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HomeMy WebLinkAboutBLD2009-00351 • 0 DEMOLITION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD09-00351 Received Date 10/14/2009 SITE ADDRESS: 41 HILLER DR Issue Date 2/2/2010 PORT HADLOCK, 98339 APPLICANT: JOHN THOMA GRAHAM PHONE: 206-783-4527 9504 PHINNEY AVE N SEATTLE WA 98103-3026 13 SUBDIVISION: HILLERS WF TR INC TL Block: Lot: PARCEL NUMBER: 960300010 Section: 7 Township: 29N Range: 01E CONTRACTOR: OWNER/BUILDER PHONE: OWNER, JOHN THOMA GRAHAM PHONE: 206-783-4527 if different: 9504 PHINNEY AVE N SEATTLE WA 98103-3026 PROJECT DESCRIPTION: DEMO EXISTING SFR 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 2/2/2011. REQUIRED INSPECTION: FinalApproval: 5(2- I\ 0 vi 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 BLD09-00351 •UILDING PERMIT APPLICP iN Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD09-00351 Received Date: 10/14/2009 SITE ADDRESS: 41 HILLER DR PORT HADLOCK, 98339 OWNER: JOHN THOMA GRAHAM PHONE: 206-783-4527 9504 PHINNEY AVE N SEATTLE WA 98103-3026 HILLERS WF TR INC TL SUBDIVISION: Block: Lot: 13 PARCEL NUMBER: 960300010 Section: 7 Township: 29 N Range: 01 E CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP DEMO EXISTING SFR TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP DEM MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2006 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: SHORELINE: GARAGE: SETBACK: CONST TYPE: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Dattre::' (ll/ - 10 - I Type aid Bv: Date: Receipt: Approved/Date Permit $71.00 LYK 10/14/09 111092 APPROVED State Building Code $4.50 LYK 10/14/09 111092 Total: $75.50 FEB 2010 Jefferson County Planning & Building Department i)gSON CO JEFFERS COUNTY • W 4 i DEPARTMENT OF COMMUNITY DEVELOPMENT 1-37 `' 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax „� , ,c0 www.co.jefferson.wa.us/commdevelopment KING Master Permit Application MLA: lap MCA 2,E:0-± Project Description(include separate sheets as necessary): d /mod fl/�7iq __ _a/OfA/ige' Tax Parcel � Property '/) Number: 9/11 4 0// Size: � . w� 3f`, (acre square feet- ) Site Addres and/or Dire ions to Property: 7/ /// Z)/. /DZ T /—' &)/ e. Property Owner(s)of Record: ....41/.//(/ 7A4i, i, er/t'/f 44.7-72 Telephone: ! 7_G Fax n email: 1?i7 I.61 �7'z��/?i1S/r Mailing Address: YS l p //V //T y .44 ; /fit- a i. Q /v ApplicantlAgent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies Building ❑Variance(Minor,Major or Reasonable Economic Use) IV Demolition Permit 0 Conditional Use[C(a),C(d),or Cj** ❑Single Family 0 Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home 0 Modular 0 Special Use(Essential Public Facilities)** ❑ Commercial* 0 Boundary Line Adjustment ❑ Change of Use 0 Short Plat** ❑ Address ❑Road Approach 0 Binding Site Plan** 0 Home Business 0 Cottagelndustry ❑Long Plat** ❑Propane 0 Planned Rural Residential Developrent(PRRD)/Amendments** ❑Sign 0 Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** ❑Stormwater Management 0 Shoreline Management Substantial Development** ❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Variance ❑Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment 0 Wireless Telecommunication a 0 Jefferson County Shoreline Master Program Amendment ❑Forest Practices Act/Release of Six-Year Moratorium 0 Tree Vegetaion Request *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 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. S access and right entry II be assumed unless the applicant informs t e County)n writing at the time of the application t ath��r wan • r notice. Signature: Z�� �2G-� .-c-•f-O '.e- Date: /t.� / 1 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 corn lance with the erson County elop nt code.The Applicant acknowledges that he she or it h ds individual and non-transferable r pon lity or adhe. o and complyi 'th t SA. The Applicant has read this disclaimer d sips `` dates it below. Signature: -4 Date: ( / CO47 C:\Documents and Settings\carat\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.doc • • BUILDER STATEMENT The signer of this statement does hereby c fy that they are t Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assumin th is nsibili 156 General Co or f he proposed project. Signatur Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: 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: ❑ New ❑ Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: Height: ❑ lndi dual System ❑ Repair ❑ Masonry SEP'.P4rmit# Li 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: °Underground Tank °Above ground Tank Size of Propane Tank: ❑Heat Stove 0 Cook Stove 0 Woodstove 0 Fireplace Insert 0 Hot Water Tank 0 Pellet Stove 0 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 ,z" EH Bld App Review: CA-.1 SFP-- 2na Floor Heated Consistency Review: 1+1 Other Heated Base fee: rl Mezzanine Additional Section: l Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: t Other Unheated Pot Water Review fee: ---_, 6arageiCarport SUBTOTAL Decks /ems V 911/Rd Approach fee: Other TOTAL: $ ' 15 .5D Receipt Number: I ' 10 t Z Cash/Check Number: 6(915— ESTIMATED COST(REQUIRED) Date: .Fair market value of all labor and materials foundation to finish I C-r i Ll Initials: �� C:\Documents and Settings\caral\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.doc • 4"--6_ I J — �3I �� fiN 'L „` Olympic Region Clean Air Agency ., ' 2940-B Limited Lane NW ,, Ohympia,WA 98502 J MI (360) 539-7610•FAX(360)491-6308 -' Port Angeles office(360)417-1466 Demolition Permit € 4 , ',c" ORC .t1 4'-'F Raymond Office(360) 942-2137 µ4f = . „ r+ www.ORCAA.org i t J ,Commercial Structure—Permit fee: $60.00—10 working day wait period tvr Owner occupied residential dwelling--Permit fee: $35.00—Prior Notice PROPERTY OWNER Named, �' •'�`t�� .'� Phone 4 '7 tSS '' ���_� �'dh � m�'�7. Email: �'°r.a_s -+rx, -.e 0y -FAX: (. ). Mobile: ,TViaiiina Arlriracc•- / to �) i��0...4.96- City: State: Site Address: j ' ate s t Cnty: r' i�fJ r�1 „/,� ,`4a • . , ,/ State: Zip: P DEMOLITION CONTRACTOR[or/Check if same as property owner information Business Name: Phone: ( ) Email: FAX ( ) Onsite Contact Phone: ( ) Mobile: ( ) E a..X: ( Mailing Address: 1- City: State: I Zip: DEMOLITION INFORMATION of Structures being demolished: Start Date: - -_ ICompletion Date: Asbestos present lures No Survey attached td Yes _.No Has all ide tified asbestos been _ removed - Yes No - DEMOLITION PROJECT CATEGORY [4 Complete Demolition [ ]Training Fire—Fire Agency: [ ]Renovation,Alteration, Remodeling,Maintenance,or other Construction [ [ 1 FWergency—Additional Fee of$50.00(must be accompanied by Government Ordered Declaration-Commercial only) I have read and will abide by the conditions set forth in this permit and any addendum thereto. I do hereby certify that all identified asbestos has been reproved and the information in this application and supplemental data described herein is, to the best of my knowledge, accurate and complete. Applicant .44. f!)- ?4, - -17. -1 :,: 1 09 :4 ; C =-- 1/1 "`~; 4 C� pp t Name Signature Date DaiRECEIVED Payment Info. pproved Asbestos Permit [ ] Cash [ ] Disapproved Permit# O 'ASB00 Z s8 DEC rrn [. Check: #2.�1� UCt,. Y 9J LUUJ [ ]Credit Card `Z � c� Demolition Permit Review date/ / //C7 / Permit#d _DEM00 2-S ) . f A A Receive date:% ./L Reviewed by: /� '"�fl" @ <gen9 Use Ott T enc� Ls Ong r4genry Use Only '0/2 I m e O rr77 Approx. Location of X-House & Deck "i 30, i ur„1 relocate *Hydrant & remove Curb Stop x-Well �.i x-Power Phrde r Enclosure Water x'E _„ _ — + neboxUg �— — — -- --- ---- — — — �� E125. 06 10' o° " relooated water upply <v. �',� P 12 0 G �i loped rut -250 gallon � .. ugppropane EL,@20.7yt...-:.... ... 1 ©i kank L .z �Slo e— i i I p� 1 i X-Oak T+Fee- i \ I, IfT (70sf) i � 10' 0" 24deep x-house & deck �� _ _ lv/ 12' co Pr 5 0 to be demolished Area of Impervious Surfaces: ��� 1312 sf House _..... 297 sf Driveway Nd r f ,--...__ .._ . _ ... �—_•-- Mt L 1-CB, old lid ' 77 sf Entry .« 4" Rw -----20 sf ; / Gravel E c)22RWP.7 1706 sf otalhan In have Edge f 14' wide paved road O� Driveway I in o nd 0" / Overhanging 55 p cp� 297sf s n conduyl enfry gravel - i.I ........... .. . x-sewer in conduit IfT (38sf) \ / '24" (jeep Use 2 1/2" Dia. PVC Sch40' Casing ; —10, 0" ' � ��e� 3 7/$" with sealed joints from 10' / from Water Main across road. 1-P II ' Line to have 2' of separation 0' ' -__ i 'i � 20 1/4 �C`nnc:•R / crossingwhere below Water Main i •' I ' � � e A ', (invert 42"down) / 38 -- �� _ ----- 0 3/8.\ 5' O'�etback' + ' ------ ----- - -- - — - — —_-- - — - — - — - — --- —.--- — --- — 93.92' / I ; I 10' 4" I • Approx. Location of x-House & Deck / W � I x-hydrant relocated �% �._ 22' 11 7/16✓ - 28' 0 5/16" 1 -beach front setback / defined by douses / 25' 1 1 /4" 27' 3 3/8" FLOOR ELEVATIONS: 32'-4" Bedrooms 23'-0" Main Floor 14'-3" Basement 11.36' Top of Seawall x-Low Retaining Wall 14' t" comer of h L ,ti I F.1:1 1 6^, . I , SS�I.AN / dated - O byJEFFERSO CO Power Pole i SIGNA' N—J� I \' x-Effluent Transport Line corner of house 52' 10 3/16" Class 200 High -Density I Polyethylene, 2" 2" Dia. ! (copper tube size) 1 i @ -36" Depth, UNO. ram, Oak Bay House Project by Thom Graham 9504 Phinney Avenue North, Seattle, WA 98103 -lam ° (206) 783-4527 Legal Description: (\ jj _ Tract 13, Hiller's Waterfront Tracts, ^3 ; � \J IS _ °-0" (g6) I together with Second Class Tidelands o _ Y, g° 8' 16, 24' 32'- Tax Lot: #960 300 010-------- In - - - Gov't Lot 3, Sec. 7, T.29N.,R.1 E., WM - - U co N m Cz m 114 td r_. pin, top of wall (not property corner) Feuary 10,82010