HomeMy WebLinkAboutBLD2011-00163 •
DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD11-00163 Received Date 6/22/2011
SITE ADDRESS: 265 SILVER MARMOT DR Issue Date 7/11/2011
QUILCENE, 98376
APPLICANT: DAVID G HAMILTON PHONE: 360-765-0065
MARGOT C HAMILTON
PO BOX 341
QUILCENE WA 98376-0341 F
SUBDIVISION: QUILCREST VIEW TRACTS Block: Lot:
PARCEL NUMBER: 701195016 Section: 19 Township: 27N Range: 01W
CONTRACTOR: OWNER/BUILDER PHONE:
OWNER, DAVID G HAMILTON PHONE: 360-765-0065
if different: MARGOT C HAMILTON
PO BOX 341
QUILCENE WA 98376-0341
PROJECT DESCRIPTION: DEMO 2 UNPERMITTED STRUCTURES W/O PLMB
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 7/11/2012.
REQUIRED INSPECTION:
FinalApproval: )r/
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#BLD11-00163:
1.) This approval for demolishing existing structures does not ensure future building approval
from health. Future building permits may require the onsite sewage system to meet the
code in effect at the time of application.
I:\F_BLD_Permit_Propane.rpt 10/29/19
MILDING PERMIT APPLICATI BLD11-00163
L3iJ
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD11-00163 Received Date: 6/22/2011
SITE ADDRESS: 265 SILVER MARMOT DR
QUILCENE, 98376
OWNER: DAVID G HAMILTON PHONE: 360-765-0065
MARGOT C HAMILTON
PO BOX 341
QUILCENE WA 98376-0341 QUILCREST VIEW TRACTS
SUBDIVISION: Block: Lot: F
PARCEL NUMBER: 701195016 Section: 19 Township: 27 N Range: 01 W
CONTRACTOR: OWNER/BUILDER
PHONE
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP DEMO 2 UNPERMITTED STRUCTURES W/O PLMB
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:
CONST TYPE: GARAGE: SHORELINE
DECK: SETBACK:
SEWAGE DISPOSAL: CON BANK HEIGHT:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total:
Routing_D
( I
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $71.00 LYK 06/22/11 123628 ,qP P R®V E L
State Building Code $4.50 LYK 06/22/11 123628
Total: $75.50 JUL 11 2011
Jefferson County Plannint
& Building Department
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c 1-;; Olympic Region Clean Air Agency
..dv~ 4Y,,p, ?940,13 T irnitcd Lane NW
" , Olympia,WA 98502 .
al (360)539-7610•FAX(360)491-6308 Demolition
.
L -�, Port Angeles office(360)417-1466 Demolition Permit
\'4 � R.CA 9 Raymond Office(360)94'2137 ,
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pCommercial StructurePertuit fee: $60.00-10 wer ' day wait period
—Owner occupied residential.dwelling -Permit fee:.$35.0 Prior Notice �-
PROPERTY OWNER
Nainc: • Phone: (% ) 2/a O46 Email dt 3Z41 to 0 q+/,9[a�d
,VGA/'d '/%1i� a t ! / r-1m/l rti FAX: ( . ) Mobile: ,
Marling Address: /
/ a n&-it. 5�l- ,O !!e. Zip:
City Sy�,� �
Site Address: • City: State:
Flo„5- ,.S f/l/.eA 4al?AG t- l Q --LC°.11 /.._ - 4 7e3-lc,
DEMOLITION CONT.
ON RAA,CTOR j heck if same as propert9'owner information
Business Name w- phi (-7)-•. Email:
FAX: ( )
Onsite Contact . • Phone: ( ) Mohile: ( )
Mailing Address: FAQ ( } - _
City: Stan I Zip:
_DEMOLITION INFORMATION _
of Structures being demoTzshed Start Date:/• Completion Date: /
f�l�ll� V///2 �// 2,
Asbestos present Yes • ,)‹.‘No Su:ey�tattacl,ed�T yes No Has all identified asbestos been
i /, removed ,, 'Yes ./No
' DEMOLITION PROJECT CATEGORY • •
[ ]Complete Demolition
[.]Training Fir :-Fite Agn,,cy: ,, ,
[ )Renovation,Alterat+.on,•Remodeling,Maintenance; or other Construction ,
[ ]Emergency—Additional Fee of$50.00(must be accompanied by Government Ordcrcd Declaration-Commercial only)
,I have,read and will abide by the cbnditions set.forth in this permit and any addendum thereto. I do hereby ce tifr
that of identified asbestos has been removed and the information in this,application and supplemental data •
described hereto is, to the best of nyknowledge,accurate and complete.:
•
•
•
•
Ap -'.ant e Sign.► e �CI�✓ •
bate CCU . ,
Date Application Received Payment Tr,Fo, i xoved
"`gyp Asbestos Permit
RECEIVED { ] Cash [ ] Disapproved Permit # ASB00
[ Check #�( f I ` Demolition Permit
JUN 2 2011 [ ] Credit Card t1 Review date:l'-f�/_/J Permit# Ji DEM009-C157
Receive date ��0/ I 1 Reviewed by: i. .C r/rO l/S
I,: a t _40ncl Use O7713,
_"1,0e1rcJ'Use Only _igencr Use Only
ryl rcn
tZ•SON C •
�p ' /�
�� 06, JEFFERSON CtT�JNTY
Ih ' A DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street • Port Townsend •Washington 98368
Itosp360/379-4450 • 360/379-4451 Fax
gS, N�sp$ www.co.jefferson.wa.us/commdevelopment
•Master Permit Application MLA: NC ill-1 CED? h
Project Description(include separate sheets as necessary):
N)Pin' 1 u ` _�Yt.cc 1/a s (AY nc� PI Im8
Tax Parcel Number: OW/ 95" /6 Property Size:
p Y (acres/square feet)
Site Address and/or Directions to Property:
6 5 3, /v , ilaAmat Dr
Property Owner(s)of Record: c )a i 1 G / Al 90� a i/�`�� ��'
Telephone: 5-t',o '/�r O(a S Fax: email: d 1 3 2 6 Co
Mailing Address: /1) A/S Y. 3 Cr// o� -
�}� ��ll�i�c.� corm
Applicant/Agent(if different from owner):
Telephone: Fax:
email:
Mailing Address:
A at kind of Permit?(Check each box that applies ❑Lot or Road Segregation
'1% ilding 0 Critical Areas Stewardship Plan
%s Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
❑Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a , _ **
❑ Manufactured Home .0 Modular
0 Discretionary"D"or I i ,riavE
❑ Commercial* 0 Special Use(Essenti IF' p¢�e
❑ Change of Use 0 Boundary Line Adjus
❑ Address 0 Road Approach 0 Short Plat**
❑ Home Business 0 Cottage Industry ❑Binding Site Plan** I JUN 2 2 2011
❑ Propane 0 Long Plat**
❑ Sign 0 Planned Rural Resi a ti evelo merit(PRRD)/Am s**
0 Allowed"Yes"Use ConsistencyAnalysis ,„k
Y 0Plat Vacation/Alters ion IEFFERS N COtJ
❑ Stormwater Management 0 Shoreline Master P granlIF-X s**
❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substan la
❑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 ❑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:
DESIGNATION OF AGENT
I hereby designate to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE 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 application that he or she nts for notice.
,l ,
'Signature: 2.1 L 1777,<, Date: 9r-LA ' ,2i //
The action or actions App icant 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-trans sable responsibility for d ring to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
/Signature: [��^ 21_ Date:v
\ ?.-.. "7� ,.2-/)//
G:\PermitCenter ###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 as uming the responsibilit .of the Gen ral Contractor for the proposed project.
signature:
e Date: 7 - /(
,,GENERAL CONTRAI'rOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:( )
( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER
NUMBER: FAX:( )
ARCHITECT/ENGINEER: PHONE ( )
MAILING ADDRESS: EMAIL
Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
tS(Project Type: Wood Existing: - ❑ Sewer
❑ New CI Steel Proposed: Bank CICommunity System
CI Addition Total: _ Height: 7�Individual System
❑ Alteration/Remodel CI Concrete SEP Permit# -lb -D;)7I
CI Repair ❑ Masonry Water Supply:
❑ Other: Bedrooms:
Demolition Existing: Setback: fig; Private well ❑ Two Party
Proposed: ❑ Public
Type of Heat: Total: Name of System:]t591 14!77t71) dd.-
If this is a Commercial Project you must answer the following: Number of ADA Parking Spaces:
Number of Parking Spaces: Current: Proposed:
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.
Square Footage Current Proposed For Office Use Only
Amount Revision
App Review:
Main Floor Heated
2nd Floor Heated Consistency Review:
Other Heated Base fee: ( —
Mezzanine
Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee: <l
' Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL
Decks 911/Rd Approach fee:
Other TOTAL: $ l LIx ,5°
Receipt Number: 19.30S
Cash/Check Number: p—n ,i
ESTIMATED COST(REQUIRED) Date: liar L
•Fair market value of all labor and materials foundation to finish Initials: 1
G:\PermitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
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