HomeMy WebLinkAboutBLD2013-00251 BLD13-00251
itUILDING PERMIT APPLICA•N Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD13-00251 Received Date: 8/16/2013
SITE ADDRESS: 141 ALDER DR
PORT TOWNSEND, 98368
OWNER: ROBERT S FELBER JR PHONE: 509-283-2591
DOROTHY A FELBER
PO BOX 13
FAIRFIELD WA 99012-0013 CAPE GEORGE VILLAGE DIV 4
SUBDIVISION: Block: Lot: 72+
PARCEL NUMBER: 940800068 Section: 13 Township: 30 N Range: 02 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOII DEMO M/H
TYPE OF WORK NON SQUARE FOOTAGE:
TYPE OF IMP DEM
VALUATION MAIN:
ADD'L: HEAT TYPE:
CODE EDITION: 2012
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total:
Routing Date: ,\(1),\(1)41\Q
Type Amount Paid By: Date: Receipt: Approved/Date
State Building Code $4.50 JLA 08/16/13 142390 (, 1
Permit $76.00 JLA 08/16/13 142390
Total: $80.50 AUG 2 6 2013
Jefferson County DCD
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y��,---,iiEG10N eit�j:I:,- Olympic Region Clean Air Agency
44P 2940-B Limited Lane NW
J cam. Olympia,WA 98502
ci; '360) 539-7610• F. .X(360,;491-6308 •
7 ' Port Angeles office(360)417-1466 Demolition Permit
y O RCAA ,a/ Raymond Office(360) 942-2137
4 °,`'-' www.ORCAA.org
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[d Owner occupied residential dwelling—Permit fee: $35.00—Prior Notice- Nonrefundable
[ ] Other Structures—Permit fee: $60.00— 10 working day wait period-Nonrefundable
PROPERTY OWNER
Name: Phone: ( -Is 3..acek i Email:
R Ci b eNc\ 5. *V e._\\ t..`c -S.(' FAX: ( ) Mobile: ( )
Mailing address: City: State: Zip:
C1 \3eX, \3 VoOocc`e\ . V A. Scn .\.. -
Site Address: City: State: Zip:
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DEMOLITION CONTRACTOR [ ] Check if same as property owner information
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Business Name: Phone: b Y,d- 3 ' b O�. Email: j
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V e r v. c ''c e. se Ni... NC-N.C. - FAX: (2366 31.s- knot l o
Onsite Contact: Phone: (Ur)) 3$S_3 nob , Mobile: (3f,i 30\-o,,y,,4
‘w` r\---h c Nnna 5 FAX: ( )
Mailing Address: City: State: Zip:
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DEMOLITION INFORMATION
#of Structures being demolished: Start Date: Completion Date:
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Asbestos present Yes -)C.No Survey attached Yes No Has all identified asbestos been
removed Yes No Al h
DEMOLITION PROJECT CATEGORY
[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 e 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.
CZ. V {
Applicant Name Signature Date
Date A plication Received Payment Info. )Q Approved Asbestos Permit
_ g s 1 ��* ] Cash ._ [ ] Disapproved Permit# ?�SB00
�` t� `'[- Check: # SS Demolition Permit
_ [ ] Credit Card Review date:7 //5—//3 Permit# /a DEM00
Receive dater / :L3 Reviewed by:
Agetu-y+.47d e.94'§ ,, Agency Use Only 1 Agent'Use Only Agency Use O n/y
08/11/11 H r _ ,P , OVER
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��vs,G10N CL - _ Olympic Region Clean .Air Agency
,,1 9��', 2940 13 Limit,-d Lane N\V'
° ' , Olympia. AX.A 98502
o '360` 539 7610• FAX 1360'. 491-6308
!�/ Poi.t \n el es Otlice 360, 417 1466 Demolition Permit
'`k . 0 RCA A .,z`;_ •
Raymond Office (360;942-2137
•'s eo'i.14%-'�.-
tcww.ORCA_�.org
Demolitions projects within Clallam, Grays Harbor,Jefferson, Mason, Pacific and Thurston counties
REQUIRE A PERMIT and require that the following conditions be met prior to the demolition.
Olympic Region Clean Air Agency (ORCAA) regulations define a demolition project as the wrecking,
razing, leveling, dismantling, or burning (by a fire department for training purposes) of a structure,
making the structure permanently uninhabitable or unusable.
Renovations include the removing of load bearing structural members, but not to the extent to make the
structure uninhabitable.
The following information is merely a reference guide and not a substitute for agency regulations.
1. The start date, on other structure demolitions,must be at least 10 working days from the submission date
of the complete application and payment.
2. A good faith asbestos survey must be conducted by a certified Asbestos Hazardous Emergency Response
Act (AHERA)building inspector. A list of qualified contractors and inspectors may be found in your local
Yellow Pages, through the Washington State Department of Labor and Industries, as well as search
engines on the Internet.
3. A copy of the asbestos survey and Demolition Permit must be kept on site and be available for review by
Agency inspection personnel;
4. Any and all structures on the same parcel of property that are not proposed to be demolished must be
identified as such;
5. It is the responsibility of the building owner and/or demolition contractor to ensure there is no ACM
present in the structure to be demolished;
6. Nuisance laws are applicable to the demolition,including nuisance related to the unreasonable interference
with the enjoyment of life and property and the depositing of particulate matter on other property.
ADDITIONAL REQUIREMENTS:
In addition to Agency requirements,most building departments require a demolition permit (separate from
ORCAA's Demolition Permit).The Washington State Department of Labor&Industry and the local fire marshal
may also require notification for asbestos removal projects.Telephone numbers for these entities are listed in the
Government Listing area of the telephone book.
Owner Occupied Residential Dwelling: Any non-multiple unit building containing space for uses such as living,
sleeping, and preparation of food and eating that is owned,used, occupied, or intended or designed to be occupied
by one family as their domicile.This term includes houses,mobile homes, trailers,houseboats, and houses with
`mother-in-law apartment'or`guest room.' This term does not include structures that are demolished or
renovated as part ofa commercial or public project. Nor does this term include any mixed-use building,
structure, or installation that contains a residential unit, or any building that is leased or used as a rental.
JEFFERS.COUNTY
'' .4 DEPARTMENT OF COMMUNITY DEVELOPMENT
P r ` '4 621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 ' 360/379-4451 Fax
kq O'1 www.co.jefferson.wa.us/commdevelopment
BIND
Master Permit Application MLA:
'Project Description(include separate sheets as necessary):
1 - =.. . • . 1i • •y,n -
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Tax Parcel Number: Atom a O R oo a b p Property Size: 4,4.5 (.fir.,v£.c (acres/square feet)
Site Address and/or Directions to Property:
\t\\ c\\ r - NA. Ck$ toR
Property Owner(s)of Record: e.-b P Y. S. 4-e...\ o e r "sc .
Telephone: ,SOO - a.1S3- 1 Fax: email:
Mailing Address: i .. - a 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
❑Bt'Iding Demolition Permit
❑Critical Areas Stewardship Plan
E" Demolition Variance(Minor, Major or Reasonable Economic Use)
❑ Single Family ❑Garage Attached/Detached ❑Conditional Use[C(a),C(d),or C] "
❑ Manufactured Home ❑ Modular ❑ Discretionary"D"or Unnamed Use Classification
❑ Commercial* ❑ Special Use(Essential Public Facilities)**
• Change of Use ❑ Boundary Line Adjustment
❑ Address ❑ Road Approach_ ❑ Short Plat**
❑ Home Business ❑Cottage Industry ❑Binding Site Plan**
❑ Propane ❑Long Plat**
❑Sign ❑ Planned Rural Residential Development(PRRD)/Amendments**
❑Allowed"Yes"Use Consistency Analysis ❑ Plat Vacation/Alteration**
❑ Stormwater Management ❑ Shoreline Master Program Exemption/Permit Revisions**
❑ Site Plan Approval Advance Determination (SPAAD)* ❑ Shoreline Management Substantial Development**
❑ 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:
DESI v".TION OF AG
I hereby designate to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE Date: i
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. Staff's access and right of entry will be assumed unless the applicant informs the County in writing at the
time of the appfjraati&Aat he orrhe�ants prior tice.
Signature: /l --�/, Date: c'/1 2126/3
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-trans onsi 'ity for dherin to nd complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature .� .s Date: �/9.2e/3
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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 an=d 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:
( ) ( )
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
0 Addition ❑ Steel Proposed: Bank 0 Community System
❑ Alteration/Remodel 0 Concrete Total: _ Height: ❑ Individual System
❑ Repair ❑ Masonry SEP Permit#
Demolition 0 Other: Bedrooms: Water Supply:
Existing: Setback: 0 Private well ❑ Two Party
Type of Heat: Proposed: ❑ 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:
l Underground Tank 1 Above ground Tank Size of Propane Tank:
l Heat Stove i Cook Stove i Woodstove 1 Fireplace Insert I Hot Water Tank t 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 Fgr.Office Use O.n1,y; A2l1 ikIllt 1 evJs Rtt
Main Floor Heated EH Bld App Review:
Floor Heated Consistency Review:
Other Heated Base fee:
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 $
Receipt Number:
Cash/Check Number:
ESTIMATED COST(REQUIRED) Date:
.Fair market value of all labor and materials foundation to finish
Initials:
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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#: BLD13-00251 Received Date 8/16/2013
SITE ADDRESS: 141 ALDER DR Issue Date 8/26/2013
PORT TOWNSEND, 98368
APPLICANT: ROBERT S FELBER JR PHONE: 509-283-2591
DOROTHY A FELBER
PO BOX 13
FAIRFIELD WA99012-0013 72+
SUBDIVISION: CAPE GEORGE VILLAGE DIV 4 Block: Lot:
PARCEL NUMBER: 940800068 Section: 13 Township: 30N Range: 02W
CONTRACTOR: OWNER/BUILDER PHONE:
OWNER, ROBERT S FELBER JR PHONE: 509-283-2591
if different: DOROTHY A FELBER
PO BOX 13
FAIRFIELD WA 99012-0013
PROJECT DESCRIPTION: DEMO 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 8/26/2014.
REQUIRED INSPECTION:
FinalApproval: 7A2—
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 8/26/2013
e450N coe JEFFERSON COUNTY
DEPARTMENT OF COMMUNITY DEVELOPMENT
ate: Time Time Received: 4 :I3 Cm pm Mon. AO Wed. Thur. Fri.
Date: Viz-
LD: /3„ exe37 .$I Contact Name:
twner: Contact Number: 360
,ddress: /ill A`off PQ 206
C&Jzs Jotes: eMot rf l® ) O ar1►�t"I' o�J
Foundation Plumbing Framing Propane Tank Mechanical
Setbacks Under-ground Framing Under ground Furance
Footing Rough In Air Seal Above ground Gas
Stemwall Hydronic Exterior shear Exterior lines Oil
Straps Hot Water Htr Interior shear Interior lines Ducts
Post Hole Ventilation Appliance
Underfloor Gas/Wood stove
Man-Homes Insulation
Final Inspection X
Setbacks Floor
Foundation Wall Address Posted
Ceiling