HomeMy WebLinkAboutBLD2009-00101 • • • - "
DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD09-00101 Received Date 4/6/2009
SITE ADDRESS: 1080 THORNDYKE RD Issue Date 4/9/2009
PORT LUDLOW, 98365
APPLICANT: WALTER HARDIN PHONE: (360) 437-2348
1080 THORNDYKE RD
PORT LUDLOW WA 98365-9289
2-3+
SUBDIVISION: TRAIL'S END 4TH ADD Block: 1 Lot:
PARCEL NUMBER: 950200107 Section: 16 Township: 27N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
OWNER, WALTER HARDIN PHONE: (360)437-2348
if different: 1080 THORNDYKE RD
PORT LUDLOW WA 98365-9289
(360)437-9340
PROJECT DESCRIPTION: DEMOgg77 EXISTINGuppag MFH
Directions HWY 19 TO HWY 11I4,7EFA�T'ON T04r4WARD HOOD CANAL(EAST)TRUN RIGHT OF SOUTH POINT
To Site: RD TO THORNDYUKE RD,TRUN OFF TO RGHT UP THORNDYKE RD AND OVER THE HILL TO 1080
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 4/9/2010.
REQUIRED INSPECTION:
FinalApproval:
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
ItILDING PERMIT APPLICATN B RD09 OOeview p101
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD09-00101 Received Date: 4/6/2009
SITE ADDRESS: 1080 THORNDYKE RD
PORT LUDLOW, 98365
OWNER: WALTER HARDIN PHONE: (360)437-2348
1080 THORNDYKE RD
PORT LUDLOW WA 98365-9289
TRAIL'S END 4TH ADD
SUBDIVISION: Block: 1 Lot: 2-3+
PARCEL NUMBER: 950200107 Section: 16 Township: 27 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI' DEMO EXISTING MFH
1977 FUQUA 48 X 24
TYPE OF WORK MOB 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:
00(6)-
,
Type Amount Paid Bv: Date: Receipt: Approved/Date
Permit $71.00 KAS 04/06/09 105638 APPROVED
State Building Code $4.50 KAS 04/06/09 105638
Total: $75.50 APR 9, 2009
Jefferson County Planning
&Building Department
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Evelens Tax Servie 13604379340 p.1
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/Q S�cREGION cuci i„ Olympic Region Clean Air Agency
ti,o ��`'4 \ 2940-B Limited Lane NW
% Olympia,WA 98502
( !. IS) (360) 586-1044• FAX(360) 491-6308
.<r Port Angeles office (360) 417-1466 Demolition Permit
ORCAA\�� ,��' Raymond Office(360) 942-2137
'--?. x�usos•Hwse27'::-- www.ORCAA.org
[ I Commercial Structure-Permit fee: $60.00- 10 working day wait period
[kr Owner occupied residential dwelling-Permit fee: $35.00 - Prior Notice
PROPERTY OWNER 364 (,'6 CL L(s
Name: Phone: -3P'I3S Fail:w 1•360-5-31-3 c1g
WAi.Jj-j)€.- d-t--10i,Ai "JALAP Mi FAX (3&o) 'us 7-9 I Mobile: •'f) -s-ac-lv re
Mailing Address: City: State: Zip:
/e ' Lasr,iG'ty lie 1 cI /20. .4aILe ai Ara. MD-
-Site Address: City: State: KiE
a`f`/2 A45 A4avif - `
DEMOLITION CONTRACTOR[ eck if same as property owner information
Business Name: Phone: ( ) ` Email:
FAX ( )
Ons ire Contact: Phone: ( ) Mobile: ( )
FAX ( )
Mailing Address: City: State: Zip:
DEMOLITION INFORMATION
# of Structures being demolished:vogq. Start Date: Completion Date:
1-I Y`T7 -r 5rofr/,4 .e/6,,,a- l,4,r�-4-6-e? lic'7.40„a.. J,✓tr eta-0 9
Asbestos present Yes et Survey attached ( No Has all identified asbestos en
removed Yes No W A
DEMOLITION PROJECT CATEGORY
[Complete Demolition
[ ]Training Fire-Fire Agency:
[ ]Renovation,Alteration,Remodeling,Maintenance,or other Construction
[ ]Emergency-Additional Fee of$50.00(must be accompanied by Government Ordered Declaration-Commercial only)
1 haw 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.
lA)i LTe? 4, 66.ed6,r (.�� Gt V z —a p
Applicant Name Signature Date
DR bViatitheFefiyd Payment Info. Approved Asbestos Permit
[ ]Cash NNDisapproved Permit# ASB00
��R 2Q� [ ]Check # Demolition P rmit _
4ACredit Car"d�ft-!t� Review dateCj /0.3/0"( Permit# °`.%4DE M00� 'j'4
(*Cr; r Receive date:F /07 Reviewed by. J ti
" �'�`" Agency /Use Oily Agencv Usea y Agency Use Onl✓
r .
50 Cr
JEFFERSON OUNTYA. •
' � • ' ` DEPARTMENT OF COMMUNITY DEVELOPMENT
`", ''4 621 Sheridan Street• Port Townsend •Washington 98368
1p
360/379-4450 • 360/379-4451 Fax
�S N��0 www.co.jefferson.wa.us/commdevelopmenl:
Master Permit Application MLA:
Project Description(includ�e separate sheets as necessary): 4
Dior-,4+c9L.il,cum 1'/ ft?7f lgvR ��X,g-V/n'e esec r/h..Ve_y,re.✓lmrre.de .cis
Tax Parcel Number: (750 z,60 /p17 Property Size: (acres/square feet)
a '77W6f..AJd kat,�iAd� dec/ /2'To' /fY/64��E'4*-3T a'�'/dY
Site Address and/or Directions to Property: � c�1
W44cf 474a''Ic-AA1��c rr) r�e.n., rey_4Taerc si ilea. 2"‹7i-c 7 n.id �'4oAAr-ur.roWm r.
z2r/a A.,ird I(e RA,y e/10,44 ave4_72,.. [MIL(7"o AOPIO. ' `�
Property Owner(s)r( of Record: GrJ,rcCTc- .i4.d't l t,4.firkp.✓-
Telephone:a' 9 7 7-034E Fax:4.=Jr/- `Z f1O email:, — _
Mailing Address:10E„ Of r/AeRJ-a/y`Ce/Lentip Pe',e7`Zt f .1 lf/f.,Srs' s
Applicant/Agent(if different from owner):
Telephone: ��..,k46/9-S f906!/ ,-' Fax:. A..r/te/t<5*- 6i'& email:
Mailing Address: —
What kind of Permit?(Check each box that applies 0 Lot or Road Segregation
❑Building 0 Critical Areas Stewardship Plan
A' Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use)
oq Single Family ❑ Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]**
110‘ Manufactured Home . 0 Modular 0 Discretionary"D"or Unnamed Use Classification
O Commercial* 0 Special Use(Essential Public Facilities)**
❑ Change of Use 0 Boundary Line Adjustment
❑ Address ❑ Road Approach 0 Short Plat**
❑ Home Business ❑ Cottage Industry 0 Binding Site Plan**
❑ Propane 0 Long Plat**
❑ Sign - 0 Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes" Use Consistency Analysis ❑ Plat Vacation/Alteration**
0 Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions**
O 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
O Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment
*May require a Pre-Application Conference ❑Tree Vegetation Request
**Requires a Pre-Application Conference
Please identify any other local, state or federal permits required for this proposal, if known:
DESIGNATION OF AGENT
I hereby designate/1/2)/Si6-'k to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE Keht- -ILyGZ h Date: /�O' li
By signing this application foim,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 application that he or she want prior notice.Signature: I //
a. I mo- Date: '"�'/"re,7 _
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
i ana non-transferable,responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
1 Signature: (-A-i eti .,- G- 7I- --i/.../L,;., _ Date: '(i-1—e-)9'
i._.--
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• .-- , ,
BUILDER STATEMENT
The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they ate not IicenS�A'contractors and that
they will be assuming the responsibility of the General Contractor for the proposed project.
Signature: Date: 1-6
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 ❑ Concrete Total: _ Height: ❑ Individual System
❑ 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 Seniice? Yes / No
If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply:
1 Underground Tank 1 Above ground Tank Size of Propane Tank:
1 Heat Stove i Cook Stove I Woodstove i Fireplace Insert 1 Hot Water Tank I Pellet Stove i Other
Is this appliance being installed in a Manufactured I Mobile Home? Yes / Nc
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 [ urrent Proposed For Office Use Only Amount Revision
Main Floor Heated EH BId App Review:
2nd Floor Heated Consistency Review:
Other Heated Base fee: I. DO
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee: 4' 5
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL 14.V 5O
Decks 911/Rd Approach fee:
Other TOTAL: $ 146. E
Receipt Number: I b5tO3
Cash/Check Number: Go 5
G
ESTIMATED COST(REQUIRED) Date: o
•Fair market value of all labor and materials foundation to finish (0
CI
Initials:
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