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HomeMy WebLinkAboutBLD2007-00202 • . 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 #: BLD07-00202 SITE ADDRESS: 55 BEACH DR Issue Date: 06/21/2007 QUILCENE, 98376 Final Date: 2/19/2008 APPLICANT: PAUL D COOVER PHONE: (909) 994-9001 JANICE COOVER 2545 NE KEVOS POND DR POULSBO WA 983706320 SUBDIVISION: KENNARD SHORT PLAT Block: Lot: 2+ PARCEL NUMBER: 701344049 Section: 34 Township: 27 N Range: 01 W PROJECT DESCRIPTION: NEW DETACHED GAR W/ SATELLITE BEDROOM THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2003 EDITION. OCCUPANCY GROUP: TYPE OF CONSTRUCTION: SPRINKLER SYSTEM yes S THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 2/19/2008 I:\F_BLD_Occupancy.rpt 10/29/19 0 Jefferso n County Building Division Permit Nuler: BLD07-00202 Applicant: COOVER • BUILDING PERMIT INSPECTION APPROVALS applicable Code: 2003 International Building Codes To schedule inspections, call (360)379-4455 no later than 7:CO AM the day of the inspection. Requests received after 7:00 AM will not be scheduled for that day's inspections. ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries. The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection Inspection Item Date Approval Si nature Notes Setbacks Erosion Control Foundation Footing 7/3//G7 Dic Footing Drains Io - I6 7 Foundation Stem Wall 9/9./07A OK Underground Plumbing 9/?/D, G�j�/ de Under Floor Framing Straps(hold downs) /Z//7/� �� Ext. Shear Wall Nailing `//�r/.7 0: Rough-in Plumbing l.07/07' Ai Framing hi/7/7 (741 DA e_. / �1//�IdIEY /�c A,eAuc� 0iz za ci Airseal 17//7/07 liti Insulation:Walls 4//07 ,V ale Insulation: Floors 5-z-415 44 Insulation: Ceiling a/.7//,07 Q/ O,( Int. Shear Wall Nailing �.A7 - 4")' S.B Wallboard Nailing r//2/GB iv ak Gas Line: Interior IJA - Gas Line: Exterior A/� Propane Tank lA Heat/Chimney Clearance I2/R//�7 ,k. Drywell/Alt Drainage L e!D //2/hg, Address Posted FINAL INSPECTION -1A �� (,k — FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR 1406 ,Si:dm &sat L' rgi,erzi<'r /ie: V4 4/C)7 07- MILDING PERMIT APPLICATION MRL Review Ty 223 ype Jefferson County Department o' Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00202 Received Date: 5/8/2007 SITE ADDRESS: 55 BEACH DR QUILCENE, 98376 OWNER: PAUL D COOVER PHONE: 360-394-1505 JANICE COOVER 2545 NE KEVOS POND DR POULSBO WA 983706320 KENNARD SHORT PLAT SUBDIVISION: Block: Lot: 2 PARCEL NUMBER: 701344049 Section: 34 Township: 27 N Range: 01 W CONTRACTOR: ROBERT W THOMAS CONSTRUCTION PHONE: (360)297-4122 PO BOX 998 KINGSTON WA 98346 Contractor's License ROBERWT133JA Expires 4/16/2009 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION NEW DETACHED GAR W/ SATELLITE BEDROOM TYPE OF WORK GAR SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 95,000.00 ADD'L: 512 HEAT TYPE: PRO CODE EDITION: 2003 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: CONST TYPE: OTHER: SHORELINE: CONST TYPE: GARAGE: 406 SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: OTHER BEDROOMS: BATHROOMS: Exist: Exist: Prop: 1 Prop: 1 Total: 1 Total: 1 Routing Date: 5 1B- Type Amount Paid By: Date: Receipt: Approved/Date Permit $958.75 CJZ 05/07/07 89951 APPRiJ /ED Plan Check $623.19 CJZ 05/07/07 89951 State Building Code $4.50 CJZ 05/07/07 89951 JUN oZ Total: $1,586.44 2007 Jefferson County Planning & Building Department • • CONDITIONS for Building Permit# :BLD07-00202 1.) MUST MAINTAIN A MINIMUM OF 10' SETBACK FROM EDGE OF DISPOSAL COMPONENT TO DOWNGRADIANT STORMWATER DISPERSION. MUST COLLECT AND DIVERT ALL SOURCES OF DRAINAGE AWAY FROM SEPTIC TANK, RESERVE & DRAINFIELD. MUST COMPLY WITH ALL PERMIT CONDITIONS, STATE AND LOCAL CODE. 2.) 10' SEPARATION REQUIRED BETWEEN A WATER LINE AND ALL PORTIONS OF THE ONSITE SEWAGE SYSTEM; EFFLUENT TRANSPORT LINE, TANKS, TREATMENT AND DISPOSAL COMPONENTS 3.) PRIOR TO OCCUPANCY& FINAL OF BUILDING PERMIT -- FINAL APPROVAL OF SEPTIC SEP06-187 IS REQUIRED. 4.) The application was reviewed by the Jefferson County Department of Community Development staff on June 12, 2007 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: landslide hazard area 2; SUSC aquifer recharge area; coastal SIPZ. 5.) 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. 6.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to groundwater aquifers. 7.) 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. 8.) Marine shorelines and islands are susceptible to a condition that is known as seawater intrusion. Seawater intrusion is a condition in which the sa twater/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. 9.) 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. 10.) A vegetative buffer of 70-feet shall be permanently maintailed from the top or edge of the Landslide Hazard Area. All buffers shall be measured perpendicularly from the top of the Landslide Hazard Area. 11.) A Geotechnical Report dated March 13, 2007 prepared by Allen Hart Engineering Geologist was submitted in conjunction with this application. The report addressed the stability of the geologic hazard area. A minimum setback cf 70-feet shall be measured perpendicularly from the top of the geologic hazard to the proposed residence. 12.) PRIORLETTER TOFROM FINALALLEN BUILDINGHART OGL�JTHEPANCY, GEOLOGIST PROPONENTWHOPREPARED SHALL SUBMITTHE •RITTEN , GEOTECHNICAL REPORT DATED MARCH 13, 2007 STATING THAT THE STRUCTURE AND/OR FACILITIES HAVE BEEN CONSTRUCTED IN CONFORMANCE WITH THE REQUIREMENTS OF THE"GEOTECHNICAL REPORT." THE LETTER SHALL BE WET-STAMPED BY THE LICENSED GEOLOGIST/ENGINEER. 13.) 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. 14.) 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." 15.) All construction activities shall not encroach upon the landslide hazard area buffer. This includes the storage or preparation of materials. 16.) 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. 17.) 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. 18.) 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. 19.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 20.) An Engineered Storm Drainage Report, Stormwater Maintenance Manual and Stormwater Site Plan prepared by ADA Engineering 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. 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. 21.) PRIOR TO FINAL BUILDING OCCUPANCY, PROPONENT SHALL SUBMIT AN ORIGINAL WET-STAMPED WRITTEN LETTER FROM ADA ENGINEERING STATING THAT THE STORMWATER FACILITY HAS BEEN CONSTRUCTED IN ACCORDANCE WITH THE REQUIREMENTS OF THE"STORMWATER DRAINAGE REPORT" DATED APRIL 3, 2007 AS SIGNED BY HERBERT A. ARMSTRONG OF ADA. 22.) 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). 23.) The revised site plan dated June 19, 2007 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 June 21, 2007 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 24.) This approval is for a single family residence with attached garage and a detached garage with a satellite bedroom 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. 25.) The parcel has been designated as RR 1:5 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 26.) A Declaration of Restrictive Covenant has been recorded on May 25, 2007 under AFN 523827 for the purpose of limited capacity of the on-site sewage disposal system to 3 bedrooms. 27.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 28.) Not more than 2 unlicensed vehil shall be stored on any lot unless totally signed 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. 29.) The building height is not to exceed 35 feet. 30.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 31.) 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. 32.) 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. 33.) Minimum setback from Beach Drive right-of-way shall be 20 feet. Minimum side (north & south) setbacks shall be 5 feet. Minimum west (landslide) setback shall be 70 feet from top of bank per submitted geotechnical report. 34.) An address of 55 Beach Drive, Quilcene has been assigned to the parcel. Beach Drive is a county local access (C580609). 35.) The parcel is served by the Dabob Cove Community water system, ID#29428. 36.) A septic permit(SEP94-0111) was cancelled on April 12, 1994 and is now filed with SEP06-0187 that was approved on October 4, 2006. 37.) The lot was created through the Kennard Short Plat on December 26, 1995 under AFN 387430. • • ALLEN L. HART ENGINEERING GEOLOGIST 1720 NORTH OAKES,TACOMA,WASHINGTON 98406 (253)752-8963 February 14, 2008 Project No. 0701003 Rob Thomas Thomas Construction P.O. Box 998 1!� Kingston, Washington 98346 ` Site Visit Report ire 08 Coover Residence G;y/1.-0/ 55 Beach Drive iga Quilcene,Jefferson County,Washington Permit Number 07-00202 At your request, this report follows my visit to the referenced site on February 13, 2008 for the purpose of confirming that the completed portions of the site work have been done in general conformance to the recommendations contained in the geotechnical report for the project dated March 13, 2007. This inspection addresses item 1 listed on the Jefferson County Department of Community Development Inspection Results form dated February 7, 2008. Geotechnical Report Referenced "Report of Soil and Slope Survey and Geotechnical Engineering Study, Proposed Single Family Residence, 55 Beach Drive, Quilcene, Jefferson County, Washington, Parcel#701344049", by Allen L. Hart Engineering Geologist for Paul Coover. Report dated March 13, 2007. Area Covered By This Report The area covered by this report extends from the driveway to the north property line and from roughly 50 feet east of the residence structure to Beach Drive and includes the detached garage with satellite bedroom structure. The residence structure and adjacent facilities are not covered by this report and will require an additional inspection when completed. Conclusions Based on my observations made during this site visit and those made during a site visit in August 2007, it is my opinion that the completed site work on the portion of the property identified above is in compliance with the recommendations of the March 13, 2007 geotechnical report and project drawings and GEOLOGIC AND GEOTECHNICAL CONSULTING r * Project No. 0701003 • I Site Visit Report Coover Residence,Permit#07-00202 February 14,2008 Page No.2 acceptable. Within the above identified area structures/facilities have been properly installed and erosion protection provided in all areas of disturbed soil. Intercepted and collected storm water is directed away from slope areas and buildings for disposal. No evidence of surface erosion was observed in or around designated areas of water infiltration or dispersion. No evidence of off-site water flow was noted. Report Limitations This report has been prepared for the exclusive use of Thomas Construction and Paul Coover for use in considerations regarding the subject property. The forgoing comments and conclusions are based on my visual observations made on February 13, 2008 and those made previously in August 2007 and a review of the March 13, 2007 geotechnical report and associated drawings. The conditions described in this report and the conclusions contained in this report are provided for the specifically identified portion of the site only and should not be expanded for use on adjacent sites or properties without additional exploration and review of those sites by this firm. The results of this review are intended for the use of the original client only. Use of this report in whole or part by third parties will require a written agreement be in place between the consultant and the third-party. Within the limitations of scope, schedule, and budget for this work, it is warranted that the work has been done in accordance with generally accepted practices followed in this area at the time this report was made. No other warranty, expressed or implied is made. Should you have any questions or if I may be of additional assistance, please call my office at(253) 752- 8963. , i',VSincerely ; co . �� . en L. Hart, CPG, RG/CEG Engineering Gaologis � Licensed Engineering Geologist / ` _ - c ' . e. - - /. oc)e LALLEN L.H R. ALLEN L.HART ENGINEERING GEOLOGIST 1720 North Oakes,Tacoma,Washington 98406 • ________ ....i...... / .? 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"1: ' -t4 -:-'1.'--.:1-1 > CD � y I v y t r ( o �► r► I - � � \;ma P � 01 )'-/ IPP41410, .44. /, ,1_ 1 __ --\-- li go zi, 4 Pf ci?. ,/ ill 0 i k4 t fl 4111 II 1 , t p. -- _..- Go !il 6 , ---N-; , •tos 'VIIIIIM 1P �,, ESERVE C I il I" P 5'-0 PI 1;:„1 '� �. , rr. , ;f .1 0 SET—BACK - ? t — if .- - - - a , ,,,/, i1 i'" F E IQ E pR` Iva. , o pO D ERA li .4 (41 z 5' -p„ a �,,� • ------ ' �t T—: A K I • SOVERALL SITE PLAN COOVER RESIDENCE N> REVISIONS AUTHORIZATION A 1 ■O. 1 Tax Parcel: 701344049 No. Description Date Owner Approval: par.a.dj� r teach Drive, Ouilcene, WA 98376 Applicable Registrations: Building do Interior Design Date: � 06.09.2y — 2545 NEKayos Pond Dr PERMIT DOCUMENTS Keyplan: 47.784 LAT, 122.783 LON — Poulsho WA 98370 -- — 360--265 9187 8'-0„ / / • C) C) rn N -P N Iv � � I N DETACHED GARAGE (406 SQFT) I- - 11111 DN • 3' 0" 16 - 1 „ i FL 1 PLAN (GARAGE) COOVER RESIDENCE REVISIONS AUTHORIZATION L. I' A2 Date: 2006.09.30 No. Description Dote Owner Approval: par,a,di� Scale: 1/4"=1' Scale n: Applicable Registrations: Building Sc Interior Design PERMIT DOCUMENTS N> _ 254.5 NE Kevos Pond Dr Poulsbo, WA 98370 360-265-9187 r ir I I • I— 1 NTOVE -0 (NI-0 - r- — —. — — z P BED RM - -1 I (146 SQFT m 1 1 0 I 1 ) N I I I I I- - - _ _ - - - J R.I 2'- 6»2'-6„ '-6' • Iv I I -----...1 I_ _ J / / ___1. \--- N TII (3oI °) (3o 14FU SQFT) SQFT) 0CAI ,,urns V r D - . - . _Err cat rC) co m c— �O I 0 0 0 --1-70 1 0 1 I LIVING RM I m UJ o 1 (146 SOFT) Vi N z o I � � I o Cp.I O � I CD 1 . 1111 CD n • 1 3' O" C � 1 L I J ROOF EDGE ABOVE • FL 2 PLAN (GARAGE) COOVER RESIDENCE REVISIONS AUTHORIZATION A2. Date: 2006.09.30Keypla No. Description Date L L Scale: t�gRE Owner Approvol: paz,a,�1�M Scale.n: Applicable Registrations: Building & Interior Design PERMIT DOCUMENTS N> 2545 NE Kevos Pond Dr Poulsbo, WA 98370 360-265-9187 �50N cO JEFFERSON.OUNTY i --/A DEPARTMENT OF COMMUNITY DEVELOPMENT `'4 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax p� www.co.jefferson.wa.us/commdevelopment HIND `'� Master Permit Application MLA: 0 Ia 3 Project Description(include separate sheets as necessary): /• • Tax Parcel Property Number. 70\ y qr.)yc\ Size: �_'( Actt�a (acres/square feet) Site Address and/or Directions to Property: �.t\- fP - qe 3`1 Cb Property Owner(s)of Record: c . C Y-,ri'i'Sk Telephone:(3&) `•t —1 5c- 5 Fax: email: c.c,c' x.Cam_��.��E,•G�,•. Mailing Address: N _QR, v'•,S Mel)t 3--rr) Applican gent if different from owner): o t T v.✓• \.i0i",c1S Telephone: (,3�') LS1-L-i 1'L,Z Fax:(?,(=e.0 j. t'1-35j email: ^-- Mailing Address: •r••C.> DO Cluj`r? \K kf 03A f y?. VVhst..kind of Permit?(Check each box that applies Muilding ❑Variance(Minor,Major or Reasonable Economic Use) El Demolition Permit / " ❑Conditional Use[C(a),C(d),or Cl*" ❑Single Family Garage Attached/Detached El Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home ❑ Modular ❑Special Use(Essential Public Facilities)** ❑ Commercial* ❑Boundary Line Adjustment ❑ Change of Use ❑Short Plat** ❑ Address El Road Approach ❑Binding Site Plan** ❑Home Business El Cottagelndustry El Long Plat** ❑Propane ❑Planned Rural Residential Development(PRRD)/Amendments** El Sign El Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis El Shoreline Master Program Exemption/Permit Revisions** El Stormwater Management ❑Shoreline Management Substantial Development** ❑Site Plan Approval Advance Determination(SPAAD)* El 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 ❑Tree Vegetaion Request *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 designateZQ ;7" TOrrN C.10AS.:. to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE/ `_-+---- Date: //e 7 By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of his,her or it's knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attomey's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any required later inspections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the application that he nor notice. Signature: Date: f a 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 lawsuiten behalf of an endangered species regarding your action(s)even if you are in compliance with the Jefferson County developmentcode:The Applicant acknowledges that he,she or it holds individual and non-transferable o r adhering to and complying with the ESA The Applicant has read this disclaimer and signs and dates it below. Signature: _ , Date:1 7 C:\Documents and Settings\caral\Local Settings\Temporary Internet FileAOLK86\Master Permit Application 12-19-2006.doc • • BUILDER STATEMENT ("�/ i The signer of this statement does hereby certify that they are the Owners of the parcel referenced ha-rein,that they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Date: < ENERAL CONTRACTOR-6R MANUFACTURED HOME INSTALLER: PHONE: FAX: �-7-- ,,.)..T�o C.t)14ts 7. t c. (3cc>)'Z..ri'i- 4)z,?, ( P) 'Z`1-) --ye 51 MAILING ADDRESS: P?Q 2 1;.c.C CCVR K)t,t.€ 1'1 V..DA, EMAIL: CONTRACTORS LICENSE i83` v WAINS NUMBER: '10 t>l�il_k_ J sr 1 3Z-Z- dt_ NUMBER ARCHITECT/ENGINEER: 1::0%.+" viAilcrtrz� _' C�Ci40.1t4 c\ PHONE ( )`s�'c1Za -".3 i'S FAX:( ) ---- - MAILING ADDRESS: ,Z-;_ N ).'.,1LlM`� \c.:;U..Sv.‘t w.4. -�f.J ._ Pro t Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: New Wood Existing: C3 ❑ Sewer ❑ Addition ❑ Steel Proposed: 'i Bank ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: t Height: Individual System ❑ Repair ❑ Masonry NA SEP Permit# 0 4-1 21 ❑ Demolition ❑ Other. Bedrooms: Water Supply: Existing: Setback: Li ,Private well ❑ Two Party Type of Heat: Proposed: 1 t'Public �vrxa�s; = Total: 1 Name of System: „7C WX3 c.,w- .�141/41 Cr...',- - C.:.rne-. rat'z' `c-"C1MA1Z--1 If this is a Commercial Project you must answer the following:( 9/ Number of Parking Spaces: Current: Propose . 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: yj� ❑Underground Tank 1I Above ground Tank Sizez?propane Tank: ❑Heat Stove 0 Cook Stove 8 W L�oodstove 0 Fireplace Insert Hot Water Tank 0 Pellet Stove 0 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 sitepshowing 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: c (ll>,Wte ) -'- c SS F,, 2"FloQrHea' Consistency Review. Other Heated Base fee: CA 0 . Mezzanine Additional Section: 0 Heated Basement Plan Check fee: ce) Unheated Basement State Surcharge fee: l 5.j Other Unheated Pot Water Review fee: C_Garagelearpet# SUBTOTAL 44 Decks 911/Rd Approach fee: Other TOTAL: $ 05 1 l\`�11 Receipt Number: SC1C 5 i 1 Cash/Check Number: �56 � ESTIMATED COST(REQU ,- Date ..\ /1 /0-1 Fair market value of all r and materials foundation, finish.- l r Initials: /�_ . „ ki,Ri t __. 1 ....,,, . C:\Documents and Settings\canal\Local Settings\Temporary 1ntlemet Files\OLK136\Master Permit Applicatign 12-19,2006.doc . .._.