HomeMy WebLinkAboutBLD2010-00286 •
DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD10-00286 Received Date 8/9/2010
SITE ADDRESS: 241 N PALMER DR Issue Date 9/29/2010
PORT TOWNSEND, 98368
APPLICANT: GERALD E ANDERSON TRSTEE PHONE: 360-531-3989
G E ANDERSON LIVING TRUST
241 N PALMER DR
PORT TOWNSEND WA 98368-9427 4
SUBDIVISION: CAPE GEORGE COLONY DIV 1 Block: 2 Lot:
PARCEL NUMBER: 937800204 Section: 12 Township: 30N Range: 02W
CONTRACTOR: DR'S PHONE: 360-301-3642
1240 W SIMS WAY# 111
PORT TOWNSEND WA 98368
Contractor's License DRS****904DK Expires 3/12/2012
OWNER, GERALD E ANDERSON TRSTEE PHONE: 360-531-3989
if different: G E ANDERSON LIVING TRUST
241 N PALMER DR
PORT TOWNSEND WA 98368-9427
PROJECT DESCRIPTION: DEMO EXSITING CARPORT
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 9/29/2011.
REQUIRED INSPECTION:
FinalApproval: /' (13 I~ C - 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 APPLICA1N BLD10-00286
Review
Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD10-00286 Received Date: 8/9/2010
SITE ADDRESS: 241 N PALMER DR
PORT TOWNSEND, 98368
OWNER: GERALD E ANDERSON TRSTEE PHONE: 360-531-3989
G E ANDERSON LIVING TRUST
241 N PALMER DR
PORT TOWNSEND WA 98368-9427 CAPE GEORGE COLONY DIV 1
SUBDIVISION: Block: 2 Lot: 4
PARCEL NUMBER: 937800204 Section: 12 Township: 30 N Range: 02 W
CONTRACTOR: DR'S PHONE: 360-301-3642
1240 W SIMS WAY# 111
PORT TOWNSEND WA 98368
Contractor's License DRS****904DK Expires 3/12/2012
REPRESENTATIVE: DAN RICHARDS PHONE: 360-301-3462
1240 W SIMS WAY# 111
PORT TOWNSEND WA 98368
PROJECT DESCRIPTION DEMO EXSITING CARPORT
TYPE OF WORK GAR 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: Pry- ____ -_ --
Total: Total:
Routing Date:
S- In-ID
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $71.00 LYK 08/09/10 119915 ^ry�®`V State Building Code $4.50 LYK 08/09/10 119915 APPROVED
Total: $75.50 SEP2 201U
Jefferson County Planning
&Building Department
AUG/11/20101ED 01 : 13 FM ORA FAX ado, 3604916308 P. 001/001
c r c ; ;.., • Ol mpic Region Clean Air Aggenet' _._ ..
..- '` 294.0-B L+mited Lane NET IN
i N�
/ ° ` �� \ Olympia,WA 98502
i I (360) 5 Angeles
0•office
(3(360)491-6308 Demolition
enrol J tion Permit
Port Angeles office(360)417-1466 1J 11
' F CAA .hl! Raymond Office(360) 942-2137
: L ?� �� www.ORCAA.org • tf'
Commercial Structure—Permit fee: $60.00.10 working day wait period �DJO
[ •
• ] Owner occupied residential dwelling—Permit fee: $35.00—Prior Notice
v •
PROPERTY OWNER
Narne: •Phone: (16a) 57/39$9 Ema
�G r I' n rit er c P� • FAX: ( ) Mobile: ( )' _
~I�dawng A dress: •
City: State: Zip:
-g_L i f fW r , i� ror7 1;76 w.€ wa. . gs3 5 Site Address: City: State: Zip'
5!.r 1??e-
DEMOLITION CONTRACTOR[ ] Check if same as property owner information
Business Name: ne:R Pho ( o)j' J.-J y6-2. E
_—.,�} S _ FA_X: ( ) 0q4-0 -.52QJii.n.eaw,
Onsite Contact / Phone: ( ) Mobile: ( )
L)a61 _Pic 6211rdJ' _ FAX J )
Mailing Address: City: • State: Zip:
j Vt. -11/ •:- -- .ate:f...r.c.,e, eV' ii `3 W345"
DEMOLITION INFORMATION _ _
#of.Structures being demolished: Start Date: „ // Completion D$te:
C ,,morfi • / / Poio / 3e/,o//
Asbestos present Yes fir" No Survey ttached • Yes , ,..,No Ras allidenttifiied asbestos been
S uj' i/kd removed Yes YYo
•
DEMOLITION PROJECT CATEGORY
[ ] Complete Demolition
[ .]Training Fire—Fire Agency. . . . -
N11.Renovation,Alteration,Remodeling,Maintenance, car. other y►or Constrixctiot r e v ll tf C a rp 0
[ )Emergency Addituiixal.FPe:Of$5.0:00 (must:k a accompatued b Government Ordered Declaration-Commercial wash}
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 ofmyknowledb�, accurate and complete.
; ., / ' 5 i)::(/0----21.1,4.•":-f • 0-m---5---.2-62-
Applicant Name Signature Date ..
t p�ti eccired Payment Info. ] Approved �c.sbcstos Permit
[ ] Cash Disapproved 'en1iT + ASBOO _
Check: # a 0.5-6 iDemolitiop Permit
AUG 11 2010 [[ I Credit Card Review date: 8//12 LO/ 'wit#i d DEM00alQ_
4 o� ,
(� Receive date:',/ (L/[a Reviewed br:P'C 1 r(A•/l
'V 7�jJ� -my i-'eno—vde Only Agent) T.se Onlp ' .. . -4,gencl.Use Only
CATF.Tz
4� ox c°A JEFFERSOPOUNTY •
W • ' \*a \ DEPARTMENT OF COMMUNITY DEVELOPMENT
h 4\ °4 621 Sheridan Street• Port Townsend • Washington 98368
360/379-4450 • 360/379-4451 Fax
..q p'. ww.co.jefferson.wa.us/commdevelopment
S�NOS w
Master Permit Application MLA: Q; Q;R 1
Project Description(include separate sheets as necessary):
I / . 4 L1 . -E 47'62,-4 2c ' x12 ' 6-arctic
Tax Parcel Number: ey,3 7 5c - ;2 d ti Property Size: ®, 3(oc ees (acres/square feet)
Site Address and/or
Directions to Property: (3' `t 7 3 Sr 3 f
a ! 1 4/ !"a//. er Dr- Ca", 6:et1t e C.,/�slY Pori- Towtiseit.7 aU�_ yy36:f
Property Owner(s)of Record: .Terry- 470fid rrii
Telephone: 360/S 3/— 3%8 9 Fax: email:
Mailing Address: i9-q1 /I/. I i lv,,r ,0,-
Applicant/Agent(if different from owner): nail Piz._ ,-„• -
Telephone: 36Z/3.0/— 3 y 62 Fax: email: c-7,,yip/i' .- S/( L;U Cam
Mailing Address: /.2 4/0 Gf/ 5.ins' Way '131/// P(7r f 77,4,.;�s-r.i,et/ elite ? 3C,s1
What kind of Permit?(Check each box that applies D Lot or Road Segregation
1RIBuilding 0 Critical Areas Stewardship Plan
Xl" Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use)
❑ Single Family )Garage - -:1 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)**
O Change of Use ❑Boundary Line Adjustment
❑ Address 0 Road Approach 0 Short Plat**
❑ Home Business 0 Cottage Industry 0 Binding Site Plan**
❑ Propane 0 Long Plat**
❑ Sign 0 Planned Rural Residential Development(PRRD)/Amendments** .
D 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**
0 Temporary Use ❑Shoreline Management Variance
*
❑Wireless Telecommunication 0 Comprehensive Plan/UDC/Land Use District Map Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium ❑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:
C c e 6-eci,�y.� Co 711
,i� / 7 DESIGNATION OF AGENT
I hereby designate ((__/pi ,G 4 /:;(5 to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE �V.4-1--"tilifs A....4....---i Date: — /0
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 applicktion that he he Want rior not .
Signature: I Date: gr" 7— f I°
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 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 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-transf re •onsibilit • :dherin• o and -.mplying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
'
Signature: IMO .. - Date: 8— 7-/0
G:\PemiitCenter\###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 ass
ing the re o ili f the General Contractor for the proposed project. �^
Signature;//_1?r1 � "r�l��� r�^ Date: 0 t. 7-
- /0
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
•
D 5 S (3(c7) Jv/ -3 if Ca ( )
MAILING ADDRESS: l a too W .r/ptS 16k, i f t EMAIL: Wagner. S/ @ /ve. G cos-1
CONTRACTOR'S LICENSE WAINS
NUMBER: i7'C S c-* qo=I Dir NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New >sr Wood Existing: 2 ❑ Sewer
W Addition ❑ Steel Proposed: pS Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: a Height: ❑ Individual System
❑ Repair ❑ Masonry SEP Permit#
❑ Demolition ❑ Other: Bedrooms: Water Supply:
Existing: a Setback: ❑ Private well ❑ Two Party
Type of Heat Proposed: 0_ ❑ Public
Total: 2 Name of System:
If this is a Commercial Protect 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.
Square Footage Current Proposed For Office Use Only Amount Revision
Main Floor Heated EH Bld App Review:
9,O2 S?0_-60- 03\07A1090
2"°Floor Heated / Consistency Review:
-Other Heated Base fee: rr
I
,..._
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee: _ I
Other Unheated s Pot Water Review fee:
Garage Carport SUBTOTAL
_ I-- C/6Sf` 5A3
Decks 911/Rd Approach fee:
Other TOTAL: $r73
a oo0 G.reeh b ous e
-
U n h ea-le, Receipt Number: 1 I63 15
Cash/Check Number: a_r_r5
ESTIMATED COST(REQUIRED) Date: Q
•Fair market value of 1l labor and materials foundation to finish (,
�____
% D Initials: •
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
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