HomeMy WebLinkAboutBLD2015-00150 - 01 PERMIT APPLICATION •
BUILDING PERMIT APPLICII iON BLD15-00150
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD15-00150 Received Date: 5/1/2015
SITE ADDRESS: 205 N OTTO ST
PORT TOWNSEND, 98368
OWNER: GLEN COVE PROPERTIES LLC PHONE: 360-385-1258
101 KIWI LN
SEQUIM WA 98382-8550
9867- PHILLIPS BAY VIEW
SUBDIVISION: Block: 19 Lot: 3+
PARCEL NUMBER: 986701902 Section: 16 Township: 30 N Range: 1V1
CONTRACTOR: PHONE:
PHONE:
REPRESENTATIVE: MICHAEL ANDERSON PHONE: 360-531-1011
330 CLEVELAND ST
PORT TOWNSEND WA 98368
PROJECT DESCRIPTIOP REMODEL PERMIT OF EXISTING WAREHOUSE- DIVIDE INTO TWO
SPACES AND ADDED 2 BATHROOMS
TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: 4,957
TYPE OF IMP ALT MAIN: INDUSTRIAL:
VALUATION 10,000.00 ADD'L: HEAT TYPE: EEE
CODE EDITION: 2012 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: ALT NUMBER OF EMPLOYEES:
WATER SYSTEM: 69000
BATHROOMS:
Exist: 1
Prop: 2
Total: 3
Routing Date:
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $157.00 SRE 04/30/15 155969
Plan Check $102.05 SRE 04/30/15 155969 APPROVED
State Building Code $4.50 SRE 04/30/15 155969
Potable Water Application $129.00 SRE 04/30/15 155969 JUN -4 2015
Permit $23.55 SRE 04/30/15 155969
Plan Check $15.30 SRE 04/30/15 155969 Jefferson County DCG
Total: $431.40
11 tidemark\data\forms\F_BLD_App_Bld.rpt 5/1/2015
• •
ON C'p6 DEPARTMENT OF COMMUNITY DEVELOPMENT
4f, 631 Sheridan Street Port Townsend,\VA 98368
W lei:3601 0 4450 � I ie:UO 379.4451 ��]P' LC �a n `-�"l
VV'el):w■tit lip.ietterson-wa.us/crm n untredcvekpnicnt
L-ma l d4d(u'Co.1ct uaon. a1 a
SNrN�z°� APR 3 0 2015 ��
PERMIT APPLICATION ---�
C. .JAN
COMMUNITY DEVELOPMENT .
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: UY ' 70/ ca
Site Address and/or Directions to Property:
05 A/ 7T777 57`
Access(name of street(s)) from which access will be gained:
Present use of property: //(/j('$724141....
Description of Work(include proposed uses): Vjj//LO//J AP0/Tl TD 6000$T/2-ti -T
'WA-Lt-5' be
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: ��627 --e7e /
Type of Sewage System Serving Property:
/Septic Septic Permit#: %r" L70/`✓'
Community Septic Name of System: j( / i9V 7?,9/ 27 e Case#:
Are other residences connected to the septic system? /1,17,/5
Additions or repairs to sewage system: Z —7V/L j3
Is it a complete or partial system installation: Complete ✓ _ Partial
Has a reserve drainfield been designated? Yes No
Date of Last Operations& Maintenance check: 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 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: •. A-Al 8,--G/Aft9Y 77 77 S
Name: 9/l 4Gc�/1J G' PAP
Address: /0/ i</W/ Z—Aii 3i2 l//0 1444- .9538Z--
Phone#: ..'0 9j(9,j /Zj E-mail Address:
Please contact Authorized Agent/Representative with project info. (select only one).
Property Owner Signature: ' - 747611 . Date:
Note: For projects with multiple owners,attach a separate sheet with each owner(s)information and signatures.
Applicant: Authorized'Agenntt/Representative(if other than owner)
Name: ,/Gr/zrvL ,4_ / .O&//
Address: ''3 7 G=G��I/ Y .A1,0 ---7-7 7 %. WA ,q,ei 3665
Phone#: ,e'0— jj/ —`Q// E-mail Address: /-j p/cJO '
4.:ii. 9eeo�c GOl,Y/
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
requenoti e of the County's inte•t to enter upon the property for visits related to this application and subsequent permit issuance.
Signat Print Name: Date: //-
�goN co DEPA1IENT OF COMMUNITY DE•LOPMENT
6.. 621 Sheridan Street,Port Iownsend,WA 98368
W Tel:360.379.4450 I Fax: 360 379.4151 \ i7 n n
ti G web.www co iefterson.wa us/commumtydevclopmcnt I
t1,:iE-mail:dcdir ico.iefferson.wa.us
.1SITNC SUPPLEMENTAL APPLICATION 3 2015
RESIDENTIAL OR COMMERCIAL BLDG PERMIT
JirY
For Department Use Only Receipt#: 11 ` 'DEVELOPMENT
Related Application Ifs: Payment It
Site Information
Owner Name: p/20/r0/1"7/ Assessor Tax Parcel#: 76 ' 762/ y0 Z
Type of Building
New Replacement Relocated
Addition X 17r1i,f/SMl4 Repair Demolition
(NA-G[S 'A separate permit is required
Select One:
Single Family Residence Modular Other list
Proposed Building/Project
Number of floors / # new bedrooms /�/ existing total bed
If 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)
Residential Commercial Main Floor 44959 °j
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 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.) GV/6�/9ba,ti
Estimated Cost of Project (Required): $ !0000 $
• •
List existing buildings on property (i.e. house,garage, accessory dwelling unit, shed, barn, mobile home, other):
All Existing Buildings on Property Use
—00 Z7 //t/r261,C
Builders Statement
The signer of this statement certifies that they are the Owners of the parcel referenced herein,that they are not licensed
contractors :nd that they will be assuming the responsibility of the General Contractor for the proposed project.
Signatur L / Print Name: /i/ d'4L ,4NDE/ ate: 4/O/
By signing this applicatio 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 I
ti
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:
• •
f E1' /�
Dan & Cindy Titterness Tr)) ' !�' VET—)
T—) I
101 Kiwi Lane, 5
APR 3 0 2015 Sequim, WA 98382
SOPi CQU■TY
•'�tiUNITY.DEVELOF'MFNIT
4/30/2015
To Whom It May Concern;
Michael Anderson has authority to act as my agent in matters in permitting.
L
Dan Titterness
• •
FIGURE 1 : NEW DEVELOPMENT
Start Here
Does the site have Yes See Redevelopment
35% or more of Minimum
existing impervious Requirements and
coverage? Flow Chart
(Figure 2)
No Does the project convert 3/4
acres or more of native
vegetation to lawn or
Does the project add No landscaped areas, or
5,000 square feet or - ` convert 2.5 acres or more
more of new of native vegetation to
impervious surfaces? pasture?
Yes Yes Na.}}
J
Does the project have
•
2,000 square feet or
"LARGE" PROJECT more of new, replaced,
All Minimum Requirements or new plus replaced
apply to the new impervious impervious surfaces?
surfaces and converted
pervious surfaces. Yes , No
"MEDIUM" PROJECT Does the project have
Minimum Requirements #1 land-disturbing
•
through#5 apply to the new activities of 7,000
and replaced impervious Yes square feet or more?
surfaces and the land
disturbed. No
"SMALL" PROJECT
See Minimum
Requirement#2,
Construction Stormwater
Pollution Prevention
Based on Fig.2.2 from 2001 Ecology Siormwarer Management Manual for Western Washington
��Sttrxo"c 0 3 ;,n,5
-
Owner Name: DA/NI i (ll E CSS - Parcel No. �eAco 70 1 `
Ste Address: 2-05-A i4O(2--rk O- Y -5T POAT-TOGuN SEEAiP 1 >S WA: 3
Water Source Existing Proposed AttacbCbpiesof:
1) Well Logs
Private well (if no log report on file,a l hr Sablliralion test may be srbdituled.)
2) Lab analysis tested within 3 yearsof application.
-Total(bliform,Ntrate-N,Chloride
2-Party Weil It ems above AND recorded Operations&Maintenance
agreement and recorded Eassment.
Alternative Provide justification and design per Jefferson County
Sistem: Environmental Health policy 97-01
www.ietrasxwountyq,dimmitn.«Oct/Fdicy_97-ot_reimiag mllea
Valid Water Fight Generally applies to springs,attach Dopy.
fbrmit:
Riblic Water: Name of Water Provider:
-glbmit Water Availability Notification form completed by
your water purveyor.
NCJ I C If any of the above utilities need to be installed and disturbance will occur in a public maintained or
unmaintained County road and/or Fight-of-Way easement,then a Fight-of-Way application will be needed.
Resoluliond99-90 requires building permit applications to provide evidence of an adequate potable water supply per the conditions
of FCN 1927.097 and the aiddines for Determining Water Mailability for New Hritdirgs
By signing this appli cat ion form,the owner/agent atteststhat the information provided herein,and in any attachments is true
and oorre t to the beb of his,her or its knowledge. My material faefiood or any omission of a material fact made by the
owner agent with respect to this application packet may result in malting any issued permit null and void.
I further agpte.to that al activities I intend to undertake or complete associated with this application will be performed in
a: ryIia n c e.,i 1: :t'I applicable federal,at and Daunt laws and regulations and I agree to provide accessand right of entry to
,:r;its employees represent at I vas or a3ent s for t tie svl e purpo of application review and any required later
11412c,io ypiicwrtrnayrc Saco,icwo';ileCbuntysintenttoareruponthepropertyforvistsrelatedtothisapplication
and sib-=.0=lt permit issiance.
sgiaturvi . / Vint Name:/YffalFrii-4146n$JDate: 00//5.-
RDRS • UEEONLY
1) Water Fit Fermit,C 3)Irdvidual Well
2)Rit.iioNier applyW lC Meets WaterCualityaar ids? Yes No
WRA17Sjfr n
:ir'Z '2ti15tal/MG sate/ -'gel
Basc4i upon information proAided bythe applicant,it apps s that the potable water supply:-
. - CydronayMeets Lbes not Meal
•
•
ON coo • •
1.9 kIxo r
/ -115 1 '
TO: ,bfferson()aunty Environmental Health Department
FROM: (Water System Name)
LOPMENr
S/stern Operator:
sate ID Number:
Total connections f or which system is approved:
Number of arvice connections existing(in use):
Number of service connections committed: -
Date and results of most recent water bacteriological analysis: I / _
The water system is capable
of and will sipply poteblewater to the following location:
Asaas is Farce! DO: I `c 70 ( 9 02_
cn
Ste Address: `c>`S 4 • OP—TI-( O 12)
aerator Smature:
Crate: / /
Xil RATION DATE CETHIS lIC1=COMMITM ENT: I /__
1
Lc M
_. Ir �! I City of Port Townsend 4(s.
!n! evelopment Services Department ''-`''Q °
APR 3 o 2015 i Madison Street Suite 3, Port Townsend, WA 9S368 gi`
(360) 379-5095 FAX (360)344-4619 °P sr
Jt�'4R:,Cr-C:Ary
r nrrT OF COMMUNITY MUN�TY DEVELOPMENT
WATER AVAILABILITY LETTER
:nine: !; ,
l 1 t f (� `- Date: ( I «:
Site Address: Phone:
City/State/Zip Parcel: / J-✓
Legal Description:
1 sic above-referenced propert, is within the City of Port Townscnd's Water Service Area ands—M-ti-
�.��erved by City water.
City of Port towi,s �1 1 1 Date
•
c -' rL� n �� 's,l�,lI
3 0
Shod Excavating Inc. _-
FO Eox 173 -
Port Radtock,WA 95339 ata355^!ee
PROPERTY INFORMATION --_�
203!205 N.Otto
location:203 N OTTO ST
Port Townsenetl
w; , GLEN COVE PROPERTIES LLC Tax.D:953701902
PGRT TOWNSEND,INA Use:
C,..,1=-:G'_EN :r`.'E F?,:Fc'.7TlES LLC
I
ON ID:SOMD7-00759
I inspected:0276/2015 -Inspection Type:ROUTINE • Correction Status No corrections needed 'R
Company. Certification-Level2
Worn Pedormeo By: Sutmgted 02114Q075 oy:
Shand Excavating Inc Timothy Johnson
Y Timothy Johnson
Thls 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
SSe and System Senderens were:
__.___ Fully Inspected
.oars a¢essLNe for msntenance,]acute and en good rArAaiar _________.____ _______
__. YES
Surfacing erlfuart from any component i'ntlu9.ng mound seepage): --�-
___...._
Somcocents__..argear to be Y al__ no Visual leaks. -- "-- - ----- __
r^ <nc a Dads bpi sys,ra.)onto u.mpene:,tsi: ... ----__.... _____
YES
em..,art serf n]p<..' ms observee ..__.
NO
_.._. ._. NO
al pocmc present tot one Cr more d the ddptsal temdocants. �---'�—�--� No
Subs.Aaue corn�, _ _.__._.—_.____
p_nems atleuus:ety wveretl
Ovmer smpl8nce sues need ______ .�__._ _ _ YES
e
N/A
Ste a..enanra reenrec(erg Landscape maintenance)if yes describe nwmments.
O.c r . _ NO
carp lance problem(otOUpeM not cperNiog the system pro r: I'v __
Pe YL ES cis lnspe in votes _ NO -
add .moles were Identified on last mspe�ion were they corrected before c:d_ing this inspection? - - — --
N!A
(If NO,describe In notes,NA=no deficiencies on last report):._
OSS Ccmponerts s. ores and appurtenances:cicalae .._..__.___.
per as-b..de re o:d to Health(if apt describe .....___.__1
In notes). If no asbufft exists or changes Y'cS
nge]made slate NO end provide record to HealLn Oepl_
.Alterations made to the OSS(valves adjusted,timer settings modified,ports installed.etc.)(If YES. --I
describe in notes): NO
The voutere;rutlue was vacantor used infrequenty,assessment of the dralnfield was not posssrle
�_.___�
If Lec -_ _— _ _—NO.
P use m a si ledlcumple�ed atalus7(d NO eKCain in to:rmenrsJ —� _
__ ..___ _ _.. _ YES
ONSITE SEWAGE SYSTEM INSPECTION DETAIL
s. o_e!wxo at - .-.__
Nor aaeec:ed
c =:ammo a YES
--Oonai l T
_. r._n;re<.ssi. YES
AS required battles in place(NIA=No baffles required):
YES
Effluent Filter Cleaned(N/A•Not Present):
YES 11
Compatmem 1 Scum accumulation(Inches,if other specify):
Effluent Ntensoeen needed Waning on artivai
Compartment l Sludge acamuletion(Inches.it othe:speciy): NO ) i
Compartment 2 Scum eccumula]on(Inches,it other specify): e
'9e- ot\
e encumulan:r(I^c= other spec; 5:
s.
i
I
_._._._.,._.^_ ,, •-,....�-,.x sir,. „.,„ - ._
IIIIII■•••••■■•■-
O •
P""P rank'
Tr,s r..'ornpr,n,arr.Ares
.,.
Component appears to be functioning as Intended: YES
.
ICcropartment 1 Sou accumulation(Inches,if other specifyI, I n -I
i Pump vsuft screen needed cleaning on anlvai I lisA I
ICornpartmant I Sluage accumulation(Incnes,it other specify): n- i
;Pumping needed: I V) I
■.- -,
Piss- .a.S
2 V Filter cieened(MA=net present, ti,4
, I ,
Approximate eDons to be purri,c-eri rif neet.lerb ny Oen:Serf Purr.per _
, ,
This component was: Nig bispected
anel funclic7ung(inOurithg alarm): i
I YES 1
Fume 1,on min0tes(override in parentheses-ii r„,4 ur,t:,-. i ,
IP Li^rip m off flours(ovemcie in parentheses-if prevent:: , 3 hrs 1
1'gaions per close tOver:-,:ie in pereiudeses-II presan;) 40
7 .
I:Eir.1 neurs(override in parentneses-if present): i 7:27 22 . .
sx I
:Pump 7 Cycle Count(override in parentheses-if present): I
.....gggemaiiimagaxey.6,44davae,6.66,61.erearserwits
ITnis"c0;np0neal was: Pay Y-.32..,-.7.zeo. i
.._,
YES i
_..,,!•..4,f,..,1C,1,;:r:1 : YES ;
-,-,,,-.,...-.11 .:. .:.,;.-...,,,n:::1 ist:.•sg',.-::-.iiOcteui.in camments) NO
:- 7. .St:1R-r.,:... V:i..:1ang specthmt,ons(by the O&M Specialist) I NO I i
.... _ 60
I Tms=v.:pc: ew.was FLky Inspected ,
IComponent appears to be functioning as ince:ipso, I YES
Lateral lines flushed: YES
;Average savart heignt(if performed)(feet,if other specify):
I 4 S'
;Pending present?If YES explain in comments: NO
....
...
I
•
15.,5 mp...,v?z,r,"-tsres caitaiw,v.5arvatics 51 foe omit,servos*system se Oa n7113 of vise in no way,s this m94111 9v:war:toe or operaVco or Mute perfonnenco
Mtn mt!":4220.?.S r>::16 C of?
. _ .
I
0 •
4SON c DEPARTMENT OF COMMUNITY DEVELOPMENT
4�� �G� 621 Sheridan Street,Port Townsend,W 198368 � E' ( 1 II RV
ti � ,.< 'I'e1:3G0.37).4450 I Fax:360379.4451
:.=..' 7
' _ Web:www.Co.jeffexson.wa.us/commun hdevetopment I
9 O� E-mail:dcd(Weo.jefferson.wa.us APR 3 ���5
I
`skING ia ,
PERMIT FEES WORKSHEET _ COUNTY J Li
"! COMMUNITY DEVELOPMENT
Name Glen Cove Properties Parcel#
Estimated Cost of Project $10,000.00 Permit#
Building Base Fees
Building Base $157.00
Plan Check Review $102.05
Land Use Review $234.00
Septic Review $258.00
Potable Water $170.00
Technology/Scan $19.50
State Fee $4.50
Other Fees
Shoreline Exemption
Zoning
Zoning Deoc ies Fee- I6)' / $38.85
New Address of ibld lase +° moo ►/
Public Works
1 oia i r._ _s 1 $983.90
Office Use Only
Receipt Number:
Cash/Check/CC:
Date:
•
c23 Ss
3b
3A • '66
11� :
��SON co DEPARTMENT OF COMMUNITY DEVELOP.�IL;NT
M�
G�
621 Sheridan Street,Port Townsend,W:1 98368 F � � '
1 AF,, 3 o
iw, ����- ,�� T'el: 360.379.4450 i E'ax: 360.379.4451 " 075
Web.www.co.ieffexson waus/conununitvdevelopment 7 //
E-mail:dcd @co_jefferson.wa.us , P`rr CUb( '
~9SI/I N G SO "Nlry p fv ,,,NT ,
PERMIT FEES WORKSHEET
Name Glen Cove Properties Parcel#
Estimated Cost of Project $10,000.00 Permit#
Building Base Fees
Building Base $157.00
Plan Check Review $102.05
Land Use Review $234.00
Septic Review $129.00
Potable Water $170.00
Technology/Scan $19.50
State Fee $4.50
Other Fees
Shoreline Exemption
Zoning
Zoning
New Address
Public Works
Total Fees $816.05
Office Use Only
Receipt Number:
Cash/Check/CC:
Date:
I
x 1S7. -`41 2 s s
0 15 /< I S . 3G