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HomeMy WebLinkAboutBLD2015-00028 - 01 PERMIT APPLICATION BUILDING PERMIT APPLI rION BLD15-00028 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD15-00028 Received Date: 1/29/2015 SITE ADDRESS: 265 ALPINE CT PORT LUDLOW, 98365 OWNER: RAFAEL SANTAMARIA PHONE: 253-302-1314 10509 90TH AVE SW LAKEWOOD WA 98498-3720 SUBDIVISION: Block: Lot: PARCEL NUMBER: 821265033 Section: 26 Township: 28 N Range: 1E CONTRACTOR: AMERICAN BUIDING SOLUTION LLC PHONE: 253-204-0207 1223 S 80TH ST. TACOMA WA 98408 Contractor's License AMERIBS861LD Expires 6/4/2016 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI Detached New Garage/Shop No heat- No plumbing SEP04-00185 TYPE OF WORK GAR SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 4,500.00 ADD'L: HEAT TYPE: CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: SHORELINE: CONST TYPE: GARAGE: 288 SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $146.00 SRE 01/28/15 154049 Plan Check $94.90 SRE 01/28/15 154049 RAV, _- State Building Code $4.50 SRE 01/28/15 154049 Total: $245.40 MA' I , 115 Jefferst Coun DCD \\tidemark\data\forms\F_B LD_Ap p_Bld.rpt 1/29/2015 BUILDING PERMIT APPLIN BLD15-00028 Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD15-00028 Received Date: 1/29/2015 SITE ADDRESS: 265 ALPINE CT PORT LUDLOW, 98365 OWNER: RAFAEL SANTAMARIA PHONE: 253-302-1314 10509 90TH AVE SW LAKEWOOD WA 98498-3720 SUBDIVISION: Block: Lot: PARCEL NUMBER: 821265033 Section: 26 Township: 28 N Range: 1E CONTRACTOR: AMERICAN BUIDING SOLUTION LLC PHONE: 253-204-0207 1223 S 80TH ST. TACOMA WA 98408 Contractor's License AMERIBS861LD Expires 6/4/2016 REPRESENTATIVE: ROBERT GRAYSON PHONE: 253-204-0207 1223 S 80TH ST TACOMA WA 98408 PROJECT DESCRIPTIOP Detached New Garage/Shop No heat- No plumbing (revision on 3/26/15 increase to 384 sq ft) SEP04-00185 TYPE OF WORK GAR SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 4,500.00 ADD'L: HEAT TYPE: UH CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: OCCUPANCY: OTHER: CONST TYPE: SHORELINE: CONST TYPE: DE RAGE: 384 SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $146.00 SRE 01/28/15 154049 APPROVED Plan Check $94.90 SRE 01/28/15 154049 State Building Code $4.50 SRE 01/28/15 154049 APR 1 4 2015 Total: $245.40 Jefferson County DCD \\tidemark\data\forms\F_BLD_App_Bid.rpt 3/27/2015 ISLAND HAMMER LLC • Page 1 of 2 Home Inicio en Espanol Contact Search L&I .t%RC A-Z Index Help My Secure L&I Safety Claims&Insurance Workplace Rights Trades&Licensing 0 Washington State Department of Labor & industries ISLAND HAMMER LLC Owner or tradesperson PO BOX 2435 POULSBO,WA 98370-0918 Principals 360-697-9434 CALAHAN,JAMES(JIM) KITSAP County S,PARTNERJMEMBER KRAFSKY,DAVID,PARTNER/MEMBER (End:09/11/2001) BROOKE,LAWRENCE,PARTNER/MEMBER (End:09/11/2001) Doing business as ISLAND HAMMER LLC WA UBI No. Business type 602 000 639 Limited Liability Company 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. ISLANHL015R9 Effective—expiration 12/29/1999-12/29/2015 Bond CBIC $12,000.00 Bond account no. SGB068 Received by L&I Effective date 09/15/2006 07/17/2006 Expiration date Until Canceled Insurance Security National Insurance $1,000,000.00 Policy no. NA107162101 Received by L&I Effective date 12/08/2014 12/02/2014 Expiration date 12/02/2015 Insurance history Savings No savings accounts during the previous 6 year period. Lawsuits against the bond or savings https://secure.lni.wa.gov/verify/Detail.aspx?UBI=602000639&LIC=ISLANHL015R9&SAW= 7/2/2015 ISLAND HAMMER LLC Page 1 of 2 • Home Inicio en Espanol Contact Search L&I A-Z Index Safety Claims & Insurance Workplace Rights C Washington State Department of Labor & Industries ISLAND HAMMER LLC Owner or tradesperson PO BOX 2435 POULSBO, WA 98370-0918 Principals 360-697-9434 CALAHAN, JAMES (JIM) KITSAP County S, PARTNER/MEMBER KRAFSKY, DAVID, PARTNER/MEMBER (End: 09/11/2001) BROOKE, LAWRENCE, PARTNER/MEMBER (End: 09/11/2001) Doing business as ISLAND HAMMER LLC WA UBI No. Business type 602 000 639 Limited Liability Company 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. ISLANHL015R9 Effective-expiration 12/29/1999-12/29/2015 Bond CBIC $12,000.00 Bond account no. SG8068 Received by L&I Effective date 09/15/2006 07/1712006 Expiration date https://secure.lni.wa.gov/verify/lletail.aspx?UBI=602000639&LIC=ISLANHL015R9&SAW= 7/2/2015 Jefferson Co Dept of Comm cv WA - Online Payments Page 1 of 1 • Jefferson County carmmn«xvairewpan-:-ots - _ - Step 1:Select Payments Step 2:Review and Submit Step 3:Confirmation and Receipt Step 3: Confirmation and Receipt Result: Payment Authorized Confirmation Number: 17541339 Your payment has been authorized successfully and payment will be processed. Jefferson County Department of Community Development thanks you for your payment.For questions about your account,please call 360-379-4452 Thank you for using our bill payment services. Please save or print a copy of this receipt for record keeping purposes. My Bills Description Amount Due Invoice Payment payment of$370.00 on Invoice Number Revisionbldl5-00028 $370.00 Subtotal: $370.00 Customer Information Convenience Fee: $10.00 First Name: Rafael Total Payment: $380.00 Last Name: Santamaria Address Line 1: 10509 90th ave sw Address Line 2: City: Lakewood State: Washington Zip Code: 98498 Phone Number: 2533021314 Email Address: rafealsantamanal2t yahoo.com Payment Information Card Number: " 3600 Expiration Date: "/" Print https://client.pointandpay.net/web/JeffersonCoDeptofCommDevWA 3/26/2015 .r- • • _.zo,_ Enviro Check, LLC — _—___—__-- - . ,_ ; ...360- 3 r�1 1612 Hastings Ave. West Pori Townsend. WA 98368 1 r-PROPERTY INFORMATION JAN 2 7 2015 House Location:265 ALPINE CT Li Port Ludlow i n'C :L'NTY Tax ID:621265033 �'ii ITv P. s"'OPMENT ma-o: Jody LECUYER __ ..�.- PO BOX 65189 Use:Residential,Single Family PORT LUDLOW.WA System Design Flow 360 983650189 GENERAL SYSTEM TYPE:Gravity Owner"Jody LE CUYER ON ID:SOM04-00185 rm Fern ON-SITE WASTEWATER TREATMENT SYSTEM INSPECTION REPORT Hen 1iei Inspected:10/10/2014 t Inspection T PROPERTY SALE - Correction Status:Ail corrections made nspactton Type: Work Performed By: Submitted 10/10/2014 by: Envu'o Company- Dale Wurtsmith Envco Check.LLC Dale WuASfnith __..I This report does not assure approvals by Jefferson County Public Health for ANY future building permits or development. COMMENTS&GENERAL INSPECTION NOTES Deficencies Were Noted:Corrections were made to resolve the deficiencies. l I1_T e septic tank needed to be pumped and was by Envmo Check,LLC on 101014. 2-What I observed was consistent with"As-built GENERAL SITE&SYSTEM CONDITIONS Folly Inspected The General Site and System Conditions were: YES .. Alf Components accessible for maintenance,secure and in good condition' ---_S Surfacing effluent from any component(including mound seepage); NO Components appear to be watertight-no visual leaks: Improper encroachment(roads,buildings.etc.)onto component(s): NO Component settling problems observed: _. .___..._. --- Abnormal pending present for one or more of the disposal components: N/A YES Subsurface components adequately covered __. _.._—_ _ NO _. Owner compliance issues noted NO Site maintenance required(e.g.Landscape maintenance)If yes,describe in comments Occupant compliance problem(occupant not operating the system Properly). If YES.describe in notes _.. NO WA If deficiencies were identified on last inspection were they corrected before or during this inspection? (If NO,describe in notes,NA=no deficiencies on last report): YES t OSS Components,structures and appurtenances located per as-builtlrecord drawing(If NO,describe 11 in notes). If no as-butt exists or changes made.state NO and provide record to Health Dept NO Alterations made to the OSS(valves adjusted timer settings modified,ports installed,etc)(If YES, describe in notes):the NO ! The house/structure was vacant or used infrequently,assessment of the drainfietd was not possible f is e SEP case in a finaled/corrpteled status?(it NO explain in comments) ---- - --_ YES ONSITE SEWAGE SYSTEM INSPECTION DETAIL TANK:Septic Tank•2 Compartment 1.000 Gal Foty� � spect This component was — YES Component appears to be functioning as intended: _... ___—. in comments): _"_.. YES Effluent level within operational limits(!NO explain YES Alt required baffles in place(WA=No bathes required): - — WA Effluent Filter Cleaned(NIA=Not Present): — Effluent liter/screen needed cleaning on arrival N/A._ /22 Compartment 1 Scum accumulation(Inches,it other specify): 22 Compartment 1 Sludge accumulation(Inches,if other specify): 5 Compartment 2 Scum accumulation(Inches.if other specify): 22 Compartment 2 Sludge accumulation(Inches,if other specify): YES Dammed Pumping needed- The report infocales certain ChanS2a1SIJOS Nix ante sewage sptaA N Me OW ew In no way is rips report a 9oaramee aopeperre w Mme pebmance. ReportlD:402425 View inspection reports online at wow"onlinerme"com Page 1 of 2 . �Gallons to be pumped(d needed)by Pumper I 1000 This component n Fully Inspected This was; YES ,D-Box in good condition YES 0-Box outlets set to allow equal effluent diLnbu5on: rain Field:Gravity Fully � Thus component was. 1 YES Component appears to be functioning as intended WA Ponding present?If YES explain in comments. Inn Wan WM,OSc 1 'tivaCigratitaofthe auee sewage system at the t ee ofegt In no wary is this repot a guarantee of opandon a future perbmm,ce. RePortlp.402426 View inspection reports online at wwnv_onknetme corn Page 2 of 2 • • • • • -L-gON co DEPARTMENT OF COMMUNITY DEVELOP! IE V II 4 6' 621 Sheridan Street,Port Townsend,\8�A 913368 I Tel:360 379.4450 I Fax:36n 379.4451 Web ��zc.cn.jcff ruln.wau /cot nnututvdevelopment JAN 2 7 2015 sN G� u J dcd aico rs etteon'l airs JEFFERSON COUNTY T.OF COMMUNITY DEVELOPMENT STORMWATER CALCULATION WORKSHEET MLA N PROJECT/APPLICANT NAME: DETERMINING STORMWATER MANAGEMENT REQUIREMENTS:This stormwater calculation worksheet should be completed first to classify the proposal as "small," "medium," or "large." The size determines whether a Stormwater Site Plan is required in conjunction with a stand-alone stormwater management permit application, building permit application, or other land use approval application that involves stormwater review. The basic information will also be helpful for completing a Stormwater Site Plan, if required. PARCEL SIZE(I.E.,SITE) Size of parcel cZei 5- acres 2 An acre contains 43,560 square feet. Multiply the acreage by this figure. v{ Size of parcel in square feet l / 5- / 70 sq/ft Land-disturbing activity is any activity that results in movement of earth, or a change in the existing soil cover(both vegetative and non-vegetative)and/or the existing soil topography. Land disturbing activities include, but are not limited to clearing,grading,filling, excavation,and compaction associated with stabilization of structures and road construction. Native vegetation is vegetation comprised on plant species, other than noxious weeds, that are indigenous to the coastal region of the Pacific Northwest and which reasonably could have been expected to naturally occur on the site. Examples include species such as Douglas fir, western hemlock, western red cedar, alder, big-leaf maple, and vine maple; shrubs such as willow, elderberry, salmonberry,and salal; herbaceous plants such as sword fern,foam flower, and fireweed. LAND DISTURBING ACTIVITY, CONVERSION OF NATIVE VEGETATION,AND VOLUME OF CUT/FILL Calculate the total area to be cleared, graded,filled, Answer the following two questions related to excavated,and/or compacted for proposed development conversion of native vegetation: project. Include in this calculation the area to be cleared for: Does the project convert%acres or more of Construction site for structures 2,If y sq/ft native vegetation to lawn or landscaped areas? Drainfield,septic tank,etc. 4 0 sq/ft Circle: Yes Well, utilities,etc. sq/fl Does the project convert 2 4 acres or more of /, native vegetation to pasture? Driveway, parking, roads,etc. [ 0 sq/ft /� Circle: Yes (No) Lawn, landscaping,etc. f (� sq/ft Other compacted surface, etc. sq/ft Indicate Total Volumes of Proposed: Total Land Disturbance J y sq/ft Cut O_ Fill ( (cu/yd) Impervious surface is a hard surface that either prevents or retards the entry of water into the soil mantle as under natural conditions prior to development. A hard surface area which causes water to run off the surface in greater quantities or at an increased rate of flow from the flow present under natural conditions prior to development. Common impervious surfaces include, but are not limited to roof tops,walkways, patios,driveways, parking lots or storage areas, concrete or asphalt paving,gravel roads, packed earthen materials,and oiled, macadam or other surfaces which similarly impede the natural infiltration of stormwater. stormwater talc worksheet—REV.10/20/2014 O • STORMWATER CALULATIONS–IMPERVIOUS SURFACE NEW EXISTING ll y Structures (all roof area) , eq/ft Structures (all roof area) > 6 Ys sq/ft Sidewalks v` / sq/ft Sidewalks sq/ft Patios sq/ft Patios sq/ft Solid Decks sq/ft Solid Decks sq/ft (without infiltration below) (without infiltration below) L Driveway, parking, roads,etc i _ sq/ft Driveway, parking, roads, etc • 220 sq/ft Other sq/ft Other sq/ft Total New _sq/ft Total Existing 126 sq/ft TOTAL NEW+TOTAL EXISTING' _sq/ft *This amount will be used to check total tot coverage. The following questions will help determine whether the proposed project is considered development or redevelopment. DEVELOPMENT v. REDEVELOPMENT Divide the total existing impervious surface above by the size of the parcel and convert to a percentage: f /o Does the site have 35%or more of existing impervious surface? Circle: Yes n No Ki FURTHER INSTRUCTIONS: If the answer is yes,the proposal is considered redevelopment and the attached Figure 2 should be used to determine the applicable Minimum Requirements. If the answer is no, the proposal is considered new development and the attached Figure 1 should be used. At this juncture, the applicant should refer to the applicable Flow Chart to determine the Minimum Requirements for stormwater management. DCD staff will help verify the classification of the project and the application requirements. For proponents of "small" projects who must comply only with Minimum Requirement #2—Construction Stormwater Pollution Prevention—an additional submittal is not required. The proponent is responsible for employing the 12 Elements to control erosion and prevent sediment and other pollutants from leaving the site during the construction phase of the project. Pick up the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet. Proponents of "medium" projects—those that must meet only Minimum Requirements#1 through#5—and for"large" projects—those that must meet all 10 Minimum Requirements—are required to submit a Stormwater Site Plan. DCD has prepared a submittal template of a Stormwater Site Plan, principally for rural residential projects. Complete the template in the Stormwater Site Plan Instructions and Submittal Template or prepare a Stormwater Site Plan using the step-by-step guidance in the Storm water Management Manual. APPLICANT SIGNATURE By signing the Stormwater Calculation Worksheet,I as the applicant/owner attest that the information provided herein is true and correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent,of all owners of the affected property. LO.'J ` {( l / �- � ��� (LANDOW r OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE) FOR OFFICE USE ONLY SMALL MEDIUM LARGE REDEVELOPMENT Stormwater Site Plan: Yes No storrnwater calc worksheet-REV.10/2012014 0 0 �sON co DEPARTMENT OF COMMUNITY DEVELOPMENT 4, �.G 621 Sheridan Street,Port Townsend,WA 98368 W Tel:360.379.4450 I Fax:360.379.4451 Web:www.co.Jefferson,wa.us/communitytlevelopment 00 4 E-mail:dcd(�co.jefferson.wa.tu I 111 't'" I% 116WI N��O iQ PERMIT APPLICATI 4)o c - ti\`� Steps in the Permit Process: D \. ��� 2 -Review application checklist to ensure all information is completed prior to su r i 't kg applicati SoN�'CU ��QtSs -Make sure septic has been applied for and water availability has been proven. \ ��.EFL�t�S Orc -Make an appointment to meet with the Permit Technician by calling 360-379-44 . c.�O�04 -This is not a standalone application;it must be accompanied by a project specific supspl-mental 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: Site Address and/or Directions to Property: ID ! ,° @fi Pe rr 4v 10 I/ r:, '7,) It- Access(name of street(s)) from which access will be gained: Present use of property: Description of Work (include proposed uses): CO,I.-SO-r oe r u .-, 6 ,e---,e--- n 3'(‘ ç ✓— £ ' ,ek &o-t..e 7a, 47 evr,( , ...1,--,,Vt. C1-.400 n o A eel it0 /21,0"r5,,---7 4 Wastewater-Sewage Disposal :zneti 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: '7 Septic Septic Permit#: S Q.p— Q L( 1 -.s_ Community Septic Name of System: Case#: Are other residences connected to the septic system? it. Additions or repairs to sewage system: it 0 Is it a complete or partial system installation: Complete )1.-- Partial Has a reserve drainfield been designated? Yes V 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(ii.e.,County email is not blocked or sent to "junk mail"). Applicant/Property Owner Information Property Owne. Name: /e`C Cer (( /) ''z t- b mr, '-c Address: $� L L/ sn, s c C Cr-/ i4"c /0d lac-) 2J ,$ Phone#!:`_ 5-3 3 ba /3 1V E-mail Address: Please co ct horized Agent/Representative with project info. (select only one). Property Owner Signature Date: 1—/ 3 -15- 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: Address: Phone#: E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES Engineer Architect op Surveyor ' Contractor Consultant Name: N2 ec..-r ,'/Cg.`• Sef f:v-is 44c- Address: /2.2'3 3 Sf0 r4 ST %et co.ma, 2.9/f 9 '- Ya Phone#: a ca a0 /-ado E-mail Address: q ,:e 4i /gv,'rc/./ 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: 1 Phone#: E-mail Address: Professional: Is this an Authorized Agent/Representative for this project? NO YES c3 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: ■ 1 SON e �w4` °> DEPARTMENT OF COMMUNITY DEVELOPMENT ca. 621 Sheridan Street,Port Townsend,WA 98368 (�''r:.- 0 II�I I �w-, -C Tel:360.379.4450 ( Fax:360.379.4451 LAC- web:www.co.ieff erson.wa.tu/cotnmtntitydeeelopment II D;I -ae' E-mail:elcd !co.iefferson.wauy Ul , - a- 11 JAN 2 7 2015 L 9`rk i N O,� SUPPLEMENTAL APPLICATIO L S RESIDENTIAL OR COMMERCIAL BLDG PERMIT i[iTERSO;:COUNTY _ ( iv NI1Y DEVELOPMENT _ For Department Use Only Receipt#: Date: Related Application#s: Payment#: Site Information Owner Name: Rafael Santamaria Assessor Tax Parcel#: 821265033 Type of Building New '/ Replacement — — Relocated — Repair Demolition * Addition _ — — `A separate permit is required Select One: Single Family Residence _ Modular Other garage Proposed Building/Project Number of floors 1 #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: St Existing Sq/Ft Proposed Sq/Ft (esidenti /Commercial ain Floor aiD 73 / Residential/Commercial Second Floor - Additional Floors-heated/unheated CI 'l 1 y . Basement-unfinished Basement-finished space or habitable ,. t � Detached arage-heated/unheated _ , <ttached Garage heated/unheated 5-0Z V _ _ 1 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): $ ' -A e al) Z`3 I American Building Solutins LLC Page 1 of 2 • • LaWashington State Department of Labor & Industries American Building Solutins LLC Owner or tradesperson 1223 S Both ST Grayson, Robert Scott TACOMA, WA 98408 253-204-0207 Principals PIERCE County Grayson, Robert Scott, PARTNER/MEMBER Doing business as American Building Solutins LLC WA UBI No. Business type 603 400 844 Limited Liability Company License Verify the contractor's active registration/license/certification (depending on trade) and any past violations. Construction Contractor Active. C ................................................._._...._..._.... Meets current requirements. License specialties GENERAL License no. AMERIBS861 LD Effective—expiration 06/04/2014—06/04/2016 Bond ................. Wesco Insurance Co $12,000.00 Bond account no. 46WB042964 Received by L&I Effective date 06/04/2014 05/30/2014 Expiration date Until Canceled Insurance Security National Insurance $1,000,000.00 Policy no. NA107631800 Received by L&I Effective date 06/04/2014 02/20/2014 Expiration date 02/20/2015 Savings _... No savings accounts during the previous 6 year period. Lawsuits against the bond or savings https://secure.lni.wa.gov/verify/Detail.aspx?UBI=603400844&LIC=AMER1BS861LD&SAW= 1/29/2015 American Building Solutins LLC Page 2 of 2 No lawsuits against the bond o•ings accounts during the previous 6 yeSriod. 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. 316,061-01 Doing business as AMERICAN BUILDING SOLUTIONS LL Estimated workers reported Quarter 3 of Year 2014"0"Workers L&I account representative T2/MATT PEDERSEN (360)902-5476-Email: PEDM235@lni.wa.gov Workplace safety and health No inspections during the previous 6 year period. *Washington State Dept. of Labor&Industries. Use of this site is subject to the laws of the state of Washington. Access AM&Washington' https://secure.lni.wa.gov/verify/Detail.aspx?UBI=603400844&LIC=AMERIBS86ILD&SAW= 1/29/2015 1/15/2015 Enviro Check, LLC 1612 Hastings Ave. West 9400 Port Townsend, WA 98368 PROPERTY INFO- IPN House I JAN 2 7 7015 Location:265 ALPI E CY I Port Ludlow -J' Tax ID:821265033— diY Mau To: Jody LE CUYER PO BOX 65189 Use:Residential,Single Fafi Y'?EVFLOPfl9EP+T PORT LUDLOW,WA System Design Flow:360 983650189 GENERAL SYSTEM TYPE:Gravity Owner.Jody LE CUYER ON ID:SOM04-00185 Fold •— ON-SITE WASTEWATER TREATMENT SYSTEM INSPECTION REPORT Fold Ham Here Inspected:10/10/2014 - Inspection Type:PROPERTY SALE - Correction Status:All corrections made Company: Work Performed By: Submitted 10/10/2014 by: Enviro Check, LLC Dale Wurtsmith Dale Wurtsmith This report does not assure approvals by Jefferson County Public Health for ANY future building permits or development. COMMENTS&GENERAL INSPECTION NOTES Deficencies Were Noted:Corrections were made to resolve the deficiencies. 1-The septic tank needed to be pumped and was by Enviro Check,LLC on 101014. 2-Vvhat I observed was consistent with"As-built". GENERAL SITE&SYSTEM CONDITIONS The General Site and System Conditions were: Fully Inspected All Components accessible for maintenance,secure and in good condition: YES Surfacing effluent from any component(including mound seepage): NO Components appear to be watertight-no visual leaks: YES Improper encroachment(roads,buildings,etc.)onto component(s): NO Component settling problems observed: NO Abnormal ponding present for one or more of the disposal components: N/A Subsurface components adequately covered YES Owner compliance issues noted NO Site maintenance required(e.g.Landscape maintenance)If yes,describe in comments: NO Occupant compliance problem(occupant not operating the system properly). If YES,describe in notes: NO If deficiencies were identified on last inspection were they corrected before or during this inspection? N/A (If NO describe in notes,NA=no deficiencies on last report): ass 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 drainfield was not possible. NO I Is the SEP case in a finaled/completed status?(if NO explain in comments) YES ONSITE SEWAGE SYSTEM INSPECTION DETAIL TANK:Septic Tank-2 Compartment 1,000 Gal This component was: Fully Inspected Component appears to be functioning as intended: YES Effluent level within operational limits(if NO explain in comments): YES All required baffles in place(N/A=No baffles required): YES Effluent Filter Cleaned(N/A=Not Present): N/A Compartment 1 Scum accumulation(Inches,if other specify): 22 Effluent filter/screen needed cleaning on arrival N/A Compartment 1 Sludge accumulation(Inches,if other specify): 22 Compartment 2 Scum accumulation(Inches,if other specify): 5 Compartment 2 Sludge accumulation(Inches,if other specify): 22 Pumping needed: YES Corrected Approximate Gallons to be pumped(if needed)by Certified Pumper: 1000 ReportlD:402425 View inspection reports online at www.onlinerrne.com Page 1 of 2 ' aistribution:V-Box This component was: Fully Inspected D-Box in good condition: YES D-Box outlets set to allow equal effluent distribution: YES grainfield:Gravity This component was: Fully Inspected Component appears to be functioning as intended: YES Ponding present?If YES explain in comments: NIA This report indicates certain charactenatics of the onslte sewage system at the time of visit.In no way is this report a guarantee of operation or Suture performance. ReportiD:402425 View inspection reports online at www.onlinerme.com Page 2 of 2 • D -Q.fl • BUILDING PERMIT APPLICATION B Reeview view 0p Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD15-00028 Received Date: 1/29/2015 SITE ADDRESS: 265 ALPINE CT PORT LUDLOW, 98365 OWNER: RAFAEL SANTAMARIA PHONE: 253-302-1314 10509 90TH AVE SW LAKEWOOD WA 98498-3720 SUBDIVISION: Block: Lot: PARCEL NUMBER: 821265033 Section: 26 Township: 28 N Range: 1E CONTRACTOR: AMERICAN BUIDING SOLUTION LLC PHONE: 253-204-0207 1223 S 80TH ST. TACOMA WA 98408 Contractor's License AMERIBS861LD Expires 6/4/2016 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI' Detached New Garage/Shop No heat- No plumbing SEP04-00185 TYPE OF WORK GAR SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 4,500.00 ADD'L: HEAT TYPE: CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: OCCUPANCY: UNHEATED: #OF STORIES: OTHER: CONST TYPE: SHORELINE: CONST TYPE: DECRKAGE. 288 SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $146.00 SRE 01/28/15 154049 Plan Check $94.90 SRE 01/28/15 154049 State Building Code $4.50 SRE 01/28/15 154049 Total: $245.40 \\tidemark\data\form s1F_B LD_App_Bld.rpt 1/29/2015 0 0 �w�S°N ooh DEPARTMENT OF COMMUNITY DEVELOPMENT W -4 621 Sheridan Street,Pon Townsend.\VA 98368 ., Tel:3 6 .379.4450 ; Fax:360.379.4451 Web:www.co.jefferson.wa.ushommunirdevelopment E-mail:dcd tco.jeffetson.na.�u f �� L _ n� 'S$f N°�° w PERMIT APPLICATI:Al *,C-- �\ 1" Steps in the Permit Process: \C`,` �N 2 -Review application checklist to ensure all information is completed prior to su\. t qg application.:,:'`g� 0 -Make sure septic has been applied for and water availability has been proven. -!;�=,,° i sF�pe�" -Make an appointment to meet with the Permit Technician by calling 360-379-445 . 0 -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: O • I a 6sc0 3 IS Site Address and/or Directions to Property: 6.s—/4- / O, Qer Po-r— 4v0ib L.,1, I-- Access(name of street(s)) from which access will be gained: Present use of property: Description of Work (include proposed uses): �J eO.2 -srvve re.1) --% © ,f- vl.� ss , (° /' J 1� 4�l O 1..0 1a,,-47.x_..._... Cei'v( rel`1lti (-LAN,- P'I o A ec4.4---- 62 b ,0110,-..,#5.-•.7 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#: S €p- 0 t( I �5-- Community Septic Name of System: t( Case#: Are other residences connected to the septic system? it, 0 Additions or repairs to sewage system: It Is it a complete or partial system installation: Complete Partial Has a reserve drainfield been designated? Yes No Date of Last Operations& Maintenance check: t.(' ' S Attach last report to application Describe or attach any drainfield easements, covenants or notices on title,which may impact the property: • gON -�¢ OG DEPARTMENT OF COMMUNITY DEVELOPMENT —7 621 Sheridan Street,Port Townsend,d IX A 93368 � 1 I- (n Cam' L V r ,-C Tel:3&t 379 4450 I Fax'360.379.4451 71 ill=. ' 'r. L.._..-, Web:www,co effcrs.on.wa.u>/cotnmunitcdevel0pment E-mail:dcd(a co.iefFcrson.a'aus `may , 27 20 15 hIj III N r N SUPPLEMENTAL APPLICATION u L V RESIDENTIAL OR COMMERCIAL BLDG PERMIT , ._, ,...;�u ii __ H''.,jhim DEVELOPMENT For Department Use Only Receipt#: Date: Related Application#s: Payment#: Site Information Owner Name: Rafael Santamaria Assessor Tax Parcel#: 821265033 Type of Building New _.,/ Replacement _ _ Relocated Addition Repair Demolition _ _ * *A separate permit is required Select One: Single Family Residence Modular Other garage Proposed Building/Project Number of floors 1 # 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: Stru r Existing Sq/Ft Proposed Sq/Ft Residential/Commercial ain Floo f pR[d 73 I Residential/Commercial Second Floor f Additional Floors-heated/unheated q ( y Basement-unfinished Basement-finished space or habitable F 4 asp g.: Detacljgd GGarage-heated/unheated _ F attached GaraR heated/unheated 57 Si 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.) I Estimated Cost of Project(Required): $ P n a Cilp 7—^ . 2—C) • • • list existing buildings on property(i.e.house,garage,accessory dwelling unit,shed,barn,mobile home,other): All Existing Buildings on Property Use House Single Family Residence 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.ordpdf/Policy_97- 01_Rainwater Collection.pdf Valid Water Right Generally applies to springs,attach copy. Permit: Public Water: ✓ Name of Water Provider: PUD#1 Jefferson County -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 ICounty road and/or Right-of-Way easement,then a Right-of-Way application will be needed. Resolution 899-90 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.cojefferson.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:Rafael Santamaria Date: 1-13-15 FOR OFFICE USE ONLY 1) Water Right Permit 8 3)Individual Well 2)Public Water Supply WS IDS 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 • Y • • • �kw�SON oo�� DEPARTMENT OF COMMUNITY DEVELOI�ME r 11 VIE 621 Sheridan Street,Port Townsend,WA 98368 __j� W Tel:360.3!9.4450 Faz.36t_l,_1:9.�dol _, Web:www.cn iefferson.ti a us 1cornmunin-development 1 JAN 2 7 9015 ' ' ' E-null dcd@4co.jefferson.wa.us sHiNG . 1_rr,_:,_,.�a4TY T e 7'iJ77rNNITY DEV::!.0°MENT STORMWATER CALCULATION WORKSHEET MLA# PROJECT/APPLICANT NAME: DETERMINING STORMWATER MANAGEMENT REQUIREMENTS:This stormwater calculation worksheet should be completed first to classify the proposal as "small," "medium," or "large." The size determines whether a Stormwater Site Plan is required in conjunction with a stand-alone stormwater management permit application, building permit application,or other land use approval application that involves stormwater review. The basic information will also be helpful for completing a Stormwater Site Plan, if required. PARCEL SIZE (I.E., SITE) Size of parcel t. .y S acres An acre contains 43,560 square feet. Multiply the acreage by this figure. Size of parcel in square feet II u2 5 l 7 0 sq/ft Land-disturbing activity is any activity that results in movement of earth, or a change in the existing soil cover(both vegetative and non-vegetative)and/or the existing soil topography. Land disturbing activities include,but are not limited to clearing,grading,filling, excavation,and compaction associated with stabilization of structures and road construction. Native vegetation is vegetation comprised on plant species,other than noxious weeds,that are indigenous to the coastal region of the Pacific Northwest and which reasonably could have been expected to naturally occur on the site. Examples include species such as Douglas fir, western hemlock, western red cedar, alder, big-leaf maple, and vine maple; shrubs such as willow, elderberry, salmonberry,and salal; herbaceous plants such as sword fern,foam flower,and fireweed. LAND DISTURBING ACTIVITY, CONVERSION OF NATIVE VEGETATION,AND VOLUME OF CUT/FILL Calculate the total area to be cleared, graded,filled, Answer the following two questions related to excavated,and/or compacted for proposed development conversion of native vegetation: project. Include in this calculation the area to be cleared for: Does the project convert Y.acres or more of Construction site for structures • // -, . • sq/ft native vegetation to lawn or landscaped areas?• Drainfield, septic tank,etc. .#7,„ W d sq/ft Circle: Yes Well, utilities,etc. 1) sq/ft Does the project convert 2 V2 acres or more of native vegetation to pasture? Driveway, parking, roads,etc. �U sq/ft 2 Circle: Yes No Lawn, landscaping, etc. ..S 15 C) sq/ft Other compacted surface,etc. 0 sq/ft Indicate Total Volumes of Proposed: Total Land Disturbance .513 Li sq/ft Cut c2, Fill / (cu/yd) Impervious surface is a hard surface that either prevents or retards the entry of water into the soil mantle as under natural conditions prior to development. A hard surface area which causes water to run off the surface in greater quantities or at an increased rate of flow from the flow present under natural conditions prior to development. Common impervious surfaces include, but are not limited to roof tops,walkways, patios, driveways, parking lots or storage areas, concrete or asphalt paving,gravel roads, packed earthen materials,and oiled, macadam or other surfaces which similarly impede the natural infiltration of stormwater. stormwater talc worksheet—REV.10/20/2014 1