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HomeMy WebLinkAboutBLD2006-00207 • BUILDING PERMIT • Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD06-00207 Received Date 04/26/2006 SITE ADDRESS: 292 SEAMOUNT DR Issue Date 05/22/2006 BRINNON, 98320 APPLICANT: DAVID F BARROWS PHONE: 253-858-8826 CAROL S BARROWS 292 SEAMOUNT DRIVE BRINNON WA 98320-9672 SUBDIVISION: SEAMOUNT ESTATES DIV 1 Block: Lot: 21+ PARCEL NUMBER: 993000021 Section: 32 Township: 25 N Range: 02 W CONTRACTOR: OWNER/BUILDER PHONE: PROJECT DESCRIPTION: ROCKERY/RETAINING WALL BUILT WITHOUT A PERMIT CALL IN FOR THE REQUIRED INSP CTIONS HAT APPLY TO YOUR PROJECT. SETBACKS: (9k 7// s UFFER: Footing: Foundation: Stormwater FINAL Approval: Underground Plumbing: Underground Insulation: Shear Wall : Sheathing: Framing: Plumbing: Propane Tank/ Lines: Insulation: Sheetrock: Septic Sytem Final Approval MUST be obtained before final of structure can be attempted. Road Approach Final Approval: Zoning Final Approval: Final/Occupancy Approval: n`_I 7/4(h(� HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED RIOR TO FI NAL 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 # BLD06-00207 • 1.) 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. 2.) A Geotechnical Report dated November 28, 2005 prepared by Stratum Group was submitted in conjunction with this application. The report addressed the stability of the geologic hazard area and stated that the"subject property is not in a geologic hazardous area." The report did not identify any setbacks. 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.) 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 FOR 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. 12.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 13.) 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. 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.) Minimum setback from Seamount Drive right-of-way shall be 20 feet. Minimum side and rear yard setbacks shall be 5 feet. If an ESA is pesent, then the more stricter setback(s) shall apply. 18.) 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.) STORMWATER SHOULD BE ROUTED TO DISPERSION AREAS ON THE SOUTHEAST AND NORTHWEST SIDES OF THE RIDGE. NO STORMWATER SHOULD BE SENT DOWN THE SOUTH SIDE OF THE RIDGE DUE TO THE STEEP SLOPE AND THIN SOILS OVER BEDROCK ON THE SLOPE. 21.) THE SLOPES TO THE EAST OF THE BUILDING SITES SHOULD BE MAINTAINED IN NATURAL VEGETATION. 22.) IN REGARDS TO THE OMISSION OF THE TYPICAL DRAINAGE COURSE AND DRAIN PIPE LOCATED IMMEDIATELY BEIND THE WALL, THIS APPEARS TO BE ACCEPTABLE DUE TO TH RELATIVELY FREE DRAINING MATERIAL USED FOR THE WALL BACKFILL AND CONCRETE SLAB-ON-GRADE STRUCTUREAL FILL. 23.) SURFACE WATER RUNOFF SHOULD BE DIRECTED AWAY FROM THE ROCKERY BACKFILL AND NOT BE ALLOWED TO FLOW OVER THE FACE OF SITE SLOPES. DRAIN WATER COLLECTED FROM IMPERVIOUS SURFACES SHOULD BE TIGHTLINED TO A SUITABLE DISCHARGE POINT LOCATED AWAY FROM THE ROCKERY TOWARDS THE BASE OF THE SITE SLOPES. I:\F_BLD_Permit_Buildng.rpt 10/29/1999 !UILDING PERMIT APPLICA•N ML Ty 196 Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00207 Received Date: 4/26/2006 SITE ADDRESS: 292 SEAMOUNT DR BRINNON, 98320 OWNER: DAVID F BARROWS PHONE: 253-858-8826 CAROL S BARROWS 292 SEAMOUNT DRIVE BRINNON WA 98320-9672 SEAMOUNT ESTATES DIV 1 SUBDIVISION: Block: Lot: 21+ PARCEL NUMBER: 993000021 Section: 32 Township: 25 N Range: 02 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOI' ROCKERY/RETAINING WALL. BUILT WITHOUT A PERMIT TYPE OF WORK NON SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 6,450.00 gDD'L: HEAT TYPE: CODE EDITION: 2003 OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: A \ Type Amount Paid Bv: Date: Receipt: /� ED Permit $139.25 KAS 04/25/06 8'1090 `�� � �// Plan Check $90.52 KAS 04/25/06 8'1090 MAYU 2006 State Building Code $4.50 KAS 04/25/06 8'1090 Total: $234.27 Jefferson County Planning &Building Department .. . • • 0 ../N _-> s (47:- • . ,i- ,_ \ m 0 \ 9 ,-, c, •...,‘Kt_ c. • \ -) —c.,.. ---, •-..e• VN \ `,. 4...._ e- ...N...._ \ ;" • \ \ •,,. r) i1.1!II!111I.I 1II.!I..!1 1i•,'_(n_----%,-..4:0)(0--,----_—.\r 4-(--_I-,i--.,1hP.4t"W61li4N ili:0laiflMiiNRi1iigiliii+%i -------7// 1---,/ // - // - - _.....__ 's 7 , N / . / / ; / 6 .-- .-.._..,i-, "— ."i • i I! :WIN r • .• - - ...xii -. (e• — ,,:g:Ig!,!:!,: 1 , -,,....s ,' - - / I N . , / / N 1 ; ,I.-- -,„ 1 ) ,,/ .. _ / . I \ / .,._,. \ ....k •r :p // --,. .,, N / i N Irs l'.. ‘ r.„ i • \ ••`, ‘..; , „ 0 0 , ,,,, „-1, _ I._.,f j Al )TZF I C F TT 7 r 14:.;1-- . --ri I ......--1.,-- .. rb , ' I 1! 73 ,eTh•-•• )9 ja \ ,, — Q.--I CI cs<ii -•,,,,,,,...th., \ / Z ViD la, a 5 f_rev",k 0, Ni ..04.' ye JEFFHISn r,,nillip-v nr, 0 . 4 u, i i Li IA y , t•,. ,f;, -:- - ..... 1 r-i- 4 .\ 0\,:t: 3 %,•9'1',-- t0'.4. D-- 0 k<s:i."- 64 i SOILS OBSERVATION GEOTEST SERVICES, INC. REPORT 741 Marine Drive, Bellingham,WA 98225 Phone: 360.733.7318 Fax: 360.733.7418 PROJECT: Barrows Residence JOB#: 06-0246 ADDRESS: 292 Seamount Drive, Brinnon, WA C, j.L. REPORT#: S3 CLIENT: David Barrows DATE: 04-24-05 CONTRACTOR:Silsbee Excavating iw A - PAGE #: 1 of 3 WEATHER: Sunny, Mid 60's PERMIT#: INSPECTOR:DS JEff[119 ' Y OCR: Observation of: Existing Landscape Rockery, Located East of Proposed Residence GeoTest was on site, as requested, to observe the constructed rockery located immediately east of the proposed mobile home pad location. The rockery construction was previously completed prior to our arrival on site. We understand that the rockery was completed without a permit and our evaluation of the existing construction is one of the steps needed in obtaining a permit. We understand that the rockery was not designed by a specific engineer. Therefore, our evaluation referenced Standard Rock Wall Construction Giidelines presented by Associated Rockery Contractors (ARC). The rockery begins off the northeast corner of the proposed mobile home pad location, continues down the east side of the pad location making a jog towards the pad and wraps around the southeast corner of the pad location and terminates approximately 10 feet west of the southeast corner of the proposed concrete slab-on-grade location. The proposed and currently formed concrete slab-on-grade will contain the residence with an approximately 3.5 foot wide sidewalk along the east side and a ten foot wide patio along the south portion of the slab-on-grade. The rockery is intended to create an increased landscaped terraced area and was not intended to provide structural support for the mobile home concrete slab-on-grade. Measured setbacks of the structural support areas of the concrete slab-on-grade were approximately 10 feet from the southeast and northeast corners of the proposed home location to the back of the closest point of the rockery. The rockery heights were measured to be approximately 9 feet at the closest point to the southeast corner and approximately 4 feet at the northeast corner of the proposed home location. Typically the rockery would need to be within a 1 H:1 V (Horizontal:Vertical) ratio from the point of structural support to be considered supporting structural loads. The measured setbacks fall outside of the typical zone providing structural support. The maximum wall height was measured to be approximately 10 feet at the eastern most point located in the approximate middle of the rockery. The average height was approximately 8 to 9 feet over the length of the rockery and tapered into the existing site grades at the north and south ends. The rocks comprising the rockery appeared to be basalt obtained from a local quarry and of suitable hardness. The average rock size appeared to range between 2 and 4 man rocks, with larger rocks near the base and smaller ones near the top in accordance with typical rockery construction. The toe of the rockery appeared to be placed on suitable native soils or near surface bedrock located beneath the site. The current key trench was observed to be less than the typically recommended 12 inches in most areas. However, we understand that approximately 10 more dump x\aa,o a.G,an.„e -06-0210-202 Seemoult Ddvs,B6nnon.wnso3.oa.,o,wThis report shall not be reproduced except in full.without the written approval of GeoTest Services,Inc. The above test results relate only to the sample(or location)tested.Copyright©1993 GTS • • SOILS OBSERVATION REPORT • CONTINUATION PROJECT:Barrows Residence G b 7 JOB#: 06-0246 CLIENT: David Barrows -,� C �% REPORT#:S3 15 1' DATE: 4-24-06 PAGE#: 2 of 3 truck loads of import gravel are planned to be brought in and placed along the toe of the rockery per the owners request. With the placement of the additional gravel, the toe of the rockery should be adequately keyed. The rocks were generally placed in a running bond, with the upper rocks supported by two underlying rocks in accordance with typical rockery construction techniques. The rockery batter was measured to be approximately 2 feet horizontal in the maximum wall height of 10 feet and is slightly flatter than the typically recommended batter of 1H6V. The wall backfill was composed of relatively free draining pit run, (3.0 percent passing the #200 sieve, based on the proctor sample obtained from the site), and a separate drainage course with drain pipe, located immediately behind the wall, was not used. The wall backfill appeared to be adequately compacted based on two dynamic cone penetrometer (DCP) tests conducted between the wall and propsed concrete pad locations. A geotextile grid was not used in the wall construction. Based on the additional fill material to be added to the toe of the wall and that the majority of the resulting wall height will be approximately 8 feet or less a geotextile grid used in the compacted backfill is not always necessary. The landscape area located above and behind the wall is proposed to be flat and will not be adding any surcharge loading. In regards to the omission of the typical drainage course and drain pipe located immediately behind the wall, this appears to be acceptable due to the relatively free draining material used for the wall backfill and concrete slab-on-grade structural fill. We recommend that surface water runoff be directed away from the rockery backfill and not be allowed to flow over the face of site slopes. To reduce the chances of initiating instability, drain water collected from impervious surfaces should be tightlined to a suitable discharge point located away from the rockery towards the base of the site slopes. Based on the observed existing site conditions, at the time of our visit, and that no additional drainage water, such as roof downspout runoff will be added to the backfill behind the wall, it appears the previously installed landscape rockery was constructed in general accordance with typical rockery construction techniques and should be suitably stable for its intended use. JEEEEP►sII.A PIMP( IJCri x\o-Pmj.�c.,kn..,ae.ow,.mox.e.2 2 ()me Bn, ,,WAsou.oe w,This report shall not be reproduced except in full,without the written approval of GeoTest Services,Inc. The above test results relate only to the sample(or location)tested Copyright 0 1993 GTS • SOILS OBSERVATION REPORT • CONTINUATION PROJECT:Barrows Residence 7 JOB#: 06-0246 CLIENT: David Barrows c,O --d / REPORT#:S3 i DATE: 4-24-06 PAGE#: 3 of 3 Our conclusions are based on visual observations of existing conditions and limited subsurface analysis made during a site visit on April 17, 2006, review of referenced rockery construction guidelines and our experience. Our evaluation included the subject rockery only, as referenced in this report. Our services have been performed in a manner consistent with that level of professional care and skill exercised by other members of the professional community practicing under similar conditions in the area. No warranty, expressed or implied, is made. Within the limitations of scope, schedule and budget, our services have been executed in accordance with generally accepted site evaluation practices in this area at the time this report was prepared. We appreciate the opportunity to be of service to you on this project. If any questions should arise regarding this report, please contact the undersigned. Respectfully submitted, GeoTest Services, Inc. otWas N, • , i <0. Engineering Geolog". �. , ca 594 p� \ ,S\atlGeo\o ,i Daniel J. Sorenson Dan Sorenson, LEG Engineering Geologist Tr--) -r _, Tq 7 �z • J I b JEFFERSON Coll\ x WProjectsc..dD.vM Barrows-0EO246-202sr.routlDew.amnm,wAso3anA,.y.rtThis report shall not be reproduced except in full,without the written approval of GeoTest Services,Inc. The above test results relate only to the sample(or location)tested.Copyright 0 1993 GTS f54� oN cow 4,ewJEFFERS COUNTY 0 A DEPARTMENT OF COMMUNITY DEVELOPMENT rf 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax it, NGa.O. www.co.jefferson.wa.us/commdevelopment 99 61 (0 Master Permit Application MLA: 1::)L, C i ? Project Description (include separate sheets as necessary): -J I Cci�N�,,, >< hr-1c: N lti�(� vu.;Gf� �o;_i ; {1 i,L:� �0,, 1 Thr , 1 . Property -t Tax Parcel Number: Cr? ..3 Ci(. 00 , ( Size: g iQC'YPS (acres/square feet) Site Address and/or Directions to Property: ,,2 qT,1 3fq ui 00,171 1'1')Yl 3.r i vt K+?,t , - et �S'' 3,�2 0 Property Owner(s)of Record: be .: d ct- GI Y 0 / [3q r 1,-0+.4_,S -1 Telephone:?Si � - �' 43' (, Fax: email: C _�=bn lc-A-Gw� S n' co t (, Ar Mailing Address: I y©O: ci'S V e4vrtr o.p, Ai .,L)/ 6-I5 f/c t 4O`) 1-it q e. 3;Z ? Applicant/Agent(if different from owner): 9 a t,,r r Telephone: Sc w r' Fax: N E,i1 r email: S a c v, -9 Mailing Address: Sa rM 4, What kind of Permit?(Check each box that applies) Li Building ❑Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit h Sr.i (N !1 gyp'j p Conditional Use[C(a),C(d),or Cj ❑ Single Family •```�' 1l ** ti Discretionary"D"or Unnamed Use Classification ❑ Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** Inufactured Home ❑ Boundary Line Adjustment 0 Modular ❑ Short Plat** ❑ Commercial* ❑ Binding Site Plan** ❑ Change of Use l Long Plat** ❑Address ❑ Road Approach f RJJIV COUN V l planned Rural Residential Development(PRRD)/Amendments** CI Propane CI 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 krtq 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 attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application re • r it d late in ctions.Access and right of entry to this property shall be requested and shall occur only during regular business hours. f /Signature: �/Yd{ e,i.�rf'Q,p .I-- _7 Date: (7 " // o o C./ ..0 T ' 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 cal file a lawsuit on behalf of an endangered species regarding your action(s) even if ou are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non- nsferable o sibili • to and complying with the ESA. The Applicant has read this disclaimer and sign and dates it below. Signatur . /�,/��j V PAL Date: y//0 062 G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc 411) 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 a ing t re risibility of the General Contractor for the proposed project.�/ Signature: rxrlir d•.�k,'. GL Date: / `// /0 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: ❑ New ❑ Wood Existing: ❑ Sewer 0 Addition ❑ Steel Proposed: Bank Height: 0 Community System ❑ Alteration/Remodel ❑ Concrete Total: ❑ Individual System ❑ Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: LI Private well [I Two Party Type of Heat: Proposed: [Public Total: Name of System: 0'7 If this is a Commercial Project you must answer the following: 7 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 w/A If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: Li Underground Tank II Above ground Tank Size of Propane Tank: ❑ Heat Stove I 1 Cook Stove I-1 Woodstove 11 Fireplace Insert 0 Hot Water Tank ❑ 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 Current Proposed For Office Use Only Amount Revision Main Floor Heated EH Bid App Review: G, 2nd Floor Heated Consistency Review: G_ 1 DJcO Other Heated Base fee: 1' `ai.5 Mezzanine Additional Section: _ Heated Basement Plan Check fee: c- Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: __________ Garage/Carport SUBTOTAL, ':, , „ ,• 4,cpa a! Decks '11 '' 911/Rd Approach fee: e`j-1,5i 1 rt rrh t OtherPA TOTAL: $ f,��J a.'a Y 1 Receipt Number: 1 b 0 Cash/Check Number: aL\ 1 LA-- ESTIMATED COST(REQUIRED) Date: �Fair market value of all labor and terials foundation to finish Ol U(2 _'"�•, '� Initials: 6;"-Z' - C.r s0eC' C7 n ermitCenterWORMSL \DRD FORDQS4M eas�i�ermit Application 12-30-05.doc , , , ,f7.1. ra, .I p v N o f;vl co tz• 0 (.1) ,, 1.1 r- — 0 C> ^t t t t-1 ' t g ' , ,.., . 01 ,,,pen ,,,....1, !,I /v.'s --7 E7 ' ' OP:. r. _. ., ,, ..4 v. .- ci z CI .1", __ , t44:. RittPeetg t.i t ' f \.>ctgl g; \ Ni.• tzf ' ;1 -i- ‘1 .3;-i .111 T t. 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