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Home My WebLink AboutBLD2013-00370 113UILDING PERMIT APPLICAS)N BLDI3-00370 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT*: BLD13-00370 Received Date: 11/21/2013 SITE ADDRESS: 11 PARADISE COVE BRINNON, 98320 OWNER: LOREN R MATLICK PHONE: 206-369-8245 146 NE 61ST ST SEATTLE WA 98115-6533 SUBDIVISION: Block: Lot: PARCEL NUMBER: 502293002 Section: 29 Township: 25 N Range: 02 W CONTRACTOR: PETITJEAN CONSTRUCTION PHONE: 360-796-4770 309870 HWY 101 BRINNON WA 98320 Contractor's License PETITC*914M2 Expires 7/22/2013 REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI DEMO EXISTING SFR, leaving foundation TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP DEM MAIN: 1,016 VALUATION ADD'L: HEAT TYPE: CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: 971 # OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: 430 SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: OSS WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: 1 Exist: 1 Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date State Building Code $4.50 MEB 11/21/13 145464 Total: $4.50 APPROVED JAN 7 2011 APPROVED Jefferson County DCD 11Krlcm•r41r1a4•1fr.rmc1P RI Il Ann P1,1 m4 1119901114 • • 00GToN ct,tN ~ .� `yam ' 2940-B Limited Lane NW -..1 -. � Olympia,WA 98502 --•. ORCAA / 1-800-422-5623 • (360) 539-7610 °`4a&•„„,,„..,.0,0s' Fax: (360)491-6308 ORCAA Permit Application Status Permit Status 0 Approved ❑ Disapproved Notes Mr. Matlick, your demolition permit is approved. need an asbestos survey-RM contacted builder 10/16/13-emailed property owner our list of AHERA inspectors. NorthWest Asbestos Consultants performed the survey. Owner abated. Witheridge performed re-inspection-ready for demo. Review Date 1/7/14 Reviewed by R Moody 13DEM003609 3/31 /14 10/16/13 Permit# Expiration Date Application Received $35.00 10/16/13 Amount Due ❑ Cash ❑ Check o Credit card Additional notes or permit conditions Port Angeles Field Office: 116 W.8th St., Suite 113, Port Angeles,WA 98362: 136W 417-1466 1, it I Raymond Field Office: 301 Ocean Ave., Raymond,WA 98577: (360)942-2137 Olympic Region Clean Air Agency (OR, • 2940-B Limited Lane NW 360-539-7610 61 9IFAX ' 360-539-7610 FAX 360-491-6308 Port Office 360-417-1466 Raymond Office 360-942-213 7 ORCAA www.orcaa.org DEMOLITION PERMIT APPLICATION Demolition and renovation projects within Clallam, Grays Harbor,Jefferson, Mason, Pacific and Thurston counties REQUIRE A PERMIT and require that the following permit conditions be met prior to demolition or renovation. 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.A good faith asbestos survey must be conducted by a certified Asbestos Hazardous Emergency Response Act(AHERA) building inspector. Qualified contractors and inspectors may be found in your local Yellow Pages, through the Washington State Department of Labor and Industries, or on ORCAA's website. 2.Asbestos samples must be sent to an NVLAP laboratory(National Voluntary Laboratory Accreditation Program) per 40 CFR 763.87. A list of labs can be found on ORCAA's website. 3. The start date on other structure demolition must be at least 10 working days from the submission date of the complete application and payment. 4. It is the responsibility of the property owner and/or demolition contractor to ensure there is no asbestos-containing material present in the structure to be demolished. 5.Any and all structures on the same parcel of property that are not proposed to be demolished must be identified as such. 6.A copy of the asbestos survey and approved Demolition Permit, as well as any subsequent amendments, must be kept on site and available for review by Agency inspection personnel. 7. Use the Completion Notification and Amendment Form to make changes to the original permit. 8. The original demolition permit will expire on the Completion Date. To change the completion date, a Completion Notification and Amendment form must be received PRIOR to expiration. If the permit expires and the project is not complete, you must submit and pay for another demolition permit. Under no circumstances will a project be extended beyond 1 year from original start date. 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& Industries may also require notification for asbestos removal projects. "Owner Occupied Residential Dwelling" means any single family housing unit which is permanently or seasonally occupied by the owner of the unit. This term includes houses, mobile homes,trailers, houseboats, and houses with 'mother-in-law apartment'or a 'guest room.'This term does not include structures that are demolished or renovated as part of a 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 use as a rental, or for commercial purposes. • • PROPERTY OWNER Name Mailing address Loren Matlick PO Box 51245 City ZIP State Seattle 98115 WA Site address City ZIP 11 Paradise Cove Brinnon 98320 FAX Phone number Other contact number Email 206 369 8245 lorenrm @gmail.com DEMOLITION CONTRACTOR ❑ check the box if same as property owner information Business/Contractor Name On-site contact Petitjean Construction Gordy Petitjean E-mail Mailing address City ZIP petitjeanconstruction @gmail.com 309870 Hwy 101 Brinnon 98320 Phone number Other contact number 360-531-1658 DEMOLITION PROJECT INFORMATION Number of structures being demolished 1 Start date Completion date Is asbestos present? 12/02/13 12/03/13 No Attach your asbestos survey below Has all identified asbestos been removed [Yes DEMOLITION PROJECT CATEGORY ® Complete demolition ❑ Training fire-(complete fields below) ❑ Renovation,alternation, remodeling, maintenance or other construction If training fire, provide fire protection agency name, point of contact and telephone number ❑ Owner occupied residential dwelling- Permit fee: $35.00-Prior Notice- Nonrefundable ❑ Other Structures- Permit fee: $60.00- 10 working day wait period- Nonrefundable ❑ Emergency Fee$50.00-must be accompanied by Government Ordered Declaration (other structures only) Attach declaration below • • PLEASE MAKE A NOTE OF YOUR FEE. Applicant name Date Loren Matlick 10/16/13 By checking the box and clicking"Submit"at the bottom of this form, you hereby certify that all identified asbestos in the project area has been removed and the information contained on this form and supplemental data described herein is,to the best of my knowledge, accurate and complete. ® I agree it Mary Blain From: Susan Porto Sent: Tuesday, January 07, 2014 2:32 PM To: Mary Blain Subject: RE: q's about demo permits I would say no, soundslike what we might be concerned about with your application is already dealt with by the new permit pending. Thanks for asking. S From: Mary Blain Sent: Tuesday, January 07, 2014 2:22 PM To: Susan Porto Subject: q's about demo permits Susan, I understand EH wants to look at demo permits to verify what will happen to the septic. In the case of BLD13-00370, a demo of a SFR, they have already decommissioned the old septic system (SEP71-00117) and have a new septic permit pending (SEP13-00018). Since we already know what is happening to the site's septic system, does EH need to review this demo permit for approval? -Mary 1 • • I -3 '-- 4 11 co JEFFERSON COUNTY j ' • 1. DEPARTMENT OF COMMUNITY DEVELOPMENT �I `'l 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax �4 p' www.co.jefferson.wa.us/commdevelopment GE Master Permit Application MLA: Project Description(include separate sheets as necessary): y Tax Parcel Number: TO 2.2 p` 3 O0 Z Property Size: (acres/square feet) Site Address and/or Directions to Property: Vi A.1---Z Pt9R47/SL C .ttiE' 3-RAN NUN R e 3 Q Property Owner(s)of Record: L O R EN P14T'L/CP-- Telephone: Zdb•3b0.- 8 ac/5- Fax: l2:I-I 70• 5 29 7 email: LcIZEN RMd,6-MPoY..CoM Mailing Address: C 0 box £• 1 2•`f 5 S E /9-TFL E / w i'4 9 811 S Applicant/Agent(if different from owner): email: Telephone: Fax: Mailing Address: What kind of Permit?(Check each box that applies 0 Critical Areas Stewards hi I' - EOEINE Building Demolition Permit ❑Variance(Minor, Major or�I . able Economic Use) L� it .r ** j Single Family ❑ Garage Attached/Detached ❑Conditional Use(C(a), C( • ❑ Manufactured Home ❑ Modular ❑ Discretionary"D"or Unna tcftlie Clas ification ;3 CI Commercial* ❑Special Use(Essential P ii cilitie ) ❑ Change of Use ❑Boundary Line Adjustmen ❑ Address ❑Road Approach ❑Short Plat** COUNTY ❑Home Business ❑Cottage Industry El Binding CO Binding Site Plan** OEPT.OF COMMUNITY UNTY ❑Propane ❑Long Plat'* DEVELOPMENT El 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: DESIGNATION OF AGENT I hereby designate 0'0?-,1)Y '. 6."f a.), to act as my agent in matters relating to this application for permit(s). . / /-.. ■••" Date: /61/41/3 OWNER SIGNATURE •,_ 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. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the sppli tion eorshe__,.•�`p'•r /�P‘//,3 Date: Signatuje . 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 S sibility for adhe1.••to d complying with the ESA. The Applicant has read this disclaimer n signs and dates it below. �� Signature_ Date: /�)/' //� — G:\PermitCenter\###FORMStift#\DRD FORMS\Master Peamt Application 5-29-08.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 be assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HO E INSTALLER: PHONE: Fax: ---!�*�) c''n Lo0AS1-1'tic(11fl� R a, �1-�e\ t 1---ca..s, (360) 7%- 4-/7 76 ( ) MAILING ADDRESS: 30G R 7b WY / oi 8rt,•vn,wt9 EMAIL' Pe-31-itaeCrNC rSTCUC'h6v\ ktovtAll.Uv, CONTRACTOR'S LICENSE q `, C}b jLa WAINS NUMBER: ET1 I Cry G I L[ H Z-- NUMBER ARCHITECT/ENGINEER: 1..C\S MOft-IS / !-)p e.: ,zj r w&j PHONE (y Z$)88 S'-,63 Ir) FAX:( ) MAILING ADDRESS: 4/9Z t"✓OriT ST- N ISSOtcy6,,c,h,oil EMAIL Project Type: Frame Type: ` 9�GZ'j C i5�\i`O�rneC�.eS�r�rWW •C o u^ ype: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New $' Wood Existing: _ ( ❑ Sewer ❑ Addition ❑ Steel Proposed: v__! Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: L. Height: rg, Individual System Repair ❑ Masonry __L _ SEP Permit# X Demolition ❑ Other: Bedrooms: Water Supply: Existing: 1 Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: Z. ❑ Public E Z__..1 .i twv \` Total: .- Ff'" Name of S tem ro�;LSe (SA�1-e L\vi.') 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 gro Tank Size of Propane Tank: I Heat Stove I Cook Stove Woodstov I Fireplace Insert 1 Hot Water Tank I Pellet Stove 1 Other Is this appliance being installed In a Manufactured I 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. J _.,' Fi d Xi• t d j i S p uare Footage --, .a. � Proposed f P a, t *IS ni v :, -, F ;Amount =�_�eMsion Main Floor Heated EH Bid App Review: 6.`- 2 Floor Heated 4 p „ Consistency Review: c,; Other Heated �. 4` Base fee: Uu Mezzanine ,x`' . Additional Section: ) "1 Heated B- •. ;t- Plan Check fee: �� i : I Unheated Basement a— � ' : State Surcharge fee: Other Unheated 'le of Water Review fee: r. ////// k ON P I Garage/Carport ,f SUBTOTAL S Decks III_; 911/Rd Approach fee: �..-- Iwt(crv;otxs Y30 44-30 � x Other �t, TOTAL $ GI I, ` i '. • l J j '__. Receipt Number. . bA- Cash/Check Number: ,s 1 ESTIMATED COST(REQUIRED) Date: t • .Fair rket value of all labor and materials foundation to finish 10/ (0 13 >'l70 ()Ck) Initials: • G'\PeimitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-08.doc Olympic Region Clean Air Agency line Payments • _ , Page 1 of -'� Olympic Region Clean Air Agency 360-539-7610 serving Cistern.Grays Harbor.Jefferson.Mason.Pacific.and Thurston Counties 800-422-5623 ORCAA info@arcaa.org Step 1:Select Payments Step 2: Review and Submit Step 3:Confirmation and Receipt Step 3: Confirmation and Receipt • Result: Payment Authorized Confirmation Number: 11641482 Your payment has been authorized successfully and payment will be processed. Olympic Region Clean Air Agency thanks you for your payment.For questions about your account,please call 360-539-7610 Please note:This permit is not valid until fees are paid and permittee receives an approved permit from ORCAA.Thank you for using our bill payment services. Please save or print a copy of this receipt for record keeping purposes. My Bills Description Amount Duel Permits payment of$35.00 on Permit Type Demolition $35.00 Subtotal: 535.00 Customer Information 'Convenience Fee: $2.00 First Name: Loren Total Payment: 537.00 Last Name: Matlick Address Line 1: PO Box 51245 Address Line 2: City: Seattle State: Washington Zip Code: 98115 Phone Number: 206-369-8245 Email Address: lorenrm @gmail.com [ ` (� Payment Information C7 • ► Card Number: ***********1764 J - Cs" 3 ;�1 Expiration Date: **/** W (2, Print attps://client.pointandpay.net/web/OlympicRegCleanAirAgencyWA 10/16/2013 • • DEMOLITION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD13-00370 Received Date 11/21/2013 SITE ADDRESS: 11 PARADISE COVE Issue Date 1/7/2014 BRINNON, 98320 APPLICANT: LOREN R MATLICK PHONE: 206-369-8245 PO BOX 51245 SEATTLE WA 98115 SUBDIVISION: Block: Lot: PARCEL NUMBER: 502293002 Section: 29 Township: 25N Range: 02W CONTRACTOR: PETITJEAN CONSTRUCTION PHONE: 360-796-4770 309870 HWY 101 BRINNON WA 98320 Contractor's License PETITC*914M2 Expires 7/22/2015 OWNER, LOREN R MATLICK PHONE: 206-369-8245 if different: PO BOX 51245 SEATTLE WA 98115 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 1/7/2015, 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 Worms\F_BLD_Permit_Propane.rpt 1/7/2014