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HomeMy WebLinkAboutBLD2010-00284I 0 • DEMOLITION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD10-00284 Received Date 8/9/2010 SITE ADDRESS. 841 FAIRMOUNT RD Issue Date 8/24/2010 PORT TOWNSEND, 98368 APPLICANT: VICTORIA WINTERINGHAM PHONE: 800-906-0653 311 FOREST AVE VERMILLION SD 570693111 T 74+ SUBDIVISION: Block: Lot: PARCEL NUMBER: 902241007 Section: 24 Township: 29N Range: 02W CONTRACTOR: OWNER/BUILDER PHONE: OWNER, VICTORIA WINTERINGHAM PHONE: 800-906-0653 if different: 311 FOREST AVE VERMILLION SD 570693111 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 8/24/2011. REQUIRED INSPECTION: )1- ,[FinalApprova 'f Z( BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:00 a.m. -4:30 p.m. SPECIAl CONDITIONS APPLY - SEE REVERSE HOT LINE AVAILABLE 24 HOURS A DAY SPECIAL CONDITIONS FOR CASE#BLD10-00284: 1.) New construction of a SFR will require a new fully conforming septic system. I:\F_BLD_Permit_Propane.rpt 10/29/19 ILDING PERMIT APPLICAN BLD10-00284Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD10-00284 Received Date: 8/9/2010 SITE ADDRESS: 841 FAIRMOUNT RD PORT TOWNSEND, 98368 OWNER: VICTORIA WINTERINGHAM PHONE: 800-906-0653 311 FOREST AVE VERMILLION SD 570693111 SUBDIVISION: Block: Lot: T 74+ PARCEL NUMBER: 902241007 Section: 24 Township: 29 N Range: 02 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: HENRY M SOUZA PHONE: (360) 379-8338 DESIGNS BY SOUZA INC (360) 379-9136 164 SWANSON PROJECT DESCRIPTIOP DEMO EXISTING SFR TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP DEM VALUATION MAIN: CODE EDITION: 2009 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE. OCCUPANCY: UNHEATED: #OF STORIES: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total:- Routine Date: C • Type Amount Paid----Bv--_Date: Receipt: Approved/Date Permit $71.00 LYK 08/09/10 119906 APPROVED State Building Code $4.50 LYK 08/09/10 119906 Total: $75.50 AU+a a1 2010 Jefferson County Planning R, Building Department . 136 3798338 p. 2 .16 10 12: 04p Laija h4sc GIOI Olympic Region Clean Air Agency/�,� �P` 29�0-B T united Lane I� ' /°~ �•,f yc � Olympia,WA 98502 cl (360) S39-7610•FAX(360)491-6308 ,• Port Angeles office(360)417-1466 Demolition Permit ,;4, 0RCA.A / Raymond Office(360) 942-2137 `e''? `Y wwvr.ORCAA.o •\°pry„r,„„4,.wsm•i • I ) Commercial Structure—Permit fee: 560.00—10 working day wait period [11 Owner occupied residential dwelling—Permit fee: $35.00—Prior Notice PROPERTY OWNER Name: Phone: (605) 624 G441 Email:vwintrrinnNimmjmai1,con, Victoria Wi.nteringham PAX: ( ) Mobiltt (605) 675 0075 Mailing Address_ City: State: Zip: 311 Forest Ave Vcrmi11ion SD 57069 Site Address: City: State: Zip: 641 Fairmount koad Port Townsend WA 9836E DEMOLITION CONTRACTOR f ] Check if same as property owner information Business Name: Phone: p 6 0) 73 2 0'17 7 F.mail• . All Save Construction & Management LLC FAQ ( ) ccson@cablespee.d.com Oasite Contacc Phone: (360) 379 8338 - Mobile (360) 643-3690 Henry M. Souza (DEA) Designs by Souza, Inc. FAX ( ) Mailing Address: City: • State: Zip: 164 Swanson Ave ti Port Townsend WA 98368 DEMOLITION INFORMATION #of Structures being demolished: Start Date: Completion Date: One 6-15-2010 8-25-2010 Asbestos present X Yes No Survey attached X Yes ' No Has all identified asbestos been cZS S'S-6'S \aSS -k -a.. `°(0 , N'-s removed Yes No DEMOLITION i'ROJECT CATEGORY [X] Complete Demolition [ ]Training Fire—Fire Agrnc-y: ( ]Renovation,Alteration,Remodeling,Maintenance,or other Construction -[ 1 Emergency--Additional Fee of$50.00 (must be accompanied by Govenuo.cat Ordered Declaration-Commercial only) I have read and will abide by the conditions set fora in this permit and any addendum thereto. I do hereby certify that all identiffed asbestos has been removed and the information in this application and supplemental data described herein is, to the best of nyknowlec e, accurate and complete. tiI To�jr� wi►� c01-, N �� - '� - 7%/ v Applicant Name S griatar 61-1-g:,r) Date • Dat Payment Info. Approved Asbestos Permit - [ ] Cash [ ] Disapproved Permit# ASB00 [X] CCheck: :1.1- (.-el b Dcmoliti Prrmit JUL 14 2010 Si] Credit Carati0.ov Review date:�,)b/ I O Prrmit#f b DEvioo It- /� Receive datc� /1S/f� Reviewed by: 0 - .T`A -4Pen(7•Use Onlv_Y -iNe ry Use Only A enc7 Urc OnIT 10/21/08 OVT-:P, I�� '' -.-k-- ��. goN co, JEFFERSO•OUNTY i ' 4 DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax 14, ,p www.co.jefferson.wa.us/commdevelopment a • Master Permit Application MLA: COA Ca7,11 Project Description(include separate sheets as necessary): Removal of Single Family Residence Tax Parcel Number: 902241007 Property Size: 0 . 5 9 9/2 6, 0 9 2 (acres/square feet) Site Address and/or Directions to Property: 841 Fairmount Road, Port Townsend, WA 98368 Property Owner(s)of Record: Victoria Winteringham Telephone: 3 6 0-3 7 9-2 9 2 4 Fax: email: Mailing Address: 311 Forest Ave, Vermillion, SD, 57069 Applicant/Agent(if different from owner): Henry Souza (DEA) Designs by Souza, Inc . Telephone: 360-379-8338 Fax: email: henry@designsbysouza.com Mailing Address: 164 Swanson Ave, Port Townsend, WA 98368 What kind of Permit?(Check each box that applies ❑Building 0 Critical Areas Stewardship Plan Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use) ❑Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a),C(d),or C]** ❑ Manufactured Home ❑ Modular 0 Discretionary"D"or Unnamed Use Classification ❑ Commercial* 0 Special Use(Essential Public Facilities)' 0 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 ❑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: /_ I hereby designate Henr so E S I At a DBA De ns y s a, Lpfc. to act TION asO F my A GENT agent in matters relating to this application for permit(s). OWNER SIGNATURI/ i/L/( Date: lt� By signing this application form,the owner/agent attests th he information provided herein,and in any attach ents,i 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 entryto.Jefferson pounty and its employees,representatives or agents for the sole purpose of application review and any requjred I r inspectighs., Staff "access an right of entry will be assumed unless the applicant inform the County in writing at the time of the ap ication a e or she!!'apts' notice. / / /� Signature: G' rt -ter i „ 0--Cj� Date: 67/ O 2 /v The action or actions Applicant will undertake as a regy of the issuance of this permit may negatively impact uport'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 iss d hot violate t e ESA!An 'ndividual, ,roup or agency can file a lawsuit on behalf of an endangered species regarding your action(s)ev if,,you -• complian*-with e -on Cou development code.The Applicant acknowledges that e,she r it holds individual and non-tr sf: ab r-sponsibility f. ` / •r}�p,mg with the ESA. The Applicant has read this dis laim and s� aqd dates it below. Signature �, L ,/ �`.i� ` skin / Date: G:\PermitCenter\###FORMS###\DRD FORMS\Master"ermit Application 5-29-08.doc /J • • 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: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTORS 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 0 Concrete Total: Height: 0 Individual Sy ❑ Repair 0 Masonry SEP Permit# CO " X Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: 0 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: I Underground Tank I Above ground Tank Size of Propane Tank: I Heat Stove i 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 / 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. fiRN ' gNr - € YI .nk % �h MrR} ' ti Iiw = --Square Footage Current Proposed g r . T a )y iN146 1 t I ;U' OAni*unt i os soti A Main Floor Heated 1n; +,�� +, ; EH Bid App Review: ,r7',-- 2"tl Floor Heated : + , ,,, Consistency Review: Other Heated t;w ,;!, I Base fee: a' �I� Aw 7 I -" Mezzanine -Ati 'iwig Additional Section: Heated Basement ,1 ' 4'gl AV Plan Check fee: tAgggtk Unheated Basement i' +'„'# �`" State Surcharge fee: `1✓ Other Unheated ;' 9 l' �= '., Pot Water Review fee: rite . Y Fri FM1.' � f. �. Garage/Carport ftli SUBTOTAL Decks ,W g 911/Rd Approach fee: Others �i>mbl,+ul,t $ l � k ti,.w� "i��l�"'���"III` TOTAL: alter r It'sGp o 3 Receipt Number: I I 90(0 �W"11 /" o: s Cash/Check Number i 'I t r ESTIMATED COST(REQUIRED) Date: -- "d('' g � •Fair market value of all labor and materials foundation to finish Initials: G:\PemutCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc ,... 1 . . _ . . _ . . _ . . _ . . _ . . _ . . _ . . _ . . _ . . _ . . __, 0 .,.._, . r r u N . m i-E-I- , II P-1 m ri 1 r J L. .. __ ___ _____ i ,.) 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