HomeMy WebLinkAboutBLD2010-00093 •
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
Al Scalf, Building Official
PERMIT #: BLD10-00093
SITE ADDRESS: 293704 HWY 101 Issue Date: 04/19/2010
QUILCENE, 98376 Final Date: 7/8/2010
APPLICANT: SAUNDRA A SHARP PHONE: 360-775-3168
FRANK J SHARP
PO BOX 426
QUILCENE WA 98376-0426
SUBDIVISION: HYDE SHORT PLAT Block: Lot: 1
PARCEL NUMBER: 932700018 Section: 14 Township: 27 N Range: 02 W
PROJECT DESCRIPTION: NEW M/H - SER#33243
THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING
CODE 2006 EDITION.
OCCUPANCY GROUP:
TYPE OF CONSTRUCTION:
SPRINKLER SYSTEM yes no
THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 7/8/2010
I:\F_BLD_Occupancy.rpt 10/29/19
MANU IN
JeffeFArson CountyURED/MOBILE Department ofHOME CommunityST DevelopmentLATIONPERMIT
621 Sheridan Street, Port Townsend, WA 98368
(360)379-4450 FAX (360)379-4451
PERMIT#: BLD10-00093 Received Date: 3/30/2010
SITE ADDRESS: 293704 HWY 101 Issue Date:
QUILCENE, 98376 4/19/2010
APPLICANT: SAUNDRA A SHARP
FRANK J SHARP
PO BOX 426
QUILENESUBDIVISION: HHYDE SHORTAPLAT6 0426
Block: Lot: 1
PARCEL#: 932700018 Section: 14 Township: 27 N Range: 02 W
CONTRACTOR/ BUY RITE HOMES PHONE: (360) 681-0777
DEALER 259403 HWY 101
SEQUIM WA 98382
Contractor's License BUYRIH*0840B(3Expire1-s 05/20/2010
PROJECT DESCRIPTION: NEW M/H
MAKE: YEAR:
SIZE:
Directions
To Site:
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 ylfit Minimum setback from SR 101 right-of-way shall be 50 feet. Minimun
Jioty'b' .-- s�I� south property setback from ingress/egress easement shall be 20 feet.
C. Minimum north and west setbacks shall be 5 feet.
Erosion Control SEE CONDITION 3
Drywell/Alt Drainage SEE CONDITION 2
"61,04--Cnel PIA410 Avi6
FINAL INSPECTION Th`c� l U
v '
FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED
THIS PERMIT IS VALID FOR ONE YEAR
SPECIAL CONDITIONS APPLY- SEE REVERSE
h.
MLA10-00120
BOLDING PERMIT APPLICATA" Review Type:
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD10-00093
Received Date: 3/30/2010
SITE ADDRESS: 293704 HWY 101
QUILCENE, 98376
OWNER:
SAUNDRA A SHARP PHONE: 360-775-3168
FRANK J SHARP
PO BOX 426
QUILCENE WA 98376-0426 HYDE SHORT PLAT
Block: Lot: 1
SUBDIVISION:
PARCEL NUMBER: 932700018 Section: 14 Township: 27 N Range: 02 W
CONTRACTOR: BUY RITE HOMES
PHONE: (360) 681-0777
259403 HWY 101
SEQUIM WA 98382
Contractor's License BUYRIH*0840B Expires 5/20/2010
REPRESENTATIVE: PHONE:
PROJECT DESCRIPTIOP NEW M/H
TYPE OF WORK MOB SQUARE FOOTAGE:
TYPE OF IMP NEW MAIN: 1,286
VALUATION ADD'L.: HEAT TYPE: EEE
CODE EDITION: 2006 HEAT BASE: HEAT TYPE:
OCCUPANCY: UNHEATED: #OF STORIES:
OCCUPANCY: OTHER: SHORELINE:
CONST TYPE: GARAGE: SETBACK:
CONST TYPE: DECK: 32 BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: PUD
BEDROOMS: BATHROOMS:
Exist: 0 Exist: 0
Prop: 2 Prop: 2
Total: 2 Total: 2
Routing Date: C
Type Amount Paid Bv: Date: Receipt: Approved/Date
Manufactured Homes $213.00 LYK 03/30/10 117490 APPROVE.
Potable Water Application $98.00 LYK 03/30/10 117490 APR �� �,��
Total: $311.00
Jefferson County Planning
&Building Department
SPECIAL CONDITIONS CASE LDIO-00093 •
1.) FULL COMPLETION OF L&I PERMIT FP1839703 FOR DECERTIFICATION" OF THE
EXISTING MOBLE HOME IS REQUIRED PRIOR TO FINAL APPROVAL OF THIS
BUILDING PERMIT (BLD10-00093).
2.) DESIGN CRITERIA FOR SPLASH BLOCKS:
A VEGETATED FLOWPATH OF AT LEAST 50 FEET SHOULD BE MAINTAINED
BETWEEN THE DISCHARGE POINT AND ANY PROPERTY LINE, STRUCTURE,
STEEP SLOPE, STREAM, WETLAND, LAKE, OR OTHER IMPERVIOUS SURFACE.
SENSITIVE AREA BUFFERS MAY COUNT TOWARD FLOWPATH LENGTHS.
A MAXIMUM OF 700 SQUARE FEET OF ROOF AREA MAY DRAIN TO EACH
SPLASHBLOCK.
A SPLASHBLOCK OR A PAD OF CRUSHED ROCK (2 FEET WIDE BY 3 FEET LONG
BY 6 INCHES DEEP) SHOULD BE PLACED AT EACH DOWNSPOUT DISCHARGE
POINT.
NO EROSION OR FLOODING OF DOWNSTREAM PROPERTIES MAY RESULT.
FOR SITES WITH SEPTIC SYSTEMS, THE DISCHARGE POINT MUST BE
DOWNSLOPE OF THE PRIMARY AND RESERVE DRAINFILED AREAS.
3.) CONSTRUCTION ENTRANCES SHALL BE STABILIZED WHEREVER TRAFFIC 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.) The application was reviewed by the Jefferson County Department of Community
Development staff on 4/12/2010for 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:
SUSC aquifer recharge area.
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.) 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.
8.) The applicant is proposing to ate or add 1286 square feet of imperviou lace and
1344 square feet of land disturbing activities. JCC 18.30.060 and 18.30.0 require your
proposal comply with Minimum Requirement#2 (Construction Stormwater Pollution
Prevention) of the Department of Ecology 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.
9.) 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.
10.) 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).
11.) The site plan as submitted with the building permit application on March 30, 2010 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 April 19, 2010 shall be resubmitted for
review and approval by Jefferson County Department of Community Development.
12.) This approval is for a manufacture home 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.
13.) The parcel has been designated as RR 1:5 under the Jefferson County Comprehensive
Land Use Map effective August 28, 1998.
14.) Outdoor residential storage shall be maintained in an orderly manner and shall create no
fire, safety, health or sanitary hazard.
15.) 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.
16.) A minimum of two (2) on-site parking spaces shall be provided for the single family
residence.
17.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of
impervious surface which includes roof tops, driveways, concrete, etc.
18.) The building height is not to exceed 35 feet.
19.) Minimum setback from SR 101 right-of-way shall be 50 feet. Minimum south property
setback from ingress/egress easement shall be 20 feet. Minimum north and west
setbacks shall be 5 feet.
20.) 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.
21.) 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.
22.) The parcel is served by a public water system.
23.) A septic permit (SEP84-0066) was finaled on December 10, 1986 and is now filed with
SEP10-0020 that was issued on April 2, 2010.
24.) An address of 293704 Highway 101, Quilcene has been assigned to the parcel. Highway
101 is a state principle arterial.
25.) The parcel was created through the Hyde Short Plat on January 17, 1984 under AFN
287576.
26.) NOTICE: This permit does AP_ xcuse the proponent from complying wither local,
state, and federal ordinances, regulations, or statutes applicable to the proposed
development, but consistent with RCW 90.58.
Development pursuant to this permit shall be undertaken subject to the applicable policies
and performance standards of the Jefferson County Shoreline Management Master
Program and the Jefferson County Unified Development Code.
If during excavation or development of the site an area of potential archaeological
significance is uncovered, all activity in the immediate area shall be halted, and the
Administrator shall be notified at once.
The Federal Endangered Species Act rules to protect threatened Chinook and
Summer-run Chum salmon became effective on January 8, 2001. Bull trout have been
listed as threatened since early 2000. Under the ESA, any person may bring lawsuit
against any individual or agency that"takes" listed species (defined as causing harm,
harassing, or damaging habitat for the listed species). In addition, the National Marine
Fisheries Service can levy penalties. All areas in Jefferson County are included as
"critical habitat" for a listed species. Development of property along any marine shoreline,
freshwater shoreline, or floodplains could harm habitat if protective measures are not
taken. To minimize the potential to damage habitat, all property owners developing
adjacent to marine shoreline, freshwater shoreline, or floodplains are advised to do the
following:
-All development activities should avoid unstable slopes, wetlands, and forested areas
near surface waters
- Remove minimal vegetation for site development, especially large trees
-Allow trees that have fallen into surface waters to remain there
- Infiltrate stormwater from buildings and driveways onsite through drywells rather than
discharging directly into surface aters or roadside ditches
Any individual, group, or agency can bring suit for a listed species "taking", even if you are
in compliance with Jefferson County development codes. The risk of a lawsuit against
you can be reduced by consulting with a professional fisheries habitat biologist, and
following the recommendations for site development provided by the biologist. For more
information, contact the National Marine Fisheries Service in Seattle, or the U.S. Fish and
Wildlife Service.
01/19/2010 10: 49 3603794451 JEFF CO PERMITCENTER PAGE 01/01
JACK WESTERIIIAN III Jrifrroon Cnnnt7 Conrtlion,tr
ASSESSOR PO Ilo. 14,220. Port TowiHr.nd.WA 98304
1360)385.9105
MOBILE HOME INFORMATION FORM
OWNER'S NAME/MAILING ADDRESS:
NAME:., j4Li_ l�- //A-d _1.-A'A41J -V /:, '
ADDRESS: .D, 11�s,Y 2-(o ( tit/f .,)( /Z-) �,? 7
PHONE NO.,._ &:'_ -7% : /(0_8.
The purpose of this questionnaire is to obtain information regarding either the
ct.rrrent location of a mobile home or the previous ownership and location of a mobile
home. This: will help onr office determine whether the mobile home is already on the
tax trolls in Jefferson County or if it has been moved to this county from another area.
l)1101IN LE “Ol*IE DATA!
(A) MARE -/% 57rAj (0)MODEL i/6/- �% (C) 'EAU ?- /t
(B) LENGTH Mr (E) WIDTH ,4(4' (I'+) SERIAL # ,J.-3;7`J
(G)YOIR PURCHASE PRICE(Do not burindc Nolen lax)-5 7 f L? PURCHASE DATE:V i)ic
20 PREVIOUS OWNER/LOCATION OF MOIlILE HOME: (IF NEW MOVE TO QUESTION 3)
(A) FROM WHOM DID YOU PURCfASE MOBILE /11a/-/:i zF` / (`"/>L Ems'
J/ n
ADDRESSZ4.5` i0.,5 . lk'cl.. /4I '-�L- L!/„'1 f<N '`l z_
r(U) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR? Ye* 6 '
Ii Ych. Previous address of mobile.
It No. What Comity was Mobile assessed in last year-
:WHERE MODIL1E HOME IS TO HE LOCATED:
(A) I1/I1LT.THE MOBILE HOME BE IN MOBILE HOME PARK? Yen �o\
(II)I 'LOCATED IN MOBILE HOME PARK:
NAME &ADDRESS OF PARR _ . .. - Lol/Spate# _
(C) IF NOT LOCATED IN MOIII E HOME PARR:
o f '
NAME OF LAND OWNER: , �ditA,CIAri (v `i�'r1L�l,f/ '-- fr7�t-
LOCATION ADDRESS ;1 j-37O '/ //Ay /D / (T`zi,L e/-;J, y F 5 7/,
REAL PROPERTY PARCEL #/DESCRIPTION 93s:- 7000/6
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Sigiintnre'of Applicant/
THANK YOIJ FOR YOUR HELPI
I.nnrafee I iese'. Property Technician
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APPROVED Wq J'X NEW DESIGNATED RESERVE AREA
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DEPT.OF C T D P
SIGNATUR ___�_ --
Stormwat ACCESS ROAD
Required -- —
196't
Sharp, Frank & Buy-Rite HomesSaundra 259403 Hwy 101
293704 Hwy 101
Quilcene WA 98339 SeCluim WA 98382
360 765 3168 360-681-777 Fax 360-681-0780
c/o Birdi Arbauh_____ —
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filrilit
", JF+ ON i DEPARTMENT OF Ct MUNITY DEVELOPMENT 621 Sheridan Street• Port Towncend -Washington 98368
4
. 360/379-4450 • 360/379-4451 Fax
www.co.jefferson.wa.us/commdevelopment
Master Permit Application MLA: 1 (J ._ 120
Project Description(include separate sheets as necessary):
Xi(5 s y?-11I,ci: Aizzthi fRr.�t c/ 44 i e----
Tax Parcel Number 9 'Z'7ODZ)// Property Size: /aL.ic` (acres/square feet)
Site Address and/or Directions to Property:
2 9370 V iyivy id/ 6a/ZE
Property Owner(s)of Record: ,�,val /
Telephone: , /o O 75-3/to 8 Fax: email:
Mailing Address: /:6,- /3 OX t/z (")a �p c 983 7/0
Applicant/Agent(if different from owner): f�t[ -,f'i 7-E 61,1
Telephone: , (,O-/o81-0777 Nod,1Z,O-6 Al-O7RO email:b-Irelia..�U blurt,ft.tin hfC5do n
Mailing Address: 259 `o 61 tl y 10 1 (SF.9 L//)r) /!1 ic 4 �$2..
What kind of Permit?(Check each box that applies
A3uilding 0 Critical Areas Stewardship Plan
0 Demolition Permit 0 Variance(Minor,Major or Reasonable Economic Use)
0 Single Family 0 Garage Attached/Detached 0 Conditional Use[C(a),C(d),or C]**
lEtr Manufactured Home 0 Modular 0 Discretionary"D"or Unnamed Use Classification
❑ Commercial* CI Special Use(Essential Public Facilities)**
❑ Change of Use 0 Boundary Line Adjustment
❑ Address ❑ Road Approach 0 Short Plat**
❑Home Business 0 Cottage Industry 0 Binding Site Plan**
❑Propane 0 Long Plat**
❑Sign 0 Planned Rural Residential Development(PREp)/Amendments**
❑Allowed"Yes'Use Consistency Analysis 0 Plat Vacation/Alteration**
❑Stormwater Management 0 Shoreline Master Program Exemption/Permit Revisions**
❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development'"`
❑Temporary Use 0 Shoreline Management Variance
❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment
❑Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment
*May require a Pre—Application Conference 0 Tree Vegetation Request
**Requires a Pre-Application Conference
Please identify any other local,state or federal permits required for this proposal, if known:
/)4W i h9IL9i; eV Alv-A(-
iC t/D' mCS
DESIGNATION OF AGENT
I hereby designate to act as my agent in matters relating to this application for
�.,( perrrtit(s).
OWNER SIGNATURE '✓ ..011',-7'47 -- 7,7_r"-----\‘ 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 its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet
may result in this permit being null and void.
I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and
expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit.
I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application
review and any r ired laterinsl?ections. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the
time o h appl' tion that a or wants prior notice.
Signs re: t� 1 4 cL J Date: h1_.0V,4(/L)
The action or actions Appf nt will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or
endangered species and could lead to a potential"take'of an endangered species as those terms are defined in the federal law known as the
"Endangered Species Act or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this
permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your
action(s)even if y.• are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual
and non n bleponsi ' for adherinato and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below.
Signature: /2(. cZ ]L . --) Date: /<,/: /,4 O/G
G:\PennitCenter\###FORMS###\DRD FORMS\Master Permit Application 5-29-O8.doc
• BUILDER STATEMENT •
The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that
they will be assuming the responsibility of the General Contractor for the proposed project.
Signature: Date:
GENERAL CON/TRACTOR R MANUFACTURED HOME INSTALLER: PHONE: FAX:
/4//q-i-. /Z /� ,`� ( �')lr l C 7 r 7 (360) (r4 ) 6 Z1 0
MAILING ADDRESS: 2`�c1 y 0 .- /1/.0- /o/ EMAIL: b t I'd i Q ha y-t'1"1 t i t O t i it`.. ,(°(>> ")
CONTRACTOR'S LICENSE ,/ 0 /(/6 WAINS /l/�/J
NUMBER: eU V gT// R4 NUMBER Gt'rr ,302, cr,
ARCHITECT/ENGINEER: /{1ii $1 c Al A'rn/-' PHONE ( ) FAX:( )
MAILING ADDRESS: EMAIL
Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal:
New /X Wood Existing: I i Sewer
❑ Addition I I Steel Proposed: Z Bank 0 Community System .
❑ Alteration/Remodel ❑ Concrete Total: 2- Height: Individual System tL"Cu
❑ Repair ❑ Masonry SEP Permit# 11 OOO la G
O Demolition ❑ Other: Bedrooms: Water Supply:
Existing: Setback: [I Private well 0 Two Party
Type of Heat Proposed: ',Z 0 Public
Total: 2. Name of System:
77,2 . 6�u (?ex, al tilr.l
If this is a Commercial Project you must answer the following:
Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces:
Number of occupants(includes owners,tenants,employees,etc) Current Proposed
IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No
If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply:
i Underground Tank T Above ground Tank Size of Propane Tank:
I Heat Stove I Cook Stove I Woodstove 1 Fireplace Insert I Hot Water Tank I Pellet Stove I 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.
r
Square Footage Current Proposed " ira ,1?rl `.• ialt t . `: . ' ''.•s a :. .
Main Floor Heated �>> Y,; `�"�f z' EH Bid App Review
ear'+ rsz t X,
2 Floor Heated ti z4 Consistency Review: 2 ,_
¢� )
Other Heated 4` A.--... Base fee: .� `�
Mezzanine s- i7 Additional Section: _
Heated Basement •• ... : Plan Check fee:
Unheated Basement , ` .°y State Surcharge fee:
,n e
Other Unheated Pot Water Review fee: t
Garage/Carport t, 1 , SUBTOTAL
Decks • /4.o 0LI 911/Rd Approach fee:
-}1 - y X`//dE-n6GC, kJz5&.)4-) ,J 1 I<s .� fle } , t�1C t,'n
Other s'; "t ,'; TOTAL: ! _
'r. Receipt Number: t_. nn
7:4 Cash/Check Number:
ESTIMATED COST(REQUIRED) Date: 4 ,
•Fair market value of all labor and materials foundation to finish
Initials: --�`—
:.---)
G:\PermaCenter\###FORMS###\ORD FORMS\Master Permit Application 5-29-08.doc