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Home My WebLink AboutBLD2009-00196 litUILDING PERMIT APPLICAPO Revviewiew T TyN BL y196 pe: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD09-00196 Received Date: 7/1/2009 SITE ADDRESS: 527 LEE WAY BRINNON, 98320 OWNER: BERNARD H GODDARD PHONE: (206) 947-2644 DIANNA E WELLER 7413 135TH PL SE NEWCASTLE WA 98059-3101 BRINNONWOLD SUBDIVISION: Block: 2 Lot: 2 PARCEL NUMBER: 936000202 Section: 23 Township: 26 N Range: 02 W CONTRACTOR: KIENHOLZ TRUCKING & EXCAVATING PHONE: (360) 240-6661 7335 GREVENA AVE NE BREMERTON WA 98311 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION DEMOLISH 16 X 16 SHED W/BATHROOM TYPE OF WORK GAR SQUARE FOOTAGE: TYPE OF IMP DEM MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2006 HEAT BASE: HEAT TYPE: OCCUPANCY: OCCUPANCY: UNHEATED: # OF STORIES: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: /7/) /0g6= Type Amount Paid By: Date: Receipt: Approved/Date Permit $71.00 KAS 07/01/09 108686 AP P R D Y Er State Building Code $4.50 KAS 07/01/09 108686 Total: $75.50 J U L 2009 Jefferson County Planning &Building Department • • DEMOLITION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD09-00196 Received Date 7/1/2009 SITE ADDRESS: 527 LEE WAY Issue Date 7/30/2009 BRINNON, 98320 APPLICANT: BERNARD H GODDARD PHONE: (206) 947-2644 DIANNA E WELLER 7413 135TH PL SE NEWCASTLE WA 98059-3101 2 SUBDIVISION: BRINNONWOLD Block: 2 Lot: PARCEL NUMBER: 936000202 Section: 23 Township: 26N Range: 02W CONTRACTOR: KIENHOLZ TRUCKING & EXCAVATING LLC PHONE: (360)240-6661 7335 GREVENA AVE NE BREMERTON WA 98311 OWNER, BERNARD H GODDARD PHONE: (206) 947-2644 if different: DIANNA E WELLER 7413 135TH PL SE NEWCASTLE WA 98059-3101 PROJECT DESCRIPTION: DEMOLISH 16 X 16 SHED W/BATHROOM 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 7/30/2010. REQUIRED INSPECTION: FinalApprova )4., 9`2,-O To Schedule inspections, call (360)379-4455 by 3:00 PM prior BUILDING INSPECTION HOT-LINE 379-4455. day. Office Hours 9:00 a.m. -4:30 p.m. NOTE: Monday inspections by 3:00 PM prior Thursday. HOT LINE AVAILABLE 24 HOURS A DAY I:\F_BLD_Permit_Propane.rpt 10/29/19 07/02/2009 10:55 425- •-3343 FEDEX OFFICE 41065 PAGE 02 • • COWS. "°ztl*N. Olympic Region Clean Alt Agency • i"''�,.n.�P\ 2940-B Lunited Lane NW r Olympia,WA 98502es �e�Residential • (360)586-1044• FAX(360)491.-6308 . \„ 1 Port Angeles office(360)417-1466 Deol]tt10 Permit ORCA % Raymond Ok6.cc(360)942-2137 \ -t-'i�,no,.0 2 ♦vww.ORCAr1.org • This pet;nla.t valid. only for residential b omeowner residing in the dwelling after renovations Permit fee: $35.00 per structure. Non-rd tradable. PROPERTY OWNi 947-24AN Name: y �' �� Phone: (-0q' F ? 4ye/ EmaiLQ,N G'a),DAw-0(y o�I o7,v ,,, 'D o� FAX: ( ) Mobile:( ) F M Address: City: State: Zi rril 13 1 s-i P�sE h n>��0�: �flgos9 Site Addtcss: Cit : State: 7'. �'2? Z.-E (An4 Y • 87e.1 n/A)o r) W A- `! 8'3 Z.D DEMOLITION CONT T R C e -E, Is . le tuition Business Name: ' Phone Email: I6-6A) 1 Etj o c FAX: ( ) _ Onsite Contact. N Phone: Mobile: (.�b i C.-- -a) t<t FAX: ( 3 `m, G Mailing Address: City") State: Zip: 7S�-5/. pg ct A. 6 NC R 've;rolL) vio. '( DEMOLITION I ORMATION • #of Structures being demolished: Start Date: .? (sA- Q.C�O 9 Completion]gate: (tit-4 .0 Asbestos present Yes No Survey attached Yes o_, •Has all identified asbestos bcc iftp)g- 11i11 •$u.1 4,11:t/1J Ry; : tctnovcd Yes_ No DEMOLITION PROJECT CATEGORY • Complete Demolition t J Training Fire-Fire Agency: - • Renovation,Alteration,Remodeling Maintenance,or other Construction f I have read and will abide by the conditions set forth in this permit and any eddendum thereto. I do hereby certify that all identified asbestos ha.r been removed and the information in this applicatic a and supplemental data described herein is, to the best of my knowledge, accurate and complete. --qurAT/4 k ,e , Applicant Name Signuaiure Date Ddplic<4,'ti-oP•}Zc<eived Payment Info. Approved Asbestos Permit 1 )Cash [ ) Disapproved Permit# ASBOO, JUL .heck: # _ Demolition ermit � � XirCredit Card' 1 tip Review date: "/,�`' /Q( Permit.#01 DEMO �' ,c, f; Rcbcive date:•`"1'/.0'7/O� Reviewed by: pn" U.se Oni`, en Use fl�gc _..,:-' ly, 11,p cY � ,flgeney Use nC�'ly Agony Use Only 09/1 9/08 OVER. 4�, ON cod,, JEFFERSO POUNTY !REI ' \ :l't ;) • y ' DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend •Washington JUL 360/379 • \N„......., �q p� www.co.j4450efferson.wa.us/commdev360/379-4451Faxelopmenr, BINS Master Permit Application MLA: 4FERON MONTY Or Project Description(include separate sheets as necessary): 12E-M v r s r7/ 16 ?r.I b S ff -A CU r i fi1 gAT 1-t- r2690r- l Tax Parcel Number: c j 6, 0O& ._D.i Property Size: ) A_G> r_ (acres/square feet) Site Address and/or Directions to Property: 5--7- 7 LC (Al 0 % Alt ,$))0)l'i) Property Owner(s)of Record: - .1e A)A724> a.3.. A ,)AA- ELL- ---(?-- Telephone: :-(7CL 9 17 7 24)f f Fax:_� email: v et G C_,-:, Mailing Address: ' I/3 $ tg c- : Pt_- -sf /V cK.)C.H`s r r. u1/{- qg� 9 Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies 0 Lot or Road Segregation ❑Building 0 Critical Areas Stewardship Plan lgi Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]** 0 Manufactured Home .0 Modular ❑ Discretionary"D"or Unnamed Use Classification ❑ Commercial* ❑ Special Use(Essential Public Facilities)** ❑ Change of Use 0 Boundary Line Adjustment ❑ Address 0 Road Approach 0 Short Plat** ❑ Home Business 0 Cottage Industry 0 Binding Site Plan** 0 Propane ❑ Long Plat** 0 Sign - 0 Planned Rural Residential Development(PRRD)/Amendments** 0 Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** ❑ Stormwater Management 0 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). 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 ins.: tions. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the appli a.on that he or sh.r - t ;or f C Signature: -t�i%/, a Date: 7 1 �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 and non-transf ble respons r or adh i to an omplying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: Date: \7" ( '-0 7 G:\PermitCenter\###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: 4A) CCl C tNoT ( ) ( ) 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 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 1 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: 2nd Floor Heated Consistency Review: Other Heated Base fee: l, 00 Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: 4.5C Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL r1 S-50 Decks 911/Rd Approach fee: Other TOTAL: $ -15 5O Receipt Number: Y Q n b - Cash/Check Number: `r, 1-1 ESTIMATED COST(REQUIRED) Date: all I (I *Fair market value of all labor and materials foundation to finish a _ "t Initials: l G:\PennitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc — -'..1171.11.111111111111111 im—f-rinex6., iir t =14F" •-• - -- 61 ite rian _ s4Ple e Check After Doing Site Plan: 1:3 Septic and drainfleld . . 0 Lot size i -- P.RProperty dmensions lataw North'Arrow tn h,r -.1ligalmems - CI S er lines CI Elevation of property vammer.•-a. ..gixisting buildings f , I x , ,tz Main tbarcokasdowf proposedith &existing buildings 0 Bodies of water Proposed building D Easementsname o oorplan 2 ..Ergccess tp proposed building n Slopes&Contours(5'increments) . ,-7 -, Job Name: ........"-)-2:4'./2,-..e.) 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Z., ! , e ! , I . 1 I , I I I t . , , i . 1 ? ! : i .1----j . -1 1 ? , , . , .1. • J L ./._...-1---;• __ . ___. , . 1 : 1 . -. 1 -J- ,......... . _... ____ DO NOT SIGN INCOME SITE PLAN! Customer has verified and approved the location of the building,orientation of e building to the North,and verifies that all White-Customer Copy White-Office Copy utilities are shown on this dra g in the correct I. at Oft //? 0 wif TR t , (n-1995 Permit-Silt Industries FR-34 6/07 ii ail INII rig IN