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HomeMy WebLinkAboutBLD2008-0461 • • DEMOLITION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD08-00461 Received Date 10/22/2008 SITE ADDRESS: 2120 BLACK POINT RD Issue Date 3/16/2009 BRINNON, 98320 APPLICANT: TERRY B EVANS PHONE: 206-713-3017 UNDIVIDED 86% INT 3310 211TH AVE NE SAMMAMISH WA 980746329 TX16� SUBDIVISION: Block: Lot: PARCEL NUMBER: 502143007 Section: 14 Township: 25N Range: 02W CONTRACTOR: NIEMAN CONSTRUCTION CO PHONE: (360) 434-0717 P. O. BOX 846 QUILCENE WA 98376 0846 (3gp g Contractor's License NIEMACC018MZ Expires 8/15/2)0105-3529 OWNER, TERRY B EVANS PHONE: 206-713-3017 if different: UNDIVIDED 86% INT 3310 211TH AVE NE SAMMAMISH WA 980746329 PROJECT DESCRIPTION: DEMO A 600 S.F. SUMMER COTTAGE Directions SEE MAP AND DIRECTIONS IN FILE To Site: THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 3/16/2010. REQUIRED INSPECTION: FinalApproval: 3 —L ' 7 ? h -Z BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:00 a.m. -4:30 p.m. HOT LINE AVAILABLE 24 HOURS A DAY I:\F_BLD_Permit_Propane.rpt 10/29/19 M 7 BUILDING PERMIT APPLIC ON RLeviewType: yp: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD08-00461 Received Date: 10/22/2008 SITE ADDRESS: 2120 BLACK POINT RD BRINNON, 98320 OWNER: TERRY B EVANS PHONE: 206-713-3017 UNDIVIDED 86% INT 3310 211TH AVE NE SAMMAMISH WA 980746329 SUBDIVISION: Block: Lot: PARCEL NUMBER: 502143007 Section: 14 Township: 25 N Range: 02 W CONTRACTOR: NIEMAN CONSTRUCTION CO PHONE: (360) 434-0717 P. O. BOX 846 QUILCENE WA 98376-0846 Contractor's License NIEMACC018MZ Expires 8/15/2010 REPRESENTATIVE: DAN NIEMAN PHONE: (360)434-0717(Cell) PO BOX 846 (360) 765-3529 QUILCENE WA 98376 PROJECT DESCRIPTIOI' DEMO A 600 S.F. SUMMER COTTAGE TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP DEM MAIN: 600 VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2006 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: 0 CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: 2WELL BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: C10 (9'-r-2710?31 Type Amount Paid By: Date: Receipt: Approved/Date Permit $52.00 AMS 10/22/08 102951 APPROVED Building Code $4.50 AMS 10/22/08 102951 Total: $56.50 MAR lb 2009 Jefferson County Planning &Building Department uR�t l;•E1 I' V -4 I! n �fr i �� �Y u I I 1/ ��,4ON JEFFERSS OUNTY • kiiv �1� DEPARTMENT OF COMMUNITY DEVELOPMENT C� T 2 2 zUCR 621 Sheridan Street• Port Townsend •Washington 98368 4,{ 360/379-4450. 360/379-4451 Fax JEFFERSON COUNn DCO "aC# IN p www.cojefferson.wa.us/commdeve!opment Master Permit Application MLA: c)b --H-4'____ Proiect Description(indWe separate sheets as necessary): Vi�.�►^esf,rflc sJ L (0 0 summer Cottaoe ) Tax Parcel Number. 50 e• /7 3 00 -7 Property Size: + /, 7 (3 / re feet) Site Address and/or Directionsto Prrooperty: c2/�- -iT.,) %l/4C.4" ?',,71' ''` l7/-70`7 14, 5 4, Property Owner(s)of Record: fi '' Telephone: .L-c7G:-- T/3 Gr i "7 ax: /�. email:7�C✓AA15/O[�s.!)I7o%e� 4U• Mailing Address: �j!t, / ./'T F'Y ,�(�.d?iish. l-'!'7/5lii L✓ 9 c7�-'7 GcYx_. Applicant/Agent(if different from owner): ,--i e ( /✓f(.r? Telephone:{3.6 c • 4 3 4• o-il Fax: '- ' 5 55S X email:iip�rx eaZi "ae„P ter.in c. .-Th s-r,.do,/y,. Mailing Address: 7 o. G'' / e . Y3 What kind of Permit?(Check each box that applies Building 0 Critical Areas Stewardship Plan . Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use) ' Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a),C(d),or C]** -❑ Manufactured Home 0 Modular 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* ❑Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment ❑ Address ❑Road Approach 0 Short Plat*" ❑Home Business ❑Cottage Industry ❑Binding Site Plan** Propane 0 Long Plat** ❑Sign 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed'Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions"* ❑Site Plan Approval Advance Determination(SPAAD)* ❑Shoreline Management Substantial Development** O Temporary Use 0 Shoreline Management Variance ❑Wireless Telecommunication* ❑'Comprehensive Plan/UDC/Land Use District Map Amendment ❑Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment *May require a Pre-Application Conference 0 Tree Vegetation Request **Requires a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal,if known: I hereby designate DESIGNATIONotas AGENT sig f�G� !� ��,(JE-'-7/�2-•lC�- my agent in matters relating to this application for permit(s). OWNER SIGNATURE L'I/G c /"y --,� Date: /0. /3- L�c1 By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of his,her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against an liabilities,judgments,court costs,reasonable attomey's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any required later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the application that he or sp is p' otice. > i / 1.)G Signature: Z �A ,,� Date: r The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the 'Endangered Species Act'or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transferable responsI ill r a ering to_and complying with the ESA. The Applicant has read this discla'rner and signs and d tes it below. •Signature: cam,-'�G -fif.�,-' Date: /v. / `5. Al A G:\PerrnitCenter\###FORMS###\DRD FORMS\Master Permit Application -29-08.doc r • BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be ass 1 the responsibil' General Contractor for the proposed project. Signature: — - Date: _ /c/ 7*' GENERAL CONTRACTOR OR UFACTURED HOME INSTALLER: PHONE: FAX:'E474-41/4/ �cr,.. 4. /NG. ( i2&ir1A-N) (.1$3`D7/7 (36a 76s% 5-zlq MAILING ADDRESS: Le©. el6 (YUIt-P-.JG.A 1�/e-. EMAn:AIPrnavTgi 57/21,t��iOn/��-di_S"0€7, CONTRACTOR'S LICENSE l .(6:;?6 WAINS NUMBER: g C.--0/0/17 NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: f Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New Wood Existing: n Sewer ❑ Addition u Steel Proposed: _ Bank ❑ Community System u Alteration/Remodel a Concrete Total: _ _. Heigtit: . )4 Individual System u Repair ❑ Masonry 3 -+ SEP Permit# f. t St r'Ai Demolition ❑ Other: Bedrooms: Water Supply: Existing: ______ Setback: I 1 Private well Two Party Type of Heat Proposed: _ 0 / ❑ Public E1.f -, 6 Total: /Q Name of System: If this is a Commercial Protect you must answer the following: Number of Parking Spaces: Current Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: _ Will you have Food Service? Yes / No If this is a Propane Tank andlor Appliance Installation permit.mark all items below that apply: i Underground Tank 'Above ground Tan) Size of Propane Tank: i Heat Stove i Cook Stoves I Woodstove ireplace Insert of Water Tank 1 Pellet Stove 1 Other Is this appliance 6e-ngininstalled in a Manufac e Home? ` es o When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. :4 -fi+ i1 Square Footage Current Proposed � .- � . .. Main Floor Heated I rt 4 EH Bid App Review: O —7 2n0 Floor Heated =. , Consislency Review: Other Heated R /� ,„ Base fee: J o Mezzanine r, Additional Section: Heated Basement N�� Plan Check fee: �. Unheated Basement �A 4 f �r 2, , State Surcharge fee:/\f/A ;" i*..4-'34-;.-4,-- L4 c—)O Other Unheated x Pot Water Review fee: —�` C:d'R..R.rirj►tr �ol2O �' * �s Garage/Carport /p �. j SUBTOTAL .J(' Decks 911/Rd Approach fee: C� ; -., L)c.i 51-)(9 Other h:k f; ,t TOTAL: $ 1 9,,Cq .50 s ', Receipt Number. )O a i 5 1 5 ► .,kiK Cash/Check Number. ESTIMATED COST(REQUIRED) Date: , l .Fair market value of all labor and materials foundation to finish i 01 0^a1 (�\. Initials: Cln • G:\PermitCcnter\###FORMS###\DRD FORMS\Master Perrnit Application 5-29-08.doc 08,/31/1999 23:13 425858 7 -[,A lr t "1� PAGE Ell I r , ;/. t09 18:30 FAX 3$0 491 "� E�,�t; -!. MD • 1 141001 a . _ RECEIVED JAN 2 ?�U9 pERMIT# . ' . %• . . - - :- • , A• l r t Ir...., a. lltiii.� JAN _ T N Cr " °IMMORALLY APPR r i Olympi¢ olrt!! it Agency APPROVED Y 4l vNOT +� �. TO, 2940=14 LimrEed Lane ei FOR COMPLIANCE WITH �� I :_ Olympia, WA 98502 ORCAA REGULATION 1 {$ ORCAA (360) 586-1044 or 1-800-422-5623 By; `"Sly Fax: (360) 491-6308 www.ORCA >� Notification of Demolition Permit it is unlawful for any person to eanse or allow the demolition (or major renovation) of any structure unless all asbestos- ° containing materials have been removed from the area to be demolished. Work shall not comma:ee on in asbestos project or demolition unless the owner or operator bat obtained written approval from OACAA. A written application for a demolition shall include a certification that there is no known asbestos-containing material remaining in the area of the structure. Project S" a Address: (ZO -40-4,--• County: _> ffz - City: eibiti - State;' ' Zip: 'I,t;>t 171.i,' c e PI 30 Completion letion Date: 1 Starting Date: #�� lOci P *(There is a 10 working day advance notification period from r ipt of permit epplioation) Property Owner: i,„/.F KEIPAI gowsTelephone: 6 '7 •,/0/1 Fax: 5( 765•15 -7 Mailing Address: 1/D {f(Ile 41/c Mk. City: gerininkiniSli _ - State:_ W/0. Zip: 074' Demolition Contractor: /► i.ei riiie/ /. .l.-r- It. bit-- State License#: _ Mailing Address: -/'0. lg ____ City: o! State: 6J • Zip: 9$17(p Contact Person:J)i ( N zm',/ Telephone: 51en•4-54-`Grit/ Fax:J6a, 74 .5 27 YES NO • • X --Y. Demolition by Wrecking or Dismantling? ($25.00 fce)cheek* nonrefundable yC Training Fire Demolition? (If yes,attach Fire department request for training fire) ' Renovation,Alteration,Remodeling,Maintenance, or other Construction? Asbestos found or suspected* *An ORCAA "Notice of Intent to Remove or Encapsulate Asbestos" farm and appropriate the roust be submitted prior to any asbestos removal work. Asbestos removal projects involving demoltitch must be preformed'by'a"Cortified Asbestos coatracmor and all friable or •• potentially friable esbestoe must be removed before any demolition begins. Rater to ORCAA Regulation 1 Article 14 for additional roquirements that may apply. Asbestos Survey Completed by A�YtA Certified Inspector g 0 h. W/l` l i t(4 "r Certification# C C" -2. — / 0/ 7 Qr/7 4 This approved permit must Enclose 525 Certification of the Asbestos Survey most be available at the job site Processing Fee accompany this form _. r • lir CC FICOMMONiortslesbssroslDemopermitd J y `�x 1 4,..:671, INJ r L R-eU1�� -gr✓D 006—UCv I Z\ 0 1 ,1 ,1 1 I IN"— WAY' �44t&tE I (.o4-90 I 0 C)T -C K I S I I Q% SCR a� �t PkoPf.1C� !-INE� _--- -V���---f-�r4NCl(i(fc lLBB Wkrl� S o —�-- -- — — 1 _ Zo GAL cti'l'if 1- kgs ?,9NK _ typo 1 C8\ I OLD Co c T i I '(b 96- Iyiq R > 7Oo r�i, (KE Jc {{ 15 a coNb r 0+ ��J ovK Oj{vil%L I n1oJ I �y PEt VMR ✓B 3{v�14. 3,s. fJNsfAt+Ev WN sgXy-(," ��� I To 8f; •/not-1 N I �vANs I � 7- f3E 1eoeM 3 - `---- 0 - -- 2120 $Lxe ft RR ZI �� i � AvN 5oG•l43•oa� I000 c.Aa^ p✓mom urgrrhra Q`QQ >L 0 fir{ IN(o AYGti V•Nh� kl V PJLVJ GAO riL O.Y. K tz0 'Pa.lmaw`l 'm VIC.&UwL jID�N 21 vo '%c pcK Pf. Oil sot 14&00 a 1[sv G¢am H.11. h/ M1. . I 2 fjV/l 5?b14-s W'JOP5MtY5 I k E A-Pvgb -Ia Scbw Pt Rm. OF.eK I � k 3xsd I I o N e4w Afff& T�eK,V t 4WIN f,VAWS 2f Zo fr SCALE: { / APPROVED S DRAWN BY DAIJ NI fw14 DATE: I' �� (>�3GO •�3 'O I ��bPoS�� siN�GE- 'I�V}w�IL1! T�lDl�ck. x ¢-3. 06 M9 tj-W4 q-PPAk5L; -rScJV J- K".4 61,4,JS DRAWING NUMBER 37i0 211- 4Ve. A(,F_