HomeMy WebLinkAboutBLD2011-00024 ItUILDING PERMIT APPLICA N
BLD11-00024 Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD11-00024 Received Date: 2/2/2011
SITE ADDRESS: 8123 FLAGLER RD
NORDLAND, 98358
OWNER: GEORGE FISHER PHONE: 917-744-7000
ANN FISHER
2402 E ESPLANADE LN#1102
PHOENIX AZ 850169104 GLENNAN SUBURBAN ACRE
SUBDIVISION: Block: 4 Lot: 13
PARCEL NUMBER: 953700432 Section: 29 Township: 30 N Range: 01 E
CONTRACTOR: LD RICHERT CONSTRUCTION PHONE: (360)379-5222
PO BOX 127
PORT TOWNSEND WA 98368
Contractor's License LDRICC*066LO Expires 5/29/2011
REPRESENTATIVE: L D RICHERT PHONE: (360)379-0236
PO BOX 127
PORT TOWNSEND WA 98368
PROJECT DESCRIPTIOP 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:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Tot •
Routing Date:
C9-5- Il
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $71.00 LYK 02/02/11 120424 \PPRVEL
State Building Code $4.50 LYK 02/02/11 120424
Total: $75.50 MAR 4 2W1
Jefferson County Planning
& Building Department
,oN JEFFERSOOUNTY •
' DEPARTMENT OF COMMUNITY DEVELOPMENT
o: 9 621 Sheridan Street• Port Townsend •Washington 98368
360/379-4450. 360/379-4451 Fax
` www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: f MCP (2e6)
N'ect Description(include separate sheets as necessary):
�f rn X Sr c -ap( ,
Tax Parcel Number 3"3--O Q 4-5'2– Property Size: 2G i,� (acres/square feet)
Site Address and/or Directions to Property:
?. F[ Lod
Property Owner(s)of Record: CO Wecoe P&D'3 "F-It-1/4 l?
Telephone: Fax: - email:
Mailing Address: 4O Z i . 7 if1i7 t- I 02 fiuh. AZ 9, (:),(1
Applicant/Agent(if differenjirom owner): L..-t )2\GI-f--12-r C--01°`" Tr3'e...
Telephone: ' --7°( ' 147':2 2- Fax: - - email: Ion C he_2 r co+,'-It/t'1)4 e
Cv �Diet>/,
Mailing Address: `? Vie;,
What kind of Permit?(Check each box that applies 0 Lot or Road Segregation
DBuilding ❑Critical Areas Stewardship Plan
i'4 Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use)
• ingle Family ❑Garage Attached/Detached 0 Conditional Use[C(a),CO on , I _ ` .
filo 0 Manufactured Home .❑ Modular - ❑Discretionary"D°or Unna d •- (Cl-
CI ; ''«=, •,.r1-4,
❑ Commercial* ❑Special Use(Essential P j.11 acildles)**
❑ Change of Use ❑Boundary Line Adjustment
❑ Address ❑Road Approach 0 Short Plat** FEB 0 201
❑Home Business ❑Cottage Industry ❑Binding Site Plan**
❑ Propane ❑Long Plat**
❑Sign ❑Planned Rural Residential D v to nt(PRRD Amend
ments**
0 Allowed"Yes"Use Consistency Analysis 0 Plat Vacation/Alteration r p { l j o Stormwater Management �o e I evl lEll
ors
**
❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development**
0 Temporary Use ❑Shoreline Management Variance
❑Wireless Telecommunication* ❑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:
C DDESSIGNATION OF AGENT
...0,-I hereby designate to act as my agent in matters relating t�o^a�t is application for permit(s).•,,'OWNER SIGNATUR- v" T CR"- 0' s,:" Date: + 1 ') ��
� t
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.
further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and
e ,penes 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 requir-• ter inspections. Staff's access and right of entry will be assumed unless the applicant i f. t forms he County in writing at the
•f the =•plicati , • sh wa is prio ',
I Signs um: _�i�/� Date:
The actin or act oo'.Ii - t 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 hat 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 � re in compliance with the Jefferson County development code.The Applicant acknowledges'hat h she or it holds individual
nd non-try sf-- - •onsibi' for adhering to and complying with the ESA. The Applicant has read this discia r d signs and dates it below.
Signature Date: I i
LIPP
G:\PennitCentet\###FORMS###\DRD FORMS\Current DRD Fonns\Master Permit Application 5-29-08.doc
BUILDER STATEMENT
41110 •
•
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:
NERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE:• FAX:
L(7 2 I C'44-610-7- CO- `1 (i.c-T 0 ( ) 3-7R'ltZZ ( )
MAILING ADDRESS: `7C I-L-1 ��( � EMAIL:
CONTRACTOR'S LICENSE / lD p 1 ey..,4 0644_0 (J WAINS
NUMBER: f‘ NUMBER
ARCHITECT/ENGINEER: PHONE ( ) ( FAX:( --)
MAILING ADDRESS: 41,0( rT rzs/a gr. Or EMAIL .---
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
❑ New , ood Existing: 5 0 Sewer
0 Addition ❑ Steel Proposed: Bank ❑ Community System
❑ Alteration/Remodel 0 Concrete Total: Height . 4ndividual System
❑ Repair 0 Masonry SEP Permit#
Bedrooms:
C3 Demolition ❑ Other: 4... Water Supply:
Existing: Setback: p Private well 0 Two Party
Type of Heats, Proposed: 2 1 ublic
jar/� GOt Ct Total: J� Name of System (
eLet-I t L- Vk6510Al"
If this is a Commercial Project you must answer the followings
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 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,
includin• the reserve area.
S•ware Foota•e Current pro.. ed G , k t � „e
:�. � �.,� �t.. . �. � .....< .�'�. ,. a�. ._ � ,� Pte: -�'_ �_. ,�,
Main Floor Heated , EH Bid App Review:
2 Floor Heated „,: ` Consistency Review:
• r � 1 --
„
Unheated Basement . ',-.1,,,k,•':—:: 73,- ,'' State Surcharge fee: -1 . /
Other Unheated - a /
• •• � " SUBTOTAL f
Number:t .'':4';';-.7* -•.' TOTAL: Mild
ESTIMATED COST(REQUIRED) Date:
•Fair market value of all labor and materials foundation to finish �� x
GAP emutCenter\###FORMS###\DRD FORMS\Current DRD Forms\Master Permit Application 5-29-08.doc
r MAR/23/2011/WED 09:47 AM ORCAA FAX No. 3604916308 P. 001/001
i .
H
.,;•`O Olympic Region Clean Air Agency b(bli- (1 .. . . . .
:�'r r ?? 2940-B Limited WIC NW
`��'''' -.'• ''`Z*r. Olympia,WA 98502
;- _ ' ice`: /,:"{-c.‘r (360)539-7610•FAX(360)491-630$ Demolition Permit
{. "''"'{` Port Angeles office(360)417-1466
" :'...:. A.,&. Raymond Office(360)942-2137
-•--., -r r,ORC.AA.o
Commercial Structure--Permit fee~$60.00—10 working day wait period
C
Owner occupied residential dwelling--Permit fee:$35.00—Prior Notice
PROPERTY OWNER r
Nazae -Phone: SgS- Enaatil:
.D a laa ^!tt gig-" FAX: ( .) V Mobile:L 1 ---
Mailmg Address:
-70 X 1V*- State:.tj � t. Z j
Site Addy
'�j r - A1+[L �7 W✓l-
W3CE 7f —,
DEMOLITION CONTRACTOR[ 3 Check if same as property ormation
Business Name: ►�^''�i �����_ Phone: V7.ris- I__,.1
L p ZtC*me-r .�_h os l . PAX: ( ) 'SI,.a,ed-' IGN 1CTWIT M,.' 'lLCoM
Onsitc Contact phone Dr-45 Mobile. L.
Gp FAX: )3p/o443
1� ; ;: ea$: )2"7— • - Ct�,, to ,a • Shy- • . t3ti'
DEMOLITION INFORMATION • ' •
#of Stqqctures being dery fished: Start Date: Completion Date-
I" rortrifrf...- Pek4o •—r--:t a ri>r i.3• Asbestos reset _Yes _ To Stuvey attached No Has all identified as too 1e
remoove&_Xee _j10 A
DEMOLITION PROJCT CATEGORY .
( ]Complete Demolition •
[ 1 Training Fire-I xe Agency: •
novation,,Altertti n,Remodeling,Maintenance,or other Construction
[ ] Emergency-Additional Pee of$50.00(must be accompanied by Govetsmnent Ordered.Declaration-Comcmereiai only)
I hare read and will abide by the conditions set firth in this permit and any addsndiem thereto. .I do betels,:rertitv that
all identified asbestos bat bees removed and the information in this appkcatiien and sap■lewenpl data described herein..,a
is to the Out of my haas'Isdse, atcarate ,end morph i
_-awl" 11110 . -.-------...„
1.-D 12 t Cik--(z-r ivar---1 - '3 ir(..I I I
Applicant Name Signature Date
• a 'eatios bad' Payment Info. ,Approved Asbestos Permit
IN�6:3_,L1,V. [ ]Cash [ ] Disapproved Permit# 4.000
[yr]Check # ter ff53 Demolition Permit
'MAR 1 8 2011 [ 3 Credit Card Review date:A41/11_ Peru it# D>1400 ((o1
• Receive date/ij", Reviewed by:
sw' UM •e• '. Use ai '_ Use On
10/2iy0 v - OVER.
Contractors or Tradespeople Prgter Friendly Page • Page 1 of 1
General/Specialty Contractor
A business registered as a construction contractor with Lftl to perform construction work within the scope of
its specialty.A General or Specialty construction Contractor must maintain a surety bond or assignment of
account and carry general liability insurance.
Business and Licensing Information
Name L D RICHERT CONSTRUCTION UBI No. 601548958
Phone 3603790236 Status Active
Address Po Box 127 License No. LDRICC*066L0
Suite/Apt. License Type Construction Contractor
City Port Townsend Effective Date 6/20/1994
State WA Expiration Date 5/29/2011
Zip 98368 Suspend Date
County Jefferson Specialty 1 General
Business Type Individual Specialty 2 Unused
Parent Company
Business Owner Information
Name Role Effective Date Expiration Date
RICHERT, LARRY D Owner 01/01/1980
Bond Information
Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date
6 CBIC SD7277 04/08/2002 Until Cancelled $12,000.00 05/29/2002
Assignment of Savings Information No records found for the previous 6 year period
Insurance Information
Insurance Company Name Policy Number Effective Date Expiration Date Cancel Date Impaired Date Amount Received Date
6 CBIC INSSD7277 05/25/2002 05/25/2011 $1,000,000.0005/01/2010
Summons/Complaint Information No unsatisfied complaints on file within prior 6 year period
Warrant Information No unsatisfied warrants on file within prior 6 year period
https://fortress.wa.gov/lni/bbip/Print.aspx 2/3/2011
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DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD11-00024 Received Date 2/2/2011
SITE ADDRESS: 8123 FLAGLER RD Issue Date 3/24/2011
NORDLAND, 98358
APPLICANT: GEORGE FISHER PHONE: 917-744-7000
ANN FISHER
2402 E ESPLANADE LN#1102
PHOENIX AZ 850169104 13
SUBDIVISION: GLENNAN SUBURBAN ACRE Block: 4 Lot:
PARCEL NUMBER: 953700432 Section: 29 Township: 30N Range: 01E 1
CONTRACTOR: LD RICHERT CONSTRUCTION PHONE: (360)379-5222
PO BOX 127
PORT TOWNSEND WA 98368 (( ggpp 33
Contractor's License LDRICC*066L0 Expires 5/29320)1179-5222
OWNER, GEORGE FISHER PHONE: 917-744-7000
if different: ANN FISHER
2402 E ESPLANADE LN #1102
PHOENIX AZ 850169104
PROJECT DESCRIPTION: DEMO EXISTING SFR
Directions
To Site:
THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE.
THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR.
THE EXPIRATION DATE IS 3/24/2012.
REQUIRED INSPECTION:
FinalApproval:
r_
S,� / /
BUILDING INSPECTION HOT-LINE 3794455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:00 a.m. -4:30 p.m.
HOT LINE AVAILABLE 24 HOURS A DAY
I:\F_BLD_Permit_Propane.rpt 10/29/19
Date—.
time received/(DO 0/ pm Mon. Tues. ,Wed: 1600 Fri.
BED: 1 I_ 0.)--$ Date: •
OWNER: p f - Contact Name:
ADDRESS: O 2 3- - '. . Contact Number.3661. C95143- . ,..
206 h . fi
Notes: e
Foundation Plumbing - Framing . Propane Tank - Mechanical -
Setbacks Under-ground Framing Underground __ Furnace
Footing — Rough in Alr seal Above ground Gas
Stemwall Hydronic Exterior shear _ Exterior lines Oil
Straps Interior shear _ Interior lines • Ducts y'_
-
Post Hole - Ventilation - . Appliance .
Underfloor Gas/wood stove
Man-Homes -
Setbacks - Insulation. Final Inspection >a
Foundation • . 4.;:: s
Block&Tie _ floor _wall ceiling. . Address Posted
1