HomeMy WebLinkAboutELIZABETH AVE., 1530 � • �
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- BUILDING PERMIT 1530 ELIZABETH AVE
, ;
1NSPECTION SFRDEMO �,
CARD
'i r y �
Building ❑ Plumbing [] 1VIechanical � Alarm/Sprinkler �
This Placard must 6e posted on or near building and the Permit &"Approved" plans must be at the sit
Permit # BB09 00760
Call the folloWinq Agency Telephone Numbers for Inspections: - Propertylines shall be properlyidentified and marked before
Building Department Inspections Call: (360) 473-5870 founda6on fooUng inspection. Setbacks are measured to the
WATER - Public Works - Water: (360) 473 finished wall structure.
- Reinspection fee may be assessed if inspection has been
PW - Public Works - Engineering: (360) 473-5270 requested when not readyor corrections are not completed.
HEALTH - Kitsap Co. Health District: (360) 337-5285 ' - permit, approved plans, engineering, and inspection card shall
Fire - Fire Department: (360) 473-5394 be on site during construc6on or Reinspec6on Fee maybe
L8�1- Dept. of Labor and Industry: (360) 415-4000 assessed. �
Inspection Approved Date Notes
Final Inspection - Building -Q,O- /
FINAL BUILDING (360) 473 C � ���
All of the above must be approved. �� `� �D � KU `� ��,� B��
Occupancy approval for SFR only - Commercial
«�u
structures require a separate Certificate of Occupancy.
DO NOT OCCUPY BUILDING WITHOUT BUILDING DEPARTMENTAPPROVAL
PROTECT THIS CARD FROM THE WEATHER �
j CITY OF BREMERTON PERMIT NUMBER: BB09 00760
DEPARTMENT OF COMMUNITY DEVELOPMENT DATE ISSUED: 12/16/2009
�.
345 - 6th Street, Bremerton, WA 98337
� � (360) 473-5275 Fax: (360) 473-5278
ASSESSOR NUMBER: 3802-002-031-0003 ZONING: R10 SITE AODRESS: 1530 ELIZABETH AVE
APPLICANT NAME: ISLAND HAMMER LLC PHONE: (360) 697-9434 ADDRESS: P.O. BOX 2435, POULSBO, WA 98370
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OWNER NAME: CRUTCHER SHIRLEY M PHONE: (360) 265-1386 ADDRESS: PO BOX 1252, BREMERTON, WA 98337
CONTRACTOR: ISLAND HAMMER LLC PHONE: (360) 265-7944 ADDRESS: PO BOX 2435, POULSBO, WA 98370
LENDER NAME: PHONE: ADDRESS.
SUBMITTED: 12/16/2009 APPROVED: 12/16/ 009 E P TION: O6/14/2010 STATUS: ISSUED
VALUATION: Demolition Permit I
Demolition Fee $ao.eo 22�a SFR DEMO I
State Surcharge $a.so ozss guilding Code Edi 'on:
I TOTAL FEES: $45 30 Occupancy Group
� Type of Construction:
Flood Zone: �
Setbacks:
Sanitation Method:
Number of Bedrooms:
I
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InspecUOn Requests FIRE: Fire InspecUOns (360) 473-5394 ��
DCD: Building InspecLOns (360) 473-5870 HEALTH: Krtsap County Health District (360) 337-5285 '�
L&I: Department of Labor and Industries (360) 415-4000 PW&U: Pubhc Works - Engineenng (360) 473-5270 ��
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This permit shall become null and void if the described and authorized by [his permit has not commenced within 180 days from the date of issuance, or if the work is suspended or abandoned
at any pme after the work �s commenced for a period of 180 days. It is the responsibility of the permit holder to see tha[ the required inspec[ions are made. Failure to obtain required j
inspections may result in stoppage of the work until such [ime that the permit holder can susbstanuate to the Ci[y of Bremerton that the concealed work meets or exceeds code i
requirements. Any demolrtio�, tesUng, or financial burden shall be borne d�rectly by [he permit holder. Failure to substantiate code requirements will indemnify the Crty aga�nst any and all
responsibility or liabih[y connec[ed with the consWCtion. I hereby certify that I have read and examined this permit and know [he same to be true and correct. All provisions of laws and i
ordinances goveming this type of work will be complied wrth whether specified herein or not. The gran[ing of a permrt does not presume to give authonty to violate or cancel prowsions of
any State or local law regulating consVUCtion or Ihe performance of the construction. If listing the owner as general conVactor, I certify that I am exempt from [he requirements of the State
Contractor's Regisvation Law under Sect' 3, Chapter 126, Laws of 1967. All revisions to an approved plan require DCD review and approval prior to pertorming work. All building and [enan[ �
occupancy permiu are required to pas mal inspecuon prior to permit expiration and obtam a certificate of occupancy prior to use or occupancy.
1 have read, and agree abid y the c d ns of t pe ' cluding all conditions of zoning, building codes, State and Federel laws.
SIGNATURE OF OWNER O
AGENT:
I PRINTED NAME: J �� DATE• `I� !° `
CONDITIONS
City of Bremerton's app oval of this application pertains only to the City's reg latory jurisdiction, and thus compliance with City
regulations does not ne essarily ensure compliance with federal or state law . �
10. (DCD-02) DCD: Validity of permit. The issuance or granting of a permit shall not be construed to be a �
permit for, or an approval of, any violation of any of the provisions of the Washington State
Building code or of any other ordinance of the City of Bremerton. Permits presuming to give
authority to violate or cancel the provisions of the Washington State Building code or other
ordinances of the City of Bremerton shall not be valid. The issuance of a permit based on �
I construction documents and other data shall not prevent the building official from requiring I I
the correction of errors in the construction documents and other data. The building official
is also authorized to prevent occupancy or use of a structure where in violation of the �I
� Washington State Building code or of any other ordinances of the City of Bremerton. �/ I
10. (DCD-01) DCD: Prior to performing any renovation or demolition work, Puget Sound Clean Air Agency ��
(Clean Air Agency) and Washington Department of Labor and Industries (L&I) regulations ��
require an asbestos survey be performed to determine whether there are asbestos- �
--�— -
containing materials in the work area or structure. The asbestos survey must be �
conducted by and EPA-certified (AHERA) building inspector (except renovation or owner-
Page 1 of 3
l CITY OF BREMERTON PERMIT NUMBER: 6609 00760
DEPARTMENT OF COMMUNITY DEVELOPMENT DATE ISSUED: 12/16/2009
i
Y `� 345 - 6th Street, Bremerton, WA 98337
(360) 473-5275 Fax: (360) 473-5278
ASSESSOR NUMBER: 3802-002-031-0003 ZONING: R10 SITE ADDRESS: 1530 ELIZABETH AVE
APPLICANT NAME: ISLAND HAMMER LLC PHONE: (360) 697-9434 ADDRESS: P 0 BOX 2435, POULSBO, WA 98370
OWNER NAME: CRUTCHER SHIRLEY M PHONE: (360) 265-1386 ADDRESS: PO BOX 1252, BREMERTON, WA 98337
CONTRACTOR: ISLAND HAMMER LLC PHONE: (360) 265-7944 ADDRESS: PO BOX 2435, POULSBO, WA 98370
LENDER NAME: PHONE: ADDRESS:
SUBMITTED: 12/16/2009 APPROVED: 12/16/2009 EXPIRATION: 06/14/2010 STATUS: ISSUED
occupied single family residences).DCD: For more information, please contact Clean Air I
Agency through their web site at www.cleanair.org or by phone at 800-552-3565 or 206-
689-4058. The L&I web site can be found at www.lni.wa.gov/p-ts/asbestos/asbestos.htm. �� � I
10. (DCD-50) Final Inspection Required: All building permits shall have a final inspection performed and
approved by the City of Bremerton Department of Community Development prior to permit �
expiration. The failure to request a final inspection or failure to obtain final approval prior to
expiration may require a reactivation fee, or a new permit application if more than a year
has passed with no activiry. �/� I
11. (DCD-DEM01) IBC SECTION 3308 TEMPORARY USE OF STREETS, ALLEYS AND PUBLIC PROPERTY ��
3308.1 Storage and handling of materials. The temporary use of streets or public property
for the storage or handling of materials or of equipment required for construction or
demolition, and the protection provided to the public shall comply with the provisions of the
authority having jurisdiction and this chapter.
3308.1.1 Obstructions. Construction materials and equipment shall not be placed or stored
so as to obstruct access to fire hydrants, standpipes, fire or police alarm boxes, catch
basins or manholes, nor shall such material or equipment be located within 20 feet (6096
mm) of a street intersection, or placed so as to obstruct normal observations of traffic
signals or to hinder the use of public transit loading platforms.
3308.2 Utility fixtures. Building materials, fences, sheds or any obstruction of any kind shall
not be placed so as to obstruct free approach to any fire hydrant, fire department
connection, utility pole, manhole, fire alarm box or catch basin, or so as to interfere with the
passage of water in the gutter. Protection against damage shall be provided to such utility
fixtures during the progress of the work, but sight of them shall not be obstructed.
A Right-of-Way permit is required if any work is to be conducted in the right-of-way,
including the placement of any dumpsters in the right-of-way. �
12. (DCD-DEMO2) IBC 3301.2 Storage and placement. Construction equipment and materials shall be stored � �
� and placed so as not to endanger the public, the workers or adjoining property for the
; duration of the construction project. �
IBC 3302.2 Manner of removal. Waste materials shall be removed in a manner which
prevents injury or damage to persons, adjoining properties and public rights-of-way.
IBC SECTION 3307 PROTECTION OF ADJOINfNG PROPERTY
3307.1 Protection required. Adjoining public and private property shall be protected from �
damage during construction, remodeling and demolition work. Protection must be provided
for footings, foundations, party walls, chimneys, skylights and roofs. Provisions shall be �
made to controlwater runoff and erosion during construction or demolition activities. The
person making or causing an excavation to be made shall provide written notice to the
owners of adjoining buildings advising them that the excavation is to be made and that the
adjoining buildings should be protected. Said notification shall be delivered not less than
10 days prior to the scheduled starting date of the excavation.
MINIMUM INSPECTIONS REQUIRED
To request an inspection, please call (360) 473-5870 and be sure to provide your permit number, name on permit, site address, contact
phone number, and inspection type.
Final Inspection - Building
Page 2 of 3
J CITY OF BREMERTON PERMIT NUMBER: 6609 00760
DEPARTMENT OF COMMUNITY DEVELOPMENT DATE ISSUED: 12/16/2009
,
:
345 - 6th Street, Bremer[on, WA 98337
� , . 4�
(360)473-5275 Fax:(360)473-5278
ASSESSOR NUMBER: 3802-002-031-0003 ZONING: R10 SITE ADDRESS: 1530 ELIZABETH AVE �
APPLICANT NAME: ISLAND HAMMER LLC PHONE: (360) 697-9434 ADDRESS: P.O. BOX 2435, POULS80, WA 98370 �
OWNER NAME: CRUTCHER SHIRLEY M PHONE: (360) 265-1386 ADDRESS: PO BOX 1252, BREMERTON, WA 98337 i
CONTRACTOR: ISLAND HAMMER LLC PHONE: (360) 265-7944 ADDRESS: PO BOX 2435, POULSBO, WA 98370
LENDER NAME: PHONE: ADDRESS:
SUBMITTED: 12/16/2009 APPROVED: 12/16/2009 EXPIRATION: 06114/2010 STATUS: ISSUED
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Page 3 of 3
. Island Hammer, L.L.C.
' � 19910 Viking Avenue, Suite B
; P.O. Box 2435
� Poulsbo, WA 98370
� � ��� ` Tel. 360.697.9434
m ; , . � � m � Fax. 360.697.6811
;
; Web. www islandhammer.com
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December 11, 2009 �,ytyofBteme
City Of Bremerton,
Department Of Community Development DEC 16 20U9
�epartment of
Re: 1530 Elizabeth Ave, Brem. 98337 �pmmunityDevelopment
Scope of Demolition:
This house has experienced a major fire which has required the structure to be re-built.
Due to the age and structural deficiencies of the house, repairing the damaged areas
And completing the building code upgrades as required is not financially prudent.
We will propose to remove the house to the existing foundation and rebuild on the existing
Concrete foundation a single story structure using the Insurance proceeds as provided.
The house has been cleared of Asbestos, the report is attached.
Please contact me with any questions that you may have,
st Regard
��
1' Calahan
sland Hammer LLC
Don't Move — Improve!
(360)-265-7944 OO
(360)-697-9434 (0)
jim@islandhammer.com �
..
� Remodels • Renovations ■ Repairs
� ISLANHL015R9
�All� ������I
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E I�1 V I R O N M E N T A L NVLAP LAB CODE 200613-0
12/8/2009
Diane Taverniti
island Hammer, LLC
P.O. Box 2435
Poulsbo, WA 9837Q-
RE: Bulk Asbestos Fiber Analysis; Batch # 92406
Dear Diane Taverniti,
Enclosed please find test results for the bulk samples submitted to our laboratory far analysis.
Examination of these samples was conducted for the presence of identifiable asbestos fibers using
polarized light microscapy (PLM) with dispersion staining in accordance with U.S. EPA method 600/R-
93/116, "Method for Determination of Asbestos in Bulk Building Materials." ,_
For samples containing more than one separable layer of materials, the report will include findings for
each layer (labeled L-1 for layer one, L-2 for layer two, etc.). For multi-layered samples, NESHAP
requires that fayers must be analyzed and reported separately. The asbestos concentration in a sample
is determined by visual estimation.
For those samples with asbestos concentrations between 1 and 10 percent based on visual estimation,
the EPA recommends a procedure known as point caunting (NESHAP, 40 CFR- Pa�t 61). Point counting
is a statistical(y more accurate means of quantification for samples with low concentrations of asbestos. If
you would like us to further refine the concentration estimates of asbestos in these samples using point
counting, please let us know.
This report is considered highly confidential and will not be released without your approval. Samples are
arcfiived for thirty (30) days following analysis. Samples that are not retrieved by the client are discarded
after thirty (30) days.
This report relates only to the items tested. If samples are not callected by RGA Environmental
personnel, accuracy of the results is limited by the methodology and expertise of the sample coNector.
Analyses are cross-checked with other laboratories for quality assurance purposes. This report shall
not be reproduced except in full, without written approval of RGA Environmental: It shall not be used to
claim product endorsement by NVLAP or any other agency of the U.S. Government. -� -- -- �
It has been a pleasure to be of service to you. Please call if there is anything further we can assist you
with.
Sincerely,
, � . ' �k.
M "�,�_..�..
Aruna Turaga
Laboratory Director
Enclosure: Bulk Sample Results
1730 Minor Avenue, Suite 900 , Seattle, WA 98101 •(206) 281-8558 • Fax: (206) 281-8922
www.rgaenv.com
it�A Environmenfial, Inc. Sample Lo�
1730 bfma� Ave, SmOe 9�
Seettlq WA �101
�.���°.°°� Chain of Custody
Ph: (206) 281-8858
c:vent: �'�S G.g�b /�A�'I7/7� , � L. . C . RGA Batch # : ��.. -� � q�
Contact: ,�j �,g,� �A�� N � �'f " CL'ent PO # �
Ciient Address: yC�, /� ,�Q x�,�/3� Ciient Job #: �,/��f -��
D�.,� �S �� � /,y� ��3 �(� Number of Samples: �
Cih' State Z,p
phone #: �o C9 - �P � � - !.�/� C� �YPE QF ANALYSIS
2�t or Cc� #: �,� . j ��"- '-_ � ASB�+ 57COS: 1dI�+ TALS:
Fax #: ' �- - rc.� (a;� r�r
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�-ma� Aaa,�: . crn�.'h� rnPi�! e� ���> w;,� �
lteports: �Chcck for PDF vis Email [] Check for Hard Cog rr. Coaet (bwt�� T�,p yy
MOLD: P&K 100 101 1Q2 105 117
PE'oject Manager Other MetLod:
�°�� I'O��o�• �'-G�TC��' Turn Around Time (other):
d U 2 6our / 4 hour Same Day One Day
�.T �r Gt��J �3 �" �o na �-s aa io a$�
Condition: �Good Damaged Severe Damage Price per Sample:, $� g a�
# Clieet Sample ID� RGA Ilabora�ry ID� Comments Sample Deseriptionil�eld Not�es
i t� � O's �-- 1� Z
2 L, Z,3
3 a Z4
4 � �-�
5
6
7
8
9
10
Si atare IDate 7['ime
Sam ed : C1,
Iielin nishe� b : y�
' et� for Laborato iZ �� !: t �
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nelimina Resalts rted t�n P.1VL
�ial rtto P.�G
Special Instrndaons:
� -Nt.;EJ �. �u�� w�{�es����
C] Chedc if Stop af First Posi#ive {Bulk PLM Samples)
CoC416-(Rev.1/0'n *Unless iequested in vKitin� � y�pi� � be groper3y disposed of30
days after snal repon aate. Page 1 of 1
. �
�;� 1730 Minor Avenue, Suite 900, Seattle, WA 98101
�`�'�=`�" OFFICE: (206 �SI-88i8 FAX: Z06) 281-8922 emaii: taborato r env.com �
x��'�� ) - ( � � � � Lr�
# *`.���:�.�
E N V t R O N M E N T A L Bulk Asbestos Fiber Analysis NVI.AP LAB CODE 200613-0
EPA 600/R-93/l l6
Island Hammer, LLC RGA Batch Number: 09-2406
Project Location: Crutcher Clietlt Job Niunber: Crutcher
1530 Elisabeth Ave Number of Samples: 4
$remerton, WA 98337
Report Key �
Client Sample [D Layer lD (if applicable) Asbestos Non-AsUestos Fibrous Non-Fibrous
RGA Lab ID Layer Description Components Com��onents Components
Layer Comments (if appticable)
p� L-I , No Asbestos Detected 85% Vinyl Fillerand Binder
���� � ��? OfF white seif ldhesive vinyl tile 10% Fil(er and Binder
5% Calcite Filler and Binder
L-2 No Asbestos Detected 100% Glue and Glue Fillers
Glue
02 Brown shredded ce(lulose No Asbestos Detecfed 98°h Cellulose 2% Miscellaneous Particles
09021723
Layer Comments: No asbestos detected in representative sampie retrieved from bulk sampie. Analyst can not determine that
no asbestos exists in entire sample.
03 �-� No Asbestos Detected 90% Paint
(���� � ��� Painted surfacing 10% Carbonates & Carbon Fillers
�-? No Asbestos Detected 10% Cellulose 85% Gypsum Filier and Binder
Gypsum drywail 5% Miscellaneous Particles
04 �-� No Asbestos Detected 95% Nylon 5% Resin and Binder
0���� � 7 �� Green carpet
►--? No Asbestos Detected 90% Nylon 10% Resin and Binder
Woven backing
L-3 No Asbestos Detected 80% Glue and Glue Fillers
Glue 20% Filler and Binder
L-4 No Asbestos Detected 100% Synthetic Foam
Carpet pudding
"fhis rc�wn rt.iules unlg to Qn: itrnts tested, if samQlea are not colleeted by RGA Farvironmentnl personcel. necuracy of Ihe �esul�s is limi�ed by �he methodo�ogy and eapenise of the somple coilector. Analyses are cn�ss-
ciKrR s1 uiU� utherlahor��ories fmqualiiyass�aarce pwposes. This report slwll not be reproduced accept in full, wiNuut �vrittrn opproval of RGA [nvironmentnl. It shatl nat bc used to claim praduct enJorsemrm b��
N V t.AP nr any oAnr ugcm�.y ol' dre U.S. CrovemmrnL
Sampled By: Client / "
Received By: Russell Browne l2/7/2009 (,�GCC��������
Reviewed By: Aruna Turaga 12/8/2009 Analyzed By: Michael NlcLeister I?/8/2009 Palc I ol' I
. ��da �
�
� iVYLAP LAB CODE 200613-0
1730 Minor Avenue, Suite 900 Seattle, WA 98101
OFFICE: {206) 281-8858 FAX: {206} 281-8922 email: luboratory cr rgaenv.com___
E N V t R O N M E N T A L Bulk Asbestos Analysis Invoice # O9'�4��
Island Hammer, LLC 12/8/2009
P.O. Box 2435 RGA Batch Number: 09-2406
Poulsbo, WA 98370- Client Job Number: Crutcher
Project Location:
Crutcher
1530 Elisabeth Ave
Bremerton, WA 98337
Purchase Order Number:
LABORATORY
Service Turn-Arounci Date Rnte Number of Snmples E�tendecl
PLM 5 day t2/8/2009 $15.00 4 $72.00
Ple�se p�y this nmounl: $72.OU
Remit to Dept. 61
RGA Environmental, Inc.
1466 66th Street
Emeryville, CA 9�4608
Phone: (800) 776-5696
Fed ID #94-3051012
Terms Net Upon Receipt of Invoice
. - � ` City of Bremerton
%1
Tax & License Division
�� f ' 345 Sixth Street, Suite 600
� ::; !' Bremerton WA 98337-1875
x'i
" (360) 473-5311 (360) 473-5298
= � Fax (360) 473-5200
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ISLAND HAMMER LLC
PO BOX 2435
POULSBO, WA 98370 "
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License Number: 22284 Location PO Box 2435
POULSBO, WA 98370
License Type: Business License Expiration Date: 12/31/2009
Issue Date: O1/06/2009
This License must be posted in a conspicuous place at the business location. This business
license is not transferable or assignable
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POULSBO WA 98370 " , � � � ° _ � '
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' all appficalal�'W�Shingtan stat�, ei�ur�t�; �►d� eit� r�guMatit�tls, ` ,. " � . � � tnrecto�; pepartment.o� i�iqen�ing ' � '. � < _
., � • PERMIT NUMBER: BU09 00292
� � CITY OF BREMERTON DATE ISSUED: 12/02/2009
c � MUNICIPAL UTILITIES
• Bremerton, WA 98374-�7°fl Phone: (360) 473-5270
����s �
� ZONING: SITE ADDRESS: 1530 ELIZABETH AVE
{ ASSESSOR NUMBER: 3802-002-03t-0043
�, APPIiCANT NAME: �SLAND HAMMER lLC PHONE: (360) 697-9434 ADDRESS: PO BOX 252, BREMERTON. WA 98337
I OWNER NAME: CRUTCHER ShIFZ�: `.' h1 PHONE:
� PHONE: ADDRESS:
j CONTRACTOR: ADDRESS: '•
PHONE: �
BILLING: �
�! SUBMI?TED: 12t02�L0�?9 APPROVED: 12/02/2009 EXPIRATION: 05/3112010
STATUS: PAID
� MINIMUM INSPECTIONS REQUIRED
�
WATER -Potable Water Backflow Prevention
PW - Final Inspection - Public Works
PW - Sewer Lateral
r�W - Sewer Main Extension Inspection
PW - Street Patch Final Inspection
FIXTURE LIST
q Descri tior
Q ;
� BR-Sewer Cap
�
,
� ,
�
�,
�
Page 2 of 2
' City of Bremerton
Department of Commanity Development
� 3d45 - 6�' Street, Swite 6t�i
Bren�ertoa, WA 98337-1893
Phone: (360) 473-5275
Faac: 360 473-5278
RESIDENTIAL BUIL�IN� PERMIT CHECKLIST
Applicant Y' ✓✓ r C.� � 1�
Building Permit #: Date: l Z °� 0 9
A!1 plaes to be feity di�neasioned or drawa to scale. _
�
ompleted Application � �/1/� � � ���"
` cope of Work
�
� Vicinity Map
� Site P�an
0 � Site Piat� Review Questionnaire
� Fouadation Plan
� Floor Plan
a
Framing Plan �
� Wall Bracing
� Elevat�ons
� Energy Code Information
� Street/Urility Permits Required
� Paved Parking Indicated (2-off st�reet)
� Contractor's License # and F.�cpirarion Date (Unless OwnerBuilder)
�
� Route to Heatth Departmeat (If there is a septic tank & c�rainfield.) �
� SEPA R�quired? �
� Yes �
No Why '
❑ 5pecial Canditions/Petmits?
,
Comments: � "
4 L
� U � ,
i�
- � a� � S r . 3 � �� �1 �
�' 3 � �'` . c� Gc-c� C� � ���
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. �JP��°f C��7C�0
- � � ���� � � �
City of Bremerton pER:MIT CENTER r/�- c��-�e
� � �� DEC 16 2009
RESIDENTIAL ���
; . � � nepartmentot Building Permit Application
ommunity Development
Denartrnent of Communitv Develoument ' 345 - 6th Stree� Suite 600 ' Bremerton * WA ` 98337-1873
(360) 473-5275 ' Fax (360) 473-5278 ` v�v.ci.bremerton.wa.us
- x'ai ���.:�'A ¢w >` �.� v��- i `,i�:'�'.� �v`.a�,.i""' �'° M °.`n•Fi�ffi`,»•, s.�•.; ,� � �
� ._. ,q �w'�t ' '<' .8¢vr� 7 '�'o-`r�'4�> �'ce� �` 8`' �b- �'��"{? Jx`� 6 �Y,.. , ' °_ "�" Y' �'� t .��".'k
�p �.i' �j y �2 . ' 6 �i, "iy^t�*.n"e.� �` _a^..�=ri'�,." �.,,.e�
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°�'� i,c�` �;a"va�c"�"`d` � ._�� :�•.2�_»:.�t, r.
SiteAddress: S U ' �z,���h ��Ve. Yew�er�►�
To apply for a property address, contact Public Works at (36 473-5270
CONTRACTOR: �g �a. �,,.�e� �.(. OWNER: aJ v ci�..�-�
Address: _ D , � Z t t"� S Address: 1530 - '� u�
Ci , State, Zi : ,,.� S�v UJ�. �J 31U Ci , State, Zi : �ce,, Vl��. `i833`1
License #& Ex . Date: (51.A�NLOt'�29 iZ o Phone #: ' 0 2 - 13 �o
Contact Name: �,,,,� Authorized Agent Name: �
Contact Phone #: 34o S- �9 K y Address: o� Z'i 3 S
Email address: �;.,,,. � io.�. InA�-,r, cx,r,�• Ci State, Zi : �� g a
Tax IDIParcel #: �� 2-GO� -v3i - a � o'a Phone #: { 34a ) Z 4 S- Z' `'� �
� Sewer ❑ Septic Email address: '�,,.... Q a, �w• �+�• �•� cv w•
°tT& .4" 'ffiC' ` Sxb _ _ ° ' /':7:�'L 1t Y'�..k ✓ �yrv 'f�vwi
���:is�t���� �i.���t3ci�a����?� c�e�k� �� �;�� �;�� �*levii° �on�'� �A1#era�iir�.- ��ci'i,'tinn�s
�, �. � .�,.:::,:� <- �;... ���w � �>
C] NEW SINGLE-FAMILY RESIDENCE ❑ RESIDENTIAL REBUILD
� NEW DUPLEX ❑ RESIDEN'fiAL ADDITION
� NEW MANUFACTURED HOME � RESIDENTIAL REPAIR
� NEW GARAGE/CARPORT � NEW ACCESSORY BUILDING
�DEMOLITION i�13L sf Interior bSZsf Exterior" _�'�sf FoundationWall•* Sq sf Roof/Section•*
"" Separafe demolition permit and fees required.
Contact Public Works for sewer cap permR (473-5270). Sewer must be capped prior to demolifion pem�if issuance.
Q OTHER:
IS THIS PROPERTY WtTHlN 200 FEET OFA SHORELINE? YES � rvO,�J
Scope of work proposed: �vr.v ��uSe. �-p ,•.Ya,� a,n
Square Footage: Building 1stFloor t3� Basement �j�(�O Garage 1stFloor
2nd Floor_ '�� Other 2nd Floor
Deck(s):
Valuation Plan Review Fee Permit Fee Surcharge Total Fees
4�, ° �' S •3 �
ApplicaGon fo� which no pertnit is issued within 180 days following the date of applicetion shall expire by limitation, and plans and other data
submitted for review may thereafter be retumed to the applicant or destroyed by the building official. The building offiaal may extend the time
for action by the appiicent for a period not exc�eding 1 BO days on request by the applicant, showing that circumstances beyond the corrtrol of
the applicant have prevented action from being taken. No appiicant shail be exlended more then once. In arder to renew action on an
appliceGon after expiration, the applicant shall resubmit plans and pay a new plan review fee.
V � �, `o�, � o...� � Z � q
I �
plican's Signature (Print) Date
, Rev. Oct. 2008 (Continued on back)
� ' ' ' -
RESIDENTIAL SITE PLAN QUESTIONNAIRE � .
. , ,
1. Site Address:
2. Are any areas being developed on the site within 200 feet of the shoreline? Yes' / No
, NOTE: If yes, please fill ont a Shoreline Permit Snbmittal Checklist (WAC 173-27-180)
CRITICAL AREA CHECKLIST: � '
' 3. Slope is calculated by dividing the vertical Check all that apply to the site and areas within 200 feet of the
distance by the horizontal distance and then site.
multiplying the result by 100. Example:
.� Flat: less than 5-feet elevafiion change over entire site.
� t Rolling: slopes on site generally less than 15%.
Vertical � �
Distance =�20' Hilly: slopes present on site of more than 15% and
less than 30%.
♦ Horizontal Steep: grades of greater than 30% present on site.
� Distance =100 p�� (please describe):
Vertical 20�feet �
Horizonta1100 feet =.2 X 100 = 20% slope
4. Does the site or properties within 200 feet of the site contain areas of standing water, creek or an area
where water flows across the ground surface? Yes / No
5. Is there an appazent wetland present on the site or on properties within 200 feet of the site? Yes / No
RESIDENTIAL DEVELOP�VIENT WORKSHEET:
6. What is the amount of grading proposed (in cubic yards), not including foundation area?
Fill amount C�it amount Total grading
NOTE: Grading over 50 cnbic yards requires a separate permit.
Will the grading material be imported or exported? Yes / No
7. Please provide the following information. The setbacks are measured from the finished exterior wall
of a stivcture to the lot line, not from the foundation. Accurately represent your setbacks on site plan.
. . j'Y'�'�� ��� Ei j ? �
Front azd setback *Use this as the second front yard setback
Rear d setback* for corner lots and tl�rough lots.
Side d setback
Side � d setback �' � **Development Coverage is defined as
Maximtun hei t that portion of a lot covered by impervious
Develo ment covera e** . surface areas of all structures, and
Number of off-street � impervious paved azeas, such as
�,� � driveways and walkways.
, '
, Residential Questionnaire Revision: October 2008
� A
BUI LDI NG ERM IT N° 4817
City of Bremerton, Washington
Phone: (206) 478-5281
�/
OWNER'S VAIUE BLDG. DEPT. VALUE PLAN CHECK FEE RECEIPT NO. PERMIT FEE RECEIPT NO. DATE
$ ,� D � S��r� $ � $ �'���' %� �` � ��
SITE ADDRE I L CATION � "
OWNER' NAIVIE . ADDRESS PHONE�i7 - 3al ~ O
CONTRACTOR �[� D� ��� dv ���,(�t��..STATE CONTRACTOR'S LIC. #
ADDRESS PHONE
� RESIDENCE ❑ BUSINESS ❑ OTHER ❑ NEW REPAIR ❑ REMODEL ❑ ADDITION ❑ DEMOLISH
❑ SIGNS
PLANNING I ZONING STORIES OCCUPANCY
THIS PERMIT ISSUED FOR: i(f � �-/�
�S ,PE fi I� � � �- o �/ �e cd � -
All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume
to g ive aut to v or cancel the provisions of any other state or local law regulating construction or the performance of construction.
INSPECTIONS REQUIRED: Foundation ❑ Framing ❑ Plumbing ❑ Electrical ❑ Wallboard ❑ FINAL ❑
SEPARATE PERMITS ARE REQUIRED (WHERE APPLICABLE) FOR PLUMBING, MECHANICAL AND ELECTRICAL.
FOR INSPECTORS USE ONLY: REINSPECTION:
NOT
TYPE OF INSPECTION DATE TIME PPROVED APPROVED COMMENT DATE TIME APPROVED
FINAL INSPECTION APPROVED BY
Bu Inspector
ISSUANCE OF OCCUPANCY CERTIFICATE REQUIRED BEFORE OCCUPYING BUILDING
OWNER'S SIGNATURE �/ BY
t ri Agent
BUILDING DEPT.