HomeMy WebLinkAboutBLD2006-00471 •
UILDING PERMIT APPLICAT!N MRL viewTy465
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Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD06-00471 Received Date: 8/16/2006
SITE ADDRESS: 248 ROBINSON RD
BRINNON, 98320
OWNER: MICHEL D JEROME PHONE: 206-632-6349
JENNIFER I MYHRE
4135 ASHWORTH AVE N
SEATTLE WA 981038147 THACKER SHORT PLAT
SUBDIVISION: Block: Lot: 2+
PARCEL NUMBER: 502153052 Section: 15 Township: 25 N Range: 02 W
CONTRACTOR: OWNER/BUILDER PHONE:
REPRESENTATIVE: ROGER MYHRE PHONE: 206-632-6349
4135 ASHWORTH AVE N
SEATTLE WA 98103
PROJECT DESCRIPTIOr DEMO EXIST M/H & SHEDS
TYPE OF WORK MOB SQUARE FOOTAGE:
TYPE OF IMP DEM
VALUATION MAIN:
CODE EDITION: 2003 ADD'L: HEAT TYPE:
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OTHER:
CONST TYPE: GARAGE: SHORELINE:
CONST TYPE: DECK: SETBACK:
BANK HEIGHT:
SEWAGE DISPOSAL: ALT
WATER SYSTEM: 2WELL
BEDROOMS: BATHROOMS:
Exist: 2 Exist: 1
Prop: Prop:
Total: 2 Total: 1
Routing Date:
)i)CD
Type Amount Paid By: Date: Receipt: Approved/Date
Permit $51.00 LYK 08/16/06 8.4714 !
State Building Code $4.50 LYK 08/16/06 84714
Total: $55.50 SEP as 2006
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& Duliartinent
S •
DEMOLITION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT #: BLD06-00471 Received Date 8/16/2006
SITE ADDRESS: 248 ROBINSON RD Issue Date 9/22/2006
BRINNON, 98320
APPLICANT: MICHEL D JEROME PHONE: 206-632-6349
JENNIFER I MYHRE
4135 ASHWORTH AVE N
SEATTLE WA 981038147 2+
SUBDIVISION: THACKER SHORT PLAT Block: Lot:
PARCEL NUMBER: 502153052 Section: 15 Township: 25N Range: 02W
CONTRACTOR: OWNER/BUILDER PHONE:
OWNER, MICHEL D JEROME PHONE: 206-632-6349
if different: JENNIFER I MYHRE
4135 ASHWORTH AVE N
SEATTLE WA 981038147
PROJECT DESCRIPTION: DEMO EXIST M/H & SHEDS
THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE.
THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR.
.
THE EXPIRATION DATE IS 9/22/2007.
REQUIRED INSPECTION:
FinalApproval: e ,e A-Ala/ia, iq f' G
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:00 a.m. -4:30 p.m.
SPECIAL CONDITIONS APPLY - SEE REVERSE
HOT LINE AVAILABLE 24 HOURS A DAY
08/09/2006 12:06 FAX 360 491 �308 ORCAA 1�j001
• rr- YAabl:►i. •
AUG 9 2006 IvP1' j-
�' CONDITIONALLY APPROVED _
CA • x^
-
i - #= INOTAPPROVE-
- ,fir •• FOR COMPLIANCE WITH
ORCAAREG ATI 1
Notification of Demolition Pe t• , C I�r�,� J i°5
It is unlawful for any person to cause or allow the demolition (or major renovation o cruse aulcds
containing materials have been removed from the area to be demolished. Work shall not commence on an asbestos project
or demolition unless the owner or operator has obtained written approval from ORCAA. A written application for a
demolition shall include a certification that there is no known asbestos-containing material remaining in the area of the
structure.
Project Site Address: a`-itt Cio gym%oN Rt> County: .1 e.fc.atzsot.)
City; Wsvest�0a State: (KA Zip: '`a3Z.e
Starting Date: A V"0 v Sf - �ZOv( Completion Date: _ 1_tt1��jj L45 f a 3 �OQ -7
*(There is a 10 working day advance notification period from receipt of permit application)
J /
Property Owner: Mkc4+. . ..r�aeoc�tN,E
. - Telephone:aou-to3- co-3ek° Fax:
Mailing Address: 'A%SS A E us. ty -
City: Et tX, . State: um Zip: ckWid3
Demolition Contractor: Slick. "\ okay State License#: IA,tr,c
Mailing Address:�'t tl'a %P C EN��ot -- ,L AN C.
City: T taws. State; WtN. Zip:`i$ k d` ,
Contact Person: MOC-4—t VVAR OWS pt Telephone:'aS? - .."111`5 _ Fax:
YES NO
!�'--- emolitiou by Wrecking or Dismantling? ($25.00 fee)check# C----
Training Fire Demolition? (If yes, attach fire department request for training fire)
..L enovation,Alteration,Remodeling,Maintenance, or otherConstruction?
Asbestos found or suspected*
*An ORCAA"Notice of Went to Remove or Encapsulate Asbestos"form and appropriate fee must'be submitted prior to any asbestos
removal work. Asbestos removal projects involving demolition must be preformed by a Certified Asbestos Contractor and all friable or
potentially friable asbestos must be removed before any demolition begins. Refer to ORCAA Regulation 1 Article 14 for additional
requirements that may apply.
..- Asbestos,SurveyeCompleted by
AHERA Certified Inspector
Certification# h./A01 G ao 12 Ib/ — `
This approved permit mast Enclose$25 Certification of the Asbestos Survey must
be available at the job Processing Fee accompany this form
J
2944 B Limited Lune NW,Olympia Washington 98502 JRFO
.Li�..• 14ll \�v E�.1�
( 360-586-1044 * 800-422-5623 * fax 360-491-6308
homepage:www.orcaa.org * email; infog,orraa-orb
Cica 1
DATE
• JEFFERSON COUNTY OCO
• •
SPECIAL CONDITIONS FOR CASE#BLD06-00471:
1.) THIS DEMOLITION PERMIT PROVIDES NO VESTING FOR USE OF THE EXISTING
SEPTIC SYSTEM. SEPARATE REVIEW SHALL BE REQUIRED PRIOR TO ANY
BUILDING PERMITS FOR A STRUCTURE.
2.) Approval of a new septic system or use of the old septic system may not be allowed for
any new construction
3.) The application was reviewed by the Jefferson County Department of Community
Development staff on August 22, 2006 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 and an investigative site
inspection, the following ESAs were confirmed to be present on the subject property:
Conservancy Shoreline Designation, Seismic Hazard Area, Level I Landslide Hazard
Areas, Erosion Hazard Areas, Susceptible Aquifer Recharge Areas and Coastal
Seawater Intrusion Protection Zones (SIPZ).
4.) Aquifer Recharge Areas in Jefferson County are characterized by porous geological
formations that allow percolation of the surface water into the soils and the underlying
zone of saturation. Aquifers are geologic formations that contain sufficient saturated
permeable material to yield significant quantities of water to wells and springs. Aquifers
serve as the source of drinking water within most of the rural portions of Jefferson
County.
5.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions
that promote rapid infiltration of recharge waters to groundwater aquifers.
6.) 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.
7.) 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.
8.) 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).
• •
9.) Marine shorelines and islands are susceptible to a condition that is known as seawater
intrusion. Seawater intrusion is a condition in which the saltwater/freshwater interface in
an aquifer moves inland so that wells drilled on upland areas cannot obtain freshwater
suitable for public consumption without significant additional treatment and cost.
Maintaining a stable balance in the saltwater/freshwater interface is primarily a function of
the rate of aquifer recharge (primarily through rainfall)and the rate of groundwater
withdrawals (primarily through wells). The Washington Department of Ecology is the
agency with statutory authority to regulate groundwater withdrawal for individual wells in
Jefferson County. New development, redevelopment, and land use activities on islands
and in close proximity to marine shorelines in particular should be developed in such a
manner to maximize aquifer recharge and maintain the saltwater/freshwater balance to
the maximum extent possible by infiltrating stormwater runoff so that it recharges the
aquifer.
10.) The parcel is located within a coastal SIPZ (seawater intrusion protection zone)according
to the County GIS map. There are voluntary and mandatory measures identified in the
Jefferson County Seawater Intrusion Policy(Resolution 44-22, effective September 23,
2002)that apply to well drilling proposals and building permit applications on existing lots
of record.
A Coastal SIPZ is defined as: all islands and area within one-quarter mile of marine
shoreline, but no history of chloride concentration above 100 mg/L in groundwater
sources within 1000 feet.
11.) 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.
12.) 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.
13.) 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."
14.) All construction activities shall not encroach upon the buffer. This includes the storage or
preparation of materials.
15.) 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.
16.) 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.
17.) 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.
• •
18.) 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.
19.) 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.
20.) 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.
21.) The applicant is proposing to demolish an existing mobile home and an existing
shed/garage. The structures to be demolished are approximately 965 square feet.
22.) 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.
23.) 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.
24.) Stormwater shall be retained and infiltratted on site. The proponents shall control all
sedimentation and erosion on the property.
25.) 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).
26.) The site plan as submitted with the demolition permit application on August 16, 2006 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 21, 2006 shall be
resubmitted for review and approval by Jefferson County Department of Community
Development.
27.) This approval is for demolition of an existing mobile home and an existing shed/garage
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.
28.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
• •
29.) Not more than 2 unlicensed vehicles shall be stored on any lot 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 Chapter 18.30 JCC. Outdoor storage of 3 or more junk motor
vehicles is prohibited except in those districts where specified as an autormobile wrecking
yard or junk (or salvage) yard and allowed as a permitted use in Table 3-1 or Chapter
18.18 JCC, and such storage shall meet the requriements of JCC 18.20.100, Automobile
wrecking yards and junk (or salvage) yards. In no case, shall any such junk motor
vehicles be stored in a critical area.
30.) The building height is not to exceed 35 feet.
31.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
32.) Minimum setback from the edge of Robinson Rd right-of-way shall be 20 ft. Minimum
setbcak from the existing concrete bulkhead shall be 30 ft. Minimum setbcak from the
western property line shall be 5 ft. Minimum setback from the 20 ft wide easemnet for
ingress and egress for well and waterline maintenance along the eastern property line
shall be 20 ft.
33.) This parcel has been designated as Rural Residential 1:5 under the Jefferson County
Comprehensive Plan Land Use Map effective August 28, 1998.
34.) This parcel is served by a private well.
35.) Robinson Rd (C240009) is a local access road. The road approach is existing and an
address of 248 Robinsin Rd has been assigned to the parcel.
36.) A septic permit (SEP06-00206)for a system of 360 gallons per day is pending on
additional information to be submitted to the county.
37.) A building permit (BLD06-00472)for a single family residence and a building permit
(BLD06-00473)for a detached garage are both pending on additional information to be
submitted to the county.
I:\F_BLD_Permit_Propane.rpt 10/29/195
(11:friii-a5°1‘1
cwJEFFERS.COUNTY ;J �� ( .' ;h, t �. ..,'rri g DEPARTMENT OF COMMUNITY DEVELOPMENT 1-1��Lt' i 'i \� �J.�
621 Sheridan Street • Port Townsend •Washington 98368
360/379-4450 • 360/379-4451 Fax
gs00 www.co.jefferson.wa.us/commdevelopment
Master Permit Application ML r, ,- ; ¶/ j I
Project Description (include separate sheets as necessary):
pEtt\m_\. tk EILis�kN 6 Mo Q\L tkorl\C N' , S kti S,
Property
Tax Parcel Number: 5 f a I S3 CDS , Size:V 5.8 L/W3.`':k5 t .'A (acres/square feet)
Site Address and/or Directions to Property: 'asA% Rib\NON R,D (3R\tV MoN `W fz q%3aCD
Property Owner(s)of Record: (\l\\CC\EL AEFsc5iV\rc Km, ,EtVN\F-LCZ Mk..ARE
Telephone: "3-06—t4,3a-63NP\ Fax: email::ecnMe Mch\ CS.Cpry\
Mailing Address: '-l\35 F‘St\kiuo tk RVc= tV x SE.CCVC\-.E `ll..j j\ c\75.\03
Applicant/Agent(if different from owner): RCGER INN..`-KtZE
Telephone: a.O t..0—t0-4_to3u" Fax: email:ceo._c.to..ip\eK‘no, cZMKS
Mailing Address:4t35 AS\\-wot-cc f\VE t\1 vSEA'CCt_ ‘w A ck%\03 C yo,V\cX, .cc,l„\
What kind of Permit?(Check each box that applies)
❑ Building ❑Variance(Minor,Major or Reasonable Economic Use)
S Demolition Permit 0 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 ❑ Road Approach ❑ 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 0 Comprehensive Plan/UDC/Land Use District Map Amendment
❑Wireless Telecommunication* 0 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 kO M. toiact as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE x ? � l / "-'<----_ Date:
By signing this application form,the owne/agent attests t at the info aion provi d 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. C��Signature: Hyev- ,
_
Date: ax-i—r—a-f a. a°c1 to
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 respo I ity for adheri to and co lying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: "N.J.—a—. Jd
Date: Q.�-�-a.�.-t a r at�0
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc
• 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 asse responsibility oft General Contractor for the proposed project.
Signature: ,P.J Date: a.1 a ao 1e
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:
( ) ( )
MAILING ADDRESS: EMAIL:
CONTRACTOR'S LICENSE WAINS
NUMBER: NUMBER' '
ARCHITECT/ENGINEER:•• i• ;•;� PHONE ( , ) .• . FAX: (
MAILING ADDRESS: EMAIL
Project Type: .` . : Franc Tyjief' ' Bathrooms:: • Shoreline: Type of Sewage Disposal:
❑ New ti .;' X-:Wood.' , Existing:;. • <. '.' : ❑ Sewer
❑ Addition.... • • ❑ Steel Proposed: Bank Height: 0 Community-System
Alteration/Remodel q.Concrete Total: ,. .,. ,T$ Individual System
❑ Repair 0 'Masonry SEP Permit#
I� Demolition 0 Other: Bedrooms: ��"• ''•' Water Supply:
i,, • . :, Existing: �- Setback •p: Private welt ?a Two Party
Proposed:.
Type.of He ,•• !' \ t ;•r, ;.. .,,• ❑;PubliC-
/V oitt r,at,e ) 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:
H Underground Tank ❑ Above ground Tank Size of Propane Tank:
❑ Heat Stove ❑ Cook Stove LI Woodstove ❑ Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove ❑ Other
Is this appliance being installed in a Manufactured/Mobile Home? Yes / No
When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property
lines, tank location and size, distances from the propane tank to all property lines,buildings and septic system components,
including the reserve area.
Square Footage Current Proposed For Office Use Only Amount Revision.
Main Floor Heated EH Bld App Review: t,C/(
2'Floor Heated Consistency Review: LL j j(.p 1D
Other Heated Base fee:
Mezzanine Additional Section:
Heated Basement Plan Check fee:
Unheated Basement State Surcharge fee:
4. 5G
Other Unheated Pot Water Review fee:
Garage/Carport SUBTOTAL
55. 5,
Decks 911/Rd Approach fee:
Other EX( 5f- n ci
TOTAL: $ 5 5 56
Receipt Number: 9-1-7
I I 1
Cash/Check Number: 10 IL1't
ESTIMATED COST(REQUIRED) Date:
*Fair market value of all labor and materials foundation to finish I ' g
Initials:
G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc
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