Loading...
HomeMy WebLinkAboutBLD2006-00258 • • BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD06-00258 Received Date 05/15/2006 SITE ADDRESS: 70 LAUREL ST Issue Date 08/1/2006 PORT HADLOCK, 98339 APPLICANT: PATRICK D WAIT PHONE: (360) 379-4990 MARY L WAIT 70 LAUREL ST PORT HADLOCK WA 98339 SUBDIVISION: PORTAGE BAY PARK Block: Lot: 25 PARCEL NUMBER: 989100019 Section: 6 Township: 29 N Range: 01 E CONTRACTOR: TOLLEFSON BUILDERS INC PHONE: (360) 732-4080 PO BOX 100 CHIMACUM WA 98325 Contractor's License: TOLLEBI977N9 Expires: 3/15/2007 PROJECT DESCRIPTION: NEW SFR ADDITION ENLARGING KITCHEN/ALSO NEW DECKS CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY 70 YOUR PROJECT. SETBACKS: tit 8-A,VjT4 UFFER: Footing: DQ., 2-1A49 Foundation:Ca yj-V, Stormwater FINAL Approval: Underground Plumbing: Underground Insulation: Shear Wall : E'jer .SN&AR/�AL[_ oe g ? GL*" Sheathing: DIG Framing: O I,J 'had Dm. asriwwP8sowsk Z VFr.ts Il01.63 •LitibJ(Ksi Boor laJbucti►a /D 4/42 Plumbing: /Zj/0z A Propane Tank Lines: . , - ,- A'r.-• • 1. LIAws Insulation: •/- :L • •174 _V — Lt, /2.dd-,SAC Sheetrock: fO/i1/D4, Septic Sytem Final ApprovaI MUST be obtained before final of structure can be attempted. Road Approach Final Approval: Zoning Final Approval: Final/Occupancy Approval: tie -Par- 0 f� QG HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL RE IRED 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 tit ILDING PERMIT APPLICAM IN M ReviewT0244 Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00258 Received Date: 5/15/2006 SITE ADDRESS: 70 LAUREL ST PORT HADLOCK, 98339 OWNER: PATRICK D WAIT PHONE: (360) 379-4990 MARY L WAIT 70 LAUREL ST PORT HADLOCK WA 98339 PORTAGE BAY PARK SUBDIVISION: Block: Lot: 25 PARCEL NUMBER: 989100019 Section: 6 Township: 29 N Range: 01 E CONTRACTOR: PHONE: PHONE: REPRESENTATIVE: TAMARA HALLIGAN PHONE: (360) 385-2628 PO BOX 862 PORT TOWNSEND WA 98368 PROJECT DESCRIPTIOr NEW SFR ADDITION ENLARGING KITCHEN/ALSO NEW DECKS TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP ADD MAIN: 231 VALUATION 150,000.00 ADD'L: HEAT TYPE: PRO CODE EDITION: 2003 HEAT BASE: HEAT TYPE: EEE OCCUPANCY: UNHEATED: # OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: 600 SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: PUD BEDROOMS: BATHROOMS: Exist: 2 Exist: 1 Prop: -1 Prop: 1 Total: 1 Total: 2 Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $1,273.75 KAS 05/15/06 81178 Plan Check $827.94 KAS 05/15/06 81178 State Building Code $4.50 KAS 05/15/06 81178 Jefferson County Planning Total: $2,106.19 & Building Department do CERTIFICATE OF OCCUPANCY Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 (800) 831-2678 PERMIT #: BLD06-00258 SITE ADDRESS: 70 LAUREL ST Issue Date: 08/1/2006 PORT HADLOCK, 98339 Final Date: 12/8/2006 APPLICANT: PATRICK D WAIT PHONE: (360) 379-4990 MARY L WAIT 70 LAUREL ST PORT HADLOCK WA 98339 SUBDIVISION: PORTAGE BAY PARK Block: Lot: 25 PARCEL NUMBER: 989100019 Section: 6 Township: 29 N Range: 01 E PROJECT DESCRIPTION: NEW SFR ADDITION ENLARGING KITCHEN/ALSO NEW DECKS THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2003 EDITION. OCCUPANCY GROUP: TYPE OF CONSTRUCTION: SPRINKLER SYSTEM yes THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 12/8/2006 6 4- « 1g10L Building Official Signature Date 1:1F_B LD_Occupancy.rpt 10/29/19 SPECIAL CONDITIONS FOR CAlt BLD06-00258 • 1.) 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. 2.) 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. 3.) 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. 4.) 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. 5.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 6.) 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. 7.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 8.) 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). 9.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 10.) Minimum setback from Laurel Street right-of-way shall be 20 feet. Minimum side yard setbacks shall be 5 feet. Minimum setback from shoreline top of bank is 40 feet. (Site plan shows a setback of approximately 43 feet from edge of proposed deck to top of bank at its closest point). 11.) 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. 12.) 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. 13.) The building height is not to exceed 35 feet. 14.) Residential developers and individual builders shall be required to preserve shoreline vegetation and reduce the associated risk of erosion during construction and any future activity which may impact the stability of the shoreline. 15.) INSPECTION BY HEALTH DEPARTMENT OF SEPTIC SYSTEM OPERATIONS REQUIRED PRIOR TO FINAL APPROVAL OF BUILDING PERMIT. 16.) There shall be no parking, driving or other land disturbing activities conducted over the drainfield area during the construction process. I:\F_BLD_Perm it_B u i ld ng.rpt 10/29/1999 7 OTAPZ r-seas. :agzi. - 01411-19'0A - _'5W oi a YF't 1..:1'ila;L: 0------------"'''..Vife4. ._01155.FIFfIt . S+:11:5 14771,1,...7J:."..-.0L-C1*. laip oot 1,C31, --Z,ve Roo -0;4: -rtv'Fr.-- 1-r-.A. . ..r :+, -53.21 .L.v.1 -0,ism +_11 RztaJ ei..z _._J-a. 5111--e's Y : "7-iirag- =-- - .-------- -•-fp'.71-1-3.0 + 1-07nd _-/ . PERMIT # R[D 7-t7r-Tv-ii,„/ F - 0 9 6 q ,,, J y.... ,,.., . ...I.-eJ JEFFENgiti COUNTY DCD . . r % / V . • . .... ...,. -•z.4. 4,---_zi.2 I- 1-. 12,1M .4L1 -1-11 1 n -.1m K ,eil i . „_.,. t,a9SiX494,/4:61./.7-7 . g ! , ..,__ ....._,.‘. - 0- „ , .., , __ • „ • i I \ t?, CE3S-1*.A-a a ta .9t,ta kg ill CD . \- itI 4 I--E. --t) T . :p.,.,. E -5 \-mo \\P. _ ./ ,% 111:, '1- affil 0 ,a) __ , tr. (/) rt - ...., %b._ \ ,IH-ftoli, . , -, Orr 11 4 ilJir %--- 1 \\ i•-•J ! lit.C'JH1-_:... T..; '- w„... I j L.-. RiLg•i IA NS. • = , i - 11--, ki 3- • -714 c---$-,.. - • 4 . . 0 Zt‘1111 to 4 ,t)lw-o, _Lti 17.ity 41 ik; 1 .1•' R 1 n te" 1.10 P-iii-rt jg &.-1 K: '7 //ii ° ; • 'i.t1 i x ' r • .b,,I. z•--. . . , . :, g t TR ' .-,5 .-\ . - ,.<1 ,•4:-._ k8',r,R2 tli, _ -... :,i,DNI W. ri'''M . P ' - W i : ,E • 11 '2r1 'it .__ --1-1 = ' * — PIT4 Z I - (-1-' IL • -11! •A - - I • t —lk • • • 1 tlit 41 0 0.4 ,.... Ca) .. I': ... t ii tfi . ' ! A. • ' ; syni. ! , co z •al i :Ask . : al 11.r , Ie. . 4 3 . ..(-4., . . ,,u, t , tcli-1 , K5., N. 4 -- F.,-..1 ..1 h„. ..-z. 1 i Pm i• tu i. c,... ...1t13. 0111: ' PO VI ul ag: , I-• :-_,•r n Z•ty !AN, I-::- ltl: ,,4 L.,- 67., T_.. i .....0.. ": : 1.k z. , , : P.r- •I • • ›*.: . 64 ' .: : I,t• ;:lii ! !•- $4 i 110'12; •-ip 41'0I .P6:, . • • !Iin -'. . tt acc P14 zA Natoli x.. iii d; . kvic , ,„io Ell- 16 to-AINIAEP4 1 PlIrtrl till ir . Wri $, ilk ij `v7.&1,' ,k2 . k-r7r4 RP Fia A . . o ; I '. ' 0,---, %.L's : • &1 . .04i_ Pi tll-.. I : lg .!;• 7 ; k. k _ - ! . 4j--- -_,-.2' _=.-_— —.7-7_..41PME _- """111,_ _••• min= izerag..___414, _ im ,i,s iv • i "1111WAIM1111, Oral V I ... 1 -.4 ••• ' -' i4 % ••••z ,_.joimas110000130'1, ' )--- , -Atintuet.,. • '10 t, If tc i tir.,„ N -'4' -1, I ... .40-3,4411t • ,,-- i • V---- • •41111 1 !HP D''' , r-• ),L , ..r. - is 0 t..N„.....r.r• .j .. ., • . I t.i.. yr .-,7,,..,. 11,42ai r•! -.- p il ! t.''.. ' - n , •'•-- . ;..,. ' • II [.. .- ci- i '''iti • ; • a)1, .,,j.r._- :!.: A 4 ....:- *,,,, .; . . .r., • • c . • - • --.?., v.„ • ___,.._ - • i.. • • . . : ..- .s e i I • ' )-- i II'-} ' 1 . -.4. 0 h 1 ' ".= ' . 1 - t A. , Ca k; I I 4; i M. tC-...1 .• ..,... I ig ip! k .,„ , im., ‘-7r rt I K , g —01‘ , , • lot I_ II: • ii.t ,, m. 0•,t,:! 4.,,•;,..11 i 2 i ,_0„,,m , -. 1:1.; ,! =z)•-• zirp, .4, = , „ ,_,w- =, i gpii ! • 1-, : iiikAl• its i--1, '°. 1 i P-, ''' --4. Wz V 'i I ,V;Mt . • r ,, Iv E rt to, 11%1 7 !%Li ' i'‘I‘r-tu' INab i‘2 ____ti ._ __Arulk1:1. : UniPti41 i fc-i. ___4 ____a3411 , ,• ' ,4 -rim -7.---- PI • - • • 0 ,1'-v' r I-'roy l e•Lo" r l 16'/ IO l Co"± / f /2'!o" _..d-c" m zcAXRI a °om fir — N 1 �Y A x - Q (11 Z 4 T- n l `II� `'p o' A r✓ ld�I s' m1 IFv I I0 I� I =' � c � a �Q 1 II�� _ 1,,I ` a yQ so� ► 0‘�i ‘I oa. a - I III ) I ZB PcfsT, 0 ZBPCKr j 1 I I `mx �� 1 \, \ (1N .1! r —_— j. I I n n ;_ �► II _ d oiia . _= ,ir —� Y I �' Ili -1-1 y, m � II 7r lzld: 2 'F x 4' iT I \ I Z.R 1 eTriH 1 al ?,14I a _.. A �I Ix 1 -.. v — o A N1 1 T � 4 )< ! ' 1 I r A1 1 11 ; F_� 3.a„C- 2 PIP. fu�«.urt . sNcµ � l, 1 ‘. 'ITT1 1 1 11 1 � I I I , � � A N. F�� :, y I I I I U- Xv1 � �p� 9 i l'?. 9- NI Im , Ix ` I A7!, � am1 13 C�} m ' Iz 1 -i ZCN -114i 0 ti'm 11 H -(si 11 z m 'd7. 71111 Z 3 ro `. p . - 1 111 1 g r 'pApI 2T Q r r O 1 P. `i I I fmTi�p 2 Az REP .73 r• l i ;: --1 ro I. ._ , .may_ �--�� SW / :! =NEN _ i' ., - l- z tom- I c� -'_: 111 r\ —\ x a +-� o T ,N o rn m CT) m T� II -y m_ -„r ti It m�� �'",4I, 51 La" r 1, ,---�-. " II 7 1 u n , , t"^ I /o-o �O IS'o C-7 X m m Xm / Igla." r - 1 b" _ 31'0" 7 ?�Z r� r � lU .gmck o a it � o N IR SIDEIiGE RMODEI_ . ,TAMAS' HALLIGAN -. NEV-4I FLDoR_ PLAH y __ - FO1=2-. ARchiITEcT PRE LI , 5.3,04, 1\ m __ PATRIch 4 MAR"1'-LotlISEI 1,4AIT :_.Po B _,_ ox _8Co2 -ro P+;RMIT 4 �NCo• S. 1s•oc.Q 11 _.1210 TAY L•.o R ST, *5 _ =- _ -*70 LALIRE I- STREET - -C PORT HADIDGK, WAr °;1 3c1 36'd 3¢5 2Cj2D !__ • • Iy--6.,r -- 1 — o AH-"N m m,Oz_x REP.. 3mNms C, 3rR s O Tx z rZ z g c- � m! - m Qa % QY `IAl �_ �. _III I � _ 'F 11 • -- 4.m IT orr Moors Al I - 'a-1s ill <-Aa �p m irom �� Cl`_ so' A ..\ III ' aL III ° �m$,l\ 10, x� % • II,. mYn' III �S D.mO m, a N- A mF� � z m 3e,m o oa- . • ==. 7A Z NI I- - . 27 I I ;1 g±z �i�. ' N a .4;'N I 3 -1IA } ?II II o mmvQO_ 3i I m em < m . I I - I L�1 `� c AZ mt11 mN s_ T. ems, ... . _ z ,_r.:___;____.7. _ r____s,..-, oil . ,.. n \ . •,...._ . ,,, :. ___, co' 2._ ,' 71 iau Zmn I ''N-I i m m=m - a W , r g,2 a,; o_zr< a t mM _pm 1S o 5-4 nx m \-7 ___,,A4 ( ro a m n s�-}l__ J o W m - -2= o z_ ` ..,,_,._ —gib,' = 6 N 1_N �3'_O''._._ ...G�S'.t 2 ;{fry; S - 14. ` \ 3 D 1 N �..--.._ -- nth - \ _ -, --,ni , --fig,,m a. _ ,_ ,ter -. B �- m m �y m a -a.� 0x op aYx I w = o m - z M^ 7a-* < P m , -.- : Tv A J m(% i <Ati sI r %'NH a m ,e <� m�� I u, 'CH- T.{� Q< ?t, I Q n m o i0 N �X ` �� 1 75 T w CI m� m ''m �W �m A n o 1 m Amm I 4 / .ii, �' STAINED GL. % \ W: - - _ _. r - 1 ▪ ra =A m Z 731Z 1 Z mTT J z N -?a --1 1� mnp ill c- N rA - 2. , „ I Z N o-o" I-O/ - la=o" , z-a" g p, 0 > 61 e.n., • 3 m 0 N ,i▪ D N co \r___Tr''m<:-°\ ' :.= ... O R IPEHC- REMoD5I- TAMARt* HALLIGAN .0er10,LitI -I. PLAID so;s I F'OR ARcHIT Cl..- 5,3•0�0 ('� REGISTERED 1. Ih ` lJ ARCHITECT m F'ATRIGI'� 4 M�R�(LOUlScIr{p.IT Po. BoX 8�2 -ro P�I„Ir * sN�. s,ls•ocA 1 210 TPNYL 'RST # 5 LLIGAN t 10 LAUI L STREET STATEOFWAS INGTON STATE Of WASHINOTON PORT 11ApL-oc1'-. WA 610sac1 3620 3a 2ry2S 4,-' °N °06, JEFFER.d COUNTY . ti a DEPARTMENT OF COMMUNITY DEVELOPMENT `4 621 Sheridan Street • Port Townsend • Washington 98368 360/379 4450 • 360/379-4451 Fax &<y41NGrS O� www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: Q(o Li 1-1 Project Description (include separate sheets as necessary): ,`t i;� ;/,`Q. l;E. i:r4frll>':r Z.5/D'k'%/.. 6 .4pf/,Tjc//[f / i c...!l/'lr//t-, IW i 74-, 9O p��� Proe �_" ° Tax Parcel Number: c --o7 Size: 7 980 $ FT � Q, (acres/square feet) Site Address and/or Directions to Property: 70 LAv)Gt .. $7; Pc/27 ,1/4p4ocx 1 /. 98339 Property Owner(s)of Record: PATEice_ pv.9.,ey L0()/56- w.f/r. Telephone: 3619—379 4990 Fax: 3/e0 379-©978 email: Mailing Address: 70 L,,4t1/? L S7 Pat.?" �/, Lo WA- • 9B33 Applicant/Agent(if different from owner): %,J-/if gr4-- ii -1 L L/�o l(-;' Telephone: ,`✓ - ,iP z b Fax: email:/l d�/i a r it.-1ik?c15:/v Mailing Address: t�(. ?jC'X & ? , / What kind of Permit?(Check each box that applies) L 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)** ❑ Manufactured Home ❑ Boundary Line Adjustment ❑ Modular ❑ Short Plat** ❑ Commercial* ❑ Binding Site Plan** ❑ Change of Use ❑ Long Plat** ❑Address t I Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** 'Propane 0 Plat Vacation/Alteration** CI Allowed"Yes"Use Consistency Analysis 0 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: r DESIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE G.q�.t/C-• Q,L/— _ Date: v —24k''0 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 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. `� 17; Signature: .-tG.— � ` 11l-22--,_ Date: ./ _ 1 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 ompl ing with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: %Z ,r_._ _ Date: /,-)V ' . G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc BUILDER STATEMENT II 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: rIG'77Cl--t� - -!_Ke. e r :. - Date: `-? /` ) C% GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: -C,O. ( ) ( ) • MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: TRMYi1 ,- Hi-)L.L.f t,prA Np PHONE (34,0 ) > . 4 e,s „ FAX: ( ) MAILING ADDRESS: i'C, Cx e(2 2 fur ow, 'vSEiD EMAIL r 1 If covAt`-Q I i,vvipuS.L 1t' Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New 2- Wood • Existing: I ❑ Sewer Er Addition ❑ Steel Proposed: I , Bank Height: ❑ Community System 0 Alteration/Remodel ❑ Concrete Total: 2 ) [ 'Individual System ❑ Repair El Masonry i`" I SEP Permit# Demolition ❑ Other: Bedrooms: Water Supply: Existing: 2 Setback: [1 Private well I I Two Party Type of Heat: Proposed: kr"-Public -` JI P N Total: 1 Name of System: r ?})Y. 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: i I Underground Tank ❑ Above ground Tank Size of Propane Tank: F% T. ' I - I 1 Heat Stove [r(Cook Stove ❑ Woodstove Ii(Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove I I Other Is this appliance being installed in a Manufactured/Mobile Home? Yes LT10 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 Bld App Review: .-157 23 i 15 priq•Iv4 L95.00 2nd Floor Heated �� ) Consistency Review: C, Other Heated Base fee: i �� N Mezzanine P y Additional Section: Heated Basement /i/� Plan Check fee: a Unheated Basement State Surcharge fee: C• Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL _._ .;Oat\, C)ik Decks 911/Rd Approach fee: — (8 )C I4-)I'la.WW t(,Sk let el Other TOTAL: $ 1', i 011 Receipt Number: CZ, l l .-1 % Cash/Check Number: I 1 ' ESTIMATED COST(RED Date: .Fair market value of abort? and materials founabtlo ,to finish r, I 15 c; ccc? c o % Initials: i 11.b G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc