HomeMy WebLinkAbout1991-05-14 2701 CLARE AVE - Permits
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Applicatianpate 03/12/1991
Issue Date 05/14/1991
Assessor Acct #3966-002-003-0009
Site Location 2701 CLARE AVENUE
Owner - Last Name KLR AS?OCIATES . . Firs't
- street 140 S .MAlUq~JiA~iIHJ~;i"';'>, '
- Ci tyBREMER',rQNu:i);'c," ". -.St:'a~t,~:WA Zip 98312.
-. Phone (20,,~J::;:~'77~"i~ ,'~,~,
Tenant's Name ,~R!M .TON~\iQt;V li~;~<f,.'p~~e. ((206))
A t' N ~". ,'~; 'ie."" "''nh .-' 206
gen 's ame ,.," .';; ,;" ;,~;, #F'i'~'" ,~.&' 'o1.";~ .
Architect's Name'''' TOM;"'~STAi5-"'" }~~~!,;;\"" ";', ,f
[X]BUildihg,fF .:~~1i,(j'~..adin9 ~"'-~t,-]Si9rt' 2" r"'] Paving ,
[X] Mechanicijl;f'l?,Move.,Building [] gU');J)ing82", ( ~]~UndEir9rOun4'"
[X]Plumbin~r, 'i:,Moblle Home [J Land',Clear,.,,,,,, ,t;;:J~;'pemolition
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BUildingio~racto;l ,'1'l""'~:~> "'5':~ l~~
contractfri;;'!!~N, . fSTEPHEN JOHiftON~'~N(f. ~
'Street;!i "iN.E. 701 MISSIOi'y"CRK ROAD,:;,
city ! BELFAIR' "~:'~',. ' " :":
Phone ii, (206)275-6734 ri;~jState WA Zip 98;52 ''::
Repres~n . \ STEVE. : ~'""'~'.A . .. . ',;
s~ate I;i:ic, :i' # . \STEPHJ*'~;~~W ~:'!;~XP~,t'~,i~on Da'te/06p~#~~~9~t,
Clty L:L~ense :It r,' "'. ,!~"~xP~~.;~lon Dat~
Nature, of ~r~rk :;:'~~~~~j~~~~;i~~I~'~:' ".l, '. , ,,' /
, Remoq.el a!~minis a:ti\~ area of15ullding, add .new d~J),ing
room and. two 2 4 'room\~,lIli ts, el iminatetwo/S-be ..
units, chai'~;,' 3-bed'r'{)om unitsto~lTer,w2-~,~~'
units. ~
Application Number 91AF030S1'
Permit Number llA8l
. Pro ject Group
MI.
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-----------~-----------~~-
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Building Valuatiori
-----~----------------------
Counci.1 District
'Census. Tract
Cons t ruc t.i on
Type
Sq Feet
Inspections
Required
Residence [ J " Zoning .Foundation [X]
Business [X] Typ. Framing [X]
Other [] Insulatiori[X]
New . [ ] "PI urnbing [X]
. R,epair [ . ] status.' Mechanical [X]
Remodei ,(X] ,,' Code wallboard' [X]
"', Adcii tJ,..an [X] " '12 . Final ", . ,," [x]
- -.... -- - -f'-..; J. ---.... -.. -.. - - -- --.:. -... -;., -- - -~...:. - - - -'~,...-'-- --... --- - -- --- - ...:-- ~----.
Receive~B I: ., ." ".' .'. '. . '.' . Approved. By: . {' '-~']'." / I Q
... .~L'L~' ~ ~,< "~")(. .~ IL( ..1./
---~------~~=~-- ---- ----_.----------_..._-------..;-~--_.._-----_..~--
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M E C H A N I C A J' P E R M I T A P P L I C A T I 0 N
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Application Number ',91AP03081
Cont.ractor
street
City
Phone
Representative
State L,icense, #
City License #
LEON~D/HILLMAN~ INC.
346'0 OLD BELFAIR HWY.
,BREMERTON
(206)
98310
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Appl ication Number 91AP03081
Permi t Numb~r'" '11,881 '
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.-~------------~-----_._---~---------------~------~----~--~-----------
Fi:t;"-e--ptovide a storz, hydrant_"i:MlR~~1"Y"lpcation
. ': .,~;rf,.;;4.~:-~'~~':;''-'''' . -. . . .:~:':ii~~.;.~: ~_\JlI
be determined by Fire",,~1i!'sh~~~c.ll)., , ~',,~
-,'.~~t~JIl" ,H# ,.*~,,;e\,
Water;"-Atmospheri.d~\la .~~~ br'
to
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all faucets f ~e~.~ "and!Jusht)met'&li~ ',n~h>.
~tl1 .":IRIC = - '''' . ,~~~\
inside and Q,u1: sh_;~onYorm to City of Brerne'F,t-On "~
. .iIY .,,"1'- . c ,4, ....~7"., '-;~R. -. ". ~~~:
Washington,~ttilf~~'~cj cro~' connectio~caf1~;rol standat~s.
,J:!; ,k:: :": ,'~~ ~,!~ ~",", it, ' , \ '
Bui Idi'ng-fARi!rOv~d per building J;itirial' s requireii\ent,~c,.
f . "t,' . H~~~ \, "_
that apptf "rotide full f'n -'showing all a,reas,~~i:.i!ill\~
".' :,~l" I" "~"T;-'--"""" ;t' ~ .:?~:~.~,"~;.'i
as remodfile~~or to final approval. App~icas..-t;':
il : ',~"r~ :c ~
understa,l.:ls~ ahy correlt,,;~ons r 'ired,~:fter subniit
::e::C:i:tem:::o~:ct:orre\~?~( "J~~ancY of I'ew
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SITE ADDRESS: d 70) (l) ~ APP. NO. q I A--Pa 3 () fl
OWNER:~LL a.l<) '\a ~^ ~ PERMIT NO.
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FILE COMMENTS
NUMBER OF PLAN SETS
FEES PAID:
PLAN CK. V
BLDG.
PLBG.
MECH.
ROUTING:
DATE DATE
SET # SENT RETURNED APP.
BUILDING B:
PLANNING B
ENGINEERING [;2(
WATER ~
FIRE [3'"
TRAFFIC 0
HEALTH DEPT. 0
3/r+}q)
13/{~/Cn 3jJWl J
3/ It./-/C/{-3( {'ifll ~
( { .. cfl&f3J
~\ 3JIC1/Qt
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DATE COMMENTS
-31'~/q,3 .
VALUATION:
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r '-100 I 660
SACHG.
OTHER
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Application Date 03/12/1991
Issue Date
Assessor Acct # 3966-002-003-0009
Site Location 2701 CLARE AVENUE
Owner - LastNam~ KLR ASSOCIATES
- Street 140 S. MARION AVEN0E
-- C i t y Bf~EME]HClN
F') l- ( ''')('); ) ':>'7' '7' '''10'''] ,
..... . Ilone '.;.. , () '::>" "':;',:: 7,) .
T t. N <' 13 f'} I"" MI""I'Yl" 'CJN <'" ("IN V A l I"" c' (.., '....N "I"
enan" same ,,' f);";; '\~~:r:,:~" ...... .. ~ .'... ::..::>... ::~
ACjerlt.. >>c' Name ,.J' P. n". If I
.., "..> - ".>/ Vl,,-,,L.- J., ('" \J e.. Cj -e.-r
Archi teet's ty,,aine,: TlJM~ HERST AD .J
[X] Bui ldi nSl:';~~:":~;'[, J>.:Gradi,no' [ ]
[X] Mechani(~alt'i; :[} J. Move Bui Idinq [:1
[x] Plumbinf! [ l,;Mobile Home [ J
Appl icat ion Number' 'J1AP03(jU1
Per-mit Number
P'roject GY'OUP
First MI
State WA Zip 98312
'". I")~' " . "'( ''''0' f: )
." IlunL .::. ..I
P hor.le( 206 ) 't-7r l.fq '77
[ J Pav i nq
[ ] Underf)round
[J Demo I :i. t ion'
Sign
Burning'
Land tlear
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-------------~----------------------_..."----------~------------------------
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:,..-, , , ''''-
Buildinq Contract;'or:
Contractor
Street.
C:i.ty
Phone. l
I:~epr eserrtat,i VE~
State License 4t
C i t y L.. i cense It.'
STEPHEN JOHNSON INC.
N.E. 701 MISSION CRK ROAD
BELFAIH
( '-'() L ) '"'71''' L "7' .-) A
,,::. . C) A::. ..:) '''-I:) ~::) "'I'
STEVE .'
STEPH;J* 199L.W :
Zip 9B5;:~U'
State WA
Expiration Date D6/0l/1991
Expiration Date
Nature of Work:,
Remodel~ admin~str~tive area of building. add new dining
y'oom and. t wo0:2::-:-bedrtJom un its. e:l. i m i nat e two 3"-bedroom;
F==; I~~;~;Y~: Cha?g:~~~~r/ ~:r:l five 2--bedroom
Xi'"~' " y--u . ~
", ;, ~ ~
. '" < .t ~
,:,-,
Buildinq Valuation
~p400000 .00.
----------------------------------.-.-------------------------------------
Council District,
Census T'( act
Construction
Type
Sq Feet
Inspections
Required
>r' ~:
Residence
Business
. Other
New
Repair
Remodel
Addition
[ :1
[X]
r ']
'" ~ '
[ ]
[ ]
[X]
[x]
Zoninq
Type
Foundation
Framing
Insulation
Plumbing
Mechanical
Wallboard
Final
[x]
[X]
eX]
[x]
[X]
[X] "
[X]
Status
Code
12
====:=:=======================:===:::=:::==::==::::::= :=========:====~::::===:==~::=:~.::===~:::::=
ENERGY APPLICATION
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HOUSE, lYPL (rambler, 2-story, et.c.) ,
. .
:Business/One Floor'
ADDRESS.:. 2701 Clare Avenue, Bremerton, WA' 98310
BUILDER: Stephen Johnson, Inc.
, HOMEOWNER:" Bremerton Convalescent Center, ,:, ',' r ' '
. " .-u.___'
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FLOOR INSUL.
\S~tf
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~.~~C>
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2nd
FLOOR AREA: 1st
WALL INSUL:.'
l\R EA '
\ z..e-tf 5+ ','
. \ ~3Y: 'S;=-'
,
.. -, ... ,', ".
AREA
AREA "
"'AREA' '\ ~3~
5E=" '
SLAB INSUL.
",. ,~
CEILING
INSUL.'~~~<a> ..
- ~ .}:... ., "
.,
VAULTED
I NSUL.
AREA
ROOF & WALL OPENING DETAIL
.' '
.~, '. ' , . '-, ' ;
WINDOWS* (Group Same ",Stze,Windows' On On,~,.L ine) 1
BRAND MODEL U-.VALUE HOW ,MANY? " SIZE AR~A (SQ.,: FT.) . -. "
. .
(Number of Windows x SQ. Ft.) ,
~ \'-e:. h~ ~~C .sS 2- 5io 'i-O " 'Sf,;'
, " ,.~'1\o Z: 3'0 So. , ::!:::P ~~
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.'5'5 (p, b ~o \4'1 ~~ ...
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**TOTAL WI NDOW AREA ;2. \4 "E>F
. (~)
tlP61D
SEE OTHER SIDE.....
CITY OF BREMERTON
'PERMIT ' APPLICATION'
CITY OF BREMERTON BUILOn"a DEPARTMENT
PHONE: 478-5281
SITE ADDRESS
ASSESSOR'S N;r;r. /I
OWNER
MAIL ADDRESS
ZIP
PHONE
CONTAAClOR
Class of work: D NEW
...--/" MAIL AD~"
l.:{I ADDITION I.:if ALTERATION
PHONE
LICENSE NO.
D REPAIR
D MECHANICAL
D PLUMBING
COMMENTS
No. 1IJpe of Equipment Fee No. 1IJpe of Flxtu.. or Item Fee
STOVES Gas_ Oil_ Wood_ ltl WATER CLOSET (TOILET)
FIREPLACE INSERT t BATHTUB
FURNACE Gas (Nat._ LPG._) Oil_ lP LAVATORY (WASH BASIN)
Wood add 0"- Other_ Electric- 4 I SHOWER
BTU KITCHEN SINK & DISPOSAL
Type: Up f1ow_ Down f1ow_ DISHWASHER
.
Horizonta~ Wall_ L LAUNDRY TRAY
4 CONVERSION BURNER: Gas '-L:,at.- LP-> CLOTHES WASHER
Under 100.000~Over 100,000 '210,000 WATER HEATER
Oil_' \('){e 6Ue,h.....s &\l~ URINAL
UNIT HEATER BTU___ Gas_ Elec._ DRINKING FOUNTAIN
BOILER Gas- Oi~ Electric_ FLOOR - SINK OR DRAIN
Other_ HP_ t SLOP SINK
GAS SYSTEM Max. 5 outlet Total_ WATER PIPING & TREATING EQUIP.
EVAPORATION COOLERS Roof_ Wall_ WASTE INTERCEPTER (Grease)
BTU_ VACUUM BREAKERS & BLACKFLOW DEVICE
AC UNIT Electric_ Gas Elec. Combo_ LAWN SPRINKLER SYSTEM
BTU_ SWIMMING POOL - Private_ Public_
HEAT PUMP Single Package_ Split- GROUNDWORK
Add 0"--,- BTU To"- SUMP
MIXING OR REHEAT BOX CFM_ BTU_ ALTERATION
r AIR HANDLING UNIT CMF _ BTU '16 'TO 10 KIDNEY MACHINE
7/ FANS Exhaust 'V Supply_ Bath_
RANGE HOOD Residentia~ Comm._ PERMIT $
ROOF DRAINS TOTAL $
CLOTHES DRYER Res._ Comm._ NOTICE
INCINERATOR THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
ALTERATION TO DUCT SYSTEM IS NOT COMMENCED WITHIN 120 DAYS. OR IF CONSTRUCTION OR WORK IS SUS-
t Heating/Coolin9--~~ 'lOt...:> I+lfL PENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK
c.DNt)\'flD'P~ IS COMMENCED.
TANKS Oil_ GaS- Propane wlOK I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPUCATION AND
from Fire Dept._ Gallons KNOW THE SAME 10 BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND
REFRIGERATION UNIT ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLED WITH WHETHER
SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME
PERMIT $ 10 GIVE AUTHORITY 10 VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER
10rAL FEE $ STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF
CONSTRUCTION.
SIGNATURE OF CONTRACTOR OR AUTHOF;l/ZED AGENT
(DATE)
FINAL APPROVAL
SIGNATURE OF OWNER (IF OWNER BUILDER)
(DATE)
RECEIPT NO.
PERMIT
IWhit....."'RIAINAI VAII__IN~PI=I"!'lnR P;nl<_APPI I('ANn
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m1 OCT 1 0 200 l0
BREMERTON
8UILDING DEPARTMENT
Letter of Transmittal
October 3, 2002
I:
i 1 CITY OF BREMERTON
i I
\ I BUILDING OFFICIAL
286 4TH ST
BREMERTON WA 98337-1813
Project Info:
Key People:
Facility
Administrator:
Architect /
Engineer:
Review Staff:
Fire & Life
Safety and
Program
Manager:
Sanitarian:
CRS# 6707
Bremerton Convalescent Health &
Rehab Center
Chapter 388-97 WAC Nursing Homes
Replace Vinyl Flooring
Project
location:
Patricia McDonald
111 W Michigan Street
Milwaukee WI 53203
(360) 377-3951
PEMcDonald@extendicare.com
Facility
Contact:
Zenos Flooring Covering
Zeno
311 Stanford Street
Tacoma, W A 98466
(253) 565-3717 .
Building
Official:
Chad E. Beebe, CSI
chad.beebe@doh.wa.gov
(360) 705-6648
Architect:
John R. Templar, R.S.
john.templar@doh.wa.gov
(360) 705-6786
Mech./
Electrical:
Small Projects Douglas Taylor
Reviewer: douglas.taylor@doh.wa.gov
(360) 705-6628
Small Projects
Reviewer:
Copies To:
181 Local Building Official: City of Bremerton
~ ~,:;u ~.uvV v.. 'VVVUUUVV"vv, - - TJ
o DOH Office of Health Care Survey
~ Architect / Engineer: Zenos Flooring Covering
o Sub-Contractor:
o Sub-Contractor:
Page 1 of 4
Construction Review Services
2725 Harrison Ave. NW Suite 500
PO Box 47852
Olympia, Washington 98504-7852
m_____u_ -----www:ooKwa.-gov/cfS~--
2701 Clare Avenue
Bremerton, WA 98310
----
Same as Administrator
City of Bremerton
Building Official
286-4th Street
Bremerton, WA 98337-1813
Richard M. Swanson
richard.swanson@doh.wa.gov
(360) 705-6782
William M. Kingrey, PE
william.kingrey@doh.wa.gov
(360) 705-6783
Rob Bradley
robert. bradley@doh.wa.gov
(705) 705-6685
o DOH Child Birth Center Licensing
~ Washington State Patrol, Fire Protection Bureau
II DSHS, Deb Burman, Aging & Adult Services Administration
TI Other:
o Other:
~ CRS File
Plan Review Comments for Project
/
~
.
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Facility Name:
Site Address:
Bremerton Convalescent Health & Rehab Center
2701 Clare A venue
Bremerton, W A 98310
Facility ill: 007626
Facility ~ata:
Occupancy Group:
Numb~r-of-Apartment-unit~
Automatic Fire Sprinkler System:
Construction Type:
" -,- .
Applicable Code:
~ri-v:ate-occupancy :
DB
D13R
D13D
'r-wO-persQtl-Qccapancy:
D Not Applicable
Automatic Fire Alarm System: ~ Yes
D Not Applicable
DYes DNot Applicable
Compartmentation on all floors required:
Special Egress Control Devices:
Approved Smoke Control System:
Maximum allowable licensable Beds:
DYes DNo
Based on size of rooms used for sleeping
Residents
Based on size of common rooms
Residents
The data above is based on the information presented to the Department of Health Construction Review Services.
Any change in the facility or facility program that causes the above information to be incorrectis subject to
review by DOH Construction Review Services. Approval for construction is not approval for licensure. A copy of
this certificate will be sent to the licensing agency.
~
. V ~
Appro v . 1"
Page 3 of 4
Review Key: A = Architect F = Fire & Life Safety S = Sanitarian
Plan Review Comments for Project # 67f'
M = M"h~k,'1 E"otrioill 8P=8,",,' P,oj<ot, C = con''''7
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</Jln'f<:/Jt, ,,> @
LETTER OF TRANSMITTAL ,to O~;:1
~f{'
"<.i1')
<JP
>'
j~ fk~Tth
Construction Review & Acute Care Services
P.O. Box 47852 '
Olympia, Washington 98504-7852
, PHONE: (360) 705-6777
FAX: (360) 705-6654
Intemet: CCR9303. ~Oh.wa.QOV Submission Status
I Date: July 9, 1997
To: Charlie Byrne
Bremerton Convalescent Center
\270'1 Clare Avenue
Bremerton, WA 98310
xx
D
D
D
D
D
Approved
Not Approved
Resubmit 0 copies for approval
Accepted as noted
Submit written responses to review
EnclosUies:
Project: carpet corridors
Submission: carpet data
Project Number: 97-7626-4973-001
Attached Review Comments.: Applicable Code:
D Architectural
o Approved
o NOT Appd
D Fire & Life Safety
o Approved
o NOT Appd
D Mechanical-Electrical.
o Approved
o NOT Appd
xx Public Health
xx Approved
o NOT Appd
Copies To:
xx
Local Building Official, City of Bremerton
DSHS,Resideniial Care Se':vices, District #. 58 '.-
DOH, Residential Care Licensing
Architect:
Contractor:
xx
,
I
D State fe Marshal
. F. Lashway, r:;"jentiai Cara Services
I
D on.A:
. I
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Notes: Carpet quality "Socrates 26" by Patcraft is approved for direct g1 down.
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, - JohR. Templar
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BREMERTON
BUlLD!NG DEPARTMENT
Letter of Transmittal
August 22, 2002 '
[.
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,
CITY OF BREMERTON
BUILDING OFFICIAL
286-4TH STREET
BREMERTON WA 98337-1813
L'-.-
Project Info:
'-~-""~~--i
I
I
-"".~".~--~ ~~~~~~- ~,--,,_.j
Construction Review Services
2725 Harrison Ave. NW Suite 500
PO Box 47852
Olympia, Washington 98504-7852
"
www.doh.wa.gov/crs
Key People:
Facility
Administrator:
Architect /
Engineer:
Review Staff:
Fire & Life
Safety and
Program
Manager:
Sanitarian:
Small Projects
Reviewer:
CRS# 6707
Bremerton Convalescent Health &
Rehab Center
Chapter 388-97 WAC Nursing Homes
Replace Vinyl Flooring
Patricia McDonald
111 W Michigan Street
Milwaukee WI 53203
(360) 377-3951
PEMcDonald@extendicare.com
Zenos Flooring Covering
Zeno
311 Stanford Street
Tacoma W A 98466
(253) 565-3717
Chad E. Beebe, CSI
chad.beebe@doh.wa.gov
(360) 705-6648
John R. Templar, R.S.
iohn.templar@doh.wa.go\r
(360) 705-6786
Douglas Taylor
douglas.taylor@doh.wa.gov
(360) 705-6628
Copies To:
[8]' Local Building Official: City of )3remerton
[8] DOH Office of Accommodations & Res. Care Survey
D DOH Office of Health Care Survey .
[8] Architect / Engineer: Zenos Flooring Covering
D Sub-Contractor: ~
D Sub-Contractor:
Page 1 of 4
Project
location:
Facility
Contact:
Building
Official:
Architect:
Mech. /
. Electrical:'
Small Projects
Reviewer:
2701 Clare Avenue
Bremerton WA 98310
City of Bremerton
Building Official
286-4th Street
Bremerton WA 98337-1813
Richard M. Swanson
richard.swanson@doh.wa.gov
(360) 705-6782
Willienll M~,Kingrey, PE . _
'wil1i'aIll.kingrey@doh.wa.gov
(360) 705-6783
Rob Bradley
robert.bradley@doh.wa.gov
(705) 705-6685
D DOH Child Birth Center Licensing
[8] Washington State Patrol, Fire Protection Bureau
D DSHS, Deb Burman, Aging & Adult Services Administration
D Other:
D Other:
[8] CRS File
Plan Review Commel1ts for Project #6707
Bremerton Convalescent Health & Rehab Center
Chapter 388-97 WAC Nursing Homes
Replace Vinyl Flooring
Memo:
- NOT APPROVED -
~ REVISE AND RESUBMIT -
This project is not approved and is not yet authorized for use by the Licensing Agency.
Provide written responses to our review, using our numbering system, for those items checked as not approved. To
help expedite our review include a transmittal with all submissions clearly identifying all documents with your project
name and CRS project number.
Include two copies of revised plans or sheets, in the same format/size as the original submission, incorporating your
corrections. Any response that does not address ALL the review comments and provide the required information will
be considered incomplete and returned without review.
All documents submitted will be retained in our office until all the construction documents have been received,
reviewed, and accepted. When the project is approved a complete package of accepted documents will be stamped and
signed by the department. One copy will be returned to the facility administrator and one retained for our records.
Please visit the link to Project Status on our web site at www.doh.wa.gov/crs.
Page 2 of 4 Plan Review Comments for Project # 6707
Review Key: A = Architect F = Fire & Life Safety S = Sanitarian M = Mechanical! Electrical SP=Small Projects C = Conference Note
Facility Name:
Site Address:
Bremerton Convalescent Health & Rehab Center
2701 Clare A venue
Bremerton W A 98310
Facility ID: 007626
Facility Data:
Occupancy Group:
Number of Apartment units:
Automatic Fire Sprinkler System:
Construction Type:
Applicable Code:
Private occupancy:
Two person occupancy:
DB
D13R
D13D
D Not Applicable
Automatic Fire Alarm System: ~ Yes
Compartmentation on all floors required:
Special Egress Control Devices:
D Not Applicable
DYes DNot Applicable
Approved Smoke Control System:
Maximum allowable licensable Beds:
DYes DNo
Based on size of rooms used for sleeping
Residents
Based on size of common rooms
Residents
The data above is based on the information presented to the Department of Health Construction Review Services.
Any change in the facility or facility program that causes the above information to be incorrect is subject to
review by DOH Construction Review Services. Approval for construction is not approval for licensure. A copy of
this certificate will be sent to the licensing agency.
Approving Authority
Page 3 of 4 Plan Review Comments for Project # 6707
Review Key: A = Architect F = Fire & Life Safety S = Sanitarian M = Mechanical/Electrical SP=Small Projects C = Conference Note
Bremerton Convalescent Health & Rehab Center
Chapter 388-97 WAC Nursing Homes
Replace Vinyl Flooring
Plan Review Comments
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Replacement of sheet vinyl in restrooms require cove base moldings up the wall at least
six inches as per WAC 388-97-46560
Page 4 of 4 Plan Review Comments for Project # 6707
Review Key: A = Architect F = Fire & Life Safety S = Sanitarian M = Mechanical / Electrical SP=Small Projects C = Conference Note
\
v
,
BUILDlNG: .f7'8-5281
TO: ,{uildingy~
Business License
Traffic
Cityof BremertOIt
DEPA.RT~IENT OF CONSTRUCTION
.-\..ND LA... YD USE
PLANNING: .f7'8-5:!7:
Building Department
REQUEST FOR OCCUPANCY APPROVAL
'~~ineering ~
,--Fire ~
~ter/Wastewater
~anning .~
lfealtn. Dept.
Please review this request for approval to occupy the following structure and
return to this department by November 18, 1991. Thank you.
Date:
'11/4/91
Permit Technician: Janet Lunceford
* * * * * * * . . * * . . . * . . . . . * . . * . * * * . * * . . * . * . . . . * * * *
Name of Building
Name of Tenant
(if applicable)
Owner of Building
Nature of Construction
(if app licable)
Address
Contractor
Permit 11
Permit Date
Type of Construction'
Square feet
Use
Bremerton Convalescent Center
~::t,mp
KLR Associates
Interior tenant remodel
2701 Clare Avenue
. ,
Stephen Johnson, Inc.
11 AA 1
')/14/Ql
V-lht.
----
5f: ;-; pt.j
Nursing Home :;
Type of Occupancy I-I
Occupant Load ~G, f.p _'
* * * * * * * * * * . * * * * * * * * * ** * * * ** * * * * * * . * . * * * * * * * ,
Comments:
Approved L:7 /Disapproved l:7 By:
Date:
817 P...CTFIC ..WENt:E . BR.E~ERTON. WASHINGTON 98:310
BUlLDlNG: .f7B.5281
.TO: Building
Business License
Traffic
City-of BremertOIt
DEPA.RT~IENT OF CONSTRUCTION
AND LA....'..n USE
PLANNING: 418.527:
GIH Of aREMc(n(~N
Building Department
REQUEST FOR OCCUPANCY APPROVAL
NOV 1 " 1:1::11
!v1UNICIPAL UTIU'l tES
Engineering
}.1ire
H"e.altn. Dept.
,Water /Was'tewater 0
Planning
Please review this request for approval to occupy the follow~ng structure and
return to this department by November 18, 1991. rhank you.
Permit Technician: Janet Lunceford
Date:
11/4/91
* * * * * * * * * * * * * * * * * * * * * * * * . * . . * * * . * * * ** * * . * . '. j
Name of Building
Name of Tenant
(if applicable)
Owner of Building
~ature of Construction
(if applicable)
Address
Contractor
Permit II
Permit Date
Type of Construction
Square feet
Use
Bremerton Convalescent Center
~Rmp
KLR Associates
Interior tenant remodel
2701 Clare Aven~e .
. .
.... \' \' ,.~,. f\\
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\jUI'-~'-
Stephen Johnson, Inc~
11~~1
<;!14!C)1
,
V-1hr.
5f: '7 pLj
Nursing Home
Type of Occupancy _..!::1
Occupant Load ~(, tp
* * * * * w * * * * . * . * * . . * . .-.
Comments:
* * * * * * * * * . . * . * * * * * * * * * ,
APproved~ /Disapproved L:7
Date:
811 P.4.CTFIC .o\VENL'E . BR.E~ERTON, ~ASHIN(jf()N 9~~
BUILDING: 478-5281
TO: Building
Business License
Traffic
Cityof BremertoIl.
DEPART~IENT OF. CONSTRUCTION
.-LVD LA.."~ USE
\1/-loM
PLANNING: 478-521:
Building Department
REQUEST FOR OCCUPANCY APPROVAL
Engineering
}'ire
l1ealth Dept,
Water/Wastewater
\:!?J;anning(ll
Please review this request for approval to occupy the following structure and
return to this department by November 18, 1991. rhank you.
Date:
11/4/91
Permit Technician: Janet Lunceford
* * * * ~ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ~
Type of Occupancy _.1.::1
Occupant Load ~G, ~ _,
* * * * * * * * * * * * * * * * * * * *. * * * * * * * * * * * * * * * * * * * * * * * ,
Comments:
Name of Building
Name of Tenant
(if applicable)
Owner of Building
Nature of Construction
(if applicable)
Address
Contractor
Permit II
Pennit Date
Type of Construction
Square feet
Use
Bremerton Convalescent Center
~,qmp
KLR Associates
Interior tenant remodel
2701 Clare Avenue
Stephen Johnson, Inc,
11 AAl
'l!14!Ql
,
V-lhr.
5 f. 'I pt..j
Nursing Home
APproved'/f! IDisapproved CJ By: ~
Date: 1/ (/~/tjl
,
811 P.6,CTFlC ..WENVC: . BRE~ERTON, WASHINGTON 9S:110
BUlLDING: 418-5281
Cityof BremertOIt
DEPA..RT~rENT OF CONSTRUCfrON r'"
, .:\..ND L...\...'-'D USE 'I
PLANNING: .rrs-S!7:
Building Department
REQUEST FOR OCCUPANCY APPROVAL
f~ I;~~ ;i~ I"--=' n ~
:.;:.,. ~ (<.~ !!./ V~f,f ~
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TO:
Building
Business License
Traffic
,Engineering i
}~ire
Irealth. Dept,
t
Water/Wastewater
r:1
'-f.y ol ert:)~. , "
'....:iG-Fta.;'j
Planning
J
Please review this request for approval to occupy the following structure and
return to ,this department by November 18, 1991. thank you.
Permit Technician: Janet Lunceford
Date:
11/4/91
,j
,
* * * * * * * * * * * * * * * * * * * * ~ * * * * * * * * * * * * * * * * * * * * * * .
Name of Building
Name of Tenant
(if applicable)
Owner of Building
Nature of Construction
(if applicable)
Address
Contractor
Permit 'IJ
Permit Date
Type of Construction
Square feet
Use
Bremerton Convalescent Center
S.qrnp
KLR Associates
Interior tenant remodel
2701 Clare~venue ,
, ,
Stephen Johnson, Inc.
1)/14/ql
,
V-lhr.
"\, \, \
............
", " f\ \
",\~,"\'D
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11 AA 1
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,- -,' ',', ~t.~\
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\- i:'>-J.\:}.
~\'; \ V:"
Type of Occupancy' _.1.::J-
Occupant Load ~G, ~
* .'. . * * * * * * * . * * * * .
-'
* * * * * * . * * * * * * * * * * * * * ~ . * * * * ,
Comments:
Approved
/Disapproved l:7 By:
Date: //-P-7(
817 P.4,CTFTC AVENL'C: . BR.E~ERTON. WASHINGTON 98:110
BUILDING: 478-5281
Cityof BremertoIt
DEPA.RT~!E~T OF CONSTRUCfrON
..-L'ID L...L "1) USE
PLANNING: .r7'8-5n:
Building Department
RE~UEST FOR OCCUPANCY ~PROVAL
TO: Building
Business License
Traffic
Engineering
,:}o'ire I
tfealtn. Dept,
Water/Wa~tewater
Planning
Please review this request for approval to occupy the fOllowing structure and
return to this'department by November 18, 1991. Thank you.
Date:
11/4/91
Permit Technician: Janet Lunceford
* * * * * * * . . * . * . * * '. * . . * . . * . * * . * . . * . . * . * * . * . * * . j
Name of Building
Name of Tenant
(if applicable)
,Owner of Building
~ature of Construction
(if applicable)
Address
Contractor
Permit IJ
Permit Date
Type of Cons true t&~~"
Square feet '
Use
Bremerton Convalescent Center
.i
~;:Jmp
KLR Associates,
Interior tenant remodel
2701 Clare Avenue
I>
/iIj ".
(S ','''''
. .
5f: 1 pLj
.:. ," ~' ~
No, .j ,:'"
h. ~ V <)... ',' (~~&.,./;?
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'It I)-
Stephen Johnson, Inc.
llAAl
')/a/Ql
.
V-1hr.
Nursing Home
Type of OccupCflcy __1=..1
Occupant Lo~d'" ~ G, ~ _'
* * * * . * * * . * . * * * * * * * * * * * * *
Commen ts : I:}--j 0. 'C V'1Cl d ~ h' I(J. ~ J <-i' r
I: 4f7fl~( AL7te), .
* * * * * * * * * * * * * * * * * * * ,
51"Sr;L~Yl-1<C k~r/~d
Approved ~ /D1s~pproved D By:
Date:
. .
811 P...CTFlC AYENL'E. . BRE~ERTON. WASHINGTON 98:110
BUlLDtNG: .f7'8.5281
TO: ~ilding
Business License
Traffic
Cityof BremertoIL
DEPA.RT~IENT OF CONSTRUCTION
..L VD L..L "1) USE .
PLANNING: 478.5!7:
Building Department
REQUEST FOR OCCUPANCY APPROVAL
Engineering'
}.'ire
Irealth Dept,
Water/Wastewater
Planning
. .
. Please review this ~equest for approval to occupy the following structure and
return ,to this department by November 1.8, 1991. Thank you.
Permit Technician: Janet Lunceford
Date:
11/4/91
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * .
Type of Occupancy _...l=1
Occupant Load ~G; (:, _.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ,
Comments:
Name of Building
Name of Tenant
(if applicable)
Owner or Building
Nature of Construction
(if applicable)
Address
Contractor
Permit II
Permit~Date
Type of Construction
Square feet
Use
Bremerton Convalescent Center
S::1mp
KLR Associates
Interior tenant remodel
2701 Clare Avenue
. .
Stephen Johnson, Inc.
11 AA 1
r:;!14!ql
,
V-Ihr.
5f: 1 pLj
Nursing Home
Approved
/Disapproved L:7 By:
Date: {/ ~ (3/1 c
817 PACJfJC ..WENt:E . BR.EMERTON. WASHINGTON 98:110
,,/
STATE OF WASHINGTON
Rick Krueger, Administrator
Bremerton Convalescent Center
!27ill-Cl~r~ ~}\v'ei.lUeJ
Bremerton, Washington 98310
DEPARTMENT OF HEALTH
1112 Sf Quince St · P.O. Box 47852 · Olympia, Washington 985fffl[2 f!j ptg ,
June 16, 1994 lf1].. ... u:; 0 W @/DJ
JUN~l ~4
8UILD/~~f~~ETq
E: Bremerton Convalescent Center
Install Window in Nurse Station
CRS #94409-4072-001
Dear Mr. Krueger:
I received sketches on June 1, 1994.. Staff has completed a review of these documents and
has found them acceptable.
The staffs review is pursuant to WAC 248-14 Nursing Home Codified Rules, Regulations
and Standards adopted by the Department of Social and Health Services as amended to
date.
I am returning a set of stamped "Approved" documents for your use at the job site. Final
approval is subject to applicable codes and field inspections. These documents shall remain
on file and available, in good condition, for inspection at the job site until the project is
completed. I recommend these documents become a permanent part of the facility records.
I am enclosing two notification cards. Please complete and return the green card when
construction begins and the pink card when construction is complete.
The Nursing Home Services Division of the Department of Social and Health Services
(DSHS) requires a minimum 90-day advance notification of anticipated completion dates.
Please contact: Director, Nursing Home Services, Aging and Adult Services, 4413
Woodview Drive S.B., P.O. Box 45600, Olympia, Washington 98504-5600. At that time you
will be given instruction on how to proceed for a timely opening of your project, induding
Medicaid and/or Medicare certification.
Please notify Amanda Carmier, District 5B Manager, Nursing Home Services at (206) 593-
2075 and the Fire Protection Services Division, (206) 493-2663, three weeks prior to the
completion of the project.
@<~18
..
Rick Krueger
Bremerton Convalescent Center
CRS #94409-4072-001
June 16, 1994
. Page 2
You shall not occupy the completed remodel area until it has been inspected by a State Fire
Marshal from the Department of Community Development, Fire Protection Services
Division and received approval by DSHS, Aging and Adult Services.
If you have any questions, please call (206) 705-6777 or directly contact the consultant at
their number listed above.
Sincerely,-
7 //
\bc;~t'll~ ~_~t:l(?
Byron Plan, Manager-
Construction Review Services
2725 Harrison Avenue N.W., Suite 500
P.O. Box 47852
Olympia, Washington 98504-7852
BRP:JRT:jp
Enclosures: Notification cards
Sketch
cc: Cathy Wiggins
Nursing Home Services, District 5B
State Fire Marshal, Fire Protection Services Division
Bremerton Building Department
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WILLIAM E. PETERSON
. CONSULTING ENGINEERS
STRUCTURAL AND CIVIL
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BUILDING DEPARTMENT ROUTING F
Name:
~S~(.,//1~
A t/ e-.
Builder:
OCCUPANCY MUST BE APPROVED BY THE FOLLOWING DEPARTMENT IN
ACCORDANCE WITH DEPARTMENT'S COMPLIANCE REQUIREMENTS:
DEPARTMENT
DATE SENT
RETURN DATELI!ill APPROVED BY
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COMMENTS Aetr
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Address:
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Name:
Builder:
OCCUPANCY MUST BE APPROVED BY THE FOLLOWING DEPARTMENT IN
ACCORDANCE WITH DEPARTMENT'S COMPLIANCE REQUIREMENTS:
DEPARTMENT
DATE SENT
RETURN DATELI!ffi APPROVED BY
U/#l~
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err! OF BREMERTON
MAR 13 1985
Water Department
BREMERTON MUNICIPAL UTILITIES
3027 Olympus Drive
Bremerton, Washington 98310-4799
(206) 478-5318
UTILITY SERVICE ~GR~EM~~
1598
Bremerton,
ReceiPt~. f~qG~
WAf ~ IL{- , , 19_
Work Order No.
Tap No.
.--
J
The undersigned
Service Address:
Legal Description:
Plat
property owner hereby applies for Utility service at:
Block
Lot
Kitsap County
------------------------------------------------------------------------
SERVICE REQUIREMENT: [] Water [] Wastewater [] Stormwater
SERVICE AREA: [] Marine Drive Water [] Sewer District #1
[] Ci ty' [] North Perry Water [] Tracy ton Water
[] County [] Port of Bremerton []
---------------------------------------------------------------------------
SERVICE CHARGES:
Connection/Inspection Fee:
Water: 'Dom.estic...............Size $
Fire .................. Size $
Wastewater ............................. $
Storm Water ............................. $
BARL!
Front Footage Fee:
. Water ................................... $
Was tewa ter .............................. $
Storm Water ............................. $
General Facility Fee:
Water ......., of units
Wastewater .., of units
StQrm Water .f of units
(jj $
(jj $
(jj $
$
$
$
~-y'stem Development Charges:
. Water' .
Wastewater
Storm Water
$
$
$
Temporary Service $
Road Permit [] City [] County ..$
Street Restoration [] Asphalt [] Concrete $
Tapping Fee ............................... $
Deposit $
Other Storz Adaptor $ 128.64
TOTAL. . . . . . . . . . . . . . . . . . $
401- 388.1000
---------------------------------------------------------------------------
1 .
Utility charges are the responsibility to the owner regardless of
whether the property is occupied by the owner or tenant. Unpaid
cltarge shall.,become a lien on the property serviced.
By. this agre~ment, the undersigned owner acknowleUges that the owner
as~umes the ~isk and the City disclaim~ responsibility for all claims
for damage or injury to person or property resulting from the
following:
a. Installation, maintenance and operation of all plumbing, fixtures
or appliances connected to the water meter or wastewater main.
(Building permit inspections are limited in scope and do not
guarantee plumbing design or workmanship.)
b. Changes in pressure, flow or temporary shut-off of services due
to system maintenance, emergency or non-payment of charges.
2.
Name KLR Associates
Billing Address
C't
Owner's Signature
Agent's Signature
Phone Number
)
State WA
ZIP 98310
, 19
, 19
Date
Date
of Bremerton Municipal Utilities:
Date
~I 14-
, 19:U
Original & Yellow Copies: Utilities Accounting
Pink Copy: Utilities Engineering Goldenrod Copy: Customer
INSPECTION RECORD CARD
CITY OF BRElJEHTON BUIlDING DEPARTMENT
p,~~ 11\
i:</l17 m /' _, ~
i:J~OO ~~v~-"
t:J/qllm
11881
PERMIT NUMBER
i
ADDRESS
OWNER
CONTRACTOR
2701 CLARE AVENUE
KLR ASSOCIATES
STEPHEN JOHNSON INC.
PHONE
PHONE
~ ---...- ~-
1 FOUNDA liON
~
1. PERMIT ON SITE 7. CHECK FOR FILL
2. CHECK PLANS TO PERMIT 8. REQUIRED STEEL IN PLACE
3. CHECK SETBACKS 9. CHECK FIREPLACE FOOTING
4. PROPERTY STAKES 10. ANCOR BOLTS
5. FOOTING WIDTH & DEPTH 11. FOUNDATION VENTS
6. SOIL BEARING O.K. 12. CRAWL ACCEp5 .
. . COIyIM~TS: ~6 ~,y{-
FOUNDATION IN~EpTION i7~ ml ~(" ~ rl-l A SJ,flJ/ qJ
APPROVED BY: .!.!::/!A::. t'II~1 ( v "-/ J ., '6-; :~:" la ,
. -- ~ -vt
2A FRAMING 20. FIREBLOCKING
5T AIRS
1.WIRING APPROVED DROP CEILINGS
2.FOUNDATION VENTS TUBS OR SHOWERS
3. SHIELD UNDER POSTS ROOF & CEILING LINES
4. POSITNE CONNECTIONS FURRED OUT AREAS
5. SOIL TO WOOD CLEARANCE FIREPLACE AT CEILINGS
6. BEAM SUPPORT HOLES PLUGGED TOP & BOTTOM
7. TA. MAT. NEXT TO CONe. LID IN VOIDS
8. WASHERS ON ANCHOR BOLTS 21. WINDOWS
9. BEAMS PROPER SIZE MEETS ENERGY CODE CLASS
10. FLOOR JOIST SPAN SAFETY GLAZING
11. NOTCHING & DRILLING REQUIRED ARE EXITS
12. STAIRS WINDOW SILL HEIGHT
WIDTH 22. CEILING HEIGHTS
RISE & RUN 23. SWAY BRACING
WINDERS 24. TRUSSES
LANDINGS PROPERLY INSTALLED .
HEADROOM STAMPED
13. ATTIC VENTILATION (upper & lower) PROPERLY BRACED
14. CHIMNEY STRAPS SECURED 25. A TIIC ACCESS
15. FIREPLACE COMBUSTION AIR 26. RAFTER & JOl5T SPAN
16. FANS VENTED TO OUTSIDE 27. ROOFING. FLASHING, SHEATHING
17. WATER CLOSET CLEARANCE ~~ 28. SIDING
18. SMOKE DETECTOR . ,61/~A( ~
19. SHEETROCK BACKING COMMENTS: tfL fo ~
UNDER STAIRS it re;J'1 ,/ 1..{' <~
ABO~ 4I\~~~ 000 HA~GERS / (lo/f.,1A --11 'It ~ ce ()
r~ ~~ ~ ,,'Iff 41,.- b
FRAMING INSPECTI . .../, ~'1 .:)~~/-rl
APPROVED BY: 'I Y:<S"'/"i' ~~~
i
COMMEN~~~ i
7lt- /'1/
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F~
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2B
INSULA liON
1. PROPER R~VALUE
2. VAPOR BARRIER
3. PROPER FASTENING
INSULATION INSPEW.(/ ;40
APPROVED BY: _ ?'V f; y: '1;
! '
~~ 9/~t1fN
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MECHANICAL
1. PERMIT ISSUED
2. FURNACE LOCATION
3. FURNACE CLEARANCE
4. 181 VENT SIZING
5. 181 VENT CLEARANCE
6. 181 VENT SUPPORT
7. COMBUSTION AIR
8. DUCT SIZING
9. DUCT SUPPORT & JOINTS
10.GAS PIPING TEST
11. GAS PIPE SIZING
12. GAS PIPE SUPPORT
COMMENTS:
p
PLUMBING
1. PERMIT ISSUED
2. UNDER TEST
3. WATER PIPE SIZING
4. DW SIZING
5. PROPER SUPPORT
COMMENTS:
UNDERG~UNDAPPROVED
BY: ~ ~ 7ft/-. ,
"2-~ rU,~ ~A-~ ~K-
- r"n ~ , ---~- J717.-~/'fI'
HVAC APPROVED BY: . ~~
GAS PIPING APPROVED BY: ~~,
WDST
1. WOOD STOVE CLEARANCE
2. CHIMNEY CLEARANCE
3. HEARTH EXTENSION
4. CHIMNEY HEIGHT
WDST APPROVED BY:
/
>>GJV-+- a-f/>t:-
?(&t/ft
. ~ ~J'l- -0/~{
6. PROPER FfITINGS
7. REQUIRED CLEANOUTS
8. PROPER GRADE
9. H'WT PRES. RELIEF VALVE & LINE
1 O. SEIS~ICfiTRAP .
?J-~~ /c~,;I.,( YC.
ROUGH-I/'i APPROVED
BY: ~ 1/~t-/i/
3 WALLBOARD
1. LID OVER SIDES
2. NAILING
3. W/R AT TUB OR SHOWER
4.5/8 UNDER STAIRS
5.RJRNACEENCLO:~~U
COMMENTS: f 1~lltfJ'
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WALLBOARD APPROVED BY:
4
FINAL
1. HANDRAILS
2. GUARDRAILS
HEIGHT
INTERMEDIATE
3. EXHAUST FANS
4. WATERPROOFING IN SHOWERS
5. DISH'NASHER AIRGAP
6. FIRE DOORS
LAB LED AS REQUIRED
SELF CLOSING
7. FIRE DAMPERS INSTALLED
8. PENETRATIONS IN FIRE WAI.LS
FINAL PLMB. APPR. (comm.)
FINAL MEeH, APPR. (comm.)
FINAL BUILDING APPR.
h~~~ 1. \ a..,.p e..
r th I iI'i ') \~ IS?
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~
6. ARE SEPARATION IN GARAGE
7. ATTIC ACCESS
8. DRAFT STOP IN ATTIC
9. PROPER CaNST. OF FIRE WALLS
10. DROP CEILING & LIGHTING
~~t!!~
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9. HOT WATER TAM< PRL
10. OUTSIDE GRADE
11. SOIL TO SIDING CLEARANCE
12. SMOKE DETECTORS
13. FIREPLACE HEARTH
14. SAFETY GLAZING
15. INSULA nON
WINDOWS MEET ENERGY CODE
UNDERFLOOR & ATTICE INSUL.
WATER PIPE & HEAT DUCTS
16. WOODSTOVE APPROVED .
17. 'MNDOWS & DOORS CAULKED_./-
COMMENTS: ~~-
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lIC..TICS IS!:oVEO '0,,: .....3.7..~~.q.~9.cjit.i.QO......:....... .......... ....................
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.".~ . L...~: . :o\.S.~9~~.a.t::~~.,. . ~n~... . . . . . . . . .
140 South ~hrion,Suite lOa, Bremerton,~A
( ~., . . . . . . . . . . . . . . . . . .. . . . . . . . .
(0": RAe ( 'l. . St.~ Dh.e.n. Johnson,'. Inc.. . . .
N~ 701 Mission Cr.Rd.,Belfair,WA
;... ~ .-, ~ !: ~ c:. , . . . . . . , .. . . . . . . . .. . . .. . . . . . .. , .'. . . . . . . . . . .
4 {':;-4S77 ,.
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SEI'.<SJ,lE rEIt~ITS REe.VIRCO F'OR PLl-~:ln;~ At:;) ",~CHA1l1CAL \oi(:Q1C:.
::.-
[CTRICAL REVIE_EO a1'..........
;::::-,~~ :.."--..~ - ~,
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Jlt~I~~ R[VJ(~to BT.......... :
~EP~RATE PERMIT REQUIRED fOR (LECTRICAL WOR~.
City of BfI:;l11tolr:on
::;i~/lri: ng DL3pt.
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~/FINAL DECLARATION
OF ~/NON-SIGNIFICill~CE.
Description of proposal -;s'1- b eel
V\uX"~~ ~
Q elL'" t-\ ~ -t-u e f'r s+r~_
Proponent B~(J ~ C'{")r\.\! D-- \ -e y~~t C-eln. tex-
Location of Proposal ~ 1-0 \ C\a. ~ f\;ve\rL\.;'--E'
~~~~. W f\:' q g3 fO
Lead Agency CITY OF BREMERTON
'This proposal has been determined to (KXHi/not have) a significant adverse
impact upon the enviror~en~. An EIS (~/is not) required under RCW 43.2lC.
030(2) (c). This decision was made after review by ~~e lead agency of a
completed environmental checklist ~~d o~~er information on file ~ith the
lead agency.
Responsible Official
Joseph W. Gero
Position/Title
CityPl~er,
Effective
Date: December 28, 19.83
Signa"turf! ~~
· \/Iq /rt
Dfte Today
cS
Staff Initials
Z. O. Req.
4. Site Coverage Rl<35% Structure
65% Open Space
5. parking?~o-. q~SCS'.-;:. \ \4CJ Ws ~4.~ )S~\\s
, ') :>\o.\\rt^ 4 kJs ~~~~ ~~ ~()~1-0
6 . Landscap i ngl Screen; ng 1l'\\"'5 . ~~\\s
CONCLUSION A-o ,CYt N - 0
I'~r- "--l - ~~f~ ~\ -~ r. .
RECOMMENDATION CIS /'-Q <); se:\ \0 q( f /1 C\. \ C" 'J. .AJJ 1J\j\ iJ'f~
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Conditions: 1. lowx af"'fJ JCV\'ct- ~h""- ~. -c.- ju~pM "::,-1:::.
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Proposed
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K.L.R. ASSOCIA--TES, INC.
140 South Marion}At)enue~ Suite 100
Bremerton, Washington 98312
479.4977
January 19, 1984
Allan Kane
City Engineering Department
239 - 4th Street
Bremerton, WA 98310
Dear Mr. Kane:
As per our conversation yesterday relat.ive to-the storm retention system
needed for the addition to Bremerton Convalescent Center, I would like
your department to investigate alternativ~~ ,toonsite retention.
Bremerton Convalescent Center would be willing to participate in any
alternatives to the maximum amount of expense associated with onsite
retention.
I would also request that the Engineering Department release this portion
of the project to the Building Department, sothat~a building permit can
be issued for the project.
t1k you,
Ii, ~K~'~~i:::
K.L.R. Associates, Inc.
DIBIA Bremerton Convalescent Center
RAK:lj
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ENV~ROin1ENTAL CHECKLIST FORM
BACKGROUND ew~Sr'iER ALL ITEMS 1-12; USE. IF NOT APPLICABLE)
To,
-J. .
1. Name of Proponent
Bremerton Convalescent Center
2. Address
2701 Clare Avenue. Bremerton. WA 98110
Phone (bus.)
{res.)
377-3951
3. Date Checklist Submitted
4. Agency Requiring Checklist
5. Name of Proposal, if applicable:
37 Bed Addition
6. Nature and Brief Description of the Proposal (includ-
ing but not limited to its size, general design ele-
ments, and other factors that will g ve an accurate
understanding of its scope and nature):
Addition to Bremerton Convalescent Center to include 37 beds,
dining room, activity room, nursing station, and other support
rooms.
1. Location of Proposal (describe the physical setting of
the proposal, as well as the extent of the land area
affected by any environmental L~pacts, inc~uding any
other information needed to give an accurate understand-
ing of the environmental setting of the proposal):
Addition will sit next to the Warren Avenue Bridge right of way,
on the west side of the building. Present. area is being used as
parking lot and driveway.
8. EstL~ated Da~e for Complet~on of the Proposal:
7/1/84 .' .
9. List of all Permits, Licenses or Governmen~ Approvals
Required for the Proposal (federal, state and local--
includin~ rezones):
Certificate of Need/D.S.H.S. - Construction Review/ and all local
permits necessary.
l
10. ~o you have. any plans for future additions, expansion,
or further activity related to or connected with this
pro2-~al~?~I~eS , , explain:
~_____~Not at this time.
C . ----/
-----
11. Do you know of any plans by others which may affect
the property covered by your proposal? If yes, explain:
No.
12. Attach a copy of any other application form ~hat has
been completed regardi.ng the proposal: (i.e., Health
uepar1:ment permit, required state permits, etc.) if none
has been completed, but ~s expected to be filed at ~~me
future date, describe ~he na~ure of such application
form: Enclosed - Health Dent. Permit. Certificate of Need.
application submitted to D.S.H.S. Construction Review 1~~~-~3~____
e
e
ENVIRONMENTAL IMPACTS
.(,~ll . -"YEs!' ANa ~/MAYBEJI ANSiAJERS r~UST BE ANSWERED or~. ADDtTIONAL
SHEETS....:US~ QUANTITATIVE INFDPJ.'1ATION. IN YOUR ANSWERS \~ERE
APPLICABLE. . Yes Maybe No
(1) Earth. Will the proposal result in:
~\ (a) Unstable Earth conditions or in
~() -changes in geologic substructures?
~~ l\ (b) Disruptions, displacements, com-
~ paction or overcovering of the soil? X
(;~ ,~\~ r;iSPlacement of soil in cutting grade for new foundation.
~l~ .~) Change in topography or ground
Q\~ surface relief features?
, (d) The destruction, covering or
modification of any unique geologic
or physical features?
II.
(e) Any inqrease .in wind or water
erosion of soils, either on or off
the site?
(f) Changes in deposition or ero-
sion of beach sands, or changes
in siltation, deposition or erosion
which may modify the channel of a
ri ver or stream' or the bed or the.
ocean or any bay, inlet or lake?
1
~I
_~& (2) Air. Will the proposal result in:
- V\ U
\ --~~~-"'(-aJ Air emissions or deterioration
of ambient air quality?
(b) The creation or objectionable
odors?
(c) Alteration of air movement,
moisture or temperature, or any
change in climate, either locally
.or regionally?
E:{P!..A.n! ALL ~s ..~,!D r'.1AY3E ...\lTS~~~S 01J ..:JJDITIO:'L~...L S~~'..l'
X
-
X
-
X
X
X
-
X
X
X
-
e e Yes
Will the proposal result in:
"
( 3 )
Water.
(a) Changes in currents, or the
course or direction of water move-
ments, in either marine or fresh
/{waters?
'^~)bp ~(b) Changes in absorption rates,
~V~rv' drainage patterns, or the rate and
JV- amount of surface water runoff?
Additional roof area.
(c) Alterations to the course or
flow of flood waters?
(d) Change in the amount of sur-
face water in any water body?
(e) Discharge into surface waters,
or in any alteration of surface
water quality, including but not
limited to teP.1perature, diss-olved
oxygen or turbidity?
(f) Alteration of the direction
or rate of flow of ground waters?
(g) Change in the quantity of
ground waters, either through
direct additions or withdrawals,
or through interception of an
aquifer by cuts or excavations?
(h) Deterioration in ground water
quality, either through direct in-
jection, or through the seepage of
leachate, phosphates, detergents,
waterborne virus or bacteria, or
other substances into the ground
waters?
(i) Reduction in the amoun~ of
water otherwise available for
puBlic water supplies?
(4) Flora. Will the proposal result ~n:
(a) Change in the diversity of
species, or numbers of any species
of flora (including trees, shrubs,
grass, crops, microflora and
aquatic plants)?
(b) Reduc~ion of ~he numbers of
any unique, rare or endangered
species of flora?
Maybe
No
x
x
x
--L
-L
x
-L
x
y------~1- '7
-- -
--L
x
Yes Maybe NO
e e
(c) In~roduc~ion of new species
of flora in~o an area, or in ~
barrier ~o the normal, replen~sh-
men~ of existing species?
(d) Reduction in acreage of any
agricultural crop?
(5) Fauna. Will the proposal result in:
(a) Changes in the diversity of
snecies, or numbers of any species
of fauna (birds, land- animals .
including reptiles, fish and shell-
fish, benthic organisms, insects or
microfauna)?
x
-X-
-L
(b) Reduction of the numbers of
any unique, rare or endangered
spe~ies of fauna?
x
(c) Introduction of ri~w species
of fauna int~ an area, or result
in a barrier to the migration or
movement of fauna?
x
(d) Deterioration to existing
fish or wildlife habitat?
x
(6) Noise. Will the proposal increase
existing noise levels1
(8) Land Use. Will the proposal
result in the alteration of the
present or plannea land use of an
area?
-L?Y:-
v- -~ic
(7) Light and Glare. Will the- pro-
posal produce new light or
glare?
x
-
(9) Natural Resources. Will the pro- .
posal result ~n:
(a) Increase in the rate of use
of any natural resources?
x
r1~ .~(b) Depletion of any nonrenewable
~J ~. J:' natural resource?
,/ ~2; E:G'LAI:r A.!..L a ;,:m ~'.A';3E AClSJERS ON ADDIT!ONAL
~r- _-~s J1~
/~t# .
_vc~"~
,...,-~~
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.."._--
._.-_._-,._-_.--~...,.....,.....--,..._.....~~- .. -,_.- ,.,._,._..-.~_.__._._-~-"-""----<<~--~-_._~-..-...~"-,.,..,.-....-~......_~"'"""" ,",'
.~ ~
. ~. _.....~
, ~, ..,.~ -;oo'~,.......,~. .
"
I es l'1aYDe --. - NO
(10)- Risk of U~t. Does the proposal 4t
involve a~k of an explosion or
the release of hazardous substances
(including, but not- limited to,
oil, pesticides, chemicals or radi-
ation) in the event of an accident
or upset conditions? x
(11) Pooulation. Will the proposal
alter the location, distribution,
density, or growth rate of the
human population of an area?
(1 ~ 37 new residents.
\^~~tl}\ Housing. Will the proposal
,~~ affect existing housing, or
{\\ ~~, (V\ crea~e a demand for a9-di tional
V~.'\ ~~l housJ.ng?
,\)- U' \ RfU3 ~ Transpor;tation/Ci:cu~a tion. Will
~lJ ~ ~Ir Ithe proposal resu.l. t J.n:
\~ "A\YJ4S' I If'- (\1JfJ (a) Generation of additional
~~. _ o~Vv vehicular movement?
~ More residents, visitors and employees.
V (b) Effects on existing parking
facilities, or demand for new.
_ I?Y' par king?
.~ --11ore than adequate parking provided at this
I/i~ (C) Impact upon existing trans-
. ~v 16-Y-\:D portation systems? ,
. \ ~ II ~ J . (d ) Alterations to present
V" O(}~l;-0rpatterns of circulation or move-
p\J tAY- ment of people and/or goods?
l.ut~ (e) Alterations to waterborne,
~- rail or air traffic?
(f) Increase in traffic hazards
to motor vehicles, bicyclists or
pedestrians?
(14) Public Services. Will the pro-
posal have an effect upon, or
result in a need for new or al-
tered governmental services in any
of the following areas:
--L
- ~_._~~-
V ~
- --
....L.
time.
V)x
- -
--L
x
---A...
x
(a) Fire protection? --L,
(b) Police protection? --L
(c) Schools? x
-
~u.nr Ai 7 :rES .~TD :<::A.5E )2iS;/~S O:-I P-..DDITIO!-T.AL 3!:~~T
-
........."'...,..~"., ''I'"~'"'' ---.. "~~,.~"-,,,,,,_,,",,,_-
....... ~,,_.....,..._..............-"
_::.. ;'!I"!~!lI{~~, ~,_~.4..... ~
1..1
, .
.
4t Yes Maybe No
(d) Parks or other recreational
facilities'?
(e) Maintenance of oublic facili-
ties, including roads?
(f) Other governmental services'?
(15) Energy. Will the proposal result in:
(a) Use of substantial amounts of
fuel or energy'?
~Q16)
(b) Demand upon existing sources
of energy, or require the develop-
ment of new sources of energy?
~-~
Utilities. Will the orouosal
result in a need for new. systems,
or alterations' to the following
utilities:
x
x
x
-
.J....
~~
~x
Note: All utility (a) Power or natural gas'? x
companies have Conununications systems? x
been notified.(b)
(c) Water'? x
~~, @ Sewer or septic tanks'? ~
(e) Storm w at er drainage? x
-
(f) Solid waste and disposal'? .....L
(17) Human Health. Will the proposal
result in the creation of any
health hazard or potential health
hazard (excluding:mental health)'?
(18) Aesthetics~ Will the proposal
result in the obstruction of any
scenic vista or view open to the
public, or will the" proposal re-
sult in the creation of ar.
aesthetically offensive site open
to public view'?
(19) Recreation. Will the proposal
result in an L~oact uuon the
quali~y or quantity of existing
recreational opportunities?
E:XPLAI:J ALL :"ES AND ~'"..Y3E .::..NS'SS O~J p-..DDITImIAL S: - {< '1'
" -
x
-L
-L
"'" ~~~.,. . .._" -.,...,..~~ .. ...."..,..........,., - "., ~_.,.".. .,..
",,~. - - - -." ,,~-
"..~ '"' _ _~, ,,~,.,~{"'" _. _ ~, '- ....,~--~ ,........... ,,..,....._... ,.., ~ ......,..,,~...~,"___ .'?>'1 ~'"""'"~ _""...~~ """"__', > .."""
. .
< ..
, .
.
e
.
) ...... .
Yes Maybe No
(20) Archeological/Historical. Willthe
proposal result in an alteration of
a significant archeological or his-
.torical site, structure, object
or building? .
x
~.
III. SIGNATURE
"
I, the undersigned, state that to. the best of my knowledge
the above information is tru.e and complete. It is understood
that the lead agency may withdraw any declaration of non-signi-
ficance that it might issue in reliance upon this checklist
should there be any willful misrepresentation or willful lack of
full disclosure on my part. /...~)~ .
/ ,
LU.
~. .10, lq~1
./
Date:
Proponent:
BUILDING
PERMIT
APPLICATION
_I
, ..- "
City of Bremerton, Washington 983,10 Phone: (206) 478-5281
Assessor's Tax Account No.: 3966-002-003-0009
Site Address: 2701 Clare Avenue, Bremerton, WA 98310 Phone No.: 377-3951
Owner's Name: K.L.R. Associates, Inc. Address: 140 S.Marion Ave.,Bremerton,WA 98312
Applicant: ~ Owner o Architect o Contractor o Tenant
Architect Firm: Tom Herstad/Norm Olson Representative: Tom Herstad
Address: 2453 Bethel Road SE, Port Orchard, WA 98366 Phone: 876-0890
Contractor: Stephen Johnson, Inc. Representative: Steve
Address: N.E. 701 Mission Creek Road,Belfair, WA 98528 Phone: 275-6734
Contractor's License No.: STEPHJ-199LW . Exp. Date: 6/1/91
o Residence GI Business o Other: 0 New o Repair Q Remodel/Addn
o Demolish 0 ,1 o Multi-Family (No. units Q Sign o Parking Lot
Duplex )
o Grading (cu. yds ) o Bldg. Move
Nature of Work Proposed: Remodel Administrative area of building.Add on new dining room and two
2-bedrooms,eliminate two 3-bedrooms,change five 3-bedroom to five 2-bedroom. Total occupancy
of licensed beds will decrease from 140 beds to 135 beds.
Sq. Ft.: 1,550 (new)
Utilities: o Water o Waste o Sewer o Septic o New [] Existing o Storm
Valuation of Materials/Labor: Plan Review Fee: Permit Fee: Surcharges:
[UBC Sec. 304(b)] $ $
400,000 State $4.500
Receipt No.: Receipt No.:
Date: Date: .
Zone Designation: Occupancy Classification (UBC): No. Stories: 1
Setbacks: Front: nla Side: 10' wes,t Rear: 50' H' existing Heat Source: gas
, . eight:
Comments/Conditions of Approval:
". ._~. .. -- --.- .- -----
'r understand that applications for which no permit is issued within 180 days following date
of application shall expire by limitation, plans and/or other data submitted may be returned
to applicant or destroyed by the Building Official. (Sec. 304(d)UBC). I certify that the
information on this application furnished by me is true and correct and that the applicable
requirements oD the City of Bremertonwill be met.
~ Sign,ature Date )
Copies to: White-owner; Yellow-file; Pink-Assessor: Goldenrod-Building
Stat. Code II
I
,..-,.c.~~J:~.E II M IT . ..J. PP~L.ICAT.I.O.N.
, , CITY OF BREMERTON BUILDING DEPARTMENT
PHONE: 478-5281
,
, -~'
SITE ADDRESS
270i ,'Clare Avenue, Bremerton, WA 98310
, . M~LADDflESS_ . AS' 100 ZIP WA 98312 PHONE
K.L~R. Associates, Inc.,140 ~outh Marlon ve., ulte ,Bremerton,
ASSESSOR'S ACCT. /I
OWNER
479-4977
CONTRAClOR' ".
Class of work:, 0 NEW
MAIL ADDRESS .
Q ADDITION GJ ALTERATION
PHONE
LICENSE NO.
o REPAIR
D'MECHANICAL.
I
o PLUMBING
COMMENTS
No.
lYpe of Equipment
Fee
No.
lYpe of Fixture or Item
Fee
4
STOVES Gas_ Oil_ Wood_
FIREPLACE INSERT
FURNACE Gas (Nat._ LPG.-> Oil_
Wood add on~ Other_ Electric_
BTU
Type: Up f1ow_ Down f1ow_
Horizontal_ Wall_
CONVERSION BURNER: Gas-x- (Nat._ LP ->
Under 100,000_ Over 100,000-X-.21 0,000
Oil_ Replace existing boiler
UNIT HEATER BTU_ Gas_ Elec._
BOILER Gas......-. Oil_ Electric_
Other_ HP ~
GAS SYSTENI Max. 5 outlet Total_
EVAPORATION COOLERS Roof_ Wall_
BTU_
AC UNIT Electric_ Gas Elec. Combo_
BTU_
HEAT PUMP Single Package_ SpliL-
Add on_ BTU Ton_
MIXING OR REHEAT BOX CFM_ BTU_
1 AIR HANDLING UNIT CMF _ BTU...2..5ton
2 FANS Exhaust..L.. Supply_ Bath_
RANGE HOOD Residential_ Comm._
ROOF. DRAINS
CLOTHES DRYER Res:_ Comm._
INCINERATOR
ALTERATION TO DUCT SYSTEM
1 :tIlllaIKrQ/Cooling_ubao51lLl.5 ton air
TANKS Oil-,- Gas_ Propane wlOK:onditioner
from Fire Dept._ Gallons
REFR,IGERATION UNIT
,
WATER CLOSET (TOILET)
BATHTUB
LAVATORY (WASH BASIN)
SHOWER
KITCHEN SINK & DISPOSAL
DISHWASHER
LAUNDRY TRAY
CLOTHES WASHER
WATER HEATER
URINAL
DRINKING FOUNTAIN
FLOOR - SINK OR DRAIN
SLOP SINK
WATER PIPING & TREATING EQUIP.
WASTE INTERCEPTER (Grease)
VACUUM BREAKERS & BLACKFLOW DEVICE
LAWN SPRINKLER SYSTEM
SWIMMING POOL - Private_ Public_
GROUNDWORK
SUMP
ALTERATION
KIDNEY MACHINE
,
PERMIT $
TOTAL $
NOTICE
PERMIT $
TOTAL FEE $
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
IS Nor COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS SUS-
PENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY, TIME AFTER WORK
IS COMMENCED.
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND
KNOW THE SAME 10 BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND
ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLED WITH WHETHER
SPECIFIED HEREIN OR Nor. THE GRANTING OF A PERMIT DOES Nor PRESUME
10 GIVE AUTHORITY 10 VIOLATE OR CANCEL THE PROVISIONS OF ANY orHER
STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF
CONSTRUCTION.
SIGNATURE OF CONTRACTOR OR AUTHOF}IZED AGENT
(DATE)
FINAL APPROVAL .
SIGNATURE OF OWNER (IF OWNER BUILDER)
(DATE)
. ~---
RECEIPT NO.
,(While-ORIGINAL, Yellow-INSPECTOR, Pink-APPLICANT)
PERMIT'
CITY OF BREMERTON BUILDING DEPARTMENT
PERMIT APPLICATION
DATE:
3-14- , 199 1
TO BE COMPLETED BY
3-19-
, 1991
l~' .'
KLR Associates
OWNER
Stephen Johnso~~Inc.
CONTRACTOR
2701 Clare Avenue
LOCATION OF .JOB
FOR remodel interior
,~ -'
ENGINEERING COMMENTS/REVIEWED BY ~
/YO CONHeJ.JlJ
h4-
L't' I'~ ['
"', I ':J (.) :::; n f"
n LS '.I) r:! f i !,") T;-:-: r-'~"
, . - 1.._, i! ! i I .,~ I n J
..... l -~. : . 1 ~
"-' , ' . !
(Ilijn 1 r, L>
11~'''.d'~ VI 1cq
-~ ",; " 1
\..'V
B,[:'WJ"-'
. -;l\/~ ~/I;~ r~T:J'~
BUILDiNG D'~P'~ 1,- .
... fiR lMENI
b R ~ MeR r 0 N
~3U-LDrNG
D E PAR r MEN T
PEf~MIT
A P P LIe A T ION
------------------..------.----------------.--.----------------------------.---
--------------------.---------------.---------------------------------.------
Application Date 03/12/1991
Issue' Date
Assessor Acct # 3966-002-003-0009
Site Location 2701 CLARE AVENUE
Owner - Last NameKLR'ASSOCIATES First
- St reet . 140 S.. MARI0N.;AVENlJE ''''',.
-City BREt:I!:RTON .,'. ."~"State WA',,, Zi.p 98:3L;~
Phone ( 206) 377,';-'3951"~" .. ::....'i... ',.
Tena~~.s Name,. ..' .,;'!~'F~~.~,~RT~~.;:s.:ONyiALE~~E~;f.".iP.:~one( 206 ) --
~;~~~ t:c~~:e N~~~ . ~dlf~Rs+~\ v ~~ e:.r. J }~hoiQe( 206 )t.r7r <-{-q '77
[x] Bu i 1 d i tljif7':.. J~,~Gr adLng......"". .q"'[..l. S.~A,;j~'~~\~i\' "':0'~~tl,;[ Jpav i ng
[x] Mechcmfcal ? J Move Building . [ r:'8urniifI9:','f, :. .if~>]' Underground
[X] Plumb}hg' .... '..... r l,/Mobile HomfL [J Land Clea ,. [~~J,' Demoli t ion
. !. ,'. ,,,'L1~ ... 'r<;I?/~~{ ,. .~~
--,------;-..~,t~:J,i[f- i"'!----------.:::~~f:L--------'-:.-~~i: --\----------
B u i 1 d i n~ C,o nt r a ct,'D r: '. " ;?~ \1~j/!}~~:~t';,
'^'"' ,'f {;.:;!.' ,. ,.'>l,; ~..:..L K.:~.;...:.:.).:,~.,...~c<..-~t~,~,',:~.'.....y.,:.:.~.:.{.~~".i.;,:.,'~.\:....-:~.:,:t;':.~.."....,~:~.'~...~..~~.:,:. i 't....;,1....,.:,'.,...
~~:!$:~;::~~~:~~ /: '.~, ':H .'." '., v' ':. ' ;:
. Contraf:tor'~. .i . STEPHEN JOHNSqN INC.' ~~r
S~ r e~t" " N . E. 701 M I 55 ~9N CRK ROAD . f,~.'..
Clty~ "8ELFAIP:u~:;',
Phon~~;~ ;~~p;, ,\( 2(6) L?5-673+~~ 5t at e WA Zi p,;98s:?8..;:...-:'..;/,~.,I..,:~.:..
. RepY'~s~ntc~~Jive~: STEVE:,\, . "i~@' . ;)"1, .:. . . '0;' df):.....,
State;~ Liicense. STEPHJ*:L99LW .;~~f.'; Exp1:rat ion. Date 06;tOl/1991 "
C i ty:it. icense #', . ';:~~:'~~~1', ;;,;{::~ Expiration, Date "".lif
Na:ure~~: ~or k: ',,':l\';'~:~i~~~,;~:;~;~!~/\:~'f~~>;~>," . .l
H~mode{;'t.admintst~~t:.ive area of:"bllilding, add ne~"d.ining
room and\;,two<:::J:2:fbedn::iom uni ts, el iminate two 3-Bedroom~
un its, cnange.:;~f;l\le 3-bed-room un it s to Yi ve 2..,.~edroom;
units. ",:".,"'" , .'c.,...."<"-...., ." '-1
~- 'L/'\t,Cf f
Application Number 91AP03081
Perm i t Numtier
Project.Group
NT
E2J
._-~'
~~';,.~
" ~
f:3uilding Valuation
$400000.00
.. .
---------------------------------------------------------------------
Council District
Census Tract
Construction
Type
Sq F::eet
Inspections
I~e(~u ired
f~es i dence
Business
Other
New
F~epa i r
r~f:m()cjc:: J
(:idd :1. t i. un
I" -J
.. .
LX]
r ]
j' "I
I.. ..
1"'1
I.. "
'''v "I
LA..!
IX]
Z (J rd, r1 <J
Type
1 '~,
".u
Foundation
F"r am i nt]
Insulation
Plumbinq
i1echan i ca 1
Wa.LlbuarcJ
F':L riG 1
["X'..,
1.' '.-1
r ']
LX..
[X]
[xl
[X]
r'.. .\
LX.!
eX]
Statw3
Code
.",-. ,.-. ,....,,,
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A P P L I CAT ION
========================================:=============================
Application'Date 03/12/1991
Issue Date
Assessor Acct #' 3966-002-003-0009
Site Location 2701 CLARE AVENUE
Owner - Last Name-KLR ASSOCIATES
- Street 140 S. M0RIPN AVENUE
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[X] Bu i I ding'> t~\Graclinq [ ] Sign,.
[X] MechanilSal ::I Mm/e eu i lell ng [J Burnind';
[X] Plumbi'ng, li'Mobile Home [ J L..and (:l~a'r::"
Application Number' 91AP03081
Pe'r m :i. t Number
Project GY'oup
F:i.rst
MI
~3ta t f~ WA
Z :i, p 98312
;;;'.PhOTH:~( 206 )
Photle( 206 )t.r7r L{.Q'7 7
r: ::I Paving
[ J Underground
[/J Demol:i. t ion
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Representative
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State I.._lcefise it "
C i t yL. i cense #'\
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STEPHEN JOHNSON INC.
N.E. 701 MISSION CRK ROAD
"BELFAIR
( 206) 275--67::34-
Sn-VE'"
ST~p;ii~J 99L.W ,,'
State WA
Zip 98~.2H'
Expiration Date 06/01/1,991
Expiration D,ate
't,
Ni:1tLlrf.~ erf Wc)rk: ,..,~, < "-<",' .,' <
~~emode 1'." aclm i qfst r ;:~'t:~"J ve area Clf~.,. bu i 1 d i nq. add new 'CJ i n :i. ng
room andt WCt~~\;2+'bedroClm un:it s. e 1 i m :i. nat e two ::l-bedroom,
fl~ ~'3~:: Ch~~:~~i~e,{~~:;I'oomuni1;' pedz;m{er_~1
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Building Valuation
'.0:::'\,,;;, ~1>4-00000 .. 00
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Council District
Census TY' act
Construction
Type,
Sq Feet
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12
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Wa 11 boa n:l
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App"licaridn tJate 03/12/199~
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4-1-91
Inter-Orfice Communication. . ')..~'J.'. ..
C. f B 'I' ':."~""",,~(~
Ity 0 remerton'" :.~::-~.
Building
utilities ~
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To
Janet Lunceford,
From
Terrie Kirchner,
Subject
REQUEST FOR REVIEW
Site Address:
2701 Clare Avenue
Building Appl. # 91AP030Bl
Owner:
KLR Associates
Contractor: Stephen Johnson Inc.
II No identifiable problems noted.
[] Developer shall contact the Utility for Application for Water Service and pay all assessed
fees prior to construction.
[] Developer shall c6ntact the Utility for Application for Sewer Connection and Sewer
Inspection Permit and pay all assessed fees prior to construction.
[] Developer shall contact the Utility for Application for Storm Sewer Inspection and pay
all assessed fees prior to construction.
II Atmospheric vacuum breakers to be installed on all faucets, hose bibs, and flushometers.
II All plumbing, inside and out, shall conform to City of Bremerton and Washington State
Cross Connection Control Standards.
[] OWner shall contact the Utility Billing Office (478-5316) prior to demolition for payment
of fees for water meter removal for existing service. If service is to remain, contact
must be made for possible recoding of billing account type.
[] Prior to demolition of existing structures, sewer laterals shall be capped. Appropriate
sewer cap permits and inspections shall be obtained by the Contractor.
[] Development is subject to AWWA Regulations, APWA Specifications, DOE Regulations,
DOH Regulations" Bremerton Municipal Code, and Utility Standards.
[] Contractor to verify location and depth of existing utilities. Contact Underground
Utility Locates (1-800-424-5555) forty-eight (48) hours prior to start of construction.
o Other:
APPROVED:
DATE:
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o E PAR T MEN T
PERM I T
A P P L I CAT ION
===================================::::====:::::==============================
~ Application Date 03/12/1991
Issue Date
Assessor Acct I 3966-002-003-0009
Site Location 2701 CLARE AVENUE
Owner - Last Name KlR ASSOCIATES
- Street 140 S. MARION AVENUE
..- C i t y BI~E:t1.ERTClN
.... Phone (.~'?O6) 377:-:3951
'lenant ~f:3 Na.me ",_,..~;:"I;~F~!:?~!~~::::I:~Tr~N J:ONVALE:SCENT'
Aqent · s, Name' ,.' )<:^ (;J<s~,t\~ \ ve.. Cj '-eJ
Architect ~s N~me TDtf HEI~STAD J
LX] Bu i 1 d i nsl" " };I~Gr ad LnSl "
[X] Mechan{6a1 ] MO~~ Building
[X] Plumbih!":] :],.Mobile Home
Application Number' 91AP03081
Pey'm :i. t Number
Py'oject [jy'oup
F:i.rst
MI
State WA
z:[ P 90~~ll ~.::~
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r '1
[ :I
S:i.S1n
Burn:lng
Land C1 ear'
,I)hone( 206 )
PhO~le( 206 )'t71-' <-fq 77
r "I Paving
'[ 1 Under9round
hJ Demol it ion
: "'" (,'
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Buildi~g cpntracf~r: "
Cont r ac.::t ark, ,
St re,at ',' I
City' !
Phone, ,': ~
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Reprl?sentat~i ve..
St at e. Li cense #
City -L.icense :If \
STEPHEN JOHNSON INC.
N.E. 701 MISSION CRK ROAD
.BEL-FAIR
(206) 275-6734. State WA
STEVE' .
STEPHJ*199L.W '
Zip 90520
;J:~~', ~;., ,', :-
Expiration Date 06/01/1991
Expiration Date
it I'
Nature of Work: ,
Ramoderadmintstr~~Jve area of building. add new dining
r Clam and t wo/;::;!.~.bedr oom units, e 1 :l m :1. na t e two 3--bedr oom;
un its ~ Changf~L;"'{i0e 3-.-t;eclroom un :i. t s to five 2..~.bedY:Clom'
un its .:'!;"'..f"';~ . ..
61 Glg; 6 -' I ?t:0!;;q:J.:(t <:::" " s.<. -IJ~/4-(
. ", . ,. ",'<<""~~ r 0 "ltL"" t'<.p1"O~~ ~ 1:/ '. ~~"'1
~~::~:'~:_~~':~~::~~________..:_~~~~:)~~~~~__.p.dJl.!::_-~-~,u:~.A.Lo.u.-
Council District Cenf."US TY'act Lf1 L'iLflD.{JP -I'(-
Canst r uct ion Sq F' eet ' I nspecJ ions
Type Required
12
Foundat :i. on
Fr-am:i.nq
Insulation
Plumb:i. nq
Meehan :i. ca I
Wallboard
F' i na I
[X]
[X]
[X]
[X]
LX]
Lx]
Lx]
, F~es i dence
BUSIness
. Ot her
New
Repair
r~emodf.~ I
Add:i.t ion
[ ]
[X]
'. [:]
r -,
L :]
[X]
[X]
Zoninq
Type
Status
Code
__.____.._______________u__~__________.___.._"__..__-._M._______________________________M____
_________M___M_______M.______________.___.___.__..__.~.__.__.___...__..___________~._.__n____M__.__~_._.____-----
'.lVO:rXCE
This perm'it shall become null and void if the' buildi:tj.9 or wor~ authorized by' this
permit is, not commenced within 180 days from the date o,f this 'permit, ox if the
building or work authorized by this permit is suspended or abandoneCi at any time
after the work is commenced for a period of, 180d~ys.
Applications for which no permit is issued within 180 days follow~ng,the date tif
application shall expire by limitation.
,. '
, '
TheraPY certify that I have read and examined this application and know the same
to, l?~)Brue and' correct.. All PrOVi'l;;~,O~~',()f,;;J,~~~",and ordinances governing this type
'o,f.wdrk will be. complied with .wp:etner , specified; h.e:t"ein or not. The granting of .a
i tdoes not 'pres:ume. to gi~e;"authori t~:.':to.,vi:olate 'or: cancel' the provision's of . any
er state or local law r~gula:ting;t1o~,st;~u.~,ti;&n,9rt~e pelf;~ormance of construction.
, "" ~ : . .. ,,:," ."" :,i,',,:( 6?Z: llstiq::(:\:':": I (1 f ( "
i~ature '~;.i';""" "'Dat'" ";';;iZ~4tNumber
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I certify that Ii!:' am eiempt" from the requirements. of: ,;,t,~~. s:~ate contractor's
registration law ii: under Sec., 3, ChaPter;:r~:~( la,ws of1961;;:~t,1f 18".27.090.
<',000
;>00, ,~
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Signature
lHd'e
Permi t;J~ti1tfijer"
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IN"SPEQTIO.NS,
'1.
Foundatio~l ,;;8:ef;&replacement of con~:~ete.'
,~< ~ 'o~' 0 ^
2. Frame, be~;or'~ ~'~'~er'ing insi<ie of watdJ~, and/after all ; cori~.~~1ied: constru9tion,
including::plumb~ng, 'mechani~~t, and:}E!lec1:.::r,~~al are ihst:a)i:;~e<i il,nd approyed.
"0 ,::',:?l{::, 0,,; ;;;"
3.' Insulation,I,; bef,ore cdvering O'::::",:::,":,}': ,.J
. ~o :'~'!ff5:::~;,;::~,fd~:;j~O
4. Wallboard, or'?ath:~,~for6 finishing?:::,"<
5 > 'Final ,after, ~ompf~~iori andbe~ore occupancY:
6~
. , ',~:'-, . ;i"~;,:'~: ~';, ,';~;,', ,:;',:
AnY'other 'inspeGt~9n ;~eClui:red for special pe~~its'.:::
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'if: ""0 ~'ooo
q~ '~
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Any inspection deemeQ'::necessa!fY:)p~; ti!1~;.libtiii"l9:ing qJifiicial.
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7.
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NOTICE--It is. therespons{bility":Of'.:the permi:t;)J;Qlde1r r not the City of, Bremerton or
Building Official to 'see to it that tne;:fi:"Jqu'fred inspections are made.}' The permit
holder must notify the Build:i,ng Off:i,cial when ready tor' inspection. Failure ofth~
perm~:t holder to notify the Building-Official of required. inspections may result in
stpppag,e of the work until such time that the permit holder can substantiate to the
Building Official .that concealed work m~ets or exceeds code.. requirements. . . Any
demolition, testing,. or financial burden ,shall Pe. porne di~~Q.,tly by the permit
holder. Failure to substantiate code requirements wil!" ,~gmlxiiftthe city against
any and allresppnsibility or liability connected Wi'),:n1"'t:ne construction.
per.it.jl f
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Tbis permit shall become null and void.if the building or work authorized by this
permi./:t i-s not commenced ~i thin 180 days from the da ts of this permi t, or if the
b4il~j/lq or work ~uth9~iz~d by this permit is suspended or abandoned at any time
~fte~ the wor~ is ~ommenced for a period of 180 days.
" ; , i"'"
,ipplications for which po permit is issued within 180 days following the date of
lapplication shall expirr~. by limitation. '.:
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I .'
r I hereby cer'tify that I have read and examined this application and know the same
to be true and correct. All provis.ions.9f:l~Ws and ordinances governing this type
of work will be complied with~be~fi~r 'specifieafie~ein ~rnot. Theg~anting of a
p,e--rlpi t do.es not presume to g.ive; autJj,pr;;j. tit9:;vi'e-lCl.te ""or; cancel the provi~ions of any
otlier state or local law r:e~rlllating;cQnst:liidcJtiqn6rt;b:e pet;,tormance of construction.,
.., .. .;i',i" .... ::ii:::i6;;'l/':~:'lJ"q\...HJt;. ,'[ () (/ ('
~~~ I- -, ~~ o~; ~'f:o';~\'O'O'~ ~;o: 6<'06, .
~:nature ..' ;";;" . ,Date" ";"i;.~~,tmi.t tf,u~ber
I certify that am ~Ye~:mPt,.trom the requirements 615. t~~ sit",ate contractor' s
registration ullger Sec .,3, Chapte;: ;;1.~;~1 laws of' "1967;~'ii~..C~ 1'~. 27.090.
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N'OT.ICE
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Signature
Perrtd t
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I)i~te
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'1.'" : ,Foundation ,b~f'<Dre placement of conc{ete.
:r.l'VSPE~'iPIONS
,,~
~.
Frame, befor:~ c6verlnq inside of wal:1:s, and,;after all. con:~'~jj.1e(t construction,
includingiplU-mlilng I ',mechani~~~, . an4it::lectr:~~al are inst{i'~~:e9 ~ndapproved.
" " ~,
'3.
Insulatio~L before covering .<i::..::;;::;;.....H:i.; .;...." ,,',
>; ,<;',-'~,:;,;; ~~o:;',:,;:'i:o'"
<^~,~<:~ <;~'L-
\
4.
Wallboard o~~lath before finishing~~;~
" , ' 0 ^ , < ,~
5.
Final, after c,?~pl,e~;j)on and' before occupaIlCY~'
~<'~
~~ ~~
, >J' ,: :, :0 ~~:
6. Any other inspe~ihion tif~~ui.:t'~d for special perlU;tt~~
<0";:;0 ;": ~oo',,,~o';,,, ,: 0 J~o;:\ o,~~; '^ o:,\~
7. Any inspection deemed nec;&$sa:rY;;l>Y;t:h~'b~il'aing of~ifcial.
0:::":,, ";,0; ','0 ~';,O ,,0:0, ^Oo:'~ ~ :o"o:";<~ ",<,y
NOTICE--It is the responsibili'€:yo~"the"p~;mit b9lide):;;,Dot the City of Bremerton or
Building Official to see to it that the'~x'equired inspections are made. The permit,
holder must notify the Building Official when ready for inspection. Failure of the
permit holder to notify the Building Official of required inspections may result in
stoppage of the work until such time that the permituholder can substantiate to the
Building Official that concealed work meets or exceeds code requirements. Any
demolition, testing, or financial burden shall be borne dir~Qtly by the permit
holder ~ Failure to substantiate code requirements will.,\;nQ-eJiihif~ the City against
any and all responsibili,ty or liability connected wi ththe construction.
permit.jl
r
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CITY OF BREMERTON - BUILDING DEPARTMENT
478-5275 - 286 FOURTH STREET, BREMERTON, WA 98310
INSPECTION REPORT
PERMIT NO.
II~$I
I have this day inspected this structure and these premises and have found the following- violations
of City, County and/or State laws governing same:
flM4tf411J
rfe-k~ls
/)1'\
~",~I be
~k.o.l-.
fr"?l'dle ~
5e e....
You are hereby notified that no more work shall be covered upon these pr mises until the above
violations are corrected. When corrections have been made, call for re-Insp, ion~
Do Not Remove This Tag DATE '-l1'"
INSPECTOR FOR BUILDING DEPT.
~DF
CITY OF BREMERTON - BUILDING DEPARTMENT
478-5275 - 286 FOURTH STREET, BREMERTON, WA 98310
INSPECTION REPORT
PERMIT NO.
111t!
.
I have this day inspected this structure and these premises and have found the following violations
of City, County and/or State laws governing same:
4re~ $- 2--
H~~
t5 fe ,.
You are hereby notified that no more work shall be covered upon these
violations are corrected. When corrections have been made, call for re-ins
Do Not Remove This Tag DATE 8-23/1 ,
~DF
"..
CITY OF BREMERTON - BUILDING DEPARTMENT
478-5275 - 286 FOURTH STREET, BREMERTON, WA 98310
INSPECTION REPORT
PERMIT NO.
11$3/
I have this day inspected this structure and these premises and have found the following violations
of City, County and/or State laws governing same:
lIrePt ..J:i -Z-
(j) hS(/"~* r frHy<
@ ~V~~ h~AJ/~ ~l-
~("v/hi C 6't< I~") :
;/(/#
0"-
fAlkkk.c';' M V(
-
Y'-A--r( ;:
t4-.
You are hereby notified that no more work shall be covered upon these
violations are corrected. When corrections have been re, call for re-ins
Do Not Remove This Tag DATE · 7.;0 '{1 INSPECTOR FOR BUILDING DEPT.
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