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Home My WebLink AboutBLD2016-00371 - 01 PERMIT APPLICATIONIPii M LA16-00005 BUILDING PERMIT APPLICATION Review Type:PI41 ---1 Terson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 BLD16-00371 Received Date: 8/12/2016 510 ADELMA BEACH RD PORT TOWNSEND, 98368 ALLISON THORESON PHONE: 206-282-8574 3055 MAGNOLIA BLVD W SEATTLE WA 98199-2412 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001324053 Section: 32 Township: 30 N Range: 1V\ CONTRACTOR: THE ACCUMAR CORPORATION PHONE: 360-779-7795 1180 FINN HILL RD NW POULSBO WA 98370 REPRESENTATIVE: STARR PERMITS LLC PHONE: 360-979-6273 P.O. BOX 222 QUILCENE WA 98376 PROJECT DESCRIPTION: TRAM TO BEACH MLA16-00005 SDP16-00001 TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 125,000.00 ADD'L: HEAT TYPE: CODE EDITION: 2015 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: SHORELINE: CONST TYPE: GARAGE: CONST TYPE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Type Amount Paid By: Date: Receipt Exist: Exist: Permit $425.00 SRE 08/12/16 165545 Prop: Prop: Consistency Review $255.00 SRE 08/12/16 165545 Total: Total: Scanning Fee $21.00 SRE 08/12/16 165545 Approved/Date Total: $701.00 APPROVED AUG 2 5 2016 Jefferson County DCG R/10/9(11R \\+mom nrL\rinto\form c\G RI fl Ann RIrV rnt • C'Oe„ DEPARTMENT OF COMMUNITY DEVELOPMENT W621 Sheridan Street,Port Townsend,WA 98368 Tel. 360.379.4450 I Fax:360.379.4451 Web:wwwco.jefferson.wa.usi communitadevelopment E-mail:dcd(fico.Jefferson_wa.us Nu 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: COI 3ay053 Site Address and/or Directions to Property: rjK) Adeima . ch R4 Access (name of street(s)) from which access will be gained: 5, D;covGr\i Present use of property: geSi e./N�ia! 5lrjk., family Description of Work(include proposed uses): ar,...‘V-to 'rove de., Ha, ;c. pp,e4 8cce ss 't'p -mac, bei 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#: SEP 77 -0O(1541 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: -1 Y Attach last report to application Describe or attach any drainfield easements,covenants or notices on title,which may impact the property: 2D Raz \ • I,' 401/i. AUG 102016 JEFFERSON COUNTY DCD IIP • The authorized agent/representativthe 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:g� 1 ,� Name: t`�` l 1�Li n/ 1 �r `h iiC - - Address: o 14 * f-QAC`I 4�`L ; C..v ' art 7( ( 4,x A q &7 q F Phone#: ; li _�„ - Email Address: \ P� 1i,,c ''t40-�-e. • . u�✓► „' Please contact Authorized Agent/Representative with project inT . (select on one). Property Owner Signature: at.,,,,,,,,,,..,� `�r`-�' Date: '? ),,- /1 (:a Note: For projects with multiple owners,attach a separate sheet with each owner(s)information and signatures. Applicant: Authorized Agent/Representative(tfother than owner) Name: St ary Pert''1 i- r♦ L..C Address: {'•(0. col Z. C ,t tCfr e. vi (leg 7(a Phone#: ( g'r 2jAe2?73 E-mail Address: „a u A ' . !i A a Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer I/ Architect Surveyor Contractor Consultant Name: ?d;P 4 Covh6, License# ca bg9 Address: Mtrth(I G /6(arf. kIPtc 781/0 Phone#: i - E-mail Address: Kelly@ 4,DrstrlA.l✓fuY0 A cp, Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer t' Architect Surveyor Contractor Consultant Name: Erik Wive/ ArySelr5er\ License# &1 7 (e Address: 2,„.1-t{t_. vpt %/Q(f Phone#: (A) g'„ 1443 E-mail Address: EAndeeser,Qatperi yea buI1 .0 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, repr:y,-ntatives or agents for the sole purpose of application review and any required later inspections. Applicant may request notice 0- z •3 s intent to enter upon the property for visits related to this application and subsequent permit issuance. it Sig ature: ! \ Print Name: a a. ra - ly I% ( r. . I V: A's n . I AUG 1 0 1016 JEFFERSON COUNTY DOD • • ¢SON co DEPARTMENT OF COMMUNITY DEVELO ' •f I ' 'f ti U 621 Sheridan Street,Port Townsend,WA 98368 Tel:360.379.4450 I Fax:360.379.4451 ti �C Web:www.co.iefferson.wa.us/communitydevelopment AUG 1 0 2016 E-mail:dcd( co.jefferson.wa.us I SN I N GC° SUPPI.EMENTAL APPLICATION JEFFERSON COUN'I`t,r OCO RESIDENTIAL OR COMMERCIAL BLDG PERMIT For Department Use Only Receipt#: Date: Related Application#s: Payment It: Site Information Owner Name: AIj153WN Th0(250m Assessor Tax Parcel#: 60134.1o$3 Type of Building New_ _ Replacement Relocated Addition Repair Demolition *A separate permit is required Select One: li"a Single Family Residence _ _ Modular _ Other list Proposed Building/Project Number of floors #new bedrooms existing total bed #new bathrooms existing total bath Heat Source Select all that apply: 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)I Residential/Commercial Main Floor tc9 q Residential/Commercial Second Floor 3Q Additional Floors-heated/unheated Basement-unfinished -c _]k Basement-finished space or habitable p r t0 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 5� Deck-uncovered 1O[7 Covered porch IR) Other(shed, barn, pole bldg,etc.) Estimated Cost of Project(Required): $ f5r o0w $ Supplemental Slit 1 • • List existing buildings on property(i.e. house,garage,accessory dwelling unit,shed, barn, mobile home,other): All Existing Buildings on Property Use tA-bt !l ' ►r\cJ, Std"NA, Builders Statement The signer of this statement certifies that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Print Name: Date: By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the be t of his or her knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to s application packet may result in making any issued permit null and void. 5feAelerr►A 1 h e., -„,fignomi _ Print Name: & AK, Date: f-JO - (O 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: Suppkcrntrra;`FR III • SON DEPARTMENT OF COMMUNITY DEVELOP 1',at , sli ,��„is coG 621 Sheridan Street,Port Townsend,WA 98368 1. Tel:360.379.4450 j Fax:360.379.4451 ti '< Web:www.co.jeffersonwa.us/communirydevelopment AUG 10 �� E-mail:dcd@co.ieffersonwa.us O '16kI N SUPPJ.F.MENTAL APPLICATION JEFFERSON COUNTY DCD RESIDENTIAL OR COMMERCIAL BLDG PERMIT For Department Use Only Receipt#: Date: Related Application its: Payment#: Site Information Owner Name: All ISCW\ l'hOre.A'SorN. Assessor Tax Parcel#: b0j3 a 41063 Type of Building New_ Replacement_ _ Relocated_ _ Repair Demolition Addition_ _ p _ — — *A separate permit is required 1.7 Select One: Ti7-am Single Family Residence _ _ Modular_ _ Other list Proposed Building/Project Number of floors #new bedrooms existing total bed #new bathrooms existing total bath Heat Source Select all that apply: Electric f 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) I Residential/Commercial Main Floor g99 l Residential/Commercial Second Floor 3Q Additional Floors-heated/unheated Basement-unfinished -s37 , Basement-finished space or habitable 8-76 Detached Garage-heated/unheated Attached Garage-heated/unheated Garage 2nd fl-unfinished storage Garage 2nd fl-finished space or habitable Carport-2 walls or less6U Deck- uncovered {0 7 Covered porch 21.) Other(shed, barn, pole bldg,etc.) Estimated Cost of Project(Required): $ IQ 5,OOC $ Supplemental:,-Ht. I • S List existing buildings on property(i.e. house,garage,accessory dwelling unit,shed, barn, mobile home,other): All Existing Buildings on Property Use HOU-b1,J I. , Builders Statement The signer of this statement certifies that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Print Name: Date: By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the be t of his or her knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to s application packet may result in making any issued permit null and void. �N��` YY �ev i?j .11 C -:,;j rr3011111%1'V� Print Name: -/ ' s Date: $-l0 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 I I Receipt# Date: Cash/Check/CC: Supplemental SFR • • Shots Excavating Inc, PO Box 179 "� 360-385-0480 Port Hadlock,WA 98339 d1.// !!i► C • IZI PROPERTY INFORMATION -. ,I /, Location:510 ADELMA BEACH RD '�uG '0 ?0 Tax ID:001324053 Mall To: ALLISON THORESON RSpN CQf`N 3055 MAGNOLIA BLVD W Use: f•/ • °C0 SEATTLE,WA 981992412 GENERAL SYSTEM TYPE:Pump to gravity Owner:ALLISON THORESON ON ID:SOM77-00054 Fole •' ON-SITE WASTEWATER TREATMENT SYSTEM INSPECTION REPORT \ Fad Here Inspected:08/01/2016 - Inspection Type:ROUTINE - Correction Status:No corrections needed "efE Company: Certification-Level 2 Work Performed By: Submitted 08/03/2016 by Shold Excavating Inc. Martin Fugere Martin Fugere This report does not assure approvals by Jefferson County Public Health for ANY future building permits or development. COMMENTS&GENERAL INSPECTION NOTES No Deficiencies Noted GENERAL SITE&SYSTEM CONDITIONS The General Site and System Conditions were: _ Fully Inspected All Components accessible for maintenance,secure and in good condition: YES Surfacing effluent from any component(including mound seepage): _.. NO 'Components appear to be watertight-no visual leaks: — YES Improper encroachment(roads,buildings,etc.)onto component(s): NO Component settling problems observed: NO Abnormal ponding present for one or more of the disposal components: NO Subsurface components adequately covered YES Owner compliance issues noted NO Site maintenance required(e.g.Landscape maintenance)If yes,describe in comments: NO Occupant compliance problem(occupant not operating the system properly). If YES,describe in notes: NO if deficiencies were identified on last inspection were they corrected before or during this inspection? N/A (If NO,describe in notes,NA=no deficiencies on last report): OSS Components,structures and appurtenances located per as-built/record drawing(If NO,describe YES in notes). If no as-built exists or changes made,state NO and provide record to Health Dept: Alterations made to the OSS(valves adjusted,timer settings modified,ports installed,etc.)(If YES, NO describe in notes): The house/structure was vacant or used infrequently,assessment of the drainfield was not possible. NO Is the SEP case in a finaled/completed status?(d NO explain in comments) YES ONSITE SEWAGE SYSTEM INSPECTION DETAIL This component was: Furry Inspected Component appears to be functioning as intended: YES Effluent level within operational limits(if NO explain in comments): YEs Ali required baffles in place(N/A=No baffles required): YEs Effluent Filter Cleaned(N/A=Not Present): N/A Compartment 1 Scum accumulation(Inches,if other specify): 0 Effluent filter/screen needed cleaning on arrival N/A Compartment 1 Sludge accumulation(Inches,if other specify): 3 Compartment 2 Scum accumulation(Inches,if other specify): 0 Compartment 2 Sludge accumulation(Inches,if other specify): Pumping needed: NO Approximate Gallons to be pumped(if needed)by Certified Pumper: 0 Page 1 of 2 ReportlD:530978 View inspection reports online at www.onlinerme.com TANK:Pump Tank This component was: Fully Inspected Component appears to be functioning as intended: YES Pump vault screen needed cleaning on arrival N/A Compartment 1 Scum accumulation(Inches,if other specify): 0 Compartment 1 Sludge accumulation(Inches,if other specify): Pump Vault Filter cleaned(N/A=not present): N/A Pumping needed: NO Approximate Gallons to be pumped(if needed)by Certified Pumper: 0 -anel:Control-1 Pump This component was: Fully Inspected Panel functioning(including alarm): YES Pump 1:on minutes(override in parentheses-if present): Demand Pump 1:off hours(override in parentheses-if present): Demand Pump 1:gallons per dose(override in parentheses-if present): 60 Pump 1:ETM hours(override in parentheses-if present): a N/a Pump 1:Cycle Count(override in parentheses-if present): Na rain field:Gravity This component was: Fully Inspected Component appears to be functioning as intended: - YES Ponding present?If YES explain in comments: NO This report irxicates certain characteristics of the onsite sewage system at the time of visit.In no way is this report a guarantee of operation or future performance ReportlD:530978 View inspection reports online at www.onlinerme.com Page 2 of 2 Parcel Details • Page 1 of 2 • „,,,,• At: je erson County , _ ,„„ ,.... , -, o,A,. base Toots =NaP5 ---.,...„.--- --,,,,‘, ..,,,,, ---7 mr,- i! Home County Info Departments Search Parcel Number: 001324053 SEARCH Parcel Number: 001324053 Printer Friendly Owner Mailing Address: ALLISON K THORESON 3055 MAGNOLIA BLVD W SEATTLE WA98199-2412 Site Address: 510 ADELMA BEACH RD PORT TOWNSEND 98368 Section: 32 School District: Port Townsend (50) Qtr Section: SE1/4 Fre Dist: Chimacum (1) Township: 30N Tax Status: Taxable Range: 1W Tax Code: 0111 Planning area: Quimper (2) Sewer: Drainage: Bank: View 1: Mew 2: Zoning 1: RR-5 - Rural Residential Zoning 2: Zoning 3: Sub Division: Assessor's Land Use Code: 1100 - Residential - Single Unit Property Description: S32 T30 R1W TAX G-16(LS SM PTN TO G-7) W/CO RD & W/TL FRTG 1— — - — — Tax, A/V, Sales, Photos, and i Permit Data Bldg Data Map Parcel lats&Surveys I Se.tic Monitonn• Info "'` '., Jefferson County HOME I COUNTY INFO I DEPARTMENTS I SEARCH Best viewed with Microsoft Internet Explorer 6.0 or later aWindows- Mac http://www.co.jefferson.wa.us/assessors/parcel/parceldetail.asp?value=001324053 8/12/2016 el II goN tet, cod DEPARTMENT OF COMMUNITY DE r rii ;f; W ( , I 621 Sheridan Street,Port Townsend,WA 98368 , Tel:360.379.4450 I Fax:360.379.4451 ..� �..� )� . 0 Web:www.co.Jefferson.wa.us/communitydevelopment E-mail:dcd(ti;cojefferson.wa.us • AUG 10 '16W I N G,SOJEF 2016 STORMWATER CALCULATION WORKSHEE9N COUNTY DCD IMLA# PROJECT/APPLICANT NAME: "1 (-prep4yn 77-am 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 .99 acres An acre contains 43,560 square feet. Multiply the acreage by this figure. Size ofparcel in square feet 4 ,c1Ioj sq/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, excavatiori,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, excavated, and/or compacted for proposed development Answer the following two questions related to conversion project. Include in this calculation the area to be cleared for: of native vegetation: Construction site for structures 9 LDoes the project convert' acres or more of sq/ft native vegetation to lawn or landscaped areas? Drainfield,septic tank,etc. sq/ft Circle: Yes112111 Well, utilities, etc. 0 sq/ft Does the project convert 2 Y acres or more of Driveway, parking, roads, etc. sq/ft native vegetation to pasture? Lawn, landscaping, etc. sq/ft Circle: Yes No Other compacted surface, etc. d sq/ft Indicate Total Volumes of Proposed: Total Land Disturbance 1ci 6 sq/ft Cut JJJ"'� Fill 16 (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 a n 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.'G::2 C2p..:. . • • 0LOZIOUOL A38-leeysjJOMoleo Je Mw.rols ON seA :ueldOSxaleauua25 iN3Wd013A3038 39UUVI —minium 'I1VWs MAIOasn3.uHoHai (31wa) 3an1VN91s 3MIiV1N3S3Nd3H O321tloHV •2 111oONVII Tv adoid papa}}e aql}o sJaunno lie}o luasuoo pue apaimou)l cin}NI.ql!m apew 2ulaq s! uolleolldde sm.lei;A.miao osle I •apa(nnow(Aw}o;sag aq;of loaaioo pue anis Si ulaJaq paranoid uol;ew.w}u!NI legl lsalle.laumo/lueDIIdde aql se!'laagsvoM uolleinolej JalennwJol5 ayl EiulAs Ag 32Jf11VN9IS 1NVDIlddV •10nuoiN.uawa6ouoVI as;DMuilols aql ui aouepin2 dais-Aq-dais ay;Su!sn ueld alis.1alemWJolS e aaedaad JO aleldwal lefllwgnS pue suolloni;sul ueld alis ialemwaols aql u! aleidwal aql alaidwoD •sloafoad Ielluap!saa le.ina ao}Alledpupd 'ueld alis aalemwJolS e}o wecdwal lelllwgns e paaedaad seq ma •Ueld alis JalemwaolS e;lwgns of paa!nbaa awe—sluawaa!nbatl wnwlui N OZ Ile laaw lsnw ley.asogl—spafoad „alael„ao}pue-5#Onoagl T#sluewaalnbaa wnw!u!IAJ/quo laaw Ism.e141 asogl—sloafOad „wnlpaw„ }o sluauodoad 7aVed (soup) sa3ll3eld luawa;leueLN lsa9 (ddMS) uo!luanaad uo!lnhod JalemwioS uol;oni;suop aql do rid •loafoad agl }o aseqd uoilonalsuoo aql Sulanp ails alp $u!Aeal woo} s.uelnliod aaglo pue luawipas luanaad pue uo!sOaa loaluoo of sluawal3 Zi aql uiAoidwa ao}alq!suodsaa s!luauodoad aqi 'paalnbaa lou s!lelllwgns leuol1!ppe ue—uoiluanaad uo!lnliod Jalemwaols uollona.su0J—Z# luawaa!nbag wnw!u!!ni gllm A!uo A!dwoo lsnw oqm sloafoad „clews„ }o sluauodoad and •sluawaalnbaa uolleo!ldde aql pue loafoad aql}o uol.eo!}!ssep aql A}laan diaq lllm}}els ma •luawaaeuew aalemwaols ao}sluawaa!nbaa wnw!u!►N alp aulwaalap o. .aegj mold algeolldde agz of as}aa wogs lueolldde aql 'aanpunf s!yl w .pasn aq wogs j aan2l3 pagoeue agl pue ;uawdolanap mau paaaplsuoo s! lesodoad aq. 'ou s! aamsue aqui •sluawaalnbaU wnw!unAi aigeD!dde aql aulwaalap of pasn aq pinogs Z aangl3 pagoelle aql pue luawdolanapaJ paaap!suoo s! iesodoad aql`saA s!aamsue aql 41 :SNOIJ.Df1111SNI 113Hlbfli oN I I SOJ. aIOJ!O teOe}ans sno!naadw!Bulls!xa}o aaow JO%gE eAeq alis ay;sada oho—'—•�T :e6elueoied e o}laanuoo pue Ieoaed-1143}o azis eq Aq anoge e3e}�ns sno!naadW! u!;s!xa Ielol-111 ap!n!a (, l!/ iN3Wd0'13A30321'^1N3WdO 13A3Q ;uawdolanapai JO luewdolanap paaaplsuoo Si loafoad pasodoad agl aaglaym aulwaalap diaq IIlm suo!lsanb 2u!mollo}eq1 a6eaanoo lo!!elo;Aoago of pasn aq!gm lunowe slgi, lj/bs I z17 h .9NliSIX3 3\1101+M3N"ild101 wbs Ohl /JL7 6u!;s!x3,..40,ol los b 1 MON!moi aagl0 wbs J" )/"'' -191410 }}lbs wbs Q/,L f/ Ola'spew '6uplaed 'AemeApa }}lbs Ola'spew `6uplaed'AeMeApa 00 i (molaq uo!lea}Iyu!lnoyl!m) (molaq uo!le-1llyu!lnogl!M) ;}lbs s�loaa ptIOs #lbs s�loaa p!IOs 0 soiled wbs soiled wbs .}lbs S sMlemap!S Albs 0 sMlemap!g wbs M C?I j'� (ewe low Ile)sa-1nlpn-1ls 14/bs ) ' (ewe low lie)sa-1nlan-1;g W.7 l� ONIiSIX3 M3N 3ovAanS SflOIM3dWI—SNOW/in-IVO 2131VMW21O1S ACCUMAR CORPORATION , • Page 1 of 2 Home Espanol Contact !Search L&I A-Z Index Help My L&I Safety&Health Claims&Insurance Workplace Rights Trades&Licensing O.Washington State Department of Labor & Industries ACCUMAR CORPORATION Owner or tradesperson 1180 NW FINN HILL RD POULSBO,WA 98370 Principals 360-779-7795 SPRAGUE,SCOTT BRINTON,PRESIDENT KITSAP County CARTER,WILLIAM M,VICE PRESIDENT SMITH,NATHAN,SECRETARY (End:02/27/2012) Doing business as ACCUMAR CORPORATION WA UBI No. Business type 601 066 065 Corporation Governing persons NATHAN SMITH SCOTT SPRAGUE; WILLIAM M CARTER; License Verify the contractor's active registration/license/certification(depending on trade)and any past violations. Construction Contractor Active. Meets current requirements. License specialties ELEVATOR License no. ACCUMC*110QG Effective—expiration 11/07/1989—06/15/2018 Bond No bond accounts during the previous 6 year period. Insurance Burlington Ins Co $1,000,000.00 Policy no. 419BW34689 Received by L&I Effective date 02/23/2016 02/28/2016 Expiration date 02/28/2017 Insurance history Savings .............. (in lieu of bond) $6,000.00 Received by L&I Effective date 11/03/1989 Release date Impaired date N/A N/A Savings account ID https://secure.lni.wa.gov/verify/Detail.aspx?UBI=601066065&LIC=ACCUMC*110QG&SAW= 8/15/2016 rz,C -1-149 c S I1LI lk o 0 42 o co .> N N V , O O C) ^N, C \r'i /4-• (3 ',:i 0 :a= ‘%3 a) CL a. lh v ` � i _ a = 'IP s Cut' ° °' 5 CO O 4 a) "' Q = o d r • ca ui 4-1 v W N ` 1 ' Q`zi c = m w > co I-- 0 O D o Q, i 1. N. e �% an v w Z Q = q. • _ > U i WI --Ia0i , 4 i � yy io.'2 S a' Z G> Z Q. 44 +�. 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