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HomeMy WebLinkAboutBLD2004-00802 • BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD04-00802 Received Date 12/17/2004 SITE ADDRESS: 813 THORNDYKE RD Issue Date 02/14/2005 PORT LUDLOW, 98365 APPLICANT: RAYMOND STELK PHONE: VERA ARLENE STELK 133 OSPREY RIDGE DR UNIT A PORT LUDLOW WA 98365 SUBDIVISION: BRIDGEHAVEN DIV 5 Block: Lot: 12 PARCEL NUMBER: 935100011 Section: 9 Township: 27 N Range: 01 E CONTRACTOR: OWNER/BUILDER PHONE: PROJECT DESCRIPTION: RETAINING WALL - NEW CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. SETBACKS: UFFER: Footing: �/� Foundation:2 t'L 4C. C,(QcL (kc to-24,—CA Stormwater FINAL Approval: Underground Plumbing: Underground Insulation: Shear Wall : Framing: Plumbing: Propane Tank/ Lines: Insulation: Sheetrock: Septic Sytem Final Approval (If not on sewer): Road Approach Final Approval: Zoning Final Approval: Final/Occupancy Approval: HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL 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 !N 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 WILDING PERMIT APPLICATION ML ReviewTy 703 Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD04-00802 Received Date: 12/17/2004 SITE ADDRESS: 813 THORNDYKE RD PORT LUDLOW, 98365 OWNER: RAYMOND STELK PHONE: VERA ARLENE STELK 1338 OSPREY RIDGE DR PORT LUDLOW WA 98365 SUBDIVISION: BRIDGEHAVEN DIV 5 Block: Lot: 12 PARCEL NUMBER: 935100011 Section: 9 Township: 27 N Range: 01 E CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI RETAINING WALL - NEW TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 1,500.00 ADD'L: HEAT TYPE: CODE EDITION: 2003 HEAT BASE: HEAT TYPE: OCCUPANCY: OCCUPANCY: UNHEATED: # OF STORIES: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: PARCEL TAGS: YES NO BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA Exist: Exist: Wetland Erosion Prop: Prop: Seismic Streams Total: Total: Flood Way Floodplain Routing Dat F&W Landslide la 11-1164 Shoreline Aquifer Forest: Commercial Rural Type Amount Paid By: Date: Receipt: pproved/Date APPROVED Permit $54.00 BAC 12/17/04 68922 Plan Check $35.10 BAC 12/17/04 68922 State Building Code $4.50 BAC 12/17/04 68922 FEB 1 4 2005 Total: $93.60 Jefferson County Planning & Building Department • SPECIAL CONDITIONS FOR CS A BLD04-00802 1.) A vegetative buffer of 25-feet shall be permanently maintained from the top or edge of the Landslide Hazard Area. All buffers shall be measured perpendicularly from the top of the Landslide Hazard Area. 2.) A Geotechnical Report dated May 14, 2004 prepared by NTI Engineering and Surveying was submitted in conjunction with this application. The report addressed the stability of the geologic hazard area. A setback of no less than 25-feet shall be measured perpendicularly from the top or toe of the geologic hazard area to the proposed foundation. 3.) Landslide Hazard Areas and their associated buffers shall remain naturally vegetated. Should buffer disturbance occur during construction, the Unified Development Code (UDC) Administrator shall require replanting with native vegetation. No alterations shall be made to the Landslide Hazard Area or its associated buffer without prior authorization by the UDC Administrator. 4.) Prior to and during approved construction activities, the perimeter of the landslide hazard area buffer shall be marked with a temporary sign. The sign shall be placed in such a manner that it can be directly observed from the construction area. The sign shall contain the following statement: "Landslide Hazard Area and Buffer- Do not Remove or Alter Existing Vegetation." 5.) All construction activities shall not encroach upon the buffer. This includes the storage or preparation of materials. 6.) The applicant shall permanently separate the boundary of the Landslide Hazard Area Buffer from the remainder of the subject property through installing logs, trees, a hedge row, or any other prominent physical marking approved by the UDC Administrator. 7.) Critical Aquifer Recharge Areas may require special protection measures to mitigate water quality degradation. The submitted proposal does not require additional aquifer protection measures. However, during construction the project shall follow the Best Management Practices (BMPs) and facility design standards as identified and defined in the Stormwater Management Manual for the Puget Sound Basin. 8.) To help prevent seawater from intruding landward into underground aquifers, all new development activity on Marrowstone Island, Indian Island and within 1/4 mile of any marine shoreline shall be required to infiltrate all stormwater runoff onsite. 9.) VOLUNTARY MEASURES OF COASTAL&AT RISK SIPZ: Water conservation measures: 1. Roof and other intercepted precipitation shall be routed to on-site detention ponds and/or other approved means and allowed to be released to the soil slowly. 2. Water collected from Storm water and roof catchments may be used for watering lawns and gardens. Unless catchment water has been treated to meet drinking water standards, there shall be no cross connections allowed between the potable supply and impounded water. 3. Water withdrawn from wells on each property shall not be used for watering of lawns and/or gardens. 4. Ground water withdrawn from each property shall be restricted to a rate of three (3) gallons per minute. 5. Installation of water conserving fixtures such as low flow toilets, faucets and shower restrictors and other water saving plumbing fixtures. 6. Landscaping plan (xeriscaping, native vegetation with minimal amounts of irrigation). Please NOTE that the above listed measures are not intended to be exhaustive, but rather is intended to be illustrative of the types of water conservation measures. 10.) VOLUNTARY MEASURES OF COASTAL &AT RISK SIPZ: 1. Installation of a flow meter. 2. On-going well monitoring for chloride concentration. 3. Submittal of monitoring data to County. 11.) MANDATORY MEASURES FFCOASTAL SIPZ: • 1. For proof of potable water on a building permit application, applicant must utilize DOH-approved public water system if available. 2. If public water is unavailable, a qualifying alternative system may be used as proof of potable water or an individual well may be used as proof of potable water subject to the following requirement: a. Chloride concentration of a laboratory-certified well water sample submitted with building permit application. 3. If public water is unavailable, a qualifying alternative system may be used as proof of potable water. 12.) The project shall adhere to the Best Management Practices (BMPs) to control stormwater, erosion and sediment during construction. BMPs shall address permanent measures to stabilize soil exposed during construction, and in the design and operation of stormwater and drainage control systems. 13.) An Engineered Stormwater Site Plan dated August 2, 2004 prepared by Tillman Engineering has been submitted and approved by the Department of Community Development. Once the subject permit has been issued the applicant shall fully 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. 14.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 15.) Not more than two (2) unlicensed or inoperable vehicles shall be stored on any lot less than one-half acre unless totally screened from view of neighboring dwellings and rights-of-way. Such screening shall meet all applicable performance and development standards specific to the district in which the storage is kept, and shall be in keeping with the character of the area. Screening shall meet the requirements of Unified Development Code (UDC) Section 6. Outdoor storage of thirteen (13) or more unlicensed or inoperable vehicles is prohibited except in those districts where specified as an automobile wrecking yard or junk (or salvage) yard and allowed as a Permitted Use in Table 3-1 of the UDC, and such storage shall meet the requirements of UDC Section 4.10. In no case, shall any such unlicensed or inoperable vehiclesbe stored in an Environmentally Sensitive Area (ESA). 16.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 17.) The building height is not to exceed 35 feet. 18.) NOTE: SETBACK FROM TOP OF BANK TO SW CORNER OF BUILDING FOUNDATION SHALL BE NO LESS THAN 25 FEET PER GEOTECHNICAL REPORT DATED MAY 14, 2004 PREPARED BY NTI. EOLOGIST SHALL DETERMINE THE TOP OF BANK OF THE LANDSLIDE HAZARD AREA AS WELL AS STAKE THE 25 FOOT SETBACK FROM THE TOP OF BANK. THIS STAKING SHALL BE PERPENDICULAR TO THE TOP OF THE BANK AND ESTABLISHED PRIOR TO POURING OF ANY CONCRETE AND PRIOR TO EXCAVATION OF FOUNDATION. 19.) GEOTECH CONDITION: IT WILL BE NECESSARY TO MAINTAIN GROUND COVER IN ORDER TO REDUCE EROSION FROM SURFACE RUNOFF. ANY BARE AREAS THAT DEVELOP, ON THE UPLAND OR BLUFF, SHOULD BE REVEGETATED. NATIVE DEEP-ROOTED VEGETATION THAT REQUIRES LITTLE OR NO IRRIGATION WOULD BE THE MOST BENEFICIAL. PLEASE CONSULT THE ENCLOSED PUBLICATIONS FOR FUTHER INFORMATION. 20.) GEOTECH CONDITION: VEGETATION ON THE BLUFF FACE PROVIDES STABILIZATION TO THE BLUFF FACE SOILS AND HELPS REMOVE WATER FROM THE SOIL. EXISTING ESTABLISHED VEGETATION SHOULD BE LEFT UNDISTURBED. IF A BETTER VIEW IS DESIRED, MINOR LIMBING AND PRUNING SHOULD BE DONE IN SUCH A WAY THAT MINIMIZES DISTURBANCE TO THE SOIL AND ROOT ZONE AND THAT INSURES THE CONTINUED HEALTH OF THE VEGETATION. TREES SHOULD NOT BE TOPPED. 21.) GEOTECH CONDITION: HEP IRRIGATION OR OTHER ACTIVITIES TFfAT WOULD CONTRIBUTE LARGE QUANTITIES OF WATER TO THE SOIL SHOULD BE AVOIDED. 22.) GEOTECH CONDITION: SURFACE RUNOFF FROM HARD SURFACES SUCH AS ROOFS, DRIVEWAYS, WALKWAYS AND PATIOS SHOULD BE CONTROLLED AND ROUTED TO A DRAINAGE CONTROL DEVICE SUCH THAT SURFACE WATER DISCHARGE TO ADJACENT PROPERTIES DOES NOT SIGNIFICANTLY EXCEED PREDEVELOPMENT CONDITIONS. REPORTEDLY, A NEIGHBOR HAS PURCHASED THE PROPERTY AT THE BASE OF THE BLUFF AND HAS AGREED TO ALLOW MR. STELK TO TIGHTLINE THE RUNOFF TO THE BASE OF THE BLUFF. THIS OPTION WOULD BE BETTER, FROM A BLUFF STABILITY STANDPOINT, THAN INFILTRATING THE WATER ON THE UPLAND. AN ENGINEERED DRAINAGE AND EROSION CONTROL PLAN SHOULD BE DEVELOPED FOR THIS PROPERTY TO ADDRESS THESE ISSUES AND THAT CONFORMS TO ALL COUNTY, STATE, ETC. REGULATIONS. 23.) GEOTECH CONDITION: DRAINAGE ROUTES FROM OFF SITE THAT COULD POTENTIALLY ALLOW RUNOFF TO FLOW ONTO THE PROPERTY SHOULD BE ADDRESSED IN THE ENGINEERED DRAINAGE AND EROSION CONTROL PLAN SUCH THAT THIS POTENTIAL RUNOFF IS CONTROLLED OR REDIRECTED IN ORDER TO PREVENT DAMAGE TO THE BLUFF. LIKEWISE, THIS SHOULD CONFORM TO ALL APPLICABLE CODES AND REGULATIONS. 24.) GEOTECH CONDITION: SILT FENCES OR OTHER SEDIMENT CONTROL DEVICES MAY BE NEEDED DURING CONSTRUCTION SUCH THAT SEDIMENTATION TO ADJACENT PROPERTIES DOES NOT SIGNIFICANTLY EXCEED PREDEVELOPMENT CONDITIONS. 25.) GEOTECH CONDITION: DRAINAGE CONTROL DEVICES SHOULD BE MAINTAINED IN GOOD WORKING ORDER AND INSPECTED AT LEAST ONCE A YEAR. 26.) GEOTECH CONDITION: PER TABLE 18-1-A OF THE UBC (SEE APPENDIX), THE ALLOWABLE FOUNDATION PRESSURE FOR THE SANDY SOIL OBSERVED IN THE TEST PITS ON SITE IS 1500 POUNDS PER SQUARE FOOT (PCF). THIS VALUE CAN BE INCREASED UP TO A MAXIMUM VALUE OF 4500 PCF SUBJECT TO FOOTNOTE 2 OF THE TABLE. FOOTNOTE 2 READS: ALL VALUES OF ALLOWABLE FOUNDATION PRESURE ARE FOR FOOTINGS HAVING A MINIMUM WIDTH OF 12 INCHES (305 MM)AND A MINIMUM DEPTH OF 12 INCHES (305 MM) INTO NATURAL GRADE. EXCEPT AS IN FOOTNOTE 7, AN INCREASE OF 20 PERCENT SHALL BE ALLOWED FOR EACH ADDITIONAL FOOT (305 MM) OF WIDTH OR DEPTH TO A MAXIMUM VALUE OF THREE TIMES THE DESIGNATED VALUE. ADDITIONALLY, AN INCREASE OF ONE THIRD SHALL BE PERMITTED WHEN CONSIDERING LOAD COMBINATIONS, INCLUDING WIND OR EARTHQUAKE LOADS, AS PERMITTED BY SECTION 1612.3.2. FOOTNOTE 7 READS: NO INCREASE FOR WIDTH IS ALLOWED. 27.) A report dated July 19, 2004 prepared by Robert M. Pride, Inc. was submitted with regards to the landslide hazard area. The report identified a minimum setback of 25 feet from the top of bank of the landslide hazard area to the foundation. 28.) ROBERT PRIDE, INC. REPO DATED 7/19/2004 • FOUNDATION RECOMMENDATIONS: THE NEW RESIDENCE SHOULD BE SUPPORTED ON CONTINUOUS BEARING WALL FOOTINGS THAT EXTEND A MINIMUM DEPTH OF 18 INCHES BELOW FINAL GRADE. IT IS RECOMMENDED THAT THE SOUTHWESTERLY FOUNDATION WALLS BE LOCATED NO CLOSER THAN 25 FEET TO THE TOP OF THE EXISTING SLOPE. AN ALLOWABLE SOIL BEARING VALUE OF 2000 PSF AND 2000 PSF MAY BE USED FOR THE LIGHTLY LOADED HOUSE FOOTINGS FOUNDED ON NATIVE SOILS AND PROPERLY COMPACTED FILL, RESPECTIIVELY. THIS VALUE MAY BE INCREASED TO 4000 PSF FOR RETAINING WALL FOOTINGS THAT ARE AT LEAST 24 INCHES IN WIDTH. SETTLEMENT OF FOOTINGS FOUNDED ON ADEQUATE BEARING SOILS WILL BE MINIMAL. RESISTANCE TO LATERAL LOADS ON THE STRUCTURE CAN BE PROVIDED BY PASSIVE EARTH PRESSURE ON FOOTINGS AND THE STEM WALLS. A RECOMMENDATION OF 300 PCF FOR PASSIVE PRESSURE, AND A COEFFICIENT OF SLIDING FRICTION OF 0.5. RETAINING WALLS SHOULD BE DESIGNED FOR AN ACTIVE EARTH PRESSURE OF 30 PCF, AND THEY SHOULD HAVE A FOUNDATION SUBDRAIN TO ELIMINATE HYDROSTATIC PRESSURE BUILDUP. ALL RETAINING WALLS SHOULD BE BACKFILLED WITH SOIL COMPACTED TO 90% OF THEIR MAXIMUM DENSITY TO REDUCE THE POTENTIAL FOR FUTURE SETTLEMENT UNDER PROPOSED CONCRETE WALKWAYS AND PORCH SLABS. EXTERIOR SLABS-ON-GRADE CONCRETE SLABS MAY BE POURED DIRECTLY ON THE VERY DENSE GACIAL SOILS OR COMPACTED FILL THAT ARE EXPECTED TO BE EXPOSED AT FINAL GRADE. CONTROL JOINTS SHOULD BE INCLUDED ON ABOUT TEN FOOT CENTERS ACROSS THE SLAB SECTIONS TO MINIMIZE SHRINKAGE CRACKING. IF THE CONCRETE IS POURED WITH A LOW SLUMP, REINFORCING STEEL IS NOT REQUIRED FOR ANY SLABS SUPPORTED ON NATIVE OR COMPACT SOILS. ALL CONCRETE SHOULD BE PLACED IN ACCORDANCE WITH ACI GUIDELINES. DRAINAGE: IN ADDITION TO THE FOUNDATION DRAINS AROUND THE PERIMETER OF THE BASEMENT WALL FOOTINGS, THERE WILL BE DRAINS AND ROOF DRAINS THAT WILL COLLECT STORMWATER RUNOFF. ALL OF THIS WATER SHOULD BE TIGHTLINED TO THE STREET AT THE FRONT OF THE PROPERTY, OR TO A SUITABLE INFILTRATION TRENCH THAT IS AT LEAST 100 FEET WEST OF THE TOP OF SLOPE. EVERY EFFORT SHOULD BE MADE TO PREVENT SURFACE WATER RUNOFF OVER THE TOP OF THE REAR YARD SLOPE, AND TO PREVENT EXCESSIVE INFILTRATION INTO THE UPPER SOILS NEAR THE STEEP SLOPE. SUMMARY: ROBERT M. PRIDE, INC. HAS DISCUSSED THEIR RECOMMENDATIONS FOR CONTINUOUS BEARING WALL FOOTINGS WITH THE STRUCTURAL ENGINEER WHO IS IN THE PROCESS OF REVISING THE HOUSE DRAWINGS. CONSTRUCTION MONITORING AND CONSULTATION SERVICES SHOULD ALSO BE PROVIDED TO VERIFY THAT SUBSURFACE CONDITIONS ARE SIMILAR TO THOSE DESCRIBED IN OUR REPORT. SHOULD CONDITIONS BE REVEALED DURING CONSTRUCTION THAT DIFFER FROM THE ANTICIPATED SUBSURFACE PROFILE, WE WILL EVALUATE THOSE CONDITIONS AND PROVIDE ALTERNATIVE RECOMMENDATIONS WHERE APPROPRIATE. 29.) This proposal is for the construction of a retaining wall wthin a utility easement. The grantee of the aforesaid easement may request the lot owner to remove the ecology block retaining wall should access of the utility easement is needed. • 30.) No drains allowed within 30' downgradient of the drainfield and reserve are• the parcel to the south or the drainfield and reserve serving this property. I:\F_BLD_Permit_Buildng.rpt 10/29/19 rON L, ii5A, o6, JEFFERSOIAIUNTY ' 40 • ' �' DEPARTMENT OF COMMON. ` `d 621 Sheridan Street• Port Tcrh LLijnV83 , 360/379-4450 • 360/379-4451 .q ..Sp www.co.jefferson.wa.us/comrrl lop t ' BnvG SEC 1 7 2004 = CF • Master Permit Application �_...T_._ MLA: h Ll 0 3 J;.r(Cf,,t'l, ✓,3:;wry i Project Description(include separate sheets as necessary):rE!�s. OF COWZI?kL7"t,r:Fe.EiOP1tift C kJ gin_ )L; E7.A: IJ r;t (,VXLi -- Tax Parcel Pro ` Number: / 3 S I C O 0/1 Size: / 7 0 C U tI (acres/square feet) Site Address and/or Directions to Property: C;%3 6RN6 Leir t= (I it° R/ZT L.u/,)L vLu (j4 7 b ei Property Owner(s)of Record: i-6/1y rr0 kill •k A mt..)is...N., 5.- L.r� Telephone: 3 6 6 ?1 3 (• '[)2_ Fax: email: Mailing Address: l S-IA C%<:f-rtk'7 + :(d)Ci. ()lc Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: Wh t kind of Permit?(Check each box that applies) T Building 0 Variance(Minor,Major or Reasonable Economic Use) a Demolition Permit ❑ Conditional Use[C(a),C(d),or C]** ❑ Single Family ❑ Discretionary"D"or Unnamed Use Classification ❑Garage Attached/Detached a Special Use(Essential Public Facilities)** ❑Manufactured Home a Boundary Line Adjustment ❑ Modular ❑ Short Plat** ❑Commercial* 0 Binding Site Plan** ❑ Change of Use ❑ Long Plat** ❑Address ❑ Road Approach a Planned Rural Residential Development(PRRDyAmendments** ❑ Propane ❑ Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** ❑Stormwater Management ❑ Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance ❑Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment ❑Wireless Telecommunication* ❑Jefferson County Shoreline Master Program Amendment 0 Forest Practices Act/Release of Six-Year Moratorium *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 to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: 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 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 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.Access and right of entry to this property shall be requested and shall occur only during regular business hours. Signature - -.-v , -- ' Date: /--/7-C j' 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 responsibility for ang to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature ' J w Date: /-- 1 7-6 Y G:\PemritCenter\FORMS\DRD FORMS\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 assuming the responsibility of the General Contractor for the proposed project. Signature:�._.._,_—a.-1. ' _4J&/ Date: /2-77 C GENERAL CONTRACTOR Oj'R 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 ❑ Wood Existing: ❑ Sewer ❑ Addition 0 Steel Proposed: . Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: ' Height: 0 Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ 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. El Underground Tank ❑ Above ground Tank Size of Propane Tank: ❑ Heat Stove ❑ Cook Stove ❑ Woodstove ❑ Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove ❑ 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 ': eeyUse`Onl k ' r"r`t; "_ 3 x t.�u �`� Current Proposed - N ' w ist*, fir. . Main Floor slstency Review: ,,., fiv�>: 2NU Floor y ' ,,s `' rirt 3m Floor Adr nal Section: `, Ik4 `• _ t+� '-€ � ' r 3 , - , i` +e,' h ,S 1 ' Y Mezzanine: Plan�C t ll `$S „- � 4 e.. ,. Heated Basement ` e e lee: ,'`• .- `?''"'' ' ►'4j��ti3 n Unheated Basement of Wat r�fee: r ;, r . 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