEXARH*842C Expires 2/24/2018 REPRESENTATIVE: LEXAR HOMES PHONE: 360-379-1799 94 KALA SQUARE DR PROJECT DESCRIPTION: NSFR w/Attached Garage SEP16-00128 REVISION 02/27/17 ADDING A 8X15 DECK TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 1,600 VALUATION 202,515.00 ADD'L: HEAT TYPE: EEE CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: 1 OCCUPANCY: OTHER: CONST TYPE: SHORELINE: GARAGE: 440 CONST TYPE: SETBACK: DECK: 133 BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: 05783 BEDROOMS: BATHROOMS: Type Amount Paid By: Date: Receipt Exist: Exist: Permit $1,609.40 HAC2 09/28/16 165759 Prop: 3 Prop: 2 Plan Check $1,136.20 HAC2 09/28/16 165759 Total: 3 Total: 2 Consistency Review $255.00 HAC2 09/28/16 165759 Approved/Date Scanning Fee $21.00 HAC2 09/28/16 165759 State Building Code $4.50 HAC2 09/28/16 165759 EH SEP/RES Rev $129.00 HAC2 09/28/16 165759 APPROVED DCD Water Review $43.00 HAC2 09/28/16 165759 AP �l Potable Water Application $129.00 HAC2 09/28/16 165759 MAR 2 6 2017 Permit $138.60 JJC 09/29/16 165745 EH SEP/RES Rev $131.00 SRE 02/27/17 166195 Jefferson County DCL Permit $45.00 SRE 02/27/17 166195 Plan Check $45.00 SRE 02/27/17 166195 Total: $3,686.70 \\+irdor, r4\rinfo\fnrrne\F RI fl Ann RH rnt )/)7/9(117 •UILDING PERMIT APPLICA•N BLD16-00427 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD16-00427 Received Date: 9/28/2016 SITE ADDRESS: 326 PINECREST DR OWNER: DANA NIEMINEN PHONE: 360-379-1154 GARY LAWN 21 SHORECREST CT. PORT TOWNSEND WA 98368 9650 - KALA POINT 3-8 SUBDIVISION: Block: Lot: PARCEL NUMBER: 965000218 Section: 27 Township: 30 N Range: 1V CONTRACTOR: LEXAR HOMES PHONE: (360) 379-1799 92 KALA SQUARE PLACE PORT TOWNSEND WA 98368 Contractor's License LEXARH*909QT Expires 2/10/2018 REPRESENTATIVE: LEXAR HOMES PHONE: 360-379-1799 94 KALA SQUARE DR PROJECT DESCRIPTION: NSFR w/Attached Garage SEP16-00128 TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 1,600 VALUATION 202,515.00 ADD'L: HEAT TYPE: EEE CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: 1 OCCUPANCY: OTHER: CONST TYPE: SHORELINE: GARAGE: 440 CONST TYPE: SETBACK: DECK: 133 BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Type Amount Paid Bv: Date: Receipt Exist: Exist: Permit $1,609.40 HAC2 09/28/16 165759 Prop: 3 Prop: 2 Plan Check $1,136.20 HAC2 09/28/16 165759 Total: 3 Total: 2 Consistency Review $255.00 HAC2 09/28/16 165759 Approved/Date Scanning Fee $21.00 HAC2 09/28/16 165759 State Building Code $4.50 HAC2 09/28/16 165759 APAPPROVED�i EH SEP/RES Rev $129.00 HAC2 09/28/16 165759 PROVED DCD Water Review $43.00 HAC2 09/28/16 165759 OCT 2 ' Potable Water Application $129.00 HAC2 09/28/16 165759 I es0 Permit $0.00 HAC2 09/28/16 Jefferson County DCD Total: $3,327.10 +„fo..,nrU,f.m+o fn.mc\C RI 11 n.,.. PIA rn+ Q/7S2/oni • I ¢$ON co DEPARTMENT OF COMMUNITY DEVELOPMENT G{� 621 Sheridan Street,Port Townsend,WA 98368 Tel:360.379.4450 lax:360.379.4451 D 3C1E \ I,' Web:www.co.iefferson.wa.us/communitydcvelopment I dcd n,co.jeffcrson.wa.us �SIINC).SO SEP 2 8 2016 JEF I~RnN COUNTY DCD 2012/2015 International Code Transition Request for Review Jefferson County will be transitioning between the 2012 and 2015 International Codes beginning July 1 , 2016. Many construction projects are in development for several months before the implementation of the new code requirements. Requiring applicant's to redesign their projects creates a hardship to the homeowner/applicant. Jefferson County will allow application for projects designed under the 2012 code to be submitted until October 1, 2016. During the transition period between July 1 and October 1 the applicant shall determine which code they wish their plans to be reviewed under. The choice will determine which building, mechanical, plumbing,fire and energy code will be referenced in the plan review. You may not switch back and forth between codes for the different trades. Once you choose a code year, your project will be regulated by this code edition until completion of the project or permit expiration date, whichever comes first. Projects received on or after October I, 2016 shall be designed and reviewed to the 2015 International Codes. r I, 1/1/Vi i I �aair) ,applicant for BLD , choose to have my permits reviewed under the: (Check one) 2012 International Codes ❑ 2015 International Codes Date Signature of owner/applicant For more information visit - http://www.energy.wsu.edu/BuildingEfficiency/EnergyCode.aspx Prescriptive Energy Code Compince for All Climate Zones in Washington Project Information Contact Information Dana Nieminen and Gary Lawn Dana Nieminen and Gary Lawn 326 Pinecrest 21 Shorecrest Ct Port Townsend, WA 98363 Port Townsend, WA 98363xx This project will use the requirements of the Prescriptive Path below and incorporate the the minimum values listed. In addition, based on the size of the structure,the appropriate number of additional credits are ecked as chosen by the permit applicant. 401 &)Ili, . . �,, � �Authorized Representative ►� rwl�Q' Date9-.0.-.8----- / A I Climate Zones R-Values U-Factors Fenestration U-Factor° n/a 0.30 Skylight U-Factor n/a 0.50 0 igazi ' 1.7 0Glazed Fenestration SHGCbe n/a n/a , Ceiling 49' 0.026 SEP Z p 206 Wood Frame Wall k 1 21 int 0.056 Mass Wall R Value' 21/21h 0.056 JEFFERSO Floor 30g 0.029 N COUNt7N®CD Below Grade Wall k 10/15/21 int+TB 0.042 Slabd R-Value& Depth 10, 2 ft n/a *Table R402.1.1 and Table R402.1.3 Footnotes included on Page 2. Each dwelling unit in one and two-family dwellings and townhouses, as defined in Section 101.2 of the International Residential Code shall comply with sufficient options from Table R406.2 so as to achieve the following minimum number of credits: ❑1. Small Dwelling Unit: 0.5 points Dwelling units less than 1500 square feet in conditioned floor area with less than 300 square feet of fenestration area. Additions to existing building that are less than 750 square feet of heated floor area. 32. Medium Dwelling Unit: 1.5 points All dwelling units that are not included in#1 or#3, including additions over 750 square feet. ❑3. Large Dwelling Unit: 2.5 points Dwelling units exceeding 5000 square feet of conditioned floor area. Table R406.2 Summary Option Description ee-la Efficient Building Envelope la 0.5 Q7 lb Efficient Building Envelope 1 b 1.0- ❑ lc Efficient Building Envelope 1c 2.0 ❑ 2a Air Leakage Control and Efficient Ventilation 2a (—D.5 2b Air Leakage Control and Efficient Ventilation 2b —7.0 ❑ 2c Air Leakage Control and Efficient Ventilation 2c 1.5 ❑ 3a High Efficiency HVAC 3a 0.5 ❑ 3b High Efficiency HVAC 3b 1.0 ❑ 3c High Efficiency HVAC 3c 2.0 ❑ 3d High Efficiency HVAC 3d 1.0 ❑ 4 High Efficiency HVAC Distribution System 1.0 L "A 5a Efficient Water Heating 5 5b Efficient Water Heating 1.5 ❑ 6 Renewable Electric Energy 0.5 j,,'' *1200 kwh 0.0 Total Credits 0.00 *Please refer to Table R406.2 for complete option descriptions http://www.energy.wsu.edu/Documents/2012%20Res%20Energy.pdf Table R402.1.1 Footnotes For SI: 1 foot .= 304.8 mm, ci .= cehuous insulation, int .= intermediate fray . a R-values are minimums. U-factors and SHGC are maximums. When insulation is installed in a cavity which is less than the label or design thickness of the insulation, the compressed R-value of the insulation from Appendix Table A101.4 shall not be less than the R-value specified in the table. b The fenestration U-factor column excludes skylights. The SHGC column applies to all glazed fenestration. Exception: Skylights may be excluded from glazed fenestration SHGC requirements in Climate Zones 1 through 3 where the SHGC for such skylights does not exceed 0.30. `"10/15/21.+TB" means R-10 continuous insulation on the exterior of the wall, or R-15 on the continuous insulation on the interior of the wall, or R-21 cavity insulation plus a thermal break between the slab and the basement wall at the interior of the basement wall. "10/15/21.+TB" shall be permitted to be met with R-13 cavity insulation on the interior of the basement wall plus R-5 continuous insulation on the interior or exterior of the wall. "10/13" means R-10 continuous insulation on the interior or exterior of the home or R- 13 cavity insulation at the interior of the basement wall. "TB" means thermal break between floor slab and basement wall. d R-10 continuous insulation is required under heated slab on grade floors. See R402.2.9.1. e There are no SHGC requirements in the Marine Zone. Basement wall insulation is not required in warm-humid locations as defined by Figure R301.1 and Table R301.1. g Reserved. h First value is cavity insulation, second is continuous insulation or insulated siding, so "13.+5" means R-13 cavity insulation plus R-5 continuous insulation or insulated siding. If structural sheathing covers 40 percent or less of the exterior, continuous insulation R-value shall be permitted to be reduced by no more than R-3 in the locations where structural sheathing is used to maintain a consistent total sheathing thickness. The second R-value applies when more than half the insulation is on the interior of the mass wall. For single rafter-or joist-vaulted ceilings, the insulation may be reduced to R-38. k Int. (intermediate framing) denotes standard framing 16 inches on center with headers insulated with a minimum of R-10 insulation. Log and solid timber walls with a minimum average thickness of 3.5 inches are exempt from this insulation requirement. Table R402.1.3 Footnote a Nonfenestration U-factors shall be obtained from measurement, calculation or an approved source or as specified in Section R402.1.3. • • Window, Skylight and Door Schedule Project Information Contact Information Dana and Gary Width Height Ref. U-factor Qt. Feet Inch Feet Inch Area UA Exempt Swinging Door(24 sq. ft. max.) 0.20 1 3 6 8 20.0 4.00 Exempt Glazed Fenestration (15 sq. ft. max.) 0.0 0.00 Vertical Fenestration (Windows and doors) Component Width Height Description Ref. U-factor Qt. Feet Inch Feet Inch Area UA Bath - Ply Gem Triple Pane Vinyl with Low E anc 1 0.27 1 4 4 16.0 4.32 ?droom- Ply Gem Triple Pane Vinyl with Low E a 2 0.26 1 6 6 10 41.0 10.66 oom - Ply Gem Triple Pane Vinyl with Low E an 3 0.27 1 7 5 35.0 9.45 ig - Ply Gem Triple Pane Vinyl with Low E and A 4 0.26 1 6 6 90 41.0 10.66 ;n - Ply Gem Triple Pane Vinyl with Low E and/5 0.27 1 4 3 6 14.0, 3.78 3 - Ply Gem Triple Pane Vinyl with Low E and/6 0.27 1 6 5 30.0 8.10 E 2 - Ply Gem Triple Pane Vinyl with Low E and 7 0.27 1 5 5 25.0 6.75 Bath - Ply Gem Triple Pane Vinyl with Low E anc 8 0.27 1 4 2 8.0 2.16 g - Ply Gem Triple Pane Vinyl with Low E and A 9 0.27 1 5 4 20.0 5.40 1 - Ply Gem Triple Pane Vinyl with Low E and An 10 0.27 1 2 4 8.0 2.16 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 , . . • I 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 Sum of Vertical Fenestration Area and UA 238.0 63.44 Vertical Fenestration Area Weighted U= UA/Area 0.27 Overhead Glazing (Skylights) Component Width Height Description Ref. U-factor Qt. Feet inch Feet Inch Area UA Great Room -skylight 0.20 1 6 2 12.0 2.40 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 Sum of Overhead Glazing Area and UA 12.0 2.40 Overhead Glazing Area Weighted U = UA/Area 0.20 Total Sum of Fenestration Area and UA (for heating system sizing calculations) 270.0 69.84 0. 1110 9 430N c,o DEPARTMENT OF COMMUNITY DEVELOPMENT �'� �� 621 Sheridan Street,Port'Townsend,W.A 98368 ;4z. '.<) Fel:360.379.4450 1 Fax 360.379.4451 Web:www.co.jefferson.wa.us/communitydcvelopment F-mail:dcd(aSco.jefferson.wa.us 2.1 C3 ir -l 0 .i \ SNI NG' PERMIT APPLICATION SEP ,� $ 2016 Steps in the Permit Process: J R ON � � -Review application checklist to ensure all information is completed prior to submitting application. NTOCD -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 o Property:,, to t),(ie-/ ,_,,c` �` S..". .,,/ � � i� , c.),,,....0„) Access (name of street(s)) from which access will be gained: //4,,,,, ' J6 fr- �-c A .,/,),,,, 3/t Present use of property: U. ,of r<, l- 0 i 0C Description of Work(include proposed uses): J' Ac. 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 o f,ewage System Serving Property: �I V Septic Septic Permit#: J---(-31(..p I [— -,g Community Septic Name of System: Case#: Are other residences connected to the septic system? (--i (.Si'_. Additions or repairs to sewage system: Is it a complete or partial system installation: Complete r/ Partial Has a reserve drainfield been designated? YesL V- Date Date of Last Operations & Maintenance check: ~-/i_/4- Attach last report to application Describe o/1attach any drainfield easements, covenants or notices on title,which may impact the property: / Vi/L�Jam , //11t( ( pei -t_ 9, 0 .... x The authorized agent/representative i_ she 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: i I . ' 14//r/ j-{`' – La‘Cit),(--' Address: � )l��• �/I e S �,, jL,c7S��� `l c Phone#: E-mail Address: r f`h Please contact Authorized t/Representative with project info. (select only one). Property Owner Signature: /1 Date: '/ - 2 I (, Note: For projects with multiple owners,attach a separate sheet with each owner(s)information and signatures. Applicant: Authorized�A®gent/Representative(If other than owner) Name: :il6'!c lvfeyi//I"' i" 4 :,i>.'t, - Address: 7/ .J ),/e..r �'j� - ,ryf, _ .„--, Phone#: - , O.3 .(7 — //1, �/ E-mail Address:.,tJcf"la-�t/4C- , / t) i' / Professional: Is tklt'is an Authorized Agent/Representative for this project? NO YES ° Engineer Architect Surveyor (/ Contractor Consultant Name: era J ,, , License# Address: - 0 t moi` t Or /0lJ,-'r ,S-J A. / 60i-ft' ?vim 8 Phone#: U`3 -3/9--//q` E-mail Address: {.fie. s '/ _L j th„ d"kDO P__,.ee)i_. Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect r—' Surveyor Contractor Consultant Name: ! License# Address: . " Phone#: r� E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: /- License# Address: /' / Phone#: _,,,,z" 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 o he Count 's int t to enter upon the property for visits related to this application and subsequent permit issuance. C/ ,SAL.. �J'l// xv:Aofizy.(4: ez,,..)fr-,41d Date: 7- e ii') Signature: � r..- .,�Ci Print Name: � • • ,sz5ONDEPARTMENT OF COMMUNITY DE G /�A. I. O6., 621 Sheridan Street,Port Townsend,WA 98368 W Tel:360.379.4450 I pax:360.379.4451 SEP t7 Q 2016 .< Wcb:www.co.jcfferson.wa.us/communitydevclopmcnt I?-mail: ci<co.jcffcrsc �.wa.us JEFFERSON COUNTY DCD dcd Is'i I NC; () SUPPLEMENTAL APPLICATION RESIDENTIAL OR COMMERCIAL BLDG PERMIT For Department Use Only Receipt#: Date: Related Application#s: Payment#: Site Information Owner Name: JVI'-e(rijY)=e/;) ,1:0(,( 12 C Assessor Tax Parcel#: 916:5—(){;( j /cK Type of Building New / Replacement Relocated _ Addition Repair Demolition *A separate permit is required Select One: Single Family Residence i,/ Modular Other list Proposed Building/Project Number of floors f #new bedrooms 73 existing (7r/f� total bed -3 #new bathrooms existing total bath •- Heat Source Select all that apply: Electric V 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 I _ C) L-1‘0) Residential /O Residential/Commercial Second Floor Additional Floors- heated/unheated Basement-unfinished Basement-finished space or habitable Detached Garage-heated/unheated Attached Garage- heated/unheated " V Ctr, ¶ ia. Garage 2nd fl-unfinished storage / Garage 2nd fl-finished space or habitable Carport-2 walls or less Deck-uncovered Covered porch / 3 3 Z16,37-, 00 Other(shed, barn, pole bldg,etc.) Estimated Cost of Project (Required): $ /6-/), 0000 O $ 61-1 rae fix.) / , I 2'O(., 5-00 • • 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 t they will be assuming the responsibility of th eneral Contractor for the proposed project. Signature /6(- t�( i4,6 /7/G/ Print Name.-' 6 Xgr 1/0/1•441/ gate: q /"6 By signing this application form,the owner/went tests 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 tozpermit null and void. Signatures: (LJZ,hi,/ dpri nt Name: 0 /0 letDate: For Department Use Only Building Permit Fees Building Base Plan Check Review Land Use Review $255.00 Septic Review $129.00 Potable Water $172.00 Technology/Scan $21.00 State Fee $4.50 Other Fees Shoreline Exemption Zoning Zoning Other New Address Total Fees Receipt# Date: Cash/Check/CC: Suhhlcmcnral SIR 1 0 • C N co DEPARTMENT OF COMMUNITY DEVELOPMENT 64, 621 Sheridan Street,Port Townsend,WA 98368 ..� Tel:360.379.4450 I Fax:360.379.4451 Web:www.co.jefferson.wa.us/communitvdevelopment E-mail:dcd@co.jgfferson.wa.usNG�O PERMIT FEES WORKSHEET Estimated Cost of Project $202,515.00 Parcel# 965000218 Permit# Building Base Fees _ 13i‘.(26 13c (2O Building Base $1,748.00 I L209• /O Plan Check Review $1,136.20 Land Use Review $255.00 Septic Review $129.00 Potable Water $172.00 Technology/Scan $21.00 State Fee $4.50 Other Fees Shoreline Exemption Zoning New Address Road Approach Total Fees $3,465.70 3j 1. IO Office Use Only Receipt Number: 1(„6--- q Cash/Check/CC: / / /j Date: / �'!6 Initials: / • ! , 1 - ,„ .,_SON DEPARTMENT OF COMMUNITY DE c i 1 - '. - �' 1 �' 4s , 44.'‘<) � co� 621 Sheridan Street,Port Townsend,W. 98368 C U 'fel:360.379.4450 1 Fax:360.379.4451 SEP 1 8 2010 0 ti '< Wcb:www.co.jefferson.wa.us/community°dcvclopment I?-mail:dcd a,co.jcfferson.wa.us `TEFF �RSCN CoUNN pCD &,ISNING ' SUPPLEMENTAL APPLICATION DETERMINATION OF ADEQUATE POTABLE WATER � � ' Owner Name: ,,,a ?(� //f/17//? J � od ty_ a°-v Site Address: 3 C210t/72I/U /Z—r 7,/' ) /��.e 17-Ux.. � � r+ It Water Source Existing Proposed Attach Copies of: 1) Well Logs Private well (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 www.jeffersoncountypubl ichealth.org/pdf/Policy_97-01_Ra inwater_Collection.pdf Valid Water Right Lab Analysis as required under private well above. Permit: Generally applies to springs,attach copy. Public Water: ,A Name of Water Provider: (PUD -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. 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, 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 application 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 subsequermit issuance. Signatur Zak-14/V Print Name: GFX taikaki Date: 944„..... 0 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 U� DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street,Port Townsend,WA 98368 Tel:360.379.4450 1 lax 360.379.4451 Web-www.eo.jefferson.wa.us/communitydevelopment E-mail:dcd a,co.icfferson.wa.us 11SWINO�O WATER AVAILABILITY NOTIFICATION PUBLIC WATER SYSTEM TO: Jefferson County Environmental Health Department FROM: (Water System Name) System Operator: State ID Number: Total connections for which system is approved: Number of service connections existing(in use): Number of service connections committed: Date and results of most recent water bacteriological analysis: / / The water system is capable of and will supply potable water to the following location: Assessor's Parcel IN: C/t (1 `i) Legal Description: Site Address: olt° or -76w4S-exai C 9&36 Operator Signature: Date: / / EXPIRATION DATE OF THIS SERVICE COMMITMENT: / / Supplemental Potable Water 2 • • lEC111-1 . • • SEP 2 8 ?016 UtilityPublic DistrictI roc© • Of Jefferson County • WATER AVAILABILITY NOTIFICATION Board of Commissioners Barney Burke, District 1 PUBLIC WATER SYSTEM Kenneth A. McMillen, District 2 • Wayne G. King, District 3 James G. Parker, Manager To: Jefferson County Environmental Health Department From: Quimper Water System System Operator(s): Eric Storey State ID Number: 05783U Number of existing connections: 2429 (Estimated) Number of permitted connections: 3149 Number of committed connections: 3 f 2-- This water system is capable of; and will supply potable water to the following location: Assessor's Parcel ID## ;2.0_).(_) _ LegalDescription L .�� '*'Water Connection is available once all fees/charges have been paid'*' Site Address:- 90? 69 Pi\ J �'U2 S± DIS ? (9S' Signature: Title: C5 Date: g ` THIS IS A NON-BINDING STATEMENT OF WATER AVAILABILITY. IT PROVIDES THAT AT THE TIMEOF REQUEST, WATER IS AVAILABLE WITHIN THIS SYSTEM. . ,, .rirri+n-rr(rm.t ic+ nnnn cnD nNII vinR • '13 R,r7D 0427 BUILDING PERMIT APPLICATION B Review Type:Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD16-00427 Received Date: 9/28/2016 SITE ADDRESS: 326 PINECREST DR OWNER: DANA NIEMINEN PHONE: 360-379-1154 GARY LAWN 21 SHORECREST CT. PORT TOWNSEND WA 98368 9650 - KALA POINT 3-8 SUBDIVISION: Block: Lot: PARCEL NUMBER: 965000218 Section: 27 Township: 30 N Range: 1' CONTRACTOR: LEXAR HOMES PHONE: (360) 379-1799 92 KALA SQUARE PLACE PORT TOWNSEND WA 98368 Contractor's License LEXARH*909QT Expires 2/10/2018 REPRESENTATIVE: LEXAR HOMES PHONE: 360-379-1799 94 KALA SQUARE DR PROJECT DESCRIPTION: NSFR w/Attached Garage SEP16-00128 TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION 202,515.00 MAIN: 1,600 CODE EDITION: 2012 ADD'L: HEAT TYPE: EEE OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: 1 CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: 440 SETBACK: DECK: 133 BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Type Amount Paid Bv: Date: Receipt Exist: Exist: Permit $1,609.40 HAC2 09/28/16 165759 Prop: 3 Prop: 2 Plan Check Total: 3 Total: 2 $1,136.20 HAC2 09/28/16 165759 Consistency Review $255.00 HAC2 09/28/16 165759 Approved/Date Scanning Fee $21.00 HAC2 09/28/16 165759 State Building Code $4.50 HAC2 09/28/16 165759 EH SEP/RES Rev $129.00 HAC2 09/28/16 165759 DCD Water Review $43.00 HAC2 09/28/16 165759 Potable Water Application $129.00 HAC2 09/28/16 165759 Permit $0.00 HAC2 09/28/16 Total: $3,327.10 \\4irlcmarL\rJafa\fnrmc\C RI Il Ann PH rn+ 0n5:2/0111a • • 4`<2 � o� DEPARTMENT OF COMMUNITY DEVELOPMENT <L 631 Sheridan Strcct,Rnr f'u\.vnacnd,��'_A 98368 W 1'cl:360.3"9.�d50 j 1 a.1:3603 9.4451 r \V`cb.www.co.j tfe on.wa u,/coinmunitvdcvclopment r r 1 -n1ai1 ]cd0>co.lctfc �a D r,on a.u; �� ry ,, ` il1NCs� PERMIT APPLICATION SEP 1 216 .1/ IN ERset A COIN .Y Steps in the Permit Process: Review application checklist to ensure all information is completed prior to submitting application. CCE -Make sure septic has been applied for and water availability has been proven. -Make an appointment to meet with the Permit Technician by calling 360-379-4450. -This is not a standalone application; it must be accompanied by a project specific supplemental application. -Fees will be collected at intake. Additional fees may apply after review and payment is required before permit is issued. For Department Use Only Building Permit# Related Application#s: MLA# Site Information Assessor Tax Parcel Number: 61z2r) f --� _ Site Address and/or Directions o Property:,, ` ,L V r P V �/F)e(7/ L� ' _�4il ii - /t A.0y) , - i L C ,-A---- ! { f-- .c.:,i(1 4,zf ; ! '1- ) !"' , t v_.)1 J Access (name of street(s)) from which access will be gained: 1 1d , (i-�- •, , y Present use of property: 1 67 a'(, ;`7 � G? e-! /2L Description of Work(include proposed uses):o Wastewater-Sewage Disposal This property is served by Port Townsend or Port Ludlow sewer system? YES NO If not served by sewer identified above, identify type of septic system below: Type of$ewage System Serving Property: i' Septic Septic Permit#: L 2c (_ l7 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: '--IL ,/ /4- Attach last report to application Describe or attach any drainfield easements, covenants or notices on title, which may impact the property: is t e rima contact • for all project-related question•d correspondence. The County will mail The authorized agent/representativep rY /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: il r�_ Ally 1 k� L.. - t(at, ' �_ Address: = ]' . M()� (/L L. 5 F CI' 1C? �--,0x?�'� %1 (,f , Phone#: 33(/'G ---377'1/Of E-mailAddress:� -/1) a iv,i6.1,. 44;64,54/),(adC0� / Please contact Authorized t/Representative with project info. (select only one). Property Owner Signature: kpnr,e_ ' Date: / - Z1>-I 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: ‘, 'j l")t, /e,'"✓ /f './� -4 r , , _ Y:cJ,' ) Address: i1r'lU� t ; "d/-; ("-)t- 1 / Phone#: 0 i/)3 -) _- //5-L E-mail Address:.,f iiC v , / (t) ,/irJ /,'%C�'g Professional: Is this an Authorized Agent/Representative for this project? NO Engineer i Architect Surveyor /� Contractor Consultant /'`_ rcv44e Name: ,,��!'� ('� 1`�7 J'��`; .,,_ License# � ��Z Address: �- 7� , Phone#: 3&O _,.3'1q./7q`% E-mail Address: - ;r A - ' l' i'41}ri:".I/D 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: z.' License# Address: Phone#: 7 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 o he Count 's int g t to enter upon the property for visits related to this application and subsequent ermit issuance. Signature: 4-0 iJ,-e l//(eL Print Name: ,6��1`'.1 C�(1!N'/,/UI Date: t • ( J'\: j; ON e DEPARTMENT OF COMMUNITY DEVEL flE( 621 Sheridan Street,Port Townsend,W-A 98368 Cel:360.379.4450 lax:360.379.4451 SEP U 2016 ti C Web:www.co.jefferson.wa.us/communitydevelopment r tl I dcdgco.jcfferson.wa.us JEFFERSON COUNT,OCO 's Ii NO�O SUPPLEMENTAL APPLICATION RESIDENTIAL OR COMMERCIAL BLDG PERMIT For Department Use Only Receipt#: Date: Related Application Us: Payment#: Site Information Owner Name: ?(()j fl /�) � tJL.I J-) CFY . Assessor Tax Parcel#: ?6,1-01()c.).1 %7 I. / y Type of Building j New V Replacement _ Relocated Addition Repair Demolition *A separate permit is required Select One: Single Family Residence ji Modular Other list Proposed Building/Project Number of floors / it new bedrooms existing c " total bed 3 #new bathrooms c existing ; total bath Heat Source Select all that apply: Electric V 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 /IP t767 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 fI-unfinished storage Garage 2nd fI-finished space or habitable Carport-2 walls or less Deck- uncovered _ Covered porch / 3 3 Other(shed, barn, pole bldg,etc.) Estimated Cost of Project (Required): $ / '5 (2, ( `)/) $ �uil>I�nu'uC:1�I i2 I • • 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, t they will be assuming the responsibility of thefGeneral Contractor for the proposed project. l 1 > ,� f Signature: ‘(...h-6/'j G`Print Name.- no-x e k1 l,)ate: 7�I)cu/ By signing this application form,the owner/a-genttests 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. f 1 1 Signature'!- LC t —/ L�✓i �'�,,, �"Print Name �?rl _G� ltd /0'l; Date: __ For Department Use Only Building Permit Fees Building Base Plan Check Review Land Use Review $255.00 Septic Review $129.00 Potable Water $172.00 Technology/Scan $21.00 State Fee $4.50 Other Fees Shoreline Exemption Zoning Zoning Other New Address Total Fees Receipt# Date: Cash/Check/CC: Sp Front Parcel Review . 6Z-72/6-001127--- Parcel 965000218 Printed: September 29, 2016 WILLIAM F DAVIES Site Address(es): MARLENE J DAVIES 326 PINECREST DR PORT TOWNSEND,WA 14 PINEWOOD CT PORT TOWNSEND, WA 98368-9570 Parcel Number: 965000218 S-T-R: 27-30N-1W Total Acreage 1 Legal Description KALA POINT#6 LOT 386 Land Use: 9100 Flood District: Fire District: 1 Planning Area: Flood Map(FIRM)Panel No: School District 50 Zoning: 4R-Pji : 5 COMP PLAN DESIGNATION: COMMUNITY PLAN: UGA: UGA Trans Plot plan states "property line" ..N., Assessor'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 NO pS q -- ]] Parcel Tags or Scanned Documents Y ESA's: Special Reports Nearby YES O Designated Ag YES NO Shoreline Designation: YES 0 Shoreline Slope Stability: YES , i Stream Type:YES a FWHCA: YES 40) Wetlands: YESo Rare Plants:YES 4`r• Seismic: YES Landslide: YES /1 Flood: YES up Erosion: YES '44 a Aquifer Recharge Area6 NO SIPZ: ,' At Risk High Risk oastal CMZ: o , High Risk Moderate RiskDisconnected CMZ Stormwater site plan su fitted: YesNod C,;�-�S IX] Forest Lands: YES O 1 Adjoining Forest Lands: Commercial/ Rural/ Inholding Mineral Lands: YES Agricultural Lands: _ YES Archaeology: YES ` No Shooting Zone: NO .a PaT' TA Stormwater: New Impervious Surface tLand Disturbing Activity 3,sco -1' ESA's Stormwater Req's:Min Req#2 q#1 t 5 Min Req#1 thru#10 Engi44ering 6Notice Provisions/Disclosure:Airport YES MRL YES Forest Lands YES e J Landscaping Required: Yes Parking Spaces Re 6 fired NO 0 Other r Building Height: 3 ' UBC Standard Impervious Surface coverage ercentage: 0 Resource Lands&Public: 10% Rural Residential:p23.1.°69 Rural Indust er UDC Sec 6.7 Rural Commercial: 60% Area 9tBuilding ge: 60%in Rural Indust only 17 Total Building (s) Size: NiPs" 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 ›] Setbacks: Front: QC)I Left Side: 5‘ Right Side: -5( Rear: 5 Shoreline Setback: Nl'7�k LSHA Setback: t � 55 . Road Classification: \0 Cat a C Road Approach: EXISTING NOT REQ'D RAP iZISEPA Required: YES PT tfJ.4C \a3 I[—tOQ(1,- "}- Flood Certificate: j Existing Case(s) &, adition(s): V9-C ‘.,v- Violations: Yes No Recorded Date of Subdivision: 1,\�„ 0119 AFN Ci' Over 5yrs=UDC Plat Conditions: (1G. Ct oC'C 2 <5yrs=Plat Conditions on plat or Old Ordinance Lots/Require Declaration of Restrict' ovenant YES 0 submitted: YES NO {[�c,] UGA No Protest Agreement `S, submitted: YES NO ] Site Visit conducted YES CFrir Require Final Zoning Approval YES Pj ADMIN: Setbacks entered in Permit Plan case' YES New Parcel Tags entered in Permit Plan YES Special Reports Scanned YES No parcel tags found for parcel Cases Associated with APN 965000218 Review Cases Name Type Status Planner ADR16-00061 NIEMINEN F Application Received: 8/22/2016 Permit Issued/Case closed: Case Finaled: 9/7/2016 NEW ADDRESS BLD16-00427 NIEMINEN P Emma Bolin Application Received: 9/28/2016 Permit Issued/Case closed: Case Finaled: NSFR w/Attached Garage SEP16-00128 SEP16-00128 DAVIES Application Received: 7/28/2016 Permit Issued/Case closed: Case Finaled: SEP94-00441 DAVIES C Application Received: 11/15/1994 Permit Issued/Case closed: 12/2/1994 Case Finaled: To Archives 5/1/2004 \\tidemark\data\forms\R_Parcel_CRMLA.rpt 9/29/2016 Page 2 of 2 Department of • • Revenue Washington Stote REAL ESTATE EXCISE TAX AFFIDAVIT This form is your receipt PLEASE TYPE OR PRINT CHAPTER 82.45 RCW—CHAPTER 458-61A WAC when stamped by cashier. THIS AFFIDAVIT WILL NOT BE ACCEPTED UNLESS ALL AREAS ON ALL PAGES ARE FULLY COMPLETED (See back of last page for instructions) 0 Check box if partial sale of property If multiple owners,list percentage of ownership next to name. SWilliam F.Davies and Marlene J.Davies,husband and Dana L.Nieminen and Gary W.Lawn,a married Name wife Name couple m zMailing Address 14 Pinewood Ct. z Mailing Address 21 Shorecrest Ct. a City/State/Zip Port Townsend,WA 98368m a City/State/Zip Port Townsend,WA 98368 Phone No.(including area code) (360)385-1951 L Phone No.(including area code) (360)379-1154 ©Send all property tax correspondence to:0 Same as Buyer/Grantee List all real and personal property tax parcel account List assessed value(s) numbers–check box if personal property Name Gary W.Lawn&Dana L.Nieminen 965000218 0 $43,920.00 Mailing Address 21 Shorecrest Ct. 3.3b0 Co ❑ City/State/Zip Port Townsend,WA 98368 0 Phone No.(including area code) (360)379-1154 0 Street address of property: 326 Pinecrest Dr.,Port Townsend,WA 98368 This property is located in®unincorporated Jefferson County OR within 0 city of Port Townsend 0 Check box if any of the listed parcels are being segregated from another parcel,are part of a boundary line adjustment or parcels being merged. Legal description of property(if more space is needed,you may attach a separate sheet to each page of the affidavit) Lot 386,Kala Point Division No.6,as per plat recorded in Volume 6 of Plats,pages 59 through 61,records of Jefferson County,Washington. Situate in the County of Jefferson,State of Washington. ® Select Land Use Code(s): 0 List all personal property(tangible and intangible)included in selling 91 price. enter any additional codes: (See back of last page for instructions) YES NO Is this property exempt from property tax per chapter ❑ CO 84.36 RCW(nonprofit organization)? 1131 YES NO If claiming an exemption,list WAC number and reason for exemption: Is this property designated as forest land per chapter 84.33 RCW? 0 ® WAC No.(Section/Subsection) Is this property classified as current use(open space,farm and agricultural,or timber)land per chapter 84.34? ❑ ® Reason for exemption Is this property receiving special valuation as historical 0 Ei property per chapter 84.26 RCW? If any answers are yes,complete as instructed below. (1)NOTICE OF CONTINUANCE(FOREST LAND OR CURRENT USE) Type of Document Statutory Warranty Deed NEW OWNER(S): To continue the current designation as forest land or classification as current use(open space, farm and agriculture, or timber) Date of Document September 14,2016 land, you must sign on (3) below. The county assessor must then determine if the land transferred continues to qualify and will indicate by Gross Selling Price $ 53,000.00 signing below. If the land no longer qualifies or you do not wish to *personal Property(deduct) $ continue the designation or classification, it will be removed and the compensating or additional taxes will be due and payable by the seller or Exemption Claimed(deduct) $ No transferor at the time of sale. (RCW 84.33.140 or RCW 84.34.108).Prior Taxable Selling Price $ 53,000.00 to signing(3)below,you may contact your local county assessor for more Excise Tax: State $ 678.40 information. This land 0 does 0 does not qualify for continuance. Local $ 265.00 *Delinquent Interest: State $ DEPUTY ASSESSOR DATE Local $ (2)NOTICE OF COMPLIANCE(HISTORIC PROPERTY) *Delinquent Penalty $ NEW OWNER(S): To continue special valuation as historic property, Subtotal $ 943.40 sign (3) below. If the new owner(s) does not wish to continue, all *State Technology Fee $ 5.00 additional tax calculated pursuant to chapter 84.26 RCW,shall be due and payable by the seller or transferor at the time of sale. *Affidavit Processing Fee $ (3) OWNER(S)SIGNATURE Total Due $ 948.40 PRINT NAME A MINIMUM OF$10.00 IS DUE IN FEE(S)AND/OR TAX *SEE INSTRUCTIONS —�f I CERTIFY UND IN Y OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. Signature of �/` Signature of Grantor or Grantor's Agent Ai"i'Ne Grantee or Grantee's Agent 607. ✓1/"� Name(print) p+William F.Davie / Name(print) Gary W.Lawn Date&city of signing: -` 1 I4 1.# cl Date&city of signing: 09/. /` ,Z / Perjury: Perjury is a class C felony which is punishable by imprisonment in the state correctional institution for a maximum term of not more than five years,or by a fine in an amount fixed by the court of not more than five thousand dollars($5,000.00),or by both imprisonment and fine(RCW 9A.20.020(1C)). 73443 i26274 *.:;,2C!,/2 : c,'4S.4;D T ui.ER'S USE ONLY COUNTY TREASURER