HomeMy WebLinkAboutBLD2010-00204 • •
DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD10-00204 Received Date 6/7/2010
SITE ADDRESS: 361 S BAY WAY Issue Date 8/24/2010
PORT LUDLOW, 98365
APPLICANT: LAWRENCE R GEARHEARD PHONE: 206-842-1498
MICHAEL F GEARHEARD
10674 NE VALLEY RD
BAINBRIDGE ISLAND WA 981101339 57
SUBDIVISION: OAK BAY WATERFRONT Block: Lot:
PARCEL NUMBER: 976800037 Section: 29 Township: 29N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
OWNER, LAWRENCE R GEARHEARD PHONE: 206-842-1498
if different: MICHAEL F GEARHEARD
10674 NE VALLEY RD
BAINBRIDGE ISLAND WA 981101339
PROJECT DESCRIPTION: DEMO EXISTING CABIN
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 8/24/2011.
REQUIRED INSPECTION:
FinalApproval: 1/
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
• BUILDING PERMIT APPLILION BLD10 00204
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD10-00204 Received Date: 6/7/2010
SITE ADDRESS: 361 S BAY WAY
PORT LUDLOW, 98365
OWNER: LAWRENCE R GEARHEARD PHONE: 206-842-1498
MICHAEL F GEARHEARD
10674 NE VALLEY RD
BAINBRIDGE ISLAND WA 981101339 OAK BAY WATERFRONT
SUBDIVISION: Block: Lot: 57
PARCEL NUMBER: 976800037 Section: 29 Township: 29 N Range: 01 E
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP DEMO EXISTING CABIN
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: ALT
WATER SYSTEM.
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total:
Routin Date:
6-10
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $71.00 LYK 06/07/10 117824
E"'
State Building Code $4.50 LYK 06/07/10 117824 �� �
Total: $75.50 AUG a'f 201U
Jefferson County Plannin1
&Building Department
• •
-- GION'CI,E��_, Olympic Region Clean Air Agency
/ti�`S BGPN� 2940-B Limited Lane NW
°^v yc'�a; Olympia,WA 98502
(�/"'� of (360)539-7610•FAX(360)491-6308 •
,` i Port Angeles office (360)417-1466 Demolition Permit
'\�-4 ORCAA 4#7 Raymond Office(360) 942-2137
\c�Je`W�.,=acssoa•�uoN, */ www.ORCAA.org
[ ],. Commercial Structure—Permit fee: $60.00—10 working day wait period
3 Owner occupied residential dwelling—Permit fee: $35.00—Prior Notice —0 /. S3��r. 2r0A--
PROPERTY OWNER
Name: Phone: 0 4Z ail �u a , _
AA i c A, l� 4tArzA-4*_,-.4-rz_b FAX: ( ) Iv1bile: ,7) _
Mailina Address: City: State: Zi
;441--A/ 144(1 PJ PAO b P.i.Jt 26 OA' MO
Sate Address: ty: j �� Stsatte: Zi :
Il ,rL Li 1
DEMOLITION CONTRACTOR. Check if same as property owner information
Business Name: Phone: ( ) Email:
FAX: ( )
Onsite Contact. Phone: ( ) Mobile: ( )
FAX: ( )
Mailing Address: City: State: Zip:
DEMOLITION INFORMATION
#of Structures being demolished: Start Date: Co ple on Date:
ijjo1,1 20Ct9 "u / 1� �t
Asbestos present Yes No Survey attached x Yes No Has all fiflennfied ashes been
removed��Yes No
// 11 • D
DEMOLITION PROJECT CATEGORY
Complete Demolition
r ]Training Fire—Fire Agency:
[ ]Renovation,Alteration,Remodeling,Maintenance,or other Construction
[ ] Emergency—Additional Fee of$50.00 (must be accompanied by Government Ordered Declaration-Commercial only)
I have read and will abide by the conditions set forth in this permit and any addendum thereto. I do hereby certify
that all identified asbestos has been removed and the information in this application and supplemental data
described herein is, to the best ofmy knowledge, accurate and complete.
'1Z,c(e,e_ C.6fC7$ LP"—r—10
Applicant Name Sign re Date
Da�� i EHcI� d Payment Info. i >4 Approved Asbestos Permit
[ ] Cash 4P3-3 [ ] Disapproved Permit#. I b ASBOO 303
JUN O 9 2010 m Check: # 1( .,5 Demolition Permit
[ ] Credit Card Review date: CP/(5-/iO Permit# tO DEMOO D(a
O C�
Receive date: G / 9 /10 Reviewed by:
Agency se Only Agency Use Ony Agency'Use y Agency Use Only
10/21/08 OVER
•
•
��SON cps JEFFERSON COUNTY •
• ' 4
7..3 DEPARTMENT OF COMMUNITY DEVELOPMENT
`4 621 Sheridan Street• Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
p'$ www.co.jefferson.wa.us/commdevelopment
S`BING .
Master Permit Application MLA: KID MLA Qa)1
Project Description (include separate sheets as necessary):
61 E-4-rL- -CLD CA u t De vt.to Li i 6I � �•
Tax Parcel Number: C Tip bave,3 Property Size: A_,' (acres/s re fee)
Site Address and/or Directions to Property:
3 to L 5_, 1;4 Li LL)A-Y �drL� Lu i��occ�
Property Owner(s)of Record: I., ( A-pb 1M
Telephone: ZDID QZ 116.i3Fax: email: bu .Fq, j,cDAI
Mailing Address: 101074 NE_ VA�L.E� j2.04D y RAt,J,9,�1d9e_ 1S . 129,4 qF rIc 1U!
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies ❑Lot or Road Segregation
Litt uilding ❑Critical Areas Stewardship Plan
V Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
VI Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a), C(d),or C]**
O Manufactured Home .0 Modular 0 Discretionary"D"or Unnamed Use Classification
O Commercial* 0 Special Use(Essential Public Facilities)**
O Change of Use 0 Boundary Line Adjustment
O Address ❑ Road Approach 0 Short Plat**
O Home Business ❑ Cottage Industry ❑Binding Site Plan**
❑ Propane ❑Long Plat**
❑ 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 ❑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 in pections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the applica' h r she wa s prior noti . -- /
Signature: Date: (.//e ` L' 1D
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;ndangered species as those terms are defined in the federal law known as the
"Endangered Species Act"or"ESA."Jefferson County makes r,o assurances to the applicant that the actions that will be undertaken because this
permit has been issued will not violate the ESA. Any individual,,Troup 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 ,evelopment code.The Applicant acknowledges that he,she or it holds individual
and non-transferable res si ty for adh ring to and c9FrVinq with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: �� ��/f� Date: tV —le, —10
0 --O
t BUILDER STA ERIEN-I'
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 ass ming e r pon�f the Gener- on actor for the proposed project. M
Signature: Date: L i, `1 9
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: Bathrooms: Shoreline: Type of Sewage Disposal:
6New o Existing: ❑ Sewer
Addition ►:■ Steel Proposed: _ Bank ❑ Community System
O Alteration/Remodel ■ Concrete Total: _ _ Height: Individual System
❑ Repair 0Masonry
30 f 8EP Permit# I 0+h
Bedrooms: Water Supply:
c Demolition � Other: Existing: Setback:
— X.Private well ❑ Two Party
Type of Heat: Proposed: / ❑ Public
1 t.,&D D S�V� 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 j Above ground Tank Size of Propane Tank:
1 H• eat Stove 1 Cook Stove i Woodstove 1 Fireplace Insert i Hot Water Tank i Pellet Stove i Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes /403
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 O li. ;�" Revision -
Main Floor HeatedAiiiitiot EH Bid App Review: 7 3. UQ
2nd Floor Heated 7L 7 — Consistency Review: 7 / G 0
fJ - . 1.
Other Heated Base fee:
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee: Y. G
Other Unheated �-Pot Water Review fee:
-Garage/Carport SUBTOTAL
Decks 911/Rd Approach fee:
�.3o r
Other TOTAL: $/J_(c(`S
—
Receipt Number: // 7` 2.Y
gr Cash/Check Number: /
ESTIMATED COST(REQUIRED) r Date: / _ l�
,;
•Fair market value of all labor and materials foundation to finish �co 70 D(� Initials: . `l •,'*"—
Ll83 x goff+) -
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