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Home My WebLink AboutBLD2015-00008 - 01 PERMIT APPLICATION • • BUILDING PERMIT APPLICATION Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD15-00008 Received Date: 1/7/2015 SITE ADDRESS: 63 FOUR CORNERS RD PORT TOWNSEND, 98368 OWNER: JEFFERSON TRANSIT PHONE: 360-385-4777 1615 W SIMS WAY PORT TOWNSEND WA 98368-3090 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001332009 Section: 33 Township: 30 N Range: 1V1 CONTRACTOR: KNIGHT FIRE PROTECTION INC PHONE: (360)417-0505 9702 LATHROP INDUSTRIAL DR SW OLYMPIA WA 98512-9188 Contractor's License KNIGHTFP044LK Expires 5/24/2014 REPRESENTATIVE: SAMATHA TRONE-CT OF PORT TOWNSEND PHONE: 360-344-4605 250 MADISON ST PORT TOWNSEND WA 98368 PROJECT DESCRIPTIOI NEW FIRE SPRINKLER SPRINKLER SYSTEM THIS IS A DEFFERED SUBMITTAL FOR BLD14-00004 TYPE OF WORK COM SQUARE FOOTAGE: COMMERCIAL: TYPE OF IMP NEW MAIN: INDUSTRIAL: VALUATION 570,792.00 ADD'L: HEAT TYPE: 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: NUMBER OF EMPLOYEES: WATER SYSTEM: BATHROOMS: Exist: Prop: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $577.00 SRE 01/07/15 154016 APPROVED Plan Check S375.05 SRE 01/07/15 154016 APPROVED Total: $952.05 JAN 15 2015 Jefferson County DCD \\tidemark\data\forms\F_B LD_App_Bld.rpt 1/7/2015 I i • S°N . . , , : • T OF COMMUNITY DEVELOPMENT 621 ' Alin 7•°. rt ownsend,WA 98368 ,--'i� - Tel:360.3 '.- ": •C60.379.4451 Web: ...s .c...-f, ,.J • oe , '._ev lo•mcnt = i i; '. JAN st d:. .m !.•7 u (0.1P �9S41INO ' ' , 15L-101Li° :,',.PERMIT ' PLICATION C-111: 010)0 . I IY 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: 001332009 Site Address and/or Directions to Property: 63 Four Corners Rd, Port Townsend, WA 98368 Access(name of street(s)) from which access will be gained: Four Corners Rd Present use of property: New construction. vCrO Description of Work(include proposed uses): Install new automatic fire sprinkler system for new transit facility. �LtiId;,, , ' REIN - 00250y R Wastewater-Sewage Disposal 1 ‘ This property is served by Port Townsend of Port Ludlow sewer system? YES NO — — _ _ 0 If not served by sewer identified above,identify type of septic system below: 9 Type of Sewage System Serving Property: Septic Septic Permit#: — Community Septic Name of System: Case#: Are other residences connected to the septic system? Additions or repairs to sewage system: 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: Permit Applleaeion Page 1 oF2 • • 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: — Name: Jefferson Transit Address: 1615 West Sims Way, Port Townsend, WA 98368 Phone#: (360) 385-4777 E-mail'Address: Please contact Authorized Agent/Representative with project info. (select only one). Property Owner Signature: Date: Note: For projects with multiple owners,attach a separate sheet with each owner(s)information and signatures. Applicant: Authorized Agent/Representative(if other than owner) Name: Knight Fire Protection, Inc Address: 9702 Lathrop Industrial Drive SW, Olympia, WA 98512 Phone#: (360) 786-8606 E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO, I/ YES Engineer Architect Surveyor ✓ Contractor Consultant Name: Chris Wilson at Knight Fire Address: 9702 Lathrop Industrial Drive SW, Olympia, WA 98512 Phone#: (360) 786-8606 E-mail Address: Chris @Knightfire.net 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? NO YES Engineer Architect Surveyor Contractor Consultant 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: � c in/�h f i A.J) Ye nit�PPlican,,an Page 2 of 2 I (,,,--ON • _0 4 06. DEPARTMENT OF COMMUNITY DE LOPMENT 11 v� ry, 1 -a 621 Sheridan Street,Port Townsend,WA 98368 �I '-% ,-C Tel:360.379.4450 I Fax:360.379.4451 Web:www.co.jefferson.wa.us/comrnunitvdevelopment JAN - 7 2015 li I E-mail:dcd(co.jefferson.wa.us JJ 1 i ��`sNI NG�� __iI SUPPLEMENTAL APPLICATION ..L'_U TY C iillTY DEVELOPMENT RESIDENTIAL OR COMMERCIAL BLDG PERMIT For Department Use Only Receipt#: Date: Related Application#s: Payment it Site Information Owner Name: 5i,U'Icr(,1 Assessor Tax Parcel#: C(1 c � � �j 171 U -CYT� 1 -,3�,� Type of Building New Replacement Relocated _ _ Addition Repair — — Demolition _ _ * 'A separate permit is required Select One: Single Family Residence _N I Modular Other v Proposed Building/Project /A /` Number of floors # new bedrooms existing total bed # new bathrooms existing total bath Heat Source Select all that apply: r)/P\ 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 or deck Other(shed, barn, pole bldg, etc.) Estimated Cost of Project (Required): $ 50 , 711„.. .. -t • • List existing buildings on property (i.e. house,garage, accessory dwelling unit, shed, barn, mobile home, other): 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 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_Rainwater_Collection.pdf Valid Water Right Permit: Generally applies to springs, attach copy. Public Water: Name of Water Provider: -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 this application and subsequent permit issuance. Signature: Print Name: Date: FOR OFFICE USE ONLY 1) Water Right Permit II 3)Individual Well 2)Public Water Supply WS ID#t 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 • • ��$0N e DEPARTMENT OF COMMUNITY DEVELOPMENT 44 er� 621 Sheridan Street, Port Townsend,WA 98368 Tel:3603'9.4450 I Fax-360.379.4451 Web:www.co.jefferson.v.a.usicommunitydevelopment Q C1- Email:dccl@ko.j_efferson.wa.us `'s�INCs. PERMIT FEES WORKSHEET Name Transit building A Parcel # 1332009 Estimated Cost of Project $50,792.00 Permit# Sprinkler system Building Base Fees Building Base $577.00 Plan Check Review $375.05 Land Use Review /7 Septic Review r1, 11 �.1E Potable Water I "/ 1 JAN - 7 2015 l� Technology/Scan I� '` _J i $19.50 ,LNTY State Fee t,,:,:,!'N11Y DEVELOPMENT Other Fees Shoreline Exemption r `f s f l're r siV I✓, feel S $156.00 Zoning New Address Public Works Total Fees $1,127.55 Office Use Only Receipt Number: Cash/Check/CC: Date: Initials: sle KNIGHT FIRE PROTECTION INC Page 1 of 3 0 Washington State Department of Labor & industries KNIGHT FIRE PROTECTION INC Owner or tradesperson 9702 LATHROP INDUSTRIAL DR SW KNIGHTON, RANDY DAVID OLYMPIA, WA 98512-9188 360-786-8606 Principals THURSTON County KNIGHTON, RANDY DAVID, PRESIDENT CANON, HERBERT DANIEL, VICE PRESIDENT WHITE, ROGER MEREDITH, SECRETARY JON E CUSHMAN, AGENT HECT, JASON (End: 01/01/1980) MEEKS, STEVEN R (End: 01/01/1980) SWEET, TIFFANY ANN SEC (End: 05/19/2010) SWEET, TIFFANY ANN TREAS (End: 05/19/2010) Doing business as KNIGHT FIRE PROTECTION INC WA UBI No. Business type 601 640 523 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. KNIGHFP044LK Effective—expiration 06/12/1996—05/24(2016 Bond ......._.... No bond accounts during the previous 6 year period. Insurance Everest Indemnity Ins Co $1,000,000.00 Policy no. 51 G L005601141 https://secure.lni.wa.gov/verify/Detail.aspx?UBI=601640523&LIC=KNIGHFP044LK&SAW= 1/7/2015 • KNIGHT FIRE PROTECTION INC Page 2 of 3 Received by L&I Effective date • 05/22/2014 05/24/2014 Expiration date 05/24/2015 Everest Indemnity Ins Co $1,000,000.00 Policy no. 510 L005601131 Received by L&I Effective date 05/19/2014 05/24/2013 Expiration date 05/24/2015 Insurance history Savings (in lieu of bond) $12,000.00 Received by L&I 04/06/2007 Savings account ID Effective date 48919-30 04/06/2007 Savings history Lawsuits against the bond or savings No lawsuits against the bond or savings accounts during the previous 6 year period. L&I Tax debts No L&I tax debts 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. 504,272-01 _....._........_......._. Doing business as KNIGHT FIRE PROTECTION INC Estimated workers reported Quarter 3 of Year 2014"31 to 50 Workers" L&I account representative TO/KRISTINE HATHAWAY(360)902-4811 -Email: HATK235 @Ini.wa.gov Workplace safety and health No inspections during the previous 6 year period. https://secure.lni.wa.gov/verify/Detail.aspx?UBI=601640523&LIC=KNIGHFP044LK&SAW= 1/7/2015