HomeMy WebLinkAboutBLD2004-00501 •
MAN
UFACTURED!MQBiLE HCrr�
Jefferson CountyD �E ;��S j�`'°LI-ATiO ' PERMIT
Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368ment
360 379-4450 FAX 360 379-4.451
PERMIT#: BLD04-00501
SITE ADDRESS: 42 MOUNTAIN VIEW DR
QUILCENE Received Date:
APPLICANT: 98376 Issue Date: 7/28/20
LARRY BROWN 11/2g/20i
2920 SAWDUST HILL RD
POULSBO WA 98370
SUBDIVISION: SNOW CREEK RANCH
PARCEL #:
995400076 Block:
CONTRACTOR/ Section: 2 Township: Lot: 80 81
28 N Range: 02 W
DEALER
INSTALLER: MODERN LIVING LIMITED
AKA FUTURE MODERLL972DO
HOMES FIFE WA 98424 Expires: 3/20/200;
PROJECT DESCRIPTION: NEW MH
MAKE: LIBERTY
YEAR:
SIZE: 2004
44X 14
THIS PERMIT IS VALID FOR
THE FINAL INSPECTION MUST BE SCHEDULED AND E YEAR,
PASSED WITHIN THAT YEAR,
CALL IN FOR THE THE EXPIRATION DATE IS
REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT 005.
Setbacks/Footing (CONTINUOUS FOOTING, SLAB or PADS
USED): ! 'L?-'oa''
Stormwater FINAL Approval:
Blocking/Plumbing:i
- A Propane Tank/Lines
Zoning Final Approval:
Septic System Final Approval (If not on sewer):
Road Approach Final Approval:
Final kirting/Vents/Porches/Steps: •
ALTH DEPARTMENT AND PUBLIC WORKS �� 2� ��"
REQUIRED PRIOR TO FINAL INSPECTION
THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED
BUILDING INSPECTION HOT-LINE 379,4455
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
SPECIAL CONDITIONS APPLY SEE REVERSE
SPECIAL CONDITIONS CASE
# BLD04-00501 •
1.) The application was reviewed by the Jefferson County Department
Development staff on September 15, 2004 for the potential presence of
Sensitive Areas (ESAs) under the provisions of the Unified Development of Community
After an initial Geographic Information Systems mappingEnvironmentally
inspection, the following ESAs were confirmed be present on thesubject Code (UDC).
2 Stream and following
Wetlands, Fish tofb Habitat reviewt and an investigative site
Recharge Area, Flood Hazard, and Seismic Hazard . property: Type
(Osprey), Susceptible Aquifer
2.) A reasonable economic use variance
was approved 2, 2004
the standard 150-foot streamside buffer to approximately 80 feet. Te
Hearing Examiner Decision dated July 12, 200 approved the seamside buffer reducton subjectto eight(8) conditions.
3.) A Buffer Reduction and Habitat Management Plan dated February
Enhancement Plan addendum to Habitat Management Plan dated March
letter with revisions to the Buffer Enhancement Plan dated April 29 2004, a Buffer
conjunction with the reasonable economic use variance a 2004 and a
address the Type 2 Stream and associated wetlands. application (MLA04.00117) to
2004 was submitted in
4.) Aquifer Recharge Areas in Jefferson County are characterized by
formations that allow percolation of the surface water into the soils and
zone of saturation. porous geological
Aquifers are the underlying
permeable material to yield significant quantities of water to wells and springs.
geologic formations that contain sufficient saturated
serve as the source of drinking water within most of the rural portions of Jefferson
5.) Susceptible Aquifer Recharge Areas are those with geologic and Aquifers
that promote rapid infiltration of recharge waters to groundwater aquifers.
County.
6.) Geologically Hazardous Areas in Jefferson County are characterized by
conditions
ype,
geologic material, and groundwater that may
stability, erosion, and water quality during and after construction or duringrin slope, soil tent
such as earthquakes or severe rainstorms combine to create problems with slope
7.) A Type 2 Stream (Fish and Wildlife Habitat Area) has been identified natural events
property. The stream will require a setback of 80-feet. The setback shall be
horizontally from the Ordinary on the subject
also have Buffers and ryi Water Mark (OHWIVI). measured
Areas
8.) Buffers are areas that shall be maintained in their natural Fish and Wildlife Habitat Areas
Building Setbacks established.
nor
pruning or alteration of vegetation maybe
of the buffer are not diminished. Permitted as long asd)the function and(character
9.) All construction activities shall not encroach upon the buffer. This includes
preparation of materials.
10.) Critical Aquifer Recharge Areas may require special protection me the storage or
quality degradation. The submitted proposal does not require additional aquifer
measures to mitigate water
protection measures. However, during construction the project shall follow the
Management Practices (BMPs)
the Stormwater Management Manual for the Puget Sound Basin. Best
and facility design standards as identified and defined in
11.) The identified Fish and Wildlife Habitat Area (Type 2 Stream),
buffer setback of 80 feet. The setback shall be measured horizontallyfrom
High Water Mark (OHWMe shall maintain a vegetative
12.) A permanent physical separation alonprog boundased ry
home. the Ordinary
and permanently maintained. g ry of the buffer area shall be installed
hedgerow, or any other prominent physseical tmark nion n include installinglogs,
13.) Bufferedgperimeters or any be marked with temporary g approved by g trees, a
area and one along the westernm buffer area. the UDC Administrator.r
ry signs, one along the northern buffer
during approved construction activities. The signs shall contain the following
Signs shall remain in place prior to and
"Stream and Buffer- Do Not Remove or Alter Existing
14.) The applicant submitted a Flood Elevation Certificate prepared by statement:
dated 12/30/03. The finished top Native Vegetation."
shall be set at or above the reference elevation of 199.44 feet(NGVD Michael J Anderson
of the bottom floor elevation for the proposed residence
benchmark.
n of 199.44 feet(NGVD 29 Datum) was established by a stake se
elevation
( D 1929 Datefor The
15.) Flood proofing measures are to be used as required by the Jeffersontat Floodsloe for site
Damage Prevention Ordinance.
16.) All new construction shall use construction methods which minimizeflood ty
flood damage.
17.) New construction shall have tf foot a west floor elevated to at least one
elevation. b�base flood
18.) Fully enclosed areas below the lowest floor that are subject to flooding are prohibited
unless designed to automatically equalize hydrostatic flood forces on exterior walls by
allowing for the entry and exit of floodwater. Designs for meeting this requirement must
either be certified by a registered professional engineer or architect or must meet or
exceed the following criteria: a. A minimum of two openings having a total net area of not
less than one square inch for every square foot of enclosed area subject to flooding shall
be provided. b. The bottom of all openings shall be no higher than one foot above grade.
c. Openings may be equipt with screens, louvers, or other coverings or devices provided
that they permit the automatic entry and exit of floodwater.
19.) All new construction shall: a. be anchored to prevent flotation, collapse, or lateral
movement of the sturcture. b. be constructed with materials and utility equipment resistant
to flood damage and potential damage to adjacent properties. c. be constructed using
methods and practices that minimize flood damage. d. have structural components
capable of resisting hydrostatic and hydrodynamic loads and the effects of buoyancy. e.
electrical, heating, ventilation, plumbing, air-conditioning equipment, and other service
facilities shall be designed and/or otherwise elevated or located so as to prevent water
from entering or accumulating within the components during conditions of flooding.
20.) Flood proofing of structures shall be provided by one or more of the following methods:
a.
Landfill: (Note: Landfills are not permitted in the floodway.)
utilized to elevate the structure and must comply with the standards and policies of the) The placement of fill may be
Jefferson County Shoreline Master Program, if applicable. b. Pole, pier or piling
construction: The use of poles, piers, or piles for the foundation of the structure may be
used to allow the unrestricted flow of flood waters during periods at a base flood. The
lowest floor must be one foot above the base flood level. c. Parallel Foundation Walls:
Foundation walls may be designed and constructed to provide open spaces through which
water can flow unrestricted to equalize pressure. In velocity flood situations, it is important
that all foundation walls be parallel to the flow of the floodwaters. d. Extended Foundation
Walls and Basements: (Note: Extended foundation walls and basements are not permitted
in the floodway.) The lowest habitable floor of a residence may be constructed on
foundation walls that extend above grade to one foot above the height of the base flood
provided that residential construction complies with the requirment of Section 5.101(2),
"Residential Construction," regarding the design of enclosed areas.
2?,/r21.) Utilities shall be designed as specified in Section 5.20 of Ordinance No. 18-1120-95.
he applicant shall follow all conditions and recommendations rendered throuferson h t
,i P' Re-vegetation/Buffer Enhancement Plan as approvedy9 he
O �( (ymmunity Development. The plantin s shall be completed prior to a.final building
of
Q ' inspection. The applicant shall a so follow the monitoring schedule as identified
Plan. 9
in the
23.) A temporary construction fence along the upland boundary of the proposed stream buffer
shall be installed prior to any site alteration other than installation of buffer enhancements.
24.) Per Condition #2 of the Hearing Examiner decision, "the proposed single-familydwelling
unit shall be no larger than 1,300-square feet as stipulated through the proposal." The
application as proposed meets this condition.
25.) The applicant, or subsequent owner, shall advise all contactors and subcontractors of
these conditions and the consequences of violations.
26.) Hearing Examiner decision condition#3 states, "the applicant shall submit and obtain
approval of a stormwater management permit in compliance with Section 6.6 & 6.7 of the
UDC." The applicant submitted a stormwater plan meeting this requirement.
27.) The applicant is proposing to create or add 1,380 square feet of impervious surface and
790 square feet of land disturbing activities with an environmentally sensitive area or its
buffer. Sections 6.6 and 6.7 of the Jefferson County Unified Development Code requires
the project applicant submit a stormwater plan meeting Minimum Requirements#1
through#5 of the Department of Ecology Stormwater Management Manual for Western
Washington. The stormwater plan shall address measures to control stormwater, erosion
and sediment during construction and shall address permanent measures to stabilize soil
exposed during construction, and in the design and operation of stormwater and drainage
control systems.
28.) A Stormwater Plan has been Stiffed and approved by the Department of ommunit
Development. Once the subject permit has been issued the applicant shall fully y
implement the provisions of the submitted plan and contact the Jefferson County
Department of Community Development to arrange a schedule to inspect the property for
plan compliance. A Certificate of Occupancy will not be issued until the Department
verifies plan compliance. No clearing for roadways or utilities shall occur on the project
site until clearing necessary for the installation of temporary sedimentation and erosion
control measures have been completed.
29.) This parcel is a legal nonconforming parcel designated Rural Residential 1:5 under the
Jefferson County Comprehensive Plan Land Use Map effective August 28, 1998.
30.) Lots 80 & 81 were created through the Snow Creek Ranch subdivision September 7, 1962
and recorded under AFN 173386, Vol 4, pp 29-30 of Long Plats with the Jefferson County
Auditor.
Snow Creek Ranch was amended June 17, 1993 under AFN 361279, Vol 6, pp 200-202
of Long Plats.
Snow Creek Ranch was amended December 10, 1993 under AFN 366746, Vol 6, pp
208-211.
An amendment to Snow Creek Ranch was recorded under AFN 400703, Vol 7, pp 66-68
of Long Plats and AFN 400704, Vol 577, pp 338.
31.) Potable water is provided to this parcel by Jefferson County PUD#1, Snow Creek Water
System.
32.) A septic permit (SEP03-00210)was approved April 21, 2004 for a system with capacity of
240 gallons per day/2 BR. A septic permit application (SEP99-00132)was cancelled
December 7, 2000 due to lack of activity. Associated critical area review (CAR99-00258)
was withdrawn January 14, 2002. SEP99-00132 is now filed with SEP03-00210.
33.) A minimum of two (2) on-site parking spaces are required for the single family residence.
34.) The building height is not to exceed 35 feet.
35.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
36.) Exterior lighting for residential uses shall not exceed twenty feet(20') in height from the
finished grade, excepting when such lighting is an integral part of a building or structure.
Ground level lighting is encouraged.
37.) Mountain View Dr is a private road. A road approach permit is not required. An address
of 42 Mountain View Dr has been assigned to the parcel.
38.) A Binding Advance Determination (CAR97-00236)was cancelled January 14, 2002 due to
lack of submittal of signed waiver.
39.) Jefferson County determined that this proposal is categorically exempt from review under
the State Environmental Policy Act(SEPA) pursuant to WAC 197-11-800(1)(b)(i).
40.) Minimum setback from Mountain View Dr right-of-way is 20 feet. Minimum side setbacks
are 5 feet. Minimum setback from Snow Creek is approximately 80 feet. All structures
shall be located outside the Port Townsend water line easement.
41.) The site plan as submitted with the building application on November 15, 2004 has been
reviewed for consistency under the UDC, and has been approved by Jefferson County
Department of Community Development. Any modifications, changes, and/or additions to
the stamped, approved site plan dated November 24, 2004 shall be resubmitted for review
and approval by Jefferson County Department of Community Development.
42.) This approval is for a manufactured home w/propane tank only. Any future permits on this
site are subject to review for consistency with applicable codes and ordinances and does
not preclude review and conditions which may be placed on future permits.
• • ei • MLA04-0047u
Review Type: I
MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD04-00501 Received Date: 7/28/2004
SITE ADDRESS: 'jrT,MOUNTAIN VIEW DR
QUILCENE, 98376
APPLICANT: LARRY BROWN PHONE: (360)698-4994
2920 SAWDUST HILL RD
POULSBO WA 98370
SUBDIVISION: SNOW CREEK RANCH Block: Lot: 80-81
PARCEL NUMBER: 995400076 Section: 2 Township: 28 N Range: 02 W
CONTRACTOR/ HAI PHAM VAN CONSTRUCTION PHONE: (360)455-4158
DEALER: W/HERITAGE HOME OF SEQUIM
6642 5TH WAY SE
LACEY WA 98503-7975
Contractor's License HAIHC*999PP Expires
INSTALLER: HAI PHAM VAN CONSTRUCTION HAIHC*999PP (360)455-4158
W/HERITAGE HOME OF SEQUIM LACEY WA
98503-7975
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTION: EW MH
ALSO 120 GAL AG PROPANE TANK
TYPE OF WORK MOB MANUFACTURED HOME: L.�8¢a' SHORELINE:
TYPE OF IMP NEW MAKE: MARLETTE• I SETBACK:
VALUATION f3; 9e.° 3'21tCb,C1C
YEAR: 2004
LABOR & INDUSTRIES APPROVAL?
SIZE: 44 X 28 BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: PUBLIC
BEDROOMS: BATHROOMS: PARCEL TAGS: YES NO
Exist: Exist: STORMWATER: YES NO
Prop: 2 Prop: 2 AREA Plat Conditions
Total: 2 Total: 2 Wetland Erosion
Seismic Streams
Flood Way Floodplain
Routing Date: F&W Landslide
Shoreline Aquifer
Type Amount Paid By: Date: Receipt: , A P"r'paov E r,.,
Manufactured Homes $154.00 KAS 07/28/04 66702 NOV 2 9 2004
Potable Water Application $52.00 KAS 07/28/04 66702
Total: $206.00 Jefferson County Planning
& Building Department
'._,:Alkszi . LQ
tr< Q �Gc�
JACK WESTERMAN III Jefferson Count urlh ouxe
ASSESSOR Po Box 1220, Port Townsend, WA 9836l
43601385-9105
MOBILE HOME INFORMATION FORM
OWNER'S NAME/MAILING ADDRESS:
NAME: /\ 79 r d\y
ADDRESS: g g a(1 S&iv ct Lk S /�7�`// 'i' a Pi 4i IS tG t Le 1.3 y 3 70
PHONE NO. Ye: 6 - X /9 9 y
The purpose of this questionnaire is to obtain information regarding either the
current location of a mobile home or the previous ownership and location of a mobile
home. This will help our office determine whether the mobile home is already on the
tax rolls in Jefferson County or if it has been moved to this county from another area.
l)MOBILE HOME DATA:
(A►MAKE
(B)MODEL L I/ J �y Si a � (C)YEAR 0 it
(D)LENGTH / 11 / (E)WIDTH /
(F)SERIAL #
(G)YOUR PURCHASE PRICE (Do not include sales tax) 3�/(yin PURCHASE DATE NOV C
2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 30
(A) FROM WHOM DID YOU PURCHASE- MOBILE (�77 -.e � r-5
ADDRESS .S� ,7O /�!l�/`} FrrpJ r/YJ /k)o /03iz
(B)WAS MOBILE HOME ASSESSEDIN JEFF It ON COUNTY LAST YEAR?Yes No
If Yes, Previous address of mobile.
If No, What County was Mobile assessed in last year.
3)WHERE MOBILE HOME IS TO BE LOCATED:
(A)WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes No
(B)IF LOCATED IN MOBILE HOME PARK:
NAME &ADDRESS OF PARK Lot/Space#
(C) IF NOT LOCATED IN MOBILE HOME PARK:
NAME OF LAND OWNER: A 14-Y I3 r 0.4'1�1 <2 0/4 14 AUig I SoG ` Cn
els
LOCATION ADDRESS QL` `'C P� f' , UJ f 7(0 /`
REAL PROPERTY PARCEL #/DESCRIPTION 9 Too O 7 Co
Sipatare of pplicant
THANK YOU FOR YOUR HELP!
JO COSSELL, Property Technician NOV 1 5 2004
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,4�gs O& JEFFERSOC ITY • �� n
DEPARTMENT OF COMMUNITY DEVELOPMENT ( � 1
621 Sheridan Street • Port Townsend •Washington 98368 FIF t
360/379-4450 • 360/379-4451 Fax .. ' al i s I
�0� www.co.jefferson.wa.us/commdevelopment
htING
JEFFERSON COUNTY'
Master Permit Application cr'T OAd I \�ELOFNIEN`
ML 'et— `T t
Proect Description(include separate sheets as n cessary):
%i� S4"// 117/9P (l f-j?-(. ��r i-Y' ci -1/c i f t ,
Tax Parcel C, Property
Number: 6 9,S- -LAY) - C.' 76 -7 Size: L tx � ci
/ (acres/square feet)
Site Address and/or Directions to Property: lei�'tc,J"-/ i p if) 1/, �.r))6'��, 1 I , ,t�
1 J SiAEt . rklfr�t~tip
Property Owner(s)of Record: l.t.-3,-0 y fq f'1,-L. 1A1
Telephon -?`t) 1 i '—99/ Fax: .514/7] email:
Mailing Address: ` ��C G: �, .S -1f '� / l''A_ I Ci1A t't I)e, if `t3 , 3 70
Applicant/Agent(if different from owner):
Telephone: Fax:
email:
Mailing Address:
What kind of Permit?(Check each box that applies)
[1 Building 0 Variance(Minor,Major or Reasonable Economic Use)
❑ Demolition Permit ❑ Conditional Use[C(a),C(d),or C)**
❑Single Family ❑ Discretionary"D"or Unnamed Use Classification
❑ Garage Attached/Detached ❑ Special Use(Essential Public Facilities)**
' Manufactured Home ❑ Boundary Line Adjustment
❑ Modular ❑ Short Plat**
0 Commercial* ❑ Binding Site Plan**
❑Change of Use Cl Long Plat**
I Address [I Road Approach tg Planned Rural Residential Development(PRRD)/Ameen ments**
, Propane ❑ Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions**
lie Stormwater Management ❑ Shoreline Management Substantial Development**
0 Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance
❑Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment
Li Wireless Telecommunication* F,Jefferson County Shoreline Master PrograrnAmendment
❑ Forest Practices Act/Release of Six-Year Moratorium De f1 f-
*May require a Pre—Application Conference "*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 k y`0 f 9-5(Y , to act as my agent in matters relating to this application for permit(s).
/
If
OWNER SIGNATURE i i /, , X Z—- Date: `' el
4
By signing this application form,the owner/ ent 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 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 attomey'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 a and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any required IsPectionsss and right of entry to this property shall be requested and shall occur only during regular business
hours.
Signature: 2.t. j/ / ---
�J t Date: /�' 7
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 .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• c fnpliance wi a Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non-transferable r_ sibility for adheig to and complying with the ESA. The Applicant has read this disclai er and signs and dates it below.
(----
t
Signature: /�, t_ ;e} �), ye.. `., _ Date: / 20 Y!-
G:\PermitCente\FORMS\D ORMS\Master Permit Application 7-8-04.doc
OWNER 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 assuitiug the responsibility of the General Contractor for the proposed project.
Ng Signature: " i+.`A Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALI,ER: PHONE: FAX:
141 4)t-�,A VI. ' ::Y ( .�cn-Ztc= F'� (oc ) i j <:4 r ? ( )
MAILING ADDRESS: 24 � &5 TN__ A r ,, _ EMAIL:
CONTRACTOR'S LICENSE ,L.A ,k^ `�l t,t)•A- el Z"jC'_' WAINS i d_
NUMBER: :4 A all-C (JQ Gi('t NUMBER t_. t i (C .•
ARCHITECT/ENGINEER: PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: 2 Shoreline: Type of Sewage Disposal:
❑ New ❑ Wood Existing: ❑ Sewer
❑ Addition 0 Steel Proposed: Bank ❑ Community System
❑ Alteration/Remodel .___ -El-pcincrete Total: Height: individual System
❑ Repair +- ip 1 Aasonry (rooms: SEP Permit# (•-. -2I CI,
�� "X Water Su
❑ Demolition - 0--0ther. Supply:
Exiting: 7 Setback: CI Private well ❑ Two Party
r<
Type of Heat:
R. 3 JUL 2d4 iPrp F sect: ;6t1\Public
Total: Name of System:
If this is a Commerci I 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 'ti,Above ground Tank Size of Propane Tank: I'Z(.•
i i Heat Stove bi,Cook Stove [I Woodstove [I Fireplace Insert [},lot Water Tank Cl Pellet Stove I 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 For Office Use Only
Current Proposed Amount
Main Floor Consistency Review: 4pK.oo
2""Floor Base fee: l f 54-.0
3`0 Floor Additional Section: ��
Mezzanine: Plan Check fee:
Heated Basement State Surcharge fee: .,/•
Unheated Basement Pot Water Review fee: GS.•00
Other Unheated 911/Rd Approach fee: 1 /I/) . oo
Garage/Carport - TOTAL $ 4.31 00
Decks �) 4 O, c Ro'64' ipt Number: 6 6/bZ + r,
_ 1 t CashlCheck Number: 22
Other1=J- 331
ESTIMATED COST(REQUIRED) Date: 1(?Ala tf- 5/42(01
•Fair ma et value of all labor and materials foundation to finish t
bo tb0 O Initials: Q4-326
YY
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
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