HomeMy WebLinkAboutBLD2009-00261 • •
DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD09-00261 Received Date 8/5/2009
SITE ADDRESS: 301 SHINE RD Issue Date 8/12/2009
PORT LUDLOW, 98365
APPLICANT: MINNIE D WELLCOME PHONE: 360-385-2653
C/O DAVID GOODING
340 WINDSHIP DR
PORT TOWNSEND WA 98368-2515 T 12+
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 821334020 Section: 33 Township: 28N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
OWNER, MINNIE D WELLCOME PHONE: 360-385-2653
if different: C/O DAVID GOODING
340 WINDSHIP DR
PORT TOWNSEND WA 98368-2515
PROJECT DESCRIPTION: DEMO EXISTING RESIDENCE
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 8/12/2010.
REQUIRED INSPECTION: 1
ISV) i
� -
FinalApproval: y_Q'f0
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
I
UILDING PERMIT APPLICA N B RD08 00eview p261
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD09-00261 Received Date: 8/5/2009
SITE ADDRESS: 301 SHINE RD
PORT LUDLOW, 98365
OWNER: MINNIE D WELLCOME PHONE: 360-385-2653
C/O DAVID GOODING
340 WINDSHIP DR
PORT TOWNSEND WA 98368-2515
SUBDIVISION: Block: Lot: T 12+
PARCEL NUMBER: 821334020 Section: 33 Township: 28 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP DEMO EXISTING RESIDENCE
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:
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:
Type Amount Paid Bv: Date: Receipt: AO
pis ! ate
Permit $71.00 LYK 08/06/09 110690 VEri
State Building Code $4.50 LYK 08/06/09 110690
Total: $75.50 AUG la as
Jefferson County Planninr
&Building Department
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d�JL/Z I2009ink I O�J.z7 AM CAA PAX No. SI
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O`"�' '4.a Olympic Reigion Clean Air Agency
I 2940-3 T .ited Lute NW
•j' i Olympia:,WA 58502 Coammercial
, '" • •j] (360)586.1Q44`1^.r .(.�50)491.6308
`,,,r ORtA, '. Port Angelus Office(.160)4174466 A •
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"Name: �'..��:`s..;'•„•; .:;;, �rltllri""��.M1,..Iti�}1:..1 `,.•
Dave Goodingr Ntinr�ie Welicome Estate now: (am es•z��a+. : , �
1Vtailittg Addscss, pia While:
340 Windship Drive Cit''Port Townsend Stat :WA Zip'98368
site Cc+ntaCC?mom --
Dave Gooding Phone:.
($60 )385-2683 Anil:
PAX:Sitt:{ Mdrc :301 Shine Rd *Port Ludlow s '4,:
Gitp:
ASBESTOS CON—T .ri4R A 6
Cautnactc�/$tzsraesF 1�1aa1e:
la.6bnc: (360 )249.5540 Email Sandia ZO kdaenv,oc+rn-1
KDr&S Environmental, Inc. ---�
Mailiuglicidr,Csw : f 249.3475 Mobile:
P fox 312Ow:Montesano s�gtr:VVA Zip,_
PROJECT tNFOR IATXON ��
Date: �j Cc+npiatioa7ate; ----
Start _~
l I�� 8/ M 1Days: _,.. ) 'otk ShiFr Harms:
5trocruree to be abated: /Sa 5u 8:017 4:QQ
•
Li Total Qitanbity to be S c
xvoaa[Site;LeMay _ — Will this atitucturie b£demolished
' ill all identified asbestos be raa eaoved£fate after asbestos
structure Yes x No removal. Yes_, No
C.beck Material being removed. +oilrzfFrr>ce _Duct InsulationInsult-don
,Paints Plarstet _Cement Board. _,Cement Pipe .Elgin y ��c _T �,.,,,r.,`Ftireptovfi
Other duretibel , $ Ap ' �y G uaLCC C4 Ltl
MBES OS PROJECT CATEGORY ADVANCE NOTIFICATION NON
1-I 259 linear or 11-159 equate feet R F[JNbAl9LB PEE
2- 260-999 linear or 160-4 999 tram feet $ A
3- 100Di� `> 9 999 lineitt or 5 000-49,999 e• feet i0w""""•" a
4• 10 000+ litteat or 50 000 a uare feet 1,3c
TO Wo,kNYG Osys
j Exkie2+BncV $1,300
[ I Ax+nuat -- $50
Annual limit of 260 linear feet or $500
160 sguat-e feet
•
I bare reed ar will abide ky rbe roXddtiors xre fora to Ails emit dat1
lerfamettiele i,+r rbytr aP'tire*v wtrd•teletIamaatal data der,ereled hart's„any dde best e t ear, I do ,arh aft a ie
be bare a a . at for
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fil�Fe.
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Ap�fzca 'Name
7l?3t�B
Date
pTuA1 1�50.RecO'e a
Payment Iola.� IAFp d
j tas pelpp. f�U 1 [ i Cs-h l xRaPProvNd Permit# 5 800,( j Check; # cDemoiirivn Permit
,JUL 23 2009 Ccdit Card as Reci v dire it� Permit# nFt003� _40o
'y� 1 Receive date j�.� a'�
ens: ;rc >rl', / Reviewed 1 :
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44�i � JE DEPARTMENT
UNTY •
W 'L DEPARTMENT COMMUNITY DEVELOPMENT
''' '4.' ''� 621 Sheridan Street • Port Townsend • Washington 98368
. 360/379-4450 • 360/379-4451 Fax
_____,y www.co.jefferson.wa.us/commdevelopment
S NO
Master Permit Application MLA: ('\tc ittil L--
Project Description(include separate sheets as necessary):
./7 Ul. `&h G7 4xir, .-17 1—/--/ C 11 cC
Property �- it
0`2 3 p y 7 3 i(? -Es (acres quar et)
Tax Parcel Number: 3 to a C� Size:
Site Address and/or Directions*Property: `3_0 / A./2c_ / 6u,-� _ (7- 1--t,L,k I V
Property Owner(s)of Reec�yord: /r'/?<C. C /7�'/'.•<2-G c�--�r J 1/cam ( ,'? 7�,1T=-.
Telephone: Z S—s2-C S.:::_? Fax: /� email:
Mailing Address: `/� te9%- st/ Z>>l L'C /7 g.e568•
Applicant/Agent(if different from owner): " .z iv/i,LL fji j q- / 7?2 V,l7E-C;
Telephone: 7,c (73 Fax: email:
Mailing Address: 3Y0 �,�/r�.3`L ,—i U-e PI.
.9Z3 t r
What kind of Permit?(Check each box that apples)
I u ing I Variance(Minor, Major or Reasonable Economic Use)
.emolition Permit i Conditional Use[C(a), C(d), or C]**
I Single Family I Discretionary"D"or Unnamed Use Classification
I Garage Attached/Detached I Special Use(Essential Public Facilities)**
I Manufactured Home I Boundary Line Adjustment
I Modular I Short Plat**
I Commercial* I Binding Site Plan**
I Change of Use i Long Plat**
I Address I Road Approach i Planned Rural Residential Development(PRRD)/Amendments**
I Propane i Plat Vacation/Alteration**
I Allowed"Yes" Use Consistency Analysis !C, — 5 200Shoreline Master Program Exemption/Permit Revisions
i Stormwater Management I Shoreline Management Substantial Development**
I Site Plan Approval Advance Determination(SPAAD)* I Shoreline Management Variance
I Temporary Use i Comprehensive Plan/UDC/Land Use District Map Amendment
I Wireless Telecommunication* I Jefferson County Shoreline Master Program Amendment
I Forest Practices Act/Release of Six-Year Moratorium I Code Interpretation
*May require a Pre—Application Conference
**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 it's 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 h. less Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and
expenses whi • ay in any wa ac• -aga efferson County as a result of or in consequence of the granting of this permit.
I further agree to pro 'de acc: -n. .ht o - to Jeffe son t ounty and its employees,representatives or agents for the sole pur se of application
review and aryy equire. later .-. • .A - • and rig t of e try to this property shall be requested and shall occur only during r gular business
hours.
/ C
Signature: — ' �V/ — I r �C_ Date: .__ .--- '( ---------
The action or actions Applicant will undertake as a result of the iss .nce of this permit may negatively impact upon one or more threatened or
endangered species and ould lead to • p, ential"take"of an e•..ngered species as those terms are defined in the federal law known as the
"Endangered ecies A t"or" SA."Je ers• County makes no assurances to the applicant that the actions that will be undertaken because this permit
has been iss ed wi not lolat the S•. An indivi ual,gr up or agency can file a lawsuit on behalf of an endangered spec s reg ding your action(s)
even if you in co plia ce i h t J-ffers•n Cou ty dev opment code.The Applicant acknowledges that he,she or it h I s in vidual and non-
transferable a ons. itity r a er g t. an. complyi wit they ESA. T licant has read this disclaimer and sins ar da it b-el
Signature:------- - Date: sue _.�� —
,--BUILDER STATEMENT 41111
The signer of thi• stat= ent d es h reb certiy th t they a the wners of the parcel referen here' ,that they are not licensed contractors and that
they will be su ing t e res nsi ity the en raj Cont ctor or the proposed project.
Signature: ate: c�
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: tJ 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:
Li New ❑ Wood Existing: ❑ Sewer
0 Addition ❑ Steel Proposed: Bank ❑ Community System
Alteration/Remodel ❑ Concrete Total: • Height: ❑ Individual System
[ pair ❑ Masonry SEP Permit#
I! 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:
1 Underground Tank 1 Above ground Tank Size of Propane Tank:
1 Heat Stove 1 Cook Stove 1 Woodstove 1 Fireplace Insert 1 Hot Water Tank 1 Pellet Stove 1 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: V U
2f0 Floor Heated Consistency Review: --_.
Other Heated Base fee: -77 06
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee: • •- j
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL A/
Decks 911/Rd Approach fee:
Other TOTAL: $ /"y 5-(.)
'
Receipt Number: t I O OCIO
Cash/Check Number:
ESTIMATED COST(REQUIRED) Date: �a
•Fair market value of all labor and materials foundation to finish _ _ /
Initials: ( -
G:\PennitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc