HomeMy WebLinkAboutBLD2010-00223 • •
DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD10-00223 Received Date 6/21/2010
SITE ADDRESS: 473 DIETZ DR Issue Date 10/7/2010
QUILCENE, 98376
APPLICANT: HAROLD R BOHMAN TRSTEE PHONE: 760-945-8913
CATHLEEN C BOHMAN TRSTEE
4986 NIGHTHAWK WAY
OCEANSIDE CA 920565441 TX 8+
SUBDIVISION: Block: Lot:
PARCEL NUMBER. 501032008 Section: 3 Township: 25N Range: 01W
CONTRACTOR: NIEMAN CONSTRUCTION CO PHONE: (360) 434-0717
P. O. BOX 846
QUILCENE WA 98376-0846
(fi360) 765-3529
Contractor's License NIEMACC018MZ Expires 8 /201
OWNER, HAROLD R BOHMAN TRSTEE PHONE: 760-945-8913
if different: CATHLEEN C BOHMAN TRSTEE
4986 NIGHTHAWK WAY
OCEANSIDE CA 920565441
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 10/7/2011.
REQUIRED INSPECTION:
FinalApproval: 11- 1 C
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
BLD10-00223
BUILDING PERMIT APPLIIPTION Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD10-00223 Received Date: 6/21/2010
SITE ADDRESS: 473 DIETZ DR
QUILCENE, 98376
OWNER: HAROLD R BOHMAN TRSTEE PHONE: 760-945-8913
CATHLEEN C BOHMAN TRSTEE
4986 NIGHTHAWK WAY
OCEANSIDE CA 920565441
SUBDIVISION: Block: Lot: TX 8+
PARCEL NUMBER: 501032008 Section: 3 Township: 25 N Range: 01 W
CONTRACTOR: NIEMAN CONSTRUCTION CO PHONE: (360)434-0717
P. O. BOX 846
QUILCENE WA 98376-0846
Contractor's License NIEMACC018MZ Expires 8/15/2010
REPRESENTATIVE: TOM SCHUCH PHONE: 253-217-2049
27044 12TH AVE S
DE MOINES WA 98198
PROJECT DESCRIPTION DEMO EXISTING SFR
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:
OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: k.Total:
Routing Date:
COY7 I —I e
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $71.00 LYK 06/21/10 117886 A PPROVED
State Building Code $4.50 LYK 06/21/10 117886
Total: $75.50 OCT 7 2010
Jefferson County Planning
& Building Department
10/07110 08:40AM THEUPSSTORE 7605983593 p.02
AUG705/2010/THU 09:26 AM ORCI) FAX No, 3604916306 P. 002
DEC-08-2004 220.3 r m: Ta 491,6308 P.E/E
Nod o." eo 2`s Ariodt — al( Nse, !0 Ark i)4$ ra
eft 4 +»+!! .r-
iaor�`c' �tr
.*4.- p Olrrnpic Region Clean.Air A
. E. 't;: 294U-1i]Armed Iane NW 'Owner Occupied
A\ Olympia.,WA 9R302
t (360)539-7610•FAX(960)'491-63C8 Residential Asbestos
' 0 RCA A � r Part Angeles Office(360) 417-1466 1 �]
\\ ` x .rc :'•/ almond Office(36 9�t2.2137 I Removal Permit
.vxrar.C7RC'A1'+.rnR
*** 'his permit valid only for residential horfleownek residing in the dwelling***
Permit fee: $30.00. Nap-refundable.
AFFLICANI, i
Name: Harold P. + ettl-i t.?o n 0 . .Tlio (7�od l9�15.,gq1, Email:�h cbo hasum eau.
�d� maxu _ 1 A ( 5 ... MI)bile:(/!e$)tag_gy•t1
Mailing,A Areas: Ca date
W R Sto �it�ti au.�tc u, y 'City:
�, An - , f ,-
Site Addxecs: zi
'-J 1 1"04 a 1 v e, ct i, l c.2io sr A i 314)
PRO]I3C 'INt ORMA,xioN
Soe tt Dar : ' { omIethnl l.�•atoc Work Sift Jan�:) Work Shift Hours:
9)5/10 8 _/.t;Q _..._M T W,X It.6,Fc„,,.Sa....Su s —ci
#of Smactures: Total Quantity to be Sgna«e Feet Linear Feet
Name and location of D'. osa1 Sire Will this suo'cturc be demolished . ` asbestos
o#y t'e Vi eu r#' .PO44 Okr.haxti removal XYes No
Will all identified asbestos be removed from the
structure .,.es Isle
Check Material being removed:
TIoilrs,Fv.cnace , Duct liisalation ,,,,,,.,`,Pipe Insulation _f=ir*prooEng Paints '
'l*Atce Cement 3oard Cenent Ptpc . . Flouring . _ .Roofing
Tutored Coating Other,..,,
i
I have read and will abide by the conditions set forth in MA pets itiand any addendum thereto. I do
hcrrbv certify that the information in this application axed upplcmcntal data described herein is, to the
best ofmy knowledge,accurate anti c:ornpk:tc,
• _ 4/1.46__..
Al�pbc r t iam e Signature pats.
Ii •
r Payment info, Nt<Armovecl • Asbestos Permit
j 1 Cash Di approved Permit# 10 ASB0(3O '
AUG 0 3 ,2010 11 Qua.: # --- Demolition Pcnruit
I 1 Credit Card Itertriem^rlare ,'l.2/ it) Permit# DEMO0- -a' C?
• O 1\CAA ILecaraa ce,fig J, / O ReFi evrd bc- e}: 1 T• l 1 No
Amer ldsr Onk Asotc y t.T.re 00 eitexer L..te.Oulr ,euq Lhe<)rrlr
10/2l/UK OVER .
III
t
-°14c° JEFFERS R COUNTY,� j DEPARTMENT OF COMMUNITY DEVELOPMENT
i� 621 Sheridan Street• Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
�q www.co.jefferson.wa.us/commdevelopment
s ecs'
Master Permit Application MLA:
Project Description(include separate sheets
/a as necessary): / /�
��Mt�r t^r- / �� 7firI 11�1�1iiS4/.sJ >� �1Y,i.�L:1 ,.,t
\, Tax Parcel Number: _j 0/0 3 a opa. Property Size: \�7 Cj I A ri'. (acres/square feet)
1 Site Address and/or Directions to Property:
4U -J 4; C i i. .6.4,'dL. , 0w , I cc',,L toA 9 r�',3 7G,
Property Owner(s)of Record: Hc(,o),,e 1c.. , �ti-�d ('i.�/�,t7 (', . 1324,.�„�u-t
Telephone: 7670 -- q` 5 r1/. Fax: e ail: he_�0t7.s"c,44 e&f1')( f.
Mailing Address: ' !'( ,i(/ ` L, t t,G,,,,--- ct L „/,, dill z j7 y `
Applicant/Agent(if different from ownesif L.
�� L.,
Telephone: 2) 7 Ogg Fax: email: ti S€' Ate.: c_ceekis2 /7'v'r
i•�
Mailing Address:,, ' '?71 1 Z l i ,4ii, 6j /--i',,' .€.. �� 99S/,�, •(7.1
What kind of Permit?(Check each box that applies 0 Lot or Road Segregation
+: ilding 0 Critical Areas Stewardship Plan
'► Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
❑ Single Family 0 Garage Attached/Detached ❑Conditional Use[C(a),C(d),or C]**
❑ Manufactured Home . ❑ Modular ❑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**
❑Sian 0 Planned Rural Residential Development(PRRD)/Amendments**
❑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 ❑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 '//toyl - c.-J.44e_ to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE -'-('_ Le `fir.2.- t ' nep Y; `AA,. ".t, `(, Date: -7 /<t JG"%'
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 nd ' t of en will be assumed unless the applicant informs the County in writing at the
time of the aPp li tion t he or she wanttf nor notice.
7Signature /J4i("i.J - Lie- Date: L r.. Z -_1 L
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 individu ,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)even if you are i compliance with the Jefferson)C develo ent code.The Applicant acknowledges that he,she or it holds individual
and non-transfera le ponsibility for a eying to an o ing with ESA. The Applicant has read this disclaimer and signs and dates it below.
Signatur • itr tfti) L c c— ��� • ;1 L I( % Date: Zr 1"/L
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: Date:
GENERAL }CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAx:
/Vyeitleiti 6471'GCST kteAIfTv% ( ) ( )
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#
tI4Demolition El 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 l Above ground Tank Size of Propane Tank:
l 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 fgrOffice Use Only Amount -,.Revision
Main Floor Heated EH Bld App Review:
& 1
2na Floor Heated Consistency Review: ---
Other Heated Base fee: I---t 1
Mezzanine Additional Section: II--�'
Heated Basement Plan Check fee: �__--
Unheated Basement State Surcharge fee: A `' _
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL �7}
Decks 911/Rd Approach fee: f(___.-_.-._-
-
Other TOTAL $ 17c ,r)
Receipt Number: t t 13o
— Cash/Check Number:
ESTIMATED COST(REQUIRED) Date: /�
.Fair market value of all labor and materials foundation to finish - 7
Initials: <"--)
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
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