HomeMy WebLinkAboutBLD2012-00336 THIS BUILDING IS
NOT FINALED .
THIS IS AN INCOMPLETE
BUILDING APPLICATION . THE
PERMIT WAS NEVER ISSUED .
•ILDING PERMIT APPLICATOIN BLDI2-00336
Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD12-00336 Received Date: 10/22/2012
SITE ADDRESS: 142 TIMBERLINE RD
PORT TOWNSEND, 98368
OWNER: LEWIS D KOBETICH TRSTEE PHONE: 360-385-2792
CYNTHIA R KOBETICH TRSTEE
PO BOX 67
CHIMACUM WA 98325-0067
SUBDIVISION: Block: Lot: TX7+
PARCEL NUMBER: 001204007 Section: 20 Township: 30 N Range: 01 W
CONTRACTOR: KOZELISKY'S HOME SERVICE INC PHONE: (360)385-3215
31 HIDDEN TRAILS RD
PORT TOWNSEND WA 98368
Contractor's License KOZELHS027C3 Expires 1/6/2013
REPRESENTATIVE: JAIME KOZELISKY PHONE: (360) 385-3215
31 HIDDEN TRAILS RD
PORT TOWNSEND WA 98368
PROJECT DESCRIPTION DEMO EXIST. M/H
TYPE OF WORK MOB 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: CON
WATER SYSTEM:
BEDROOMS: BATHROOMS:
Exist: Exist:
Prop: Prop:
Total: Total:
Routing Date: _
o `22--1 a
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $74.00 LYK 10/22/12 135330
State Building Code $4.50 LYK 10/22/12 135330
Total: $78.50
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IECEOVED 4i t,, JEFFERSON'UNTY
' 1' DEPARTMENT OF COMMUNITY DEVELOPMENT'' 621 Sheridan Street• Port Townsend •Washington 98368 OCT 2 2 2012
360/379-4450 • 360/379-4451 Fax
v O www.co.jefferson.wa.us/commdevelopment '
vv.. JEFFERSON COUNTY
OF fOEVEtOPMENT
,,Master Permit Application MLA: 1� ,�"�
7 Projetct Description(include separate sheet as necessary):
anD tsr.
LTax Parcel NumberQO 12... % 007 Property Size: ` A C.ce S (acres/square feet)
Site Address and/or Directions to Property:
1112. i ,,,bc 1 i,m.4, ?0 pc(21r -1-0L-e..)Ns NA
Property Owner(s)of Record: 1 _ IRMAIRIMIL
Telephone: 3 g$-- Z-] 9 Z Fax: email:
Mailing Address:
Applicant/Agent(if different from owner): J02■Mk_ ('cote t S k-vi
Telephone: 3 5S- 3 Z i j Fax: - . 2 email:����
Mailing Address: 4; etc" 't S I �( ---Ti •EMI E i 3 6 it
What kind of Permit?(Check each box that applies ❑Lot or Road Segregation
►.': ilding ❑Critical Areas Stewardship Plan
,'' Demolition Permit ❑Variance(Minor, Major or Reasonable Economic Use)
❑ Single Family ❑Garage Attached/Detached ❑Conditional Use[C(a),C(d),or C]""''
❑ Manufactured orne .❑ 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 Rurai 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:
DESIGNATION OF AGENT
I hereby designate., 1 -1(hE KbZ E-L' .r' l to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE ,._ r; i 7g` y Date: JO / 2 — / 2—
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 applicatioithat he or he wanti prior notice.
\Signature: - Vi"--12- ' 9 ( Date: I O — I Z f 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 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_responsi ility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
�>:Signature: 8,ltkt . IV°-j� Date: /D CZ 1-
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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 tfie responsibility of the General Contractor for the proposed project.
- _ Date:
_SiGEN@RAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAx:
ikt2e. Vs 'S J--e vie c u �- _ (?�t;o) �- 2 13 (aka 3 g -12 i�"
MAILING ADDRESS: 1 /4 c A A.,-..\ }S c' tS 1�� EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: PHONE ( ) FAx:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: 0 Shoreline: Type of Sewage Disposal:
❑ New Wood Existing: ❑ Sewer
❑ Addition ❑ Steel Proposed: Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: _ Height: Individual Syst. qj�o
❑ Repair ❑ Masonry SEP Permit# C`'►–(. 10
Bedrooms: Water Supply:
Demolition ❑ Other: reExistin g: Setback:
Private well ❑ Two Party
Type of Heat: Proposed: o Public
k \t �z ft 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 i Cook Stove i 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.
Square Footage [urrent Proposed For Office the 00,1y Amount Revision
Main Floor Heated EH Bld App Review:
na Consistency Review: ,
2 Floor Heated
Other Heated Base fee: .7A1 ,- — —
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee: /j ` ",
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL
Decks 911/Rd Approach fee:
Other TOTAL: $ I C)1---1-,Tip
Receipt Number: 1 333
Cash/Check Number:
ESTIMATED COST(REQUIRED) Date:
•Fair market value of all labor and materials foundation to finish
Initials:
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12.10.14
frwgso co JEFFERSON COUNTY
� DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street I Port Townsend,WA 98368(Web:www.co.iefferson.wa.us/communitydevelopment
�9skrxG�o� Tel:360.379.4450 I Fax:360.379.4451 I Email:dcd @co.iefferson.wa.us
Building Permits&Inspections I Development Consistency Review I Long Range Planning I Watershed Stewardship Resource Center
1/22/2014
Mr. Lewis Kobetich
Mrs. Cynthia Kobetich
P.O.Box 67
Chimacum WA 98325
Dear Mr. &Mrs. Kobetich,
According to our records you applied for a building permit for a demo permit on parcel#001204007 on 10/22/2012.
Upon review of your application file we show that a request for additional information for an ORCAA was sent out to you
on 11/13/20112 and we have not received the material needed to complete the permitting process.
Jefferson County Code states:
15.05.060 Building permits—Department of community development.
(3) Time Limitation for Applications. An application for a permit for any proposed work shall be deemed to have been
abandoned 180 days after the date of filing, unless such application has been pursued in good faith or a permit has been
issued; except that the building official is authorized to grant one or more extensions of time for additional periods not
exceeding 90 days each. The total time period of such extensions shall not exceed 180 days; provided, that additional
time extensions may be granted by the building official based on justifiable cause and written request of the applicant.
As of the date of this letter, we have no evidence of activity on this permit application in the time frame indicated above.
We strongly encourage you to either fulfill completion of this application so the permit can be issued or withdraw the
application.
Please be aware that building without required permits will incur significant penalties, as shown on the reverse of this
letter. If construction was started without a permit, we strongly encourage you to finish the permit application to avoid
additional penalty fees.
If we do not receive a response from you by March 31,2014 we will deem the permit abandoned and proceed with closing
out the file. Any future work for this project will require a new permit application, and payment of current fees.
Please contact our department as soon as possible to arrange for completion or cancellation of your permit application.
Sincerely,
Mary Blain
Permit Technician
(360)379-4452
4wgs0N cod JEFFERSON COUNTY
4,.. ,.. ,ti DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street I Port Townsend,WA 98368 I Web:www.co.iefferson.wa.uslcommunitydevelopment
4t --'co Tel:360.379.4450 I Fax:360.379.4451 I Email:dcd @co.lefferson.wa.us
Building Permits&Inspections/Development Consistency Review r Long Range Planning'Watershed Stewardship Resource Center
January 14, 2014
Penalties for work without required permits or inspections
Pursuant to the authority granted to the Building Official in Section A109.6 of the 2012 International Building
Code, the penalty for commencing any work prior to obtaining required building permits shall be as follows:
For commencing work up to one year prior to issuance of required permits; the current standard fee, plus 15%
of the current standard fee, as established by the Jefferson County Community Development Department.
For commencing work more than one year but less than two years prior to issuance of required permits;
the current standard fee, plus 20% of the current standard fee, as established by the Jefferson County
Community Development Department.
For commencing work more than two years but less than three years prior to issuance of required permits, the
current standard fee, plus 30% of the current standard fee, as established by the Jefferson County Community
Development Department.
For commencing work more than three years but less than four years prior to issuance of required permits; the
current standard fee, plus 40% of the current standard fee, as established by the Jefferson County Community
Development Department.
For commencing work more than four years but less than five years prior to issuance of required permits, the
current standard fee, plus 50% of the current standard fee, as established by the Jefferson County Community
Development Department.
For commencing work more than five but less than six years prior to issuance of required permits, the current
standard fee, plus 60% of the current standard fee, as established by the Jefferson County Community
Development Department.
For commencing work six or more years prior to issuance of required permits; the current standard fee, plus
75% of the current standard fee, as established by the Jefferson County Community Development Department.
The penalty for commencing any work prior to obtaining required building inspections may include an
immediate stop-work order and other measures as determined necessary by the Building Official, pursuant to
Jefferson County Code Chapter 18.50.
illir °dr
r' p
Carl Smith
Community Development Director and Building Official
Page 2
S ca a
NORTHST ASBESTOS CONSULTS
Surveys, Inspection, Sampling
AHERA Building Inspector / Mgmt. Planner
EPA Certification WAMOA-0042
406 Reed St. Port Townsend, WA 98368
northwestasbestosconsultants @cablespeed.com
360-385-0584
Date: 10/19/12
'fob Location: 142 Timberline Rd.
Port Townsend,WA 98368
Owner: Dean Kobetich
142 Timberline Rd.
Port Townsend,WA 98368
Contact: Kozelisky Construction Company
32 Hidden Trails Rd.
Port Townsend,WA 98368
Subject: Demoliton
Inspector: Bob Witheridge
AHERA - Building inspector / Management Planner
WAMOA-0042-1019201202
Expires - 10/19/13
OCT 2 2 2012 J
JEFFERSON COUNTY
DEPT.OF COMMUNITY DEVELOPMENT
• •
Scope of work
1) Good faith inspection for asbestos containing building materials (ACBM).
2) Report to Kozelisky Construction Company with results from Northern Industrial
Hygiene, Inc.
Inspection Report
Inspection of 600 sq. ft. manufactured home.
The inspection started with a visual survey looking for Asbestos Containing Building
Material (ACBM).
Home had carpet, vinyl and wood floors. Fiber glass insulation, and metal clad windows.
Exterior had suspect skirting material.
Sample results are as follows:
Sample #1: Homogeneous floor vinyl with mastic. Gold and green pattern.
S. ple #2: Silver seal roof coating identified at job site as non suspect.
Sample #3: Exterior skirting material.
Samples were sent to lab. See results.
ASB OS BULK SAMPLE DATA
NORTH ST ASBESTOS CONSULTANTS
Surveys, Inspection, Sampling
AHERA Building Inspector / Mgmt. Planner
EPA Certification WAMOA-0042
406 Reed St. Port Townsend,WA 98368
northwestasbestosconsultants @cablespeed.com
360-385-0584
To Northern Industrial Hygiene, Inc.
Date: 10/13/12
Tob Location: 142 Timberline Rd.
Port Townsend, WA 98368
Owner: Dean Kobetich
142 Timberline Rd.
Port Townsend, WA 98368
Contact: Kozelisky Construction Company
32 Hidden Trails Rd.
Port Townsend,WA 98368
Sample #1: Homogeneous floor vinyl with mastic. Gold and green pattern.
Sample #2: Silver seal roof coating identified at job site as non suspect.
Sample #3: Exterior skirting material.
Inspector: Bob Witheridge
AHERA - Building Inspector / Management Planner
WAMOA-0042-1019201202
Expires - 10/19/13
See attachment.
Thank you,
Bob Witheridge, EFM
• •
215 SW 153rd Street Burien,WA 98166
OFFICE:(206)988-1746 FAX:(206)988-1978
0 R T H E IZN NVLAP Lab Code:200511-0
,N ■YSTRU►L MYOiEv . !NC-
Bulk Asbestos Analysis Report
Northwest Asbestos Consultants NIH Batch Number: 12-00629
406 Reed Street Client Job Number:
Port Townsend,WA 98368- Turn Around Time: 5 Day
Project Location: 142 Timberline Rd.,Port Townsend, WA Samples Analyzed: 2
Client Sample Number: 1 Lab Sample Number: 12-00629.0001
Client Sample Description: Floor Vinyl-Gold Brown Patttern
Client Sample Location: Not Given
Sample Comments: Materials distinguishable but inseparable Checked If Sample Not Analyzed Ei
Black and light brown pattern vinyl with green fibrous backing
Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components:
No Asbestos Detected 30% Cellulose 12% Filler and Binder
58% Vinyl Filler and Binder
Client Sample Number: 2 Lab Sample Number: 12-00629.0002
Client Sample Description: Silver Seal Roof Coating
Client Sample Location: Not Given
Sample Comments: Not Analyzed Per Client Request-not submitted Checked If Sample Not Analyzed
Client Sample Number: 3 Lab Sample Number: 12-00629.0003
Client Sample Description: Skirting Material
Client Sample Location: Not Given
Sample Comments: Materials distinguishable but inseparable Checked If Sample Not Analyzed Ei
Blue paint and white fibrous compressed material
Asbestos Fibrous Components: Non-Asbestos Fibrous Components: Non-Fibrous Components:
No Asbestos Detected 20% Cellulose 5% Paint
75% Filler and Binder
Sampled by: Bob Witheridge 10/13/2012
Received by: Fermin Uribe 10/18/2012
Reviewed by: Jude Cummings 10/18/2012
Jude Cummings,Laboratory Manager
Page 1
• •
Summary of Inspection
Sample #1: Homogeneous floor vinyl with mastic. Gold and green pattern.
No asbestos detected.
Sample #2: Silver seal roof coating identified at job site as non suspect.
No asbestos detected.
Sample #3: Exterior skirting material.
No asbestos detected.
All asbestos containing building materials with a reading greater than 1% is
considered a hazardous material if disturbed.
If removed a certified abatement contractor must follow the rules of the EPA and
governed by Olympic Region Clean Air Agency.
During demolition it is possible that additional suspect asbestos containing building
material (ACBM) may be found. Should such suspect material be discovered an AHERA
certified inspector will have to sample and test the material to prove it is of non-
asbestos.
Northwest Asbestos Consultants is not responsible for identification of hidden
materials that are not identifiable with reasonable diligence.
Thank you,
Lt), ' `
Bob Witheridge, E.F.M.
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Contractors or Tradespeople Pri Friendly Page Page 1 of 2
•
General/Specialty Contractor
A business registered as a construction contractor with Lal 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 KOZELISKY'S HOME SERVICE INC UBI No. 601765504
Phone 3603853215 Status Active
Address 53 N Gary Ave License No. KOZELHS027C3
Suite/Apt. License Type Construction Contractor
City Port Townsend Effective Date 2/23/1998
State WA Expiration Date 1/6/2013
Zip 98368 Suspend Date
County Jefferson Specialty 1 General
Business Type Corporation Specialty 2 Unused
Parent Company
Other Associated Licenses
Specialty Specialty Effective Expiration
License Name Type Status
1 2 Date Date
K0ZELSM200K9KOZELISKY'SMANU Construction General Unused 5/29/1980 12/14/1997 Archived
HOME SER Contractor
Business Owner Information
Name Role Effective Date Expiration Date
KOZELISKY,JAIME ELTON President 01/01/1980
KOZELISKY,JASCHA GABRIEL Vice President 01/01/1980
KOZELISKY,JOSEPH 01/01/1980 12/30/2010
KOZELISKY, KATHERINE 01/01/1980 12/30/2010
Bond Information
Bond Bond Company Name Bond Account Number Effective Date Expiration Date Cancel Date Impaired Date Bond Amount Received Date
1 CBIC SE0961 12/14/2001 Until Cancelled $12,000.00 12/18/2001
Assignment of Savings Information
Savings Assignment of Savings Account Number Effective Date Release Date Assignment Type Impaired Date Amount Received Date
1 0702000143 2/23/1998 Until Bond $6,000.00 2/26/1998
Released
Insurance Information
Insurance Company Name Policy Number Effective Date Expiration Date Cancel Date Impaired Date Amount Received Date
Contractors
11 Bonding& C11SE0961 12/31/2011 12/31/2012 $300,000.0011/17/2011
Insuranc
10 CBIC C11SE0961 12/31/2010 12/31/2011 $300,000.0011/18/2010
9 CBIC C11SE0961 12/31/2009 12/31/2010 $300,000.00 12/28/2009
8 AMERICAN CAS M1250000012 12/31/2008 12/31/2009 $300,000.00 12/19/2008
INS CO
7 ATLANTIC CAS M125000001-1 12/31/2007 12/31/2008 $300,000.00 12/28/2007
INS CO
ATLANTIC CAS
6 M125000001-0 12/31/2006 12/31/2007 $300,000.00 12/27/2006
INS CO
ATLANTIC CAS
5 M088000134 12/31/2004 12/31/2006 $300,000.00 12/08/2005
INS CO
Summons/Complaint Information No unsatisfied complaints on file within prior 6 year period
https://fortress.wa.gov/lni/bbip/Print.aspx 10/22/2012
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