HomeMy WebLinkAboutBLD2006-00092 ILDING PERMIT APPLICATION ML ReviewTy 093
Type: I
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD06-00092 Received Date: 3/3/2006
SITE ADDRESS: 140 JUPITER LOOP
BRINNON, 98320
OWNER: JAMES R BOND PHONE: 360-796-0066
SUSAN K BOND JTWROS
PO BOX 221
SNOHOMISH WA 982910221
SUBDIVISION: Block: Lot: T 35+
PARCEL NUMBER: 502152003 Section: 15 Township: 25 N Range: 02 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOr NSFR W/ATT GARAGE & UNHTD SHOP - U/G 250 GAL PROP TANK
TYPE OF WORK RES SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 1,009
VALUATION 75,000.00 ADD'L: HEAT TYPE: PRO
CODE EDITION: 2003 HEAT BASE: HEAT TYPE: RAD
OCCUPANCY: R-3 UNHEATED: # OF STORIES:
OCCUPANCY:
CONST TYPE: 5N OTHER: 104 SHORELINE:
CONST TYPE: GARAGE: 240 SETBACK:
DECK: BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 2 Prop: 2
Total: 2 Total: 2
Routing Date:
L-5/4°/° C
�+ r s .,
Type Amount Paid By: Date: Receipt: Approved/Da# ' '
Permit $818.75 LYK 03/03/06 79133
Plan Check $532.19 LYK 03/03/06 79133 APR '7 2016
State Building Code $4.50 LYK 03/03/06 79133 Jefferson County Plannint;
Potable Water Application $55.00 LYK 03/03/06 7C133 & Building Department
Total: $1,410.44 ColitQDQ0A-\
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4
0 •
BUILDING PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD06-00092
SITE ADDRESS: 140 JUPITER LOOP Received Date 03/3/2006
BRINNON, 98320 Issue Date 04/7/2006
APPLICANT: JAMES R BOND
SUSAN K BOND JTWROS PHONE: 360-796-0066
PO BOX 614
BRINNON WA 98320
SUBDIVISION:
Block: Lot: T 35+
PARCEL NUMBER: 502152003
Section: 15 Township: 25 N Range: 02 W
CONTRACTOR: OWNER/BUILDER
PHONE:
PROJECT DESCRIPTION: NSFR W/ATT GARAGE & UNHTD SHOP - U/G 250 GAL PROP
N
CALL IN FOR THE REQUIR N PECTIONS THAT APPLY TO YOUR PROJECT.
SETBACKS: _
UFFER: 41418FAYI
Footing: ,AME 0
Foundation:
S
Stormwater FINAL Approval:
Underground Plumbing: N
Underground Insulation: N/A
Shear Wall : ` 6
Sheathing:
Framing: p
Plumbing: -«1 / OG
Propane Tank/ Lines: _
Insulation: •
d 7a #F�rr�>�+ES APPD 4FB 31 4
8
�I1
•
Sheetrock: APpb c r 7 c UL
Septic Sytem Final Approval MUST be obtained before final of structure can be attempted.
Road Approach Final Approval:
Zoning Final Approval:
Final/Occupancy Approval: /� 6/.��e8 1
HEALTH DEPARTMENT AND PUBLIC WOF(KS APPROVAL - QUIRED 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 FOR CASE A BLD06-00092 •
1.) A vegetative buffer of 15-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 prepared by Stratum Group dated March 13, 2006 was submitted
in conjunction with this application. The report stated that the parcel was not a landlide
hazard area but required a minimum 10 foot setback from the down slope side of the level
building area. Per UDC Section 3.6.7.b(7) only allows a buffer reduction of 15 feet from
the top or toe of a bank. Therefore, a setback of 15-feet shall be measured
perpendicularly from the top or toe of the geologic hazard to the proposed single family
residence with an attached garage.
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 landslide hazard area 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.) 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.
8.) 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.
9.) 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.
•
10.) MANDATORY MEASURESFR COASTAL 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.
11.) The property owner shall comply with Water Conservation Measures (per list maintained
by the UDC Administrator).
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.) A Stormwater Site Plan 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.) Exterior lighting for commercial and industrial uses shall not exceed thirty feet(30') in
height from the finished grade. 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.
19.) 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.
20.) Minimum setback from Jupiter Loop right-of-way shall be 20 feet. Minimum side and rear
yard setbacks shall be 5 feet. Minimum setback from top or toe of a bank shall be a
minimum of 15 feet.
21.) A minimum of two (2) on-site parking spaces shall be provided for the single family
residence.
22.) An administrative approval was granted by the UDC Administrator, Stacie Hoskins on April
5, 2006 to allow a minimum 15-foot landslide hazard area buffer from the top or toe of a
bank.
I:\F_BLD_Permit_Buildng.rpt 10/29/1999
tD
c° , JEFFERSON COUNTY _ ` ` 1
14hr .04 DEPARTMENT OF COMMUNITY DEVELOPMENT
621 Sheridan Street• Port Townsend • Washington 98368
360/379-4450.360/379-4451 Fax [i
httpr/www.coJefferson.wa.us/commdevelopment/ J E FFE II S tl N COUNTY U C
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
twu►ff M LAQb- OOO,3 T/AppucANT tom: James Bond/Sue Bond
Please answer all of the following questions to the best of your ability. Where the question calls for depiction on a site map, the
applicant may choose to either incorporate the elements into the general plot plan for the Master Land Use Application or le submit a
separate stomnwater site plan map.
Project Overview
1. Describe the proposed developed conditions of the site. indicate position and relative size of proposed improvements on the
site map.
ITe site is approx. 2500 sq.ft which comprises 2%of the total acreage of 5.86 acres.The site has been cleared of
noxious weeds and Scotch broom. After construction the area around the site will be replanted with local
native growth.
Existing Conditions Summary
2. Describe the existing topography. Indicate contours on the site map.
The existing topography is a cleared area with a slope and a cleared level building area.The area is glac4I till and
bedrock fragments.
3. Describe the eAstinggovegetation. indicate nativevegetati areasthe site
Of the total area,2%of the building site has been clearedof on weeds.. The remaining 5-plus acres are
trees and native vegetation which will be maintained as such.
4. Describe the existing soils. Indicate soil type on the site map.
The existing soil is glacial till and bedrockfragnients. The remaining 5-plus acres are topsoil which will be
maintained.
5. Describe the existing site hydrology(i.e.,drainage;behavior of water on the site—above,below,and on the ground). Indicate
existing stormwater drainage to and from the site on the site map. Depict separate drainage basins on the site map, if
applicable,and indicate acreage of each.
The drainage of storm water runs along the north side of the property in a small natural ravine. See plot plan
addendum for flow and location.
6. Describe any excess levels of noise generated by the proposed use or activity: APPROVED
P
Construction machines and carpentry activity. PRQVE�
STORMWATER PLAN
APR - 5 2006
Stormwat
etonnwater site "template—rev.10/t24ai Required JEFFERSON UN 5
DEPT.OF Crryt DEVF. PMFNT
SIGNATURE:
7. Describe significant geographic lea sand critical areas Q.e., environmentally sensitive areas such as wetlands, streams,
steep slopes,etc.)on the site. Indicate location on the site map.
See addendum to site plan for the landslide area and location.
8. Describe the general vicinity of the site,including adjacent land uses and structures.utilities,roads,and sensitive/critical areas
(streams,wetlands,lakes,steep slopes.etc.).
All native vegetation in area are on "--plus acre tracts.
Permanent Stormwater Control Plan
This portion of the Stonnwater Site Plan consists of the selection and installation.of the appropriate stormwater control BMPs
and facilities to remain In place after construction of the project Is completed.
"Medium" size projects are required to have the totals calculated of all Impervious surfaces, pollution-generating impervious
surfaces, and pollution-generating pervious surfaces to verify that the thresholds for treatment facilities and flow control
facilities are not exceeded.
g, Describe the developed site hydrology,as proposed. Indicate whether stormwater will be fully dispersed(i.e.,per BMP T5.30
In the Manual)or,if not,what types of stormwater flow control wilt be utilized for the site or specific threshold discharge areas
within the site. Locate these facilities on the site plan and differentiate proposed facitiee from existing facilities.
There will be downspouts going into two 300 gallon cisterns.The remaining run-off will be directed to the
natural storm water run-off area.
10. If the project requires the use of stormwater treatment facilities,describe the types of stonnwater treatment facilities proposed
for use on the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. [This is
normally for large'projects or projects that involve the potential for dispersion of contaminants.)
N/A
11. 1 esscAribe the performance goals and standards applicable to the project.
12. Describe the flow control system.
N/A
r
stomweater she pan template—rev.1&1P2003 6
• CONSTRUCT STORMWATER POLLUTION PREY (SWPPP)
The Construction SWPPP addresses sediment and erosion control during construction. The BMPs indicated by the applicant in the
template that follows must be installed on the ground during all construction phases of the project. The proponent is responsible for
preventing sediment and erosion impacts to environmentally sensitive areas and off-site areas. Consult the Construction Stormwater
Pollution Prevention (SWPP) Best Management Practices (BM.Ps) Packet for guidance, particularly with rural residential
development.
SECTION I—CONSTRUCTION SWPPP NARRATIVE
1. Construction Stormwater Pollution Plan Elements. Describe how each of the Construction SWPPP elements has been or
will be addressed. Identify the type and location of BMPa used to satisfy the required element if an element Is not applicable
to the proposal.justify in writing. Descriptions of the 12 Elements are found at section 2.52 of the Manual
2-15). (beginning on page
12 Required Elements—Construction SWPPP
Site ribbon t Mark wo mark clearing only feature piece to be cleared. Site has been clearded of ail noxious weeds.
2. Establish Construction Access.
Logging road to Jupiter Loop Road to existin&private road established.
3. Control Flow Rates.
N/A
4. Install Sediment Controls.
Filter fence will be used if needed.
5. Stabilize Soils.
Dirt mounds to be covered with straw or plastic tarp.
6. Protect Slopes.
Native grass and vegetation on slope. from top to bottom of slope.
7. Protect Drain Inlets.
N/A
etorrnwater the plan template—rev.181/2003
8
•13. Describe the water quality system. •
14. Describe the conveyance system analysis and design.
Cistern to catch water rim-off. See also#9
15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material.
No fill material utilized
16. Proposed methods of placement and compaction consistent with the applicable standards on
Uniform Building Code. Appendix Chapter 33 of the
Contractors will assume applicable standards during construction.
17. Describe the proposed surfacing material.
Crushed gravel or natural driveway.
18. Describe methods for restoration of the site.
Remainder of parcel to be natural growth. Will transplant native trees and vegetation.
•
19. An Operation and Maintenance Manual Is required for each flow control and treatment facility. [This is normally required for
large'projects only and only those for which facilities are required to control flow or treat runoff.] If included,list the Manuals
here.
N/A
20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
Refer to Stratum letter dated March 13, 2006
21. List other necessary permits and approvals as required by other regulatory agencies. If those permits or approvals include
conditions that affect the drainage plan or contain more restrictive drainage-related requirements,describe those conditions or
restrictions here.
N/A
storrrwtater site plan torrpla1e—rev.1011/2003
7
••
12 Required Elementsts-Construction SWPPP(continued)Exist g drainag to be mainfairied into natural vegetation. See site map and dispursal area.
9. Control Pollutants.
N/A
10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
N/A
11. Maintain Best Management Practices(BMPs).
Will maintain BMP
12. Manage the Project
Owner will live at site during contruction.
2. Adjacent Areas.
a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential
areas,roads).
None will he affected-natural distribution into vegetation.
b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400
yards.
Hood .anal is greater than 1 mile distant-natural dispersion into native vegetation
3. Environmentally Sensitive Areas.
Slo a. Description
of environmentaity sensitive areas that are on or adjacent to the site.
s
stormwater site pen tenptate—ror.1 On/2003
9
• • .
Will main�ta np 15-foa se ial requi ements orto ekiang ator ne r environmentally sensitive areas.
4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site
soils(e.g.,erodibility,settteabifiity,permeability,depth,texture,soli structure).
Due to type of soil there are no erosion problems
5. Construction Phasing.
a. Construction sequence
April- foundation excavation and foundation installation.May -house framing,siding and roof.
June/July/August- interior work including insuhating,electrical,plumbing, wallboard. Sept.final finishing
b. Construction phasing(if proposed)
None Construction should be completed by December.
6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual).
{. N/AProvide a proposed construction schedule.
{I. Wet Season Construction Activities.
a. Proposed wet season construction activities.
N/A
N/A b. Proposed wet season construction activities for environmentally sensitive areas.
7. Financial/Ownership Responsibilities.
a. Identify the property owner responsible for the initiation of bonds and/or other financial securities.
James and Sue Bond,owners
b. Describe bonds and/or other evidence of financial responsbiliity for liability associated with erosion and sedimentation
N/A impacts.
8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable.
a. Sediment Ponds/Traps.
N/A b. Diversions.
c. Waterways.
d. Runoff/Stormwater Detention Calculations
stor,water site plan template—rev.10V1r2003
10
SIN C4111
Ae O JEFFERSOh COUNTY
� DEPARTMENT OF COMMUNITY DEVELOPMENT
' `4 621 Sheridan Street• Port Townsend • Washington 98368 MAR - 3 2006
360/379-4450 • 360/379-4451 Fax
O� www.co.jefferson.wa.us/commdevelopment
0'S
Master Permit Application MLA: of '6
Project Description(include separate sheets as necessary):
it) t.u- S i n ,(E Cc2/ a ll.( ci Co/9R/fri c, r a;C� s ,�
Tax Parcel0502.152003 Property
Number: Size:
_ 5•�` tic-t2E5 (acres/square feet)
Site Address and/or Directions to Property: l40 J u P creek. RO, P Rt NtvoN, luA 9 8320
Property Owner(s)of Record: Ja�GS Pf-•p 5 Le 5flNo
Telephone: 3L0 • 1n6. 006C.. Fax: email:�R8dN�2teNETzeco.cof-1
Mailing Address: P. o. 44. 1:5R,ntntoh! w A. 9$320
Applicant/Agent(if different from owner):
Telephone: Fax: email:
Mailing Address:
Whet kind of Permit?(Check each box that applies)
I9Building ❑Variance(Minor, Major or Reasonable Economic Use)
❑ Demolition Permit ❑ Conditional Use[C(a), C(d),or C]**
ringle Famil ❑ Discretionary"D"or Unnamed Use Classification
l-arage ttacfied Detached ❑ Special Use(Essential Public Facilities)**
❑ Manufactured Home ❑ Boundary Line Adjustment
❑ Modular ❑ Short Plat**
❑ Commercial* ❑ Binding Site Plan**
❑ Change of Use ❑ Long Plat**
❑Address L I Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments**
opane ❑ Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions**
*tormwater Management Shoreline Management Substantial Development**
Site II Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance
❑Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment
El 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& r1J .. &c d oesi9 to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE 4£ 4i .11);:e)- Date: 1S7 /°A"
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: v110421 Date: ./5/
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 r�espo ability for adhering to and complying with the ESA. The Applicant has read this disclaimer d skins and dates it below.
Signature;')CL ( Date: 3/3 l)��
V
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc
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410
OWNER BUILDER STATEMENT /he 1-t, i 1' :' 7'r
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 9ssuming the responsibility of the General Contractor for the proposed project.
Signature: �"�(t A 41.) Date: ,3 t/I a HAP' -/ ""r�r�.
et,dr ,
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER
ARCHITECT/ENGINEER: GE-._Nt_ --l4Ol.•lpr , DfAi6w.: L'NL4441 t1HONE (3to ) 16 305-F FAX: ( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
SY'New ®"\/Vood Existing: c4 ❑ Sewer
Addition ❑ Steel Proposed: 'Z- • Bank ❑ Community System
❑ Alteration/Remodel ❑ Concrete Total: 21 Height: 6 Individual System
❑ Repair ❑ Masonry N I SEP Permit# O5^O0l9
[l Demolition ❑ Other: Bedrooms:
pp y:
44 Water Su
Existing: _ Setback: n�Private well i i Two Party
Type of Heat: Proposed: - / [i Public
r„ K,j Total: _ r Name of System:
If this is a Commercial Proiect 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 pis is a Propane Tank and/or Appliance Installation permit,mark all items below that apply:
Underground Tank CI Above ground Tank Size of Propane Tank: SO
NY 1eat Stove [sir"Cook Stove 6/Woodstove ❑ Fireplace Insert [V1lot Water Tank ❑ Pellet Stove Li 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 C,..r 567II1tE7 RRty, ( 5 co
Current Proposed Amount �
Main Floor Consistency Review:
1 009 t 5 iii.)�! ) 55. CC)
2N0 Floor r Base fee:
.4rig ', SC 8,"8
3fd Floor 4// Additional Section: . _
Mezzanine: M Plan Check fee:
Heated Basement State Surcharge fee:
ri/a 4- 5D
Unheated Basement Pot Water Review fee:N Ill I. , "�
Other Unheated /A 911/Rd Approach fee: En
r 1 1
ti
Garage/Carport .Z. TOTAL: $
Decks r�j
(P Receipt Number: 1 Ct ' 5-6
Other i 0 i„r. aLI J I.ACash/Check Number:
t tirirAiirD .5 ___.
ESTIMATED COST(REQUIRED) Date: b
•F,ir market a ue o iatwr and mated founds ' n o ftni ----"sh �-- ne ?)
-..../fY 7 j-G00� D 0
/.1 !ials:
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