Loading...
HomeMy WebLinkAboutBLD2007-00601 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 #: BLD07-00601 SITE ADDRESS: 1251 WEST VALLEY RD Issue Date: 02/4/2008 CHIMACUM, 98325 Final Date: 11/5/2008 APPLICANT: PETER E BRUMMEL PHONE: 360-638-1140 CAROLYN BRUMMEL 39200 BEAR BERRY PL NE HANSVILLE WA 98340 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901154008 Section: 15 Township: 29 N Range: 01 W PROJECT DESCRIPTION: NSFR W/ HTD BASEMENT & A/G 120 GAL PROP TANK THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2006 EDITION. OCCUPANCY GROUP: R-3 TYPE OF CONSTRUCTION: 5N SPRINKLER SYSTEM yes no THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 11/5/2008 I:\F_BLD_Occupancy.rpt 10/29/19 Jefferson County Building Dion Permit Num BLD07-00601 Applicant: BRUMMEL BUILDING PERMIT INSPECTION APPROVAL.S applicable Code: 2006 International Building Codes To schedule inspections,call (360)379-4455 no later than 7:00 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 Signature Notes Setbacks Erosion Control SEE CONDITION 2&3 WITH ATTACHED BMPs. Foundation Footing 2�2, 08 a Footing Drains 4(31as S. e„,_,, t.,r- Foundation Stem Wall 3/,/DB G4 ,i( Underground Plumbing 3/24/08 `i / OK Under Floor Framing (--f(3(de -- CLOP'edLX-S Straps(hold downs) /a/N/De #`cir 3r�a;S e5K .//Ih// Ext. Shear Wall Nailing /0 3.1/4f Fln DE 11;-7 .5",-/EA,c't J4LI-S 61‹ S/2S/C�1 Rough-in Plumbing Framing `r Airseal q il Insulation:Walls i f Insulation:Floors (, h '1, Insulation:Ceiling '^,'ih t Int. Shear Wall Nailing 7//7/bg- #4,/ Wallboard Nailing //0d 4/ l 7 /EE ,ezPar7►auMe ire PATFC /7 7 — Gas Line: Interior // / /'j Gas Line: Exterior 4/3 /;g'- le;l` Propane Tank ja/Z, Q,8," Heat/Chimney Clearance A%/Dt0/ Drywell/Alt Drainage SEE CONDITION 1. Address Posted lti1f/o8 FINAL INSPECTION 1(_ ,y UI,9 FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR MLA07-00646 UILDING PERMIT APPLICA N Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00601 Received Date: 12/11/2007 SITE ADDRESS: WEST VALLEY RD OWNER: PETER E BRUMMEL PHONE: 360-638-1140 CAROLYN BRUMMEL 39200 BEAR BERRY PL NE HANSVILLE WA 98340 TAX 34 SUBDIVISION: Block: Lot: A PARCEL NUMBER: 901154008 Section: 15 Township: 29 N Range: 01 W CONTRACTOR: S B C CONSTRUCTION PHONE: (360)732-7530 PO BOX 1228 PORT HADLOCK WA 98339 Contractor's License SBCCOCI961JT Expires 4/26/2008 REPRESENTATIVE: PHONE: I �n 'C) I Abb, 1 PROJECT DESCRIPTIOP NSFR W/A/G 120 GAL PROP TANK Oct 1e15E= TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: 884 VALUATION 224,560.00 CODE EDITION: 2006 ADD'L: 621 HEAT TYPE: EEE OCCUPANCY: R-3 HEAT BASE: HEAT TYPE: PRO OCCUPANCY: UNHEATED: #OF STORIES: OTHER: CONST TYPE: 5N GARAGE: SHORELINE: CONST TYPE: SETBACK: DECK: 480 BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: PWELL BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 3 Prop: /3'i Total: 3 Total: /3 Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Permit $1,693.75 LYK 12/11/07 95602 Plan Check $1,100.94 LYK 12/11/07 95602 State Building Code $4.50 LYK 12/11/07 95602 Potable Water Application $58.00 LYK 12/11/07 95602 Total: $2,857.19 1110 • CONDITIONS for Building Permit# :BLD07-00601 1.) DOWNSPOUT DISPERSON WILL BE ROUTED INTO A 27 FOOT TRENCH WITH 4 IN CH PERFORATED PIPE. A VEGETATED FLOWPATH OF AT LEAST 25 FEET IN LENGHT MUST BE MAINTAINED BETWEEN THE OUTLET OF THE TRENCH AND ANY PROPERTY LINE, WETLAND, OR IMPERVIOUS SURFACE. A SETBACK OF AT LEAST 5 FEET SHOULD BE MAINTAINED BETWEEN ANY EDGE OF THE TRENCH AND ANY STRUCTURE OR PROPERTY LNE. NO EROSION OR FLOODING OF DOWNSTREAM PROPERTIES MAY RESULT. 2.) THE MINIMUM HEIGHT OF THE TOP OF SILT FENCE SHALL BE 2 FEET AND THE MAXIMUM HEIGHT SHALL BE 2/5 FEET ABOVE THE ORIGINAL GROUND SURFACE. SILT FENCE REQUIREMENTS ARE PROVIDED IN BMP C233 (SEE ATTACHED). 3.) CONSTRUCTION ENTRANCES SHALL BE STABILIZED WHEREVER TRAFFIC WILL BE LEAVING A CONSTRUCTION SITE AND TRAVELING ON PAVED ROADS. SEE ATTACHED SHEET FOR BMP C105. ANY SEDIMENT THAT IS TRACKED ONTO PAVEMENT SHALL BE REMOVED BY SHOVELING OR STREET SWEEPING. 4.) This 480gpd septic system does not have capacity for an ADU (assesory Dwelling Unit) and this 3bdr home. 5.) A setback of 50-feet, measured perpendicularly from the wetland edge, shall be permanently maintained as a buffer. No filling, grading, clearing, or other alteration of the wetland or its buffer is allowed. 6.) Wetland buffer perimeters shall be marked with temporary signs at an interval of one per parcel or every one hundred (100)feet, whichever is less. Signs shall contain the following statement: "Wetland & Buffer- Do Not Remove or Alter Existing Vegetation." 7.) A permanent physical separation along the upland boundary of the wetland buffer area shall be installed and permanently maintained. Such separation can include installing logs, trees, a hedgerow, or any other prominent physical marking approved by the UDC Administrator. 8.) 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. 9.) 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. 10.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 11.) Not more than 2 unlicensed veh4111k shall be stored on any lot unless totally sljned 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. 12.) A minimum of two(2) on-site parking spaces shall be provided for the single family residence. 13.) The road approach permit(RAP07-00194) must be inspected and finaled by the Jefferson County Department of Public Works prior to the final inspection/certificate of occupancy of this residence. Contact Terry Duff, Department of Public Works at 360-385-9159 for the final road approach inspection. 14.) Maximum lot coverage is not to exceed 10%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 15.) 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. 16.) 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. 17.) The building height is not to exceed 35 feet. 18.) Minimum setback from West Valley Road right-of-way shall be 20 feet. Minimum side and rear yard setbacks shall be 5 feet. If ESA are present, then the more stricter setbacks shall apply. III 0 RE CEWED 50N w4 O JEFFERSON COUNTY EEC I 1 2007 ,. ►.< DEPARTMENT OF COMMUNITY DEVELOPMENT to jr 'µy.' 621 Sheridan Street• Port Townsend • Washington 98368 OHM�0 Ealle( litil y ,0 360/379-4450 • 360/379-4451 Fax "'xCING http://www.co.jefferson.wa.us/commdevelopment/ STORMWATER SITE PLAN SUBMITTAL TEMPLATE MLA# V - lG t(4) PROJECT/APPUCANT NAME: y/4/-e J'7Ji/y 4G' ./i E% lit Mel depiction answer all of the following questionsto the best of your ability. Where the question calls for depi on on a site map, the applicant may choose to either incorporate the elements into the general plot plan for the Master Land Use Application or to submit a 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. T wrud-Q /VD rc�c(1j, J ik i . Pi/�n tiri, 5 L am/ inn �� 7 rot ✓ i')1 / Existing Conditions Summary 2. Describe the existingogr top . Indicate contours o the site wp. _/9 G,,,Ne r/' jpi '/? &ion fit-fari-W .e / 1ir M . / 3. Describe the existing vegetati Indicate nativeve on areas on the site map Ait d lei fo� �e / �� 1.24/&/(—? 4. Describe the existing soils. Indicate soil type on the site map. arm) /d014 'Z//drn1 / • 10f/ 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 o each. ,ey $2i'/1I '� - . /ni,/? 11 17T 7 '1141' 6. Describe any excess levels of noise generated by the proposed use or activity: 4 0 /1/ 1041 �y`1 OVED r//J7 riDH �/ 02 lf2rr2MWATFR PLAN F E B - 4 2008 :N Stormwa S , seam etersiteplantemplate.doc-rev-10/12/2003_����r�d �1`+I,,�.I;•- JEFFERSO OU 5 R DEPT.OF C , Y DEV' P NT SIGNATURE: 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 ma.. • 4.7 / 12/ , �� �7�7 — - 4jr/// / i / L '''i 0 , , 8. Describe the general vicinity of the site, including adjacent land uses and structures, utilities, roads, and sensitive/critical areas (streams,wetlands,lake ,steep slopes,etc.). /9/ iv'zig,c, , -1/i7:0 tywrii3 ., ,0‘2,fi/~/1,/,e li/. a ivw ill-i< /- PermanentStonnwater Control Plan i , 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, p©ffvtioh-reiterating impervious surfaces, and pollution-generating pervious surfaces to verify that the thresholds for treatment facilities and flow control facilities are not exceeded. 9. 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. Lo a se fact-'es on the site and differentiato�ecq ili ves from existing facilities. /7� 1 0. 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 tit t involve the potential for dispersion of contaminants.] fl//fr 11. Describe the performance goals and,a dards applicable to the pr ject. 77� i7 '2 - �-� - t7/1�, 12. Describe the flow coy stem_ /Y=4/y /�// Z ?r.fr/V/7 / //j/ ' stormwater site plan template.dos-rev.10/12/2003 6 411 • r lay I 'CE1 VEIL) 13. Describe the water quality system. `, .n 41 /4„ RffERSON COUNTY UCU 14. Describe the conveyance system analysis and design. .0rii Deb i% '� �� r-e r reo / �rri w y �i '/Y Jr ... 194 15. Describe the source of fill materiall " " i characteristics of fill material,and deposition of excess material. 16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the Uniform Building Code. 77rA Pertri4W2 z,12/ 7-11 c5--/* 0/7e) e-i/ip,A4r-A;`>2 1/?ll�L� 51' e7 MA l'el 17. Describe the pr., ,t �g material., rJ1i3 �r, 1 18. Describe methods for restoration of the sit . ' C g h 't - 7 ��� ,(3 19. An Operation and Maintenance Manual is required for each flow control and treatment facility. [This is normally required for "large"projects only and only those for which facilities are required to control flow or treat runoff.] If included, list the Manuals here. N/f- 20. List here and include any special repork qt studies conducted to prepare the Stormwater Site Plan. 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 here14� r� stormwater site plan template doc—rev.10/12/2003 7 o CONSTRUCTION STORM WATER POLLUTION PREVENTION PLAN(SWPPP) The Construction SWPPP addresses sediment and erosion control during construction. The BMPs indR e}d b'fs alilicant ` 'e 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 Stormriator 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 Litlrits. =rrMit 417�i—V /Z� / r � /i z'J f?i-piai7 , 2. Establish Construction cress. 1 ' If 3. Control Flow Rates. 'v/h- 4. Install Sediment Con ols. .fir 17/ A)7e-e 4�/ �r� '/s 5. Stabilize Soils. • I vey 4/1/ 4e4filip4 .,,i9/e> tri)/- ( 12 Mr/211,-5 6 r-t A' fr/Y./ ,e1 /7y 6. Protect Slopes. 1/ 7. Protect Drain Inlets. 4 ✓ stormwaterseeplantemptate.doc—rev 10/12/2003 8 • • 12 Required Elements—Construction SWPPP(continued) RE 8. Stabilize Channels and Outlets_ � ��r) � 4/C 2e DEC 11 2807 - 9. Control Pollutants. FFI 1lFY D1 N Pii e 1 0. Control De-Watering(the act of pumping ou dwater or stormwater away from an active construction site). AT 41— 11. Maintain Best Mana ment Practices(BMPs). v V r��7 o p -y -,e 7�� 12. Manage the Project. a17# ri2e,/ rr ei ii;a 2. Adjacent Areas. a. Description of the adjacent areas that may be affected by site disturbance (e.g.,g. streams, lakes, wetlands, residential areas,roads).4/7 l 611-- ,,r�tJ� a e /22 .4ce 4,70 b. Description of the downstream drainage path leading from the site to the receiving body of water(minimum distance of 400 yards). _ - i r G�17T l//7 J W/7 c2 / l4/ Y o/ . -iw 3. Environmentally Sensitive Areas. a. Description of environmentally sensitive areas that are o r adjacent to the site. • -ljcj7t d >/1y l/. 14�/' /l/W / 4l Q -e • stormwater site plan template.doc-rev.10/122003 9 • • b. Description of special requirements for working in or near environmentally sensitive areas. 4. Erosion Problem Areas. Description of potential erosion problems on site in the context of the characteristics of the on-site soils(e.g., erodit ility,settleahility,permeability,delp�lt),texture,soil structure). ope 5. Construction Phasing. a. Conk ctie quenc i iiiiVidf/tiriki// /,`',2/7t,f -.41 /./77, i/2/Lenv- work fx/?'r /7i7J 1 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 • oposed construction schedule 5 4 1OF ', C. ai. 'A iv •�/ ,/A i 0S-- Ye 1 Wet Sea.• Construction Activities. a. Pro wet season co ction tivi'es" • V b. Proposed wet ason construction activities for environmentally sensitive areas. 47 7. Financial/Ownership Responsibilities. a. Identify the/7krmd --eft);owner resib( / 217y,7J for the i tiation of s and/or other ficial securities. e b. Describe bonds and/or other evidence of financial responsibility for liability associated with erosion and sedimentation impacts. 8. Engineering Calculations. Provide Design Calculations on a se rate sheet for the following,if applicable. a. Sediment Ponds/Traps. /1 ' b. Diversions. c. Waterways. d. Runoff/Stormwater Detention Calculations stormwater sae plan template doe-rev 10/12/2003 10 • • • Stormwater Site Plan Changes If the designer wishes to make changes or revisions to the originally approved Storrnwater Site Plan, the proposed revisions shall be submitted to DC(:), 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 shalt submit a Sinai corrected ply: ("as-buitts")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 an owners of the affected property. iyvy/ 7 (LQNIYNNNER ..,,.!ZED RE AT!VE S!GN .TURF) (DATE) THIS SPACE MAY BE USED FOR ADDITIONAL NOTES,IF NEEDED: Tr74f1 .� iN A_,‘ i A stormwater site plan template.doc—rev.10/122003 12 c(csON OG JEFFER.COUNTY410 t� DEPARTMENT OF COMMUNITY DEVELOPMENT `` t 621 Sheridan Street• Port Townsend •Washington 98368 360/379-4450 • 360/379-4451 Fax Is:), , ,,y www.co.jefferson.wa.us/commdevelopment IiING Master Permit Application MLA: �� j (,��( , Project Description(include separate sheets as necessary): :'YP ._/ ,J / / / 49r%o-/2r2' 7/u, Tax Parcel / Property Number: /��/ '� v / Size: ..- 01-1 C--... (acres/square(acres/square feet) Site Address and/or Directio s to Pr erty: •. l' cv fJi2ek e -6%f— i//i 7d l%i 1/27 7 j.'rry Property Owners)of Reco : f' ( 4' ,ert j lw/ 7 Telephone: ' ' ;)'1—'-,E-74 l MailingAddress: .• �,/ Applicant/Agent(if different from owner): / Telephone: Fax: email: Mailing Address: Whalkind of Permit?(Check each box that applies wilding ❑Variance(Minor,Major or Reasonable Economic Use) El molition Permit ❑Conditional Use[C(a),C(d),or C]** Ingle Family ❑Garage Attached/Detached ❑Discretionary"D"or Unnamed Use Classification ❑ Manufactured Home ❑ Modular ❑Special Use(Essential Public Facilities)** ❑ Commercial* ❑Boundary Line Adjustment ❑ change of Use ! ❑Short Plat** Address Ergo-ad Approach ❑Binding Site Plan** ❑Home Business ❑Cottagelndustry El Long Plat** D'Propane ❑Planned Rural Residential Development(PRRD)/Amendments'"` El Sign ❑Plat Vacation/Alteration'" ❑9llewed"Yes"Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisions*" tormwater 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 ❑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 designate /,/y to act as my agent in matters relating to this application for permit(s).7 OWNER SIGNATURE Date: z cy/' 7 ' ` By signing this application form,t e owne agent atte at the information provided herein,and in any attachments,is true and correct to the best of his,her or it's knowledge. Any m terial 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_ Staffs s and right of entry will be assumed unless the applicant informs the County in writing at the time of the application t e wa ri oti . $k' Date: / � The action or actions A plicant w' 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" ith the Je n County development code.The Applicant acknowledges that he,she or it holds individual and non-transferable nsi ' fora • o a complying with the ESA The Applicant has read this d" c imer arp sigpsorates it below. Signature: Date: 'OW C:\Documents and Settings\carat\Local Settings\Temporary Internet Files\OLK$6\Master Permit Application 12-19-2006.doc P 9 BUILDER STATEMENT • The signer of this statement does hereby certi that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that Si they willgnatu be a assumi. .. . i - ♦eneral Contractor for the proposed projegi � 1 41011 /ft"�� / 1 GENERAL CONT'•CTOR OR MANUFACTURE HOME INSTALLER: PHONE: FAX: Pei eOf fti t? 7� y in ( ) MAILING ADDRESS: %Q v ') fr,- gef Cii/i i, Wil EMAIL: 43� /n f/ �Yn,, ,4NA/,e+ CONTRACTOR'S LICENSE / A WAINS NUMBER: z k'.2AJ T NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frarye Type: Bathrooms: Shoreline: Type of Sewage Disposal: New ood Existing: - t;i • ❑ Sewer ❑ Addition ❑ Steel Proposed: 1Bank L Community System ❑ Alteration/Remodel Li Concrete Total: _ Height: [ dividual System Li Repair ❑ Masonry SEP Permit# 177--c93s) Li Demolition ❑ Other: Bedrooms: WatvSupply: Existing: Setback: rrivate well ❑ Two Party Ty of Heat: Proposed: —J ❑ Public ' e'er Total: _'5 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 nd/or Appliance Installation permit,mark all items below that apply: 0 UU dergroundTapk Above ground Tank Size of Propane Tank: /Z 1e7 Ai/f /2 L7 I3 O Heat Stove 'book Stove 0 Woodstove 0 Fireplace Insert E7 Hot Water Tank 0 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 /3 e/L 1(.‘1_ EH Bld App Review: (,, 2"°Floor Heated OA/ 4 `5 Consistency Review. 155(K2i Other Heated Base fee: I'j 72- (p43. Z5 12.LID Mezzanine - , Additional Section: r1 Heated Basement Pe-NI'SILT-) `�civz• Plan Check fee: 1 151.9D Iz- I-7- gSLiI i oC • i 50.4(0 Unheated Basement State Surcharge fee: ~3L Other Unheated Pot Water Review fee: Garage/Carport SUBTOTAL , 3113. ('d1•3t Decks 911/Rd Approach fee: c-----\ jam ' Other II r f'/c TOTAL: $ 3Z �) I� (g� Receipt Number. C,c ,,Q 2. lap I 0 Cash/Check Number: ^� 1t ) Cr) 1 0v ES MATED COST(REQUIRED) Date: .Fa market v ue of all labor and�materials fou cation to nl l 7.�1}'C i 1 (a," 01 ,.) C:\Documents and Settings\canal\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.doc 0 O 1NAWG5V9 �Nb'd MONIS) (07 2! I x„g-,Z -/+ (.(21 p_q x p_Z -/+ �� 1N 'dN ,A-,8 ® gIMX� (Z) O MLAdN M ONINMO 1N3WDSb9 �Ndd Ai9NI5, �� �� . *WA .4 „8-,q 0 I8Z2!'d lir al-I 'du „O-,g 0 qh , r 111 MUM I , dNIM Nag =4 „Z-,Li N - "' - 'IMX9,,N1,) rNr �' Y f 161 __, „,„ �' C v t� 7 51 d Ndl % w g10N O Q I` f -r�Ma► ►►,� N7I� ��,� N1b II NQd2 0 -_ 'II „8 Z„P „.•-,Z w ,O-q i.4--I4Al \ i i '•• • =2,2,.,,t,,i;tk gvifi\ O `� °� .111NbA N 9 - 7 0 ZZ x,vZ I !76 JI I N - 10N ^"Ct.• 4 ,M c_7) CIA f-J MI --I t . � _ . dcl„ MON „X„ n 6, s Jg. -d_ 'Jr °1 FINIS O cl p I w s . ; fs- __-- Wf 1 -, _. NIS xglMx� ,� - 1C. �-�c' 11 ' I 0 I „8-,II „tt- Igr 21QN Wd� b'd ,, 1 II -6 x„z/I- \, ` :1 Idu W Ibd „z/I y �du Wddd-+ „Z/1-6 x„Z/I-� IIlM 0 i' .Z/I-6 x 1/1.- . _ ` x „ „ x q� -. O Ill 080q GMJ —�- x (D'� ,A-5 x„Z-,L -/+ 1, ( p O 1N3WgSb7 �lbd 1d211) Q 08O' �M� /„ -,I „�-,5 / 1 _ - /• 1u '41 I p-,8 SUMO u? „cp J_____ �• N'J JQ `ADJ g-,zl i u urz--- rii ,, „o-,zl IT: 1 �� (� u3 1u ld w�----� ___ ,�• v'- _ � I II ,L OI-,� Q „t'i „{�-01 I - / I „ ' x= „� „q-,q I „, 1-5 ryA-,� „t� I---- t, -1129 IA 1- Mr ddiS 11�6 ' — Q a „g-,Z ,01-, IL w 0 b a .� Nil • (1dZl, �„91 t� N Fil I, I I -NC- R 1u '-id „I-,5 ` - - 1-1- J dODI t�v I- -r _ • x o - x1 ) o N _ idu ZI x Z (Z) I I X o _ `� ill aN x _._� o �IYw� g ao II _ — - — •ems „I-,8 1 Z c NJ _ v. N 5 'irA _ • S y L I 11-1 Id „I-,5 L. a I- „ZZ x„q� T 0 , rn rn -1 , A J � gxZ . . I Q 1.-.� -+ L „t/ „O-, I '1u -Id „Z-,L „V ,0- „q 0- „Z-,6 L_J e N, -G-I9 „I--,q IC; L__.) 4. " 1NDW�5y0 ;Mid NIS) •1u id „Z-,L .41 CJ�p � , 1u 'au „g-,g frIx r---1 r--, „g-,ZI I I r'---1 „O-,ZI I I L-_J 1 I I I i--i r- 1 L__J I I I 1 1 ! L__J L__J 1 1 L__J ' c_ T "Tn g n _ o � _ c g ...2, t ~ � . . e e=3 I t 1 s �%rM I 1 \\\ I / i \vit. 0 - i 0 , ' _ �`' -i-; A / ki‘ 1 ) i ----_ . ® --i. . / , II 1 i t- 1 -.. ..___ i it F 1 _ .w 1 i S., ' i i , \kci"-- /,, ; ; i \\\ 1 j �` -` r '�- F II '/ 7/ ( ; , {r- i , . • T , i E • , , . I ,I . . , , s ; , . • . . ��� '.1 ..�....�.- .�. _ ...,- 1-� i ..... Ti r—r-i r-Tr; tt C.PD cv rolik)-- : . 0 ",(0..1 r- ,/,4- -1- -f tP7 _ / -- 40( 0 I ' . ......___ .. ) ', /z - -- I ...... ' .- L *1. NI / , . i 1 , , • 'Jo ' - . , } \ t.-i - - IA v § /- /. .,,---- -A. .7% /--- , 1-,2_ . ......- i '''' 10 ! - 1' - ii . \-33 • , ,. • - ,.,' itit- .._://i.. < ‘ --V I -NM --", j 00/ * . / • t *V-1. . klc Z — z(g-I\L fr, ;-a (:-------- - \II _,..f.-- -s- -\1_ i --‘, 1; 1 `1\ A a v 1 ..„ -,,-., ..t.ri + ---...-t _A— • - : \SI ' ... - .1,' , '.1 \\V . , i • xt,/- * i A, n --- 1 IA •H ,0)0/-------' ' 1%i ---il / \kk i— — — — — — - /- , • — 5 I ` , J 1 ) / I'; _4 I, , .. . lk .15... tn‘111‘ 1_‘ \--_,\ 5 \\•;\ k 1--:„.z.__'s, ) - 'A'-ic• -4. I - lilt' li Vil 'Ili-4 'i---i !i-1- , -A lz_ 1 kc 1 ,, , ,A., ‘ li, 1 --A V\.y I* rt 7116 svir„ z ‘1.1 C'g k (4;) ----""--111D t 4.00,01 I ' —e-i >• i.4 c,.. xj. g rim 7.:AT ce3 ca. c o t=1 ...I gisi ........ lir. tpl ":1.., co GI , I.° 1 Amiej 111W. W *" 0.1 iii 1 I w 8.69/1 ...._ 'I _ic — tam -v-- .• ,"se ' . V., t-: °I)