HomeMy WebLinkAboutBLD2008-00232 tUILDING PERMIT APPLIC MLA08-002i
AN Review T :i
Jefferson County Department of Community Development ype
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD08-00232 Received Date: 6/2/2008
SITE ADDRESS: (BOA RHODODENDRON LN
OWNER: MIKE RASTELLI PHONE:206-244-7783
JODEE L RASTELLI
15640 18TH AVE SW
BURIEN WA 981662702 PLEASANT TIDES
SUBDIVISION: Block: Lot: 29
PARCEL NUMBER: 988500029 Section: 14 Township: 25 N Range: 02 W
CONTRACTOR: SEAHOME SERVICES, INC PHONE: (360)765-3749
7425 THORNDYKE RD
QUILCENE WA 98376
Contractor's License SEAHOSI077KS Expires 11/30/2009
REPRESENTATIVE: GREG BARRON PHONE: 360-765-3749
7425 THORNDYKE RD 360-765-4551
QUILCENE WA 98376
PROJECT DESCRIPTIOl NEW DETACHED GARAGE & HTD 2nd FLOOR W/ BATHROOM
TYPE OF WORK GAR SQUARE FOOTAGE:
TYPE OF IMP NEW
VALUATION 160,000.00 MAIN:
CODE EDITION: 2006 ADD'L: 660 HEAT TYPE: PRO
OCCUPANCY: HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
CONST TYPE: OTHER:
CONST TYPE: GARAGE: 820 SHORELINE:
DECK: SETBACK:
SEWAGE DISPOSAL: ALT BANK HEIGHT:
WATER SYSTEM: OTHER
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 0 Prop: 1
Total: 0 Total: 0
Routing Date:
Type Amount Paid Bv: Date: Receipt: Approved/Date
Permit $1,329.75 LYK 06/02/08 100304
Plan Check $864.34 LYK 06/02/08 100304 APPROVED
State Building Code $4.50 LYK 06/02/08 100304
Total: $2,198.59 SEP (] 2008
Jefferson County Planning
& Building Department
•
Jefferson County Building Division Permit Number: BLD08-00232
BUILDING PERMIT INSPECTION APPROVALS Applicant: RASTELLI
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 Minimum setback from Rhododendron Lane right-of-way shall be 20
Feet. l imum-side yard setbacks shall be 5 feet. Minimum-setback
c , from Ordinary High Water Mark,as depicted on the site plan, is 90 feet.
Erosion Control i � `� ;" 'SEE CONDITION 2t 3 FOR SILT FENCE AND STABILIZE
C Cam. e i# ��.
Foundation Footing t f
'1 4L L -
Foundation Stem Wall /6/40B v Grp
Under Floor Framing N
Straps(hold downs) ///2cajQR �►/
Ext.Shear Wall Nailing // t,,a „
Rough-in Plumbing - - �
( •
Framing-
Blocking
Airseal r,
,.,)--CZ-Di i
Insulation:Walls p
Insulation:Floors ' `
Insulation:Ceiling
Int. Shear Wall Nailing
Wallboard Nailing l l'o
Gas Line: Interior t
Gas Line:Exterior
Propane Tank
Drywell/Alt Drainage SEE CONDITION 1 FOR DISPERSION TRENCH
REQUIREMENTS.
Address Posted
Jf�Pt-O. wile
la ty�
FNo D in-ts�'
FINAL INSPECTION 1_5_ Iv J-DC_ TT_Achets.
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
• •
CONDITIONS for Building Permit# :BLD08-00232
1.) THE FOLLOWING MINIMUM LENGTHS (LINEAR FEET) PER 1,000 SQUARE FEET OF
ROOF AREA BASED ON SOIL TYPE MAY BE USED FOR SIZING DOWNSPOUT
INFILTRATION TRENCHES:
COARSE SANDS AND COBBLES 20 LF
MEDIUM SAND 30 LF
FINE SAND, LOAMY SAND 75 LF
SANDY LOAM 125 LF
LOAM 190 LF
MAXIMUM LENGTH OF TRENCH MUST NOT EXCEED 100 FEET FROM THE INLET
SUMP.
MINIMUM SPACING BETWEEN TRENCH CENTERLINES MUST BE 6 FEET.
FILTER FABRIC MUST BE PLACED OVER THE DRAIN ROCK PRIOR TO
BACKFILLING.
A VEGETATED FLOWPATH OF AT LEAST 25 FEET IN LENGTH MUST BE
MAINTAINED BETWEEN THE OUTLET OF THE TRENCH AND ANY PROPERTY LINE,
STRUCTURE, STREAM,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 LINE.
NO EROSION OR FLOODING OF DOWNSTREAM PROPERTIES MAY RESULT.
2.) A SILT FENCE SHALL BE INSTALLED BETWEEN THE PROPOSED STRUCTURE AND
HOOD CANAL, AT A MINIMUM OF A LEAST 50 FEET LANDWARD OF ORDINARY
HIGH WATER MARK PRIOR TO ANY LAND DISTURBING ACTIVITY.
THE MINIMUM HEIGHT OF THE TOP OF SILT FENCE SHALL BE 2 FEET AND THE
MAXIMUM HEIGHT SHALL BE 2 1/2 FEET ABOVE THE ORIGINAL GROUND
SURFACE.
THE SILT FENCE SHALL BE BURIED IN A TRENCH TO A MINIMUM DEPTH OF 5
INCHES BELOW THE GROUND SURFACE. THE TRENCH SHALL BE BACKFILLED
AND THE SOIL TAMPED IN PLACE OVER THE BURIED PORTION OF THE SILT
FENCE, SUCH THAT NO FLOW CAN PASS BENEATH THE FENCE AND SCOURING
CAN NOT OCCUR.
ANY DAMAGE TO THE SILT FENCE SHALL BE REPAIRED IMMEDIATELY.
SEDIMENT DEPOSITS SHALL EITHER BE REMOVED WHEN THE DEPOSIT
REACHES APPROXIMATELY ONE-THIRD THE HEIGHT OF THE SILT FENCE, OR A
SECOND SILT FENCE SHALL BE INSTALLED.
3.) CONSTRUCTION ENTRANCES•LL BE STABILIZED WHEREVER TRAF•WILL
BE LEAVING A CONSTRUCTION SITE AND TRAVELING ON PAVED ROADS OR
OTHER PAVED AREAS WITHIN 1,000 FEET OF THE SITE.
THE ENTRANCE SHALL BE CONSTRUCTED ON A FIRM COMPACTED SUBGRADE.
QUARRY SPALLS (OR HOG FUEL) SHALL BE ADDED IF THE PAD IS NO LONGER IN
ACCORDANCE WITH THE SPECIFICATIONS. (BMP C105, 2005 DOE STORMWATER
MANUAL).
ANY SEDIMENT THAT IS TRACKED ONTO PAVEMENT SHALL BE REMOVED BY
SHOVELING OR STREET SWEEPING. THE SEDIMENT COLLECTED BY SWEEPING
SHALL BE REMOVED OR STABILIZED ON STIE.
ANY QUARRY SPALLS THAT ARE LOOSENED FROM THE PAD, WHICH END UP ON
THE ROADWAY SHALL BE REMOVED IMMEDIATELY.
UPON PROJECT COMPLETION AND SITE STABILIZATION, ALL CONSTRUCTION
ACCESSES INTENDED AS PERMANENT ACCESS FOR MAINTENANCE SHALL BE
PERMANENTLY STABILIZED.
4.) 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.
5 ) The property owner shall comply with Water Conservation Measures (per list maintained
by the UDC Administrator).
6.) 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.
7.) 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.
8 ) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
9 ) 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 automobile 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 requirements 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.
10.) This parcel is within the Black Point no shooting area per JCC 8.50.
11.) Residential developers and individual builders shall be required to preserve shoreline
vegetation and reduce the associated risk of erosion during construction and any future
activity which may impact the stability of the shoreline.
•
1'?.) •Maximum lot coverage is not to exceed 25%. Lot •
impervious surface which includes roof tops, driveways,concrete, etc. as amount of
13.) Minimum setback from Rhododendron Lane right-of-way shall be 20 feet. Minimum side
yard setbacks shall be 5 feet. Minimum setback from Ordinary High Water Mark, as
depicted on the site plan, is 90 feet.
14.) 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.
15.) 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.
1(3.) The building height is not to exceed 35 feet.
17.) The applicant shall fully adhere to all conditions and requirements of the eagle habitat
management p
il
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NCp ` , r— �^! -`I1:iJEFFERSON COUNTY ' '
at i J U N - 2 2008 '' . '1'
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DEPARTMENT OF COMMUNITY DEVELOPMENT ,
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,� . + 621 Sheridan Street • Port Townsend • Washington 98368 1
,CO 360/379-4450 • 360/379-4451 Fax p r
d` http://www.co.jefferson.wa.us/commdevelopment/ _ —
STORMWATER SITE PLAN SUBMITTAL TEMPLATE
MIA f# L OW PROJECT/APPLICANT NAME: L1,tFicSrle, t
1
Please answer a I of the following questions to the best of your ability. Where the question calls for depiction on a site map, the
nipplic:ant may choose to either incorporate the elements into the general plot plan for the Master Land Use Application or to submit a
.eparate stormwater site plan map.
Project Overview
1. Describe tie proposed developed conditions of the site. Indicate position and relative size of proposed improve rents on the
site map.
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Existing Conditions Summary
2. Describe tie existing topography. Indicate contours on the site map.
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3. Describe tie existing vegetation. Indicate native vegetation areas ;in the site map.
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4. Describe tie existing soils. Indicate soil type on the site map. _
5. Describe tie existing site hydrology(i.e., drainage; behavior of water on the site—above, below, and on the grouid). 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.
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6. Describe eny excess levels of noise generated by the proposed use or activit APPRBV'JD
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Stormwa 'S ate,doc--ray. 10/12/2003 Require A`
JEFFERSON .
DEPT.OF '., ♦j�itS
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• •
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.
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8. Describe tie general vicinity of the site, including adjacent land uses and structures, utilities, roads, and sensitivei'critical areas
(streams,wetlands,lakes,steep slopes,etc.).
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Permanent Stormwater Control Plan j
JUN - 2 2008 ,
This porticn of the Stormwater Site Plan consists of the selection and installation of the appropriate p stormwater control BMPs
and facilities to remain in place after construction of the project is completed. ( J
"Medium" size projects are required to have the totals calculated of all impervious surfaces,es, pollution-generating`itrOru�bus�1
surfaces, and pollution-generating pervious surfaces to verify that the thresholds for treatment facilities and flow control
facilities are not exceeded.
g. Describe tie developed site hydrology, as proposed. Indicate whether stormwater will be fully dispersed (i.e., per BMP T5.30
in the Mar ual)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 tJ site plan and differentiate proposed facilities from existing facilities.
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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]
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1.1 Describe tie performance goals and standards applicable to the project.
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12. Describe tie flow control system.
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13. Describe tie water quality system.
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14. Describe tie conveyance system analysis and design.
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16. Describe tie source of fill material, physical characteristics of fill material,and deposition of excess material.
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16. Proposed methods of placement and compaction consistent with the applicable standards on Appendix Chapter 33 of the
Uniform Building Code.
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17. Describe tie proposed surf cing mate '
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18. Describe methods for restoration of the site.
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19. An Operat on and Maintenance Manual is required for each flow control and treatment facility. [This is normal,required for _ __
"large"projects only and only those for which facilities are required to control flow or treat rinofk] If included,list the�Manuals
here.
JUN - 2 2003
20. List here and include any special reports or studies conducted to prepare the Stormwater Site Plan.
N /,pt —
2'1. List other necessary permits and approvals as required by other regulatory agencies. If those permits or approvah>include
conditions that affect the drainage plan or contain more restrictive drainage-related requirements,describe those conditions or
restriction;.here.
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WIMP DCII7
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CONSTRUCTION STORMWATER POLLUTION PREVENTION PLAN(SWPPP)
he Construction SWPPP addresses sediment and erosion control during construction. The BMPs indicated by the applicant in the
l)mplate that folkiws 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
i levelopment.
l E CTION 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 net 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.
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2. Establish Construction Access.
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3. Control Flow Rates. •
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4. Install Sediment Controls. --
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5. Stabilize Soils. -- — . ) yt t ..:., 1
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6. Protect Slopes.
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7. Protect Drain Inlets.
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•
12 Required Elements—Construction SWPPP(continued)
8. Stabilize Channels and Outlets.
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9. Control Pollutants.
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10. Control De-Watering(the act of pumping groundwater or stormwater away from an active construction site).
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11. Maintain Best Management Practices(BMPs).
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-
12. Manage the Project.
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2. Adjacent.4reas.
a. Desc iption of the adjacent areas that may be affected by site disturbance (e.g., streams, lakes, wetlands, residential
areas, roads). n
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b. Description of the downstream drainage path leading from the site to the receiving bodyof riee-4400. ,�II11
yards).
JUN =220081
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3. Environmentally Sensitive Areas.
a. Description of environmentally sensitive areas that are on or adjacent to the site.
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e'orr we ter site plan tempi 3te.doc—rev.10/12/2003
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:3tonnwater Site Plan Changes
II the designer wishes to make changes or revisions to the originally approved Stormwater Site Plan, the proposed revisions shall be
:.ubmitted to DCD prior to construction. The submittal shall include substitute pages that include all proposed changes, revised
drawl igs showinc any structural changes,and any other supporting information that explains and supports the reason for the change.
I'inai Corrected Plan Submittal
If the project incl_ded construction of conveyance systems, treatment facilities, flow control facilities, or structural source control BMPs
Inot 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
r onst•ucted.
APPLICANT SIGNATURE
B :signing the Con ruction SWPP worksheet, I as the applicant/owner attest that the information provided herein is true and
corn ct to the b:s my knowl . I also certify that this application is being made with the full knowle e and consent of all
owners of the of d propert .
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(LAND HO PRESENTATIVE SIGNATUR /
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HIS SPACE MAY BE USED FOR ADDITIONAL NOTES, IF NEEDED:
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PERMIT # 8L1
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or iwzler site plan temp)ate.doc-rev.10I12I2003
12
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Cad JEFFERSuN COUNTY 17, `'-!: �' T+,; .;
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621DEP SheridanRTM T StreetOF • PoMrtUNI Tov rj"se •"WasPqhingtonT 98'368 'I I ' f
,�� k. 360/379-4450 • 360/379-4451 Fax 1
www.co.jefferson.wa.us/comnad`eielppmentN - 2 L�G� j
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Master Permit Application
Project Description(include separate sheets as necessary):
e e 7QLam, —AP AI 057A-G-liZV
Tax Pa tel �gg� � _
Number: �g Property
t Size:
(acres/square feet)
Site Address and/or Directions to Property:
(R)1,Cd 0 cizAidr 0•J LetiOZ- B I i N 1.—d LA)
Property Owner(s)of Record: M.f r� R kSTe I I f ( t)ft l Y
Telephone: R 06 If if —,-)g 3 Fax:
Mailing Address: 54 Q -AK Jam. S gJ er4oi IA/Pr all. R
Applicant/Agent(if different from owner): ,p
Telephone:36 0 -1 6%— 3.1 L7 9 Fax: 0 — S—
N� email:
Mailing Address: (
.� � .�i C� WA' 74
What kind of Permit?(Check each box that app ies
KrBwilding ❑Variance(Minor,Major or Reasonable Economic Use)
C Demolition Permit ❑Conditional Use[C(a),C(d),or C]**
E Single Family .Garage Attached/ ached ❑Discretionary"D"or Unnamed Use Classification
❑ Manufactu"ed Home 0 Modular ❑Special Use(Essential Public Facilities)**
❑ Commercial* 0 Boundary Line Adjustment
❑ Change of Use 0 Short Plat**
El Address ❑Road Approach 0 Binding Site Plan**
0 Home Busin:ss 0 Cottagelndustry ❑Long Plat**
j>?l Propane ❑Planned Rural Residential Development(PRRD)/Amendments**
❑Sign ❑Plat Vacation/Alteration**
❑Allowed"Yes"Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit:Revisions**
❑:Stormwater Management ❑Shoreline Management Substantial Development
0 Site Plan Approval Advance Determination SPAAD *'
❑Temporary Use ( ) El Management Variance
❑Wireless Tel * ❑Comprehensive Plan/UDC/Land Use District Map Amendment
❑Jefferson County Shoreline Master Program Amendment
❑ Forest Practices Act/Release of Six-Year Moratorium
*May require a Pre-Application Conference Tree Vegeta** ionRequires
Request
a Pre-Application Conference
Please identify any other local, state or federal permits required for this proposal, if known:
I hereby designate �
se@ pot JDESIGNATION OF AGENT
to act as my agent in matters relating to this application for permit(s).
OWNER SIGNATURE 3/5/p S'
Date: !/
B!r signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of
his,her or it's knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet
may result in this permit being null and void.
I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and
expenses which rray in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit.
I further agree to F rovide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpo:.e of application
review and any required lat I spections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
tine of the app' th h or she wants prior notice.
..Signature: �//a
-- Date: a9_ _
The action or acticns Applicant will undertake as'a result of the issuance of this permit may negatively impact upon one or more threatened or
endangered specir;s 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 c liance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
arid+ion-trans e I le esp ility for adhering to and complying with the ESA. The Applicant has read this disc aim r nd signs and dates it below.
Signature: r�
Date: WO
I :\])o::uments and Settings\caral\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.doc
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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
th ay will be assum ng the responsibility of the General Contractor for the proposed project.
Signature:
Date:
GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX:( ) � _37 (30 76S-ems l
. ArkAte S �rcf ?Li Soo ? S y9
MAILING ADDRESS: -7 it AG )rN,404 y lc. Ad EMAIL:
CDNTRACTOR'S L CENSE WAINS
N JMBER: L !
s t HoSl 0 7 7/J NUMBER
et 1
PHONE ( ) FAx:( )
ARCHITECT/ENGINEER: --
MAIL ING ADDRESS: EMAIL Project Type: Type:
Frame Bathrooms: Shoreline: Type of Sewage Disposal:?)(NewP�Wood Existing: I Sewer
❑ Addition ❑ Steel Proposed: 1 Bank O l 1 Community System
❑ /iteration/Re•nodel ❑ Concrete Total: t Height. individual System ri
❑ MasonrySEP Permit# , Po2t 71
❑ De Bedrooms: Water Supply:
❑ Demolition ❑ Other: Existing: Setback: 1 Private well I I Two Party
of Heat: Proposed: Co .,�" t i�Public
0pa o.pfta� Total: �- I Name of System:.
If this is a Commercial Project you must answer the following: ii
N inter of Parking Spaces: Current: Proposed: Number of ADA Parking,.Spacesl t ''
N Jmber of occupants(includes owners,tenants,employees,etc) Current Proposed
IE C Occupancy: IBC Type of construction: Will you have Food Service? Yes,U J�o 2 n r
If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply:
IJ Underground lank Above ground Tank Size of Propane Tank: 5%.0
Beat Stove 0 Cook Stove 0 Woodstove ❑ Fireplace Insert aKot Water T k 0 Pellet Stove !CI Other ��f
Is this appliance being installed in a Manufactured/Mobile Home? Yes I N
<l iY
When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property
line., tank location and size,distances from the propane tank to all property lines,buildings and septic system components,
including the reserve area. Revision
S�3uare Footage Lc. rrent Proposed For Office Use Only Amount
Main Floor Heated EH Bld App Review: In
2`�I-loo Heated At,„1 JL}?O Consistency Review: 137
Other Heated Base fee: ` + g
1- 1
Mezzanine
n: -
H aated Baseme it Plan Check fee:
Unheated Baserient State Surcharge fee:
Other Unheated Pot Water Review fee:
Garage/Carport s2R O 2o6TV SUBTOTAL
Dacks 911/Rd Approach fee: i e a0
Other TOTAL: $ 40 Receipt Number: 1D0
Cash/Check Number: ( Jl 1
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