HomeMy WebLinkAboutBLD2009-00331 O •
DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD09-00331 Received Date 10/1/2009
SITE ADDRESS: 340 E PRICE ST Issue Date 10/15/2009
PORT HADLOCK, 98339
APPLICANT: HELENA R STAPF PHONE: 360-385-0791
PO BOX 262
PORT HADLOCK WA 98339-0262
SUBDIVISION: IRONDALE 1 3
Block: 23 Lot:
PARCEL NUMBER: 961802301 Section: 35 Township: 30N Range: 01W
CONTRACTOR: OWNER/BUILDER PHONE:
OWNER, HELENA R STAPF PHONE: 360-385-0791
if different: PO BOX 262
PORT HADLOCK WA 98339-0262
PROJECT DESCRIPTION: DEMO SFR
Directions
To Site: r A r'
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 10/15/2010.
REQUIRED INSPECTION:
Fin alApprova I: (51—' 2/'"2-t.9
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#BLD09-00331:
1.) Approval of this permit does not provide review of the on site sewage capacity for this
property. Any future development will require full evaluation of the on site sewage system
and designation of a reserve drainfield area. Existing record shows the system was not
inspected or given final approval.
I:\F_BLD_Permit_Propane.rpt 10/29/19
SUILDING PERMIT APPLICASN BL Revviewiew T Tyy331
pe:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD09-00331 Received Date: 10/1/2009
SITE ADDRESS: 340 E PRICE ST
PORT HADLOCK, 98339
OWNER: HELENA R STAPF PHONE: 360-385-0791
PO BOX 262
PORT HADLOCK WA 98339-0262
IRONDALE
SUBDIVISION: Block: 23 Lot: 1-3
PARCEL NUMBER: 961802301 Section: 35 Township: 30 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr DEMO SFR
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP DEM
VALUATION MAIN: 1,088
CODE EDITION: 2006 ADD'L: HEAT TYPE:
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: # OF STORIES:
CONST TYPE: OTHER:
GARAGE: SHORELINE:
CONST TYPE: SETBACK:
DECK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total:
Routinq Date:
1(� i —CC)
Type Amount Paid Bv: Date: Receipt: Approved/Date
Permit $71.00 LYK 10/01/09 111039 APPROVED
State Building Code $4.50 LYK 10/01/09 111039 r
Total: $75.50 OCT (J 2009
Jefferson County Planning
Building Department
SEP-16-2009 03 :49 PM 111 MONTANA^S
J66 6722
P.01
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F Rapmood Office(3641J 942-,2137 Permit
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Permit fie:$ .00 per ire Kew
PROPERTY OWNER 4 GAO,
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DEMOLITION CONTRACTOROg
BusinessName ..1 Cfa:ctc if same as .:; :::�'oeetr aria
Plion Eamon
Onaitc Contact
Mining Addreexraaninallillaing
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D=+..OLI'TION INFORMATION
#of Structi<,m,being demolished S�,Daoc � i ;:11;, I 0 u� D�
Asbestos lament Yes No _ "� 05 i'Q 30 i
Survey atracbted Y. Has an is +rsw bees
gemmed Yes No p
DEMOLITION PRO CT CA.TBGOBiC
[kftomplete Demolition
l )Training Fun--nitre Agency:
Renovation,Ake ion,Rein Maintenance,or otter.'Comeniairmi
1 haw road aid sill midi by the ceirelitiesr ret forth is thin
frerrait aid erg aelerealsse all starter hsr km resume'sad the iafir eatial _ l is
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JEFFERSON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street• Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
www.co.jefferson.wa.us/commdevelopment
�"IS87N 3
Master Permit Application 1 3
MLA: e_,
Project Description(include separate sheets as necessary):
'' ,/' C>I / %, / /i cI -C
Tax Parcel Number: a CZ CI
- Property Size: (acres/square feet)
Site Address and/or Directions to Property:
ri✓L' 1
- / 1 e .
• -1' kc t. is e'-'. 3
Property Owner(s)of Record: h ' _ AINET , 1 . c 4
Telephone: ,:,�C 3 3_-, !.2y/
J Fax:mil-d--=a y 5 / 7e y email:,&' " .
Mailing Address: ' 1 "15 Ti/le s i-1v '` '„` srw C��4�'�l�'r'�-
Applicant/Agent(if different from owner): r _ �G '
Telephoner Li r 2 /1 S /4/1) 1 12E% Fax: S J ice+-.—
Mailing Address: email:
What kind of Permit?(Check each box that applies
.:uilding 0 Lot or Road Segregation
s I Demolition Permit 0 Critical Areas Stewardship Plan
❑ Single Family ❑Garage Attached/Detached 0 Con dit onalninor U a[C(a)rC(d) or C]able Economic Use)
*
❑ Manufactured Home 0 Modular 0 Discretionary"D"or Unnamed Use Classification
❑ Commercial*
❑ Change of Use 0 Special Use(Essential Public Facilities)**
0 Boundary Line Adjustment
❑ Address ❑Road Approach
❑ Home Business ❑Cottage Industry-- 0 Short PlatSite
❑ Propane ❑Binding Plan**
0 Sign 0 Long Plat**
0 Planned Rural Residential Development(PRRD)/Amendments** •
❑Allowed"Yes"Use Consistency Analysis
❑Plat Vacation/Alteration**
0 Stormwater Management
SPAAD 0 Shoreline Master Program Exemption/permit n/permit Revisions**
❑Site Plan Approval Advance Determination
❑Temporary Use ( ) 0 Shoreline Management Substantial Development**
❑Wireless Telecommunication* 0 Shoreline Management Variance
of Six-Year Moratorium 0 Comprehensive Plan/UDC/Land Use District Map Amendment
❑ Forest Practices Act/Release
*May require a Pre-Application Conference 0 Tree VegetationJeffersen County Shoreline a Master Program Amendment
0 Tree Request
Please identify any other local,state or federal permits required for th saprop sal if known:
I hereby designate DESIGNATION OF AGENT
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
,her its dg . A materi falsehood Jar amaterial fct ma by we/age wi respect to s ationpacket
may
his h result in this permit beingny null and void.
I further agree to saveknowle ,indemnifye and hold harmlessh000r Jeffersonny Counn ty againstia alla liabilitiedes,judgments,court coststh, reasonable attorneapplicys feespa and
expensesor which may in any way accrueal against Jefferson County asof a resumlt of or in consequence theo ofn ther grantingnt of this permit.thi
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 shy wants,prior notice.
Signature: : . ,
Date: /rC f C
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-transfer9 a responsibility f� -,adhering complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: ... .t _ ,:- � c
>l�- Date: /�� - / _
/�
• •
BUILDER STATEMENT
The signer of this statement does hereb(Certify
General tt tthey
ar Owners of the
the proposed cellprojed referenced herein,that they are not licensed contradors and that
they will be assuming the responsibility of e _
Date: /eD -
ignature: —� /
1 PHONE: Fes'
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: ( ) ( )
r) -{- EMAIL:
► MAILING ADDRESS: a n 1 I WAINS
CONTRACTOR'S LICENSE NUMBER
NUMBER: PHONE ( ) Fes'( )
ARCHITECT/ENGINEER: EMAIL
MAILING ADDRESS:Project Type: F e Type: Bathrooms: Shoreline: Type of Sewage Disposal:
•❑ Steel Proposed: ❑ Swer
Wood Existing: e
Bank ❑ Community System
❑ New
O Addition Total: Height: ❑ Individual System
❑ A ❑ Concrete SEP Permit#
❑ Repair ❑ Masonry —9/Demolition Bedrooms: Water Supply:
Existing:
❑ Other: Setback: ❑ Private well ❑ Two Party
Proposed: ❑ Public
Type of Heat: Total: Name of System:
•
If this is a Commercial Project you must answer the following: Number of ADA Parking Spaces:
Spaces: Current: Proposed:
Number of Parking p Proposed .
Number of occupants(includes owners,tenants,employees,etc) Current Will you have Food Service? Yes / No
IBC Occupancy: —
IBC Type of construction:
If this is a Pro ane Tank and/or A liance Installation Size of Paopaee itemsT below
that a
Underground Tank Above ground Tank
i Heat Stove i Cook Stove l Woodstove I Fireplace Insert i Hot Water Tank i Pellet Stove I Other
Is this artrIliance bein installed in a Manufactured I Mobile Home? Yes I 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,
includin• the reserve area r v�siQil
S.uare Foots•e Current Pro•osed Review:
r�B --
Main Floor Heated EH BId App U ;
Consistency Review:
2 ' Floor Heated
Other HeatedIiii ' ®_
Additional Section:
Heated Basement
State Surcharge fee:
Unheated Basement WM
Pot Water Review fee:
Other Unheated
SUBTOTAL
Garage/Carport
911/Rd Approach fee: ______.---"
Other
Decks
_ TOTAL: MEMReceipt Number:
, EOM
Cash/Check Number: IIMINI
•
ESTI
MATED COST(REQUIRED) Date: III �.i.
.Fair market value of all labor and materials foundation to finish Initials: