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Home My WebLink AboutBLD2015-00042 - 01 PERMIT APPLICATION BLD15-00042 BUILDING PERMIT APPLICA ON Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD15-00042 Received Date: 2/2/2015 SITE ADDRESS: 1452 GARDINER BEACH RD SEQUIM, 98382 OWNER: PATRICK KALE PHONE: 818-274-4645 1452 GARDINER BEACH RD SEQUIM WA 98382 SUBDIVISION: Block: Lot: 1 PARCEL NUMBER: 002284020 Section: 28 Township: 30 N Range: 2V1 CONTRACTOR: REED GRIFFIN PHONE: 360-460-4644 GRIFFIN CUSTOM HOMES INC P.O. BOX 3071 SEQUIM WA 98382 Contractor's License GRIFFCH918BW Expires 1/15/2016 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP NEW GARAGE& SHOP WITH 1 BATHROOM- UNHEATED sep06-00457 TYPE OF WORK GAR SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 43,465.00 ADD'L: HEAT TYPE: UH CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: S-1 UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: U SHORELINE: GARAGE: 1,504 CONST TYPE: DECK: 32 SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: 07877 BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $523.00 SRE 02/02/15 154102 Plan Check $339.95 SRE 02/02/15 154102 APPROVED State Building Code $4.50 SRE 02/02/15 154102 Potable Water Application $68.00 SRE 02/02/15 154102 MAR 10 2015 Total: $935.45 Jefferson County DCD \\tidemark\data\forms\F_BLD_App_Bld.rpt 3/10/2015 • • Local Designers The following is a list of licensed designers and professional engineers that have submitted onsite sewage system designs in Jefferson County. This list does not constitute an endorsement of these licensees nor is it all-inclusive. Before contracting with one of these licensees you should confirm that their license is still valid. A state-wide list is available from the Department of Licensing website at: http://www.dol.wa.gov/business/checkstatus.html NAME CITY PHONE Cleaver, Eric Poulsbo (360) 779-5652 Cleaver, Nathan Poulsbo (360) 598-6546 Deeney, Michael Scott Port Angeles/PT (360) 379-2879 Ericsen, Bernt Paul Port Townsend (360) 301-0324 Garcelon, Ron Port Angeles (360) 461-3575 Ghylin, David A Seabeck (360) 830-9699 Godsalve, Jess Port Hadlock (360) 551-9973 Jensen, Dave Seattle (425) 827-3063 Knopf, Eric Poulsbo (360) 779-5233 Left, Rodney Silverdale (360) 698-8488 Martin, Suzanne Chimacum (360) 990-3304 Sorensen, Everett Port Townsend (360) 821-9960 Tahja-Syrett, Toby Shelton (360) 427-0255 H:\WEB\EH-WQ\SEPTIC\Certified Professionals\Local Designers Current List 110314.doc • • �� SON G� DEPARTMENT OFC COMMUNITY DEVELOPMENT w Tel:360.379.4450 I Fax:360.379.4451 .< Web:www.co.ie£ferson.wa.us/communitydevelopment L-mail:dcdla,co.jefferson.wa.us 16'11 t NOC) SUPPLEMENTAL APPLICATION RESIDENTIAL OR COMMERCIAL BLDG PERMIT For Department Use Only Receipt#: Date: Related Application#s: Payment#: Site Information Owner Name: Assessor Tax Parcel#: Type of Building New Replacement Relocated Addition Repair Demolition ,4 •A separate permit is required Select One: Single Family Residence Modular Other list Proposed Building/Project Number of floors #new bedrooms existing total bed # new bathrooms existing total bath Heat Source Select all that apply: Electric Heating Oil Wood Propane Enter the square footage(sq/ft)that applies in each field: Structure Existing Sq/Ft Proposed Sq/Ft Residential/Commercial Main Floor 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.) Estimated Cost of Project (Required): $ S List existing buildings on property (i.e. house,garage, accessory dwelling unit, shed, barn, mobile home, other): All Existing Buildings on Property Use 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 related to this application and subsequent permit issuance. Signature: Print Name: Date: Estimated Cost of Project $ For Department Use Only Building Base Fees Building Base Plan Check Review Land Use Review $234.00 Septic Review $86.00 Potable Water $109.00 Technology/Scan $19.50 State Fee $4.50 Other Fees Shoreline Exemption Zoning Zoning Other New Address Road Approach Total Fees Receipt # Date: Cash/Check/CC: • • ,�50N DEPARTMENT OF COMMUNITY DEVELOP 11 _ • W �,�, 621 Sheridan Street,Port Townsend,AX 98368 � - ��:J i ., ,, 'I'a 360.379.4150 Fax 360.379.4451 ��\ �� •� Web:www.co.ieffersonwams/communitydevelopment , j ; '. 4 1 mail:dcd(d!co.jefferson.wa.us FE6 - 3 2-015 v '9547NG. O PERMIT FEES WORKSHEET ' "`�'�� oviv�l,N. DLVFIdpMf_NT Name Old Fort Townsend Parcel # x5846-z$— Estimated Cost of Project 1452 Gardiner Beach rc Permit# Building Base Fees Building Base $523.00 Plan Check Review $339.95 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 Zoning Stormwater Zoning New Address Public Works Total Fees $1,315.95 Office Use Only Receipt Number: `S 0 2-- Cash/Check/CC: I C.0 Date: 2 2- s - III • �-S ,gON ooe, DEPARTMENT OF COMMUNITY DEVELOPMENT W 621 Sheridan Street,Port Townsend,W A 98368 -< Tel:360.379.4450 I Fax:360.379-4451 r- F Ci V E•Web:www.co. ffetson.wa.us commuai develo 13 G E-mail:dcd(alco.jefferson.wa.us — �i{ '1sk r N�`c°� En — 3 2015 , F PERMIT APPLICATION --y Steps in the Permit Process: r. _� '=� �� -Review application checklist to ensure all information is completed prior to submitting application. r -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: 002-284-020 Site Address and/or Directions to Property: 1452 Gardiner Beach Road Sequim WA, 98382 Access(name of street(s)) from which access will be gained: Old Schoolhouse Road Present use of property: r 1 Description of Work(include proposed uses): Unheated Garage 49.. t Wastewater-Sewage Disposal This property is served by Port Townsend of Port Ludlow sewer system? YES _ — NO —i If not served by sewer identified above, identify type of septic system below: Type of Sewage System Serving Property: 1 Septic Septic Permit#: sep06-00457 Community Septic Name of System: Case#: Are other residences connected to the septic system? no Additions or repairs to sewage system: yes Is it a complete or partial system installation: Complete _✓_ Partial Has a reserve drainfield been designated? Yes _ _ No _ _ Date of Last Operations&Maintenance check: 01/12/15 Attach last report to application Describe or attach any drainfield easements,covenants or notices on title,which may impact the property: 1I The authorized agent/representative is the primary contact for all project-related questions and correspondence. The County ivi.l mail/ e-mail requests and information about the application to the authorized agent/representative allot will copy(liu)othe owner noted below. The authorized agent/representative is responsible for communicating the information to-all parffes htVolved with the application. It is the responsibility of the authorized agent/representative and owner to ensure their mailbox accepts Coin* email(ii.e.,County email is not blocked or sent to"junk mail"). Applicant/Property Owner Information Property Owner: Name: Patrick and Denise Kale Address: 1452 Gardiner Beach Road Phone it _ E-mail Address: Plea 41111tac . f. o • ed Age resentative ith project info. (select only one). Property Owner Signatur:. "IA /Le /`." ` Date: 1/5/15 Note: For projects with multiple o, •ers, ach a separate sheet with each owner(s)information and signatures. Applicant: Authorized Agent/Representative(if otherthan owner) Name: Address: Phone#: E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO Engineer Architect Surveyor Contractor ✓ Consultant Name: Griffin Custom Homes Inc. Reed Griffin Address: P.O. Box 3071 Sequim, WA 98382 Phone#: 360-460-4644 E-mail Address: rjgriff25 @gmail.com 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#: E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? f-----rNO �� fl \/ � Engineer Architect Surveyor Contractor - Consultant Name: Address: Phone#: E-mail Address: Attach additional pages if necessary Y 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: II it • • ,SON C,O <4w G DEPARTMENT OF COMMUNITY DEVE q v •'+ 'C Tel:360.379.4450 � Fax:3 379.445 WA 98368 W Web:aww.co.jefferson.wa,us/communrtydevelopment 4. .. E-mail:dcdna,co.jefferson.wa.us FEB - 3 2015 SUPPLEMENTAL APPLICATION SINGLE FAMILY RESIDENCE PERMIT OR DUP N LYEI9.2ENT For Department Use Only Receipt#: Date: Related Application#s: Payment#: Site Information Owner Name: I p,T COCK Ns,,o � /mac C Assessor Tax Parcel#: Od2-Z E3` -02C Type of Single Family Residence or Duplex New x. Replacement Relocated Addition Repair Demolition *A separate permit is required Select One: Modular Duplex Single Family Residence Proposed Building/Project Number of floors i #new bedrooms existing total bed #new bathrooms existing total bath Heat Source Select all that apply: N/p Electric Heating Oil Wood Propane Enter the square footage(sq/ft)that applies in each field: Structure Existing Sq/Ft Proposed p Sq/Ft Main Floor Second Floor Additional Floors-heated/unheated Basement-unfinished Basement-finished space or habitable Detached Garage-heated/unheated i56 L Attached Garage-heated/unheated Garage 2nd fl-unfinshed storage Garage 2nd fl-finshed space or habitable Carport-2 walls or less Deck-uncovered Covered porch 32 Other(shed, barn, pole bldg,etc.) Estimated Cost of Project(Required): $ 3 y(1)5 • Jeffers ounty Department of Community DevelopmW n 621 Sheridan St, Port Townsend WA 98368, (360)379-4450 APPLICATION FOR DETERMINATION OF ADEQUATE POTABLE WATER SUPPLY Resolution#99-90 requires building permit applicants to provide evidence of an adequate potable water supply. If initial information submitted is not adequate for approval and additional information or work is needed, an hourly rate will be charged accordingly. Name Patrick and Denise Kale Phone 1-818-274-4645 Mailing Address 1452 Gardiner Beach Road, Sequim WA Zip Code 98382 Parcel ID#002-284-020 Subdiv. Block Lot(s) Site Address 1452 Gardiner Beach Road, Sequim WA Zip Code 98382 Type of Structure Garage Check all that ass! Note: Special conditions may apply within Seawater Intrusion Protection Zones. (SIPZ) ■ Alternative system(provide justification and design per Jefferson County Environmental Health policy 97-01) I Valid Water Right Permit(generally applies to springs, attach copy) INApproved Public Water(Submit the attached Water Availability Notification form completed by your water purveyor stating the system is capable of and will supply water.) II Individual Well--attach copy of: 1) Well logs (If no well log report is on file, a 1 hr stabilization test may be substituted) 2) Lab analysis for water quality parameters tested within 3 years of application: -Total coliform -Nitrate-N -Chloride II Two-party Well—items above AND recorded Operation &Maintenance agreement and recorded Easement. By signing the application form,the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. Any material falsehood or any omission of a material fact made by the applicant/owner with respect to this application packet may result in this permit being null and void. I further agree to save, indemnify and hold harmless Jefferson County against all liabilities, judgments, court costs, reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employees, representatives or agents for the purpose of application review and any required later inspections. Access and right of entry to the applicant's property or structure shall be requested and shall occur during regular business hours. Signature E-! "z'°L� - ; � J Date / 7( -/ $ FOR OFFICE USE ONLY 1) Water Right Permit# r 2) Public Water Supply WS ID# In Compliance Yes No 3) Individual Well FEB - 3 7015 Driller Name Date Drilled Depth Production Meets Water Quality Standards Yes No WRIA 17 r{PPIFInpf9FNT SIPZ Yes Circle: Coastal Moderate High No Subbasin Based upon information provided by the applicant, it appears that the potable water supply: meets conditionally meets does not meet the conditions of RCW 19.27.097 and the Guidelines for Determining Water Availability for New Buildings. Application Reviewed by Date Date Fee Receipt# Check# Case#BLD • • Public Utility District #1 Of Jefferson County WATER AVAILABILITY NOTIFICATION Board of Commissioners Barney Burke, District 1 PUBLIC WATER SYSTEM Kenneth A. McMillen, District 2 Wayne G. King, District 3 James G. Parker, Manager To: Jefferson County Environmental Health Department From: Gardiner Water System System Operator(s): Doug Reeder n L VF Sri State ID Number: 07877W I • FEB - 3 2015 Number of existing connections: 128 (Estimated) �!-J J ;ri OoliiNTY Number of permitted connections: 200 !.coV4rdineFVLip�g�rrur Number of committed connections: 150 This water system is capable of; and will supply potable water to the following location: Assessor's Parcel ID# 2-? gy DZo LegalDescription 1-14) V)/011 o r } ?(ot+ LI! /e 1 *** Water Connection is available once all fees/charges have been paid*** Site Address: 1457_ �q r `i ti f IJ e4� let Go A �83sz Signature: Title: GS Q Date: 1/2-6/t5 THIS IS A NON-BINDING STATEMENT OF WATER AVAILABILITY. IT PROVIDES THAT AT THE TIMEOF REQUEST, WATER IS AVAILABLE WITHIN THIS SYSTEM. THIS NOTIFICATIOON IS GOOD FOR ONE YEAR 230 Chimacum Road/P.O. Box 929, Port Hadiock,WA 98339 PH (360) 385-5800 FX(360) 385-5945 FEB - 32015 H '; List existing buildings on property(i.e. house,garage,accessory dwelling unit, shed, barn, mobile home,othet),.._. All Existing Buildings on Property Use Public Health Information Water Source Existing Proposed Attach Copies of: Private well 1) Well Logs(if no log report on file, a 1 hr stabilization test p 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 http://www.jeffersoncountypublichealth.org/pdf/Policy_97- 01_Ra inwater_Collection.pdf Valid Water Right Permit: Generally applies to springs,attach copy. Public Water: Name of Water Provider: --p6D -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.http://www.co.jefferson.wa.us/commissioners 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 related to is application and subsequent permit issuance. Signature': 1 Print Name: <IL c_-11-S> �i?� �'{--,_r -71 Date: / FOR OFFICE USE ONLY 1) Water Right Permit# 3)Individual Well 2)Public Water Supply WS ID# Meets Water Quality Standards? Yes No In 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 1/21/2015 Mold Excavating/Inc. PO Box 179 r Port Hadlock,WA 98339 I�l,_�: _ M ,� 36360-385-0480 E 'ROPERTY INFORMATION FEB - 3 2015 Patrick Kale ' ji■ Location:1452 Gardiner Beach Rd 11 L1 Sequim kJ-LUX COUNTY Tax ID:002284020 kW To Patrick Kale -'T CC'' :alNITY DEVELOPMENT 1452 Gardiner Beach Rd — Use:Residential,Single Family Sequim,WA System Design Flow:360 98382 GENERAL SYSTEM TYPE:Two Pressurzed Beds 10x22.5 Owner Patrick Kale ON ID:SOM06-00457 Fo0 ON-SITE WASTEWATER TREATMENT SYSTEM INSPECTION REPORT Fold Here Here Ins par ted:01/09/2015 - Inspection Type:ROUTINE - Correction Status:No corrections needed Company: Certification-Level 2 Work Performed By: Submitted 01/12/2015 by Shold Excavating Inc. Timothy Johnson Timothy Johnson This 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 The General Site and System Conditions were: Fully Impeded AI Components accessible for maintenance,secure and in good condition: YES Surfacing effluent from any component(including mound seepage): NO Components appear to be watertight-na visual leaks: YES Improper encroachment(roads,buildings,etc.)onto component(s): NO Component settling problems Observed: NO Abnormal pending present for one or more of the disposal cannonade NO Subsrsface components adequately covered YES Owner compliance issues noted WA Site maintenance required(e.g.Landscape maintenance)If yes,describe in comments: NO Occupant corrrptience problem(occupant not operating the system properly). If YES,describe in nobs: NO If deiclen ies were identified on lest inspection were they corrected before or during this inspection? YES (If NO,describe In notes,NA=no deficiencies on last report)! 038 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 dralnfleld was not possible. NO Is the SEP case in a finaled/completed status?(d NO explain In comments) YES ONSITE SEWAGE SYSTEM INSPECTION DETAIL TANK:Septic Tank•2 Cornpar:moat_Manufacturer= Local Manufacturer-Concrete 4000 Gal. Manufacturer. Local Manufacturer r Model:Concrete This component was: Fully Inspected Component appears to be functioning as intended: YES Effluent level within operational limits(if NO explain in comments): YES !i All required baffles in place(N/A=No baffles required): YES Effluent Filter Cleaned(N/A=Not Present): YES Effluent titer/screen needed cleaning on arrival NO Compartment 1 Scum accumulation(Inches,if other specify): 6' • Compartment 1 Sludge accumulation(Inches,if other specify): 4' Compartment 2 Scum accumulation(Inches,if other specify): e• Compartment 2 Sludge accumulation(Inches,if other specify): Pumping needed: NO Approximate Gallons to be pumped(d needed)by Certified Pumper. 0 ReportlD:416739 View inspection reports online at www.onlinerme.com Page 1 of 2 limmenimommomasmaton. Manufacturer. Local Msnufecmrer Modal:Concrete This component was: Fully Inspected Component appears to be functioning as Intended: YES Compartment 1 Scum accumulation(Inches,if other specify): 0• Pump vault screen needed cleaning on arrival N/A Compartment 1 Sludge accumulation(Inches,if other specify): t' Pump Vault Filter cleaned(N/A=not present): NIA Pumping needed: NO Approximate Gallons to be pumped(if needed)by Certified Pumper 0 urnp:Effluent Pump The component was: Fully Inspected Component appears to be functioning as intended: YES Controls functioning: YES Dose setting different than original(If YES,detail in comments) No Dose setting adjusted to meet as-built/record drawing specifications(by the O&M Specialist) NO Tested gallons per minute lbw: 40 •ancl:Control•1 Pump 05-07-0358 Manufacturer:Aquawon This component was: Fully Inspected Panel functioning(including alarm): YES Pump 1:on minutes(override in parentheses-if present): 27 Pump 1:of hours(override In parentheses-if present): 2 hrs. Pump 1:galons per dose(override in parentheses-t present): 20 Pump 1:ETM hours(override in parentheses-if present): 30:24:38 Pump 1:Cycle Count(override in parentheses-it present): 3653 ■ainfield-Pressure Bed 10X22 5 Bed(NORTH; Manufacturer Local Manufacturer This component was: Fully Inspected Component appears to be functioning as Intended: YES Lateral lines flushed: YES • Average squirt height(if performed)(feet,if other specify): 5.5' Pending present?If YES explain in comments: NO Drainfield:Pressure Bed 10X225 Bed!SOUTH/ Manufacturer: Local Manufacturer This component was: Fully Inspected Component appears to be functioning as intended: YES Lateral lines flushed: YES Average squirt height(if performed)(feel;if other specify): 6.5 Pending present?If YES explain in comments: No PW road indicates rwrtea Chrads tkks d ar ones sewage system at the time of visit.In na ways this raper.pia..r .oropersImn or Mum performance_ ReporttD:416739 View inspection reports online at www.onlinerrne.com Page 2 of 2 Griffin Custom Homes Inc Page 1 of 2 • • Home Inicio en Espanol Contact Search L&I 5 A-2 Index Help My Secure 1.8t1 Safety Claims&Insurance Workplace Rights Trades&Licensing Oak Washington State Department of 4.) Labor & industries Griffin Custom Homes Inc Owner or tradesperson P O Box 3071 SEQUIM,INA 98382 Griffin,Reed(JAMES) 360-4604644 Principals CLALLAM County Griffin,Reed(JAMES),PRESIDENT Doing business as Griffin Custom Homes Inc WA UBI No. Business type 602 812 849 Corporation License Verify the contractor's active registration/license/certification(depending on trade)and any past violations. Construction Contractor Active. Meets current requirements. License specialties GENERAL License no. GRIFFCH918BW Effective—expiration 01/1612009—01/16/2017 Bond Lexon Ins Co $12,000.00 Bond account no. 9815453 Received by L&I Effective date 09/21/2012 09/27/2012 Expiration date Until Canceled American Contractors Indem CO $12,000.00 Bond account no. 100140571 Received by L&I Effective date 09/28/2010 09127/2010 Expiration date Until Canceled Bond history Insurance Capitol Specialty Ins Corp $1,000,000.00 Policy no. CS01232604 Received by L&I Effective date 01/09/2015 01/15/2015 Expiration date 01/15/2016 https://secure.lni.wa.gov/verify/Detail.aspx?UBI=602812849&LIC=GRIFFCH9I 8BW&SAW= 2/17/2015 Griffin Custom Homes Inc Page 2 of 2 Insurance history • • Savings No savings accounts during the previous 6 year period. Lawsuits against the bond or savings No lawsuits against the bond or savings accounts during the previous 6 year period. L81 Tax debts No.L&Itaxdebts are recorded for this contractor license during the previous 6 year period,but some debts may be recorded by other agencies. License Violations No license violations during the previous 6 year period. Workers' 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. 075,275-01 Doing business as GRIFFIN CUSTOM HOMES INC Estimated workers reported Quarter 4 of Year 2014"0"Workers L&I account representative T3/DEBRA MODER(360)902-5598-Email:MORE235 @Ini.wa.gov Workplace safety and health No inspections during the previous 6 year period. 0 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=602812849&LIC=GRIFFCH918BW&SAW= 2/17/2015 Parcel Details Page 1 of 2 • • Rrr Jefferson County Home County Info Departments Search Parcel Number: 1002284020 SEARCH Parcel Number: 002284020 Printer Friendly Owner Mailing Address: PATRICK KALE 1452 GARDINER BEACH RD SEQUIM WA98382 Site Address: 1452 GARDINER BEACH RD SEQUIM 98382 Section: 28 School District: Sequim (323) Qtr Section: SE1/4 Fire Dist: Sequim (8) Township: 30N Tax Status: Taxable Range: 2W Tax Code: 0781 Planning area: Discovery Bay (5) Sewer: Drainage: Bank: View 1:VIEW - Territorial View 2: Zoning 1: Zoning 2: Zoning 3: Sub Division: Assessor's Land Use Code: 1100 - Residential - Single Unit Property Description: HANLON SHORT PLAT LOT 1 SUBJ/OPEN SPACE TRACT Tax,A/V, Sales, Photos, and Permit Data Blda Data Map Parcel plats &Surveys Septic Monitoring Info Jefferson County HOME I COUNTY INFO I DEPARTMENTS I SEARCH Best viewed with Microsoft Internet Explorer 6.0 or later 66 Windows- Mac http://www.co,jefferson.wa.us/assessors/parcel/parceldetail.asp?Parcel NO=002284020 2/17/2015 • • BUILDING PERMIT APPLICATIui' BLD15-00042 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD15-00042 Received Date: 2/2/2015 SITE ADDRESS: 1452 GARDINER BEACH RD SEQUIM, 98382 OWNER: PATRICK KALE PHONE: 818-274-4645 1452 GARDINER BEACH RD SEQUIM WA 98382 SUBDIVISION: Block: Lot: 1 PARCEL NUMBER: 002284020 Section: 28 Township: 30 N Range: 2V1 CONTRACTOR: REED GRIFFIN PHONE: 360-460-4644 GRIFFIN CUSTOM HOMES INC P.O. BOX 3071 SEQUIM WA 98382 Contractor's License GRIFFCH918BW Expires 1/15/2016 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIO! NEW GARAGE WITH 1 BATHROOM- UNHEATED TYPE OF WORK GAR SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 43,465.00 ADD'L: HEAT TYPE: UH CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: SHORELINE: GARAGE: 1,504 CONST TYPE: DECK: 32 SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: 07877 n /� BEDROOMS: BATHROOMS: it LC F l! V Exist: Exist: — - Prop: Prop: Total: Total: IMAR - 9 2015 Routing Date: u' -__1ErrLnaO?; uUNTY COMMUNITY DEVELOPMENT Type Amount Paid By: Date: Receipt: Approved/Date Permit $523.00 SRE 02/02/15 154102 Plan Check $339.95 SRE 02/02/15 154102 o Sec, State Building Code $4.50 SRE 02/02/15 154102 )(c rPotable Water Application $68.00 SRE 02/02/15 154102 Ia Total: $935.45 F n