HomeMy WebLinkAboutBLD2010-00377 •
DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD10-00377 Received Date 11/3/2010
SITE ADDRESS: 540 S BAY WAY Issue Date 11/9/2010
PORT LUDLOW, 98365
APPLICANT: STEPHEN RAMSEY PHONE: 203-255-3557
ANN JONES
363 OLD POST RD
FAIRFIELD CT 06824-6644 TX 76
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 921294004 Section: 29 Township: 29N Range: 01 E
CONTRACTOR: TRS TRASH REMOVAL SERVICE LLC PHONE: 360-373-2007
PO BOX 2185
BREMERTON WA 98310
Contractor's License TRSTRTR923P3 Expires 10/23/2011
OWNER, STEPHEN RAMSEY PHONE: 203-255-3557
if different: ANN JONES
363 OLD POST RD
FAIRFIELD CT 06824-6644
PROJECT DESCRIPTION: DEMO 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 11/9/2011.
REQUIRED INSPECTION:
/1(irly
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.
SPECIAL CONDITIONS APPLY - SEE REVERSE
HOT LINE AVAILABLE 24 HOURS A DAY
SPECIAL CONDITIONS FOR CASE#BLD10-00377:
1.) Approval of this demo permit does not provide any assurance of future approvals for
onsite sewage disposal on the property. Actions taken to date and proposed as part of this
project may limit or prevent future development of an onsite sewage system. Future
proposals must meet current code at the time of application.
BLD10-00377
UILDING PERMIT APPLICA JN Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD10-00377 Received Date: 11/3/2010
SITE ADDRESS: 540 S BAY WAY
PORT LUDLOW, 98365
OWNER: STEPHEN RAMSEY PHONE: 203-255-3557
ANN JONES
363 OLD POST RD
FAIRFIELD CT 06824-6644
SUBDIVISION: Block: Lot: TX 76
PARCEL NUMBER: 921294004 Section: 29 Township: 29 N Range: 01 E
CONTRACTOR: TRS TRASH REMOVAL SERVICE LLC PHONE: 360-373-2007
PO BOX 2185
BREMERTON WA 98310
Contractor's License TRSTRTR923P3 Expires 10/23/2011
REPRESENTATIVE: KAREN PAGE PHONE: 360-774-2350
1064 EGG & I RD
CHIMACUM WA 98325
PROJECT DESCRIPTIOP DEMO 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: CON
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total:
Routing Date:
Type Amount Paid Bvr---Date: Receipt: Approved/Date
Permit $71.00 LYK 11/03/10 120245 APPROVED
State Building Code $4.50 LYK 11/03/10 120245
Total: $75.50 NOV 1
Jefferson Countl, r ritoninc
& Building De9artm,,
OOCT!21/2010/THH 12: 08 PM OPl ; FAX l i:', 360401a F, 001
09/30/2010 14:13 203- 12B7 RAMSEY JONES 7 PAGE 02
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PortAr,Seles office(3G0}427-1446' �,)e o on Permit
Itaarriovd Office(360)942-2137
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' [ ) Contmereiat tritettiu-e-Permit fee;S60.00- x 0'working day wait period
( ' Owner ocCupled i'esiden#a1.dwe.0ing-Pel it fee: S35.6,0—Prior Notice
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P;E2OpERT-y OWNER- • � C f Pk& F 6 0 7 71(- S`t'aw4 eyC3 bra" e
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site Addroys / 1d d r /��f ;,, ,,
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DEMOLITION CONTRACTOR f 1.Clccb name as proverty owner information
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°mite Contact:
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DEMOLITION><,NPO A.TIo
#of Structures b•ng dauoIished 1 5tar:Dater ' /'o 25 CoCovaplcdn
Aabe.aems present 'Yes ' _,,,No Survey attached • , cg No H,as all ideotit d asbeema been
O7�I-T-ON PR(-�JEC-T-G-A,'�-EGOR'Y ----- - - • -
v Complete De eoolition -- _ _ _ --
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( J Renovation,Alteration,Re node_liog,Ivlaiatec ance,or,o.ther Consetuction
Ems r�_ 1—.A.4ditionalrFee_of$5.0,00-pau tbe-Hceom anicd-by-OoTsument-Otdrzed-D.e
I have,tead a4d r+rUAbide by the conktions set torch iv thisprxmitmad sorry aelcimotrum therein "etc,
that all identih"ed eshesros kis.6ren.+�aaowed and the rn fortnstiau h?his.a J+cadnaa Arad s hedatarelry ccr�%
described fit . is to the best ofrn .koawie ° r' ,raXexxsertceJdara
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10/21/6.8)•K'k.•ir-'0. ovER ..Q nc�'lire Ong _
�4ON c�lr JEFFERSON c;OUNT( !! Nc 37 7
�4 ' \ I DEPARTMENT OF COMMUNITY DEVELOPMENT
Al'7 'N o "4 621 Sheridan Street• Port Townsend • Washington 98368
4, -t� 360/379 4450 • 360/379-4451 Fax
�'�iITJ www.co.jefferson.wa.us/commdevelopment
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Master Permit Application MLA:
Project Description(include separate sheets as necessary):
D e ii'.ks i/n d F Mu i4 L ie c
Tax Parcel Number: Lt 9 4 00 q Prope S Sie:�X (acres/square feet)
�•c)�U arrt 5 ( q
Site Address and/or Directions to Property:
ON S- 1 AA R 4 c d(o(A) ?s-3 6 c-
Property Owner(s)of Record: S h-e" tZQi/Yl ' " ,o✓i e t
Telephone: 20 3 . 2 i' - 3 4-6-7 Fax:/� 2-0 '3 - z-c- /2F7 email: .Sta , 0 car+on)r1 . KO--
Mailing Address: Sc( S L�a`�' /�� /�'Or7 L-Ltd7o c-,i fiv/9- C-i'1f3GS— /
Applicant/Agent(if different from ovine*.____LE=trciA (: 100
Telephone: 1�O 771f .- Z;tin Fax: email: /ce.:Pe N Paya 77?[ 3-Mvl;1,co,/t—
Mailing Address:
What kind of Permit?(Check each box that applies D Lot or Road Segregation
‘FIBuilding 0 Critical Areas Stewardship Plan
Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
❑ Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a),C(d),or C]**
❑ Manufactured Home . 0 Modular - ❑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 0 Binding Site Plan**
❑ Propane CI Long Plat**
❑ Sign -. 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 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 0 Tree Vegetation Request
**Requires a Pre-Application Conference
Please identify any other local,state or federal permits required for this proposal, if known:
J DESIGNATION OF AGENT
^'I hereby designate C f t';A to act as my agent in matters relating o this application for permit(s).
�L�,fir V
OWNER SIGNATURE Date: G 1�l ��
By signing this application form,th own /agent att sts that the informatio ided herein,and in any attachments,is true and correct to the best of
his,her or its knowledge. Any m erial f Isehood 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 way76cr e against Jefferson County as a result of or in consequence of the granting of this permit.
I further agree • •ro ide a "-saand r ght of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and an r-•u1 ed late i spedans. Sta s access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the a,plicar•' at h? •r sh: ants priStt notice.
Signature: l ' Date: kip I1 Z // d
� ...AI
action or actio !Apphi •nt will u dertake as a result of the issuance of this permit may negatively impact upon one or ore threatened or
endangered specie- and could lead r : potential"take"of an endangered species as those terms are defined in the federal law known as the
"Endangered Species Act"or"E A."Je'-rson County makes no assurances to the applicant that the actions that will be undertaken because this
permit has been i •ued will not .io.to t e ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)even if • a - in corn.r=nce ith th; Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transf; •in—,,•n i• I'y f. -.heri•. to complying with the ESA. The Applicant has read this di me[antrignalan1q/at s it below.
Si nature: `�IJ!/ l fl
MINN 1
G:\PermitCenter\###F'IRMS##•\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
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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:
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#
Li Demolition ❑ 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:
I Underground Tank i Above ground Tank Size of Propane Tank:
T 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 a;so 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 C nljf Amount Revision
Main Floor Heated EH Bld App Review: q5--
2nd Floor Heated Ccnsistency Review:
-Other Heated Base fee: 1
I i
Mezzanine Additional Section: 1
Heated Basement 1 Plan Check fee:
Unheated Basement State Surcharge fee: A .5°
Other Unheated Pot Water Review fee:
G- arage/Carport SUBTOTAL
Decks 911/Rd Approach fee:
Other TOTAL $ (l E ' , DU
Receipt Number:
— Cash/Check Number:
ESTIMATED COST(REQUIRED) Date:
•Fair market value of all labor and materials foundation to finish
Initials:
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