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HomeMy WebLinkAboutBLD2011-00198 a DEMOLITION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD11-00198 Received Date 7/25/2011 SITE ADDRESS: 2230 BEE MILL RD Issue Date 9/19/2011 BRINNON, 98320 APPLICANT: WALTER L DICKERMAN PHONE: 503-519-3871 BARBARA J PRIEST JTWROS 16754 S HOLCOMB BLVD OREGON CITY OR 970457204 TX 12 SUBDIVISION: Block: Lot: PARCEL NUMBER: 601074014 Section: 7 Township: 26N Range: 01W CONTRACTOR: OWNER/BUILDER PHONE: OWNER, WALTER L DICKERMAN PHONE: 503-519-3871 if different: BARBARA J PRIEST JTWROS 16754 S HOLCOMB BLVD OREGON CITY OR 970457204 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 9/19/2012. REQUIRED INSPECTION: 171 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. HOT LINE AVAILABLE 24 HOURS A DAY I:\F_BLD_Permit_Propane.rpt 10/29/19 I GILDING PERMIT APPLICATJ BLD Review Type: ype: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD11-00198 Received Date: 7/25/2011 SITE ADDRESS: 2230 BEE MILL RD BRINNON, 98320 OWNER: WALTER L DICKERMAN PHONE: 503-519-3871 BARBARA J PRIEST JTWROS 16754 S HOLCOMB BLVD OREGON CITY OR 970457204 SUBDIVISION: Block: Lot: TX 12 PARCEL NUMBER: 601074014 Section: 7 Township: 26 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI 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: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: 1PWELL BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $71.00 LYK 07/25/11 127940 State Building Code $4.50 LYK 07/25/11 127940 APPROVED Total: $75.50 SEP ;()! 2U11 Jefferson County Planning &Building Department • • ,,-40.10N c ...,y OIympic Region Clean Air Agency .$ 4' \'.ot 2940-B Limited Lane NW !° fG ;: Olympia,WA 98502 pi: (360)539-7610•FAX(360)491-6308 Port Angeles office 360 41Z 1466 Demolition Permit . ORCAA 4 s', Raymond Office(360)942-2137 a.ritrgio ua,�- m>vw ORCAtLorg I I 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: ( ) Email:A 7ne.it'e'' 5Ar s,_4,- ScLab cA. 1�rtest 4 4)4.ii- Qt c►lvemt.^ FAX: ( ) . Mobile:( ) Mailing Address: City: :State: Zip: Ilo-/Sfi' S. 1-1-o1com4.0"wluci ore o c -L6 ©g-- 9i2D1-� Site Address: City: State: Zip: :.ZZ l -c r 1) . ►3rrn.tion wc.,_ 9 T 32.21 DEMOLITION CONTRACTOR 1 Check if same as property owner information Business Name: Phone: ( ) Email: FAX: ( ) Onsite Contact Phone: ( ) Mobile: ( ) FAX: ( ) Mailing Address: City: State: Zip: DEMOLITION INFORMATION #of Structures being demolished: z Start Date: r ' • I Completion Date: .64-ot. . -shy) n -2 i -11. Asbestos present _Yes i/i3o Survey attached k es _No Has alt identified asbestos been removed Yes No DEMOLITION.PROJECT CATEGORY • t4 Complete Demolition [ ]Training Fire-Fire Agency: [ ]Renovation,Alteration,Remodeling Maintenance,or other Construction [ ]Emergency—Additional Fee of$50.09(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 of my knowledge, accurate and.complete: , WhCc_1.•/b>0.-V-E=Ri totsl 1.7 .....)Ms..".... ..g = 2:4 / //2 / Applicant Name Signature '-' Date d Payment Info_ pr Approved , Asbestos Permit L''' { ]Cash [ ] Disapproved Permit# ASB00 JUL 2 5 2011 [ et:. #r7` q Demolition Permit. [ Credit Card Review elate: 7 i2) 1 Permit# I I .DEM00 /�, Receive date: / . //l I Reviewed by: . e ed`""#, Agency Use Only 4gency Use Only Amy Use Only 10/21/08 OVER ,� N Cpd • JEFFERSON NTY W ' DEPARTMENT OF COMMUNITY DEVELOPMENT *C 621 Sheridan Street • Port Townsend •Washington 98368 1G 360/379-4450 • 360/379-4451 Fax ` .�'�Np�Sp www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: !�,( () \( /\ t t Ci II Project Description(include separate sheets as necessary): D A,.c.l,.-j-7 • C k t 3 i 1 h-F i t ( `-'1. t bt..i k't Tax Parcel Number: Cr,G j t..)-?4-0 i.4- Property Size: /. G,,3r•c._ (acres/square feet) Site Address and/or Directions to Property: a. 3i) c e rn`t1 l2uc_c ti —Property Owner(s)of Record: rxz.,L,p/- J- /�. :_t, rt / is E,< /� �,,�i,� Telephone: t; „Si'? - ,3S-7/ Fax: email: ,CDAe;r 7-Cv <-futsh=,,...2t' Mailing Address: t lv.7 S 4- n _ Hz-.t c c,,,,—t,, to(Jc.9 Qh,; �;,•N. C. O/z- /7 G 4 S Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies 0 Lot or Road Segregation B ilding 0 Critical Stewardship Pla Demolition Permit 0 Varian ( . . . . e •1 n• i Use) ❑ Single Family 0 Garage Attached/Detached 0 Conditio all -.,,-r. Gin:* `. �- ❑ Manufactured Home .0 Modular ' - - 0 Discretign r�'b"or �:Unnamed Use Class i '• ❑ Commercial* 0 Special pse(Essential Public Facilities) ❑ Change of Use 0 Boundary Lii;e Adjustment_ ❑ Address 0 Road Approach 0 Short PI t**' ❑ Home Business 0 Cottage Industry 0 Binding site pl:n** ❑ Propane 0 Long Plat** JEFFERSON COUNTY . ❑Sign - 0 Planned Rural-fte jdwp peye r(pRRD Amendments** ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacat h/Alters ion ❑ 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: 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 ap lication that he or sh wants prior notice. ,/Signature: - i.:') ��sa _��� �� _ Date: Ili)5/r) 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 adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. /Signature: u �<c r A.� ��a. ,, — Date: 7/-3 5// G:\PemvtCenter\###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 assuming the responsibility of the General Contractor for the proposed project. Signature: /.it+-etciN 7/ f i'--4 4ce, Date: 0 Sl// 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: 0 Sewer ❑ Addition ❑ Steel Proposed: Bank l] Community System O Alteration/Remodel ❑ Concrete Total: _ Height: LI Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: CI 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: 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 Main Floor Heated EH Bld App Review: �F 2�Floor Heated Consistency Review: Other Heated Base fee: r • Mezzanine Additional Section: I Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: /I l�(.-, Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $ �3 3L. Receipt Number: 1 7:1`1 0 Cash/Check Number: _ `73 72- ESTIMATED COST(REQUIRED) Date: ��2 + •Fair market value of all labor and materials foundation to finish 1 Initials: - - G:\PennitCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc a) o_ a) o Qr 1.0 o = a. Z c..;!...? co yy. co o ff 0 I— \� � 1� •c CV C • o o E 1W fI z pQ We ° ma °° r . Noo (D 7 LLI �i `r.■ = m CD -p U) �- N O OU LL. �l o a) otsc p � � •,- Cp � o E0o m E p C. ' aco€ QomL-toZ b Tr . . .� n p CD 4 • ciCD a. 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