HomeMy WebLinkAboutBLD2011-00126 DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD11-00126 Received Date 5/23/2011
SITE ADDRESS: 2150 BLACK POINT RD Issue Date 8/18/2011
BRINNON, 98320
APPLICANT: CARL E STRACENER PHONE: 253-582-5842
ANNE B LERUP STRACENER
1811 STARLING ST
STEILACOOM WA 98388-2216 TX3+
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 502143003 Section: 14 Township: 25N Range: 02W
CONTRACTOR: OWNER/BUILDER PHONE:
OWNER, CARL E STRACENER PHONE: 253-582-5842
if different: ANNE B LERUP STRACENER
1811 STARLING ST
STEILACOOM WA 98388-2216
PROJECT DESCRIPTION: DEMO EXISTING CABIN
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 8/18/2012.
REQUIRED INSPECTION:
FinalApproval:1'L (0-(4,- (2.
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
1
Ii ILDING PERMIT APPLICA1SN MRLAew00p108
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Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD11-00126 Received Date: 5/23/2011
SITE ADDRESS: 2150 BLACK POINT RD
BRINNON, 98320
OWNER: CARL E STRACENER PHONE: 253-582-5842
ANNE B LERUP STRACENER
1811 STARLING ST
STEILACOOM WA 98388-2216
SUBDIVISION: Block: Lot: TX3+
PARCEL NUMBER: 502143003 Section: 14 Township: 25 N Range: 02 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: C.D. GALLUP PHONE: 800-888-8715
3726 PACIFIC HWY E (253) 922-9351
TACOMA WA 98424
PROJECT DESCRIPTIOP DEMO EXISTING CABIN
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: ALT
WATER SYSTEM: 1PWELL
BEDROOMS: BATHROOMS:
Exist: 1 Exist: 1
Prop: -1 Prop: -1
Total: 0 Total: 0
Routing Date:
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $71.00 LYK 05/23/11 123521 APFRtD\JE[)
State Building Code $4.50 LYK 05/23/11 123521
Total: $75.50 AUG g 2011
Jefferson County Planning
&Building Department
• 0
���gON c0�� JETY
DEPARTMENTFFERSON OFCOUN COMMUNITY DEVELOPMENT
4 ` '"d 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
G0 www.co.jefferson.wa.us/commdevelopment
16W
Master Permit Application MLA: Nr: 11
P o'ect Description(include separate sheets as necessary):
n n EkISr CAnf h�
Tax Parcel Number: .jj 2/ 430 0 3 Property Size: /. /4 e5 (acres/square feet)
Site Address and/or Directions to Property:
2/So 7?44c.,e eo,' ,- /eo g:/e//W o.J (1.4)
Property Owner(s)of Record: (.19.eL AIM'. ,ST,eAGL=h‘t2,
Telephone: 253 - .>gL— 5$y7.L Fax: email:
Mailing Address: /8// ..5-TLy2G/.�1cr Sr
Applican ,gent f different from owner): - •D_ a.,47 Gu.0.
Telephone: go - $108'- Ee71$ Fax: 05-3 - 9Z2- -93S/ email: filcc.d.oe Se,4,var,c o.
Mailing Address: 37 26 - PA,Gi...--:-/s //w y,E. F iP'6. 4,,,o q i 4 Z 4
What kind of Permit?(Check each box that applies
t*: tiding d Critical Areas Stewardship Plan
ko Demolition Permit ❑Variance(Mir}or;MTi ble Economic Use)
✓t' gle Family g Garage Attached/Detached 0 Conditional Us (qyS, ••, .•r *
0 Manufactured Home 0 Modular 0 Discretionary;" 1 Gil M.:._+. Lice ', f Clafit
❑ Commercial* 0 Special Use� se a u lc acl 1 les
❑ Change of Use ❑BoundaryLin�e'A ustment
❑ Address 0 Road Approach IDShort Plat** ' I ,, A
❑ Home Business 0 Cottage Industry 0 Binding Site flan, " `7 ����
❑ Propane ❑Long Plat** i
❑ Sign 0 Planned Ruril Residential me dments**
❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration"'4 i l 1-,SO%COUNTY
❑Stormwater Management ❑Shoreline Master_Oicigriiiii 8A Mi 111btpiElilifiItH visio **
❑ 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:
DESIGNATION OF AGENT
I hereby designate -J'. at A4..L.' P to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE % .,a C/ (4)--e- ..,-- 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 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 applicatio at he�I she wants prior notice.
.._/-
Signature: ,T�Xr�9 �z� — /
� .-< -- 4''4(
Date:
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-transferable responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: Date:
G:\PermitCenter\###FORMS###\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 assumin esp ibility of the General Contractor for the proposed project.
Signature. `'------ Date: S/2--e//
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:
0 New ❑ Wood Existing: ❑ Sewer
0 Addition ❑ Steel Proposed: — t Bank ❑ Community System
❑ Alteration/Remodel 0 Concrete Total: Height: ❑ Individual System
❑ Repair ❑ Masonry SEP Permit#
❑ Demolition 0 Other: Bedrooms: WaterSupp y:
Existing: I Setback: 0 Private well ❑ Two Party
Type of Heat: Proposed: — 0 Public
Total: if Name of System: '
If this is a Commercial Project you must answer the following: J
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 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 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.
it T..`t j ''',`� 1 j E y � ` t L � Y
Square Footage Current Proposed eU a o • 'f Main Floor Heated ram. :'.,. _ EH Bid App Review:
2m Floor Heated
�� '' ��. Consistency Review:
Other Heatedt-i>
it- fee
cisiAir
- 'e :
Mezzanine fl , G -�, I .•itional Section:
Heated Basement jn Check fee:
MAY 4
Unheated Basement - �t ,34�� et, _ e Surcharge fee: 4 57-)
Other Unheated• JEFI•LIiSU ! • ;,. Poi Water Review fee:
)EP T.OF COMM!! ' ![
Garage/Carport SUBTOTAL
Decks s 911/Rd Approach fee:
Other TOTAL $ r7 ,50 -
Receipt Number: I(35. ,
ve.11 .-- — -
Cash/Check Number:.
'SA$f
r
-1—7413
ESTIMATED COST(REQUIRED) Date:
•Fair market value of all labor and materials foundation to finish
.__--0____E<
Initials: /-'
• • 1
..
-, _---
. . GI.N ci.„ Olympic Region Clean Air Agency
940-B Limited Lane NW
o lc„'•, Olympia,WA 98502
(360) 539-7610• FAY(360)491-6308 Demolition Permit
:- k.c o Port Angeles office (360)417-1466
RCAA ,�j% Raymond Office (360) 942-2137
vl\�k.j�rzrasm•ursa�,Q+°E-, w w.ORCAA.org
[X Commercial Structure-Permit fee: $60.00-10 working day wait period
' Owner occupied residential.dwelling-Permit fee: $35.00-Prior Notice
PROPERTY OWNER -
Name Phone (( j- 582-5mt, Emait•
_ C RL- 6Z..4..ClJie-C FAX: ( Mobile: ( )
Mailing Address: City: State: I Zip:
1111 Siwr.u-wlc S�. . STa.I ft coom ‘dp- 9 831Lg
Site Address: Ci State: Zip:
.gl SO 13LfK-K. Toi►Jr QoAb ISrirlNOrl - �R q$ O
DEMOLITION CONTRACTOR [ ] Check if same as property owner information
Business Name: Phone: (36o)t.4t0-3ZSa Email•
bJ mi > Col,s-riw LW'tV>a FAX: ( ) cyc7<<ss t.G..acw 0_,
Onsite Contact: Phone: (3t,gl 442o 3&Sk Mobile: (gyp) 32
3ruc.s.. �%-i-z4.,Ci . , FAY: ( ) 17-0
Mailing Address: City: State: Zip:
,P41,41 ELK, Dr MT. 14..e.1oMS �J,A etga13
DEMOLITION INFORMATION
#of.Structures being demolished Start Date: Completion ate:
1 �)1 . I1) % t,1-1 1 \\
Asbestos present Yes ?( No Survey attached _Yes No Has all identified asbestos been
\ 5 ,V,(sr.-, .5 removed Yes No
DEMOLITION PROJECT CATEGORY
[) Complete Demolition
[ ]Training Fire—Fire Agency:
[ ] Renovation,Alteration,Remodeling,Maintenance,or other Construction
[ ] Emergency-Additional Fee of$50.00 (must be accompanied by Government Ordered Declaration-Commercial only)
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.ofmyknowledge, accurate and complete.
tfr),111..M ''. eC.,,UALre- 'gnat4 �r $I 1 ill
Applicant Name uze Date
D2.19,:copipt Retrivied Payment Info. [)C] Approved Asbestos Permit
k.r [ ] Cash [ ] Disapproved Permit# ASBOO
Check: # 1 d -- Demolition Permit
AUG 0 4 20 71 [ ] Q Credit Card Review date: v / f7//t ermit# i/ DEM00349b
.0Z..,nr,rA A Receive date O �j/44 / t( Reviewed by: I 1 A oS
4t-1 e ?. _4,ency Use Only _4gen;•Use Only _4jencj Use Only
10/21/08 OVER
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