HomeMy WebLinkAboutBLD2015-00214 - 01 PERMIT APPLICATION .UILDING PERMIT APPLICA•N BLD15-00214
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD15-00214 Received Date: 6/24/2015
SITE ADDRESS: 232 S PALMER DR
PORT TOWNSEND, 98368
OWNER: VIRGINIA& EDWIN KRAFT PHONE: 786-338-1321
232 S PALMER DR
PORT TOWNSEND WA 98368-9497
9381 - CAPE GEORGE COLONY DIV.
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 938100421 Section: 12 Township: 30 N Range: 2\A
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION REMODEL/FINISH OF EXISTING DAYLIGHT BASEMENT.
ADDING A BEDROOM, HOME OFFICE, STORAGE AND WOOD SHOP
SEP90-00518
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP ALT MAIN:
VALUATION 20,000.00 ADD'L: HEAT TYPE: EEE
CODE EDITION: 2012 HEAT BASE: 993 HEAT TYPE:
OCCUPANCY: UNHEATED: 126 #OF STORIES: 2
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: 2 Exist: 2
Prop: 1 Prop: 1
Total: 3 Total: 3
Routing Date:
Type Amount Paid By: Date: Receipt: 0`1P •!�(�d�V G�
Permit $0.00 SRE 06/24/15
Plan Check $0.00 SRE 06/24/15 AUG 0 5 2015
State Building Code $0.00 SRE 06/24/15
Total: $0.00 Jefferson County DCC
1'e3C`S ?a &use' 14- 116.416
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• III
• ��SON e0 DEPARTMENT OF COMMUNITY DEVELOPMENT
Wk a 621 She id:ui Street.Port Townsend,W. 98368
Tel:;60.379.-1450 . Fax..360.379.-1451
Web:\r'\r-w.co.ic fteron.wa.us/communitydevelopment
E-mail dcd utco-iefferson.wa.us
`4`9kI N G�0
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: q.3 e f a Q 4- Z I
Site Address and/or Dir ctions to Property: _ S, PA1"vi e-r /r ,
(Cpe Gear e. parr Ttv445 el, d , G4JR 9836 $
Access (name of street(s)) from which access will be gained: 5-0 frcf h po._/.-14.^ e_r Pr.
Present use of property: Res ?4.,'19 /-4.r..,
Description of Work(include proposed uses): 1 € -i to ' (/F--..,,, . -t" Dezyk p.4 t ,r3a'S',?Nrpi✓
.5-pd-r e- F ar 's", � g_ Pte':c / �1`-on4�'e / Woo oQ G✓orK 5 AoP
Wastewater-Sewage Disposal
This property is served by Port Townsend or Port Ludlow sewer system? YES NO j/
If not served by sewer identified above, identify type of septic system below:
Type of Sewage System Serving Property:
/ Septic Septic Permit#: ? 71 F - 10(7- 4 I
_ _ Community Septic Name of System: Case#:
Are other residences connected to the septic system? ,4J I
Additions or repairs to sewage system: 5—,v./'.it, fr i t.yF.� 4- ki.,art vsl, J/ & 3/g¢7/5
Is it a complete or partial system installation: Complete r Partial
Has a reserve drainfield been designated? Yes ,/ _ No _ _
Date of Last Operations &Maintenance check: 3/Z 4/'f Attach last report to application
Describe or attach any drainfield easements, covenants or notices on title, which may impact the property:
The authorized agent/representative is tf�e 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: /-ii n r
Name: gd,..., rn /L i t1, rg ;4.1lct li .. Kra-ff
Address: .232 S. Pot.,l-,,,, er.r Dr, � Po Tocv-rt s e..d Gd/� 9$363
Phone It: ,� 78'6— 333— / 3,2 I E-mail Address: 2kra-ifl'7P a;1 _ c!--eM
Please contact Authorized Agent/Representative with project info. (select ontV one).
— —
Property Owner Signature: �, i.L 1, Date: 6//13
Note: For projects with multiple owners,attach a separate sheet ith ea�information and signatures.
Applicant: Authorized Agent/Representative(it other than owner)
Name:
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:
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 ounty's intent to enter upon the pro•erty for visits related to this application and subsequent permit issuance.
Signature: , /;� �r 1 6 ,■� Print Name:e d , ,t) 1 , -a Ft Date: 07//,j�
,e ON e DEPAR*ENT OF COMMUNITY DE O'PMENT
c{� (j 621 Sheridan Street,Port Townsend,\VA 98368
W Tel:360.379.4450 Fax:360.3 79.4451
■-< \N eb: co.iefferson.wa.usicommunindecelopment
E-mail:dcd6 co.jefferson.wa.us
-4rING��$ SUPPLEMENTAL APPLICATION
RESIDENTIAL OR COMMERCIAL BLDG PERMIT
For Department Use Only Receipt#: Date:
Related Application#s: Payment#:
Site Information
Owner Name: Ee4./ - i Ai, /rot-ie f Assessor Tax Parcel#: F38/ 004,2 /
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 # new bedrooms / existing ,, total bed 3
# new bathrooms / existing total bath 3
3
Heat Source
Select all that apply:
Electric Y Heating Oil Wood Propane t/(ew; tie)
1
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 /2,24S
Residential/Commercial Second Floor ,-
Additional Floors- heated/unheated
Basement- unfinished f 6 £d A4q Q i ei�
Basement-finished space or habitable 993ileA1k
Detached Garage- heated/ unheated
Attached Garage-heated/ unheated C/6
Garage 2nd fl- unfinished storage
Garage 2nd fl-finished space or habitable
Carport-2 walls or less
Deck- uncovered 3 4
Covered porch (filf b u der Dime 4- o
Other(shed, barn, pole bldg,etc.)
Estimated Cost of Project (Required): $ �,p 000 $
•
•
List existing buildings on property(rouse, garage,accessory dwelling unit, she,barn, mobile home, other):
All Existing Buildings on Property Use
i/aUse- / /J 6A,-.,4(7,2_ ,4e_5 icii--r, c.e___
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 II for the proposed project.
Signature: Print Name:�o/w--v, fi`_ Krct r't Date: 618/4S
By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and
correct to the best of his or her knowledge. Any material falsehood or any omission of a material fact made by the owner/agent
with respect to this application packet may result in making any issued permit null and void.
Signature: Print Name: Date:
For Department Use Only
Building Permit Fees
Building Base
Plan Check Review
Land Use Review $234.00
Septic Review $80.00
Potable Water $109.00
Technology/Scan $19.50
State Fee $4.50
Other Fees
Shoreline Exemption
Zoning
Zoning
Other
New Address
Road Approach
Total Fees
Receipt # Date: Cash/Check/CC:
7 col' e'
• •
40N ooh DEPARTMENT OF COMMUNITY DEVELOPMENT
4, 621 Sheridan Streer.Port Townsend,WA 9836S
Tel:360.379.4450 I Fax:360.379.4-1.51
Web!www.co.iefferum.wa.u,/coinnnnutvdevelopmcnr
E-mail:dal;i:c,,1efferson.wa.us
ISkI N����
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# 4
Related Application #s: MLA#
Site Information
Assessor Tax Parcel Number: 9 3R I O O 4-2. I
Site Address and/or Dir ctions to Property: 2 32 5, PA17rt ,r Qr ,
(CApe Geor e ) Parf 745P , jg 7 3 6 g
Access (name of street(s)) from which access will be gained: Sou,-f ci /?-./,,--, e-r Dr,
Present use of property: Re6 i de, IT a. I
Description of Work(include proposed uses): f e. tc+Ia f/F; m, , 5t Dcz y/'•IA 't' ,has'e rare 'f"
"—pet re_ gadraes4 Ato*1e_ Pc4,-cL I 51=2, e 7 Woo of arK5/,of) 12.0 (-Allan
{roPgw.e. -tun k_
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#: ? ji rj' - foo- L 7 t
_ Community Septic Name of System: — Case#:
Are other residences connected to the septic system? p
Additions or repairs to sewage system: .,viPto ��,[M/Bd a' //, .4r=ni3l,l/ a 3/,2 47/5
Is it a complete or partial system installation: Complete l Partial
Has a reserve drainfield been designated? Yes ,/ No _ —
Date of Last Operations & Maintenance check: 3,/z,/LS Attach last report to application
Describe or attach any drainfield easements, covenants or notices on title,which may impact the property:
p Rv -Si
}--- 1-09'2. - I cap - C-1--.) Cor) uc erti ar'
2 bed blrocS —
2 Ire .hs '
The authorized agent/representative is Srimary 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 r
Property Owner: ��(( �} Kra. ( WI re t±'
Name: apfw: -vi g_ V: e-V ;-PI;a 1? - T t ��0-q "oscP)
Address: .232 S. '60-w1 t r Or. Part Taw4t s e -c' 1 U/fr 98363
Phone#: ,..,/— 7g6_ 333- / 3, I E-mail Address: eAj-a-c-f f 7( 9-141 a ,.I LOM
Please contact Authorized Agent/Representative with project info. (select onIV one).
Property Owner Signature: �i�- , /1! Date: 6/ //,5
Note: For projects with multiple owners,attach a separate sheet ith each owner(s)information and signatures.
Applicant: Authorized Agent/Representative(If other than owner)
Name:
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:
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 ounty's intent to enter upon the property for visits related to this application and subsequent permit issuance.
Signature: Jl� 4r 1 >.Ii Print Name:a"p'whA) / ,4 -a-It Date: 6//7//,'
SON c DEPARTMENT OF COMMUNITY DEVELOPMENT
�4 �� 621 Shedan Street,Port Townsend;WA 98368
W Tel:360.379.4 50 I Fax:360-379.4431
-� Web:w w.co.iefferson.wa.us/commumurvdevelopment
E-mail:dcd(aco-ieffersonwa.us
11`SW'NO�O SUPPLEMENTAL APPLICATION
RESIDENTIAL OR COMMERCIAL BLDG PERMIT
For Department Use Only Receipt#: S( 24 ) Dtattee:: p
( ( 2
Related Application# ,.
s: Payment#: t _S
Site Information
Owner Name: Eeit,tr --p,t As-a-fit Assessor Tax Parcel#: `7381 004,2 1
Type of Building
New Replacement Relocated
Addition Repair Demolition
*A separate permit is required
Select One:
Single Family Residence Modular Other list
Proposed Building/Project
Number of floors # new bedrooms / existing L total bed 3
#new bathrooms / existing total bath 3
Heat Source
Select all that apply:
Electric l'✓ Heating Oil Wood Propane I/(,vew� iflos
Enter the square footage (sq/ft)that applies in each field:
Structure Existing Sq/Ft Proposed Sq/Ft ICC Valuation (office use)
Residential/Commercial Main Floor
Residential/Commercial Second Floor(/ h•
Additional Floors-heated/unheated
Basement- unfinished 26 L- ,A gg eI;
Basement-finished space or habitable 9g3NeAte v
Detached Garage - heated/unheated _
Attached Garage-heated/unheated -77
Garage 2nd fl- unfinished storage
Garage 2nd fl-finished space or habitable
Carport- 2 walls or less
Deck- uncovered 3 4s'
_
Covered porch (/ f,, U1tje.t Did) 4-60
Other(shed, barn, pole bldg,etc.)
Estimated Cost of Project (Required): $ )s 0i 000 $
List existing buildings on property (i.e. ouse, garage, accessory dwelling unit, shed, arn, mobile home, other):
All Existing Buildings on Property Use
}lrru:s` # M Ae-y 6 Af.4(7°- Re.5 ioPP.y, c.e,
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: �� iyC�/ Print Name: o/w;-,� /�_ ,e-ra r7` Date: 6/8/4
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.
cw_'- 16/,..Signature /4 Print Name: Date:
For Department Use Only
Building Permit Fees
Building Base 24077- 00
Plan Check Review 173 "S r
Land Use Review
Septic Review $80.00 1.211 '°C)
Potable Water
Technology/Scan $19.50
State Fee $4.50
Other Fees
Shoreline Exemption
Zoning
Zoning
Other
New Address
Road Approach
Total Fees •S—c- `
Receipt # Date: Cash/Check/CC:
Geederee, me. •
2495 Cape George Rd 360-385-7155
Port Townsend, WA 98368
PROPERTY INFORMATION
Location:232 S PALMER DR
Port Townsend
Tax ID:938100421
Mall To MARTHA MEAD
309 N HONEYCOMB CIR Use:Residential, Single Family
SEQUIM,WA
983823262 GENERAL SYSTEM TYPE:Gravity
Owner:MARTHA MEAD
ON ID:SOM90-00518
Fold "- ON-SITE WASTEWATER TREATMENT SYSTEM INSPECTION REPORT Fold
Here Here
Inspected:01/06/2015 - Inspection Type:PROPERTY SALE - Correction Status:All corrections made
Company: Certification-Level 1 Work Performed By: Submitted 03/252015 by:
Goodman, Inc. Doug Nebel Doug Nebel
This report does not assure approvals by Jefferson County Public Health for ANY future building permits or development.
COMMENTS&GENERAL INSPECTION NOTES
Deficencles Were Noted:Corrections were made to resolve the deficiencies.
Tank was pumped on 03/06/2015.Installed riser over tank clean out.
GENERAL SITE&SYSTEM CONDITIONS
The General Site and System Conditions were: Fully Inspected
All Components accessible for maintenance,secure and in goad 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?(if NO explain in comments) YES
ONSITE SEWAGE SYSTEM INSPECTION DETAIL
ANK:Septic Tank-2 Compartment
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): N/A
Compartment 1 Scum accumulation(Inches,if other specify): 5
Effluent filter/screen needed cleaning on arrival N/A
Compartment 1 Sludge accumulation(Inches,if other specify): 8
Compartment 2 Scum accumulation(Inches,if other specify): 0
Compartment 2 Sludge accumulation(Inches,if other specify): 6
Pumping needed: YES C::rPcren
Approximate Gallons to be pumped(if needed)by Certified Pumper: 1000