HomeMy WebLinkAboutBLD2009-00084 �UILDING PERMIT APPLICA N Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #:
SITE ADDRESS: BLD09-00084 Received Date: 3/24/2009BLD09-00084
OWNER: BECKETT POINT FISHERMEN'S CLUB PHONE:
% GOODING O'HARA & MACKEY
PORT TOWNSEND WA 983685717
BECKETT POINT FISHERMAN'S CLUB
SUBDIVISION: Block: Lot: 2
PARCEL NUMBER: 932200502 Section: 23 Township: 30 N Range: 02 W
CONTRACTOR: NELSON CONSTRUCTION INC PHONE: (360)385-3062
31 COMBS PL
PORT TOWNSEND WA 98368
Contractor's License NELSOCI972C1 Expires 1/10/2010
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP DEMO EXISTING CABIN - 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:
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: �
Type Amount-Raict—,v: Date: Receipt: Approved/Date
Permit $71.00 LYK 03/24/09 105655 \IDIDRVED
State Building Code $4.50 LYK 03/24/09 105655
Total: $75.50 MARS{ 2009
Jefferson County Planning.
&Building Department
IIPP-
0 •
DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD09-00084 Received Date 3/24/2009
SITE ADDRESS: Issue Date 3/24/2009
APPLICANT: BECKETT POINT FISHERMEN'S CLUB PHONE:
% GOODING O'HARA & MACKEY
PORT TOWNSEND WA 983685717
2
SUBDIVISION: BECKETT POINT FISHERMAN'S CLUB Block: Lot:
PARCEL NUMBER: 932200502 Section: 23 Township: 30N Range: 02W
CONTRACTOR: NELSON CONSTRUCTION INC PHONE: (360)385-3062
31 COMBS PL
PORT TOWNSEND WA 98368
Contractor's License NELSOCI972C1 Expires 1/10/2010
OWNER, BECKETT POINT FISHERMEN'S CLUB PHONE:
if different: % GOODING O'HARA& MACKEY
PORT TOWNSEND WA 983685717
PROJECT DESCRIPTION: DEMO EXISTING CABIN - NO MLA REQ'D
Directions
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 3/24/2010.
REQUIRED INSPECTION:
FinalApproval: 3. (-ZOO?
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
• •
ION--
q�`�lc ^A4� �� Olympic Region Clean Air Agency
;'c. ' 7� l 2940-B Limited Lane NW Owner Oc c up ie d
i A, Olympia,WA 98502
° �i ��; (360) 586-1044•FAX(360)491 6308 Residential As b e s to s
�\Tyc ORCAA CrJ~� Port Angeles Office (360)417-1466
q,'r*p. . Q*�'�i Raymond Office(360) 942-2137 Removal Permit
----- www.ORCAA.org
***This permit valid only for residential homeowner residing in the dwelling***
Permit fee: $30.00. Non-refundable.
APPLICANT
Name: Phone: ( 0)3 kS- t 95 7 Email: y,en -r-A&`to 6) D(yper
11 ,2. . 't- th,S. Vi N'c % At I L J}( FAX ( ) Mobile: ( ) (Ay
Mailing Address: City State: Zip:
/6 $o /ymArR OE 517 1o121-- Tocuoven0 Gu �4 • 1834s F'
Site Address: City State: Zip:
S�iio .6o�rErt Po,�rr IooRT /Ot,unrsM.;j Wi'1-. 9?338
PROJECT INFORMATION
Start Date: Completion Date: Work Shift Days: 14 if/1- Work Shift Hours: ;j•7/4
# of Structures: Total Quantity to be Square Feet: U-i-nki I Linear Feet: cc!,,'at u L
/ Removed c -f- �,e,,¢ ,,- *.. 2
_i_....
Name and location of Disposal Site: Will this shfict'ure be demolished after asbestos
Pole7- AZ-N'EE-y&IS removal es No
Will all identified asbestos be removed from the
structure es No
Circle Material being removed:
Boiler/Furnace Duct Insulation Pipe Insulation Fireproofing Paints Plaster Cement Board
Cement Pipe Floorin Roofing Textured Coating Other Al,rYDok,.; p LcrTy
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.
MAR 2 4 2009� 4 2009
Aisi-�� ,� - /- / dx__62_,A.4,-
6'. .,t, 3— /D —4 7
Applicant Name Signature Date
Da c R� ved Payment Info. Approved Asbestos Pe •
� �E- A �, [ ]Cash [ ] Disapproved Permit# �ASB00.
[ ]Check # Demolition ermit
MAR 1 J 2009 [',Credit Card— ?c; Review date: 3 /1I / jot Permit#d( DEM00D: t.
-ism-o,
�~ Receive date /1\ / ( Reviewed by: Survey:((Yes [ ]No
l' cs. Agency Use Oily Agency Use Agency Use Only
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/ 4' ON Col, JEFFERSOSOUNN • --
' DEPARTMENT OF COMMUNITY DEVELOPMENT e__,
'' ' '� 621 Sheridan Street • Port Townsend •Washington 98368 (Jo 1,A n D Z
360/379-4450 • 360/379-4451 Fax
�gS, NCIp� www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: t\ 1" \Z.e-c., h
roject Description(includ separate sheets as�nnecessa ): t
'1? USClD ��Ou�Q�U►gw-het) W 1, +cuu�ltc lac Q11.91040,,A,,,,,,,,3 �; Gu��tJc0�1 � 1
jitil
Tax Parcel Number: (MI r
(���<,O{� ( Property Size: (acres/square feet)
Site Address and/or Directions tq Property:
S yidtb �Lt ' 1. Pa
Property Owner(s)of Record: I ik KO
Telephone: I'Slab.-r J'i'I T1 ,ax: email:lr nth nb Oiy pen ,cot'+
Mailing Address: /ee0 `ifri1311144g 4*-- \ c ov-ltfQ L4 U,,3 4. 9 tame
Applicant/Agent(if different from powner): Ni 012C t. NQ�.SOtn (e. Nei vi C@rt i.ruCtiov'
Telephone: I-•3 .36.5"3ttZ(& :301-90334 Fax: i -360 '3 ' 306Z email: 1rlCtatl
���L ny 31pjw1SN.,<0t+'t
ca�
Mailing Address: 3i (Owl bs 1, :.t I Ot"k To W ftSi t , LA)4• cl`r4,8
What kind of Permit?(Check each box that applies
ElVeltng 0 Critical Areas Stewardship Plan
'Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
Q Single Family Garage Attache Detached ❑ Conditional Use[C(a), C(d),or C]**
O Manufactured Home 0 Modular 0 Discretionary"D"or Unnamed Use Classification
❑ Commercial* 0 Special Use(Essential Public Facilities)**
O Change of Use 0 Boundary Line Adjustment
❑ Address 0 Road Approach ❑ Short Plat**
❑ Home Business 0 Cottage Industry 0 Binding Site Plan** ma 2 4
gip
❑ Propane 0 Long Plat**
❑ Sign 0 Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration**
0 Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions**
❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development**
❑Temporary Use ❑Shoreline Management Variance
0 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 0 Tree Vegetation Request
**Requires a Pre-Application Conference
Please identi any other
�local,
`state
�or federal permits required for this proposal, if known:
��((,, Qp �'�' ` k t DESIGNATION OF AGENT
I hereby designate Fv1CV\�a,1f0. E . 1V2,• d1/� to act as my agent in matters relating to this application for permit(s).
( , ^). C/ Date: ._ ' �_ UGOWNER SIGNATURE t.:� C"✓� = / � '
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 -.uired I- :-ction . aff a ess and right of entry will be assumed unless the applicant informs the County in writing at the
time of the -bon t •e or s w or t /�C�
Signature. .. Date: — ,�
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)e - ,••- - •n co p• with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non- _. z-t�>resp,n il' adhering to and complying with the ESA. The Applicant has read this disclaimer+a, i and dates it below.
Signatur. tt I ' Date: 3 ` I(� 7
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
0 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:
GE RA��CONTRACTORe,R MANUFACTURED HOME INSTALLER: PHONE: FAX:
t�C t,r o btS\Y(AO-r o�,�\ ( ).�°S- , L (3�,)i8 -3041—
MAILING ADDRESS: .A 1 COW06 S lace thr-t fo ' w i W EMAIL: o( k a All
0@ it K•c ovo
CONTRACTOR'S LICENSE WAINS
NUMBER: NE1,6 MI 2C I NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Fie Type: Bathrooms: Shoreline: Type of Sewage Disposal:
Li New to Wood Existing: I ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: Hei ht: ❑ Individual System
❑ Repair Fl Masonry WO K' SEP Permit# .SI 0� -41_5
sr Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type of H, at: Proposed: CI Public
Syc 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 Stov k to, Woodstove i Fireplace Insert i Hot Water Tank i Pellet Stove i Other
Is this appiiINMI airkiffalAled 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 `i� a�,1} �, EH Bld App Review:
2nd Floor Heated WCC�' Consistency Review: r--
Other Heated Base fee: 1` 00
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee: 5D
Other Unheated Pot Water Review fee: _
Garage/Carport SUBTOTAL t
Decks 911/Rd Approach fee:
-Other TOTAL: $l f',g )
Receipt Number: I 0(0 c"3
Cash/Check Number: ' /'
ESTIMATED COST(REQUIRED) Date: v - 4 o(+
•Fair market value of all labor and materials foundation to finish
Initials: — i
G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc