HomeMy WebLinkAboutBLD2009-00074 •
DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD09-00074 Received Date 3/16/2009
SITE ADDRESS: 640 TALA SHORE DR Issue Date 4/23/2009
PORT LUDLOW, 98365
APPLICANT: DAVID NEAULT PHONE: (360) 620-2629
ANDREA NEAULT
640 TALA SHORE DR
PORT LUDLOW WA 983659782 22
SUBDIVISION: TALA SHORES#3 Block: Lot:
PARCEL NUMBER: 998200322 Section: 15 Township: 28N Range: 01E
CONTRACTOR: SHOLD EXCAVATING PHONE: (36)385-0480
PO BOX 179
PORT HADLOCK WA 98339
Contractor's License SHOLDI*224LT Expires 7/9/2010
OWNER, DAVID NEAULT PHONE: (360) 620-2629
if different: ANDREA NEAULT
640 TALA SHORE DR
PORT LUDLOW WA 983659782
PROJECT DESCRIPTION: DEMO EXISTING SFR
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 4/23/2010.
REQUIRED INSPECTION:
FinalApproval:__ /Z"`27 o'Y
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
•
MLA09-00089
UILDING PERMIT APPLICA N Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD09-00074 Received Date: 3/16/2009
SITE ADDRESS: 640 TALA SHORE DR
PORT LUDLOW, 98365
OWNER: DAVID NEAULT PHONE: (360)620-2629
ANDREA NEAULT
640 TALA SHORE DR
PORT LUDLOW WA 983659782 TALA SHORES#3
SUBDIVISION: Block: Lot: 22
PARCEL NUMBER: 998200322 Section: 15 Township: 28 N Range: 01 E
CONTRACTOR: TBD PHONE: 205-807-2541
REPRESENTATIVE: KELLEY SHIELDS INC PHONE: (360) 385-7156
DENNIS KELLEY (360) 385-3115
260 KALA POINT DR
PROJECT DESCRIPTION DEMO EXISTING SFR
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:
OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total:
Routing Date:
5- _-
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $71.00 LYK 03/16/09 105566 APPROVED
State Building Code $4.50 LYK 03/16/09 105566
Permit $142.00 LYK 03/16/09 105567 APRa3 2009
Total: $217.50 Jefferson County Planninc
& Building Department
'.`'k 21 '009TUE 04: 17 PM ORCA FAX No. 860491E4 P. 002
' - •, 1 '1' ( I // i
/0R� t ,. Olympic Region Clean Air Agency
" 2940-B Limited Lane.NW
>+ N. Olympia,WA 98502
(360)586-1044••FAX(360)491-6308Re1ntX
k.; / Port Angeles office(360)417-1466 jl���Oy _��Q� Permit
.CA Raymond Office(360)942-2137
\ .t ,'+ www.ORCAA.org
This permit valid only for residential homeowner
residing in the dwelling after renovations
Permit fee: $35.00 per structure. Non-refundable. .
PROPERTY OWNER�" C�
` \Tame:�/ .J ' 1n-e-1. . ) 07 Z(i Email, iKook 6: of , ,l i li 0 G6� ' T/L1 FAX: .
cpao, - .:Mobile: CCrwi
Mailing Address: state:
A_1 a�a S lw�e 1)A ptyi.4._:
-� Li,)(e vt) . A- 1 6 5•67.E
Site Address:
S e- City: State Zip:
_DEMOLITION CONTRACTOR[ 1._Cheek if same as property owner information
tsinessNone: Phone: '�S I5 O Em :
N- -L0 6?(clidifii N6. FAX: 3--)Q 8q2_
Onsite Entact Fhoon.e: 660 04: Mobile:DILkir1� toi�_
( ) _ -X20 Z3 ?�(c�Z
Mailing Address: ty State.
r 0 5C)% — q • [*:f-6- f (0 Ck- (A/ 43kr
•
DEMOLITION INFORMATION
#of Structures being demolished: I Start Date: Completion Date:
I A-pp. 4(2-1109i 01fh- t° ?
Asbestos present Yee No Survey attached YesX, No Has all identified sbestos been
removed Yes No
_
DEMOLITION PROTECT CATEGORY �6 4i s Y'awti`k
bia Complete Demolition
( _l Training Fire-Fire Agency: -. •
r 1 Renovation,Alteration,Remodeling,Maintenance,or other Construction
I have read and will abide by the conditions set forth in this permit and any addendum thereto. I do hereby certify that
all identified asbestos has been removed and the information in this application and supplemental data described herein
is, to the best of my knowledge, accurate and complete.
(-C) ,.qk3 tIRAAA4--- . \ '‘i"kki S(-&.'"cl d zi
Applicant Name Signature Date
- •.t ^ pad ' Payment Info, approved Asbestos Permit
[ ] Crib. [ ) Disapproved Permit#(Viii ASBOO a'
Permit
MAR 2 7 2009 ij Credit ard I j Review date /0(ti-I.( Pprmpt#�)Emo l.C1
Receive dated ( /(- Reviewed by: e
( e A y . !Manny Use Only Agency Use my Agency Use Only
09/19/08 OVER .
ON6 JZ. -01710
��w o�� JEFFERSO�OUNTY4IP
W �g ,a DEPARTMENT OF COMMUNITY DEVELOPMENT
'', - '4 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
www.co.jefferson.wa.us/commdevelopment
� ?NG�r�t
Master Permit Application MLA: Oo mcA CLO 't
Project Description(include separate sheets as necessary):
Ot 'l sb clicJE lEvi, 1�'-,1 r �G 4�Jik z�Xa G '
Tax Parcel Number: I �'t , l C tr : Z. Property Size: , 7 I 4 C,^rJ (acres/square feet)
Site Address and/or Directions to Property:
(rt <C a Ia S twe Ovi,:e P&1 1.,,t,)too/ Lw 4 4'8 3(� j
Property Owner(s)of Record: (%,, r•,) 'I ./i.,.,, r /\14 el.,r. 1, "
Telephone: �(,,,L.) (n-L`' 2 L .c-1 Fax: email: 4 Lt!ACE E-- Li ('j J pen, <<, 'ill
Mailing Address: 6 Li e I t (o •S ki G.� I)n �w t= L.v,ti tot,/ v.'4 ci l s�I
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies
Iyilding 0 Critical Areas Stewardship Plan
10, Demolition Permit ❑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* 0 Special Use(Essential Public Facilities)**
O Change of Use ❑ Boundary Line Adjustment
❑ Address 0 Road Approach 0 Short Plat**
0 Home Business 0 Cottage Industry 0 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 D Shoreline Master Program Exemption/Permit Revisions**
0 Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development**
❑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 Conferenc
Please identify any other local, state or federal permits required for this proposal, if knomrki
' ?�w
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 laser inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the application tha hehe nts for notice.
Signature: • �.I E lk j�,ktu Date: I A%1 C ri
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 mpliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transferable respo sibility a herig to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: Date: ? 2/
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.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 responsibility of the General Contractor for the proposed project.
Signature: Date:
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:
El New ❑ Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ Individual System
L7 Repair ❑ Masonry SEP Permit#
❑ 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 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:
Underground Tank Above ground Tank Size of Propane Tank:
Heat Stove Cook Stove Woodstove Fireplace Insert Hot Water Tank 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 Bld App Review: CO . .N k, oci.0:6 )
2f°Floor Heated Consistency Review:
Other Heated' Base fee: t-1 fa
I.
Mezzanine Additional Section: OD
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee: SO
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL
1 .5C0
Decks 911/Rd Approach fee: ___c__.,
Other TOTAL: $ r15 c�0
Receipt Number: i .51t
Cash/Check Number: (�a2
{-1
ESTIMATED COST(REQUIRED) Date: Cl
•Fair market value of all labor and materials foundation to finish
Initials:
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
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