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HomeMy WebLinkAboutBLD2006-00580 • • BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD06-00580 Received Date 10/5/2006 SITE ADDRESS: 234 OLD OAK BAY RD Issue Date 11/9/2006 PORT HADLOCK, 98339 APPLICANT: WINIFRED L YABE PHONE: 360-379-6488 121 RANDOLPH ST PORT HADLOCK WA 983398507 SUBDIVISION: EAST RIDGE SHORT PLAT Block: Lot: 3 PARCEL NUMBER: 921182036 Section: 18 Township: 29 N Range: 01 E CONTRACTOR: TERHUNE CUSTOM HOMES PHONE: (360) 681-8898 PO BOX 3125 SEQUIM WA 98382 Contractor's License: TERHUCH984MA Expires: 7/1/2008 PROJECT DESCRIPTION: NSFR WI ATT GARAGE CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. SETBACKS: V/ UFFER: ✓ Footing: 7k &/e k/et/ems W70 M ` Foundation: D/C �B/d7 Stormwater FINAL Approval: Underground Plumbing: Underground Insulation: Shear Wall : /AJr 'f Eger osly 9X 'b/�°76' Sheathing: Framing: Ll/P DK 02,/o7 OK 4/0/67g Plumbing: Zack-n) /'A 3/i8/G7 7 -Propane Tank/ Lines: ' et1- C>� 1,^4-a. 6 C i-kt; 1/( j �s= L '7 V1A 1\- Insulation: 4 SA Ld (ExC&Pr B�Wliuo -ra6c) /e a? cargo 7Uk365 k 4/120 Sheetrock: G toe t W 4/I7/07 41Vreet02_ id .SNk-A�2li/A1-c-5 OK 4/17/671'% Septic Sytem Final Approv I �M(UST be obtained before final of structure can be attempted. Road Approach Final Approval: Zoning Final Approval: Final/Occupancy Approval: .-Z -07 jAA-�, . HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED 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 HC)URS 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 EsEILDING PERMIT APPLICATII MLA06-00563 Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00580 Received Date: 10/5/2006 SITE ADDRESS: 234 OLD OAK BAY RD PORT HADLOCK, 98339 OWNER: WINIFRED L YABE PHONE: 360-379-6488 121 RANDOLPH ST PORT HADLOCK WA 983398507 EAST RIDGE SHORT PLAT SUBDIVISION: Block: Lot: 3 PARCEL NUMBER: 921182036 Section: 18 Township: 29 N Range: 01 E CONTRACTOR: TERHUNE CUSTOM HOMES PHONE: (360) 681-8898 PO BOX 3125 SEQUIM WA 98382 Contractor's License TERHUCH984MA Expires 7/1/2008 REPRESENTATIVE: TERHUNE CUSTOM HOMES PHONE: (360)681-8898 PO BOX 3125 SEQUIM WA 98382 PROJECT DESCRIPTIOP NSFR W/ATT GARAGE TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 1,309 VALUATION 163,531.00 CODE EDITION: 2003 ADD'L: HEAT TYPE: HTP OCCUPANCY: R-3 HEAT BASE: HEAT TYPE: UNHEATED: #OF STORIES: OCCUPANCY: CONST TYPE: 5N OTHER: SHORELINE: CONST TYPE: GARAGE: 473 SETBACK: DECK: 210 BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: OTHER BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 2 Prop: 2 Total: 2 Total: 2 Routing D te: 1O\5 OCo Type Amount Paid By: Date: Receipt: Approved/Date Permit $1,385.75 LYK 10/05/06 85074 C) 1,— L . . -...,- I EPlan Check $900.74 LYK 10/05/06 85074 State Building Code $4.50 LYK 10/05/06 85074 NOV "1 2006 Potable Water Application $55.00 LYK 10/05/06 85074 Jettersot County Pla;iniri;,, • Total: $2,345.99 & Budltlincl Oenartmer,. • • 4p'-6" 10'-10' 28.-e" 13'-0" ,r'-e, 6'-0" 4'-2" , 6'-4" , 0'-6" 6'-6" , 6'-4" 6'-3" 6'-8", ,r- I—Cedar Ra.% b L'x3'engle L'x3'sngla Covered Deck .1 Z window thaws 4'x3' Plc abwa ands ebave Z� Post L'x5'Ple �L',6'Pic �L'x5'Pw: I V 13'-O• x 10'—Q" Cedar ♦ ♦ \ • L-Cedar Railing 8' Ceiling Ht. 0 Covered N M t IT Porch #> Dv 1a 10'—l0 x ,'-,• Great Room Dlning Roomr ` ° . �''�`� Ceder De:kmp L� L'xS'xa Soma Door co °+ \tl IS'-2' x IL'-O" Carpet 'ti �'-L' x 1'-6'*-Carpet "\ \ 1/ ♦Yeult °/9craor Trues Vault W/9cwa Trues — - 1' 10' Plate Height 10' Plata Height 3'O' 'li 111 f/ e0'p I/2 Wap to ast 1 > / 1 under cantertep In —mat J�— IOcfa Her Preastatdap etave !' PIt. H: +,� • e/fluah tLe hearth ♦� I b. '� —I► / „�p I :Itchen Pplea \IE Master Suite g•Q...Z. VI �!♦ c- 9'-2' z 10'- S+0 I2'-C x 13'-1' Carpet Pedestal V,Lult a/9clsasr Truss I? Vlrnpl t 8' Ceding Ht./Flat 11 "``CCCC Sink 1 4'-2" 1 6'-6" 1Plat Calling f8' Plate Ht.7 --- Plat Ceiling I Q 10 If If \ FF lJ 'In -. 3'O• 1n Carpet 1 a L.._—\ L „ so - ♦ y -•- 8 \ ( ♦ \ 4'_4. / 4. T77. 6'-10" I I 2'e• 1 m 2'8" .� ✓ 3 O' AteK O' T � M tr w Na satmlq Act... 3'0' ,n h Cerpe ♦ 3 ee!! Y 'n t ,tO r'•= 8'J kt Baum 4' NI a ' pai t� "t --J�T R19 3 0• ] Vinyl I W'T era w'o t TIN Vapl 'g 'a �' Bedroom#2 /\ "� 14're.14 "-- 2 r I O iD It 10'-1•dl'-2• Carpet 9 i o ode 1 7 1 / -:I_< yi 41 10 ' 1 Vinyl I Q - -- '15 , M =? m F O mo Calf �^ L r da 18'x24 1 9 x3 ah to ^g C\ g Croat 1 si \ \<TLIli Acce> Il20Min. �♦ I� " u' door - 10-10' !Ir-2 :.-1: e'-e' O T \ / I Rar alaa 16 I stp tap 1 \ / I bottom I/3'a \ / I R-10 Pad I/2. OWB on sill \ / I rare gaps I ceding \ / I / q, < 4 1? \/ $ I 10 //\\ of 2 Car Garage " ,/ \ NI 2l'-0" x 21'-0' I / \ I / \ / \ I 1 • / \ I / \I �\ V C •2.-8., 3-0' 1 3'-11' f2'-1"f 6'-6" t 4'-2. , 4'-g 6'-6" 22•-0' 22'-0" 48'-6" 1 - it Vain Floor Play Sale: _ ,'_O+I Square Footage: Living 130E3.5 Garage 4113 i IP SPECIAL CONDITIONS FOR CASE # BLD06-00580 1.) A Geotechnical Report dated May 18, 2005 prepared by Stratum Group was submitted in conjunction with this application. The report addressed the stability of the geologic hazard area. The report states there is very low risk of landsliding impacting the subject property and "no unstable slopes are present on the site." 2.) 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. 3.) 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. 4.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 5.) 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. 6.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 7.) 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. 8.) Minimum setback from Old Oak Bay Road right-of-way shall be 20 feet. Minimum side and rear yard setbacks shall be 5 feet. 9.) 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. 10.) 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. 11.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 12.) The building height is not to exceed 35 feet. 13.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 14.) THE ROAD APPROACH PERMIT (RAP06-0079) MUST BE INSPECTED AND FINALLED BY THE JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS PRIOR TO THE FINAL INSPECTION/CERTIFICATE OF OCCUPANCY OF THIS RESIDENCE. CONTACT THE DEPARTMENT OF PUBLIC WORKS AT 360-385-9160 FOR THE FINAL ROAD APPROACH INSPECTION. • I:\F_BLD_Permit_Buildng.rpt 10/29/19 • 0 g °. PERMIT # BID JEFFERSON COUNTY 1 DEPARTMENT OF COMMUNITY DEVELOPMENT - 58 0 11404 621 Sheridan Street •• Port Townsend •Washington 9836 4.O 360/379-4450 . 360/379-4451 Fax tf F E R S 0 N COUNTY D C D jinicts http://www.co.jefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# 0 6— + � ^ PROJECT/APPLICANT NAME: �+� t h f'1 Please answer all of the following questions to the best of your ability. Where the question calls for depiction on a site applicant may choose to either incorporate the elements into the general plot plan for the Master Land Use Application or to ubmitha separate stormwater 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. F V....'I ll Cr. l •>>- -t G fit'' S ' ° -> \ Existing Conditions Summary 2. Describe the existing topography. I •'cate contours on the site map. JV I• . t 3. Describe the existing vegetation. Indicate native vegetation area on the site map. 4. Describe the existing soils. Indicate soil type on the site map. w 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. A L' /14 ■ i 6. Describe any excess levels of noise generated by the proposed use or activity; f APPROVED STORMWATER PLAN NOV - 9 2006 Storrnw o - storwater site plan template—rev.10/1/2003 Required r.t- : JEFF RSO C m4 a \ Y 5 DEPT.OF I Y 1 PMF SIGNATUR_: • • , 7. Describe significant geographic features and critical areas (i.e., environmentally sensitive areas such as wetlands, streams, steep slopes,etc.)on the site. Indicate location on the site map. (A 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.). LV /PV Permanent Stormwater Control Plan This portion of the Stormwater 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 will be utilized for the site or specific threshold discharge areas within the site. Locate these facilities on the site plan and differentiate proposed facilities from existing facilities. Vv.l2 w L(",� '�1 q�1.- -�ti vL� c c 10. If the project requires the use of stormwater treatment facilities, describe the types of stormwater 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.] P` 11. Describe the performance goals and standards applicable to the project. ( 12. Describe the flow control system. PERMtI # RH} (Pc . EFFtPSU N CUONTI' D 6 stormwater site plan template—rev.10/1/2003 • • 13. Describe the water quality system. 14. Describe the conveyance system analysis and design. Urn I 4111 15. Describe the source of fill material,physical characteristics of fill material,and deposition of excess material. 16. Proposed methods of placement and compaction consistent with the applicable standards on AppendixChapter 33 of the Uniform Building Code. •_._ . : r L4 _4111.&411 i_ ■ C/V1 17. Describe the proposed surfacing material. L J ! .,L • ..� & 18. Describe methods for restoration of the site. IIMM■ .62 42—. 19. An Operation and Maintenance Manual is required for each flow control and treatment facility. [This is normally required "large"projects only and only those for which facilities are required to control flow or treat runoff.] If included,list the Man for uals here. 20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan. A 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. Ng Ma stormwater site plan template—rev.10/12003 7 • • CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN(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 (BMPs) 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 BMPs 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 2.5.2 of the Manual(beginning on page 2-15). 12 Required Elements-Construction SWPPP 1. Mark Clearing Limits. 2. Establish Construction Access. Q.U-e__A CN (Ocae_ u ��� .� ' ►t" - 3. Control Flow N ( � dr(6w-e-LA 4. Install Sediment Controls. 0 f A dwr t6uus 5. Stabilize Soils. CArl QJ)( posed s . 6. Protect Slopes. CS- (/vtiA I -E- )1_12 i LL 1...k* d 7. Protect Drain Inlets. stormwater site plan template—rev.10/1/2003 J E F F E R S D N COUNTY D C D 8 • • 12 Required Elements—Construction SWPPP(continued) 8. Stabilize Channels and Outlets. V 9. Control Pollutants. 10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site). 11. Maintain Best Management Practices(BMPs). • RIO 12. anage the Project. `i s L ��—•� S 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential areas, roads). b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are on or adjacent to the site. stormwater site plan template—rev.10/12003 9 • • b. Description of special requirements for working in or near environmentally sensitive areas. 11 s 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,settleability,permeability,depth,texture,soil structure). • (Pc k), 12) 4 ' 5. Construction Phasing. a. Construction sequence 1N3 b. Construction phasing(if proposed) 6. Construction Schedule. Wet season is October 1 through April 30(page 2-21 of the Manual). I. Provide a proposed construction schedule. II. Wet Season Construction Activities. a. Proposed wet season construction activities. • 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. b. Describe bonds and/or other evi6rlde of financial responsibility for liability associated with erosion and sedimentation impacts. • / a 8. Engineering Calculations. Provide Design Calculations on a separate sheet for the following,if applicable. a. Sediment Ponds/Traps. b. Diversions. 1 I c. Waterways. d. Runoff/Stormwater Detention Calculations 10 stormvrater site plan template—rev.10/1/2003 • Stormwater Site Plan Changes If the designer wishes to make changes or revisions to the originally approved Stormwater Site Plan,the proposed revisions shall be submitted to DCD prior to construction. The submittal shall include substitute pages that include all proposed changes, revised drawings showing any structural changes,and any other supporting information that explains and supports the reason for the change. Final Corrected Plan Submittal If the project included construction of conveyance systems,treatment facilities,flow control facilities,or structural source control BMPs (not standard on-site stormwater management BMPs),the applicant shall submit a final corrected plan ("as-builts")when the project is completed. These should be engineering drawings (stamped by a licensed civil engineer) that accurately represent the project as constructed. APPLICANT SIGNATURE By signing the Construction SWPPP worksheet, I as the applicant/owner attest that the information provided herein is true and correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all owners of the ted property. 10- 2-C f , . (DATE) (LANDO ER OR AUTHORIZED REPRESENTATIVE SIGNATURE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED: • PERiviII # BiD 06 - 0580 JEFFERSON COUNTY DCD 12 stormwater site plan template—rev.10/1/2003 I • • ,,......._ ,00..c., JEFFERSON COUNTY L DEPARTMENT OF COMMUNITY DEVELOPMENT . '41 621 Sheridan Street• Port Townsend•Washington 98368 360/379-4450. 360/379-4451 Fax }0 www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: 0 �.i � o3 Project Description(include separate sheets as necessary): Z C�1/- c tY --�-- CA, 2 ►i-�e�.Ya o Yti, C, �/o Fc�� ..d c o..1Va c)-e Tax Parcel Number. 621 Z I t t l Ca - _ O k7 Property She (acres/square feet) ,,__,,11 7 ll l Site Address and/or Directions to Property: !i-6 bra •- Kl 1 ` " �S0C__ Property Owner(s)of Record:(A)1'►-&'L.1( 'N({t8 E. Telephone: awl " •. + _j; Fax: email: Mailing Address: +� >• :: att it `1�II O. ' . ii - 9 Applicant/Agent(if different from owner): ex a _ 1� •� fit AL 1 Telephone:(.--,e I - SS 6 Fax: ro`C3l-1?©1t email: Mailing Address: d.3x D12.. -L-1-k YVA., t-.}.- N- '125 3 e2." What kind of Permit?(Check each box that applies) tilt:Pwilding U Variance(Minor,Major or Reasonable Economic Use) U Demolition Permit U Conditional Use[C(a),C(d),or CI** Single Fami U Discretionary"D"or Unnamed Use Classification arage Attach_ Detached U Special Use(Essential Public Facilities)** U Manufactured Home U Boundary Line Adjustment U Modular U Short Plat" U Commercial* U Binding Site Plan" U Change of Use U Long Plat" )akzAddress Road Approach U Planned Rural Residential Development(PRRD)/Amendrnents** U Propane U Plat Vacation/Alteration** U Allowed'Yes"Use Consistency Analysis U Shoreline Master Program Exemption/Permit Revisions** Stommater Management U Shoreline Management Substantial Development** u Site Plan Approval Advance Determination(SPAAD)* U Shoreline Management Variance U Temporary Use U Comprehensive Plan/UDC/Land Use District Map Amendment u Wireless Telecommunication* U Jefferson County Shoreline Master program Amendment U Forest Practices Act/Release of Six-Year Moratorium *May require a Pre—Application Conference "Requires a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal,if known: DESIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of his,her or it's knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attomey's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and a wired r inspections.Access and right of entry to this property shall be requested and shall occur only during regular business hours..: 0 _ ?- Sig ature:e: • _ Date: G�—`J 50 The action or actions Applicant will undertake as a result of the issuance of this oermit 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-transfe •,,iii.l insibility foo dherin to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signatures! .. Date: (0—Z—U s , C:\Documents and \mochil\Desktop\Master Permit Application 7-8-04.doc r i OWNER BUILDER STATEMENT The signer of this statement does hereby cettrty that they are the Owners of the,pircel referenced herein,that they are not licensed contractors and that theywill be assumingthe re onsibit' the General Contractor for the r .- sP �Y P oposed project. Sjgn3fure: /--'---%i CDate: �— GENERAL CONTRACTOR(3R-MAtdJEACTtJREtj-HeMEINSTAI L ER PHONE: FAX: ^l Q-v h.u-Y\Q u,, kb van rn_Q.,_ oO)C ft (-88a8 $ ) -t3"l I MAILING ADDRESS: .0;yOx 31�S SQ yvv-E tA1L,: ,pl. C�LE5 3p Z CONTRACTOR'S LICENSE TTT WAINS C3 NUMBER: TQ___Nr 1evATN` \S Lk w'\A NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: C1.— Y` ) 7 EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: �%`New po Wood Exb,ing: a Sewer u Addition u Steel Proposed: 2 Bank u Community System J Alteration/Remodel U Concrete Total: Z. Height: X Individual System ❑ Repair ❑ Masonry SEP Permit#5eP6 .-c-v"v)t l J Demolition u Other. Bedrooms: Water Supply: -Existing:---- Setback: u Private well u Two Party Ty a of Heat_ Proposed: 'Z. X.Public ���� Total: Z" Name of System: If this is a Commercial olect you must answer the following: Number of-Parking Spar Current Proposed NuEr of ADA Parking Spaces:---) Numtier of occupants W cludesoners,tenants,a loyees,etc)-Current Proposed "- 1 C Occupancy: IBC Type of const clion: Will you have Food Service? Yes / No If this is a Prep k and/or Ap Installation permit--mark all items below that apply: I UndGd Ta I Abov and ja k — e of Propang,Tairile- t...1-gat Stove I ove I Woo I Fir Inser Tank <1 Pellet-Stove-I-DFier - ) Is this app- e bei installed in actured/ obile Horn ' s I No _ W�applying fora pe " install a propane k ou-nfust also submit a ite planstiowinga llof the bui dings,all property lies,tank location and size,distances from the propane tank to all property lines,buildings and septic sysem components, including the reserve area. -_-- - -_ Square Footage For Office Use Only -- Current Proposed L ' unt Main Floor 1 S IQri-.K, Consistency Review: 0 21 O Floor Base fee: Floor ----_ Additional Section: Mezzanine: .- Plan Check fee: q co �,t, Heated Basement State Surcharge fee: A `f Unheated Basement '. �- Pot Water Review fee: gar l30 Other Unheated 911/Rd Approach fee: /. --------------------------- - Garage/Carport 4, 3 1 11 La,(oy TOTAL: $ '� Decks - — - -- — Cc - ) 20905 ,Icel. 1J Receipt Number: Other Cash/Check Number: ESTIMATED COST(REQUIRED) 10 1 3f,5,4, Date: .Fair matte e eFaN Tabor and materials foundation to finish r---S 3 1 -- Initials: c:\ • esktop\Master Permit Application 7-8-04.doc 355A6' NO O6'8I"W - _ - ": - i[In —_________ crn t w ,m rn pH F. k < -{n \ ' < cn D . 1 7ZC 1m Jm \ Cn S, ,m m 775'+- Ll442,j&;V'cl 115'+- 1 m ` 4C/j 1 1 m 0 1 1 ' m _, O PROP/ DRIVEWAY \\Po+ 0 -� \ 1O 4 1 \T Vi _ 2i3111d ON'S 4ce \ ��ti =(ll 1 ,jI AO + �ts- �, _ F N s� rn L • CP Q�31�N1'��Cl �. 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