HomeMy WebLinkAboutBLD2012-00145 •
DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD12-00145 Received Date 5/7/2012
SITE ADDRESS: 331 COOK AVE EXT Issue Date 5/31/2012
PORT TOWNSEND, 98368
APPLICANT: JAMES W MAUPIN PHONE: 360-385-6917
NORA PETRICH
291 COOK AVENUE EXT
PORT TOWNSEND WA 98368-9627 TX 48
SUBDIVISION: TIBBALS LAKE PARK Block: Lot:
PARCEL NUMBER: 999000309 Section: 4 Township: 30N Range: 01W
CONTRACTOR: JEFFERSON COUNTY FIRE PHONE: (360)732-4533
DISTRICT 1
9193 RHODY DRIVE
CHIMACUM WA 98320
OWNER, JAMES W MAUPIN PHONE: 360-385-6917
if different: NORA PETRICH
291 COOK AVENUE EXT
PORT TOWNSEND WA 98368-9627
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 5/31/2013.
REQUIRED INSPECTION:
FinalApproval: fz
BUILDING INSPECTION HOT-LINE 379-4455. Request must be received by 7am the day the inspection is needed
Office Hours 9:00 a.m. -4:30 p.m. MONDAY-THURSDAY
HOT LINE AVAILABLE 24 HOURS A DAY
I:\F_BLD_Perm it_Propane.rpt 10/29/19
1001
BUILDING PERMIT APPLICAl.N BR vie Type45
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD12-00145 Received Date: 5/7/2012
SITE ADDRESS: 331 COOK AVE EXT
PORT TOWNSEND, 98368
OWNER: JAMES W MAUPIN PHONE: 360-385-6917
NORA PETRICH
291 COOK AVENUE EXT
PORT TOWNSEND WA 98368-9627 TIBBALS LAKE PARK
SUBDIVISION: Block: Lot: TX 48
PARCEL NUMBER: 999000309 Section: 4 Township: 30 N Range: 01 W
CONTRACTOR: JEFFERSON COUNTY FIRE PHONE: (360)732-4533
DISTRICT 1
9193 RHODY DRIVE
CHIMACUM WA 98320
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION DEMO EXISTING SFR
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP DEM MAIN:
VALUATION ADD'L: HEAT TYPE:
CODE EDITION: 2009 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total:
Routing Date:
.5-"-12_
Type Amount Paid Bv: Date: Receipt: Approved/Date
Permit $74.00 LYK 05/07/12 131701 J\JDpR J /E[
State Building Code $4.50 LYK 05/07/12 131701 \,, V
Total: $78.50 MAY 31 2012
Jefferson County Plannin,
& Building Deoartmp„.
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or Ill
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EL. 194' "Found" ' or i a...
' •� Corner � it
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IN. 1 p. i. BERNT PAUL ERICSEN 41
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.` ' _!- .ice CENSD DE IGNER 1
`` /09 EXPIRES 'r 11�h\\�\\���
`\ -32.
P 'Sssos t2-24•-!I
Delete existing SS•E El. 192.15 "Found"
water line, relocate P 2 Corner
10'min.from all , 20.68'
septic components/ �` ti �t�,, f /'-sss^o5'S5•E
downslope protection Q- •
areas. Install bentonite R 1
dam here.1u.st sac .•
o � do a.,slc - �`N r'eserve 2 f P
nl,•e1 ec#ie.. 42M. i‘ I slpe
Reserve 1 ,,� >/ Note:
Dwnslpew Soil Logs 1 -4
�u a/� ~ -- _01 were previously
o ,;; /�I�\/'/\ _ / logged for OTH99-047
o t �j
I \
? 1 Downslope I' Existing 1.5"
I
Protection r water line
r` 43' Areas exposed \ C6
r
o� Q
Existing fire i
i ' damaged shop Existing 0
1"SCH 4$ ,r StEP 75-108 with plumbing Gravel Drive 01 U
V� r
g ! r 1 (30'x 50') i
mils
' af Ii ` 999000309
((OC I o , �3 19675 SqFt
'<'3 ��O 71 6 1- I 0.• . 4 res
1 Existing
1 .
EL. 188' ,' 3i� _ - Water Meter
•/ ' - 129.00' O
N 88'25'12•W • Existing
.‘ -/ Powe l?qt i C /J Eli?
Existing C.O.on 4"
sewer line to(999001801 ) - 1-`
Cut and glue LiI UAY - 7 2Q'2
cap here. I
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JEFFERSON COUNTY
i- DEPT OF COMMUNITY DEVELOPMENT
0 30' (-FILE NAME N I OWNER \
INN NORA PETRICH.TRV Petrich
SCALE DATE DRAWN BY
30 Ft/In 12-26-2011 Bemt Ericsen
PARCEL# REVISION SHEET
.999000309 1/1 1/1 J
This map drawn with TRAVERSE PC,Software
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-� , ."Z&tflx , Olympic Region Clean Air Agency
a j i;" err 2940-B Limited Lane N W
° ti Olympia,WA 9$502
yet � Lt
E...'!- (360) 539-7610•FAX(360)491 630$ Demolition Permit
r t /' Port Angeles office(360)417-1466
;►CA may`: Raymond Office(360)942-2137
Sfi . .14 +lmtusm+_,,,w_:`' www.ORCAA.org
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:`7_ cm omercial Structure—Permit fee:$60,00—10 working day wait period Pt I V 4 rL Shop Q rjJ a�,,,r
A I•'Owner occupied residential dwelling—Permit fee:$35.00—Prior Notice j„ res(4 pf o
`PROPERTY OWNER �'y
Name:, / Phone: (3Gd 3� 7/f i7 Email:naPe4r� @9M hr
a4:i•ro
Cif p, IIa u p l vt and Alp rol Pe.-t-r(Oh FAX: ( ) Mobile:( )
Mailing Address: City: of� / State: zip
Z AIJL q 1 book EK f' Poet' 014 4 Sevt W f 4b6, g
Site Address: City: State: Zip: f
33 / Cflo4. /due tst
DEMOLITION CONTRACTOR[ j Check if same as property owner information
Business Name: Phone: Fttal 77tf-2Emil:<a GEmil:Ao ,�/ E yc�,0 y FAX ( )
Onsite Contact , � Phone: ( ) Mobile: ( )
1 V 1C^�( k tACGA1 FAX: ( )
Mailing Address: ( City: State: Zip:
DEMOLITION INFORMATION
#of Structures being demolished: / Start Date: ti G di 20 1 Completion Date: Jw . 3 20 1 o&
Asbestos present Yes 1/No Survey attached Ices _No Has all identified asbestos been
removed Yes No
DEMOLITION PROJECT CATEGORY
[ j Complete Demolition
Training Fire—Fire Agency: Ea5 t cJeccc rso n Ii re, Re5 cu e.
[ 1 Renovation,Alte,ritian,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 bereby 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.
4
•
iMVfilif,rr)"" dpra /ei4-14 4 S ' ZZ- /ApplicName gnature Date
6® �✓F aa�fEeMyed Payment Info. . Approved Asbestos Permit
• '�.; 99 [ j [ 1 Disapproved Permit# ASBOO
.[ Check # I CCIS Demolition Permit
MAY 07 201Z •f j-Credit Card Review date: 5/[D/ i Z Permit# 13 DEM0O I q I
Receive dates1/ /I�- Reviewed by:
,RA Agency Use Only z4,9,ency se Only AAency Use Only
10/2U08 OVER
•�gONc,
w off, JEFFERSON COUNTY
t1 DEPARTMENT OF COMMUNITY DEVELOPMENT
I-; ` ''4 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
.1 ci www.co.jefferson.wa.us/commdevelopment
SINGS
Master Permit Application MLA: IC) mLA pc-Q'
Project Description(include separate sheets as necessary): /^ •
7Trair)10, fire- g.asf' Jeccer54Y/ /'"//'G /165C. - --
Tax Parcel Number: 7 l 9000 ..30 9 Property Size: etjr ac re 5 (acres/square feet)
Site Address and/or Directions to Property:
3 3 I Co-o A AUG 1c 71: ww n I
Property Owner(s)of Record:Jim Maurlh a•hd I \D r-C Pe,. -r,C
Telephone: 3(po 32 5 LA 11 Fax: email: na p e-l-rt•G q hnat I•eo►+t
Mailing Address: Zol 1 C.00k. Auer
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
What kind of Permit?(Check each box that applies
❑Building 0 Critical Areas Stewardship Plan
t . Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use)
❑Single Family ❑Garage Attached/Detached ❑Conditional Use[C(a),C(d),Or ** �/J ,
❑ Manufactured Home 0 Modular ❑ Discretionary"D"or Unnamett'' C�s1Qica_; U G 1V
❑ Commercial* ❑Special Use(Essential Public Fbdi tiub)'* 1
❑ Change of Use ❑Boundary Line Adjustment
❑ Address ❑ Road Approach ❑Short Plat**
❑Home Business ❑ Cottage Industry 0 Binding Site Plan** ' ' ! MAY — 7 21 ,z
0 Propane 0 Long Plat** J1
❑Sign 0 Planned Rural Residential Development(PRRDj/Amendments*',
0 Allowed"Yes" Use Consistency Analysis ❑Plat Vacation/Alteration** I! , jr COUNTY
❑Stormwater Management 0 Shoreline Master Program Exemption/Pemiit Revisimslr1 OPMrNT
0 Site Plan Approval Advance Determination(SPAAD)* ❑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 ❑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:
oRc.AA
7� DESIGNATION OF AGENT
I hereby designates JA rC -v t� , } ct as my agent in matters relating to this application for permit(s).
OWNER SIGNATURES . )g 0A : t(7'�� Date: 3=2—/Z_
By signing this applica ion form,the own /a�sts 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 •• of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application
review and any required later i,s.-ctio Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the applicetjgpvthat he . prior n ce. _
Signature: * [.l./ Date: Z—!
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 violat e SA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)even if you are in complia ce wi the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-trans responsibili he ng to d complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: A ( Date: C—2 —./z
(i:\PermitCenter\###FORMS###\DRD FORMS\Master I'ermit Application 5-29-08.doc
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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: Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
EQaA-- _Sp R-co # I ( ) ( )
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 0 Wood Existing: ❑ Sewer
n Addition f l Steel Proposed: Bank 0 Community System
CI Alteration/Remodel Li Concrete Total: Height:_ ❑ Individual System ( —
Li Repair ❑ Masonry S rtrit
N. Demolition ❑ Other: Bedrooms: t1-�V
I
Existing: Setback: Er—Private-well U Two 1P )l
Type of Heat: Proposed: , - ❑ Public
Total: Name of System:
If this is a Commercial Proiect you must answer the following: tI Jl
Number of Parking Spaces: Current: Proposed: Number of ADA Parking gQg;ji rq
Number of occupants(includes owners,tenants,employees,etc) Current . Proposed •i'( ' ry Ir�irr l f1PMFNT
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:
1 Underground Tank 1 Above ground Tank Size of Propane Tank:
1 Heat Stove 1 Cook Stove 1 Woodstove I Fireplace Insert I 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.
r �, _' �•tom,.,,,
ex xn
Square Footage Current Proposed For OfficU� e•Only? ,; ,, Amount ision "
Main Floor Heated , • EH BId App Review: �C(J r
CtJ
2r4 Floor Heated 1z{ Consistency Review:
Other Heated Base fee:
M ;
Mezzanine Additional Section:
Heated Basement `.', Plan Check fee:
Unheated Basement State Surcharge fee: it CS.0
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL
Decks 911/Rd Approach fee:
Other TOTAL: $ ( c4-a)
Receipt Number: ( �170 0
} Cash/Check Number:
ESTIMATED COST(REQUIRED) Date: ^^��
.Fair market value of all labor and materials foundation to finish ! �l
Initials:
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G:\PermitCcnter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc