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Home My WebLink AboutBLD2016-00442 - 01 PERMIT APPLICATION BUILDING PERMIT APPLICATS1 BLDI6-00442 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD16-00442 Received Date: 10/5/2016 SITE ADDRESS: 23 KALA SQUARE PL PORT TOWNSEND, 98368 OWNER: SAN JUAN TAQUERIA PHONE: 360-531-4393 23 KALA SQUARE PL PORT TOWNSEND WA 98368 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001342038 Section: 34 Township: 30 N Range: 1V\ CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: MATT WALLACE PHONE: 360-531-4393 23 KALA SQUARE PL. PORT TOWNSEND WA 98368 PROJECT DESCRIPTION: CONVERT OVERFLOW DINING AREA AND STORAGE AREA INTO A BAR AREA. CONSTRUCT BAR AND INSTALL 3-COMP. SINK, DUMP SINK HANDWASHING SINK, AND SODA FOUNTAIN INCLUDING ICE WELL, ANCHOR FREE STANDING BAR BACK SEP05-00214 TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: TYPE OF IMP ALT MAIN: INDUSTRIAL: VALUATION 3,300.00 ADD'L: HEAT TYPE: CODE EDITION: 2015 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: NUMBER OF EMPLOYEES: WATER SYSTEM: BATHROOMS: Type Amount Paid By: Date: Receipt Exist: Permit $170.00 SRE 10/05/16 165777 Prop: Plan Check $85.00 SRE 10/05/16 165777 Total: Scanning Fee $21.00 SRE 10/05/16 165777 Approved/Date State Building Code $4.50 SRE 10/05/16 165777 EH SEP/Commercial Rev $129.00 SRE 10/05/16 165777 APPROVED EH SEP/Community OSS f $0.00 SRE 10/05/16 Total: $409.50 1 Jefferson Count4, [)c::. 6 `DI - Mciki �50N (be/. DEPARTMENT OF COMMUNITY VELOPMENT �� r� 621 Sheridan Street,Port Townsend,WA 98368 / tiTel:360.379.4450 I Fax:360.379.4451 �/4-i.; Web:www.co.jefferson.wa.us/communitydevelopmentf,i ilifell- C)� E-mail:dcd@co.jefferson.wa.us OCT . D SNING� :� _ OS a PERMIT APPLICATION a`'u`'lisaA/Cpl 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: rte;1 - jL}Z -O3' Site Address and/or Directions to Property: 2-3 kstla, ci e.re p i - T 'N!f Access(name of street(s)) from which access will be gained: K,1o, Set,.,c,..ra N., 1 PQr-r To&:.,IAS I VICI Present use of property: (2e4-4-) 'c4 In1r a.vA, TO,a+ti `i 41 t.ro'4.. Description of Work(include proposed uses): \''.0 0,,ve,ri- 0vu-c10 cl:n.' .r¢,c. c,vicl Storaje $ Pct e/ 1ut'FL Ck bc.r ares.,,,, fir a::nk•.. b:„,:.,6._ . C>►s4r'c4— 6ca- Gvil L.ssiwiI 3 cooAto . ...k1 dv o s,`.-,k1 inaHaWAs.L.%t �i`'..tk. iawl et S'eClesCoVni-A .',t i✓tc Vc,:-t- rCe iisi+'•lia ti—inGht,^ FICC sPet rid:'.1y� bA.^ Mick. Wastewater-Sewage Disposal 1 This property is served by Port Townsend or Port Ludlow sewer system? YES NO > . N A If not served by sewer identified above, identify type of septic system below: Type of Sewage System Serving Property: 1- Septic Septic Septic Permit#: Oma C.)02.1 L_f r Community Septic Name of System: 0.2, . P e.we be-c 1 - Case#: Are other residences connected to the septic system? NJ a 11 Additions or repairs to sewage system: N1��t e Is it a complete or partial system installation: Complete Partial �.. Has a reserve drainfield been designated? Yes No e Date of Last Operations& Maintenance check: l l /i,,/2Q t s-- Attach last report to application - Describe or attach any drainfield easements, covenants or notices on title,which may impact the property: N e r Sl, ce v~ n S FE04-C co -he r >cnm ;App Kai on P,1,;(2 I<;f • The authorized agent/representative is the primary contact for all project-related questions and correspondence. The County will mail /e-mail requests and information about the application to the authorized agent/representative and will copy(cc)the owner noted below. The authorized agent/representative is responsible for communicating the information to all parties involved with the application. It is the responsibility of the authorized agent/representative and owner to ensure their mailbox accepts County email(i.e., County email is not blocked or sent to"junk mail"). Applicant/Property Owner Information Property Owner: Name: Rev%a 1-e L3Leeter Address: + t 1< :� Le.,r L cj..N C r P r Tow�15 u}, tA)4 q Phone#: iGc 3ss-_ c TA. s- E-mail Address: N(A Please c,�ct A,horize• A:- `Or R:presentative with project info. (select only one). Property Owner Signature:A cit � , Date: Cl�2 . Note: For projects with multiple owners,attach a separate sheet with each owner(s)information and signatures. Applicant: Authorized Agen Representativerother than owner) �, . rte ti , Name: Sct; Tk ti et-. Me.14-L L..Lt et et Address: 23 ike t.c� �c „Lit.:r.e_ Pt , Pc-r Y"aw:&s—td wA q Phone#: (16 ) 4:71 i- '-13 q3 E-mail Address: c_i.te , oeS.$ level Professional: Is this an Authorized Agent/Representative for this project? Engineer Architect Surveyor ; Contractor Consultant Name: D co vie,- 13 LA..'(d License# Address: Phone#: E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect _ Surveyor Contractor Consultant Name: License# Address: Phone#: E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: License# Address: Phone#: E-mail Address: By signing this application form, the owner/agent attests that the information provided herein, and in any attachments, is true and correct to the best of his or her knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in making any issued permit null and void. I further agree to that all activities I intend to undertake or complete associated with this permit will be performed in compliance with all applicable federal,state and county laws and regulations and I agree to provide access and right of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application review and any required later inspections. Applicant may request notice of the County's intentt,to ente upon the property for visits related to this application and subsequent permit issuance. if,Signature: 41315k:i `�/�Ir Print Name: tit ct lT"�Cw hf_ U- //4 i Date: a /z, /Lot la 2,12 .... SON • DEPARTMENT OF COMMUNITY DEVELOPM °C.. 621 Sheridan Street,Port Townsend,WA 98368 9;;� / "- Tel:360.379.4450 Fax 360.379.4451 o • ti �C Web:www.co.jefferson.wa.us/communitydevelopment ` �> 1 -mail:dcd@co.jefferson.wa.us OCT CIC) DS ?D1n + N SUPPLEMENTAL APPLICATION Sp RESIDENTIAL OR COMMERCIAL BLDG PERMIOVNTy For Department Use Only Receipt#: Date: 000 Related Application#s: Payment#: Site Information Owner Name: Re j—e_. ;(,.)k eet€t Assessor Tax Parcel#: CDC.) Type of Building �DrYti e i C;c,t LY-\/ 'Nrk-1 e-Pr – New Replacement Relocated Addition Repair Demolition *A separate permit is required Select One: Single Family Residence Modular Other list Proposed Building/Project //1 Number of floors #new bedrooms existing total bed #new bathrooms existing total bath Heat Source / Select all that apply: Electric Heating Oil Wood Propane Enter the square footage(sq/ft)that applies in each field: Structure Existing Sq/Ft Proposed Sq/Ft ICC Valuation (Office Use) 1 Commercial Main Floor 0 7�Q rj%�/Commercial Second Floor ( I ) '2-04...5 Additional Floors-heated/unheated Basement-unfinished Basement-finished space or habitable Detached Garage -heated/unheated Attached Garage- heated/unheated Garage 2nd fl-unfinished storage Garage 2nd fl-finished space or habitable Carport-2 walls or less Deck-uncovered Covered porch Other(shed, barn, pole bldg,etc.) Estimated Cost of Project (Required): $ 3r 3 00.-- , Or` $ Sii� • • List existing buildings on property(i.e. house,garage,accessory dwelling unit,shed, barn, mobile home,other): Ali Existing Buildings on Property Use ( $ Jravc,f Iles J- yr»�r— 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: -744612* ( _ itriii6e4 Print Name: M-A-1 iFt,, i4f. L)t//act Date: Vle,//6 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�z=Iapll-ication packetmaay result in making any issued permit null and void. Signature: 7114,u,° J _ 4Li Print Name: M,,.14-1,e,..i t4. 1.J.1.14.6.z Date: 4/Zi/f(, :For Department Building Permit Fees Building Base q I o \ 1-0 -Co }'Nt.'N Plan Check Review 5ct - 1 S i es•oc Land Use Review $ Septic Review $129.00 Potable Water Technology/Scan $21.00 State Fee $4.50 Other Fees Shoreline Exemption Zoning Zoning Other New Address Total Fees `�09 Receipt# Date: Cash/Check/CC: is.. 5 A-c1.2-1f_ 43 ad" 0..c k 1--0 c /0 0 2_ K . LA vt.'F ( ke9,. code.— 7c4,15peose," a foto ka,,,c, ) , 4.4' (( is 4C.lvdt eleciv,:c.. I .,I FerAl-,(0 4 5 by A li'ce“. ecil 'OP sA.S.C.'0.4,, it do4d Ws, /4 10( ex ii'Ci'vt sedi o i,,;.„., I d tr- ° s •-i Sin(( A (A tA C( C`. IA G I- CA i'Lei C CACI tni it Pei- -C v tlpdly t, 70,,, 3 S lAcwizi I I I i:fiV 0."11, ill 4..4 I I ' OCr n , JE'r,p6., 2016 SON Coop,_ ' r 000 1 • • 9/27/2016 AQUA TEST, INC. P.O. Box 1116 (425)432-9360 Black Diamond, WA 98010-1116 j N Fax:(425)413-9431 PROPERTY INFORMATI • Dream City Cafe �' !pi Location:23 KALA SQUARE P C 7� Port Townsend e 0 5 ?D/6 Tax ID:001342038 Mail To: JOSEPH WHEELER 81 KALA LAGOON CT Use:Commercial,FSE:Other "J4I PORT TOWNSEND,WA `- .48/1 983689502 ° °CO Owner:JOSEPH WHEELER ON ID:SOM05-00214 Fold '-- ON-SITE WASTEWATER TREATMENT SYSTEM INSPECTION REPORT . Fold Here Here Inspected:11/20/2015 - Inspection Type:ROUTINE - Correction Status:Corrections in progress Company: Work Performed By: Submitted 01/07/2016 by: -'f- AQUA TEST,INC. Travis Stoneburner(80) Matt Lee This report does not assure approvals by Jefferson County Public Health for ANY future building permits or development. COMMENTS&GENERAL INSPECTION NOTES Deficiencies Were Noted:Corrections are in progress. Recommend pumping 2000 Gallon grease trap. 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 ...................._.__._..._....................... .....__..............._...__.—...._ P Problems ..................._..----.............-- 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(reference Septic YES Permit#in notes). If NO,describe in notes and 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?(if NO explain in comments) YES ONSITE SEWAGE SYSTEM INSPECTION DETAIL ANK:Grease Trap 2000 Gallon This component was: Fully Inspected Effluent level within operational limits(if NO explain in comments): YES Component appears to be functioning as intended: YES All required baffles in place(N/A=No baffles required): YES Compartment 1 Scum accumulation(Inches,if other specify): g Compartment 1 Sludge accumulation(Inches,if other specify): 24 Pumping needed: YES In Progress Approximate Gallons to be pumped(if needed)by Certified Pumper: 2000 ReportlD:485777 View inspection reports online at www.onlinerme.com Page 1 of 3 ANK:Septic Tank-1 Compartment Peninsula 2000 gallon 24"risers This component was: Fully Inspected Component appears to be functioning as intended: YES Effluent level within operational limits(if NO explain in comments): YES All required baffles in place(N/A=No baffles required): YES Effluent Filter Cleaned(N/A=Not Present): NO Effluent filter/screen needed cleaning on arrival NO Compartment 1 Scum accumulation(Inches,if other specify): 12 Compartment 1 Sludge accumulation(Inches,if other specify): 18 Pumping needed: NO Approximate Gallons to be pumped(if needed)by Certified Pumper: TANK:Surge Tank Peninsula 1000 gallon 24"risers one compartment This component was: Fully Inspected Component appears to be functioning as intended: YES All required baffles in place(N/A=No baffles required): YES Compartment.I Scum accumulation(Inches,if other specify): 0 Compartment 1 Sludge accumulation(Inches,if other specify): 10 Pumping needed: NO Approximate Gallons to be pumped(if needed)by Certified Pumper: TANK:Pump Tank Peninsula 2000 gallon 24"risers This component was: Fully Inspected Component appears to be functioning as intended: YES Compartment 1 Scum accumulation(Inches,if other specify): 0 Pump vault screen needed cleaning on arrival NO Compartment 1 Sludge accumulation(Inches,if other specify): 10 Pump Vault Filter cleaned(N/A=not present): YES Pumping needed: NO Approximate Gallons to be pumped(if needed)by Certified Pumper: r• Dills-riarr • Pim . • Jalag Ec u. cremiR:7/y um •tom. Manufacturer:Orenco Model:PF200511 This component was: Fully Inspected Component appears to be functioning as intended: YES Controls functioning: YES Dose setting different than original(If YES,detail in comments) NO Dose setting adjusted to meet as-built/record drawing specifications(by the O&M Specialist) NO Tested gallons per minute flow: 21 Panel:Control-1 Pump,Manufacturer=Orenco-MVP-S Series MVP-S1;IR2;PT RO Manufacturer:Orenco Model:MVP-S Series This component was: Fully Inspected Panel functioning(including alarm): YES Pump 1:on minutes(override in parentheses-if present): 1.5m Pump 1:off hours(override in parentheses-if present): 28.5m Pump 1:gallons per dose(override in parentheses-if present): 31.5 Pump 1:ETM hours(override in parentheses-if present): 38222 Pump 1:Cycle Count(override in parentheses-if present): 36081 TANK:Recirculation Tank Peninsula 1500gal;single compartment This component was: Fully Inspected Component appears to be functioning as intended: YES All required baffles in place(N/A=No baffles required): YES Effluent Filter Cleaned(N/A=Not Present): YES Effluent filter/screen needed cleaning on arrival YES In Progress Compartment 1 Scum accumulation(Inches,if other specify): 0 Compartment 1 Sludge accumulation(Inches,if other specify): 8 Compartment 2 Scum accumulation(Inches,if other specify): na Compartment 2 Sludge accumulation(Inches,if other specify): na Pumping needed: NO Approximate Gallons to be pumped(if needed)by Certified Pumper: •anel:Control-2 Pumps,Manufacturer-Orenco-MVP-DAX Series Gravel Filter Panel Manufacturer:Orenco Model:MVP-DAX Series This component was: Fully Inspected Panel functioning(including alarm): YES Pump 1:on minutes(override in parentheses-if present): 1m Pump 1:off hours(override in parentheses-if present): 6.5m Pump 1:gallons per dose(override in parentheses-if present): - na Pump 1:ETM hours(override in parentheses-if present): 336891 Pump 1:Cycle Count(override in parentheses-if present): 331412 Pump 2:on minutes(override in parentheses-if present): 1m Pump 2:off hours(override in parentheses-if present): 6.5m Pump 2:gallons per dose(override in parentheses-if present): na Pump 2:ETM hours(override in parentheses-if present): 336897 Pump 2:Cycle Count(override in parentheses-if present): 331414 ReportiD:485777 View inspection reports online atwww.onlinerme.corn Page 2 of 3 Pump:Effluent Pump,Manufacturer-Orenco-30 05 HHF Gravel Filter Pump#1 Manufacturer:Orenco Model:30 05 HHF This component was: Fully Inspected Component appears to be functioning as intended: YES Controls functioning: YES Dose setting different than original(If YES,detail in comments) NO Dose setting adjusted to meet as-built/record drawing specifications(by the O&M Specialist) NO Tested gallons per minute flow: na Pump:Effluent Pump,Manufacturer-Orenco-30 05 HHF Gravel Filter Pump#2 Manufacturer:Orenco Model:30 05 HHF This component was: Fully Inspected Component appears to be functioning as intended: YES Controls functioning: YES Dose setting different than original(If YES,detail in comments) NO Dose setting adjusted to meet as-built/record drawing specifications(by the O&M Specialist) NO Tested gallons per minute flow: na istribution:Automatic Distributing Valve Gravel Filter Hydro Valve This component was: Fully Inspected Component appears to be functioning as intended: YES Distributing valve dosing as intended: YES edia Filter:Recirculating Sand Filter Recirculating Gravel Filter This component was: Fully Inspected Component appears to be functioning as intended: YES Average squirt height(if performed)(feet,if other specify): na Lateral lines flushed: YES TANK:Pump Tank 1000 Gallon For Drain Field This component was: Fully Inspected Component appears to be functioning as intended: YES Compartment 1 Scum accumulation(Inches,if other specify): 0 Pump vault screen needed cleaning on arrival YES In Progress Compartment 1 Sludge accumulation(Inches,if other specify): 6 Pump Vault Filter cleaned(N/A=not present): YES Pumping needed: NO Approximate Gallons to be pumped(if needed)by Certified Pumper: -ump:Effluent Pump,Manufacturer-Orenco-PF300511 Pump For Drain Field Manufacturer:Orenco Model:PF300511 This component was: Fully Inspected Component appears to be functioning as intended: YES Controls functioning: YES Dose setting different than original(If YES,detail in comments) NO Dose setting adjusted to meet as-built/record drawing specifications(by the O&M Specialist) NO Tested gallons per minute flow: na '•ane: ontro -1 -ump, anu acturer=•renco- r •-a eves•renco r r- •.► - -.. Manufacturer:Orenco Model:MVP-DAX Series This component was: Fully Inspected Panel functioning(including alarm): YES Pump 1:on minutes(override in parentheses-if present): 2:40m Pump 1:off hours(override in parentheses-if present): 57:20m Pump 1:gallons per dose(override in parentheses-if present): na Pump 1:ETM hours(override in parentheses-if present): 34118 Pump 1:Cycle Count(override in parentheses-if present): 27333 aistribution:Automatic Distributing Valve Drain Field Hydro Valve This component was: Fully Inspected Component appears to be functioning as intended: YES Distributing valve dosing as intended: YES rain field:Sand Lined Trench 3-5x80'sand lined beds w/1 additional for future capcity This component was: Fully Inspected Component appears to be functioning as intended: YES Lateral lines flushed: YES Average squirt height(if performed)(feet,if other specify): na Ponding present?If YES explain in comments: NO �1 OCT p52016 JEFF . COf,p �7/''. This report indicates certain characteristics of the onsite sewage system at the time of visff.In no way is this report a guarantee of operation or future t,l�!' ••�V ) ReportiD:485777 View inspection reports online at www.onlinerme.com �J Page 3 of 3