The URL can be used to link to this page

Home My WebLink AboutBLD2015-00103 - 01 PERMIT APPLICATION AIA 1111r 111 BLD15-00103 BUILDING PERMIT APPLICATION Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD15-00103 Received Date: 3/31/2015 SITE ADDRESS: 190 BEE MILL RD BRINNON, 98320 OWNER: ANN MATSUNAMI PHONE: 1650 LILIHA ST#201 HONOLULU HI 96817-3169 9639 SUBDIVISION: Block: Lot: PARCEL NUMBER: 963900023 Section: 13 Township: 26 N Range: 2\. CONTRACTOR: TBD PHONE: 253-584-6606 REPRESENTATIVE: VERN PETERS PHONE: 360-477-1053 PROJECT DESCRIPTIOP NSFR SEP13-000116 TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 1,048 VALUATION 210,000.00 ADD'L: 624 HEAT TYPE: EEE CODE EDITION: 2012 HEAT BASE: HEAT TYPE: PRO OCCUPANCY: UNHEATED: #OF STORIES: 2 OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: SETBACK: DECK: 690 BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: 27047 BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 2 Prop: 2 Total: 2 Total: 2 Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $1,797.00 SRE 03/31/15 154304 Plan Check $1,168.05 SRE 03/31/15 154304 APPROVED State Building Code $4.50 SRE 03/31/15 154304 APR 0 8 2015 Potable Water Application $68.00 SRE 03/31/15 154304 Total: $3,037.55 Jefferson County DCG \\tidemark\da ta\form s\F_BLD_App_Bld.rpt 3/31/2015 •LDING PERMIT APPLICATII BLD15-00103 Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD15-00103 Received Date: 3/31/2015 SITE ADDRESS: 190 BEE MILL RD BRINNON, 98320 OWNER: ANN MATSUNAMI PHONE: 1650 LILIHA ST#201 HONOLULU HI 96817-3169 9639-JACKSON COVE PARK SUBDIVISION: Block: Lot: PARCEL NUMBER: 963900023 Section: 13 Township: 26 N Range: 2V1 CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: VERN PETERS PHONE: 360-477-1053 PROJECT DESCRIPTIOP NSFR with covered deck and concrete pad for future hot tub SEP13-000116 - vision -received 6/16/15 06/1612015: Bldg revision received -- adding 3 windows in stairwell. Structural changes to shearwall, hold l downs Revision received- TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 1,048 VALUATION 210,000.00 ADD'L: 624 HEAT TYPE: EEE CODE EDITION: 2012 HEAT BASE: HEAT TYPE: PRO OCCUPANCY: R-3 UNHEATED: #OF STORIES: 2 OCCUPANCY: OTHER: CONST TYPE: 5N GARAGE: SHORELINE: CONST TYPE: SETBACK: DECK: 690 BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: 27047 BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 2 Prop: 2 Total: 2 Total: 2 Routing Date: Type Amount Paid By: Date: Receipt: Approv Permit $1,797.00 SRE 03/31/15 154304 APPROVED Plan Check $1,168.05 SRE 03/31/15 154304 JUN 1 ! 2015 State Building Code $4.50 SRE 03/31/15 154304 Potable Water Application $68.00 SRE 03/31/15 154304 Jefferson County DCG Plan Check $78.00 NEW 06/17/15 156199 Total: $3,115.55 11/f,icmnr4A,la}n1fnrmc\ RI n Ann RI,1 r..+ A/17/9(11F • 0 4goN co DEPARTMENT OF COMMUNITY DEVELOPMENT 4,�� 6r, 621 Sheridan Street,Port Townsend,WA 98368 W Tel:360379.440 I Fax:360.379.4431 ti Web:wvww.co.ietferson.wa.us/communitvdevelopment E-mail:dcd(tt>co.iefferson.wa.us �1,skI N Cs`s9 PERMIT FEES WORKSHEET Name Ann Matsonami Parcel# 963900023 Estimated Cost of Project $210,000.00 Permit# bld15-00103 Building Base Fees Building Base $1,797.00 Plan Check Review $1,168.05 Land Use Review $234.00 Septic Review $86.00 Potable Water $109.00 Technology/Scan $19.50 State Fee $4.50 Other Fees Shoreline Exemption $546.00 Zoning DEMO $78.00 Zoning E/H Demo $86.00 New Address Public Works Scanning DEMO $19.50 Total Fees $4,147.55 Office Use Only Receipt Number: Cash/Check/CC: Date: Prescriptive Energy Code Comp a for All Climate Zones in Washington. Project Information Contact Information NEW RESIDENCE FOR MATSUNAMI VERN PETERS 190 BEEMILL ROAD 360-477-1053 BRINNON, WA This project will use the requirements of the Prescriptive Path below and incorporate the the minimum values listed. In addition, based on the size of the structure,the appropriate number of additional credits are checked as chosen by the permit applicant. l I Authorized Representative Date 1/ �/ 5 All Climate nes R-Values U-Factors Fenestration U-Factor° n/a 0.30 n_os3 _____. Skylight U-Factor n/a 0.50 Glazed Fenestration SHGCh'e n/a n/a MAl 3 1 2015 Ceiling 49 0.026 Wood Frame Wallg.KI 21 int 0.056 �f E pN Mass Wall R-Value' 21/21h 0.056 {V DEVELOPMENT Floor 309 0.029 Below Grade Wall`k 10/15/21 int+TB 0.042 Slab°R-Value& Depth 10, 2 ft n/a *Table R402.1.1 and Table R402.1.3 Footnotes included on Page 2. DEPT.01FCFfOMM Each dwelling unit in one and two-family dwellings and townhouses,as defined in Section 101.2 of the International Residential Code shall comply with sufficient options from Table R406.2 so as to achieve the following minimum number of credits: 1. Small Dwelling Unit: 0.5 points Dwelling units less than 1500 square feet in conditioned floor area with less than 300 square feet of fenestration area. Additions to existing building that are less than 750 square feet of heated floor area. O 2. Medium Dwelling Unit: 1.5 points All dwelling units that are not included in#1 or#3, including additions over 750 square feet. ❑ 3. Large Dwelling Unit: 2.5 points Dwelling units exceeding 5000 square feet of conditioned floor area. Table R406.2 Summary Option Description Credit(s) la Efficient Building Envelope la 0.5 ❑ 1b Efficient Building Envelope lb 1.0 ❑ lc Efficient Building Envelope 1c 2.0 ❑ 2a Air Leakage Control and Efficient Ventilation 2a 0.5 ❑ 2b Air Leakage Control and Efficient Ventilation 2b 1.0 ❑ 2c Air Leakage Control and Efficient Ventilation 2c 1.5 ❑ 3a High Efficiency HVAC 3a 0.5 ❑ 3b High Efficiency HVAC 3b 1.0 ❑ 3c High Efficiency HVAC 3c 2.0 ❑ 3d High Efficiency HVAC 3d 1.0 CI 1.0 4 High Efficiency HVAC Distribution System 1.0 ❑ 5a Efficient Water Heating 0.5 CI 0.5 5b Efficient Water Heating 1.5 ❑ 6 Renewable Electric Energy 0.5 *1200 kwh 0.0 Total Credits 1.50 *Please refer to Table R406.2 for complete option descriptions htt_pi8www.energy.wsu.edu/Document5j2012%20Res%20Ener_gygdf Table R402.1.1 Footnotes • For SI: 1 foot .= 304.8 mm, ci .= continuous insulation, int .= intermediate framing. a R-values are minimums. U-factors and SHGC are maximums. When insulation is installed in a cavity which is less than the label or design thickness of the insulation,the compressed R-value of the insulation from Appendix Table A101.4 shall not be less than the R-value specified in the table. b The fenestration U-factor column excludes skylights.The SHGC column applies to all glazed fenestration. Exception: Skylights may be excluded from glazed fenestration SHGC requirements in Climate Zones 1 through 3 where the SHGC for such skylights does not exceed 0.30. ` "10/15/21.+TB" means R-10 continuous insulation on the exterior of the wall, or R-15 on the continuous insulation on the interior of the wall, or R-21 cavity insulation plus a thermal break between the slab and the basement wall at the interior of the basement wall. "10/15/21.+TB" shall be permitted to be met with R-13 cavity insulation on the interior of the basement wall plus R-5 continuous insulation on the interior or exterior of the wall. "10/13" means R-10 continuous insulation on the interior or exterior of the home or R- 13 cavity insulation at the interior of the basement wall. "TB" means thermal break between floor slab and basement wall. d R-10 continuous insulation is required under heated slab on grade floors. See R402.2.9.1. e There are no SHGC requirements in the Marine Zone. Basement wall insulation is not required in warm-humid locations as defined by Figure R301.1 and Table R301.1. g Reserved. n First value is cavity insulation, second is continuous insulation or insulated siding, so "13.+5" means R-13 cavity insulation plus R-5 continuous insulation or insulated siding. If structural sheathing covers 40 percent or less of the exterior, continuous insulation R-value shall be permitted to be reduced by no more than R-3 in the locations where structural sheathing is used to maintain a consistent total sheathing thickness. 'The second R-value applies when more than half the insulation is on the interior of the mass wall. i For single rafter-or joist-vaulted ceilings, the insulation may be reduced to R-38. k Int. (intermediate framing) denotes standard framing 16 inches on center with headers insulated with a minimum of R-10 insulation. Log and solid timber walls with a minimum average thickness of 3.5 inches are exempt from this insulation requirement. Table R402.1.3 Footnote a Nonfenestration U-factors shall be obtained from measurement, calculation or an approved source or as specified in Section R402.1.3. • w Glazing Schedule Project Information Contact Information NEW RESIDENCE FOR MATSUNAMI VERN PETERS 190 BEE MILL ROAD 360-477-1053 BRINNON, WA R402.3.3 Exception (15 sq. ft. max.) Vertical Glazing (Windows and glazed doors) Plan Component Glazing Width Height Glazing ID Description Ref. U-factor Qt. Feet Inch Feet Inch Area UA 2ND 2038 PIC 0.30 2 2 3 8 147 4.40 2ND 2638 CSMNT 0.30 3 2 6 3 8 27.5 8.25 2ND 2640 SL 0.30 2 2 6 4 20.0 6.00 2ND 4040 SL 0.30 2 4 4 32.0 9.60 1ST 3650 SL 0.30 2 3 6 5 35.0 10.50 1ST 3068 DOOR 0.30 1 3 ° 6 8 20.0 6.00 1ST 2640 SL 0.30 2 2 6 4 20.0 6.00 1ST 2630 SL 0.30 1 2 6 3 7.5 2.25 1ST 2620 SL 0.30 2 2 6 2 10.0 3.00 1ST 3650 PIC 0.30 2 3 6 5 35.0 10.50 1ST 3650 SL 0.30 1 3 6 5 17.5 5.25 1ST 3620 SLOPED 0.30 1 3 6 2 7.0 2.10 1ST 3633 SLOPED 0.30 1 3 6 3 3 11.4 3.41 1ST 3646 SLOPED 0.30 1 3 6 4 6 15.8 4.73 1ST 3046 SLOPED 0.30 1 3 6 4 6 15.8 4.73 1ST 3068 DOOR 0.30 1 3 ° 6 8 20.0 6.00 1ST 6036 SL 0.30 1 6 ° 3 6 21.0 6.30 1ST 6026 SLOPED 0.30 1 6 2 6 15.0 4.50 1ST 3036 SH 0.30 2 3 0 3 6 21.0 6.30 1ST 3068 DOOR 0.30 1 3 6 8 20.0 6.00 1ST 2068 PIC 0.30 1 2 6 8 13.3 4.00 2ND 2630 SLIDER 0.30 1 2 6 3 7.5 2.25 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0 • 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 0.0 0.00 Sum of Area and UA 406.9 122.06 Area Weighted U = UA/Area 0.30 • 4 Simple Heating System Size: Washington State A This heating system sizing calculator is based on the Prescriptive Requirements of the 2012 Washington State EnergyCode(WSEC)and ACCA Manuals J and S.This calculator will calculate heating loads only.ACCA procedures for sizing cooling systems should be used to determine cooling loads. The glazing(window)and door portion of this calculator assumes the installed glazing and door products have an area weighted average U-factor of 0.30. The incorporated insulation requirements are the minimum prescriptive amounts specified by the 2012 WSEC. Please fill out all of the green drop-downs and boxes that are applicable to your project.As you make selections in the drop-downs for each section, some values will be calculated for you.If you do not see the selection you need in the drop-down options,please call the WSU Energy Extension Program at(360)956-2042 for assistance. • Project Information Contact Information SINGLE FAMILY RESIDENCE FOR MATSUNAMI VERN PETERS 190 BEE MILL ROAD 360-477-1053 BRINNON,WA Heating System Type: OA Other Systems ®Heat Pump To see detailed instructions for each section,place your cursor on the word"Instructions". Design Temperature Instructions Design Temperature Difference(AT) 47 Quilcene 2 SW AT Indoor(70 degrees)-Outdoor Design Temp Area of Building Conditioned Floor Area Instructions Conditioned Floor Area(sq ft) 1,672 Average Ceiling Height Conditioned Volume Instructions Average Ceiling Height(ft) 9.3 15,600 Glazing and Doors U-Factor X Area = UA Instructions 0.30 407 122.10 Skylights U-Factor X Area = UA Instructions 0.50 0 --- Insulation Attic U-Factor X Area = UA Instructions -_ No selection -- Single Rafter or Joist Vaulted Ceilings U-Factor X Area UA Instructions - 0.027 1,672 45.14 Above Grade Walls rse„r,gure 1) U-Factor X Area UA Instructions R it Intermediate 0.056 737 41.27 Floors U-Factor X Area UA InstructionsR-3a A 0.029 1,672 48.49 Below Grade Walls(see Figure ti U-Factor X Area UA Instructions No Below Grade Walls in the project. V Slab Below Grade(see FigureI) F-Factor X Length UA Instructions No Slab Below Grade in this project V Slab on Grade(seeFigure1) F-Factor X Length UA Instructions 65 No Slab on Grade in this project. _ Location of Ducts • Instructions Duct Leakage Coefficient hi No Ducts t• • 1.00 Sum of UA 257.00 Envelope Heat Load 12,079 Btu l Hour Figure 1. Sum of UAXST Air Leakage Heat Load 7,918 Btu/Hour Volume 0.6 X AT X.018 Above Grade Building Design Heat Load 19,998 Btu/Hour Air Leakage+Envelope Heat Loss Building and Duct Heat Load 19,998 Btu l Hour Ducts in unconditioned space:Sum of Building Heat Loss X 1.10 Ducts in conditioned space:Sum of Building Heat Loss X 1 Maximum Heat Equipment Output 24,997 Btu/Hour Building and Duct Heat Loss X 1.40 for Forced Air Furnace Building and Duct Heat Loss X 1.25 for Heat Pump (07/01/13) • • ,,4 ON oG� DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street,Port Townsend,W.\98368 Tel:360.379.4450 I Fax:360.379.4451 0 Web:www.co.iefferson.wa.us/eommunitvdcvclopment (3&_C))S -- 13 E-mail:dcd@co.iefferson.wa.us ✓/ �SNIN( O PERMIT APPLICATIONnEOEUVE0 Steps in the Permit Process: I I n I OR 31 2015 -Review application checklist to ensure all information is completed prior to submitting appItttIHHHt[b -Make sure septic has been applied for and water availability has been proven. I JEFFERSON COUNTY -Make an appointment to meet with the Permit Technician by calling 360-379-4450. nFP1.OF COMhIUNIIYDEVELOPMFNT -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: 963-900-023 Site Address and/or Directions to Property:190 BEE MILL ROAD,BRINNON Access(name of street(s)) from which access will be gained: BEE MILL ROAD Present use of property: RESIDENTIAL - SINGLE FAMILY Description of Work(include proposed uses): DEMOLISH AND REMOVE EXISTING MOBILE HOME AND CONSTRUCT NEW SINGLE FAMILY RESIDENCE (2 STORY) Wastewater-Sewage Disposal This property is served by Port Townsend of 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#: SEP13-00116 Community Septic Name of System: Case#: Are other residences connected to the septic system? NO Additions or repairs to sewage system: NONE; EXISTING SYSTEM WILL BE REPLACED PER PERMIT Is it a complete or partial system installation: Complete _ Partial — — Has a reserve drainfield been designated? Yes —✓— No Date of Last Operations&Maintenance check: NOT BUILT YET Attach last report to application Describe or attach any drainfield easements,covenants or notices on title, which may impact the property: NONE Pcrma \pplicarIr n Page I 42 The authorized agent/representative is the primary contact for all project related questions and correspondence. The County will mail/ e-mail requests and informationn about the application to the authorized agent/rcpcntative and will copy(cc) the.ownernoted below. The authorized agent/representative Is reslxinsible for couuurxs catmg the information to all patties involved with the application. It is the responsibility of the authorized agent/representative and owner to ensure their mailbox accepts County enstil_lLc,County email is not blocked or sent to "junk mail")_ Applicant/Property Owner information Property Owner: Name: ANN MATSUNAMI Address: 1650 LILIHA ST. #201 HONOLULU, HI 96817 Phone#: 808-595-6600 E-mail Address: ann@padgroup.com Please contact thorized Agent/Representative with project info.(select only one). Property Owner Signature: 1/Z.Ze ,(kui{,0— Date: 1/z Note: Far projects with multiple owners,Ittach a separate sheet with each owner(*)information and signatures. Applicant: Authorized Agent/Representative(tr Omer than owned Name: VERN PETERS Address: Phone#: 360-477-1053 E-mail Address: Professional: is this an Authorized Agent/Representative for this project? NO YES 1 Engineer 1 Architect Surveyor Contractor Consultant Name: ZENOVIC &ASSOCIATES, INC. Address: 301 EAST 6TH STREET. SUITE#1 PORT ANGELES, WA 98362 Phone#: 360-417-0501 E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor _ Consultant Name: Address: Phone#: E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant Name: Address: - --.. Phone It: E-mail Address: ' Professional: is this an Authorized Agent/Representative for this project? NO YES Engineer Architect Surveyor Contractor Consultant I Name: Address: Phone#: E-mail Address: Attach additional pages if necessary 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: �So co DEPARTMENT OF COMMUNITY DEVE V' 621 Sheridan Street,Port Townsend,WA 98368 3 1 2015 I' 2, Tel:360.379.4350 ! Fax:360.379.4451 j I �A� -C \N'eb:v.r w.co.Jefferson.wa.us/communitvdevelopment i 'I E-mail:dcd@co.jefferson.wa.us { J ,;(111N11 f COMti'i �E�JELOPMENT I NCs�� SUPPLEMENTAL APPLICATION -'_O DETERMINATION OF ADEQUATE POTABLE WATER Owner Name: AAA Nk-Acovv►a AA i Parcel No. 1I;13-Wj- 023 0o Site Address: l°1O B — Mtt_c aolvb f -eat 14 OW Water Source Existing Proposed Attach Copies of: 1) Well Logs Private well (if no log report on file,a 1 hr stabilization test may be substituted.) 2) Lab analysis tested within 3 years of application. -Total Coliform, Nitrate-N,Chloride 2-Party Well Items above AND recorded Operations& Maintenance agreement and recorded Easement. Alternative Provide justification and design per Jefferson County System: Environmental Health policy 97-01 www.jeffersoncountypublichealth.org/pdf/Policy_97-01_Rainwater Collection.pdf Valid Water Right Generally applies to springs, attach copy. Permit: Public Water: 1/' Name of Water Provider: (log (aw.wt7n t1y(',)„p -Submit Water Availability Notification form completed by your water purveyor. NOTE: If any of the above utilities need to be installed and disturbance will occur in a public maintained or unmaintained County road and/or Right-of-Way easement, then a Right-of-Way application will be needed. Resolution#99-90 requires building permit applications to provide evidence of an adequate potable water supply per the conditions of RCW 19.27.097 and the Guidelines for Determining Water Availability for New Buildings. 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, her or its 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 application 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 intent to enter upon the property for visits related to this application and subsequent pe mit issuance. Signature: Print Name: Gktalft 14k •ltrtorn. Date: 3/31/15- FOR (3111'5FOR OFF E USE ONLY 1) Water Right Permit# 3)Individual Well 2)Public Water Supply WS ID# Meets Water Quality Standards? Yes No I n Compliance Yes No WRIA 17 Subbasin SIPZ -Coastal/Moderate/High Yes No Based upon information provided by the applicant,it appears that the potable water supply: Meets Conditionally Meets Does not Meet I �oN J °, DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Tercet,Port'lownsend,A\rA 9836S -< Tel:360.3-9.430 Fax:3603'9.4431 Wei):www.co.lefferson.wa.us/communitydevelopment dcdrdco.jefferson.wa.us 9S�JNGO WATER AVAILABILITY NOTIFICATION PUBLIC WATER SYSTEM TO: Jefferson County Environmental Health Department FROM: (Water System Name) System Operator: State ID Number: Total connections for which system is approved: Number of service connections existing(in use): Number of service connections committed: Date and results of most recent water bacteriological analysis: / / The water system is capable of and will supply potable water to the following location: Assessor's Parcel ID#: Legal Description: Site Address: Operator Signature: Date: / / EXPIRATION DATE OF THIS SERVICE COMMITMENT: / /_ I I. „ON co DEPARTMENT OF COMMUNITY DEVELOPMENT W �,1, 621 Sheridan Street,Port Townsend,WA 98368 ti ,�� Tel:360.379.4450 I Fax:360.379.4451 qs7� WebE-mail: .cto.ieffetson.wa.us/c ommunindecelopment ~ co.jefferson.wa.us PERMIT FEES WORKSHEET Name Ann Matsonami Parcel # 963900023 Estimated Cost of Project $210,000.00 Permit# bId15-00103 Building Base Fees Building Base $1,797.00 Plan Check Review $1,168.05 Land Use Review $234.00 Septic Review $86.00 Potable Water $109.00 Technology/Scan $19.50 State Fee $4.50 Other Fees Shoreline Exemption $546.00 Zoning Zoning New Address Public Works 3964.05 .0 � Total Fees $ , ...g \, ,\ Office Use Only -- .)'1', '�� 5) �f 0 Receipt Number: U1 Cash/Check/CC: MPS\ N , Date: \ �, o• \ G G • • I SON 0 DEPARTMENT dF COMMUNITY DEVELOPMENT u7�� 6215herlrJan Street,Port Townsend;WA 98368 Tel 360.379.4450 I Fax:360.379.4451 ' '< Web:www,49..ig•fr sQzpa usjtmu.•aItyd_ veloaT,ga F-mall; c �A2 Cb.J Q Tigre o ruw:,S6 !x WATER AVAILABILITY NOTIFICATION PUBLIC WATER SYSTEM TO: Jefferson County Environmental Health Department FROM: 'AC- x'5 C-1)‘") ("1"C 1LL `T'1 CLI-112) (Water System Name) System Operator: ' P3( PCM CO 3) State ID Number: 7-q-t Total connections for which system 1s approved: . 2..3 Number of service connections existing(in use►: Number of service connections committed r+ Date and results of most recent Water bacteriological analysis: 02 / / LS- rielSeroc E The CKS:v4 Cove. C'ENAMLWLVY uES water system is capable of and will supply potable water to the following location: Assessor's Parcel ID#: dlCO - ° OP — O Legal Description: R7T O' LDY' W ` 1N) cxxArc_ rz ie— 66C. ?3 -amp. Z( fJ: gO GI 2 ck.) u 0 ,M • Site Address:. y c \3€ -, cc 4,1 GO`€.. LAY' ' ( Operator Signature Date: j //1 EXPIRATION DATE OF THIS SERVICE COMMITMENT; _/ I __ Revimd 12/10/14 • ikH :"teh riaszlae, , • ~ . . Water Source Existing Proposed Attach Copies of: - _ 1) Well Logs Private Well (If no log report on file,a 1 hr stabilisation test may be substituted.) 2) Lab analysis tested within 3 years of application. -Total Coliform, Nitrate-N, Chloride 2-Party Well Items above AND recorded Operations&Maintenance agreement and recorded Easement. Alternathie Provide justification and design per.Jeffersbn County System: Environmental Health policy 97-01 http://www.jeffersoncountypublIchealth.org/pdf/Poky_97- 01 Rainwater Collection.pdf Valid Water Right Generally appiles to springs,attach copy. Permit: Public Water. }C-. Name of Water Provider: at.44' 1 Cd/ _ OWN1l. GGGz Submit Water Availability Notification form completed by Z 7o y 76- your water purveyor: • NOTE: If any of the above utilities need to be installed and disturbance will occur In a public maintained or unmaintalned _a/A.R.) road antILE iaight•Of•Way easement,then a•Right-of•Way application will be needed. w. Resokution#99.90 requires building permit appiicetlons to provide evidence of an adequate potable watersupply per the conditions of RCw 19.27.097 and the Guldsllrres for DaterminM9 Water Availabilityfor Nein 8blidings.t4aigww;r_gte1e, stcommitOoners. ORO USE nw"'..''. 1 Y t tes ill t P mIt* 4 i lhf(ilrVRf4d1l W11i. ~ 2)PublIc WaiN Sopipiyl S lb Meets w QualityStandatdaf` :;��,;... No Yes _ ., WFttA 7Si, n Y x m�tnplianbN /,1._� ., ! �'i-Coask t�IM1!derMe islr[ • q•, TCM1I eduptphlnfdiXliitfpnpf�kkJ byteapplit:Mnt Itippe'arat�lattthepot bIa�wateI ppiy:, Y Meu s ,- -,, Cot>dt4011ly Meets floras nbl Meets r. i...;r." .:',4'...-.." ••••:•:!• •1""t'.:.,''" '.. ........••.,, ... • ' •...• • • - --.:',1'..--: 1•••••• •..... . - - . •• • .. . . . . , . . .• . .• , •-•-..• ::,.-:.• .4•6; .;.:...• ••.., :-. ,•,::•••16iy•i3;; 0iiiiiiI..',...,.••', , •••-' \••••• •• ' „I'SSV•••••ri.buts0•;••vidAg 21.6...••• . . • • , .... i. :.' ''''...'• -..! iiiim•jtonext.ststc, • ••060)-1"451.41:•. "..• •' .• • .••, ''• 'i • •.• : • •COLOORMOAttEilliA ANALiealti,.:. • • ;.• ••::'..;:•."1 i' . i •0164tipie.,C,1:111iiiiiii::;',e''•••• •••:Iliiii•••tithoii"":-•:.: 4 ;1•i''.1-• :4 C • •••• .'...:,.:,z r• • • • -• . ••••••:f•••••.•••,;,. '10.0.1:**k.-:5.':-.. :•• ::.' .. • . ' I: •• .3 •.i:•:1,,,.... 1:::.•.•/..•.5-7' •. .... ••: • . •• ..Aill,..... .,„.„... .. . • , . - .........,, 1, •. :Atrit•,:...•.F-.Difj. .•':"Iii,":'••••••'':••:••••••••:::., .......:4. ...., :..• '••-;;;:.•:,,,%:?°F•44114Att,0"1).......','•••1 . . . . - „- ..lype of 0ii.k.ff.8silektctaiakiiiitifiii1iOt'':,;::.;y..1.::.• -:'..'•.:•.:::::7.' ".' ,..:...:‘.°,..: .'..2.::::.:::i..:, .:'....'. l'',........::,-, i*iir. .......'. ': ': i. primp•,4 and,66011,Syttenis,7!Tvyefar',W,terfaditiiiiiiiiittgoryl}:•.::.• ,:,:•••••:,.‘• ' -1 . 10tf• • -2.- '-'t •••! ...''''..• 44'' '±1•;...":.S.', .. • • ,. . ],',,...::.."41,0,8e)<14::::,r•)V.,C Chii' 4•4'..: '••i; •,,..• • •V. •:• •• •••CctPt ''-. ..•' • ' '' '.•'-'T . ' ..". ':•' •• . •.• .. "..6... . . °t0 Ph6iii.4':•-c5.(b.'i44•41ekile,:..,''71 .411.:FtlarlE1 .'.: 1.-' . ' ::• .':••." '•••' I. :....:1 i • •elo,Pb0013;(,:' '..)•:'•' ...."•: ...':i••: .., .•!*•47'.:"."•:"., •••::;,""I l• : ,..:.. •.:0:en-cii*iicdRififfieirithitiO•ifititift.60P6' ,.117:''71'; ••!• , ;•::-.1 ; ! : . ••• ' ...,• , . ::••::- : '....,. .;•;.•-•;...:tkiti.:IVI.E.I.Envi4. :-.-, ..,,:::•.:,;:,:- ..;-•:, 1 . : — • • •-•:::••,.•..•••••.,,:•?.,,.:;,.;•.::... ,•:-4485,040,„SEV.VLUIF543-•:.: •..•.?• .' i • .... - -L7L .--7 '-•, • ,..43finilo.lizsApiA4902126,---. T.:' . ..• • 1 . • ,•• • • :smotoNfoomAttit •-•i•• • ....•••••• • --:•:. •• : ..1 . . . ... • samiaoroted:bitrigoo••• _...„..,,,•••:•.•••.••:.-.....::....••••.• .,:-... • ..• • ...,.:,•,...- ••.•:...... ,•.,.; . --.-• ',••••••• - .• • ,._-;.•••••••:::;.;iacii.• •-•)..41,.:.•:-, • ••••;:. .... ... ..... -:.:.... .....z ..."---... i .• •;soolklastioyi4 hii,•-**,:044.10 ::•,',40 .• 5r,000*-Par0.0*.. .•...."•:. :4-.4',.:...: 1';1 r'' i : ..4".fi ...:0:44.4..•;:•tAt: i:....;:. •••.y-:..,,:.. ••: ........:'',.• ....••,.;:•.,.,:.S...• ,,...:-.•.,,.:•••••: •••••'.:;:•:::::•;'.;:•,,,...ilc:4:.••••,1!p.i.4i,...i.44,...•1 bi.,4--•••i'",4.•'Art -w:9'.1-i•,• •• •, .: •• •.:• •'••• • • • • •',• • • •-..1,4 ! •• : •TY06:Of'MO*Otil6cfladOnOre0 6;3.(tif#1 fift4441**16*..:.::'':'„:•;1'. Ifrttgaitt:6461**.80010.: • r : '.2.:1413.at:• 16#41:(0*41!iiiS,404 **rr;.'1 . • ,:.;.... -, 6h1o'rihpraii;Yei ..„'":•Fici,,•;•_,,_•„,. : ., •••:••ij plit3t*ii 6;tion.:,;• : , •••••_•:.••, .; •.•,•••::::• . .•„,:i . '.. ': •'chOlikdii0*tolitlf30i.gio:.,,,,,I .''•::•••:.•ti: 1344660014i.43111iO4.14$[:-' •••:.-:.:,:',:ii '• - . • •• '.- " '., '- • -'• •. •.• : • .0'0614 i•.dtio os -:-,:•• ' ."*.••I .3,kaii,Viateit sOiiiei Sitiiille , • .•. '•.• .• • . ..•--..: , - .•• : .••• .. :, -:: ,-: •.7. i •' '• • " ' ' • • •'• ••-• • '••••UitiOrifictiiiitstifiiiiir6 initilbOr.".. -'...•:•••••' ! ' 1 • - tr.Potal.Stictice;',6Vit.Ii tome i.••!-,.•:.••,!,-;4!•:4 .......:-.::•.;.L'.1."*.,;,..Lir•,H,L..- •-4,-•-•t.......1 i .. • 004 ar '• '• : :1,. ., .• • . ..,. ,.1iFiaiiiii001: e•It0initliati...".• :'' ,. 4'1 I ' ! ,. •-. •:` eftlorlhahrid:Yes. ' ,t,kt:,•••", ,..-.'....,..•••,. . .• :.•4 ; ...i."Ribtmkron;tatoroiitaisrai06:1n-yeG:::...•.'",•....e. ,...; • ...••..••,:: ,.--, • .• . . • .••...:;•[ ; 1 ••• .itItioiiireAteitiii,164fitittrriiii:..;'.• -, ....: , :.: • •'' •••' .,, :.::-,.••: .::-.,..-..: :::,..,.• ,:•'.' :Itfiriisiiiiwe ••:. . ni*Ii.in,1Riotiri .,• .....;.•:*i!3143ttiiiiiir :qt4r.:••_ ,;.. :.. .tiAttuSt6.14iLY.,..::,.:,tititiii*GliAtOtt.Ktstiert•::•'..- A0,•*OLvf.:...r. •.•:•A i . .. Outiotattodroabiorotoriotiini!-...T-.•• : . ..,.....':•-, ..,., •• ,.: , , fad" .:•." ::•,:. '.;, '. • ;'....ti.:Li'd'eu'itOlstioi-: :-...l''''''..1.,: .•••:'•,tfl,:•,40.i.abileilt.. ,...'.....•••••'',; •.: "',' '•. . : ..•:'':; '.,.' '.'.i I •'..;d ac.al,calltrit r.:41iiint.2. '. .•1.0.:rRt;-: biti.••::' • '•:., • .... .;. ... .:".•-• '1 : .• - '• pb6imerit•tiiiniili Riiiiiiied;.••. •• ..' • ' - • ' : • - • '• - • ;:: :1 ! • • .',.-14.3•Sample too old 0Oiirs).'.Ctritire: •' •,• ••,:t;I:•. •• •",;•.:'.. ';1 , 1 ......... 1111toPer c000er..,. •:."‘•.., C!1.1',.1.$*41IN ri;::...':.i'-•:•r:,.1:'1 :. ::::::•:,...:.:•:.•....,;s'. .:! •••.:i • , . ',. • . 0!sete!Ial DenOltv Rotit P1eiti Coliiit:.:;- -frid. teo/i : - • •JI0imi.:. ..•..J i• ':'. •.Toti:ba0ronil. - ::-:••.,: .i10.61.:''•,*ItOtt0tri•...2..., ':'''••,;;:.;/,100..'.7 .:•:.:• .:Ji '.' "MOS Cede::•..•: . • ••,. ;......:: •• •:•.••.•:i. ;...,'."•. :,..:'..•'114°.4,0•7".1040!*.•.••••,.,.::.' :'••:•1 i. • ' 46)1-.PA-6:;•._L. ' ..-.—' ••'• '...L,, ;..... 1'...• ,H.'7-..:.:•••. 1.7,;•6...',:j Co%Aolyzad: . : ,. -77.-01".e.ii•;1:;'2'••:-. •'..: : , • Poe 14.)0014.•4711'../.1:1•4; . ..•.':1 amps mum*mom unbarowto1;0 dialt0i.' .'"....!`. • i4b•me°ivy: : :•.7-•••.• .•1 .ij .,:•. 3.'71_,,L):•:..j."-.• • ....• ....• M )7-•;(a 1. I. .. 1 ,.._, •,1 i• 00.14 Png#3111.9113(revlse6 ii41.41) . ••—.6"- --s— . - '''-f. Lib rd,ion -ta •..••.; . • • • - .1 S • ¢SON co DEPARTMENT OF COMMUNITY DEVELOPMENT G 621 Sheridan Street,Port Townsend,WA 95368 Tel:360379.4450 I Fax:360.379.4451 EaEq -G Web:uww.co.Jefferson.wa.us/communiq'decelopment r------�� F�mail:dcd@co.ieffeson.wa.us l `mss I h� SAA 3 12.015 9 h't N G SUPPLEMENTAL APPLICATION RESIDENTIAL OR COMMERCIAL BLDG PERMIT iY nr"'"IT For Department Use Only Receipt#: Dater Related Application#s: Payment#: Site Information Owner Name: A.Kh y{1,0„"01,1 Assessor Tax Parcel#: 02'3 Type of Building New v Replacement Relocated Addition Repair Demolition *A separate permit is required Select One: Single Family Residence ,/ Modular Other list Proposed Building/Project Number of floors 2 #new bedrooms 2. existing 45 total bed 2.. #new bathrooms 2. existing total bath Z Heat Source Select all that apply: Electric r/ Heating Oil Wood Propane ✓ Enter the square footage(sq/ft)that applies in each field: Structure Existing Sq/Ft Proposed Sq/Ft Residential/Commercial Main Floor In4$ Residential/Commercial Second Floor LZ 4 Additional Floors-heated/unheated Basement-unfinished Basement-finished space or habitable Detached Garage-heated/oaf T eat€D I,0o0 Attached Garage-heated/unheated Garage 2nd fl -unfinished storage Garage 2nd fl-finished space or habitable Carport-2 walls or less Deck-uncovered ZSo Covered porch ¢110 Other(shed, barn, pole bldg,etc.) Estimated Cost of Project(Required): $ 2 (Otocz • • • List existing buildings on property(i.e. house,garage,accessory dwelling unit,shed, barn, mobile home,other): All Existing Buildings on Property Use (� D-Ck-4 C A •D�AGw,NF I STD''a Mt& tti lloA a To Le. ck{uaol.ik 4 3 41..,aAodtd6• 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, her or its 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 intent to enter upon the property for visits r lated to this application and subsequent permit issuance. Signature: Print Name:S lvu. UN . Date: 35/4/c Estimated Cost of Project $ 'L to,D0 For Department Use Only Building Base Fees _ Building Base Plan Check Review Land Use Review $228.00 Septic Review $79.00 Potable Water $107.00 Technology/Scan $19.00 State Fee $4.50 Other Fees Shoreline Exemption Zoning Zoning Other New Address Road Approach Total Fees Receipt# Date: Cash/Check/CC: