HomeMy WebLinkAboutBLD2011-00284 • •
DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD11-00284 Received Date 10/13/2011
SITE ADDRESS: 309852 HWY 101 Issue Date 10/17/2011
BRINNON, 98320
APPLICANT: JAMES V PEARSON TRUSTEE PHONE: 253-752-0367
JAMES V PEARSON TRUST
6415 N PARK WAY APT 1
TACOMA WA 98407-2276 TX 50
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 502164054 Section: 16 Township: 25N Range: 02W
CONTRACTOR: STEVE KELLY CONSTRUCTION CO LLC PHONE: 360-509-3817
PO BOX 327
PORT LUDLOW WA 98365
Contractor's License STEVEKC907QN Expires 11/15/2012
OWNER, JAMES V PEARSON TRUSTEE PHONE: 253-752-0367
if different: JAMES V PEARSON TRUST
6415 N PARK WAY APT 1
TACOMA WA 98407-2276
PROJECT DESCRIPTION: DEMO EXISTING 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 10/17/2012.
REQUIRED INSPECTION:
•
FinalApproval: 1-D ' ' f-1,Z
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# BLD11-00284:
1.) This approval for demolishing the residence does not ensure future building approval.
Future proposals must meet current code at the time of application, this includes the
septic system.
I:\F_BLD_Permit_Propane.rpt 10/29/19
likJILDING PERMIT APPLICASN BLD11-00284
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD11-00284 Received Date: 10/13/2011
SITE ADDRESS: 309852 HWY 101
BRINNON, 98320
OWNER: JAMES V PEARSON TRUSTEE PHONE: 253-752-0367
JAMES V PEARSON TRUST
6415 N PARK WAY APT 1
TACOMA WA 98407-2276
SUBDIVISION: Block: Lot: TX 50
PARCEL NUMBER: 502164054 Section: 16 Township: 25 N Range: 02 W
CONTRACTOR: STEVE KELLY CONSTRUCTION CO LLC PHONE: 360-509-3817
PO BOX 327
PORT LUDLOW WA 98365
Contractor's License STEVEKC907QN Expires 11/15/2012
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION DEMO EXISTING 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:
OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total:
Routing Date:
Type Amount Paid Bv: Date: Receipt: Approved/Date
Permit $71.00 LYK 10/13/11 128245
Plan Check $0.00 LYK 10/13/11 APPROVED
Total: $71.00 OCT 17 2011
Jefferson County Planning
&Building Department
III III
44.. " c/1111%14,4 JEFFERSON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
�<y��NaO www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: V -/'l _ r
Project escription(jnclyde separate s eets as necessary):
.r t..,k .: / fit A v + 10L A /.o H'4, .t.
Tax Parcel Number: 50 cl /6 y U S' Property Size:4/ 73 acre quare feet)
Site Address and/or Directions too Property: G �/
t/ 4) y /O / 7/et../vc�/U O/ �S.2 /4-e_/ 7d/
Property/Owner(s)of Record: Jft-vvr-ed. t/ ,-,4 -G ,,
Telephone: S- -0 Fax: email: v. v 4 r >,.)
Mailing Address: 6'`// 5�.�1. Af /mot A ,/ 71p4- / c/`/GhAl.A-J-014
Applicant/Agent(if different from owner): /
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies
uil ing ❑Critical Areas Stewardship Plan
Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use)
Dingle Family 0 Garage Attached/Detached 0 Conditional Use[C(a),C(d),or C]**
Manufactured Home 0 Modular 0 Discretionary"D"or Unnamed Use Classification
❑ Commercial* 0 Special Use(Essenti Pt,hlic Facilities)**
❑ Change of Use ❑Boundary Line Adjus I I 0
❑ Address 0 Road Approach ❑Short Plat**
❑Home Business ❑Cottage Industry 0 Binding Site Plan**
0 Propane ❑Long Plat**
❑Sign 0 Planned Rural Resid ri,a' velopment(PRRD)/Amend n
❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alterati 'I** I
❑Stormwater Management ❑Shoreline Master Pr ilL xemption/Permit Revisions
❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Managem nt Su ment--
❑Temporary Use ❑Shoreline Managem nt Variance JEFFERSON COUNTY
❑Wireless Telecommunication* 0 Comprehensive Pla haVLIVMStriqh0P AiRfPment
❑Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program-Mr
*May require a Pre—Application Conference 0 Tree Vegetation Request
**Requires a Pm-Application Conference
Please identify any other local,state or federal permits required for this proposal, if known:
0 RCAA I 0E iv,o 3o 3 3Qj .3t.A 6//k/ i0/ t8 a,_ ,s.v'
DESIGNATION OF AGENT // r
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 re,uired later inspection Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the appli'--.on that he or she 0 nor notice.
Signature: A-.. - i Date: 40/2 e[/
The action or acti• s Appl ant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or
endangered specie -nd .•uld lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the
"Endangered Species • *"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-transf ble responsibili bp
adhering to and complying with the ESA. The Applicant has read this disclai r and igns and dates it below.
Signature: `0 Date: /4 ZtJl cii
G:\PemvtCenter\## FO S###\DRD FORMS\Master Permit Application 5-29-08.doc
I
• !
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 ai ing the responw•b•••y of the General Contractor for the proposed project.
Signature:7 w '-^1A)\ Date: 10` t)/i?,C/
GENERAL CONT' 'OR ANUFACTURED HOME INSTALLER: PHONE: FAX:
�:...) -PryI c pilewc1-,VV (360.97-3s-icy ( a97— -o 7
MAILING ADDRESS: C) BO . X 7 EMAIL:5/C , ,N„"4,.r g 11 v,7/t C0
til
CONTRACTOR'S LICENSE WAINS
NUMBER: v.0 ke T o 7 ai,i NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: ' Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New El Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank ❑ Community System
❑ Alteration/Remodel 0 Concrete Total: Height: ❑ Individual System
U Repair 0 Masonry SEP Permit#
❑ Demolition 0 Other: Bedrooms: Water Supply:
Existing: Setback: - ri Two Party
Type of Heat: Proposed: I C I ■'r' Itlic I��
Total: Name of S'yalerrr.
I
If this is a Commercial Project you must answer the following:
n '
Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: 2 /1
Number of occupants(includes owners,tenants,employees,etc) Current r Proposed
IBC Occupancy: IBC Type of construction: Will you have FoodJStF"i CNtiTY/ No
If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: I'MlJNITY DEVELOPMENT
1 Underground Tank 1 Above ground Tank Size of Propane Tank:
1 Heat Stove 1 Cook Stove 1 Woodstove 1 Fireplace Insert 1 Hot Water Tank 1 Pellet Stove 1 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.
,fir i ,5
'u: �, Lai Ty;
Square Footage Current Proposed For Office Use'.Only, Amount ', Revision
Main Floor Heated EH Bid App Review:
rb
2'Floor Heated Consistency Review:
Other Heated Base fee: rf'I ,--
Mezzanine .,:.-q:LL, Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee:
4. 50
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL
Decks 911/Rd Approach fee:
Other TOTAL: $ 14S 50
4345
Receipt Number:
• Cash/Check Number: 7(
ESTIMATED COST(REQUIRED) Date:
.Fair market value of all labor and materials foundation to finish I r)'" ✓L
Initials:
•
G:\PcrmitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc
OC"A`.!20I 1/WED 08:58 AM ORCPA• FAX No. 36049163080 P. 002
��G10 c eN Olympic Region Clean Air Agency
oy� 44i 2940-B Limited Lane NW
•
Olympia,WA 98502
60 539-7610•FAX(360 491-6308
1 , t Angeles office(360)417-1466 Demolition Permit
0
`�. RCA c Raymond Office(360)942-2137
/340.,.,� .w►+a►'' .ORCAA.ocg
•
[ ] Owner occupied residential dwelling—Permit fee: S35.00—Prior Notice-Nonrefundable
V; Other Structures—Permit fee: $60.00—10 working day wait period-Nonrefundable��'t�1en�
`>�—4�l—l0•5�1'�I 'Sari,
PROPERTY OWNEt�
Phone: 4�—75a-03e, Email:Q A e/1 pJ ek
M1 A�v,.e S V' P.PA rsa-i FAX: ( . , iv�bue,,( Sb 6-y/, 6JC LAii
(•_L ' st. to• Zip-.
, Ar OM* I
t,J
I�
I
z: .i'v1i. 1.1-1UN .V7".i1\.iC3.Uit 1 itC. ..7.:1:cL•_i.e:_ :Yt'GuE�ix; .J.+�— .0t:::_::.:St.:7_
Sf-4...,4 k.e it (o _ ;-- Q� 97_ +7~5 ' rrl 1� _,
P
—- _ __it: is::ii)u;- `k- _ _v 'V
io
: :-; :iy.-Sehl_411JN,TY I, ! -
---- • f> _J .. ! .
DEMOLITION PROJECT CATEGORY
X] 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 of myknowledge, accurate and complete.
A frt./ .PM(Se A. .--- — J --e c /0_ t/ - 6/f
Date Ap lication Received Payment Info. [ Approved Asbestos Pe t
RE [ ] Cash [ ] Disapproved Permit# I 1 ASBOO'yLia
���� Check: # Demolition Permit
D [ ] a /—��--
OC� 4 5 2011
-"[�l-GrPrlit.Card�l.oc>,G _.`�- Review-daze:—�-(� � 1�.ermit�# I f �EMoo --��__
• Receive datel° /. . /I I Reviewed by: 1 ?°t/4 .-
CAAlY08/ Ageng Use Only _4genc�t Use Only _4�encj, Use Only
OVER
_ -
...a _,..,- ..., ...., cane ininn v gni-I n+.n•cn I I nn inn
Wt
?Prtix 4el 1t3 to col r,,,,4�
0/I.Oae I:(
' fie .
pay` 1� I D
-� - -- -- -- �� go
/v' /��
-to toe it
Pot.-6-0-, 0„,„
10
II,, ,Mar.
b twaw+ ?oxlantiq
02o6;le „ ' flAre4,
1
,!
•
aba�p
. .
. . .
. .
I
OCT, 0,1 ., oFEov-IE . ,
, _.../ , .
, , _ , ......
, • , ., , 1-3' 2011 -
. '
• JEFFERSON COUNTY
L DFPT.QF COMMUNITY DEVELOPMENT'.
•
,{ t N
� ' '.�- - --.. ram- __
, id ,
•
i,
: ,�,.
a1� A ray : t - •
F
.
J I
p-
1
Z`
•
'.., ! ��� ,;.III
t
mom .
v
•
"
•
•
•
•
: _ ----W
J FFERSON COUKTv. ,
,. :'>T-OF COMMtJNITv oev tOpTv1 fT--•-=e,to 74,
r
t1