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HomeMy WebLinkAboutBLD2005-00128 • • MANUFACTURED/MOBILE HOME INSTALLATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD05-00128 Received Date: 3/4/2005 SITE ADDRESS: 261 SENTINAL FIRS RD Issue Date: 9/28/2005 PORT HADLOCK, 98339 APPLICANT: ROY L MERGEL MARY L MERGEL 261 SENTINAL FIRS RD PORT HADLOCK WA 98339-9765 SUBDIVISION: Block: Lot: T48A-i PARCEL#: 921193033 Section: Township: N Range: 11 W CONTRACTOR/ OWNER/BUILDER PHONE: DEALER PROJECT DESCRIPTION: NEW MANUFACTURED HOME FLEETWOOD SER It ORFLK48A10682BM MAKE: FLEETWOOD YEAR: 1990 SIZE: 66X14 THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 9/28/2006. CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. Setbas/Footing (CON INUOU OTING, SLAB or PADS USED): ��'?BA"i< 4.4/71ey[4#__, Stormwater FINAL Approval: OK 7/ /D) Blocking/Plumbing: fA,,e,,er�a�c 4jr-DQt&.>iJS OK /0/2-5/65fr. Propane Tank/Lines ►J/A Zoning Final Approval: Septic System Final Approval (If not on sewer): Road Approach Final Approval: Final/Skirting/Vents/Porches/Steps: aR _dr J n J 7/24/67 HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED RIOR 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 IPU ILDING PERMIT APPLICA1IN MLA05-00132 Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00128 Received Date: 3/4/2005 SITE ADDRESS: 261 SENTINAL FIRS RD PORT HADLOCK, 98339 OWNER: ROY L MERGEL PHONE: 360-437-2768 MARY L MERGEL 261 SENTINAL FIRS RD PORT HADLOCK WA 98339-9765 SUBDIVISION: Block: Lot: T48A-i PARCEL NUMBER: 921193033 Section: Township: Range: 11 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOr NEW MANUFACTURED HOME FLEETWOOD SER # ORFLK48A10582BM TYPE OF WORK MOB SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION 10,000.00 MAIN: CODE EDITION: 1997 ADD'L: HEAT TYPE: OCCUPANCY: HEAT BASE: HEAT TYPE: 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: 2 Exist: Wetland Erosion Prop: 1 Prop: 2 Seismic Streams Total: 1 Total: 2 Flood Way Floodplain Routing Date: F&W '� J(��� �v� Shoreline Landslide Aquifer Forest: Commercial Rural Type Amount Paid By: Date: Receipt: Approved/Date Permit $157.00 BAC 03/04/05 71539 /r-` ®,/ Potable Water Application $53.00 BAC 03/04/05 71539 V Total: $210.00 SEP 2 8 2005 fferson • my Planning I & Bui �in� , ,rtment I t . _...----1v ] FERSON COUNTY ASSESSOR JACK WESTERN�N III ���� cFFERSON COUNTY COURTH ASSESSOR PO BOX 1220, PORT TOWNSEND WAA 98368 (360) 385-9105 MOBILE HOME INFORMATION FORM OWNER'S NAME / MAILING ADDRESS: THIS/S NOT A TAX STATEMENT NAME: _ . A r "tteG-eL The purpose of this questionnaire is to obtain infonation ADDRESS: 2 ( ( S c T/ti%1 G �,`,r%ti 5 �rn9 either the current location of a mobile home or the -- previous ownership and location of a mobile home. This will ,/�©� T �� G c G;: � o �. help our office determine whether the mobile home is already j ! Y3 on the tax rolls in Jefferson County or if it has been moved to TELEPHONE NO: '3 r"1 — 7�- dry / - ��j this county from another area. Please see reverse side for a± tional information. 1) MOBILE HOME DATA: (A) MAKE F e'er INv�r (B) MODEL ,f4 / 4- f O.f/ (C) YEAR (D) LENGTH , �< , (� (E) WIDTH / `'y (F)SERIAL NUMBER Oil rL r< 'iki /e S-J-24 (G) YOUR PURCHASE PRICE(DO NOT INCLUDE SALES TAX) C e c•!> (H) PURCHASE DATE / U - 30 - ¢a 2) PREVIOUS OWNER/ LOCATION OF MOBILE HOME: (A) FROM WHOM DID YOU PURCHASE MOBILE C .4 At 4 , C 4 ,` rr is 7/1 ADDRESS C L 3 Li', .'It 1-14V Ci 7 • C/?E LG+.f, (B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR? YES NO (IF NO,WHAT COUNTY? C. iTl v/ ) IF YES,WHAT WAS PREVIOUS ADDRESS OF MOBILE? !i G 3 w, i`r¢,4' j�, •G/1 J 1.-'1�`f"7G- 3) WHERE MOBILE HOME IS TO BE LOCATED: (A) WILL THE MOBILE HOME BE IN A MOBILE HOME PARK? YES (B) IF LOCATED IN A MOBILE HOME PARK: NAME&ADDRESS OF PARK SPACE NO. (C) IF NOT LOCATED IN A MOBILE HOME PARK: NAME OF LAND OWNER: L. , /1 c /41//1 L< LAG +(` LOCATION(ADDRESS) 2- (, / 7 1"4r' %/.y-f jam, /4/\rf • Al', st 11! —5-7 REAL PROPERTY PARCEL NUMBER/DESCRIPTION c( Z- I '7 / Y 3 c' � j I I MAR - 4 200 THANK YOU FOR YOUR HELP! SIGNATURE V KELLI LARSON, roperty Technician THIS FORM CONFORMS TO THE STANDARDS OF THE STATE DEPARTMENT OF REVENUE AND IS SUBJECT TO AUDIT VERIFICATION. ,9 (.... _..,, 1 . * _•.: 1 : i .7 iklit 'l- ___..............., ,2 ,..,.. ip )7. ,ii .*..‘`tA•"4 - 1; • ....i ,.: 0 .4* I itpC 'i " •r.:. z Qs a 0 Ile O' I_ ..,, sa ; : ......„ torn,94g ' .t 0 I i a. ,, 1=' c•r-:IN.-_-r--:„. @ - A,- t.2 1 I * = a 2 lu 0 [ • ',:t•-.1.1:f * -';', (.0.....,_.u.i.. 1, 0 ....... .lie '".4''''':•:- • 0 S o , :a ,......,, , .,. 4 M I I ' I .C3 "..Z / ill ' 1 • , . il ' N9 -''f'..'''''.,' L r° * / IN. . 1.....-....... .-....4 1._,.._3.2 ,_ ,. , ‘14':3..'• Mi.; ,,,i,f, i si - 61---) ,_ GO e_ •/0 i — FER f....,, ' • •4' .4..,`''."," . e . it• .t 0 4.11 M I I 2 . ,_ . . I I sox 17 - idVil i .t i I ? ,- .— oaf) = --._._ 1 a p, -..,.. §1 ,',.i --- ,2. ,4 _ i'.;;?'5 '3 I•' ,-, r•-t), la ...:,. t:C) Clr•': (1 C)1 :0 z'4), 0.C\k .., •• cl E e --4i?, L,m 0 -.- rn ..1 i E t_.,..,..-• c) /:-. It 8 jog il 4 i g (i; i ill® > / , ® = S3 T, t 3 ? A MI i r6Z---• . -o 4D 1 RADCO .. 1 t• , ,ii , 1 • .. . . ,, 1--4--,.-- - , I -.........„ ,,,,Q.2 i I , . .: ,..„....,,.,........ ---„,- ... .. ',..' 1,7, _• ,<_, 1 . .-':•-.• - :-:•-•,,77-1-&-V:1„,A3 C 0 4 Z i --.•- .... ,,,,,,,:ert _,,..: I. n P Q Z I : . n 0 0 ,-;f Fl ") L I r• ---P.4 ' '-•"j'il.4-,,',..* ° g ,_ - re) i a,, 1 0 . . -c• - es' y----' . . . . .-., \,- ,,. APPROVED :. 6 0 — , 0 ,, ,.,, ..; '; -,4•'7,-014..-.1y. I 0' WI 1 .',- t'S'I i -.--...• .- ...F '...-•.4.,A•4 it,I1 Por-- [ ;;...7., ,w -t,vW9„,_.• #,..4.; -' •,, s .,,z , 2 8 I I i a D 1'- > I Z •Li---- . -".-1 -_--/ - Av-,,v,e,.,-.-.,.7- - ' ;.•.`;',..:---:..2. '.5'.':-•X-4:41-2-,'' 0 T _ 5'1 I i .'-'-i . • A, -. i -, ':•-". - ' -"' ',"!-,;%-/;,, • • It , ' -. • SPECIAL CONDITIONS CASE # BLD05-00128 1.) The application was reviewed by the Jefferson County Department of Community Development staff on April 5, 2005 for the potential presence of Environmentally Sensitive Areas (ESAs) under the provisions of the Unified Development Code (UDC). After an initial Geographic Information Systems mapping review, the following ESAs were confirmed to be present on the subject property: Type 5 Stream, Eagle, Slight Landslide Hazard. 2.) Geologically Hazardous Areas in Jefferson County are characterized by slope, soil type, geologic material, and groundwater that may combine to create problems with slope stability, erosion, and water quality during and after construction or during natural events such as earthquakes or severe rainstorms. 3.) A Type 5 Stream (Fish and Wildlife Habitat Area) has been identified on the subject property. The stream will require a setback of 50-feet. The setback shall be measured horizontally from the Ordinary High Water Mark (OHWM). Fish and Wildlife Habitat Areas shall also have Buffers and Building Setbacks established. 4.) Buffers are areas that shall be maintained in their natural condition, however, minor pruning or alteration of vegetation may be permitted as long as the function and character of the buffer are not diminished. 5.) Among the native conifer species which may be used in buffers or for re-vegetation include, but are not limited to: Grand Fir(Aibes grandis), Sitka Spruce (Picea Sitchensis), Shore Pine (Pinus Contorta), Douglas Fir(Pseudotsuga Menziesii), Western Red Cedar (Thuja Plicata), and Western Hemlock (Tsuga Heterophylla). Among native tree species which may be used includes: Vine Maple (Acer Circinatum), Big-Leaf Maple (Acer Macrophyllum), Red Alder(Alnus Rubra), Pacific Madrone (Arbutus Menziesii), Quaking Aspen (Populus Tremula), Black Cottonwood (Populus Trichocarpa), Bitter Cherry (Prunus Emarginata), Oregon White Oak (Quercus Garryana), Cascara (Rhamnus Purshiana), Pacific Willow (Saliz Lasiandra), and Scouler's Willow(Saliz Scouleriana). Among the native shrub species which may be used are: Sevice-Berry(Amalanchier Alnifolia), Red Osier Dogwood (Cornus Stolonifera) Salal (Gaultheria Shallon), Ocean Spray(Holodiscus Discolor), Indian Plum (Oemlaria Cerasiformis), Pacific Ninebark (Physocarpus Capitus), Red Flowering Currant(Ribes Sanguineum), Wild Rose (Rosa Nutkana), Swamp Rose (Rosa Pisocarpa), Willows (Salix ssp.), Red Elderberry (Sambucus Racemosa), Snowberry (Symphoricarpos Albus), Evergreen Huckleberry (Vaccinium Ovatum), Red Huckleberry(Vaccinium Parvifolium). 6.) A vegetative buffer of 30-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. 7.) 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. 8.) 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." 9.) All construction activities shall not encroach upon the buffer. This includes the storage or preparation of materials. 10.) 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. 11.) The identified Fish and Wildlife Habitat Area (Type 5 Stream), shall maintain a vegetative buffer setback of 50 feet. The setback shall be measured horizontally from the Ordinary High Water Mark (OHWM) to the manufactured home. 12.) An additional setback of five (5) feet is required from the edge of the buffer area to the proposed manufactured home. 13.) A permanent physical separa ion along the boundary of the buffer area shall be installed and permanently maintained. Such separation can include installing logs, trees, a hedgerow, or any other prominent physical marking approved by the UDC Administrator. 14.) Buffer perimeters shall be marked with temporary signs at an interval of one per parcel or every one hundred (100) feet, whichever is less. Signs shall be in place prior to and during construction activities. The signs shall contain the following statement: "Buffer- Do Not Remove or Alter Existing Vegetation." 15.) The applicant is proposing to create or add 980 square feet of impervious surface and 980 square feet of land disturbing activities. Sections 6.6 and 6.7 of the Jefferson County Unified Development Code requires that your proposal comply with Minimum Requirement #2 (Construction Stormwater Pollution Prevention) of the Department of Ecology Stormwater Management Manual for Western Washington 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. 16.) 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. 17.) The project shall comply with Construction Stormwater Pollution Prevention (SWPP) Elements#1 through #12 of the Department of Ecology's Stormwater Management Manual for Western Washington 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. 18.) 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). 19.) The revised site plan as submitted on September 21, 2005 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 September 27, 2005 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 20.) This approval is for a manufactured home 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. 21.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 22.) 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). 23.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 24.) The building height is not to exceed 35 feet. 25.) Exterior lighting for residential uses shall not exceed twenty feet(20') in height from the I finished grade, excepting when such lighting is an integral part of a building or structure. Ground level lighting is encouraged. 26.) Lighting fixtures shall be designed and hooded to prevent the light source from being directly visible from outside the boundaries of the property. The intensity or brightness of all lighting, during construction and after project completion shall not adversely affect the use of surrounding properties or adjoining rights-of-way. 27.) Setback from Sentinel Firs Rd. right-of-way is no less than 20 ft., side and rear setbacks are no less than 5 ft. If an environmentally sensitive area (ESA) is present, then the more restrictive setback shall apply. 28.) This is a legal non-conforming parcel designated as Rural Residential 1:5 under the Jefferson County Comprehensive Plan Land Use Map effective August 28, 1998. 29.) This parcel is served by an individual well. 30.) A septic permit (SEP82-007was approved May 10, 1982 for a capacityo240 gallons per day. This permit was finalled September 9, 2005. 31.) Sentinel Firs Rd. (C567009) is a county local access road. A road approach is existing and an address of 261 Sentinel Firs Rd. has been assigned to the parcel. 32.) A minimum of two (2) on-site parking spaces is required for the single-family residence. 33.) Stormwater shall be retained and infiltrated on site. The owner shall control all sedimentation and erosion on the property. 34.) An eagle habitat area is mapped on the southeast corner of the parcel. The proposed manufactured home will be place on the western portion of the parcel. Since the distance from the mapped eagle habitat area and the proposed manufactured home is over 400 ft. staff concluded this proposal does not conflict with the eagle habitat. This proposal was not sent to the Dept. of Fish and Wildlife for comment. *144-5°19. ' JEFFERSONlikUNTY 110 ,.a DEPARTMENT OF COMMUNITY DEVELOPMENT '41 621 Sheridan Street• Port Towns d •rW hi gton'9$36 360/379-4450 • 360/379-4451 Fa r Lu ! h': Ica .`11 `tp$ www.co.jefferson.waus/commdev lop nt R I`�FIING r MAR - 4 2005 I L. Master Permit Application M r)5 • Project Description(include separate sheets as necessary): ' V 5 I ✓�- 1-1- /7 e'/3 / i s e ., , y Tax Parcel Property Number: % Z i - l f'30 3 3 Size: Z g-C 4 0 (acres/square feet) Site Address and/or Directions to Property: 2- 4 ( 5 z 'Ti`V, L �/4 S A4 /,,4 r )i,f/i40•eft' Property Owner(s)of Record: L- : 40 y X- -'t 4-R Si L . l tt 4`.LiL Telephone: -5 4, 0 - ti 3 7- 7 7 Fax: email: Mailing Address: Z 4-/ 5 "4v'17-,/rt I- j'i/i f /I 0, /74v4 i 1-1-4-i Lp c K % g-F 3 f Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) jik Building ❑ 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)** IA Manufactured Home ❑ Boundary Line Adjustment ❑ Modular ❑ Short Plat** ❑Commercial* ❑ Binding Site Plan** ❑ Change of Use ❑ Long Plat** ❑Address ❑ Road Approach 0 Planned Rural Residential Development(PRRD)/Amendments** ❑ 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 ❑ 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 arrpcs 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: ' � / // — el Date: / `"O 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 adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: jZ, 17. ,-f �07.?„..1, Date: /l_/I! — U aJ G:\PennitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc el 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: /---- L c?/ / �, 1/ Date: l7, �✓ "l GENERAL CONTRACTOR OR 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: Pf New ❑ Wood Existing: L 0 Sewer ❑ Addition ❑ Steel Proposed: Bank ❑ Community System ❑ Alteration/Remodel 0 Concrete Total: '7-- Height: Individual System ❑ Repair ❑ Masonry SEP Permit#YCj.i. ` 1 J ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: 2' Setback: $ Private well ❑ Two Party Type of Heat: Proposed: --i— ❑ 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: ril Underground Tank ❑ Above ground Tank Size of Propane Tank: ❑ Heat Stove ❑ Cook Stove ❑ Woodstove 0 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 ForOfflce-Usii`Only 1. �, s4H it.';,,, y '�: w. F, Current Proposed at1 ._ Main Floor Consistency Review: 2Nu Floor Base fee: - ,- -1, 3`"Floor Additional Section: , ,u. y,. ;t ; �` ; � r . Mezzanine: ,!I t f. ' ' ;Plan Check fee: .. , "• -' rr� s'�`' Heated Basement nil I! '; State Surcharge fee: °.*,:'Z qt;� NSar ' MAR — 4 2005 Unheated Basement , Pot Water Review.fee p,,-4�" t4v 4. z6 , Other Unheated n 1911/Rd Approach fee: ` u ,, s/„--r am , Garage/Carport _._._ -_. _ s TOTAL: $ • l 3 }N k Decks Receipt Number. '1 k . V ; K Other Cash/Check Number: } a:; ESTIMATED COST(REQUIRED) Date: J. ) .Fair market value of all labor and materials foundation to finish s:.` . [ U 7 Initials: 100 G:\PemutCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc ' , ,.• ,,, ....:,.... — ..,.,.:-':•:::••• ' • • . . ' ' ,.. ,..... .71!!• Vic) 4.k,I / t 4, .:'''! • ..' '•-•,..P. .4.!:.P. • - • ' • ' ,.. , 1 .... 1..... ..., ........ . .. . .. . . . .... .4......,.....,.:2:-........., :........ _.. _.......—._ •.:1. u ,.;, i . r, _._,..................... •. , It, V' 1:Lv• \ \c, ,,i. ''• ‘1/4' t..,..." \ ' , \4::., - , •,,,„.4 ,4`4,, P,4.4 03 I4111Nitil66 1., Z L r.h, z ,.;. ........._. 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