HomeMy WebLinkAboutBLD2009-00057 litUILDING PERMIT APPLICAJN BLD09-00057
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD09-00057 Received Date: 2/23/2009
SITE ADDRESS: 131 SHORE DR
PORT LUDLOW, 98365
OWNER: JEFFREY A REMBAUGH PHONE (425) 350-7307
GAYLE S BERRY REMBAUGH
131 SHORE DR
PORT LUDLOW WA 98365-9257 PARADISE BAY ESTATES
SUBDIVISION. Block: 13 Lot: 13
PARCEL NUMBER: 983401310 Section: 23 Township: 28 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION DEMO EXISTING SFR - TRAINING FIRE BY PORT LUDLOW FIRE &
RESCUE
NO MLA REQ'D
TYPE OF WORK RES SQUARE FOOTAGE::
TYPE OF IMP DEM
VALUATION MAIN:
CODE EDITION: 2006 ADD'L: HEAT TYPE:
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: # OF STORIES:
CONST TYPE: OTHER:
SHORELINE
E:
CONST TYPE: SETBACK:
DECK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total:
Routing Date:
ala5lo(--;
;
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $55.00 KAS 02/23/09 105438 APPROVFH
State Building Code $4.50 KAS 02/23/09 105438
Total: $59.50 MAR 5
2009
efrerson County Planning
& Building Department
• •
DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD09-00057 Received Date 2/23/2009
SITE ADDRESS: 131 SHORE DR Issue Date 3/5/2009
PORT LUDLOW, 98365
APPLICANT: JEFFREY A REMBAUGH PHONE: (425) 350-7307
GAYLE S BERRY REMBAUGH
131 SHORE DR
PORT LUDLOW WA 98365-9257 13
SUBDIVISION: PARADISE BAY ESTATES Block: 13 Lot:
PARCEL NUMBER: 983401310 Section: 23 Township: 28N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
OWNER, JEFFREY A REMBAUGH PHONE: (425) 350-7307
if different: GAYLE S BERRY REMBAUGH
131 SHORE DR
PORT LUDLOW WA 98365-9257
PROJECT DESCRIPTION: DEMO EXISTING SFR -TRAINING FIRE BY PORT LUDLOW FIRE &
Directions RESCUE
To Site: NO MLA REQ'D
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 3/5/2010.
REQUIRED INSPECTION:
c a g
FinalApproval: (L► '' t (5 4! G Q rtS) if (,(
c
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#BLD09-00057:
1.) ALL AREAS APPROVED FOR SEPTIC SYSTEM USE, UNDER PERMIT SEP08-166,
ARE TO BE COMPLETELY PROTECTED FROM VEHICULAR TRAFFIC OR
MECHANICAL DISTURBANCE. DIVERT ALL SOURCES OF DRAINAGE AWAY FROM
DRAINFIELD & RESERVE AREAS. RECOMMEND PROTECTIVE BARRIERS
ALONG/AROUND THE PRIMARY DRAINFIELD TO PROTECT FROM PARKING,
DRIVING, AND OTHER LAND DISTURBING ACTIVITIES.
I:\F_BLD_Permit_Propane.rpt 10/29/19
• !
�c%%ION
y 3 4,t
Olympic Region Clean Air Agencyo: r 2�J44BIimit�ed Lane IOW
'' Olympia,WA 98502 �.^�
.^,� (360)586-1044•FAX(3 �t91-63QEt Residential Port Angeles office(36()417-14
0 RCA A Raymond Office(360)942-2137 Demolition Permit
�e,,°.e..m�.. •44,0. anvw.ORCAA_org
. This permit valid only for residential her
residing in the dwelling alb renovations.
Permit few$35.00 per stirs N We.
PROPERTY OWNER II
N � � ,UCa r1 Pbooc . . )35O-7 i 7 Emil ti f3AUCI4 a •IMAl L
FAX
Mailing Address ( Moftrl - v,
31 S -N,O'RE DRIVE_ '•%: LtL4 o Ai ' 9 36
Site Address:
�.�.%1,1-'41e INIIMIIIIIIII Stair_
DEMOLITION CONTRACTOR Check if same as , ,„_ Millet-
thilpirMariug
Business Name: Phallic ( ) Ems&
FAX: ( )
Onsite Contact Phone ( ) Mobile ( )
FAX: ( )
Mailing Address:
City: 'Suite: I ZiF
DEMOLITION INFORMATION
#of Structures being demolished Start D �(-'' 1 c ei C /
Asbestos present Yes V No Survey ched Yes// No 1
removed Yes_ sq�
DWOLITLON PROJECT CATEGORY
(Complete Demolition
Training Fire-Fire Agency: Pae�- Ll.l F��� _ �
1 1 Renovation,Alteration,Remodeling,Maintenance,or other C rrtion
I have mad aid will aside by the esslitiose set forth is this permit grad grey sddeslrm two. I is hereijr q that
all idexlifted asbestos has bees removed asl the isfisms:iss is this 4p irmd.a sal ssprlesera;tst&eta dersrihel hcseis
is, to the but of ay ksasaledge, accrete aid complete.
-\PEt :,,,V1L6446A
jgn 4/(„` .. 1 _1,5/0_1_APNLIVrIVED
Date Application Received Payment Info. i ) ,approved
it+L' [ ] Permit t4` _OSBOQI E 0)
oRca4 Demolition et t i
[ 1 edit Card Review date.: -I C"i Permit#07 o/~Moo2 l S 7
PA�('cc� Receive date /_J Reviewed by: fic L ir61 1i 5
AeNg Use 04 _ Agesey tIw Only Azoig(lie Omit f
loe"lb
09/19/08 OVER •
k, iOiNN cc6 JEFFERSO UNTY •
i. W g� ,� DEPARTMENT OF COMMUNITY DEVELOPMENT
13 ' `< 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax q O� www.co.jefferson.wa.us/commdevelopment
SONG'S
Master Permit Application MLA:
+4L=CkefPj== g-7s3 :1
Project Description(include separate sheets as necessary):
DE .x15-r E4ous�. Si R - Py 1.-Ln1.01,d, F E 4
Tax Parcel Number: ‘342,540 1 310 Property Size: (acres/square feet)
Site Address and/or Directions to Property:
131 shioRE pI? V Pots Lufl Lo�,•l , LJ A otS3G5
Property Owner(s)of Record: J
Telephone:425 350-7307 Fax: email: 1,16 @( T'EAI L
Mailing Address: ISI SHOE CRIVE 191Kr LupLo 4/ NA G,V-21,O5_ .cp(,,1
Applicant/Agent(if different from owner):
Telephone: Fax:
Emaii:
Mailing Address:
What kind of Permit?(Check each box that applies
❑Building ❑ Critical Areas Stewardship Plan
Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use)
❑ Single Family ❑ Garage Attached/Detached ❑ Conditional Use[C(a), C(d),or C]**
0 Manufactured Home ❑ Modular 0 Discretionary"D"or Unnamed Use Classification
❑ Commercial* ❑ Special Use(Essential Public Facilities)**
❑ Change of Use 0 Boundary Line Adjustment
❑ Address 0 Road Approach ❑ Short Plat**
❑ Home Business ❑ Cottage Industry ❑ Binding Site Plan**
❑ Propane ❑ Long Plat**
❑ Sign 0 Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes"Use Consistency Analysis ❑ Plat Vacation/Alteration**
❑Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions**
❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development**
❑Temporary Use 0 Shoreline Management Variance
❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment
*May require a Pre—Application Conference ❑Tree Vegetation Request
**R•.uires a Pre-A..lication Conference
Please identify any other local, state or federal permits required for this proposal, if known:
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 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 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 app' ti• th r wants prior notice.
Signature: / �— Date: _
The actio or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon ne 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,responsibilityfor adhering to and complying with the ESA. The Applicant has read this disclaims and signs and dates it below.
Signature:
Date: C
Z
i "
Cl ,
G:\PcrmitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
7
• BUILDER STATEMENT • 1
The signer of this statement d hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that 3
they will be assumi_ e,re lity the General Contractor for the proposed project.
i / project.
Signature: r/ "� / /-��( Date:
GENERAL C TRACTOROR MANUFACTURED HOME INSTALLER: PHONE: FAX:
f Von- LL poet / E . ( ) ( )
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 11 Wood Existing: ❑ Sewer
I Addition Li Steel Proposed: Bank [! Community System
Li Alteration/Remodel ❑ Concrete Total: Height: [1 Individual System
❑ epair LI Masonry SEP Permit#
demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: I Private well u Two Party
Type of i-ieat: Proposed: — - _ i Public
YP Total: Name of System:
If this is a Commercial Project 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:
i Underground Tank i Above ground Tank Size of Propane Tank:
i Heat Stove i Cook Stove 1 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 Revision
Main Floor Heated EH Bid App Review: 16.ao
-2nd Floor Heated Consistency Review:
Other Heated Base fee: 55_00
Mezzanine Additional Section:
Heated Basement Plan Check fee: ---_
Unheated Basement State Surcharge fee: LA 5C
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL 15a 3O
Decks 911/Rd Approach fee:
Other TOTAL: $ 1 a 50
Receipt Number: 1 05 LI OV
- Cash/Check Number: ri k
OESTIMATED COST(REQUIRED) Date: ���
•Fair market value of all labor and materials foundation to finish Initials:
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
V -
..i .. 3 -
off. �
-& ..-
3 , ,,c.0 •
Z ., -
ILI'
c-.)
. , • .0
: . gym
r • 1 °: V
---1 . \ .1:1-.: 0 0 p
1), g
r-Tio . < ,� \ VE
1,- \
, \\ � __ _ _S\ \\ L
A
\ ' 'El I\
, / -144_, \(\ \ „ ,
•
i \
„,
. \ qi. , \ .. .-- X
3 , ' . Aftili,
i \e,c,
9 �•._ _ J �.
\--
0
6 fi‘
IkiAkA
A\ -
.6 , %,...,
,,,
, e_3 At
a I *
,'l - x
Ua 6' (\ . .i I,‘ . .,
-..1 :I 1,4. _13s
0 .4)
4. GN Z, R-‘;'4, 6 , 11/11 . ° ' ---4
cP _....4P ki\ ,--fv5i 1 , I I; a / x
-P- _74 _2.5 '6-1-1) 'pc,, v ,,! —(;) t" ---) . X-- 1
6"\S\ / / killk
> iN g \II-
I i
/ )( /
w ill1- (� o / \ /
w3 E % /
`�
/ ` —\
. \I WW --1 o ---N
O \ ,,i • )/e
G / / m �
0
'CP 7
--_ trn J t/ 1-- P r --5-\„
It
At'-'71 -' • 0, ; ci; t'`,)1 z /
g0101t; c:, ''1'. . /
It ill v
:. O I ::•m
__ 1 --..- LQ„
f