HomeMy WebLinkAboutBLD2009-00162 BLD09-00162
0:3UILDING PERMIT APPLICAWN Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD09-00162 Received Date: 6/2/2009
SITE ADDRESS: 230 OLD FERRY RD
PORT HADLOCK, 98339
OWNER: DANA A STOCKS PHONE: 425-891-4048
RICHARD A STOCKS
230 OLD FERRY RD
PORT HADLOCK WA 98339-9762 PORTAGE BAY PARK
SUBDIVISION: Block: Lot: 12+
PARCEL NUMBER: 989100011 Section: 1 Township: 29 N Range: 01 W
CONTRACTOR: QED BUILDERS LLC PHONE: (360)385-5743
630 CASS STREET
PORT TOWNSEND WA 98368
Contractor's License QEDBUL*043D1 Expires 9/14/2010
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI' DEMO EXISTING CABIN
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 Paid By: Date: Receipt: Approved/Date
Permit $71.00 LYK 06/02/09 108530 A#�P R®V E�
State Building Code $4.50 LYK 06/02/09 108530
Total: $75.50 JUN 152009
Jefferson County PIa .
& Building Deaf-'
• •
DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD09-00162 Received Date 6/2/2009
SITE ADDRESS: 230 OLD FERRY RD Issue Date 6/15/2009
PORT HADLOCK, 98339
APPLICANT: DANA A STOCKS PHONE: 425-891-4048
RICHARD A STOCKS
230 OLD FERRY RD
PORT HADLOCK WA 98339-9762 12+
SUBDIVISION: PORTAGE BAY PARK Block: Lot:
PARCEL NUMBER: 989100011 Section: 1 Township: 29N Range: 01W
CONTRACTOR: QED BUILDERS LLC PHONE: (360)385-5743
630 CASS STREET
PORT TOWNSEND WA 98368
Contractor's License QEDBUL*043D1 Expires 9/(34/2)10385-7627
OWNER, DANA A STOCKS PHONE: 425-891-4048
if different: RICHARD A STOCKS
230 OLD FERRY RD
PORT HADLOCK WA 98339-9762
PROJECT DESCRIPTION: DEMO EXISTING CABIN
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 6/15/2010.
REQUIRED INSPECTION:
FinalA proval:___
BUILDING INSPECTION HOT-LINE 379-4455.
SPECIAL CONDITIONS APPLY - SEE REVERSE
HOT LINE AVAILABLE 24 HOURS A DAY
• •
SPECIAL CONDITIONS FOR CASE#BLD09-00162:
1.) No future approval for an onsite sewage system is assured as part of this review for
demolishing the existing residence. Any future development on the site must meet current
onsite sewage codes at the time of application.
2.) This structure was previously changed to a storage building only. No inspection of the
septic system serving the structure has been completed as part of this application. Prior to
final it shall be verified if there is a septic tank. If present it shall be decommissioned by a
Jefferson County Certified Installer Written confirmation of the decommissioning must be
submitted by the Certified Installer prior to final of the building permit.
I:\F_BLD_Permit_Propane.rpt 10/29/19
Tay flee/d 9,
~fin , Olympic Region Clean Air Agency
ti ' 2940 B Limited Lase NW
Olympia,WA 98502
(360)586 1044•FAX(360)491-6308 Residential
Port Angeles office(360)417-1466
\OAJ•,". Raymond Office(360)942-2137 Demolition Permit
'"• umx .e www.ORCAA.org
•
This permit valid only for residential homeowner
residing in the'dwelling after renovations
Permit fee: $35.00 per structure. Non-refundable.
PROPERTY OWNER
N e: QficvnS Phone: aS)$ ItOetzg fj/�G O` Gl" r7S FAX ( ) ( MobiliJ�tS7 z+c e�15/d c'o
Mailing Address: ( )
A 3Q y r r city/i�1Uf c l ✓c Z g'3
Site Address:
— City: State: Zip:
DEMOLITION CONTRACTOR[ ]Check if same as property owner information
Busi4a"4 *,.k
Name: ,pPhone: ( ) Email
&Ci9 T ,js/ FAX: ( )
Onsite Coact, ! Phone:
Mailing Address:
FAX: ( ) 77S/-.2( 6
City: State: Zip:
DEMOLITION INFORMATION
#of Structures being demolished: / I Start Date:
Completion Date:
Asbestos present Yes No, Survey ched es � � •
.� No Has all identified asbestos been
removed Yes_ No_ A f IA
DEMOLITION PROJECT CATEGORY
[XI Complete Demolition
[ J Training Fire-Fire.Agency:
[ I Renovation,Alteration,Remodeling,Maintenance,or other Construction
•
r have read and will abide by the conditions set forth in this permit and any addendum thereto. I do hereby certify that
.11 identified asbestos has bun removed and the information in this application and supplemental data described herein
to the best of my knowledge, accurate and complete. .
.319/17# ..5k,tA 5 . ,,,,,,,,24,,e. .
plicant Name Si a $1?
ture - Date "
tzt it 9 R Payment Info. )< Approved Asbestos Permit
[ ) Cash [ ] Disapproved Permit# ASB00
[heck: # �/.oS Demolition Permit
MAY 2 9 2009 [ ] Credit Card Review date:C. J/act°/(')� Permit# g DEMOO-39(..
4 Receive date:51/�q/9 Reviewed by: _. t
.ERIse n Agency Use Only Agency Use 0
'08 OVER Y Agency Use Only
-�
,v- c06 JEFFERSONCOUNTY
W �
DEPARTMENT OF COMMUNITY DEVELOPMENT
-%
in •N „ 04 621 Sheridan Street• Port Townsend •Washington 98368
41,:.` t,oe
360/379-4450 • 360/379-4451 Fax
www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: IQ() (YlLA OE:Q A
Proj ct Description(include separate sheets as necessary):
Tax Parcel Number: j E 7 1 O') 0 / / Property Size: (acres/square feet)
Site Address and/or Directions to Property:
.2 2..) CO/ r rr v k cp-ram-Y
Property Owner(s)of Record: I),' k g pr .celizk_ ->is)(1,kc
Telephone: i7'` 5 c'r; / `tort ' Fax: email:
Mailing Address: i,3 0 ( 1/4 F r r`-,, pal Her, 1�,,,k ktt�r&.
. •
Applicant/Agent(if different from owner): att /)i _1 i in< 0
Telephone: S GC) ___-'0( 2(Po a Fax: email:(-take r-h.d S Q.MVra tt
Mailing Address: ---, 2,0 9e' . S q
What kind of Permit?(Check each box that applies 0 Lot or Road Segregation
51:1Building 0 Critical Areas Stewardship Plan
4 Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use)
• Single Family 0 Garage Attached/Detached ❑ 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)**
❑ Change of Use 0 Boundary Line Adjustment
,j31 Address 0 Road Approach 0 Short Plat**
❑ Home Business 0 Cottage Industry 0 Binding Site Plan**
❑ Propane 0 Long Plat**
0 Sign - 0 Planned Rural Residential Development(PRRD)/Amendments** .
❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration**
❑ Stormwater Management 21 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 0 Jefferson County Shoreline Master Program Amendment
*May require a Pre-Application Conference 0 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 to act as my agent in matters relating to this application for permit(s).
ii
OWNER SIGNATURE IA N.6_ �f c%t,- Date: _ /./i r•
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 applic,a�t jn that a or she wL prior notice. ,
Signature: //1 4 1-6---"--f.. i Date: 57 7 0 q
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 n complia ,. with the Jeff on County development code.The Applicant acknowledges that he,she or it holds individual
and non-transfprap!e r onsibility/ -.hering to complying with the ESA. The Applicant has read this dis la' er an signs and dates it below.
Signature: - 7 -- Date: . Oa b
G:\PennitCenter\###FORMS###\DRD FORMS\Current 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:
CP4'YJ 8ram.t" )c ,, �C. i (%0) 3s�5"7` Y3 (1Ct) 3 ' 5`�'
1-0
MAILING'ADDRESS: 630 U C.c(.Scs S'f per,-f lc PAgei�.`�1 EMAIL: d f k e r 1 Get el Q l- G`6 )'Y�1� t 1
CONTRACTORS LICENSE I WAINS
NUMBER: lA 4 0µ� 'f NUMBER
ARCHITECT/ENGINEER: 6 I y PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: tj Shoreline: Type of Sewage Disposal:
Ile New in Wood Existing: g., ❑ Sewer
❑ Addition ❑ Steel Proposed: 2'& Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: ___ Height: tit Individual System
❑ Repair ❑ Masonry /•e' SEP Permit#
m Demolition ❑ Other: Bedrooms: Water Supply:
Existing: A Setback: H Private well ❑ Two Party
Type of Heat: Proposed: %Z t! 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:
i Underground Tank i Above ground Tank Size of Propane Tank:
i Heat Stove i 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 Revision
Main Floor Heated EH Bld App Review: -,
2"tl Floor Heated Consistency Review:
Other Heated Base fee: ,-- ( t
Mezzanine Additional Section: ( ._t_
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee:
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL I` ''-)-°
Decks 911/Rd Approach fee:
Other TOTAL: $ U c)
Receipt Number: f C
Cash/Check Number:
ESTIMATED COST(REQUIRED) Date:
•Fair market value of all labor and materials foundation to finish (. -2 79
Initials: —
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
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