HomeMy WebLinkAboutBLD2010-00094 •
DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD10-00094 Received Date 3/31/2010
SITE ADDRESS: 60 LILLIAN ST Issue Date 4/6/2010
CHIMACUM, 98325
APPLICANT: MAUREEN R KUDRONOWICZ PHONE: 360-385-7012
ROBERT A JOHNSON
PO BOX 384
PORT HADLOCK WA 983390384 1+
SUBDIVISION: OLSON'S TO IRONDALE Block: Lot:
PARCEL NUMBER: 978300104 Section: 10 Township: 29N Range: 01W
CONTRACTOR: OWNER/BUILDER PHONE:
OWNER, MAUREEN R KUDRONOWICZ PHONE: 360-385-7012
if different: ROBERT A JOHNSON
PO BOX 384
PORT HADLOCK WA 983390384
PROJECT DESCRIPTION: DEMO EXISTING M/H -SEE BLD10-76
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 4/6/2011.
REQUIRED INSPECTION:FinalApproval: /G ' / '1137
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
BOLDING PERMIT APPLICATIM BL 094
Revv iewiew T Tyype:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD10-00094 Received Date: 3/31/2010
SITE ADDRESS: 60 LILLIAN ST
CHIMACUM, 98325
OWNER: MAUREEN R KUDRONOWICZ PHONE: 360-385-7012
ROBERT A JOHNSON
PO BOX 384
PORT HADLOCK WA 983390384 OLSON'S TO IRONDALE
SUBDIVISION: Block: Lot: 1+
PARCEL NUMBER: 978300104 Section: 10 Township: 29 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION DEMO EXISTING M/H - SEE BLD10-76
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:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: PUD
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Ts�tal:-
Routing Date:
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $71.00 LYK 03/31/10 117492
State Building Code $4.50 LYK 03/31/10 117492 �.i
Total: $75.50 AVR ( LUfiit
Jefferson County Planning
&Building Department
aI - —161.46' -
Rese • area
drainfield
North
85.42' [ �y �i
Sept iiu soN C�iiUONIY scale r" =25'
mer
A
Existing
14 l Hone 24x5,2 162.15'
To F.e
IFMgl4
ceb
4x41anding
L 1 .0e V
URM
41 42.01' -
Existing
Proposed 1MD I
Manufactured
Home
28x69 I 50.00'
162.85' r_ I I — —
4x4landin— g ��
P
` t
`Owl 45.94'
iZY
Exlsting
driveway
48.61' I i2x46
I I
II water
meter
161 OW
60 Lillian St
Johnson, Robert & Maureen Buy-Rite Homes
60 Lillian St Chimcum 259403 Hwy 101 Sequim
Parcel 978300104 360-681-0777 fax
360-681-0780
co it 1 r au
MAR 22 2010
1
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��Q`G SGi0N C1tm, Olympic Region Clean Air Agency
pv� �,•••‘......\1 2940-B Limited Lane NW
'i'A Olympia,WA 98502
cl (360)539-7610•FAX(360)491-6308
Port Angeles office (360)417-1466 Demolition Permit
''i• O R CA A ��`!" Raymond Office(360) 942-2137
`p,..-,,„B r* '`' www.ORCAA.org
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!llcasoM•4aSp�' 0,..
[ I Commercial Structure—Permit fee: $60.00—10 working day wait period
04 Owner occupied residential dwelling—Permit fee: $35.00—Prior Notice
PROPERTY OWNER
Name: Phone: Email
I�ob r - h'1C�u.- een r on FAX g�0°) 38S--7aiz rr,ce wq Q er�,�v
Mailin Address: ( ) Mobile: ( 3t�_ ny3 -
1; City: State: Zip:
ddr City:O. P� 0 X 3 q q Po r�- cto_l 1 o cic Ut) a� qi 3 39
Site A�� 1 I c t c ki S T' o State: Zip:
C h l mai°I B n^ LAD a 91-2,,z-T-
DEMOLITION CONTRACTOR[ ]Check if same as property owner information
Bii.liness Name: Phone: (3 41 335-7(o c)3 Email:
e % h �u�� � eeC{e �i`n � FAX ( )
Onsite Contact Phone: ( ) Mobile: p)
(A ff -P�-1— FAX: ( ) 3 0 I- 12.2,1
Mailing Address: I
9 tate• tr3,e___c____
t �O)C qo C'l �(n' .CC-R--iIA Sw
DEMOLITION INFORMATION
#of Structures being demolished: Start Date: Completion Date:
Asbestos present Yes )( No Survey attached x Yes No Has all identified asbestos been
removed Yes No
DEMOLITION PROJECT CATEGORY
l i J Complete Demolition
[ ]Training Fire—Fire Agency:
[ ]Renovation,Alteration,Remodeling,Maintenance,or other Construction
[ ] Emergency—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 removed and the information in this application and supplemental data
described herein is, to the best of my knowledge,accurate and complete.
�'Yl 0.,u,�r,e S�,h rn S Oil C 1 A �, Or\ 3 31 _ 10
Applicant Name Signatilire Date
Date Application Received Payment Info. '/] Approved Asbestos Permit
RECEIVED [ ] Cash [ ] Disapproved Permit# ASBOO
[ Check # l0"7 Demolition Permit
APR 0 1 2010 [ ] 3t Card
r o I
Review date: ' s/7_/ 1 0 Permit#I D DEM00�Le1(_0
Receive date:''`1 /I ,f
/ i Reviewed by: 1 '�"
�R4r�k7'4 )! Agency Use Only Agency Use Only Agency Use Only
10/21 !�� OVER
�. N cod JEFFERSON CONTY
4
W \. ` DEPARTMENT OF COMMUNITY DEVELOPMENT
'' 621 Sheridan Street • Port Townsend • Washington 98368
360/379-4450 • 360/379-4451 Fax
�q� N3t�p'� www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: ( rxA e -6;" f
Pr, 'ect Description(include separate sheets as necessary):
(l ) CSC (sr" ! K- -:t
Tax Parcel Number: q 7-s 3 00 1 O c( Property Size: . ij c (acres/square feet)
Site Address and/or Directions to Property: ,, `` v / I(.00 L 1 1 &1 Sf cJ r l ar 1.rv1 6 Q h Lr .� A`I"G 6 rt odl�' �Property Owner(s)of Record: �
Telephone: 3(0 6 - S- 7 012, Fax: email: nn o p b er-I-- e. $, con-1
Mailing Address: p 0 90tic 38 L( Por-I- 1-1-aA l n ck_ t )&_ ct 331
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
.W F-t kind of Permit?(Check each box that applies 0 Lot or Road Segregation
a: i ding 0 Critical Areas Stewardship Plan
•emolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
0 Single Family ❑Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]**
❑ Manufactured Home 0 Modular . 0 Discretionary"D"or Unnamed Use Classification
❑ Commercial* 0 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**
❑ Propane 0 Long Plat**
0 Sign 0 Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration**
0 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 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 want prior notice.
___...--Signature: 1 A t o 4 ra� Date: 3 • 3 I - I 0
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 tederal 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-transferable responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
,_,„-signature: m drok-A---dC.-.._ Date: 3 • 3 1. • to
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: Jt... J n L41./.10r,. Date: 3 - Z, i - I O
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: ❑ Individual System
❑ Repair ❑ Masonry SEP Permit#
❑ Other: Bedrooms: Water Supply:
❑ Demolition Existing: 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 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 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 Only Amount Revision
Main Floor Heated EH Bld App Review:
22 Floor Heated Consistency Review:
Other Heated Base fee: r (
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee: 3Z)
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL
Decks 911/Rd Approach fee:
Other TOTAL: $ t-1 `*
Receipt Number: 1 q1-1 °iZ
Cash/Check Number: �(p�
ESTIMATED COST(REQUIRED) Date:
(��
*Fair market value of all labor and materials foundation to finish Initials: — j
L
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc