HomeMy WebLinkAboutBLD2011-00276 • •
DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD11-00276 Received Date 10/10/2011
SITE ADDRESS: 1154 BECKETT POINT RD Issue Date 11/3/2011
PORT TOWNSEND, 98368
APPLICANT: MELANIE GAUTHIER PHONE: 206-369-5033
25565 BAKER ST
BLACK DIAMOND WA 98010
13
SUBDIVISION: BECKETT POINT FISHERMAN'S CLUB Block: Lot:
PARCEL NUMBER: 932200713 Section: 24 Township: 30N Range: 02W
CONTRACTOR: OWNER/BUILDER PHONE:
OWNER, MELANIE GAUTHIER PHONE: 206 369 5033
if different: 25565 BAKER ST
BLACK DIAMOND WA 98010
PROJECT DESCRIPTION: DEMO EXISTING STORAGE SHED
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 11/3/2012.
REQUIRED INSPECTION:
FinalApproval: 1 9 --a.
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_Perm it_Propane.rpt 10/29/19
tILDING PERMIT APPLICAI.N BLD11-00276
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD11-00276 Received Date: 10/10/2011
SITE ADDRESS: 1154 BECKETT POINT RD
PORT TOWNSEND, 98368
OWNER: MELANIE GAUTHIER PHONE: 206-369-5033
25565 BAKER ST
BLACK DIAMOND WA 98010
BECKETT POINT FISHERMAN'S CLUB
SUBDIVISION: Block: Lot 13
PARCEL NUMBER: 932200713 Section: 24 Township: 30 N Range: 02 W
CONTRACTOR: OWNER/BUILDER PHONE
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr DEMO EXISTING STORAGE SHED
TYPE OF WORK GAR 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:
GARAGE: SHORELINE:
CONST TYPE: SETBACK:
DECK:
BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: JotaJ;_._
Routing Date:
01 0-1
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $71.00 LYK 10/10/11 128221
State Building Code $4.50 LYK 10/10/11 128221 APPROVE
Total: $75.50
NOV3 A
Jefferson County Plannin
& Building Departmen*
• .
,
``e`G ,G1ON CL'91- Olympic gion Air
6, t� 2940-B LimReited Lane NA Agency
1 �F Olympia,WA 98502Clean
(360) 539-7610• FAX(360)491-6308
Port Angeles office (360)417-1466 Demolition Permit
`•; ORCA1� Raymond Office (360) 942-2137
=rF ' www.ORCAA org
p(J 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: (360)886-9227 Email:mgauthier40@comcast.net
Melanie Gauthier
FAX: ( 206)766-5201 Mobile: (206)369-5033
Mailing Address:25565 Baker St City:Black Diamond stare:WA zi :
98010
Site Address: City:Beckett Point Rd. City:Port Townsend state:WA Zip:
98368
DENIOLITION CONTRACTOR [X] Check if same as property owner information
Business Name: Phone: ( ) Email:
< i
i
FAX )
Onsite Contact rl ! Phone: ( ) Mobile: ( )
Li I
f ' I FAX: ( )
Mailing Address:
n I n cT 1 0 2011 I Cis State: Zip:
I. ii1 !f
L.,DEMOLITION INFOR FFRenN cntINP/
#of Structures being demolis OF con,M1 1N T ANT —'
L,�- — '`j I C hon Date:
Asbestos present Yes X No Survey attached _Yes y`L, No Has all identified asbestos been
rliitdJ-6s removed Yes No
DEMOLITION PROJECT CATEGORY
[X] Complete Demolition
I ]Training Fire—Fire Agency:
[ ]Renovation,Alteration,Remodeling,Maintenance,or other Construction
[ I 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 of my knowledge, accurate and complete.
Melanie Gauthier r._ Ql� y 0. ,,, August 12, 2011
Applicant Name Sign e Date
D ?l c0i9:n ilRefqty.stl Payment Info. 94 Approved Asbestos Permit
[ ] Cash [ ] Disapproved Permit# ASBOO
AUG 1 2 2011 [ ] Check: # i Demolition Permit
f? CreditspCa t 1 Review date:_/ (Zr' I 1 Permit# I I DEMOO
QW44A. Receive date: /L/ I [ Reviewed by:
Agency Use Only Agency Use Only Agency Use Only
10/21/08 OVER
�� ox oo& JEFFERSON•UNTY
' DEPARTMENT OF COMMUNITY DEVELOPMENT B - ��
'� 621 Sheridan Street • Port Towns •
360/379-4450 • 360/379-4451 Fax ��'
�' www.co.jefferson.wa.us/commdevelgprrle
4%INe
Master Permit Application f OCT1�1 1 0 201iv[LA ,
Proj t Description(include separate sheets as cessary): [[ u I -J
�.� 1.4 - I ST I I JEFFERSON COUNTY
Tax Parcel Number: a3a -0 "7( 3 __ T CO'
:nMUNlly Utvtrurmtivi
1Z (acres/square feet)
Site Address and/or Directions to Property:
l l `3`t t3.4..,.Ir`t 4-4- p{--. IZ ok. i f o v- k-- *T-ipuJ .,-S r_1.1 r LA) it
Property Owner(s)of Record: TA-C,lti- v 4.- (.44- . cal (,,PA-4 ,,,.,_(
Telephone: j17l.t.- (c ‘'> - St- 3 Fax: aa,i?tn - 7 4 4- Six,1 email: Win,(eci"-i.-c( /k 1 p,c.��l,LL*;.-n
Mailing Address: A 5 L ff 3 j S . $,r�l� lbi A w.u,.'N-el Wlft� iti f 'r `GYM f t,
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies ❑Lot or Road Segregation
Building 0 Critical Areas Stewardship Plan
Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use)
❑ ingle 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* 0 Special Use(Essential Public Facilities)**
❑ Change of Use 0 Boundary Line Adjustment
❑ Address 0 Road Approach ❑Short Plat**
❑ Home Business 0 Cottage Industry 0 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**
❑Temporary Use ❑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 �'✓J .1.�pp 6-1-v-. U/i1� - Date: v ci - �{1(,(
11
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 thathe or she wantJ�pfior notice.
---Signature: '" 1 . .4t.wt- (////CCrr .( I.LL't..a.,,i ,t (O 2-6 I 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 adheriing to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
-Signature: ,./ (21. ,ndl.-.- t.. t
Date: (( -L0 llt ( 14.1 t
G:\PeimitCenter\###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...KSignature: A -�"""' Ld ' -��iLt-(-1- ^'t, Date: 1{
I (.1 t 'f)—t) I
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
O Alteration/Remodel ❑ Concrete Total: •c _ Height: ❑ Individual System
O Repair ❑ Masonry — SEP Permit#
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 1 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:
(k' S L
2nd Floor Heated Consistency Review: 1 Sr0
Other Heated Base fee: r�
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee: ,/_\ ('.
Other Unheated Pot Water Review fee: —
Garage/Carport SUBTOTAL
Decks 911/Rd Approach fee:
Other TOTAL: $ i ) F DT•
Receipt Number: 07S,93 I
Cash/Check Number:
ESTIMATED COST(REQUIRED) Date: 0_t
.Fair market value of all labor and materials foundation to finish /—
Initials: (-__
G:\PermitCenter\###FORMS###\DAD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
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