HomeMy WebLinkAboutBLD2009-00190 IF NIi
•
DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD09-00190 Received Date 6/30/2009
SITE ADDRESS: 312407 HWY 101 Issue Date 7/14/2009
BRINNON, 98320
APPLICANT: CALVIN W SCHURMAN TRUSTEE PHONE: (360) 796-4684
BARBARA J SCHURMAN TRUSTE
PO BOX 196
BRINNON WA 98320 TX16-1
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 502291003 Section: 29 Township: 25N Range: 02W
CONTRACTOR: BISHOP ENTERPRISES PHONE: (360) 417-0861
982 LEWIS RD
PORT ANGELES WA 98362
Contractor's License BISHOE*999MT Expires 7/24/2010
OWNER, CALVIN W SCHURMAN TRUSTEE PHONE: (360) 796-4684
if different: BARBARA J SCHURMAN TRUSTE
PO BOX 196
BRINNON WA 98320
PROJECT DESCRIPTION: DEMO MFH - 1961 COLUMBIA 10 X 46
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 7/14/2010.
REQUIRED INSPECTION:
FinalApproval: 6'
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#BLD09-00190:
1.) H-The existing pre permit septic system must be pumped by a licensed pumper and the
tank filled with soil. Documentation to be provided to health department prior to final
approval of this or other permits.
I:\F_BLD_Permit_Propane.rpt 10/29/19
BUILDING PERMIT APPLICAIN B RD09 001eview p90
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD09-00190 Received Date: 6/30/2009
SITE ADDRESS: 312407 HWY 101
BRINNON, 98320
OWNER: CALVIN W SCHUMAN TRUSTEE PHONE: (360) 796-4684
BARBARA J SCHURMAN TRUSTE
PO BOX 196
BRINNON WA 98320
SUBDIVISION: Block: Lot: TX161
PARCEL NUMBER: 502291003 Section: 29 Township: 25 N Range: 02 W
CONTRACTOR: BISHOP ENTERPRISES PHONE: (360) 417-0861
982 LEWIS RD
PORT ANGELES WA 98362
Contractor's License BISHOE*999MT Expires 7/24/2010
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr DEMO MFH - 1961 COLUMBIA 10 X 46
TYPE OF WORK MOB SQUARE FOOTAGE:
TYPE OF IMP DEM MAIN:
VALUATION
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:
IP /00/0
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $71.00 KAS 06/30/09 108677 APPR ' EIJ
State Building Code $4.50 KAS 06/30/09 108677
Total: $75.50 JUL 2009
Jefferson County Planning
Rnilrlinn Ronarfmn+er
•
�� oN cVi JEFFERSONUNN „` `':
1, • DEPARTMENT OF COMMUNITY DEVELOPMENT
''4 621 Sheridan Street• Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax j
gsN��p www.co.jefferson.wa.us/commdevelopment
Master Permit Application ii MLA: n0 him-- 7f'Q tD
Project D scription(include separate sheets as necessary): y.Y1 () r y
,
0 (--vt141((. 1/; t q& I 4/1/4ik/tI rrlC—t ✓c4J;f_9 /_/orLfe-: 10 Y121(‘,
Tax Parcel Number: L Property Size: (acres/square feet)
Site Address and/or Directions to Property:
'// .
Property Owner(s)of Record: �t ' Ni r at , , /�.� .}4�+ ,=,. • l4 a;2_17 4i1.1
Telephone:.`;[Cr 7c/6 ,/14, "'/ Fax: email: ,' / ,
Mailing Address: i 'C t3C r /(11, .n 11V)6 C R. lz(, /-1 /' ' 1 c'
Applicant/Agent(if different from owner):
Telephone: ' . Fax: email:
Mailing Address:
yrW t kind of Permit?(Check each box that applies ❑ Lot or Road Segregation
ulding ❑Critical Areas Stewardship Plan
emolition Permit 0 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 • - ❑ Discretionary"D"or Unnamed Use Classification
❑ Commercial* 0 Special Use(Essential Public Facilities)**
❑ Change of Use ❑ Boundary Line Adjustment
❑ Address 0 Road Approach 0 Short Plat**
❑ Home Business 0 Cottage Industry 0 Binding Site Plan**
❑ Propane ❑ Long Plat**
❑ Sign -. • 0 Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration**
❑ Stormwater Management ❑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* ❑ 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).
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 application that he or she wants prior notice.
Signature: ate:
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
nd non-transferable responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: / _ . )Date:
G:\PernutCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Peon it 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 assu ingthe responsibility of thh r Gener Contractor for the proposed project.r�
Signature: (X.^ �J. ' \)"� (2/.41- 6./Date: - 3U (> 7
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
RIS i'l° P . C E fi21S6-S al)) 417- g.& ( ( )
MAILING ADDRESS: �ii15 . ��JI 5 J6 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#
Bedrooms: Water Supply:
�. Demolition II Other: pp Y:
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:
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 Qlily _ Amount Revision
Main Floor Heated i EH Bld App Review: 3
2"°Floor Heated Consistency Review:
Other Heated Base fee: ,l V
/1 h
lJ
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee: ?, 50
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL I
L}o �o
Decks 911/Rd Approach fee: ,
Other TOTAL $ 1 LI 8.5n
Receipt Number: 1 f0 6-1-1
Cash/Check Number: v 3
ESTIMATED COST(REQUIRED) Date: , I \l�o
•Fair market value of all labor and materials foundation to finish lP J} U
Initials: C1 ']\y
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
hw/ zQ
9q,wo
R
14 •t4
MOO-LOft0 PRoP(Gf�iY I
9,19"3FI03 vacnrt,D E15wu5et5 AJf-
9.�t agBlvo 34'f
0,e8A oV- loT 13toa•1q f
94,42'
— ro S�BacK
�- f0'^Io' 816Ar
i 9+ 5" PACK
'PRopf, f
PhRCEC1*- 946(oo3,103
PAfZr-&,Lµ-
`jV8@O39 uy
DIE oa.toP?-9
PRO PEITi
9`l'dtea'�gos.
DFLq,0 OPE.D
Paop4aTy
0 orerri {`
5C,IAL�L 1/P"- 1'
`)IGhJ 1.0CATI00 -*
1)C0r 0Pt,) PRoPgRry VPtQC£t 1✓• 001,z,P-019
ID'
1
5t�1`1 L
1
piy0�l l'r7t'S G°rvajy b-l�' �oOTI Nb,
ON,-, x I°o' r�at;P
w+TN NO• ¢ gwr�, AT HAOIA
WILI " ALP[ 6- t=6anN,�1 MIN, 12" �jG-Lout
14' Fko� P2PP��Ty EIS tD F�R1t4CT PRJtn1G
15'Tv 0 19/ lo' o (VAC.,A
9,�a �Dcpno1l
� 17 y t' m•Pl ocG PI1oPeR't'y LIn!¢
I P, e.
�traaronl
f
a
�D+.111 SA
STP,F- ,r
i� S Ia, ♦r� �OOTj rtJ L.+
' Ll,.ror3�u �r Snl'ra-� �1�c,N,rar;.TS w•
'r
e:) a
�cxrsaa>sY
aseaxa�r
-"
e•
IXA`9
-GePT IG ey sx m
(REssrhl>E. gaea)
LAS' 5STt3+IcK (Mlfl)
SF-PTIC. sy5iEm
P(PF-rN of= Lorr ng(OF(o$,
35 lal
Gfii"AG E
JUL 1 3 2009
D -PT. OF O 11�Y E r E
SIGNATUR
CLOUISa
1 91 S�Bgcr( Pht�C�..� �jy �ao'1103
1 SA++1�s r M�psq�+ EWDt=S (ol.�Ar.QS)
I
-
• S(&,t� L-0C,AX10t1) 2
DATAaA —rDP ROCK �1=�tc,a� VctJ�e,� •a�K �C�� �Rv, c �aata�
I to"0C,
wALI
8" o1,lJ)Z Fi°7
I
I
L
I
GoNC R2re. t= oorlrJe
2a•OG
M.
- 11'
tf q (3RR to " r7, C. 2 ",o I'3AI
G Ra9�
la MI
1 2'
REVISIONS BY
a
F-
t!�
2 �
r
y� cq
of r-
cr
NNn rq
P �
LL/ N
in
i✓
to
p t�iD ro
wn
O
w 'W-
2
0
v O
J
T �
O a
C
� Z
Z D
G1 Q
Date SwJ 30,zooq
/ .
Scale I�rtr
Drawn �^MEJ'E4DE 5
Job SIGjj ? QM+jF
Sheet
Of Sheets
18 % 24 MIMI'D ON NO. IWON CI RPRIM •