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HomeMy WebLinkAboutBLD2008-00088 THIS BUILDING IS NOT FINALED . PERMIT WAS CANCELLED PRIOR TO RECEIVING ALL INSPECTIONS AND HAS NOT BEEN ISSUED A CERTIFICATE OF OCCUPANCY. • BUILDING PERMIT APPLI*ION MLA08-00097 Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD08-00088 Received Date: 2/29/2008 SITE ADDRESS: 5713 BEAVER VALLEY RD CHIMACUM, 98325 OWNER: BRADLEY J HEINZEN PHONE: 415-290-2235 MARGINE A SAKO PO BOX 522 MOSS BEACH CA 940380522 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901361002 Section: 36 Township: 29 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: JEFFERSON COUNTY DCD BUILDING PLAN REVIEW APPROVED AS SUBMITTED REPRESENTATIVE: PHONE: 0 APPROVED AS NOTED 0 RLJEC Ito PROJECT DESCRIPTIOr DEMO EXISTING GARAGE ,T- TYPE OF WORK GAR SQUARE FOOTAGE: TYPE OF IMP DEM MAIN: VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2006 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routin_ Date: oui-e4 - or C-7_3�3 os Gam, Type Amount Paid By: Date: Receipt: '-• � Iö'/EID Permit $52.00 AMS 02/29/08 96966 State Building Code $4.50 AMS 02/29/08 96966 SEP Total: $56.50 Jew &Wog Department Comity Planning i. i*1*, , ;aB:., Ke- 4;:, '=�kea. rz- ,. JEFER CO tlTY ' DEPARTMENT OF COMMUNITY DEVELOPMENT iffifyilik 621 Sheridan Street• Port Townsend •Washington 98368 i 360/379-4450 . 360/379-4451 Fax a.,, .a.. ` 194froe wvvw.co.jefferson.wa.us/commdevelopment ,......." Master Permit Application 1 MLA: - 7. Proj Description(include separate sheets as nece sary): r 1 ' Esc= tv 0i T1 xi v Tax Parcel q Property Number: /i�( 3�r± �� Size: V.' ti 35;tvo (acres/square feet) Site Address and/or Directions,to Property: 54P) 9 Epry c1 dctilGe y AzJoto CkittAkrAitA4 wk Ci, 932c Property Owne s)of Record: 9-' 1 e14 4. . J k Telephone:��1tc Z U-L23� Fax: email: l8:f1.W__ 9_ & n•I r,c Mailing Address: `?U 13.0X 57.1- M •,, P7 AZ C* cm 632 Appticant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies ❑ uilding ,. ❑Variance(Minor,Major or Reasonable Economic Use) emol`ition Permit 0 Conditional Use[C(a),C(d),or C]** Single Family ❑ Garage Attached i Detached ❑`Discretionary"D"or Unnamed Use Classification ❑ Manufactured.Home ❑ Modular ' ` 0 Special Use(Essential Public Facilities)** O Commercial* ❑:!:Boundary Line Adjusanent ❑ Change of Use El-Short Plat*" ❑ Address. ❑ Road Approach ❑Binding Site Plan*" Home Business ❑Cottagelndustry ❑Long Plat** ❑Propane 0 Planned Rural Residential Development(PRRD)/Arnendments** ❑Sign 0 Nat Vacation/Alteration** ❑Mowed"Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permli Revisions** ❑Stormwater Management El Shoreline-Management Substantial Development*" ❑SitePlan Approval Advance Determination(SPAAD)* 0 Shoreline Management Variance 0 Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment 0 Wireless Telecommunication.* „ D Jefferson-County Shoreline Master Program Amendment ❑Forest Practices-Act/Release:of Six-Year Moratorium ❑Tree Vegetaion.Request *May require a Pre-Application Conference **Requires a Pre-Application Conference Please identify any_other iocal,,statior federal penni�uired for this proposal,_.if known _ �fY/� o�-[ v e,'t i et DESIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application for pemiit(s). OWNER SIGNATURE Date: By signing this application form,tlie°owiler/agent attests that the information provided herein,and in any attachments,is true and correct to the best of his,her or it's knowledge. Any materialxfalsehood 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 agsiinst 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 ap lication that helot,.she wants prior notice. Signature: 0 r11 J& h & ' Date: 2-Z vt-e)gl The action or actions Applicant will undertake as a result of the issuance of this permit maynegativey impact upon one or more threatened or endangered species and`c+ould 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 issuedVill 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-tra ferable revolt Ilityfor adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: _ ' A-97..._--7\. --1 Date: 7— /5?- G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc 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 ssuming t responsibility of the General Contractor for the proposed project. - J Z2f Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: .';E FAX: ( ) 1P rr ( - --3- tt i = MAILING ADDRESS: EMAIL: , `V' CONTRACTOR'S LICENSE WAINS FEB 2 9 20U8 1 NUMBER: NUMBER, i ARCHITECT/ENGINEER: PHONE ( FM:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:' ❑ New 0 Wood Existing: 0 Sewer O Addition 0 Steel Proposed: Bank ❑ Community System ❑' Alteration/Remodel. ❑ Concrete Total: Height: 0 Individual System ❑ Repair 0 Masonry SEP Permit# Be rooms: ❑ Demolition 0 Other: d Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: ❑ Public Total: Name of System: If this is a Commercial Project 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: 1 Underground Tank I Above ground Tank Size of Propane Tank: I Heat Stove 1 Cook Stove I Woodstove 1 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. x.., S.uare Fops .e Current Pro.=sect w° r� �,,. . . ,_�t. ,a ' w_. Main Floor Heated EH Bid App Review: 2n°Floor Heated Consistency Review: Other Heated Base fee. p --\ 00 -r Mezzanine Additional Section: Heated Basement w Plan Check fee: ntik Unheated Basement State Surcharge fee. Other Unheated Pot Water Review fee: pi iNc. SUBTOTAL a Garage/Carport .5 . Decks `"."7":::-.2;;,„,,,,;;;;;-: 911/Rd Approach fee Other = Y1p xd TOTAL: $ Li . -,,,,'',;?,-27 Receipt Number; Ci I e G - , Cash/Check Number 1© ESTIMATED COST(REQUIRED) Date: aim O .Fair market value of all labor and materials foundation to finish Initials: G:\PermitCenter\###FORMS###\DM)FORMS\Master Permit Application 12-19-2006.doc ©LAD ne( LA-) -�u Sipe ' ' O'nC2 .APF4sale CON* F E B 2 9 2008 CA.A ,nsw-sara.v+° Notification of Demolition Permit It is unlawful for any person to cause or allow the demolition(or major renovation)of any structure unless all asbestos- containing materials have been removed from the area to be demolished. Work shag not commence on an asbestos project or demolition unless the owner or operator has obtained written approval from ORCAA. A written application for a demolition shall include a certification that there is no known asbestos-containing material remaining in the area of the structure. Project Site Address: 5 it?) ()2 ehVeQ. 1 1 A1.46"4 ci-ze AD C t(Uq- Co unty: 3er Ee. City:C ktti v • State: U.-4r Zip: 9&3z-5- Starting Date: 3 U�� /0 6 Completion Date: crti 4 9u t? •(There is a 10 working day advance notification period from receipt of permit application) Property Owner:6 t 1 01.-7"l/ Telephone: Lt 17 Ecru z-7-236"6" fax: Mailing Address: Pv 922- city:A O y )e State: c Zip: cj 40-3$ Demolition Contractor. 0 N 4- . —' State License#: Mailing Address: City: State: Zip: Contact Person: Telephone: Fax: YES NO Demolition by Wrecking or Dismantling? ($25.00 fee)check# Training Fire Demolition? (If yes,attach fire department request for training fire) Renovation,Alteration,Remodeling,Maintenance,or other Construction? Asbestos found or suspected* *An ORCAA"Notice of latent to Remove or Encapsulate Asbestos"fmm and appropriate fee must be submitted prior to any asbestos removal work. Asbestos removy(projects involving demolition must be preformed by a Certified Asbestos Contractor and all friable or potentially friable asbestos must be removed before any demolition begins. Refer to ORCAA Regulation 1 Article 14 for additional requirements that may apply. Asbestos Survey Completed by AHERA Certified Inspector Certification# This approved permit must Enclose$25 Certification of the Asbestos Survey must be available at the job site Processing Fee accompany this form • 2949 B Limited Lane NW,Olympia,Washington 98502 360-586-1044 • 800.422-5623 • fax 3604916308 homepagc www.orcaa.org • email:ipfpoa rcaa.orn Rev.07/1 I/02 • • RECEIVED • LGt; )N i41,,1 ,{' Olympic Region Clean Air Agency .~ k 940-B Limited Lane NW S E D U 9 ..,, .� ~ �.�. Olympia WA 98502 �' (360) 586-1044•FAX (360)491-6308 (� "d.4,°'""f,~ Port Angeles office(360)417-1466 Demolition Pre t I •ffit j� oRCA t ; Raymond Office(360)789-3652 'nn 1 Uf wwww.ORC_A A.org �0 Residential ( 1 Commercial Permit fee: $25.00 per structure. Non-refundable. **10 Working Day wait period** PROPERTY OWNER e i,/1 _d✓1 0 Name:''2_ I — Phone: (Ie55)ZGIu 'L1--')5' Email: tvt,✓04)rc,";119 -r&,41 kjY, -(� ."1 ei NM-ei,) i \X: ( ) Mobile;( ) Mailing, ddres•• Ciq:, State: Zi r rD) jC)K 5-2;-- 1 0I)‘, 6 -' tk Ct �jle3i3 Site Address: ' f City; State: 7.i • _ 5j ( 7 r FRtJ 2 V kLLEt1 2-C C14-t 0A,Rl—Ctiv" W` l 'J�J DEMOLITION CONTRACTOR [VECheck if same,as property owner information Business Name: Phone: ( ) Email: FAX: ( ) Onsite Contact Phone: ( ) Mobile: ( ) FAX: ( ) Mailing Address: City: State: l Zip: I DEMOLITION INFORMATION #of Structures bey demolished: Start Date: Completion )ate: 9 '(C-08) ci.-1c)• c: `, Asbestos present Y © Survey attached c) N Will all asbestos be removed Y N A DEMOLITION PROJECT CATEGORY _ [vt(omplete Demolition [ 'Training Fire—Fire Agency: [ 1 Government Ordered Demolition—Attach copy of Order [ }Renovation, Alteration,Remodeling,Maintenance,or other Construction I have read and will abide by the conditions set forth in this permit and any addendum thereto. I do hereby certify that the information in this application and supplemental data described herein is, to the best of my knowledge, accurate and complete. ''5c pr EtJv VTJA) ijci 11k-) 1 8 .2.o •03 Applicant Name Signature Date Ejt t�ed Payment Info. Approved Asbestos Permit �d✓✓1L .. vY [ ]Cash 1 1 Disapproved Permit# ASB00 pi-Check: # (b Z Demolition Permit r\ AUG 252008 [ I Credit Card Review dates./ S/G Permit# l)EM0(1 ICI. Receive date.: �� Reviewed by: '~ �Icf Agency Use Only Agency Use f))Jrly AAenp)' Use Only 02/25/08 i eri t x ' 1I / t 3vIw1O a i1 \ 1"( e V . I 1111.11°14 : :c . . ‘. .. 1 s ) 1 �, erg. €i %1 're.r 5 ., C\`'1 744 ‘ . '''. AIV • • I. Itiiif ' ,, . . !: ii • i 1 '1 , ,e--...r , , A ' ' A r (i 1 it pi k. '�` -c. - K . — .e 5. ',1111\ . 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