Loading...
HomeMy WebLinkAboutBLD2015-00179 - 01 PERMIT APPLICATION UBUILDING PERMIT APPLICA BLD15-00179 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD15-00179 Received Date: 5/28/2015 SITE ADDRESS: 423 ADELMA BEACH RD PORT TOWNSEND, 98368 OWNER: KAREN CROUSE PHONE: 423 ADELMA BEACH RD PORT TOWNSEND WA 98368-9280 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001324062 Section: 32 Township: 30 N Range: 1V1 CONTRACTOR: BRENT DAVIS PHONE: 360-643-1258 BRENT DAVIS CONSTRUCTION INC 1339 14TH ST PORT TOWNSEND WA 98368 Contractor's License 603013002 Expires 2/19/2016 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION REMODEL PERMIT TO_EXFSTING-S€R EXCHANGEJNG LOCATION OF EXISTING BATHROOM AND LAUNDRY ROOM,--ADDING 120GALLON PROPAN AND CHANGING WINDOW T(-DQOR TYPE OF WORK RES~ SQUARE FOOTAGE: TYPE OF IMP ALT MAIN: 1,796 VALUATION 8,000.00 ADD'L: HEAT TYPE: EEE CODE EDITION: 2012 HEAT BASE: 300 HEAT TYPE: PRO OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: SHORELINE: CONST TYPE: �ECRKAGE' �O SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: 2 Exist: 2 Prop: 0 Prop: 0 Total: 2 Total: 2 Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $135.00 SRE 05/28/15 156116 APPROVED Plan Check $87.75 SRE 05/28/15 156116 State Building Code $4.50 SRE 05/28/15 156116 JUN 1 1 2015 Total: $227.25 Jefferson County DCD 11tirinmmr41r1fnIfnrmdC RI V Ann RId rnf R/91:2/9MF • f SON 4c c'G DEPARTMENT OF COMMUNITY DEVELOPMENT U .-- 621 Sheridan Street,Pert Tcnvnsciici-l\'-{9R;(,R rd .1603-9.4450 ' Fax.36!t3-944 1 I� C 1 rf p n Web..www ct.-ictYctrn>nwa-us a,nmm:un-dcaeinpn-ieat j D L'C (f v G E-nail S +Fi o,:cFFeru n n i r �Si�60 iln MAY 2 8 2015 i i . PERMIT APPLICATION uL.____.______ j JEFFERSON COUNTY Steps in the Permit Process: 0,-PT.OF COMMUNITY DEVELOPMENT -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. 1 1 For Department Use Only I - Related Application#s: Building Permit# MLA# Site Information Assessor Tax Parcel Number: .. ` ' -" 1.1: t 'ti Site Address and/or Directions to Property: Y 2.3 Access(name of street(s)) from which access will be :ained g 2t✓hQ. 5 {�a, �� 1-Z,O Q Present use of property: re.S 1 d e r14•t , i Description of Work (include proposed uses): e x c‘,u n -t -r)q bc,}-�roQ �. tf t �„ _ r. f ( �1 d ,m Mn d )Q Lk.,),-04 Y� r oc r, - 1 r1 ci i r 1, J ,/ f¢ S r d, 4t , Ck an 6e.. vv 1 0/t9v/ `lei AO G rti 1 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#: L. la cr 7 - 3 0 3 Community Septic Name of System: Are other residences connected to the septic system? Case#: Additions or repairs to sewage system: Q Is it a complete or partial system installation: f C'� pl n s n C � ai Complete _ Partial _ Has a reserve drainfield been designated? Yes V Date of Last Operations& Maintenance check: c No 1 !.Z7 17 $ Attach last report to application Describe or attach any drainfield easements, covenants or notices on title,which may impact the property: e • The authorized agent/representative is a 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: /� ��1` Name: ((a 'e ti Irfot75 Z ;')')A1+1� &fin f'tLlC ,:Address: W Aae.1M � $P�tth RocAA Phone#: _ 3/,0- X1( -4'15- E-mail Address: rouse ( 2 C'-f M p'a 5 . n e4' Please conta ized Agent/Representative with project info. (select only one). Property Owner Signature: - Li, )' 1,,4 ,,r ' .ilk„di, ! Date: ,..,.6- .a Note: For projects with multiole owners,attach a separate sheet with each owner(s)information and signatur'esi.- Applicant: Authorized Agent/Representative Of other than owner) Name: Address: Phone#: E-mail Address: Professional: _ Is this an Authorized Agent/Representative for this project? I NO YES Engineer Architect Surveyor Contractor Consultant Name: a,,,, I' t8. 1 v r'± 5 1 Cie-4i p-ie 1 license# Address: e> a�. V Q �{ $ D ujN3,,„d, i g Phone#: S :70 - 3g ti 4.6 E-mail Address: 5A ast- s0 --- 41=eel, Ch Professional: Is this an Authorized Agent/Representative for this project? ' , _ :,. YES ' Engineer Architect Surveyor / Contractor Consultant - license# C G`L +!�15 C ; Name: 1JC E'i}1 JGy+S ° W- R83te' Address: i 5 9 ( ,'"?0\-1" 1 C � 'ft� - a �} Phone#: J�CQ n , " r' . 4<":".7. E-mail Address: "r,Ar1i�0■I C rSC_i.t a'l 1' 6 i Professional: • Is this an Authorized Agent/Representative for this project? NO Engineer Architect Surveyor Contractor Consultant Name: License it 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, representativ• or a:ents for the sole purpose of application review and any required later inspections. Applicant may request notice of the o qty's' -nt to enter upon the property for visits related to this application and subsequent permit issuance. i I / Date: a 43' Signature: _ I . _ L....� Print Name:l r en d�� 0 IA(Ai re+r) '-\v t' ,5"--2.z -1,5 • 0 • EC {ElVC , (.‘sON � co�� DEPARTMENT OF COMMUNITY DEVELOP' Fii •621 Sheridan Street,Port Townsend,AC';1 98368 A Tel:360.3?9-4430 J Fax:360.3;'9.4451 MAY 2 8 2015 \\'eb:www.co.lefferson.wa.us/comnninitydevelopment E-mail:dcd�;co.ieffersonm•a.us -J JEFFERSON COUNTY V�S INGO SUPPLEMENTAL APPLICATION I DEPT.OF COMMUNITY DEVELOPMENT RESIDENTIAL OR COMMERCIAL BLDG PERMIT For Department Use Only Receipt#: Date: Related Application #s: Payment#: Site Information Ow:i,_r P1am=: ��G ren C,poUse ffGtvr.Qe)1 ,, u . Assessor Tax Parcel ;;: p V i3 Zefa 4 2 Type of Building New Replacement Relocated Addition Repair Demolition * re n oUa ory I 'A separate permit is required Select One: Single Family Residence a Modular Other list Proposed Building/Project Number of floors . v bwaery # new bedrooms existing An \ g total bed P ov one. ki ne. # new bathrooms existing total bath o, Coavle. ' 41i"\ad`A 0azy. eKc..ha.no\, )11 it.lcc `Lon 0 p/ ,. h•oct 4aK ov,tk ( . VIe Heat Source Select all that apply: Electric )( Heating Oil Wood X Propane Enter the square footage(sq/ft)that applies in each field: Structure .• �.isting Sq/Ft I Proposed Sq/Ft ICC Valuation (Office Use) Residential/ Commercial Main Floor I 11 , 'Residential/Commercial Second Floor I Additional Floors - heated/unheated Basement- unfinished Basement-finished space or habitable 3 p D I.L,.._∎ .0 V,irage - nea,eu / unheated Soo -49- CJrage 2nd II - u. _ ,i.;e Garage 2nd fl- finished space or habitable Carport -2 walls or les De( ,. - ':Luv;rau /5-0 �' Covered porch - -- - Other(shed, barn, pole bldg,etc.) -4(-7X- Estimated Cost of Project (Required): $ ?) C •oo $ . I List existing buildings on property (i.e. house, garage, accessory dwelling unit, shed, barn, mobile home, other): All Existing Buildings on Property Use e E -zi V�00642- wl Gsa EIvcfra ; reSi( nce, shoe Jr>Clte,c1N,2 ■ _ rvor{ 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: I,, no this apol c I:;: t attests that the information rmvided herein,and in any attachments, is true and wirect to tile best of Ls r 111/ 111,„erial falsehood or any omission of a material fact made by the owner/agent with respect tot •- j•jation packet may result in making any issupd permit null and void. 61g9-1 16 liiV v i Print Name: NA RV( Gar *-i. f Date: 5 - Signature: f,.+....,�..� For Department Use Only Building Permit Fees 11 GG Building Base Plan Check Review v 3C Land Use Review Septic Review Potable Water Technology/Scan $19.50 State Fee $4.50 Other Fees Shoreline Exemption - Zoning Zoning New Address Rod, Total Fees Receipt # Date: Cash/Check/CC: • • ���4$ON .. . JEFFERSON COUNTY r_. ��-- �.�, +3 DEPARTMENT OF COMMUNITY DEVELOPMENT I �UI E C I�' 0 V J"" ^.-`„. 621 Sheridan Street • Port Townsend • Washington 98368 1h r82015 4 ' `SrIN G G' http:// www.co.jefferson.wa.us/commdevelopment/ J ,L__ JEFFERSON COUNTY PEPT.OF COMMUNITY DEVELOPMENT Stormwater Calculation Worksheet MLA# PROJECT/APPLICANT NAME: K 'fP n Cu ' 1v1Qr'fF' ;) H Q w a, �""( 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 1 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 /• acres An acre contains 43,560 square feet. Multiply the acreage by this figure. Size of parcel in square feet 7 D 4 7. 2 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, excavation, 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, Answer the following two questions related to excavated, and/or compacted for proposed development conversion of native vegetation: project. Include in this calculation the area to be cleared for: Does the project convert'A acres or more of Construction site for structures ,6 sq/ft native vegetation to lawn or landscaped areas? Drainfield, septic tank, etc. Ri sq/ft Circle: Yes PO Well, utilities,etc. J..? sq/ft Does the project convert 2'/2 acres or more of native vegetation to pasture? Driveway, parking,roads,etc. /' sq/ft Circle: Yes No Lawn, landscaping, etc. P' sgift Other compacted surface, etc. X5 sq/ft Indicate Total Volumes of Proposed: Total Land Disturbance 9 sq/ft Cut Fill (cu/yd) [over] stormwater talc worksheet Rev 9-9-2010—REV 979/2070 • • 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 an 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 CALULATIONS-IMPERVIOUS SURFACE NEW EXISTING Structures (all roof area) . sq/ft Structures(all roof area) / '7 4 6, sq/ft Sidewalks �,Np, , sq/ft Sidewalks sq/ft Patios '' / sq/ft Patios sq/ft Solid Decks \`r / sq/ft Solid Decks .43 s q/ft (without infiltration below) / (without infiltration below) • Driveway, parking, roads,etc sq/ft Driveway, parking, roads, etc .- 3 0 D sq/ft Other sq/ft Other p II�� °8 sq/ft Total New sq/ft Total Existing S 2 `i sq/ft TOTAL NEW+TOTAL EXISTING* 5 21./ sqlft *This amount will be used BY STAFF to check total lot coverage. The following questions will help determine whether the proposed project is considered development or redevelopment. DEVELOPMENT v. REDEVELOPMENT Divide the total existing impervious surface above by the size of the parcel and convert to a percentage: 1.LI Does the site have 35% or more of existing impervious surface? Circle: Yes No FURTHER INSTRUCTIONS: If the answer is yes, the proposal is considered redevelopment and the attached Figure 2 should be used to determine the applicable Minimum Requirements. If the answer is no, the proposal is considered new development and the attached Figure 1 should be used. At this juncture, the applicant should refer to the applicable Flow Chart to determine the Minimum Requirements for stormwater management. DCD staff will help verify the classification of the project and the application requirements. For proponents of "small" projects who must comply only with Minimum Requirement #2—Construction Stormwater Pollution Prevention—an additional submittal is not required. The proponent is responsible for employing the 12 Elements to control erosion and prevent sediment and other pollutants from leaving the site during the construction phase of the project. Pick up the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet. Proponents of"medium" projects-those that must meet only Minimum Requirements #1 through #5—and for "large" projects—those that must meet all 10 Minimum Requirements—are required to submit a Stormwater Site Plan. DCD has prepared a submittal template of a Stormwater Site Plan, principally for rural residential projects. Complete the template in the Stormwater Site Plan Instructions and Submittal Template or prepare a Stormwater Site Plan using the step-by-step guidance in the Storrnwater Management Manual. APPLICANT SIGNATURE By signing the Stormwater Calculation Worksheet, I as the applicant/owner attest that the information provided herein is true and correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all owners of the .. e !d property. r.iy1 I. ...- , :r" 1 ,-. `i Ir ,&Atkp.�!' r 1 3 a .;/�, (LA'.OWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) FOR OFFICE USE ONLY SMALL MEDIUM LARGE REDEVELOPMENT Stormwater Site Plan: Yes No storrmveter talc worksheet Rev 9-9-2010—REV 9!912010 • • Env/ro Check, LLC 1612 Hastings Ave. West - veaamoten Pod Townsend. WA 98366 PROPERTY INFORMATION J v House Location:423 ADELMA BEACH ! MAY 2 8 2015 Port Townsend _ Tax ID:001324062 ,J M°u m. BERNARD ARTHUR JR TRSTE JEFFERSON COUNTY 423 ADELMA BEACH RD Use:Residential,Single Family DEPT.OF COMMUNITY DEVELOPMENT PORT TOWNSEND,WA System Design Flow 360 983689280 GENERAL SYSTEM TYPE:Gravity Owner.BERNARD ARTHUR JR TRSTE ON ID:SOM97-00305 F044. r- ON-SITE WASTEWATER TREATMENT SYSTEM INSPECTION REPORT • Foy Here Inspected:04/28/2015 - Inspection Type:FOLLOW UP - Correction Status:Some Corrections Made Here Company: Work Performed By. Submitted 0428/2015 by' Enviro Check,LLC Dale Wurtsmith Pale Wurtsmith This report does not assure approvals by Jefferson County Public Health for ANY future building permits or development. COMMENTS 8 GENERAL INSPECTION NOTES No Deficiencies Noted THIS IS A FOLLOW-UP REPORT ONLY. On 042815 Enviro Check.LLC installed risers on the septic tank. Note-Refer to EES Inspection,dated 042715 for more information. GENERAL SITE&SYSTEM CONDITIONS The General Site and System Conditions were: Partlaly 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 pontling present for one or more of the disposal components: - N/A Subsurface components adequately covered - _ -----–YES Owner compliance issues noted - NO Site maintenance required(e.g.Landscape maintenance)If yea,describe in comments: YES 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): _ng -_ - ---- - ---- The house/structure was vacant or used infrequently,assessment or the dreinfieid was not possible. NO - � Is the SEP case in a finaled/completed status?(if NO explain in comments) YES ONSITE SEWAGE SYSTEM INSPECTION DETAIL TANK:Septic Tank-2 Compartment 1000« This component was: Not Inspected • Component appears to be functioning as intended: Effluent level within operational limits(if NO explain in comments): All required baffles in place(N/A=No baffles required): • Effluent Filter Cleaned(N/A=Not Present): - Compartment 1 Scum accumulation(Inches,if other specify): Effluent filter/screen needed cleaning on arrival Compartment 1 Sludge accumulation(Inches,if other specify): Compartment 2 Scum accumulation(Inches,it other specify): Compartment 2 Sludge accumulation(Inches,if other specify): --- Pumping needed: Approximate Gallons to be pumped(if needed)by Certified Pumper: ReportlD:436612 View inspection reports online at www.onlinenne.com Page 1 of 2 r —_ Parcel Details • Page 1 of 2 fern County ""° -` ath Station ;,Database Tools--. '--Maps. we r:,,-= v Home , County Info . De ortmentF s�Y _ Parcel Number: 001324062 SEARCH 1.------- 1 Parcel Number: 001324062 .r ;' r;.�Q;� 8 2015 . J 1 i Owner Mailing Address: JEFFERSON COUNTY KAREN CROUSE _ DEPT.OF COMMUNITY DEVELOPMENT 423 ADELMA BEACH RD PORT TOWNSEND WA98368-9280 Site Address: 423 ADELMA BEACH RD PORT TOWNSEND 98368 Section: 32 School District: Port Townsend (50) Qtr Section: SE1/4 Fire Dist: Chimacum (1) Township: 30N Tax Status: Taxable Range: 1W Tax Code: 0111 Planning area: Quimper (2) Sewer: Drainage: Bank: View 1: View 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-26 Tax, A/V, Sales, Photos, and I Permit Data Bldg Data Map Parcel Flats&Surve s __—_ septic Monitoring Info -_- _, °_ 3a$ rsc Count y HOME I COUNTY INFO I DEPARTMENTS I SEARCH Best viewed with Microsoft Internet Explorer 6.0 or later OWindows - Mac http://www.co.jefferson.wa.us/assessors/parcel/parceldetail.asp?value=001324062 5/28/2015 • Parcel Details Page 1 of2 r t: Jefferson � ..'-.s... `L5.6atahase!Toots --. "f;ps- M'.4. , . Home - County Ina Departments Search Parcel Number: 1001324062 SEARCH Parcel Number: 001324062 Printer Friendly Owner Mailing Address: KAREN CROUSE 423 ADELMA BEACH RD PORT TOWNSEND WA98368-9280 Site Address: 423 ADELMA BEACH RD PORT TOWNSEND 98368 Section: 32 School District: Port Townsend (50) Qtr Section: SE1/4 Fire Dist: Chimacum (1) Township: 30N Tax Status: Taxable Range: 1W Tax Code: 0111 Planning area: Quimper (2) Sewer: Drainage: Bank: View 1: View 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-26 Tax, A/V, Sales, Photos,and Permit Data Bldg Data Map Parcel Plats&Survey ➢tic Monitoring Info itt Jefferson Courlt) HOME I COUNTY INFO I DEPARTMENTS I SEARCH Best viewed with Microsoft Internet Explorer 6.0 or later Windows- Mac http://www.co.jefferson.wa.us/assessors/parcellparceldetail.asp?value=001324062 5/28/2015 BRENT DAVIS CONSTRUCTION. Page 1 of 1 Home Inicio en Espanol Contact Search L&I A-Z Index Help My Secure L&I Safety Claims&Insurance Workplace Rights Trades&Licensing 0.Washington State Department of Labor & industries BRENT DAVIS CONSTRUCTION INC Owner or tradesperson 1339 14TH ST BRENT DAVIS PORT TOWNSEND,WA 98368-8632 Doing business as BRENT DAVIS CONSTRUCTION INC WA UBI No. 603 013 002 IWorkers' comp Do you know if the business has employees?If so,verify the business is up-to-date on workers'comp premiums. L&I Account ID Account is current. 244,858-00 Doing business as BRENT DAVIS CONSTRUCTION INC Estimated workers reported Quarter 1 of Year 2015"Less than 1 Workers" L&I account representative TO/KRISTINE HATHAWAY(360)902-4811 -Email:HATK235©Ini.wa.gov IWorkplace safety and health No inspections during the previous 6 year period. ©Washington State Dept.of Labor&Industries.Use of this site is subject to the laws of the state of Washington. https://secure.lni.wa.gov/verify/Detail.aspx?UBI=603013002&SAW= 5/28/2015