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HomeMy WebLinkAboutPermit File 5503 Doon Way 0732304-1 0009 11/19,12007 002 Fermat Fees 004t 3 X27.00 GZT Qom, City of Anacortes PPermit#: BLD-2007-0798 904 6th Street Issue date: 11/19/2007 P.O.Box 547 Expire date: 11/18/2008 CO.' Anacortes, WA 98221-0547 Job Address: 5503 DOON WAY Permit Type: Irrigation Permit ANACORTES WA 98221-2917 Project: APN: P59609 Remarks: Backflow device for landscape water system Owner: TED CHEPLOLIS Contractor: SIMPLY YARDS Address: 5503 DOON WAY Address: 1010 34TH ST STE B ANACORTES WA 98221-2917 ANACORTES WA 98221-4258 Phone: (425)392-1502 Phone: (360)293-3456 License#: SIMPLYI999KC General Information: Fees: #of Backflow Devices 1 Plumbing Permit Fee 27.00 Total Calculated: 27.00 Deposits/Receipts: 0.00 Total Due' 27.00 THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. 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 GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. /�� /v-r ,-r, l " -(G-OZ,-- LP SIGNATURE OF OWNER OR AUTHORIZED AGENT ISSU BY \-fki" \NoN kic Ritif • �& 9CP4 WSJ . �.,�� QpictuP 4 RRP\) LL --,, Department of ' ' ' "' " "'"" ' ' �"��" ' ' " ' % " `� 16018 Mill Creek Boulevard ` i FISH and RCW 77.55.021 -Appeal pursuant to Chapter 34.05 RCW Mill Creek,WA 98012-1296 p'' WILDLIFE (425)775-1311 Issue Date: June 09, 2006 Control Number: 105346-1 Project Expiration Date: March 14, 2007 FPA/Public Notice#: N/A PERMITTEE AUTHORIZED AGENT OR CONTRACTOR Ted Chepolis 5503 Doon Way Anacortes,WA 98221 Project Name: Ramp, Float and Piling Replacement Project Description: Remove existing 6-foot by 36-foot wooden float and gangway, replace with new wooden float of same size and grated gangway. Remove two creosote piling and replace with two steel pilings. PROVISIONS 1. TIMING LIMITATIONS: The project may begin June 15, 2006 and shall be completed by March 14, 2007. 2. Work shall be accomplished per plans and specifications approved by the Washington Department of Fish and Wildlife entitled JARPA, dated February 7, 2006, and email dated April 12, 2006, except as modified by this Hydraulic Project Approval. A copy of these plans shall be available on site during construction. 3. This approval is for replacement of the existing float and ramp structure only and shall not result in expansion of the structure. 4. The existing ramp and float shall not be re-located within waters of the state without written authorization from WDFW. They shall be removed and disposed of upland such that they do not re -enter such waters. 5. The float structure shall not exceed 36 feet in total length. 6. The solid decked portions of the structure shall not exceed the following widths: the 36-foot long rectangular shaped float, 6-feet. 7. No portion of the dock or float system shall ground. A minimum space of eight inches shall be maintained at all times between the bottom of the dock or float and the beach grade. 8. Floatation for the structure shall be fully enclosed and contained to prevent the breakup or loss of the floatation material into the water. 9. All lumber and other materials treated with preservatives shall be sufficiently cured to minimize leaching into the water or bed. Department of 16018 Mill Creek Boulevard FISH and RCW 77.55.021-Appeal pursuant to Chapter 34.05 RCW Mill Creek,WA 98012-1296 WILDLIFE (425)775-1311 Issue Date: June 09, 2006 Control Number: 105346-1 Project Expiration Date: March 14, 2007 FPA/Public Notice#: N/A 10. All treated lumber to be used for the project shall meet or exceed the standards established in, 'Best Management Practices For the Use of Treated Wood in Aquatic Environments' developed by the Western Wood Preservers Institute, revised July 1996, and Amendment#1, dated April 17, 2002. 11. The pier, ramp, float, and associated moorings shall have been designed and shall have been located to avoid shading of eelgrass (Zostera spp). 12. The two existing creosote treated wood pilings shall be removed and disposed of upland such that they do not enter waters of the state. 13. As specified in the application, the two new pilings may be steel pilings. 14. Piles shall be driven by means of a vibratory hammer. In the event that an impact hammer is required for driving or proofing steel piles, the following sound attenuation methods shall be required for work below the ordinary high water line: a. For steel piles, 10 inches in diameter or less, a 6 inch thick wood block shall be installed between the piling and the impact hammer during pile driving operations or a bubble curtain shall be installed around the pile during pile driving operations. b. For steel piles greater than 10 inches in diameter, a bubble curtain or other WDFW approved sound attenuation shall be installed around the pile during pile driving operations. 15. Beach area depressions created during project activities shall be reshaped to preproject beach level upon project completion. 16. Eelgrass and kelp shall not be adversely impacted due to any project activities (e.g., barge shall not ground, equipment shall not operate, and other project activities shall not occur in eelgrass and kelp). 17. Project activities shall be conducted to minimize siltation of the beach area and bed. 18. All debris or deleterious material resulting from construction shall be removed from the beach area and bed and prevented from entering waters of the state. 19. No petroleum products or other deleterious materials shall enter surface waters. 20. Project activities shall not degrade water quality to the detriment of fish life. 21. If at any time, as a result of project activities, fish are observed in distress, a fish kill occurs, or water quality problems develop (including equipment leaks or spills), immediate notification shall be made to the Washington Department of Ecology at 1-800-258-5990, and to the Area Habitat Biologist listed below. � ; Department of ' " 16018 Mill Creek Boulevard FISH and RCW 77.55.021 -Appeal pursuant to Chapter 34.05 RCW Mill Creek,WA 98012-1296 Yi' WILDLIFE (425)775-1311 Issue Date: June 09, 2006 Control Number: 105346-1 Project Expiration Date: March 14, 2007 FPA/Public Notice#: N/A PROJECT LOCATIONS Location #1 Chepolis Property WORK START: June 15, 2006 (WORK END: March 14, 2007 WRIA: Waterbody: Tributary to: 03.9070 Wria 03 Marine Puget Sound 1/4 SEC: Section: Township: Range: Latitude: Longitude: County: All 28 35 N 01 E N 48.4953 W 122.6804 Skagit Location#1 Driving Directions NOTES APPLY TO ALL HYDRAULIC PROJECT APPROVALS This Hydraulic Project Approval pertains only to those requirements of the Washington State Hydraulic Code, specifically Chapter 77.55 RCW(formerly RCW 77.20). Additional authorization from other public agencies may be necessary for this project. The person(s)to whom this Hydraulic Project Approval is issued is responsible for applying for and obtaining any additional authorization from other public agencies (local, state and/or federal)that may be necessary for this project. This Hydraulic Project Approval shall be available on the job site at all times and all its provisions followed by the person(s)to whom this Hydraulic Project Approval is issued and operator(s) performing the work. This Hydraulic Project Approval does not authorize trespass. The person(s)to whom this Hydraulic Project Approval is issued and operator(s) performing the work may be held liable for any loss or damage to fish life or fish habitat that results from failure to comply with the provisions of this Hydraulic Project Approval. Failure to comply with the provisions of this Hydraulic Project Approval could result in a civil penalty of up to one hundred dollars per day and/or a gross misdemeanor charge, possibly punishable by fine and/or imprisonment. All Hydraulic Project Approvals issued pursuant to RCW 77.55.021 (EXCEPT agricultural irrigation, stock watering or bank stabilization projects)or 77.55.141 are subject to additional restrictions, conditions or revocation if the Department of Fish and Wildlife determines that new biological or physical information indicates the need for such action. The person(s)to whom this Hydraulic Project Approval is issued has the right pursuant to Chapter 34.04 RCW to appeal such decisions. All agricultural irrigation, stock watering or bank stabilization Hydraulic Project Approvals issued pursuant to RCW 77.55.021 may be modified by the Department of Fish and Wildlife due to changed conditions after consultation with the person(s)to whom this Hydraulic Project Approval is issued: PROVIDED HOWEVER, that such modifications shall be subject to appeal to the Hydraulic Appeals Board established in RCW 77.55.301. APPEALS INFORMATION If you wish to appeal the issuance or denial of, or conditions provided in a Hydraulic Project Approval, there are informal and formal appeal processes available. Department of ' ' ' '"—. ' """�-" ' ' " "'" "' '� 16018 Mill Creek Boulevard FISH and RCW 77.55.021 -Appeal pursuant to Chapter 34.05 RCW Mill Creek,WA 98012-1296 WILDLIFE (425)775-1311 Issue Date: June 09, 2006 Control Number: 105346-1 Project Expiration Date: March 14, 2007 FPA/Public Notice#: N/A i A. INFORMAL APPEALS (WAC 220-110-340) OF DEPARTMENT ACTIONS TAKEN PURSUANT TO RCW 77.55.021, 77.55.141, 77.55.181, and 77.55.291: A person who is aggrieved or adversely affected by the following Department actions may request an informal review of: (A) The denial or issuance of a Hydraulic Project Approval, or the conditions or provisions made part of a Hydraulic Project Approval; or (B)An order imposing civil penalties. A request for an INFORMAL REVIEW shall be in WRITING to the Department of Fish and Wildlife HPA Appeals Coordinator, 600 Capitol Way North, Olympia, Washington 98501-1091 and shall be RECEIVED by the Department within 30 days of the denial or issuance of a Hydraulic Project Approval or receipt of an order imposing civil penalties. If agreed to by the aggrieved party, and the aggrieved party is the Hydraulic Project Approval applicant, resolution of the concerns will be facilitated through discussions with the Area Habitat Biologist and his/her supervisor. If resolution is not reached, or the aggrieved party is not the Hydraulic Project Approval applicant, the Habitat Technical Services Division Manager or his/her designee shall conduct a review and recommend a decision to the Director or his/her designee. If you are not satisfied with the results of this informal appeal, a formal appeal may be filed. B. FORMAL APPEALS (WAC 220-110-350) OF DEPARTMENT ACTIONS TAKEN PURSUANT TO RCW 77.55.021 (EXCEPT agricultural irrigation, stock watering or bank stabilization projects)or 77.55.291: A person who is aggrieved or adversely affected by the following Department actions may request a formal review of: (A)The denial or issuance of a Hydraulic Project Approval, or the conditions or provisions made part of a Hydraulic Project Approval; (B)An order imposing civil penalties; or (C)Any other'agency action'for which an adjudicative proceeding is required under the Administrative Procedure Act, Chapter 34.05 RCW. A request for a FORMAL APPEAL shall be in WRITING to the Department of Fish and Wildlife HPA Appeals Coordinator, shall be plainly labeled as'REQUEST FOR FORMAL APPEAL'and shall be RECEIVED DURING OFFICE HOURS by the Department at 600 Capitol Way North, Olympia, Washington 98501-1091,within 30-days of the Department action that is being challenged. The time period for requesting a formal appeal is suspended during consideration of a timely informal appeal. If there has been an informal appeal, the deadline for requesting a formal appeal shall be within 30-days of the date of the Department's written decision in response to the informal appeal. C. FORMAL APPEALS OF DEPARTMENT ACTIONS TAKEN PURSUANT TO RCW 77.55.021 (agricultural irrigation, stock watering or bank stabilization only), 77.55.141, 77.55.181, or 77.55.241: A person who is aggrieved or adversely affected by the denial or issuance of a Hydraulic Project Approval, or the conditions or provisions made part of a Hydraulic Project Approval may request a formal appeal. The request for FORMAL APPEAL shall be in WRITING to the Hydraulic Appeals Board per WAC 259-04 at Environmental Hearings Office, 4224 Sixth Avenue SE, Building Two- Rowe Six, Lacey, Washington 98504; telephone 360/459-6327. D. FORMAL APPEALS OF DEPARTMENT ACTIONS TAKEN PURSUANT TO CHAPTER 43.21L RCW: A person who is aggrieved or adversely affected by the denial or issuance of a Hydraulic Project Approval, or the conditions or provisions made part of a Hydraulic Project Approval may request a formal appeal. The FORMAL APPEAL shall be in accordance with the provisions of Chapter 43.21 L RCW and Chapter 199-08 WAC. The request for FORMAL APPEAL shall be in WRITING to the Environmental and Land Use Hearings Board at Environmental Hearings Office, Environmental and Land Use Hearings Board,4224 Sixth Avenue SE, Building Two- Rowe Six, P.O. Box 40903, Lacey, Washington 98504; telephone 360/459-6327. E. FAILURE TO APPEAL WITHIN THE REQUIRED TIME PERIODS results in forfeiture of all appeal rights. If there is no timely request for an appeal,the department action shall be final and unappealable. Department of ' ' ' "' "'"�" """`" ' " ' ' f" "' 16018 Mill Creek Boulevard 17 FISH and RCW 77.55.021 -Appeal pursuant to Chapter 34.05 RCW Mill Creek,WA 98012-1296 ',9' WILDLIFE (425)775-1311 Issue Date: June 09, 2006 Control Number: 105346-1 Project Expiration Date: March 14, 2007 FPA/Public Notice#: N/A ENFORCEMENT: Sergeant Heinck (25) P3 Habitat Biologist 9 for Director Doug Thompson 360-466-4345 1'54-j rL WDFW CC: • -«------ - - �� AY eH L.t April - , } � | I \ \ } / ) - }"/ i ] ; . ) { ' \ ! 1 ! # | { : - I ! ! frAncsik? { } JJ k3 i ._ , 1 - | i 1 \ 4 e/ ) f «\ : I-1 � I i 1 I \ \C v yA;' 22 : /\% \ \ 3V imW\ NICA QF&cr C« t. i (bbJISDD \6 Q»3 / a {LP d« 2 « § f. *siti'',-6-c::::. W:% ttiLEL 9 «. s • JEN—JAY, INC. Preliminary Eelgrass Macro Algae Habitat Survey Theodore Chepolis 16 May 2006 LOCATION: Skyline Marina, Fidalgo Island, Anacortes, Washington. PURPOSE: To replace an existing dock system with reorientation of the float. TIME: Between 5:30 and 6:30 pm. DEPTH CALCULATIONS: Measurements were made with a submersible electronic computer with the accuracy of+/-two feet. These were cross-checked with an oil-filled depth gauge. Corrections were made using the Port Townsend tide tables, corrected to MLLW. BOTTOM TYPE: Riprap on shore,then mud. VEGETATION: No macro algae. No Zostera marina(eelgrass). SURVEY PATTERN: From the center of the waterward end of the existing pier,out 80'on a line under the existing float with 20'transects. Two identical lines 30'to either side. VISIBILITY: 10't. VERTEBRATE and INVERTEBRATE SPECIES: None with numbers enough to be significant. FORAGE FISH HABITAT: The project site has solid riprap on shore and is not potential forage fish habitat. Any questions regarding this survey should be addressed to: Chris Betcher JEN-JAY, INC. P.O. Box 278, Deer Harbor, WA 98243-0278 Ph: (360)376-4664 Fax: (360)376-6446 Boat:(360)317-5373 Email:jenjay@rockisland.com MON 27 28 , --------wii4i FIDALGO ISLAND 29 30 nnacoereswA. :_,,,,,, E.opt.ti'�\ TAX PARCEL S 38230000290009 7• V BI no ma ag. bCrEraP rin n 'aocva._�\ Chf' P O �u ����XX�\J\\�J ra x mud n•tbose Ernpr]6\ �\ ��� no macm agx b m c m aex 1/ � mud m agae send niva 0 no macro namacroasxvn magi SCALE P'=40' O mmud ud n m® o macm agac used ® macro ape ® r no macm ague macroayai+l N ao KEY \In-EELGRASS BED SKYLINE MARINA I'.4 estimates.Trans¢Is old]colgrass Te I dnsity M=medmm dense. H=Meh densm 0=No eclSrass 1B d" MLLPs. =Contour Imes corrected m0'-11'MLLW IA Jon la)DIN mg Inc, PRELIMINARY EELGRASS MACROALGAE HABITAT SURVEY FOR: THEODORE CHEPOLIS BY: JEN—JAY DIVING INC. NOT CONSTRUCTION DRAWINGS DATE: MAY 16, 2006 DEPTH CONTOURS ARE APPROXIMATE I CITY OF ANACORTES TY it z # s Ota S_col ^11''. EXEMPTION FROM SHORELINE MANAGEMENT ACT SUBSTANTIAL DEVELOPMENT PERMIT REQUIREMENT TO: Ted Chepolis 5503 boon Way Anacortes, WA 98221 The proposal by Ted Chepolis to undertake the following development: Replace two creosote pilings with steel pilings (existing dock is 36' x 6'). Upon the following property: 5503 boon Way, Anacortes, Skagit County, Washington. Within (name of water area) Flounder Bay and and/or its associated wetlands is exempt from the requirement of a substantial development permit because the development constitutes: Normal maintenance or repair of existing structures or developments, including damage by accident, fire or elements WAC 173.27.040(2)(6) Description of any other work planned in the future which is related to this project. N/A Corps Public Notice Number: unknown CONSISTENT INCONSISTENT (Check one) n Policies of the Shoreline Management Act. The guidelines of the Department of Ecology where no Master Program has been finally approved by the Department. The master program 0/" Date Shorelines Administrator y AGENCY USE ONLY Agency Reference#: Date Received: Circulated by: (local govt.or agency) JOINT AQUATIC RESOURCES PERMIT APPLICATION FORM (JARPA) �n (for use in Washington State) i & „r" PLEASE TYPE OR PRINT IN BLACK INK OR FILL IN ELECTRONICALLY QApplication for a Fish Habitat Enhancement Project per requirements of RCW 77.55.290. You must submit a copy of this completed JARPA application form and the(Fish Habitat Enhancement JARPA Addition)to your local Government Planning Department and Washington Department of Fish&Wildlife Area Habitat Biologist on the same day. NOTE: LOCAL GOVERNMENTS—You must submit any comments on these projects to WDFW within 15 working days. Based on the instructions provided,I am sending copies of this application to the following: (check all that apply) ❑ Local Government for shoreline: ❑Substantial Development D Conditional Use 0 Variance ❑Exemption ❑Revision ❑Floodplain Management ❑Critical Areas Ordinance ❑ Washington Department of Fish and Wildlife for HPA(Submit 3 copies to WDFW Region) ❑ Washington Department of Ecology for 401 Water Quality Certification(to Regional Office-Federal Permit Unit) ❑ Washington Department of Natural Resources for Aquatic Resources Use Authorization Notification ❑ Corps of Engineers for. ❑Section 404 ❑Section 10 permit ❑ Coast Guard for: ❑ General Bridge Act Permit ❑Private Aids to Navigation(for non-bridge projects) ❑ For Department of Transportation projects only: This project will be designed to meet conditions of the most current Ecology/Department of Transportation Water Quality Implementing Agreement SECTION A-Use for all permits covered by this application. Be sure to ALSO complete Section C(Signature Block)for all permit applications. 1.APPLICANT itb CHGP0Lig MAILING ADDRESS 5-33 be1/43i 1 vj�� P$ n 6o�VU V i f � M fJ �jV `� Vv 0�` WORK PHONE g-MAIL4 {{�� r Gtrm` GO mDD(2EsS HOME PHONE l FAX# If an agent is acting for the applicant diking the permit process,complete#2. Be sure agent signs Section C(Signature Block) for all permit applications 2.AUTHORIZED AGENT MAILING ADDRESS WORK PHONE E-MAIL ADDRESS HOME PHONE FAX# 3.Relationship of applicant to property: DOWNER ❑PURCHASER ❑LESSEE ❑OTHER: 4.Name,a`d1d AAss and phone number of property owner(s)if other than applicant: Nr 5. Location(street address, including city,county and zip code,where proposed activity exists or will occur) 5503 D0013 WAY.) AIJPC121ts WA Ck0,0\.l Local government with jurisdiction(city or county) Waterbody you are working in j`(aU 0 I (SAY Tributary of WRIA# Is this waterbody on the 303(d)List YES ill NOV If YES,what parameter(s)? For 303d List, Shoreline designation http://www.ecy.wa.gov/programs/wq/303d/index.html Zoning designation 'A Section Section Townsttip Range Government Lot O1Sv 3_5 )9 I t DNR stream type if known Latitude and Longitude: Tax Parcel Number I 1 ECY 070-15(Revised 11/04)JARPA, Contact the State of Washington Office of Regulatory Assistance for latest version or call 360/407-7037 or 800/917-0043 1 " 6. Describe the current use of the property,�nd structures existing on the property. Have you completed any portion of the proposed activity on this property? OYES El NO For any portion of the proposed activity already completed on this property, indicate month and year of completion. G15-lt1 Doc it_ is 36i v 6' vow cQ Ckt-Rss lC Yit irr34S Dott QLS€3 PiJ Hai tf,\ -ISk> TT IS CuNIAGG V D do Lear 8\e/ A 3 ' 31 6g+116(O ,4? Is the property agricultural land? nYES 1"1 NO Are you a USDA program participant? n YES f` 1 NO 7a. Describe the proposed work that needs aquatic permits: Complete plans and specifications should be provided for all work waterward of the ordinary high water mark or line,including types of equipment to be used. If applying for a shoreline permit,describe all work within and beyond 200 feet of the ordinary high water mark. If you have provided attached materials to describe your project,you still must summarize the proposed work here. Attach a separate sheet if additional space is needed. iWu PAP- oiE w1L�tJUS cwa 73-gam kaLithrify V+ fn 5-pen Pk `Vkactli.ivLU k Q,oP-VD) It, $t Dore LW PPPt.,1vv) a' i ILIAPSot PI,LG- iouG ev aiia 6r PREPARATION OF DRAWINGS: See sample drawings and guidance for completing the drawings. ONE SET OF ORIGINAL OR GOOD QUALITY REPRODUCIBLE DRAWINGS MUST BE ATTACHED. NOTE: Applicants are encouraged to submit photographs of the project site,but these DO NOT substitute for drawings. THE CORPS OF ENGINEERS AND COAST GUARD REQUIRE DRAWINGS ON 8.1/2 X 11 INCH SHEETS. LARGER DRAWINGS MAY BE REQUIRED BY OTHER AGENCIES. 7b. Describe the purpose of the proposed work and why you want or need to perform it at the site. Please explain any specific needs that have influenced the design. i w.6 Ttiav GgaSS 4�c t1 (t�' PiLrt.) m �QE ipas� iciaD wag gta'? phs i4b Vcsi a�ic � pAyp2D w 3L C' 9 Doots WnEactPPV Pool..D *-1 ¢R� t Lb.ct 14 pie rn, tia D�sl� eAp1J�1t7SoQ fi owjcP7lu*-f 6.0e an CA ACV)J 1o1\) et pt \o --D- 7c. Describe the potential impacts to characteristic uses of the water body. These uses may include fish and aquatic life,water quality, water supply, recreation and aesthetics. Identify proposed actions to avoid, minimize,and mitigate detrimental impacts and provide proper protection of fish and aquatic life. Identify which guidance documents you have used. Attach a separate sheet if additional space is needed. ttavf20+.iltt;Ggi, �415L Y'kSbr c'w AQl�'F`G'bc (in: B oak. caAce.D .. 1` CI.yrnit+At10i1 of C uaSt C:. rflf6TUVpt IS DCA 112PQLC. DoGtL 5 t pi Eat, or F�t17ftAt) ci t'; C &SJg(�rc ITS S1G6Ln'? �ai.a. pP(s t c f t'ac4 i�tt141:1ail uF Wgt, eR:OF, IDS GOOF+ D rJ� R- 7d. For in water constructiortk,will you project be in compliance with the State of Washington water quality standards for turbidity WAC 173.201A-110? fuwo r`I YES (,NO (See USEFUL DEFINITIONS AND INSTRUCTIONS) 8. Will the project be constructed' in stages? YES n NO Prl Proposed starting date: Cr IS) 1t9ti Estimated duration of activity: 9.- 4 1.-1©V��'S 9. Check if any temporary or permanent structures will be placed: TAJWaterward of the ordinary high water mark or line for fresh or tidal waters AND/OR ❑Waterward of the mean higher high water for tidal waters? 10.Will fill material(rock,fill,bulkhead,or other material)be placed. No QWaterward of the ordinary high water mark or line for fresh waters? If YES,VOLUME(cubic yards) /AREA (acres) nWaterward of the mean higher high water for tidal waters? If YES,VOLUME(cubic yards) /AREA (acres) ECY 070-15(Revised 11/04)JARPA, Contact the State of Washington Office of Reuulatory Assistance for latest version or call 360/407-7037 or 800/917-0043 2 11. Will material be placed in wetlands? [OYES "NO 0 I F If YES: A. Impacted area in acres: B. Has a delineation been completed? If YES,please submit with application. ❑YES ❑NO C. Has a wetland report been prepared? If YES,please submit with application ❑YES INC) D. Type and composition of fill material(e.g.,sand, etc.) E. Material source: F. List all soil series(type of soil)located at the project site,and indicate if they are on the county's list of hydric soils. Soils information can be obtained from the natural Resources Conservation Service(NRCS). G. WILL PROPOSED ACTIVITY CAUSE FLOODING OR DRAINING OF WETLANDS? ❑YES i' NO IF YES, IMPACTED AREA IS ACRES OF DRAINED WETLANDS. NOTE: If your project will impact greater than%of an acre of wetland,submit a mitigation plan to the Corps and Ecology for approval along with the JARPA form. NOTE:a 401 water quality certification will be required from Ecology in addition to an approved mitigation plan ifyour project impacts wetlands that are: a)greater than%acre in size, orb)tidal wetlands or wetlands adjacent to tidal water. Please submit the JARPA form and mitigation plan to Ecology for an individual 401 certification if a)orb)applies. 12. Stormwater Compliance for Nationwide Permits Only: This project is(or will be)designed to meet ecology's most current stormwater manual, or an Ecology approved local stormwater manual. YES n UJ NO If YES—Which manual will your project be designed to meet? If NO—For clean water act Section 401 and 404 permits only—Please submit to Ecology for approval, along with this JARPA application,documentation that demonstrates the stormwater runoff from your project or activity will comply with the water quality standards,WAC 173.201(A) 13 Will excavation or dredging be required in water or wetlands? DYES 1KNO If YES: A. Volume: (cubic yards)/àrea (acre)B. Composition of material to be removed: C. Disposal site for excavated material: D. Method of dredging: F 14. Has the State Environmental Policy Act(SEPA)been completed ❑YES M NO SEPA Lead Agency: SEPA Decision: DNS,MDNS, EIS,Adoption, Exemption Decision Date(end of comment period) SUBMIT A COPY OF YOUR SEPA DECISION LETTER TO WDFW AS REQUIRED FOR A COMPLETE APPLICATION 15. List other Applications, approvals or certifications from other federal,state or local agencies for any structures,construction discharges or other activities described in the application(i.e.preliminary plat approval, health district approval,building permit, SEPA review, federal energy regulatory commission license(FERC), Forest practices application,etc.). Also, indicate whether work has been completed and indicate all existing work on drawings. NOTE: For use with Corps Nationwide Permits, identify whether your project has or will need an NPDES permit for discharging wastewater and/or stormwater. TYPE OF APPROVAL ISSUING AGENCY IDENTIFICATION DATE OF APPLICATION DATE APPROVED COMPLETED-, NO 16. Has anya enc denied approval for the activityyou're applying for or for anyactivitydirectlyrelated to the activitydescribed herein? Y PP EYES NO If YES,explain: ECY 070-15(Revised 11/04)JARPA Contact the State of Washington Office of Regulatory Assistance for latest version or call 360/407-7037 or 800/917-0043 3 SECTION 8- Use for Shoreline and Corps of Engineers permits only: 17a.Total cost of project. This means the fair market value of the project, including materials, labor, machine rentals,etc. ro .Cs "3 oo6- (155,0Q1 17b. If a project or any portion of a project receives funding from a federal agency,that agency is responsible for ESA consultation. Please indicate if you will receive federal funds and what federal agency is providing those funds. See instructions for information on ESA.* FEDERAL FUNDING Q YES �C) NO If YES,please list the federal agency. 18.Local government with jurisdiction: 19. For Corps,Coast Guard, and DNR permits,provide names,addresses and telephone numbers of adjoining property owners,lessees, etc. Please note: Shoreline Management Compliance may require additional notice—consult your local government. 1 NAME ADDRESS PHONE NUMBER SECTION C-This section MUST be completed for any permit covered by this application 20. Application is hereby made for a permit or permits to authorize the activities described herein. I certify that I am familiar with the information contained in this application,and that to the best of my knowledge and belief,such information is true,complete,and accurate. I further certify that I possess the authority to undertake the proposed activities. I hereby grant to the agencies to which this application is made,the right to enter the above-described location to inspect the proposed, in-progress or completed work. I agree to start w (9NLY after all necessary permits have been received. 6 DA 1 e SIGNATURE OF APPLICA DATE SIGNATURE OF AUTHORIZED AGENT I HEREBY DESIGNATE TO ACT AS MY AGENT IN MATTERS RELATED TO THIS APPLICATION FOR PERMIT(S). I UNDERSTAND THAT IF A FEDE RAL PERMIT IS ISSUED, I MUST SIGN THE PERMIT. SIGNA— E OF APPLICANT DATE SIGNATUR N O R(EXCEPT PUBLIC ENTITY LANDOWNERS, E.G. DNR) THIS APPLICATION MUST BE SIGNED BY THE APPLICANT AND THE AGENT,IF AN AUTHORIZED AGENT IS DESIGNATED. 18 U.S.0§1001 provides that: Whoever,in any manner within the jurisdiction of any department or agency of the United States knowingly falsifies,conceals,or covers up by any trick,scheme,or device a material fact or makes any false,fictitious,or fraudulent statements or representations or makes or uses any false writing or document knowing same to contain any false,fictitious,or fraudulent statement or entry,shall be fined not more than$10,000 or imprisoned not more than 5 years or both. COMPLETED BY LOCAL OFFICIAL ' A. Nature of the existing shoreline. (Describe type of shoreline,such as marine,stream, lake,lagoon,marsh, bog,swamp,flood plain,floodway,delta;type of beach,such as accretion,erosion, high bank,low bank,or dike; material such as sand,gravel, mud,clay, rock, riprap;and extent and type of bulkheading, if any) B In the event that any of the proposed buildings or structures will exceed a height of thirty-five feet above the average grade level, indicate the approximate location of and number of residential units,existing and potential,that will have an obstructed view. C. If the application involves a conditional use or variance,set forth in full that portion of the master program which provides that the proposed use may be a conditional use,or,in the case of a variance,from which the variance is being sought: - f i These Agencies are Equal Opportunity and Affirmative Action employers. For special accommodation needs, please contact the appropriate agency in the instructions. ECY 070-15 JARPA(Revised 11104) Contact the State of Washington Office of Regulatory Assistance for latest version or call 360/407-7037 or 800/917-0043 4 Ted Chepoha 5503 Doan Way Anacortea, WA 98221 C5i 550$ 5 ; 41 ----. t *///ii I � 5502 inemes '412 15" CONC SS ___..- n \ i _ 17 r I ri 911' 501 5411 I 30 lil19* 1�At 31 pi 4.itt t\\.\ \ \ (/ i / k..\y Locations of two p�ere N II J requiring maintenance/ J/ replacement ` Sold To Delivered To Customer Approval Special Instructions Address y j1netrY by Sold B Delivery Date PLAN NO. li 1 8 - - - I. I 1 l �- BOX: 17' �'I - - -- - - - - '', - , - -- -- �w� DR. STYLE: � / f FINISH: �+ 1 +o G 5rti�,evq - yro 7 ty� • I 1 : . 1 1 , . 1 I di 1 1 -: QTY CABINET PRICE �Gf! i— � I . I 13' ,f/i {Z - - I- �,_ i '-- 6'a wa - 1Pit�-dI . ---- - - - I - .-- - -- I- • r--- -I - - ,1 Iva ' // _ I 11 11 � , - 1‘ � . �. �} _ '' i,e ae`es Seloa7� C titAil� L. _ - -,- - I- II �- �1/1 9ecorlw-y /°r n,,,,, _,.-Pre ew:- Wt _ h$ _ ,4uey -10' 1/444/1/1/ �� �Yko,- Sao L fbA✓ - k /I l s' / f _ c p�a. J r 1 /I I p 1 - I_ /��; jilt__, 1 I I 5 6 - ICI _=---'_ -- '_ -` -----' ..- - , ` LE �I i T �p1 tL 1 I 1 1 5' J 11 1 I I_ J I - I 2' --- I - - - - i� -L •��- - -- 11 -.- - - - - -IIiI- - - ---- - I � I I I I • List 1 -_-r 11 I- -- jT-, -_i.J I- .-' — - II- ICI - - - 1 - 1- - ' _ I - ' - 1- Other ` • ----� -1 - - 1- _ - �-_ �- •- -I - ---'i 1 . _- _ - -- -- — - - I - -- 1 Net Sales Tax 1 2 1 3 4 5 6 7 8 9 10' 11' 12' 13' 14' 15' 16' 17' 18' 19' 20' 21' 22' 23' 24' 25' 26' 27' Item 11-5302-9950 .25M/WP/0704 NOTE:ALL DIMENSIONS SHOWN ARE FINISH TO FINISH Total V2"SCALE Each Small Square Equals 3 inches We have excluded all cabinets not listed on this sheet. 0604004-1 0002 02/009/2006. 002 S . Fermi Fees 006854 $836.65 0%'T Y 0$., City of Anacortes Permit#: BLD-2006-0081 904 6th Street Issue date: 02/09/2006 `"" P.O.Box 547 Expire date: 02/09/2007 `."` irk,' Anacortes, WA 98221-0547 �' (360) 293-1901 Job Address: 5503 DOON WAY Permit Type: Single Family Alteration/Repair Permit ANACORTES WA 98221-2917 Project: APN: P59609 Remarks: Addition and remodel to existing single family residence. 360square foot addition. Owner: TED CHEPLOLIS Contractor KREIDER CONSTRUCTION INC Address: 5503 DOON WAY Address: 13142 PERSONS RD ANACORTES WA 98221-2917 BOW WA 98232-7222 Phone: (425) 392-1502 Phone: (360)421-1901 License#: KREIDC1024DE General Information: Fees: Building Valuation 86400 Building Permit Fee 394.00 # Forced Air Furnace <=1,000 1 Plan Review Fee 256.10 #of Clothes Dryers 1 State Building Code Fee 4.50 #of Clothes Washers 1 Mechanical Permit Fees 106.05 #of Dishwashers 1 Plumbing Permit Fee 76.00 #of Gas Fireplace 2 Total Calculated: 836 65 #of Gas Water Heaters 1 Deposits/Receipts: 0.00 #of Ventilation Fans 2 #of Range Hoods 1 Total Due: 836.65 #of Water heaters 1 #of Water Closets 2 #of Showers 2 #of Kitchen Sinks 1 THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING O PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LA LATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �� SIGNATURE OF OWNER OR AUTHORIZED AGENT ISSUED To: Building Department, City of Anacortes Subject: Proposed remodel of Chepolis residence, 5503 Doon Way We have no objection to the proposed remodel, which includes a 360 square foot, one-story addition as replacement for existing deck, as depicted on the drawing (below). i?tc hare( I-Lp-net, 5321r loon (A)a7 Name (print) Address ILIA; IL 1 opi 55u1, ;1 I ‘ i 1 1 r 1 "%SF' r i er ff I 1 i 28 �( r �'/ � 5501 � i 5411 L____ al 3 0 ��-0�'�.��'7 � j • PROPOSED ADDITION .-360 S.F. 31 ___-- �� `QQ�O�V (REPLACING EXIS ,G it DECK DECK OVER 18" IGH) - - ' I \ /4 So. / / \ \ \. \ Measamer, Don From: Measamer, Don Sent: Friday, February 03, 2006 7:50 AM To: 'Paul Schwulst' Subject: Chepolis Project Hello Paul, We need confirmation of Skyline approval for the Chepolis project. Thanks, Don 1 To: Building Department, City of Anacortes Subject: Proposed remodel of Chepolis residence, 5503 Boon Way We have no objection to the proposed remodel, which includes a 360 square foot, one-story addition as replacement for existing deck, as depicted on the drawing (below). n 6 A 5'.1o/ Vf A( 19,E y Name (print) Address 55U2, r r r r r r r r r r r eSS):// / • 1/4 re/ i 1 At28 //// I /I // 5501 ,, 5411 40�.;' It � / 30 fir *� PROPOSED ADDITION .-360 S.F. 31 fi----- 400•i � (REPLACING EXIS G it DECK, DECK OVER 18" IGH) - 11111.111.11.11\ \ I \ lj / 1 7 \ i , I ..- Residential Building Permit Application "..zw Building Department P.O.Box 547 Anacortes,WA 98221 Phone No.:360-293-1901 FAX:360.293.1938 SITE ADDRESS: i 603 bot,)0 (A) of2zc,_s ijj.p., tlgaat . ... .... .coNT, ..8,citoibAi,t. PliOJEC:iDRSCRIPTION ,:' . ,•'::-: • ' Name 44.E13)01- COKIZI2VCriolii ::1.1\C' ADD actOSILAJ To rikikoe etorn 44 o 5ri Address 13 ILla PEakbil Pb UP6aP[it- Kirci4E--)) 4 c) Rfaufzuortk.S CityiState/Zip P,011) .?JP d'02 a: A 1)17 I 11 01-3 gy I LT o 0 esa1r1t46 p424601-5kgAx f4i6t4 egisi-loc. pea- State License# lSxp PArte,4 NUMBER City of Anacorte,License 3C13- 603-°X -OW t, Picq 60q ilio-P.ERTY.OWNF4:4.,. :. .)4Applicatit: -:LEPAVTASCKiii-OM -i' .:.;;;•. , ., -:::- NameTES\CiAEPOLIS Address c5 03 Dq..) Ay (ut elt&c., i4u) City/StatelZiplAtaliC3)1/J44(Rot) pitopp.VALUATION phone435 Til ihib). ,ix Number of Dwelling Units I E-Mail Address kea 0 -l- CLIPO'°11`' CAM'DIT\ NBuwilndbienrp Area: „Ion sprAtelikeettrOeSiiner„Ell Enkiniefil Applicant l'Flour, SI. -2.'d Floor si . Name PAOL 3CA i'll OLST 3rd Floor s.f. Basement s.f. . i Address i&it Cp.rogaL L . I..,‘,-,e.airtt• Garage DIA—I sl., Carport st CityiState/Zip Plill.00f.#1.E,„S IA"JE3L0,,I DeckVx1fni Lot Area Mona° 0.1lI3aR' FAX ArVilell$i: 340* i ._.. 4,4 .cict,6uts10, L1scaa,- . 1,..cosuct, : ,, ,:, ,i,,,0,4„,,.,,„ ,T;ENDtxt.:, LENDER INFORMATION MUST BE PROVIDED FOR PROJECTS OVER S5,000 : Name i\vrrOti IN VALUATION tra RCW. Address i Name City/State/Zip Address Phone FAX City/State/Zip ' E-mail Address Phone No. CONTINUED ON TEE DACE • Bo - t>c)8( 1. Residential Mechanical Fixtures Fuel Type Natural Gas 0 Electric 0 Wood 0 Propane Gas ❑ Other • Type of Equipment Number of Type of Equipment I Number of - Fixtures Fixtures Furnace <=100K BTU ( < Clothes Dryer I Boilers/AC/Heat Pump Gas Water Heater i Gas Outlets Gas Fireplace _ a Ventilation Fans ' a. Fireplace insert _ Stove, Appliance i Other Units j Range Hood I DiSNWA.cua Residential Plumbing Fixtures Type of Fixture Number of Type of Fixture I Number of _ Fixtures Fixtures Toilet a , Clothes Washer Bathtub Electric Water Heater L I Shower 4 Utility Sink Dishwasher Hose Bibb Rand Sink Water Piping Kitchen Sink Iv/Disposal 1 Additional Fixtures I HEREBY ACKNOWLEDGE IF RASE REA D IBIS PERMIT APPLICANT AND STATE THE I p0Rf1AT10N IS CORRECT,AND AGREE TO COMPLY NTTB ALL CITE OEDLNANCES AND STATE LAWS REGULATING ACITIS'IESCOE'FR Ell BY THIS PERLIIT APPLICATION. WIT{i T HIS PERMIT ALL CONTRACTORS AND SUBCONTRACTORS SHALL RASE A CE'RR ENT WASHINGTON STATE CONTRACTORS LICENSE AND A CITY BUslNEss LICENSE. STOP IN K OItWERS RILL BE ISSUED ON JOB SITES 1511F,RE CONTRACTogs/suscu.NT1tACTORs ARE WORKING WITHOUT PROPS ENS E1AO ca 't3G APPLICANTS GNATURE DATE z,x. _ PLUMBING PERMIT APPLICATION ..% , Building Department ..'' _,?' P.O. Box 547 Anacortes, WA 98221 Phone No.: 360-293-1901 FAX: 360.293.1938 SITE ADDRESS: sSo.S bill J CONTRACTOR Name }C K.)Dt2 Cat I QU GI Lew -We, PROJECT DESCRIPTION Address I I arm( 9t Qsot3&,0.y . CRY/Sttaate/Z p B 0'V .YUA) 9&t 2 1 Phond 3 po17o2 -350p6 FM Permit Fee 20.00 State Licence# ,Exp Fixture Type Fee Each No. Amount City of Macorles Business License# _ Toilet 7.00 1 7 PROPERTY OWNER ( Bathtub 7.00 - Name Ttr1' CHRP0L11�) Shnwer 700 .7., IL/ J Address )V DOut\ WA? Dishwasher 7.00 I 7 City/State/21p ANAGofd-TCS Uk)P 9io75 _Hand Sink 7.00 - Phone 115. 3qa 150aFAx Kitchen Sink 7.00 I 7 C E-man Address ied :pi alPo.CCLGofit Wt \ Clothes Washer 7.00 I 7NWTAPPLICANT `\1.1 -ty1�I Electnc NWT 7.00 1 9 Name , Pga ,� U1I� Utility Sink i 7.00 Address Urinal 7.00 City/State/Zip Water Interceptor 7.00 Phone FAX Drinking Fountain 7,00 E-mail Address Slop Sink 7.00 CONTACTr� `� 0 Oa Water Piping 7.00 Name 1t/Q.lIY Hose Bibb 7.00 Address 1 Grease Interceptor 7.00 City/State/Zip Additional Fixtures 7.00 Phone FAX �� TOTAL FEES DUE E-mail Address I HEREBY ACKNOWLEDGE I HAVE READ THIS PERMIT APPLICATION AND STATE THE INFORMATION IS CORRECT,AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING ACTIVITIES COVERED BY THIS PERMIT APPLICATION.WITH THIS PERMIT ALL CONTRACTORS AND SUBCONTRACTORS SKILL HAVE A CURRENT WASHINGTON STATE CONTRACTORS LICENSE AND A CITY BUSINESS LICENSE.$TOP WORK ORDERS WILL BE ISSUED ON JOB SITE WHERE CONTRACTORS/SUBCONTRACTORS ARE WORKING WITHOUT PROPER LICENSE. Jan riot, APPLICANT' SIGN T E DATE Last Updated 11-29-05 Property Description: 5503 Doon Way Anacortes 98221 Ted & Elaine Chepolis PARCEL A: C©t 29!;-SkriLli E N&.7,according to the plat thereof recorded in Volume 9 of Plats, pages 70 — and 71, records of Skagit County, Washington; PARCEL B: That portion of Section 28, Township 35 North, Range 1 East of the Willamette Meridian, described as follows: Beginning at the most Southeasterly corner of Lot 29, Skyline No. 7, according to the plat thereof recorded in Volume 9 of Plats, pages 70 and 71, records of Skagit County, Washington; thence South 26°44'45"West 97.00 feet; thence Westerly on a curve to the left having a radius of 50 feet an arc distance of 16.29 feet to a point which lies South 08°04'40"West from the most Southwesterly corner of said Lot 29; thence North 08°04'40" East a distance of 97.00 feet to the most Southwesterly corner of said Lot 29; thence Southeasterly along the Southerly line of said Lot 29, a distance of 47.90 feet to the point of beginning. Situated in Skagit County, Washington. C a FOR INSPECTIONS CALL: CITY OF ANACORTES PERMIT NI 7878 293.1901 BUILDING PERMIT 24 Hrs. Notice Requested _ Site Address J503 Dean Way NAME (OR NAME OF BUSINESS) . Robertson Smith PLUMBING sMAH.IIfG ADDRESS '�'. s'I .1• f- ' .JI� �"� IQ . No. TYPE OF FIXTURE OR ITEM FEE 0 ±k CITY TFI.FPHONE )NUMB,.NUMB - 2 Water Closet $ 4 •00 Temecula CA 92390 71 -1-676-5765 2 Bathtub 4 . 00 ti NAME - 4 Lavatory - 8 .00 Jerry's •Designs I Shower 2 .00 ADDRESS • I Kitchen Sink 2 •00 °r u 5809 Sands Way 1 Dishwasher 2 . 00 T., a CITY TELEPHONE NUMBER I _Laundry Tray _ 2 . 00 &+ Anacortes , WA 98221 293-2771 1 Clothes Washer 2.00 NAME I Water Heater __ 2.00 qr James Zevely Urinal gi x ADDRESS . Drinking Fountain 5102 Dundee Drive - Floor Sink or Drain CITY TELEPHONE NUMBER - Slop Sink 00 Anacortes, WA 98221 293-3091 1 Water Piping 2 .00 STATE LICENSE NUMBER CITY LICENSE NUMBER a ZEVEL110DN 4796 _ " - . • [{Residential 0 Non-Residential - _ PERMIT - $ _ 3 .00 Utica ❑Add ❑ Alter 0 Repair TOTAL'PEE $ 33 .00 Building la Plumbing [ Mechanical MECHANICL • ❑ Sign ❑ Demolition D Other C;GAS Q OIL ❑ ELECT. ❑ OTHER Legal Description of Property or Tax Account Number No. TYPE OF EQUIPMENT FEE Lot Block 7 of Slryl •Lne #3823 000 029 0006 Air Cond. Unit $ ' ' Refrigeration Unit- HP - -;' Boiler- HP _ • 1 Forced Air System- BTU/KW 9 .00 _ Describe Work _ . Floor Furnace Maw Si ngl a Family Rnsi rtenra _ Wall Heater _ _ Unit Heater _ _ Clothes Dryer q ; Occupancy Use �_ Ventilation Fan _ _ `•, ESingle Family Residence ❑ Multi-Family Residence Range Hood _ ❑Office . ❑Retail ❑Storage D Church Air Handling Unit- CFM ii i ❑ Restaurant 0 Other Pre-manufactured Stove or Fireplace _ `,`` NOTICE 1 Gas Piping -O O - This permit is issued by the Building Official and,under the provisions _ 1 7 o rn 01 ea a r n p c.a FL- S 0- ,;: of the Uniform dhi%Code,shall expire by limitation and.become null I. and void;iflthe '.pr work authorized by such permit is not corn- PERMIT $ 1 S-no_ meRced,svithtm front the date of permit issuance,.or if the building TOTAL FEE $ '# or work*, days by such permit is suspended or abandoned at any lime 33 .60 after the wdrk i8 cotmenced for a period of 180 days. . 1, TOTAL FEES VALUATION FEE • By affxmg my signature, I hereby certify that I am the owner of the - property for which this permit is issued or am an authorized represen- Building 1] 1,666 00 $ 4/1_ n . ' tative of the owner._ Plan Check locF, 00_ � Al provisions of laws and ordinances governing this type of work will Plumbing ?; 0 O y be compd with whether specified herein or not,including routine calls ' Mechanical - - ?'� ri1_ -e for " us.. Sign - - _ Demolition - - .,,� +i a Energy Surcharge '` "sky -. �(D.i> State Surcharge ,I-. r,0 IStreet SeAaBr ' - ' Side Yard setback RearYid Setback Other 4 e.. eV 1 3 1 E .00 20 10 5 20 TOTAL $fa , 19f -00 .y Use zone Occupancy Group roe of Coast. Conditions: RI, R:1 t-ii VN - Lot Area Vacant Site Dwelling Units 8 218 dtYa ❑No 1 Fire Sprinklers Required No.of Stories Bedrooms Occupant Load 'Il' ❑yea -�(.No 1 Sac of Bldg. Plan Checked By Ray WIEN SIGNED AND DATED BELOW,THE IS YOUR PFBMI' Penniseice is harsh)given to do do above described wart wording to the conditions . lam and raw to the approved pions end spotilicettoniptetsktiog therta subject to compliance with the drd'wracea of the(ATV OF ANAW1lTES. .:. i Permit Issued By 7 t, .i,_ 05/29/90 fin O®ciat (Date) - fa Frank PERMIT r `,� OF CITY OF ANACORTES WASHINGTON yCOa4W BUILDING DEPARTMENT CERTIFICATE OF OCCUPANCY This is to certify that the(Description of Building or Structure): Single Family Residence Located At: 5503 Doon Way STREET&NUMBER Owner: Robertson Smith ConstructedBy: Jim Zevely OWNER OR CONTRACTOR Bldg.Permit# 7878 Date Of Issue: 5-29-90 Occ.Group: R3/M Use Zone: RL Has Been Inspected And Occupancy Is Hereby Authorized, This 23 1p Day Of 1`1Tannusgy 19 AUTHORIZING OFFICIAL SEE REVERSE SIDE FOR SPECIAL REQUIREMENTS. 4 "EINSPECTION CHECKLIST ' y Address : 35C'3 )c'c-c"t-� t c� Permit No.:7 P Date: 5/ { jl clo Zone: R t. Owner: gC ss-2. . on-'cc Contractor: 1( y�e , aa e Legal Description: O Q Q i o-1 Variances: IL c- Occupancy Group:_______°4 Construction Type: Vl Ng Energy Code : >( Ch . 6 Ch. 4 FINAL INSPECTION Insulation Cert: CAC. House Numbers: CLt._ Wa �r ter Pressure:)` �%'`,- 50-yJ Site drainage: l�A Insul .--Crawl Space: Attic: ei Crawl Space Vapor Barrier: (` r c:arage/house door L D.W. air gap: °jC Traps: C- Exh. Duct dampers: e Detectors) O V Safety Glass: C Guard rails: Hand rails: Bedroom windows: at Sewer Inspected: 0 it CIO Curb cut inspected: Water heater: Strap: T & P drain: (011 Sewer rec't . : 51;61010 Date: I `I S '9 Dryer vent: Wood stove: ld i9-- 1 .✓�s LL 11LLu✓ VUs (:LVL 1-W_V1\iVLL 1V nu.LLlUi1,ol+ LILL"HL(11"IGLV J. 1JGt VI( ULLU VHLNL.Y (FM — CAUTION — ' This card must be posted in a conspicuous place on the premises. /r INSULATION CERTIFICATION THIS IS TO CERTIFY THAT, IN CONFORMANCE WITH THE CURRENT THERMAL PERFORMANCE STANDARDS (REVISED CODE OF WASHINGTON, TITLE 19.27, STATE OF WASHINGTON") AND APPROVED PLANS, INSULATION HAS BEEN INSTALLED IN THE BUILDING LOCATED AT: 55(A Dorx)wAY --7 " ZEVELy tE. "1o`lO ADDRESS OF PROPERTY BLDG. PERMIT NO. Vapor barrier at 4 mil polyethylene or equivalent must be installed in crawl space. Weatherstriping, caulking, gasketing and/or other treatment to prevent air leakage must be installed around all exterior openings. ROOFS Type of Material Manufacturer Thickness R Value** (Or trade name) EXTERIOR WALLS ,4/� 4r TG� r TypeI Material Si ,- !{I� Manufacturer L�J w(x`w L�(�lUr�l� Thickness 6 /y R Value*` t (Or trade name) CEILINGS _ I( BATTS: ,,((//��// ll ���\�\��,,rm� 7(� Type of Material 401S el Manufacturer C iIS GrZwi Lr Thickness 12 R Value*` (Or trade name) // Sq. Ft. Coveredif {�(QJ BLOWN: / V Type of Material Manufacturer Thickness I_2 No, Bags (Or trade name) 9 Z1Wt./Bag R38Osq. Ft. Covered R Value" ..,v FLOORS /� ,\l y f� ( / _ I/ is Type of Material }J411(ONI-F J Manufacturer O VrRA\ L ,b�(,4✓""I Thickness to [Z R Value" (Or trade name) / SLAB ON GRADE Type of Material Manufacturer Thickness R Value" (Or trade name) Width of Insulation Inches FOUNDATION WALLS (if required) Type of Material Manufacturer Thickness R Value" _ (Or trade name) DUCT AND/OR PIPE INSULATION Type of Material Manufacturer Thickness R Value" 67P—Lx)No CD'LIe-12 G Qvt.ltm \rsQ0etY4 r i/O p . General Contractor (Builder) �#dVvt�ES C ZtllCt=� Contractor's Registration Number e`L'Q`w C4 BY Ck/yyQ4 C� �^ -nTitle -LJ—✓L�i� Date IZ` Io k9,0 /,. Sub-coitractor (Insulati n Applica r) 70h1.6 t A 3'L-w A. Contractor's Registration Number ¶, Ft— 2L9OI[ (Insulation, Masonry, etc.) (State "SAME" if same as General Contractor) By Title Date 5 ATt*c$ oo Ca *Revised Code of Washington - Thermal Performance Standards, declares: Upon completion of the installation of insulation, a card certifying that the insulation has been installed in conformance with the requirements of this 1977 amendatory act shall be completed and signed by the builder or insulation applicator. For this purpose, any certification card which contains all the essential data may be used. The insulation compliance card shall indicate the "R" value of insulation (material only) installed in the ceilings, walls, floors, on the perimeter, and ducts. When loose fill insulation is used the card shall show the square footage and the number and weight of bags installed to obtain the"R"value listed. The card must be posted at a conspicuous location within the building and will indicate the installation date. **R Value (thermal resistance) means the measure from the resistance of a material or building component to the passage of heat. The resistance value (R) of mass type insulation shall be for the material only."R" values shall be as listed in the current ASHRAE Handbook of Fundamentals, or as tested in accordance with current applicable standards. No certification of occupancy or similar certification that a newly constructed apartment house three stories or less in height, home, or other residential dwelling is habitable shall be issued by such a building department unless the structure at least satisfies the minimum energy insulation standards established pursuant to this chapter. BU-3 INSULATION CERTIFICATION G-e% (THIS CARD IS TO REfi'TN PERMANENTLY POSTED IN A READILY ACCES +2 LOCATION) THIS IS TO CERTIFY THAT IN CON} JRMANCE WITH THE CURRENT THER .,. PERFORMANCE STANDARDS WASHINGTON. STATE ENERGY CODE, CHAP. 51-12 WAC, REVISED 1986, AND APPROVED PLANS, I HAVE INSPEC- TED THE ENERGY PACKAGE AND CERTIFY THAT IT HAS BEEN INSTALLED IN ACCORDANCE WITH THOSE STANDARDS IN THE BUILDING LOCATED AT: '-66-eas of Piopeny #d 9- / q(% s'Perrnn No.— • 7 DESCRIPTI OF INSTALLATION ROOFS �/^ Type of Material ��/Jtl"" Manufacturer Thickness R Value (Or trade name; EXTERIOR WALLS - ,f / _'i{— Type of Material J J Idanufaca rer 4 C / Thickness �Y�""" R Value, (Or trace name) CEILINGS 6ATTS. rl) Type Of Material _ !J�a Hula Cl U'El iMcknE55 • V R Value SO (Or trade name) 16 pp�� C/ Sq Ft.Covered '/1�"��LO W N: //1 y+ 7 Material Manufacturer &I- Thickness 12 No.Gaos WVBzg -Ft Covered __ R value FLOOR {/ / Type of Material ' i Manufacturer^ a C Gr Thickness 4 -Or rR Valuc 7 (Or trade name)• 666 SLAB ON GRADE Type of Material �� Manufacturer Thickness R Value (Or trade name) Width of Insulation inches FOUNDATION WALLS Of recurr d p P Type of Material /� Manufacturer Thickness R Value (Or trade name) DUCT AND/OR PIPE INSULATt9I .s Type of Material /��// - Manufacturer Thickness R Value (Or trade name) HEATING SYSTEM Type of System Manufacturer Inout Output ❑ 1:IGHT SETBACK THERMOSTAT INSTALLED ❑ I-EATING SYSTEM INSTALLED TO NO MORE THAN 150%OF DES N LiKe::; ❑ GLAZING—ALL GLAZING INSULATED GLASS OR STORM WINDC 'S PROVIDED O WATER HEATERS—ASHRAE BOA-SO LABELED ❑ WATER FLOW RESTRICTORS—ALL SHOWERS LIMITED TO 3 GPM ❑ INFILTRATION—DOORS&WINDOWS WEATHERSTRIPPED OR APPROVED BY ASTM 283-73 ❑ INFILTRATION—ALL OPENINGS IN EXTERIOR WALLS CAULKED OR SEALED O FIREPLACES—OUTSIDE AIR VENT(SIX SQUARE INCHES) WITH DAMPER TO FIREBOX ' ❑ SLAB THERMAL BREAK CREATED ❑ VAPOR BARRIERS—INSTALLED PER CODE REMARKS(if desired) I CERTIFY UNDER PENALTYOF PERJURY UNDER THE LAWS OFTHE STATE OF WASHINGTON THATTHE FOREGOING IS TRUE AND CORRECT. _ General Co ractor(Builder) ./,4rriES C zt' vL,1 Contractors Reg. No. Ztv6L.Ta !1Dus! By cte-n2�G/3"� G Title C'J �iC�/t/fJ�- Date and Place ��/7�Aot lilit / ZA)/ ) SQ J�0ntr c rs R-T t Rldt S IITION — # SO-NO-TI-26406 Sutecontra tor(Insulation Applicator) (Insulation awn ,etc-)(StateAAME" ' same as General Contractor) - ✓��R�/ - _ By A0 (C? � ���/r� T41e u•ld(LX/•�T-i•' Date and Place 6/ r !(}'Q( o /�'c } c s ( Cm I 1�t:T�tt•I �y^�L � I I � I (�rEx--; I d In 2'z LDE ---9 \ � � HEAT LOSS LOCATION: Gera 3 I eonrG r Pa • ge of = i` � DESIGN TEMPERATURE DIFFERENCE: y •;�' '�• 'CALCULATION FORM Plan or Model No. Dated / / Heated Square Ft. ADDED . INSULA- HEATED SPACE TION R-VALUE Number N..nber Worker Nw.Dee Kotler em.;rr I 1 MATERIAL SOURCE OF Watt of sa. .t sa. of so. I , of se. or .,. .a. 1 ONLY HEAT LOSS Table loss cu. or snit Cu. or Watt Cm. or Watt cu. of Watt Cu. 'r Watt Cu. or 1 Watt 1 Wueber /in_ft. tt�oee,, lie.rl. toss lin.ft. Eon lis"tt. tress U. il. I ices lir rt te., • ///�iF GROSS 4WA WALLS e /i %/// , J .. - ��/ • �/: �/ ���//. / �e ��g �/ LESS WINDOWS: f fir S:rew -roof I J2 Y E LESS WINDOWS: —Tablet • � -- �f/ /�/ -(Double) j LESS DOORS real. I an 1 ya I I I (Exterior) la" 1 NET WALLS: hare *able T FM sees, . I5* :SO I 1 (above WALLS : concreteT _ I I +` I I . y a et •el T !.CEa;bIoNG. ,.iakh k .q C ?VWaoFsy o l _ CEILING: open Stem. Table 5 / • - 1 FLOOR: own went" * .11 !l p.u's/ )4_64 �r • I'll tea. , sone *Table b l '/'J / _ FLOOR: over onvenue Table 7 6 , r A --- i FLOOR:e.$11 imitating �� • -- II ML. �r..e wlls•lir.l It. T+blt ! C_ H COMMON WALLS: labia f l w te:.l. .was a ' COMMON CEILING: Table 9 I sad p Npl. en;n ' 1 p COMMON FLOOR: T,►le 5 a multiple units A %/, I NF I LTRAT I ON Kerr l < ,-Ail ENrye/err. Table 1, �?g"� we" Spa, —T— .—") R V N ILTRATIONIEo.dI.) - sWan ba...• nt Table I rat%% sR Air f Feat. 9 , SWATT LOSS PER ROOM %/,Vr 2.-.4 i tAP V4S n INSTALLED WATTAGE m ` n . E. 1 . Structure Heat Loss (SHL) . > Watts. 5. Estimated Duct or Piping Heat Loss = .w^. 2. Duct or Piping Insulation (inches or approx. SHL (1) !x DHLM (3) x Fraction (4)- - Watts. R-value . 6. Total Heat Loss (1 plus 5) . Watts. 3 . Duct Heat Loss Multiplier (Table II) DHLM e a 7. Total Installed Watts Watts. cis 4. Fraction of Ductwork in Unheated Space. ^ J tticbi le Moines - Use Table 12 and 13. WORKED BY DATE / / -