HomeMy WebLinkAboutBLD2008-00518 •
DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD08-00518 Received Date 12/29/2008
SITE ADDRESS: 4399 S DISCOVERY RD Issue Date 1/12/2009
PORT TOWNSEND, 98368
APPLICANT: CHARLES A SCHMUCKER TRSTE PHONE: 303-973-0828
LINDA SCHMUCKER TRUSTEE
6251 S GARLAND ST
LITTLETON CO 80123-3115 T 57
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 001321020 Section: 32 Township: 30N Range: 01W
CONTRACTOR: OWNER/BUILDER PHONE:
OWNER, CHARLES A SCHMUCKER TRSTE PHONE: 303-973-0828
if different: LINDA SCHMUCKER TRUSTEE
6251 S GARLAND ST
LITTLETON CO 80123-3115
PROJECT DESCRIPTION: DEMO EXISTING M/H
Directions SEE DIRECTIONS& MAP 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 1/12/2010.
REQUIRED INSPECTION:
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:00 a.m. -4:30 p.m.
SPECIAL CONDITIONS APPLY - SEE REVERSE
HOT LINE AVAILABLE 24 HOURS A DAY
SPECIAL CONDITIONS FOR CASE#BLD08-00518:
1.) ALL COMPONENTS OF THE SEPTIC SYSTEM ARE TO BE COMPLETELY
PROTECTED FROM SOIL COMPACTING ACTIVITIES; INCLUDING BUT NOT LIMITED
TO VEHICULAR TRAFFIC OR MECHANICAL DISTURBANCE.
I:\F_BLD_Permit_Propane.rpt 10/29/19
UILDING PERMIT 41111)N 13 Review
OOpe 8
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD08-00518 Received Date: 12/29/2008
SITE ADDRESS: 4399 S DISCOVERY RD
PORT TOWNSEND, 98368
OWNER: CHARLES A SCHMUCKER TRSTE PHONE: 303-973-0828
LINDA SCHMUCKER TRUSTEE
6251 S GARLAND ST
LITTLETON CO 80123-3115
SUBDIVISION: Block: Lot: T 57
PARCEL NUMBER: 001321020 Section: 32 Township: 30 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION DEMO EXISTING M/H
TYPE OF WORK MOB SQUARE FOOTAGE:
TYPE OF IMP DEM MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 2006 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total:
Routing Date: `_D
Iz-30-C
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $52.00 LYK 12/29/08 105194 APPROVED
State Building Code $4.50 LYK 12/29/08 105194
Total: $56.50 JAN ON2009
Jefferson County Planning
& Building Department
• •
N t 1014 CIS'
l��$ G 4' ` Olympic Region Clean Air Agency
2940-B Limited Lane NW
,, Olympia,WA 98502 Residential Asbestos
r`' i (360) 586-1044 • FAX(360)491-6308
'' '.,„ORCA,E . tl'' Port Angeles Office (360) 417-1466
- `: ''" Raymond Office (360) 789-3652 Permit
wwww.ORCAA.org
***This permit valid only for residential homeowner residing in the dwelling***
Permit fee: $25.00. Non-refundable.
APPLICANT
Name: , / • Phone: (3 o3) 973 D$l8' Email: C R ScGI c4 cke/- 6
C a r(e S C 4 rn a C/der FAX: ( ) Mobile: ( ) Corneal Sf',ii e f-
Mailing Address: City: / State: Zi
CZ.Si S• 6-4 e(cK d St, L —i 7�n G' o i,z3
Site Address: Ci�y State: Zi
L13eig S, pisc7Verry leo( Nor-` Cou�nSe�e( WA- g8365
PROJECT INFORMATION
Start ate: Com le on ate: Work Shift Days: Work Shift Hours:
/O/ 6 /0 /°/�/D 8 MO Th F Sa Su 6 h o u v s
# of Structures: Total Quantity to be Square Feet: Linear Feet:
ohe Removed $0 -5eXuQ4^.e`Pt
Disposal Site: D/y pi U
G 7 e� `T 7-�- S44 o77
Will this structure be demolished after asbestos removal 0 N
Circle Material being removed
Boiler/Furnace Duct Insulation Pipe Insulation Fireproofing Paints Plaster Cement Board
Cement Pipe Flooring Roofing Textured Coating Other
I have read and will abide by the conditions set forth in this permit and any addendum thereto. I do hereby
certify that the information in this application and supplemental data described herein is, to the best of my
knowledge, accurate and complete.
041 .---(e's II- 5-6- 4'ivi a-a4ev— .__ ____ G -(,,tg____- _____e- /.'' 9//17//0 S.
Applicant Name
pp Signature Date
DREC f i c(i9d Payment Info. Approved Asbestos Permit
w L. s [ ] Cash �y [ I Disapproved Permit# ASB00
SEP 1 [N.],Check: # a3q 9 Demolition Permit
2008 [ ] Credit Card - Review date:0 5 / ( /n r Permit# DEM00
CAW/Mv Receive date: —1/1�/ c Ll Reviewed by: Tpp1�4—"-! Survey: [ ]Yes [ ] No
Agency Use Only Agency Use'Only Agency Use Only
02/25/08 OVER
JO • •
(4,4,,,iirmiokONc1_, JEFFERSON COUNTY
r3 DEPARTMENT OF COMMUNITY DEVELOPMENT
, 1-7 kit- s-c
621 Sheridan Street • Port Townsend •Washington 98368
�.q , (0) 360/379-4450 . 360/379-4451 Fax
40ING http://www.co.jefferson.wa.us/commdevelopment/
Stormwater Calculation Worksheet
z.MLA# 00 pack e 0 N PROJECT/APPLICANT NAME: v C1 a r t e5 A 5 c 4bx(4, c-er
DETERMINING STORMWATER MANAGEMENT REQUIREMENTS: This stormwater calculation worksheet should be completed first
to classify the proposal as"small,""medium,"or"large." The size determines whether a Stormwater Site Plan is required in conjunction
with a stand-alone stormwater management permit application, building permit application, or other land use approval application that
involves stormwater review. The basic information will also be helpful for completing a Stormwater Site Plan, if required.
PARCEL SIZE(I.E.,SIT J
qs
Size of parcel # • acres An acre contains 43,560 square feet. Multiply the acreage by this figure.
Size of parcel in square feet IC t(c'O sq/ft
Land-disturbing activity is any activity that results in movement of earth, or a change in the existing soil cover (both vegetative and
non-vegetative) and/or the existing soil topography. Land disturbing activities include, but are not limited to clearing, grading, filling,
excavation, and compaction associated with stabilization of structures and road construction.
Native vegetation is vegetation comprised on plant species, other than noxious weeds,that are indigenous to the coastal region of the
Pacific Northwest and which reasonably could have been expected to naturally occur on the site. Examples include species such as
Douglas fir,western hemlock,western red cedar, alder, big-leaf maple, and vine maple; shrubs such as willow, elderberry,salmonberry,
and salal; herbaceous plants such as sword fern,foam flower, and fireweed.
LAND DISTURBING ACTIVITY, CONVERSION OF NATIVE VEGETATION,AND VOLUME OF CUT/FILL
Calculate the total area to be cleared, graded,filled, Answer the following two questions related to
excavated, and/or compacted for proposed development conversion of native vegetation:
project. Include in this calculation the area to be cleared for:
Does the project convert'A acres or more of
Construction site for structures sq/ft native vegetation to lawn or landscaped areas?
Drainfield,septic tank,etc. sq/ft Circle: Yes N;
Well, utilities, etc. 0 sq/ft Does the project convert 2'/z acres or more of
native vegetation to pasture?
Driveway, parking, roads, etc. 0 sq/ft
Circle: Yes No
Lawn, landscaping,etc. sq/ft
Other compacted surface, etc sq/ft Indicate Total Volumes of Proposed:
Total Land Disturbance sq/ft Cut Fill (cu/yd)
[over]
stormwater calc worksheet—REV.11/3/2008 1
• APIL
Impervious surface is a hard surface that either prevents or retards the entry of water into the soil mantle as under natural conditions
prior to development. A hard surface area which causes water to run off the surface in greater quantities or at an increased rate of flow
from the flow present under natural conditions prior to development. Common impervious surfaces include, but are not limited to roof
tops, walkways, patios, driveways, parking lots or storage areas, concrete or asphalt paving, gravel roads, packed earthen materials,
and oiled, macadam or other surfaces which similarly impede the natural infiltration of stormwater.
STORMWATER CALULATIONS—IMPERVIOUS SURFACE
NEW ryLD `�` I e l' (ext o✓ea' EXISTING
Structures(all roof area) �d 0 sq/ft Structures(all roof area) 2 () sq/ft
Sidewalks sq/ft Sidewalks sq/ft
Patios sq/ft Patios sq/ft
Solid Decks sq/ft Solid Decks sq/ft
(without infiltration below) (without infiltration below)
Driveway, parking, roads,etc sq/ft Driveway, parking, roads,etc l 0 0 sq/ft
Other � sq/ft Other sq/ft
c67
Total New 0 0 sq/ft Total Existing 3 z G 0 sq/ft
TOTAL NEW+TOTAL EXISTING* Z `f 0 0 sq/ft *This amount will be used to check total lot coverage.
The following questions will help determine whether the proposed project is considered development or redevelopment.
DEVELOPMENT v. REDEVELOPMENT
Divide the total existing impervious surface above by the size of the parcel and convert to a percentage: , j L
Does the site have 35%or more of existing impervious surface? Circle: Yes 1655
FURTHER INSTRUCTIONS: If the answer is yes, the proposal is considered redevelopment and the attached Figure 2 should be
used to determine the applicable Minimum Requirements. If the answer is no, the proposal is considered new development and the
attached Figure 1 should be used. At this juncture, the applicant should refer to the applicable Flow Chart to determine the Minimum
Requirements for stormwater management. DCD staff will help verify the classification of the project and the application requirements.
For proponents of "small" projects who must comply only with Minimum Requirement #2—Construction Stormwater Pollution
Prevention—an additional submittal is not required. The proponent is responsible for employing the 12 Elements to control erosion and
prevent sediment and other pollutants from leaving the site during the construction phase of the project. Pick up the Construction
Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet. Proponents of"medium" projects—those
that must meet only Minimum Requirements #1 through #5—and for "large" projects—those that must meet all 10 Minimum
Requirements—are required to submit a Stormwater Site Plan. DCD has prepared a submittal template of a Stormwater Site Plan,
principally for rural residential projects. Complete the template in the Stormwater Site Plan Instructions and Submittal Template or
prepare a Stormwater Site Plan using the step-by-step guidance in the Stormwater Management Manual.
APPLICANT SIGNATURE
By signing the Stormwater Calculation Worksheet, I as the applicant/owner attest that the information provided herein is true and
correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all
owners of the affected prop rty.
6-4
12- (7 L( °gf
(LANDOWNER OR AUTHORIZED REPRESENTATIVE SIGNATURE) (DATE)
FOR OFFICE USE ONLY '' ht° ,4 `_ p `
r .
t sue- �i.'.y a� y p� ` ys
,
SMALL MEDIUM LARGE REDEVELOPMENT Stormwater Site Plan: Yes No
stormwater calc worksheet—REV.11/3/2008
:0'
) cO6tJEFRUNTYik
DEPARTMEFE NT COMMUNITY DEVELOPMENT •
621 Sheridan SO
Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
�q�,�N��p www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: },_.,� MCA. (C) '6
Project Description (include separate
sheets as necessary):
rit I ( ,/eM2L'l c -l0 n .
Tax Number: ! Z Z v Property
Size: / 113 (acres/square feet)
Site Address and/or Directions to Property:
4(3gC, <1-, a Cc)LAY'Y PC"
Property Owner(s)of Record: G l it i(C L c,, c(k 5- t c c c�c Pr
Telephone: 3 k '( 7 3 0 2 Fax: email:
Mailing Address: L Z 55l 3 , Grp r (aao( 5 f- L c t{-(e.tz,,, <_U 90(23
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies
❑Building 0 Variance(Minor, Major or Reasonable Economic Use)
_)Demolition Permit 0 Conditional Use[C(a), C(d),or C]**
❑ Single Family 0 Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification
❑ Manufactured Home 0 Modular 0 Special Use(Essential Public Facilities)**
❑ Commercial* 0 Boundary Line Adjustment
❑ Change of Use 0 Short Plat**
❑ Address ❑ Road Approach 0 Binding Site Plan**
❑ Home Business 0 Cottagelndustry 0 Long Plat**
❑ Propane ❑Planned Rural Residential Development(PRRD)/Amendments**
❑ Sign 0 Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions**
❑ Stormwater Management ❑Shoreline Management Substantial Development**
❑ Site Plan Approval Advance Determination (SPAAD)* 0 Shoreline Management Variance
❑ Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* 0 Jefferson County Shoreline Master Program Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium 0 Tree Vegetation Request
*May require a Pre—Application Conference **Requires a Pre-Application Conference
Please identify any other local, state or federal permits required for this proposal, if known:
,l_ '-f 1 CkC' CA
DESIGNATION OF AGENT
I hereby designate to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE Date:
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 fa:t 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 all liabilities,judgments,court costs, reasonable attorney'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 she wants prior}'�ice.
Signature: C �- Ic t -- L(iL'-J Date: 0 / z `/ i 3-
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-transfer le r sponsi lity f dhering to and complying with the ESA. Tie Applicant has read this disclaimer nd signs nd dates it below.
Signature: (- ` 2 --' c �!' z _\ Date: /L- Z `( C''�v
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc
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 assuming the respoili f the Gener ontractor for the proposed project.
Signature: G/% 'i �'"`�t '`` Date: =� t( �
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New ❑ Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank ❑ Community System
❑ Alteration/Remodel 0 Concrete Total: Height: ❑ Individual System
❑ Repair ❑ Masonry SEP Permit#
E0 Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type of Heat: Proposed: ❑ Public
Total: Name of System:
If this is a Commercial Proiect 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 and/or Appliance Installation permit,mark all items below that apply:
Underground Tank i Above ground Tank Size of Propane Tank:
I Heat Stove Cook Stove i Woodstove i Fireplace Insert I Hot Water Tank i Pellet Stove i Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No
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.
Square Footage Current Proposed For Office Use Only Amount r,: zRe �sx�7 " .:rt
Main Floor Heated EH Bld App Review:
2f a Floor Heated Consistency Review:
Other Heated Base fee:
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee: %
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL
Decks 911/Rd Approach fee:
Other TOTAL: $ '()(c 5L:
Receipt Number: (C'F3 IC�LI
`t I
Cash/Check Number:
ESTIMATED COST(REQUIRED) Date: ?Li
•Fair market value of all labor and materials foundation to finish
Initials:
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc
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i Schmucker
104&moan Ave PM Transom!,Washington
90300
WIN Pin 379-0339 Fon(300)3T9.1327 Orm7QlsokmMwam•cor^