HomeMy WebLinkAboutBLD2010-00339 • •
DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD10-00339 Received Date 9/22/2010
SITE ADDRESS: 702 ADELMA BEACH RD Issue Date 11/15/2010
PORT TOWNSEND, 98368
APPLICANT: LAURA C SOUTHMAYD PHONE: 360-385-1387
702 ADELMA BEACH RD
PORT TOWNSEND WA 983689282
T 29
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 901051021 Section: 5 Township: 29N Range: 01W
CONTRACTOR: BISHOP BROTHERS CONSTRUCTION PHONE: (360)301-1979
LOREN BISHOP
371 BISHOP HILL RD
CHIMACUM WA 98325
Contractor's License BISHOBC093D6 Expires 1/11/2011
OWNER, LAURA C SOUTHMAYD PHONE: 360-385-1387
if different: 702 ADELMA BEACH RD
PORT TOWNSEND WA 983689282
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 11/15/2011.
REQUIRED INSPECTION:
FinalApproval: q-jf..
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
UILDING PERMIT APPLICA.N BL v
Reviewiew T Ty339
ype.
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD10-00339 Received Date: 9/22/2010
SITE ADDRESS: 702 ADELMA BEACH RD
PORT TOWNSEND, 98368
OWNER: LAURA C SOUTHMAYD PHONE: 360-385-1387
702 ADELMA BEACH RD
PORT TOWNSEND WA 983689282
SUBDIVISION: Block: Lot: T 29
PARCEL NUMBER: 901051021 Section: 5 Township: 29 N Range: 01 W
CONTRACTOR: BISHOP BROTHERS CONSTRUCTION PHONE: (360)301-1979
LOREN BISHOP
371 BISHOP HILL RD
CHIMACUM WA 98325
Contractor's License BISHOBC093D6 Expires 1/11/2011
REPRESENTATIVE: PHONE:
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:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop:
Total: Total:
Routi Date:(-11a5-10
Type Amount Paid Bv: Date: Receipt: Approved/Date
Permit $71.00 LYK 09/22/10 120118 APPROVED
State Building Code $4.50 LYK 09/22/10 120118
Total: $75.50 NOV 15 2010
Jefferson County Planning
& Building Department
11/13/7010 21:47 13603859187
F A GE 02/02
NOV/05/2010RJ 12:52 FM IllkAA FAX No, 36049111, F. 001
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P,• ' 1 1,1 CerallieiCiai Structure—Permit fee: $60.00 P7-10 mirk:lag day wait period
f.104.. Owner occupied residential dwelling—Penult fee: $35.00—Prior Notice
PROPERTY OWNER
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DEMOLITION CONTRAcrax r 1.Check if same as to' •own.=intoptaation . .
13usjrans Name:
• , Mao= - ' ./.../10 Email:
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DEMOLIT101\,.7 PROTECT CATEGORY ' ' '
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.. , . i Emergency—.Additional,Nte of$,50.00 (natmt be accomRanieli by Government Oteletedneelaration-Commeeciat only)—
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I bare react Rrid will abide 4,p,ebe conditions set 4,.rtla th thiSpe-Mit id itely Riertfeiaciton thereto. I:do hereby cette4,
that gil A:lent-Serf vsbestos•has beet.'i rernavea7 ond tote iii.7facaladon in this,appliemtiort and slippleinenral data
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Demolition?emit
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OVER
ON:0 •
kwiiii � JEFFERSON COUNTY
�� DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street• Port Townsend •Washington 98368
4, � 360/379 4450 • 360/379-4451 Fax
www.co.jefferson.wa.us/commdevelopment
Master Permit Application r ,�
MLA: Its•�'
Proje t Description(include separate sheets as necessary):
Now t i s f
Tax Parcel Number: 90/0 /(22/ Property Size: /
5, L=) '- ` - (acres/square feet)
Site Address and/or Directions to Property: •
Property Owner(s)of Record: .'(c,(,,., a. Sol.,4 f ,,,,ck
yj
Telephone: Fax: email:
Mailing Address: S, y' G cr'o', f 5 s
Applicant/Agent(if different from owner): J,-, r,_, ,g, r4n 0
Telephone: 1',t; ), > ' i` Fax: / email:
Mailing Address: 3 7/ 8 ,z:,. f 4
What kind of Permit?(Check each box that applies ❑Lot or Road Segregation
lA:Building
Demolition Permit 0 Critical Areas Stewardship Plan
0 Variance(Minor,Major or Reasonable Economic Use)
❑ Single Family 0 Garage Attached/Detached ❑Conditional Use[C(a), C(d),or C]**
❑ Manufactured Home .0 Modular - 0 Discretionary"D"or Unnamed Use Classification
❑ Commercial* ❑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 0 Long Plat**
❑Sign 0 Planned Rural Residential Development(PRRD)/Amendments** '
❑Allowed"Yes"Use Consistency Analysis ❑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 0 Shoreline Management Variance
0 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 ❑Tree Vegetation Request
**Requires a Pre-Application Conference
Please identify any other local,state or federal permits required for this proposal, if known:
• i DESIGNATION OF AGENT
I hereby designate or•e,-r „ �S S O/4 to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE ' C?/1 �
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 an required later' ctions. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the ap li lion that h r hew t prior notice.
Signature: t 'tACL Ot
Date: I r 9 / ICI /lc0
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)f you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transfer le ressp�n • ili fo a h rin to and corplying with the ESA. The Applicant has read this disc) ime a Si ns and dates it below.
Signature:4 l i�� '�1 ���� '% ! n/d
Date: C, 1 /
0 —II
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.
Date:
Signature:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER:
PHONE: FAX:
" ,,Slop 5'"iI/e,s Co'L 74- 0 0)3O/ _,/' '7 9' ( )
�
MAILING ADDRESS: 3 2/ /31,54 ' /./!!jfo, (4,, ,•'" "`° EMAIL:WAINS
CONTRACTOR'S LICENSE c� r�, NUMBER
NUMBER: BX NoSC O 9/t 4 NUMNE ( ) F ( )
ARCHITECT/ENGINEER: PHON
MAILING ADDRESS:
Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
Project Type: %WoodExisting: / ❑ Sewer
New ❑ Steel Proposed: T_ — Bank ❑ Community System
n
❑ Alterati
❑ Alteration/Kemodel ❑ Concrete Total: () Height: Tif Individual System
SEP Permit#
❑ Repair ❑ Masonry Bedrooms: Water Supply:
;1‹,..Demolition 0 Other: Existing: — Setback: ❑ Private well 0 Two Party
Proposed: 1� Public
Type of Heat: Total: V Name of System: PU )
If this is a Commercial Project You must answer the f w
inT
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 Pro ane Tank and/or A liance Installation rmit mark all items below that a I :
i U rgtound Tank Above •round Tank Size of Propane Tank: 75O
Heat Stove I Cook Stove i Woodstove i Fireplace Insert (Hot Water Tank) i Pellet Stove i Other
Is this appliance being installed in a Manufactured I 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, property
all
lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system components,
including the reserve area. ° , z * � ,< ., ' r ,
�p
' ,,,.;� _t 4b.., -1.°i;' --j-ic
Square Fie Current Proposed For Office Use; is w `f _ �;r
Main Floor Heated so()
EH BId App Review:
\ SFE
- Floor Heated <�J�J Consistency Review: _
Base fee: '
Other Heated I
Additional Sedfi bti
Mezzanine
Heated Basement
Plan Check fee:
Unheated Basement
State Surcharge fee: 5°
Other Unheated Pot Water Review fee: -
SUBTOTAL
Garage/Carport
911/Rd Approach fee: - —
Decks
Other TOTAL: $ r-15 (..)
Receipt Number: I ao 1 ` O
Cash/Check Number '( �
ESTIMATED COST(REQUIRED) Date: 4 • ►""
•Fair market value of all labor and materials foundation to finish Initials:
ii•
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