HomeMy WebLinkAboutBLD2010-00281 •
DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD10-00281 Received Date 8/4/2010
SITE ADDRESS: 291 E PRICE ST Issue Date 8/26/2010
PORT HADLOCK, 98339
APPLICANT: RICHARD T AMERSON PHONE: 360-316-9159
MARIE L AMERSON
2109 LANDES ST
PORT TOWNSEND WA 983687816 34-39
SUBDIVISION: IRONDALE Block: 24 Lot:
PARCEL NUMBER: 961802410 Section: 35 Township: 30N Range: 01W
CONTRACTOR: OWNER/BUILDER PHONE:
OWNER, RICHARD T AMERSON PHONE: 360-316-9159
if different: MARIE L AMERSON
2109 LANDES ST
PORT TOWNSEND WA 983687816
PROJECT DESCRIPTION: DEMO EXISTING M/H
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 8/26/2011.
REQUIRED INSPECTION:
FinalApproval:
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
',WIL',WILDING PERMIT APPLICPDN BL view Ty281
DINGReview Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD10-00281 Received Date: 8/4/2010
SITE ADDRESS: 291 E PRICE ST
PORT HADLOCK, 98339
OWNER: RICHARD T AMERSON PHONE: 360-316-9159
MARIE L AMERSON
2109 LANDES ST
PORT TOWNSEND WA 983687816 IRONDALE
SUBDIVISION: Block: 24 Lot: 34-39
PARCEL NUMBER: 961802410 Section: 35 Township: 30 N Range: 01 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOI' DEMO EXISTING M/H
TYPE OF WORK MOB SQUARE FOOTAGE:
TYPE OF IMP DEM
VALUATION MAIN:
CODE EDITION: 2009 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:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop
Total: Total:
Routing Date'-
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $71.00 LYK 08/04/10 119892 APPROVED
State Building Code $4.50 LYK 08/04/10 119892
Total: $75.50 AUG c2b 2010
Jefferson County PlanninG
& Building Department
d -2g�
6J41 • •
�4N G1ON CLE ,
44. Olympic Region Clean Air Agency
o� ..1�� 70 2940-B Limited Lane NW Owner Occupied
' e, Olympia,WA 98502
o / lr' "` (360) 539-7610•FAX(360)491-6308 Residential Asbestos
,,. Q CA A �4
R '" Port Angeles Office(360) 417-1466
,,,,,y�� rem'- Raymond Office(360) 942-2137 Removal Permit
,..„,.....0M' www.ORCAA.org
***This permit valid only for residential homeowner residing in the dwelling***
Permit fee: $30.00. Non-refundable.
APPLICANT
N Phone: (ae( ) l i-&O Email:
ill r i t,a FAX: ( ) Mobile: ( )
M ling Addre;s La-- d ` cit. or �JM-kCt''Y' S � IIP
Site Address: l � Ci : C""`v" State: Zip:
9'q/ 5-1 P_12-jc7_ "(J iff A n -cCL_ LAyl air
PROJECT INFORMATION
Start D e: Completion Date:
1 ,� Work Shift Days: Work Shift Hours:
,1 7 -.�O .6.�yt�t liM `C Ewx...T F Sa_Su y�.
# of Structures: Total Ouantity to be Square Feet: � Linear Feet:
Removed r- ,
Name and coca 'on of Disposal Site: llthis structure be demolished after asbestos
�sY- - '7� s removal ,kYes _No
Will all iden ' e a estos be removed from the
structure \ Yes _No
Check Matenal being removed:
Boiler/Furnace Duct Insulation Pipe Insulation Fireproofing Paints
Plaster Cement Board Cement Pipe Flooring Roofing
e
Textured Coating Other
I have read and will abide by the conditions set forth in this permit and any add dui 5he#0. I do
hereby certify that the information in this application and supplemental data described herein is, to the
best of my knowledge, accurate and complete.
L��(i) e44o3o,6 )6241-401A__
A plicant Name Signature Da
Etirt WCtYd
Payment Info. Approved Asbestos Permit
[ ] Cash [ ] Disapproved Permit# 10 ASBOOW1
NCheck: # 5 �]2 Demolition Permit
A U G 2 3 2010 [ [Credit Card Review date:_L/)3 �0 Permit# (O DEMOO 7— f-7
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Receive dater / /[O Reviewed by: S4-eV .---
Survey:)Q Yes [ ]No
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JEFFERSON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
` '4 621 Sheridan Street • Port Townsend • Washington 98368
$ 360/379-4450 • 360/379-4451 Fax
.4"ING
www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: _lam (YHA OE'M
Project Description(include separate sheets as necessary):
77.'mo r'�o� ��r AT t) :ir.,red (40/nc,
Tax Parcel Number: qb 130 1-I1`0 Property Size: f/2,5" X /cr (acres/square feet)
Site Address and/or Directions to Property:
t� l
Property Owner(s)of Record: l E.
Telephone: 3 7% 3 0 3 t7 Fax: email:
Mailing Address: ,2-e Z-ez-Yrit9C (�i�; %2c;,h SrvlJ L,V0 47cF36
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies El Lot or Road Segregation
❑Building ❑Critical Areas Stewardship Plan
Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use)
❑ 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
i 0 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 ❑Binding Site Plan**
❑ Propane ❑Long Plat**
❑ Sign ❑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 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 applicationfor permit(s).
OWNER SIGNATURE 't 2Dl'Z Date: *IX / '7 7
By signing this applica ion 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 attorneys 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 appli atio thatt 7or she wants prior notice.
•Signature: l /,stL k�L.j.__— Date: 1447 V a_t,(o
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: i
9 ! �� Date:ffZtr/ :-7C/C
! •
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 a rml //the re ponsibilit of the General Contractor for the proposed pr.,r.'ect.
g ,�C 1J f Li - Date: II 2 o'
kr
Signature:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: Fax:
(50 32i3034 ( )
MAILING ADDRESS: POei (.et4.4_)PS EMAIL: _LtlLr"d(ZviLEi'SO,vr0: -hor4lflrl c sel
CONTRACTOR'S LICENSE WAINS
NUMBER: t�� NUMBER .
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New yi. Wood Existing: 1 ❑ Sewer
Li Addition ❑ Steel Proposed: Bank [] Community System
Alteration/Remodel ❑ Concrete Total: _ Height: XI Individual System//1�l 4
El Repair ❑ Masonry SEP Permit# lQ-`'I`T
Demolition 0 Other: Bedrooms: Water Supply:
Existing: Setback: ❑ Private well ❑ Two Party
Type9f Heat: Proposed: Public
1 ! Total: N e 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 1 Above ground Tank Size of Propane Tank:
1 Heat Stove 1 Cook Stove i Woodstove 1 Fireplace Insert 1 Hot Water Tank 1 Pellet Stove 1 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.
S•uare Foota•e Current Pro•osed • Office Use``.c t,,,,A', . "14i:i. ' Amount Revision
Main Floor Heated 4''' EH ' ' App Review:
2`d Floor Heated Consistency11111
Other Heated Base fee:
Mezzanine IllAdditionalHeated BasementUnheated Basement -Jv
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL
DecksApproach
Other • $ 1 Li$ .
- Receipt Number: ic) g'l2
Cash/Check Number:
06 H_
ESTIMATED COST(REQUIRED) Date: =
.Fair market value of all labor and materials foundation to finish do ,ff_.1