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Home My WebLink AboutBLD2012-00405 S DEMOLITION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD12-00405 Received Date 12/11/2012 SITE ADDRESS: 61 OLD FERRY RD Issue Date 1/10/2013 PORT HADLOCK, 98339 APPLICANT: CLAYBORN J BURLESON PHONE: 360-379-0547 ANGELA C BURLESON 61 OLD FERRY RD PORT HADLOCK WA 98339-9761 6+ SUBDIVISION: PORTAGE BAY PARK Block: Lot: PARCEL NUMBER: 989100007 Section: 1 Township: 29N Range: 01W CONTRACTOR: OWNER/BUILDER PHONE: OWNER, CLAYBORN J BURLESON PHONE: 360-379-0547 if different: ANGELA C BURLESON 61 OLD FERRY RD PORT HADLOCK WA 98339-9761 PROJECT DESCRIPTION: DEMO EXIST 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 1/10/2014. REQUIRED INSPECTION: FinalApproval: BUILDING INSPECTION HOT-LINE 379-4455. REQUESTS MUST BE RECEIVED BY 3 PM THE DAY BEFORE THE INSPECTION IS NEEDED. Office Hours 9:00 a.m. -4:30 p.m. Monday-Thursday HOT LINE AVAILABLE 24 HOURS A DAY \\tidemark\data\forms\F_BLD_Permit_Propane.rpt 1/10/2013 BLD12-00405 *BUILDING PERMIT APPLIC PGN Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD12-00405 Received Date: 12/11/2012 SITE ADDRESS: 61 OLD FERRY RD PORT HADLOCK, 98339 OWNER: CLAYBORN J BURLESON PHONE: 360-379-0547 ANGELA C BURLESON 61 OLD FERRY RD PORT HADLOCK WA 98339-9761 PORTAGE BAY PARK SUBDIVISION: Block: Lot: 6+ PARCEL NUMBER: 989100007 Section: 1 Township: 29 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOP DEMO EXIST 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: 05783 BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Routing Date: Type Amount Paid Bv: Date: Receipt: Approved/Date Permit $74.00 LYK 12/11/12 139820 State Building Code $4.50 LYK 12/11/12 139820 APPROVED Total: $78.50 JAN 10 2012 Jefferson County DCD \\4irl.rn,r,\r4n4a\fnrmo\C RI fl Ann RIA rn4 97NAPN199 j OCIll irC4t,, JEFFERSO�UNTY ' 1�� DEPARTMENT OF COMMUNITY DEVELOPMENT _ • 621 Sheridan Street• Port Townsend•Washington 98368 360/379-4450• 360/379-4451 Fax ttezati www.co.jefferson.wa.us/commdevelopment Go,. Master Permit Application MLA: 1vO Yt A Project Tption(include separate sheets as necessary): ewvo e7tts '8 S Tax Parcel Number: (e 0 C)C 7 Property Size: 1- (acres/square feet) ��9 Site Address and/or Directions to Property: Property Owners)of.^record: _ •i ► •111/.,i - `'MI - vs `�� Telephone: 3GO 3 • —a 16 Fax " email: C,' 11® q� �3tk* Mailing Address: M` • " Q Applicant/Agent(if different from owner): Telephone: - Fax: email: Mailing Address: What kind of Permit?(Check each box that applies T I � \vJ I Building 0 Critical Areas �In Demolition Permit 0 Variance(Minor,Major or F�easona Use) Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a),C(d),or CI** ❑ Manufactured Home 0 Modular 0 Discretionary"D"or Unnamed Use Classi ❑ Commercial* 0 Special Use(Essential Public Facilities)714 ❑ Change of Use ❑Boundary Line Adjustment . ❑ Address 0 Road Approach 0 Short Plat** i ❑Home Business 0 Cottage Industry 0 Binding Site Plan** ERSON COUNTY .,,_ ❑Propane 0 Long Plat** ❑Sign 0 Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration** ❑Stormwater Management ❑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* ❑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 to al,state or federal permits required for this proposal,If known: 0Rc(kl/C vvwk t- it t2 \VM orb. 33.5 Jo l6 -/2 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 attomey'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 wants prior notice. Signature: T 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 r pqn 'bility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: ':.-t"--�6�—�'_"G Date: G:\PemvtCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc k. SBUILDER STATEMENT • The signer of this statement does hereby certify that• - are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be ass • g t r•s• nsibilityt of the Ge ' nt :•o - the •roposed project. Signature: • _ 1l >T,/1.� a`te: f d -Z C- 2 GENERAL CONTRA ' •F 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 16 Wood Existing: ,I Sewer ❑ Addition Steel Proposed: Bank ❑ Community System 0 Alteration/Remodel 0 Concrete Total: Height: ❑ Individual System El Repair El Masonry SEP Permit# Demolition El Other: Bedrooms: Water Supply: Existing: Setback: I Private well Cl Two Party Type of Heat: Proposed: j i Public Total: Name of System: If this is a Commercial Protect 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 1 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 . ' r + . , 0 ' ', 4fr°.;._'..i ion ,-;-,',,:fit, :, Main Floor Heated 1%1° EH Bld App Review: 2"°Floor Heated •n \\'� I IR *")f Other Heated '='•�e'#. ': .1 l Mezzanine F I ,, , Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: 4 Other Unheated I Pot Water Review fee: i'„ fGarage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other TOTAL: $ q 2 50 Receipt Number: 13C\Dc3d Cash/Check Number: 5(4a ESTIMATED COST(REQUIRED) Date: .Fair market value f al labor and materials foun ' n to fi 'sh 1"›.— 1_k D Initials: C)76 vie 91I��C 11t1 /�,'f/ • G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc 0 • - GION CLtm, Olympic Region Clean Air Agency '�$ 44 . 2940-B I.imited Lane NW ri c) f l % Olympia,WA 98502 ' q (360)539-7610•FAX(360)491-6308 Demolition Permit Port Angeles office(360)417-1466 \`fG 0 RCAA c'' Raymond Office(360)942-2137 `�'' rP�l` www.ORCAA.org Nj Owner occupied residential dwelling-Permit fee: $35.00-Prior Notice-Nonrefundable Other Structures-Permit fee: $60.00-10 working day wait period-Nonrefundable [ I Emergency Fee$50.00-must be accompanied by Government Ordered Declaration(other structures only) PROPERTY OWNER Name: Phone: 36d 379 0547 Email:cj.burleson@gmail.com Clayborn & Angela Burleson Fax: ( ) Mobile: (778 8481337 Mailing Address: City: State: Zip: 61 Old Ferry Road Port Hadlock WA 98339 Site Address: City: State: P'Ci 61 Old Ferry Road Port Hadlock WA 98339 DEMOLITION CONTRACTOR[)cj Check if same as property owner information. Business Name: Phone: ( ) Fax: ( ) • 1 Onsite Contact Phone: ( ) Mobile: ( ) Fax: ( ) -- _____� •7 Mailing Address: City' r lS / �`_ . I I DEMOLITION INFORMATION I ate: Completion Date: J #of structures being demolished: I Estim Start ated May 13,2013 Estimated May 18,2013 One Asbestos present? [_..1 Yes r<1 No Survey attached? [T Yes LI No Has all identified asbestos ben removed? j Yes -No' DEMOLITION PROJECT CATEGORY [)Complete Demolition j ]Training Fire-Fire Agency,Contact,Phone: [ ]Renovation,Alteration,Remodeling,Maintenance,or other Construction • I do hereby certify that all identified asbestos bar been removed and the information contained on this form and supplemental data described herein is, to the best of mj knowledge curate and complete. Claybom J. Burleson ��- f -- October 18,2012 Applicant Name Signature Date DWe Application Received Payment Info. K Approved Asbestos Permit Ed 'E 1 J E D [ ]Cash j ] Disapproved Permit# ASBOO �✓ �` [ }Check: # ( Demolition Permit [v Credit Card '35" Review date: 10 /fir/ / - Permit# /v2 DEMOO 3335- OCT 18 2012 Receive date:12/�42 Reviewed by: )oo / ��'e/��' Agency Use Only �J{ Agency Use Only Agency Use Only 06/l ie�1t-i OVER SOR*-'+ Ordinal. igh y �� d Water Mark if� y� ' ill:e6e>1 f / . ( ;!'v ('� Silt Fence During Construction !per 32550 �4 n` to capture sediment / ^s-CISTti�C� s�OvA[ ti . � i A(1 �CYUv�j . uAl \'� ' s 4�.sL �lflel `ks ' 36" `y Fir 11 30'Marine ' 3 '" .� • rneNQ- V eld1ec /. pp Bank Setback ..-• 2)9• ;�,- "" - ,. '% , "teoU.) a fe N• 5 _ e \" ♦OOi♦i♦`•+DOi`Oe Proposed Roof Extent O+oO♦o♦o♦�+• +♦♦+�♦• +♦ p • 3 ' .• ♦♦i♦i♦i♦Oi+i♦i♦i♦04�♦�♦`\iDoi+♦'► • \\ • j .♦so0♦00+0+0♦i♦. Ob°c Existing " \•Oi��'it•ii♦+♦ ' �Cp�`��♦+ Stormwater ' 1' ,' �s♦iiO!OOii.♦ii r" \ lit. \ \ifInfiltration ♦♦�• ✓�. �•��A�� + "{ Pro osed Bed ••♦+ i�+�♦�♦�.�� '' p ° ��`. Existing ♦+♦♦♦♦♦♦♦♦♦+♦♦+♦♦♦.�,♦+ \' Replacement Parcel \ ♦i♦i♦i+i4tii♦i♦i♦• 'ss ' ,, \ ` Residence ►�+♦ Fence BoundaryOi♦i♦i♦i♦i4♦i♦i♦i♦i♦i+♦ �� (2,793 SF) ++♦ 00000♦''♦DOO+♦p+♦ . Existing House \ \ �i�♦ ♦;.��Ov��j��D♦� gip♦ �. ♦♦♦�♦♦♦♦♦♦Q♦♦ • I to be removed *♦ Straw Mulch spread as ++i♦i♦i♦i♦i♦i♦i I •' ♦ needed during construction 42" ♦�♦�♦�+�♦�♦�♦♦ Downs .ut and .' 7� `` to minimize erosion +++++ + p oo Fi i♦i♦i♦%'•:*♦♦i ,�'•I Splash : ock ♦i♦O♦i♦. o♦ ExistingDry-Stack ; ♦i♦i♦i�0♦i♦i♦i+i,. (Typical o 4 ♦i i♦♦♦i i♦♦ Rock RetainingWall 29' '♦�+�+�+�D♦�0 �;0 ) ♦�+�♦+�♦ �i♦♦, ` ��♦O�pOlie- • \ O+♦pOp�♦ 5' Existing ‘ ,�:♦w,+Oi� 6.s' � Curtain Drain �:��♦�� ` " ♦�♦♦ ,s`•, ♦+♦��i� Existing Dry-Stack O -'-.- +�♦�%%%%%i� Rock Retaining Existing Septic O.._ ,,,.oy40+.♦.♦.♦+�. . Tank and Pump 4♦,,—4.,+%%♦`�%%i♦♦, • Wall Tank ♦�i � %♦a♦%y�`i♦ �i;♦ Drawn by: Everett A. Sorensen, P.E. ♦�- 715 Grant Street ;�i�;:♦+; .♦ `:�\ Port Townsend, WA 98368-2405 ;if;':♦♦ 360-821-9960 ., Existing Water Supply December 11, 2012 Pressurized"\\ approximate route 0 Pipeline s 0 20 40 Ft Glendons �\ Existingv Site Plan--Northern Detail KS -Q�+• -ti • : " Burleson Family Replacemeri !- R, - Le 0 o Electric `, ''••\ Service , 61 Old Ferry Road � Port Hadlock, WA 98339 :;�;� ( \ Existing Parcel 989100007 i R Garage (NW Corner) Construction Lot 6&7, Portage Bay Park )EFFE SON COUfNTY Section 1, Township 29N, Range 01 W': F '/'l!li,ITY DE/FLO2MENT Entrance dc?a\1 ,.--- Ordinary High Water Mark . n 0 o �0 30'Marine 36 (1, Proposed Roof I Bank Setback / Extent I 1 ' Fir �. Proposed / )' • \ Replacement �O i ' 37, �•'� ('� , Residence i 1� . 0 ' ,' �� \ \:,'• (2,793 SF) i Existing House to be removed I 989100009 I • Existing Dry-Stack 1 \•,*42" I \\ _ } Rock Retaining Wall i Fir \ 6.5' 1 / , Existing 29' 1 \ / I Curtain Drain • #\',..-;=- 1 989100008 'I Existing Septic Tank Existing 1 \ I and Pump Tank \ s .. Water Supply 1 •\ ?� approximate i Pressurized ':� route 1. \. Pipeline to A, •' i I 1 I Glendons i', �\rg i Parcel 1 1 �O ':�\ �-1-5 9e Boundary i �-v A. SOR.z, . co(:) � :" i i ! 4, 07e, . 1,.•./<Nt . \ ' ... '‘, VCP. I I , .4)4( . /A' CI . '' , ti, �' N \ Existing 61,i' - I `?o :�� Barn - o I s STE� G\ `ram :� 1 ��, cS I / 7ONALti do • rn ; I L : �� \•� Existing Two Pod `� , :� \Glendon Septic i / System with • Site Plan (Sheet 1 of 2) / •.� Reserve Area' Burleson Family Replacement Residence / `. 1 / 61 Old Ferry Road ; `\ Port Hadlock, WA 98339 • k.. ; I Parcel 989100007 / `• ' Q j I i •: \ I Lot 6&7, Portage Bay Park '� . Section 1, Township29N, Range 01 W o , Y 9 M ;,,,,,go.,—,. I Ui 0 50 100 150 200 Ft �\ 0 1 i \ o Cr i /`\ t, M N Parcel Boundaries and 10-ft Elevation Contours Existing Electric Service / °� �. taken from Jefferson Co.On-line Mapping Tool approximate-route— / �\ Z Li.. 1 , �� rG' V 1 , ' o Drawn by: Everett A. Sorensen, P.E. l i r— ��' ,% `, Water ' Y 715 Grant Street ' - '\ Meter Port Townsend, WA 98368-2405 / / 360-821-9960 1 \ i December 11, 2012 I - i Construction JEFFP,S` ' :;Ty J, Utility \. r.r _!r,��TNT ! Easement Entrance -- — (PSE)